P A U L E T T E G O L D E N M S , R N

Evaluating the Effectiveness of Strategies and alternatives to attain

expected outcomes in the Faith Community

PART 1

Introduction

Learning Objectives

Compare and contrast health promotion and health education programs

Discuss Evaluation of Faith Community Nursing Strategies and alternatives

Discuss the need for evaluating Faith community Nursing strategies and alternatives

Identify methods of evaluating Faith Community Nursing strategies and alternatives

Basic Terminology

Evaluation: “ a process of reflection through which the value of certain actions are assessed.

The comparison of an object of interest against a standard of acceptability.

Standard of Acceptability: Minimum level of performance, effectiveness, benefits.

Faith Community Nursing :Evaluation

Is determining the extent to which a strategy or alternative have been carried out and it’s actual effectiveness. (PROCESS EVALUATION).Whether the strategy being used is effective in meeting the goals and objectives

To determine the immediate observable effects the strategy or alternative has had on the faith community’s health risks.(IMPACT EVALUATION)

Measurable ultimate goal or outcome of the program measured by reduction in morbidity, mortality, ED visits, signs and symptoms or physiological, spiritual indicators. ( long term) (OUTCOME EVALUATION)

Knowledge Check

Process Evaluation: Will help us identify whether the number of identified individuals with signs and symptoms of Hypertension did receive blood pressure screening.

Impact Evaluation: Blood pressure screening program resulted in identifying individuals with abnormal blood pressures,behavioral change, willing to check blood pressure, referral to PCP,

Outcome Evaluation: Controlled BP, decreased morbidity, and mortality etc.

Faith Community Nursing Strategies and Alternatives

Are measurable activities and practices that addresses identified diagnoses, issues and strengths within the Faith Community

Includes health promotion and restoration of health, spiritual enhancement, prevention of illness, injury and disease, alleviation of suffering and provision of supportive care for those who are dying.

Includes health education.

Health Education

Health education is any combination of learning

experiences designed to help individuals and

communities improve their health, by increasing their

knowledge or influencing their attitudes.

Tells us about health

Give information without follow up.

Does not include long term planning.

Individualistic

Health PromotionHealth promotion is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions.

Developing the whole community

Targets those in most need

Seeks to activate resources

Seeks to empower communities to identify their own health priorities

Implement strategies needed to overcome identified social challenges.

Health Promotion and Health Education

Health promotion programs use elements of health education.

Health education is a subset of overall health promotion activity.

Health Education

HEALTH PROMOTION

Importance of Evaluation

Ensures that the strategy/ alternatives/ activity is implemented and operating as planned.

Reaching the intended or target audience.

Reveals challenges and potential Solutions

Assess effectiveness of strategies, activities etc..

Demonstrate productive use of resources

Influence decisions about the continuation, refinement or expansion of the program.

Importance

Achieving it’s outline objectives

Worth the cost

Needed and beneficial

Making an important contribution to the health of the individuals and the communities we serve.

Ensures accountability to the standards of practice for the faith community nurse.

Faith Community Nurses standard of Practice: Competencies

Practice 6 : Evaluation: (refer to pg. 33 of Faith Community Nursing Scope and Standards Practice.)

The Faith Community Nurse Will: Conduct a wholistic, Systematic, systematic ongoing criterion –

based evaluation of the outcomes in relation to the structures and process prescribed by the plan and the indicated timeline.

Collaborate with the healthcare consumer and others involved in the care or situation in the evaluative process

Evaluates, in partnership with the health care consumer, the effectiveness of the planned strategies in relation to the healthcare consumers responses and attainment of expected outcomes

Uses ongoing assessment data to revise the diagnoses, the outcomes, the plan and the plan’s implementation as needed.

Faith Community Nurses standard of Practice: Competencies

Practice 6 : Evaluation: (refer to pg. 33 of Faith Community Nursing Scope and Standards Practice.)

The Faith Community Nurse Will: Disseminates the results to the healthcare consumer and others

involved in the care or situation as appropriate, in accordance with state and federal laws and regulations.

Participates in assessing and ensuring the responsible and appropriate use of interventions to minimize unwarranted or unwanted treatment and healthcare consumer suffering.

Documents the results of the evaluation including results from the faith or spiritual realm.

PART 2

Planning and Implementation

Assessment

Define the Need: Assessment

Wholistic data Collection.

Use of appropriate evidence based assessment techniques and instrument. E.g. Faith Community Nursing Health Needs assessment Survey, Focus groups, observation etc.

Synthesize data collection to identify patterns and variances and health promotion needs

Diagnosis

Derives Diagnoses or issues from the Holistic Assessment Data.

Identifies needs and strengths to enhance health and spiritual well being.

Prioritize needs and strengths. E.g.. Health education, use of peer/ family support to enhance wellness.

Outcomes Identification(goals setting and objectives)

Identifies expected outcomes for a plan individualized to the individual or situation and or tailored to the community.

Must be clear and measurable

Involves the individual and the faith community in formulating expected outcomes.

Derives culturally and spiritually appropriate outcomes from identified needs and diagnoses.

Involves a realistic time estimate for attaining expected outcomes.

Use Collaboration in developing expected outcomes

Goal and Objectives

Goals: Broad statements of what we intended to achieve.

Objectives: steps need to achieve our goals. Specific measures we use to determine whether or not we are successful.

Planning

Develops a plan that prescribes strategies and alternatives tailored to attain expected outcomes.

