Further synthesis of the community assessment data

This week assignment 1

Further synthesis of the community assessment data for planning and intervention purposes can be a daunting task. These are complex issues.  Sometimes we need to ask “Why?” five times to get a deeper level of understanding. This  web of causality activity will provide you with a tool to use when complex addressing community health issues. The web of causation is an epidemiological concept that applies to communities.  By creating a web of causality you will have a better idea about the relationship between certain variables and how they impact the health of your community. You can create your web of causality using words, pictures, clipart, etc.

Keep in mind that this activity is really creating a concept map to help you look at  the needs and/or strengths of a community in light of contributing factors. These contributing factors are called the  determinants of health . Some important factors include the physical environment ( safety, transportation, pollution ) and social situations ( income, education, resources, laws, values,  racism ) because they affect our health behaviors ( eat healthy foods, preventive health care, manage stress).

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Think about what makes a community vulnerable (in #1) and what provides strengths (in #2). Complete a web of causality for each below.

1. Web of Causality 1  It is reasonable to consider alcohol consumption as a causative factor in motor vehicle accidents because alcohol is known to increase the time needed to react to changing traffic conditions. Draw a web of causality related to motor vehicle accidents and alcohol as a community health issue. Identify a particular population (i.e., gender or age range) that might have unique factors. Include community level contributing factors in your diagram.

2. Web of Causality 2 Select a community health (wellness) condition, such as preschoolers normal growth and development or elders healthy aging.List several (3-5) of the causal factors that might contribute to this healthy state. Identify the population ( age range/gender/ethnicity).  Include community level contributing factors. Now, plot these schematically in a diagram to show the web of causality for this condition.

 

 

Resources for Creating the Web of Causation

The five WHY ‘s technique for understanding a problem A familiar acute care setting WHY question

A patient failed to respond to therapy and his condition deteriorated WHY

The patient received the wrong medication Why

Because the nurse gave it to him by mistake WHY

Because she misread the drug name WHY

Because we have two drugs with similar names stored side by side

WHY Because we store them in alphabetical order so

we can find them quickly BUT WHY?

A social determinants of health WHY? Why is Jason in the hospital? Because he has an infection in his leg.

But WHY does he have an infection? He has a cut on his leg that got infected. But WHY does he have a cut on his leg? He was playing in a junk yard next to his apartment building

and fell on some sharp, jagged steel But WHY was he playing in the junk yard?

His neighborhood is run down. Kids play there with no one to watch them.

But WHY does he live in that neighborhood? His Dad lost his job and his Mom is sick. That’s all they can afford

But WHY is his Dad unemployed? Because he doesn’t have much education and can’t find a job.

BUT WHY?

 

The five WHY ‘s technique for understanding a problem

 

A familiar acute care setting WHY question

A patient failed to respond to therapy and his condition deteriorated

WHY

The patient received the wrong medication

Why

Because the nurse gave it to him by mistake

WHY

Because she misread the drug name

WHY

Because we have two drugs with similar names

stored side by side

WHY

Because we store them in alphabetical order so

we can find them quickly

BUT WHY?

 

 

A social determinants of health WHY?

Why is Jason in the hospital?

Because he has an infection in his leg.

But WHY does he have an infection?

He has a cut on his leg that got infected.

But WHY does he have a cut on his leg?

He was playing in a junk yard next to his apartment building

and fell on some sharp, jagged steel

But WHY was he playing in the junk yard?

His neighborhood is run down. Kids play there with no one to

watch them.

But WHY does he live in that neighborhood?

His Dad lost his job and his Mom is sick. That’s all they

can afford

But WHY is his Dad unemployed?

Because he doesn’t have much education and

can’t find a job.

BUT WHY?

 

The five WHY ‘s technique for understanding a problem

 

A familiar acute care setting WHY question

A patient failed to respond to therapy and his condition deteriorated

WHY

The patient received the wrong medication

Why

Because the nurse gave it to him by mistake

WHY

Because she misread the drug name

WHY

Because we have two drugs with similar names

stored side by side

WHY

Because we store them in alphabetical order so

we can find them quickly

BUT WHY?

 

 

A social determinants of health WHY?

Why is Jason in the hospital?

Because he has an infection in his leg.

But WHY does he have an infection?

He has a cut on his leg that got infected.

But WHY does he have a cut on his leg?

He was playing in a junk yard next to his apartment building

and fell on some sharp, jagged steel

But WHY was he playing in the junk yard?

His neighborhood is run down. Kids play there with no one to watch them.

But WHY does he live in that neighborhood?

His Dad lost his job and his Mom is sick. That’s all they can afford

But WHY is his Dad unemployed?

Because he doesn’t have much education and can’t find a job.

BUT WHY?

 

 

CHAPTER 4 / Theoretical Foundations for Community Health Nursing 67

(MacDonald, 2004, p. 387), namely that health and ill- ness are the result of factors related to the individual alone and not to society as a whole. Figure 4-3 depicts a composite determinants-of-health model that reflects elements included in many of the models found in the literature.

GENERAL NURSING MODELS One of the hallmarks of a scientific profession is the unique body of knowledge that it uses to direct profes- sional practice. This body of knowledge is the result of systematic, scientific inquiry involving the formulation and testing of theory. As is the case with other scientific disciplines, professional nursing practice needs a sound theoretical foundation that describes the interrelation- ships among key concepts. These concepts form the metaparadigm for the discipline. A metaparadigm is a global overview or explanation of a discipline. The metaparadigm for nursing traditionally encompasses four related concepts of person, health, environment, and nursing (Parker, 2001).

Nurse theorists have developed unique perspec- tives on the relationships among the concepts of the nursing metaparadigm to create different conceptual models. A conceptual model is a schematic or verbal pic- ture of the interrelationships that exist among concepts.

A number of conceptual models can be used in commu- nity health nursing. Five of these models will be dis- cussed here.

Early conceptual models for nursing were devel- oped to assist in the care of individual clients. Some of these models were adapted by community health nurses for use with families and communities or popu- lation groups. For example, previous community health nursing texts examined several of the traditional nursing conceptual models and demonstrated their application to community health nursing (Clark, 1984, 1992, 1996, 1999; Hanchett, 1988). Other authors have applied a single conceptual model in community health nursing practice (Melton, Secrest, Chien, & Andersen, 2001; Stepans & Knight, 2002; Wilson, 2000) or research (Bebe, 2003; Fawcett & Giangrande, 2001; Fawcett & Gigliotti, 2001). Of the general nursing models, the one most easily and often adapted for community health nursing is Betty Neuman’s health systems model.

Neuman’s health systems model involves a client system striving to prevent “penetration” or dis- ruption of the system by a variety of stressors. Stres- sors are problems or conditions capable of causing instability in the system or “tension producing stimuli or forces occurring both with the internal and external environmental boundaries of the client system” (Neu- man, 2002, p. 21). The client’s state of health is

Human Behavioral Determinants Health-promoting behaviors

Risk behaviors

Environmental Determinants

Built environment Natural environment

Sustainability

Human Biological Determinants

Intrinsic characteristics Genetics

Physical health status Maturation/development

Functional status Nutritional status

Immunity

Social Determinants Social status

Politics/power Education

Culture Religion

Social support/capital Social stability

Health System Determinants Acceptability Accessibility Affordability

Appropriateness Competence Continuity

Effectiveness Efficiency

Safety Utilization

Economic Determinants Income

Employment Poverty/prosperity

Psychological Determinants

Stress Coping abilities Mental health/

illness

Population Health

FIGURE 4-3 A Composite Determinants-of-Health Model

M e d

iaLin k

The Population Focus

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