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Family Nurse Practitioner Clinical Session Essay
Family nurse practitioner clinical session
Reflect on your practicum experience by writing your responses to the following questions:
· What were the highlights of practicum?
· What challenges did you face?
· What did you learn that you did not expect?
· How has your understanding of the Nurse Practitioner provider role changed?Family Nurse Practitioner Clinical Session Essay
· Which system exams or techniques do you feel most confident performing?
· Which system exams or techniques do you feel least confident performing? Neurological assessment
· Do you feel you are proficient and timely in performing exams?
· To what extent do you feel prepared for the clinical practicum specialty course?
· What have you seen in practicum that would be helpful to address in the online course?
Support your paper with 3 nursing articles not older than 5 yrs.
This pack provides practical help and guidance to a nurse1 undertaking community health
needs assessment. It provides information and advice on the stages of needs assessment,
enabling the nurse to complete the process realistically within her/his everyday work. This
pack does not assume any prior knowledge of the subject.
What is a community health needs assessment?
Community health needs assessment is a process that:
describes the state of health of local people;
enables the identification of the major risk factors and causes of ill health; and
enables the identification of the actions needed to address these.Family Nurse Practitioner Clinical Session Essay
A community health needs assessment is not a one-off activity but a developmental process
that is added to and amended over time. It is not an end in itself but a way of using
information to plan health care and public health programmes in the future.
The steps of community health needs assessment are as follows.
the collection of relevant information that will inform the nurse about the state
of health and health needs of the population; and
analysis of this information to identify the major health issues.
Deciding on priorities for action
Planning public health and health care programmes to address the priority issues
Implementing the planned activities
Evaluation of health outcomes
Why do it?
Needs assessment will enable the nurse to:
plan and deliver the most effective care to those in greatest need;
apply the principles of equity and social justice in practice;
ensure that scarce resources are allocated where they can give maximum health
The term “nurse” is used as a generic term throughout this pack to cover all nurses, midwives and public
health nurses. Family Nurse Practitioner Clinical Session Essay
work collaboratively with the community, other professionals and agencies to
determine which health issues cause greatest concern and plan interventions to
address those issues.
Concepts and principles of health needs assessment
Defining “health” and “need”
This pack uses a holistic model of health, emphasizing the social, economic and cultural
factors that affect health as well as individual behaviour. The concept of “need” used in this
pack incorporates those needs felt and expressed by local people as well as those defined by
professionals. It moves beyond the concept of demand and takes account of people’s
capacity to benefit from health care and public health programmes.
Factors affecting health
Health is affected by a number of factors:
the physical environment in which people live, such as the quality of the air they
breathe and the water they drink;
the social environment – the level of social and emotional support people receive
from friends and/or family;
poverty, a significant factor worldwide, which shortens and reduces enjoyment of
behaviour and lifestyle – for example, smoking causes lung cancer and coronary
heart disease so a reduction in this behaviour will reduce the disease; and
family genetics and individual biology – if you come from a healthy family you
have a better chance of staying well.
This pack will encourage the nurse to consider all these risk factors in relation to a
community and make an assessment of their importance.
Involving the community
It is assumed that the nurse using this pack has responsibility for providing nursing
services to a caseload of individual patients and a wider responsibility for improving the
health of the community.Family Nurse Practitioner Clinical Session Essay
The pack also assumes that the nurse wishes to work in partnership with local people and
will be looking for ways to involve others in her/his work. Community needs assessment
incorporates many of the principles of community development (Appendix 1), which has
been defined as: “…a way of tackling a community’s problems by using the energy and
leadership of the people who live there” (Thomas 1995).
Involving other professionals and agencies
If people feel involved in developing a local health plan they will be more committed to
putting it into action. It is therefore important that all those who will be involved in using
the plan are also involved in the health needs assessment process. For the nurse this means
collaborating with other professionals and the local community. Nurses will also need to
agree with their employers on the flexibility and autonomy to change their work patterns
according to the needs identified through the community needs assessment process.
