Chapter 7
Community Health Planning,
Implementation, and Evaluation
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
The Community as Client
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 2
Figure 7-1
Levels of
Community Health Nursing Practice
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 3
Client Example Characteristics Health
Assessment
Nursing
Involvement
Individual Lisa McDonald Individual with various
needs
Individual strengths,
problems, and needs
Client-nurse interaction
Family Moniz family Family system with
individual and group
needs
Individual and family
strengths, problems, and
needs
Interactions with
individuals and the family
group
Group Boy Scout
troop
Alzheimer’s
support group
Common interests,
problems, and needs
Interdependency
Group dynamics
Fulfillment of goals
Group member and
leader
Population
group
AIDS patients
in a given state
Pregnant
adolescents in
a school
district
Large, unorganized
group with common
interests, problems, and
needs
Assessment of common
problems, needs, and
vital statistics
Application of nursing
process to identified
needs
Organization A workplace
A school
Organized group in a
common location with
shared governance and
goals
Relationship of goals,
structure,
communication, patterns
of organization to its
strengths, problems and
needs
Consultant and/or
employee application of
nursing process to
identified needs
Community Italian
neighborhood
Anytown, USA
An aggregate of people
in a common location
with organized social
systems
Analysis of systems,
strengths,
characteristics,
problems, and needs
Community leader,
participant, and health
care provider
Health Planning Model
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 4
Figure 7-2
Hogue (1985)
Steps in the Health Planning
Model
 Assessment
 Meet with group leaders of aggregate to clarify mutual
expectations
 Determine sociodemographic characteristics
 Interview a key informant
 Consider both positive and negative factors
 Compare the aggregate with the “normâ€
 Research potential problems
 Identify health problems and needs
 Prioritize the identified problems and needs to create an
effective plan
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 5
Four Types of Needs to Assess
 Expressed needs
 Demand for services and the market behavior of the targeted
population
 Normative needs
 Lack, deficit, or inadequacy of services determined by health
professionals
 Perceived needs
 Wants and desires expressed by audience
 Relative needs
 Gap showing health disparities between advantaged and
disadvantaged population
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 6
Factors for Determining Priorities
 Aggregates preferences
 Number of individuals affected by the health
problem
 Severity of the health need or problem
 Availability of potential solutions
 Practical considerations such as skills, time,
and available resources
 May use Maslow’s hierarchy of needs or
levels of prevention to further refine priorities
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 7
Community Involvement Is Essential
“Start where the people are!â€
 Five spheres of empowerment
 Interpersonal (personal empowerment)
 Intragroup (small group development)
 Intergroup (community)
 Interorganizational (coalition building)
 Political action
– Labonte (1994)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 8
Steps in the Health Planning Model
(Cont.)
 Planning
 Determine the intervention levels
• Subsystem, aggregate system, and/or suprasystem
 Plan interventions for each system level
• Primary, secondary, or tertiary levels of prevention
 Validate the practicality of the planned
interventions according to available resources
• Personal, aggregate, and suprasystem
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 9
Development of Goals and
Objectives
 Goals—where we want to be
 Objectives—steps needed to get there
 Measurable
 Specific measures
 Instructions to guide population
 Used to measure outcomes
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 10
Steps in the Health Planning Model
(Cont.)
 Intervention
 Often the most enjoyable stage for the nurse and
the clients
 Implementation should follow the initial plan
 Should include a variety of strategies
 Prepare for unexpected problems
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 11
Interventions by
Type of Aggregate and System Level
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 12
Project Type of Aggregate System Level for Intervention
Rehabilitation group Group Subsystem and aggregate system
Textile industry Organization Aggregate system and suprasystem
Crime watch Group, organization,
and population group
Aggregate system and suprasystem
Bilingual students
(case study)
Community Aggregate system and suprasystem
Steps in the Health Planning Model
(Cont.)
 Evaluation
 Include the participant’s verbal or written feedback and the
nurse’s detailed analysis
 Reflect on each previous stage to determine the plan’s
strengths and weaknesses
 Evaluate both formative (process) and summative
(product/outcome) aspects
 Communicate follow-up recommendations
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 13
Importance of Each Step in the
Nursing Process
 Aggregate assessments must be thorough.
 Should elicit answers to key questions about the aggregate’s
health and demographic profile
 Should compare this information with similar aggregates
presented in the literature
 The nurse must complete careful planning and set
goals that the nurse and the aggregate accept.
 Mutual planning is very important.
 Interventions must include aggregate participation
and must meet the mutual goals.
 Evaluation must include process and product
evaluation and aggregate input.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 14
PRECEDE-PROCEED Model
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 15
Federal Legislation Affecting Health
Planning
 Hill-Burton Act
 Regional Medical Programs (RMP)
 Partnership for Health Program (PHP)
 Certificate of Need (CON)
 National Health Planning and Resources
Development Act
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 16
Comprehensive Health Reform
 Patient Protection and Affordable Care Act
(2010)
 Preventive services based on evidence-based
recommendations
 National strategy to improve the nation’s health
 CMMS innovation center
 National quality improvement strategy for services
and population health
 Improved access to care
 Reduction in the growth of Medicare spending
 National workforce strategy
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 17
Nurses’ Role
 Work collaboratively with health planners to
improve aggregate health
 Fuse technology with knowledge of health
care needs and skills
 Become directly involved in the planning
process
 Engage in aggregate-level projects
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. 18
Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?
Whichever your reason is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.
Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.
Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.
Computer science is a tough subject. Fortunately, our computer science experts are up to the match. No need to stress and have sleepless nights. Our academic writers will tackle all your computer science assignments and deliver them on time. Let us handle all your python, java, ruby, JavaScript, php , C+ assignments!
While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.
Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.
In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.
Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.
We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!