Integrate evidence based strategies to address the identified diagnosis.

Includes strategies for addressing health and wholeness across the life span.

Develops an evaluation plan.

Planning

I. When and how to monitor program and conduct process evaluations

II. Determine when to conduct impact evaluation

III. Determine when to conduct outcome evaluation or how soon you want to measure outcomes

Implement

The Faith Community nurse implements the identified plan

Utilize evidence based strategies to implement interventions .

Tailor interventions

Culturally sensitive interventions

Utilize community and faith community resources and systems to implement the plan

PART 3

EVALUATION: Needs to be considered in the planning stages.

The Faith community nurse evaluates progress toward

attainment of goals Conducts a wholistic, systematic ongoing criterion

– based evaluation of the outcomes in relation to the structures and process prescribed by the plan and the indicated timeline

Uses ongoing assessment data to revise the diagnoses, the outcomes, the plan and the plan’s implementation as

needed.

Determine Information needed. Use process evaluation during program implementation , impact

evaluation at the end of the program and outcome evaluation at follow up.

Develop a data collection Design

I. Record KeepingII. Pre-Post (before and after to measure change, Change= impact.III. Post only IV. Observational studies/ auditsV. Controlled experiments (complex and time consuming)

Determine the Method of Data CollectionStandard and consistent Format.I. InterviewsII. QuestionnairesIII. Counting number of events that occurredIV. Surveys

V. Observation./Audits.

Cont.-

Whatever method is chosen, a collection form, such as a questionnaire or checklist will be needed so that data is collected in a standard manner and in a common format.

Evaluates, in partnership with the health care consumer, the effectiveness of the planned strategies in

relation to the healthcare consumers responses and attainment of expected

outcomes

Focus your evaluation

Identify the purpose of the evaluation.

Determine the kind of evaluation; PROCESS, IMPACT, OUTCOME.

Consider what questions needs to be answered by the Evaluation.

Develop Data collection forms:

Must address either, the process, impact and or outcomes of the planned strategies

Directly assess attainment of Expected outcomes.

Determine who needs to be assessed to determine effectiveness of the planned strategy

Data Collection and Analysis

Collect data.

Organize and Analyze Data:

I. Statistical Analysis: descriptive statistics/ inferential statistics.(mean, graphs, chi square etc).

II. Compare Pre-post Changes ( report measured differences in percentages)

III. Identify Patterns and themes in self reports.

Interpretation

Interpret changes, patterns and themes as either :

A. An Impact: Immediate

B. An outcome: may require additional follow-up

c. Process: changes made to program design and implementation as a result of little or no success in achieving goals and objectives

Conclusion

Summarize findings.

Present to Faith Community

Present to Texas Health Fort Worth-Faith Community Nursing Coordinator.

Celebrate achievement.

Putting it all together Tracy R N. administered her quarterly needs assessment survey to the FCN congregation. Analysis of

data revealed emerging themes for 3 top priority areas in the FCN Community: 48% had no access to a regular dentist and a lack thereof of healthy oral health behaviors. 22% Diagnosed High Blood pressure. 10% were obese.

Strategically intervenes : Based on the above data, Tracey RN, in collaboration with the Faith community and their sponsors decided to make oral health promotion a priority in the next quarter.

Plan : Oral health promotion program

I. Plans method and design of evaluation,.

II. Decides on Pre-Post survey questionnaire.

III. Goal of the program is adoption of healthy oral behaviors( Objectives:- to enroll at least 80% of the faith community in need of oral health, teach flossing , oral care , distribution of dental and how to acquire supplies and referral, to local dentist, phone reminders.) and to improve oral health of the community.

IV. Designed survey questions that addressed access to regular dental supplies, knowledge of how to practice good oral hygiene and frequency and knowledge of local oral care resources

V. Administered pre survey questions before start of the program

VI. Implement Program; includes :

a. Distribution of dental supplies

b. Teaching and demonstration of oral care

c. referral to oral health care providers and resources.

VII. Process evaluation during program implementation to assess whether program is achieving goals and objectives.

Uses survey questions to asses, ease of participation, comprehension, usefulness, barriers etc.

VIII. Once program is completed,administer same survey questionnaires for post testing.

IX. Analyze Data and determines pre-post changes

Putting it all together

Changes reported as percentages

RAW % TOTAL RAW % TOTAL Pre-postchange

10 10/50*100

20% 40 40/50*100

80% (80-20)/20*100=300%

15 15/50*100

30% 35 35/50*100

70% 133.3%

5 5/50* 100

10% 45 45/50*100

90% 800%

PRE TEST/BASELINE

POSTTEST/FOLLOW UP

Dental supply

Dental Practice

Resources

Putting it all togetherTracy RN, presented program impact to the faith

community

0

100

200

300

400

500

600

700

800

Dental practices Dental supples Dental Resources

pre 20 30 10

post 80 70 90

changes 300 133 800

pre

post

changes

Putting it all together

x.. Impact: Data interpreted as:

3-4 times more access to dental supplies

1-2 times improvement in dental practices.

8-9 times more access to regular dentist.

XI. Outcome

Data collection and analysis repeated at five months to determine sustained oral health behaviors.-Outcomes reported as improvement in oral health in the faith community.

Case study

Conduct a needs assessment in your faith community and describe how you will intervene.

Describe and design an appropriate Evaluation for the intervention

Interpret Findings .