Format of the pack
The pack takes a user-friendly approach to community health needs assessment, guiding
the beginner through the process. Section One outlines the type of information a nurse
needs to think about when creating a profile of the community. Reasons are given for the
inclusion of each piece of information. Section Two gives practical advice on how a nurse
might find this information. Section Three helps the nurse to analyse and use the
information, decide on priorities and create action plans. By working through the pack, the
nurse will gain a basic knowledge of the health needs assessment process and will be able
to begin this task within his/her own work setting.Family Nurse Practitioner Clinical Session Essay
1. The nurse should read through this pack to become familiar with the complete
health needs assessment process.
2. Other key local people and professionals whom the nurse would like to be
involved in the work should be approached. Ideally, these people will form a
working group to develop the community health needs assessment together.
3. The scope and purpose of the health needs assessment should be decided on. Will
this be a way of planning work for local community nurses, or will it identify
health service needs on a wider scale and make recommendations to other
providers of services? These decisions will influence the approach taken.
4. People who will be able to help with the community health needs assessment
should be identified. These may be local community leaders, whose approval may
allow greater access to communities, or local administrative staff who may have
useful information. Access to someone with an understanding of epidemiology or
statistics would also be helpful, but is not vital.
5. The nurse must decide how much time and resources he/she is realistically able to
give to the work, and adapt each stage of the process to take account of this.
6. Consideration should be given to the ethical issues regarding ownership and use
of information, confidentiality, raised expectations versus unmet needs, and the
dangers of stigmatizing groups and communities.
Section One: Profiling the population
Think about what you want to find out about your local population. What information will
help you define and describe the community and its health needs? You may find it helpful
to ask yourself the following questions.
1. What are the key characteristics of the population?
2. What is the health status of the people?
3. What local factors are affecting their health and what impact do they have (good
4. What services are currently being provided?
5. What do local people see as their health needs
6. What are the national and local priorities for health?
This section describes the type of information that you may find useful when answering
these questions. What you choose to include in your profile is up to you and will depend on
local circumstances and the availability of information. Do not be tempted to collect too
much information; this is time consuming and makes it difficult to use the profile. It is
more important to define clearly the questions you want to answer and spend the time
acting on the information you have collected.Family Nurse Practitioner Clinical Session Essay
Characteristics of the population
A number of elements will enable you to describe the community you work in:
Geography: which area/population does this profile cover?
A description of a community includes its location. It is assumed that the community
identified will coincide with the nurse’s area of responsibility. You may be responsible for
a village with distinct and recognizable boundaries, a section of a town with named roads
marking the outer limits, or a refugee camp. If you are responsible for a population with no
fixed location, such as nomadic or homeless people, describe the people themselves rather
than the location. Defining the boundaries is necessary to identify who is included within a
community and to aid information collection. If possible, match the boundaries you choose
with administrative ones, especially if information is already collected on that basis or
other local workers share responsibility for the same population.
Numbers: how many people?
The total number of people within the community should include all people from birth to
death. This will show the number of people the community assessment is designed to
Age distribution: what age are they?
It is important to examine the age distribution of a community because this will have a
major influence on health needs. Most profiles divide the community into the following
school-age children and young people
The old and young age groups in a population have greater health care needs. This does not
necessarily imply, however, that a community that has a large dependent population (i.e.
many children and elderly people) will use the majority of its resources to care for those
groups. It may instead choose to invest resources in maintaining the health of adults, as
their ability to work and function is key to maintaining the dependent groups.Family Nurse Practitioner Clinical Session Essay
Gender distribution: how many males and females?
The ratio of males to females in a community obviously also has a major bearing on the
community’s health needs. Gender distribution has some standard patterns on a large scale,
such as more boys are born than girls and there are more women than men in the very old
age group. It is important to know whether your community fits this pattern, as this will
affect the range of services required. Gender is also important when looking at specific
health issues, such as family planning, maternity services or diseases that are genderspecific, such as ovarian cancer.
Ethnicity and religion
Minority ethnic and religious groups can be marginalized within a community; a lack of
awareness can result in a community health needs assessment that may not include the
most vulnerable groups. Nurses need to be aware of the different ethnic and cultural groups
within the community. Ethnic groups can be classified by racial origin, religion, colour or
nationality. You may choose to use the national classification so that you can make
comparisons with other areas. Different groups face different problems and require services
that are sensitive to their cultural and linguistic background. This can be seen in diseases
that are specific to one group such as sickle cell anaemia and thalassaemia. Religious
groupings are useful to know, as they can have a powerful influence over people’s lives
and are often a source of community support and influence health behaviour.