We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.
Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.
We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.
Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.
There is a very low likelihood that you won’t like the paper.
Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.
We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.
You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.
We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.
You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.
Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.
You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.
The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.
GET A PERFECT SCORE!!! 
Chapter 7
Community Health Planning, Implementation, and Evaluation
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
The Community as Client
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Figure 7-1
Levels of Community Health Nursing Practice
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
Client Example Characteristics Health Assessment Nursing Involvement
Individual Lisa McDonald Individual with various needs Individual strengths, problems, and needs Client-nurse interaction
Family Moniz family Family system with individual and group needs Individual and family strengths, problems, and needs Interactions with individuals and the family group
Group Boy Scout troop Alzheimer’s support group Common interests, problems, and needs Interdependency Group dynamics Fulfillment of goals Group member and leader
Population group AIDS patients in a given state Pregnant adolescents in a school district Large, unorganized group with common interests, problems, and needs Assessment of common problems, needs, and vital statistics Application of nursing process to identified needs
Organization A workplace A school Organized group in a common location with shared governance and goals Relationship of goals, structure, communication, patterns of organization to its strengths, problems and needs Consultant and/or employee application of nursing process to identified needs
Community Italian neighborhood Anytown, USA An aggregate of people in a common location with organized social systems Analysis of systems, strengths, characteristics, problems, and needs Community leader, participant, and health care provider
Health Planning Model
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4
Figure 7-2
Hogue (1985)
Steps in the Health Planning Model
Assessment
Meet with group leaders of aggregate to clarify mutual expectations
Determine sociodemographic characteristics
Interview a key informant
Consider both positive and negative factors
Compare the aggregate with the “norm”
Research potential problems
Identify health problems and needs
Prioritize the identified problems and needs to create an effective plan
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Four Types of Needs to Assess
Expressed needs
Demand for services and the market behavior of the targeted population
Normative needs
Lack, deficit, or inadequacy of services determined by health professionals
Perceived needs
Wants and desires expressed by audience
Relative needs
Gap showing health disparities between advantaged and disadvantaged population
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6
Factors for Determining Priorities
Aggregates preferences
Number of individuals affected by the health problem
Severity of the health need or problem
Availability of potential solutions
Practical considerations such as skills, time, and available resources
May use Maslow’s hierarchy of needs or levels of prevention to further refine priorities
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7
Community Involvement Is Essential
“Start where the people are!”
Five spheres of empowerment
Interpersonal (personal empowerment)
Intragroup (small group development)
Intergroup (community)
Interorganizational (coalition building)
Political action
– Labonte (1994)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8
Steps in the Health Planning Model (Cont.)
Planning
Determine the intervention levels
Subsystem, aggregate system, and/or suprasystem
Plan interventions for each system level
Primary, secondary, or tertiary levels of prevention
Validate the practicality of the planned interventions according to available resources
Personal, aggregate, and suprasystem
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
9
Development of Goals and Objectives
Goals—where we want to be
Objectives—steps needed to get there
Measurable
Specific measures
Instructions to guide population
Used to measure outcomes
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10
Steps in the Health Planning Model (Cont.)
Intervention
Often the most enjoyable stage for the nurse and the clients
Implementation should follow the initial plan
Should include a variety of strategies
Prepare for unexpected problems
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11
Interventions by Type of Aggregate and System Level
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12
Project Type of Aggregate System Level for Intervention
Rehabilitation group Group Subsystem and aggregate system
Textile industry Organization Aggregate system and suprasystem
Crime watch Group, organization, and population group Aggregate system and suprasystem
Bilingual students (case study) Community Aggregate system and suprasystem
Steps in the Health Planning Model (Cont.)
Evaluation
Include the participant’s verbal or written feedback and the nurse’s detailed analysis
Reflect on each previous stage to determine the plan’s strengths and weaknesses
Evaluate both formative (process) and summative (product/outcome) aspects
Communicate follow-up recommendations
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13
Importance of Each Step in the Nursing Process
Aggregate assessments must be thorough.
Should elicit answers to key questions about the aggregate’s health and demographic profile
Should compare this information with similar aggregates presented in the literature
The nurse must complete careful planning and set goals that the nurse and the aggregate accept.
Mutual planning is very important.
Interventions must include aggregate participation and must meet the mutual goals.
Evaluation must include process and product evaluation and aggregate input.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14
PRECEDE-PROCEED Model
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15
Federal Legislation Affecting Health Planning
Hill-Burton Act
Regional Medical Programs (RMP)
Partnership for Health Program (PHP)
Certificate of Need (CON)
National Health Planning and Resources Development Act
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16
Comprehensive Health Reform
Patient Protection and Affordable Care Act (2010)
Preventive services based on evidence-based recommendations
National strategy to improve the nation’s health
CMMS innovation center
National quality improvement strategy for services and population health
Improved access to care
Reduction in the growth of Medicare spending
National workforce strategy
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17
Nurses’ Role
Work collaboratively with health planners to improve aggregate health
Fuse technology with knowledge of health care needs and skills
Become directly involved in the planning process
Engage in aggregate-level projects
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
18
Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?
Whichever your reason is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.
Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.
Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.
Computer science is a tough subject. Fortunately, our computer science experts are up to the match. No need to stress and have sleepless nights. Our academic writers will tackle all your computer science assignments and deliver them on time. Let us handle all your python, java, ruby, JavaScript, php , C+ assignments!
While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.
Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.
In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.
Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.
We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!
We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.
Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.
We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.
Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.
There is a very low likelihood that you won’t like the paper.
Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.
We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.
You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.
We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.
You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.
Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.
You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.
The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.
GET A PERFECT SCORE!!!
Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.
You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.
Read moreEach paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.
Read moreThanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.
Read moreYour email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.
Read moreBy sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.
Read more