Ethnicity and cultural background have a significant impact on health, and individuals,
whatever their ethnic background, are entitled to equal access to health care. Even if the
numbers are small, nurses should take action to ensure equality of access to health care and
health programmes that are culturally and linguistically appropriate.
Population trends: patterns over a period of time
Population trends give an indication of patterns of disease and the need for services. The
birth rate (Appendix 2) going up or down may suggest that a population is increasing or
decreasing, and may also indicate a need for service changes. The mortality rate
(Appendix 2) can give information about the size of a population and its state of health.Family Nurse Practitioner Clinical Session Essay
Language and literacy
There may be one or many languages in use within the community, together with local or
regional dialects. Language and literacy are essential for communicating health
information and for accessing services. If literacy is a problem within the community, be
sensitive to this and take account of it when deciding on methods of community
participation. Knowledge of local minority languages is vital to ensure equity and to enable
the whole community to become involved in the community health needs assessment
The health status of the population
There are different ways of finding out about the health status of the community:
people’s own views of their health
the knowledge of local health care workers and other agencies.
There are a number of measures commonly used to identify the health of a population.Family Nurse Practitioner Clinical Session Essay
This generally describes patterns of death in relation to age, gender and cause of death. It is
a basic measure of epidemiology – the study of disease in populations. Information is
collected nationally, regionally and sometimes at local level, usually from death
certificates. It indicates deaths from disease, accidents, suicides and homicides, and the
general health of the population in terms of life expectancy (Appendix 2). Mortality rates
work best for large populations; in small communities a little change can produce large
statistical distortions. A problem in using mortality rates is that they depend on a shared
understanding of cause of death and do not describe the health of the living.
This is information on types of illness and disability, their incidence and prevalence. It can
be taken from a wide range of sources including hospital records, infectious disease
notifications and disability registers, sickness records, general medical practice, child
health records, census material and other surveys. Information collected in this way should
be treated with care, as it may be a measure of health service activity rather than true
disease patterns. It is a reflection of illness and not health.
These are often used as indicators of health. Smoking is one of the best examples. This is
an activity proven to cause ill health, so if a lot of people smoke it shows a large potential
for illness in the population. Breastfeeding is considered the best of all infant feeding Family Nurse Practitioner Clinical Session Essay
methods, so it is taken as an indication of good health. These measures should be treated
carefully as they are about behaviour, yet are sometimes used as proxy measures for health.
“Quality of life” measures
These are a means of assessing physical health, functional ability and psychological
wellbeing. The assessment scales are based primarily on an individual’s own assessment.
These have been developed mostly in North America and the United Kingdom to measure
health outcomes based on people’s perception of their health. The reliability and validity of
these tools vary, but they are still useful in providing people-based measures of health.
Examples include the Barthel Index, the Nottingham Health Profile and the Index of
Activities of Daily Living.2
Use of service information
This information can help build a picture of morbidity as it can describe the diseases that
are being treated by the health services. It will cover both treatment, for example hospital
admissions, and uptake of preventive services, such as immunization and screening
programmes. Care may need to be taken, however, as some health problems may not yet
have any services. In countries where access to services is limited through inadequate
provision or an individual’s ability to pay for treatment, this information will often be
unreliable as an indicator of population health.Family Nurse Practitioner Clinical Session Essay
It is essential to collect information, not only about health and disease but also about health
inequalities. This applies to rich and poor countries alike. Most disease and illness patterns
relate closely to economic circumstances, so that those in poverty suffer disproportionately
high rates of poor health. Health statistics reveal that, even where death rates improve for a
disease, this is less likely to be true for the poorer sections of the population. For this reason
it will be important to record patterns of health inequality in your local population. When
considering equity you may find it useful to ask yourself the following questions.
Who is disadvantaged in this community?
Why are they disadvantaged?
What can I do about it?
Who has unmet needs in this community?
Who does not access care in this community? Family Nurse Practitioner Clinical Session Essay