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Cheticamp Primary Health Care Project
Interim Report
April 1993
Project Interim Report
CHETICAMP PRIMARY HEALTH CARE PROJECT
A Project co-funded by:
The Registered Nurses Association of Nova Scotia
The Nova Scotia Department of Health
Sacred Heart Hospital -Cheticamp
Submitted by Karen Parent
Project Coordinator
April 16, 1993
CPHE
Table of Contents
i.
Introduction
1.1 Purpose of Report
1
1
2.
Background
2
2
3
2.1
2.2
i
Geographic
'Organizational Considerations
3.
Project as Proposed
3.1 Overarching Goal
4
4
4.
What has been Accomplished
4.1 Community Needs Assessment
A.
Key Informant/General Public
Questionnaire
B.
Focus Groups
C.
Kitchen Table Discussions
4.2 Community Advisory Board
4.3 Community Profile
4.4 Raising the Level of Awareness
4.5 Educational Opportunities
5
5
5
8
9
11
12
13
15
5.
Process Evaluation
5.1 Keeping on Track
16
16
6.
Cooperation Among Sectors
6.1 What Partnerships are being developed?
16
16
7.
Conclusion
17
8.
References
17
Appendices
A.
Proposal
B.
Critical Pathway
C.
Map
D.
Roles/Responsibilities and Terms of References
E.
Survey - Key Informant/General Public
F.
Advisory Board Profile
G.
Letters (French/English to Community Committees)
Interim Report- PHC Project 04/93
1. Introduction
The Primary Health Care Project (P.H.C.) currently being
developed and implemented in the Cheticamp area is a three year
initiative jointly sponsored by the Registered Nurses Association
of Nova Scotia (R.N.A.N.S.), the Nova Scotia Department of Health
(D.O.H.), and Sacred Heart Hospital (S.H.H.).
The RNANS has guided the project from its initial discussions
"explore
the feasibility of implementingj a primary health care
to
■ .
It’ was through the efforts of
project" to proposal development.
I
the RNANS that the preliminary model, "Developing a Healthy
Community", was endorsed and accepted by the province. In November
1990, the Minister of Health, the Hon. George Moody, announced
funding for the project. The project has an office in Sacred Heart
Hospital, Cheticamp.
The project coordinator was hired and the official opening of
the project was held on November 24, 1992 at the Cheticamp Site and
by the Minister of Health, the President of the RNANS,
was attended
<
’ '
‘
the Administrator of Public
Health
Services,, members of the PHC
■
~
j and forty-eight community residents.
The
Steering
Committee
opening was not well covered by the media.
1.1
Purpose of Report
This report will focus on the challenges and successes that have
been encountered during the first seven months of the ten months
that will be required to complete Phase 1 - Community Needs
Assessment.
The assessment involves developing a community
profile, determining priority health concerns, forming a Community
Advisory Board, raising the level of awareness of the project, and
developing a framework for process evaluation.
The report will
discuss the extent to which the objectives outlined in the project
proposal (Appendix A) and Critical Pathway (Appendix B) are being
achieved.
As well, this report will consider the challenges and
successes facing each of the objectives.
i
Interim Report- PHC Project 04/93
2. Background
In May 1991, the Board of Directors of the RNANS submitted a
proposal entitled, Community Primary Health Care Implementation.
The proposal supported a "co-funded project to demonstrate how
health care resources can be utilized to improve the health of
Nova Scotians.
It was the belief of RNANS that the project
would show how all health care team members can fully utilize
their abilities working with community residents, programs,
and resources to manage and meet the identified priority
health needs".14
The initial proposal recommended the project be initiated in
two Nova Scotian communities for comparative analysis. Feasibility
allowed for only one community site to be chosen, which was
Cheticamp and area on Cape Breton Island.
2.1
Geographic
The project catchment area extends approximately 130 km along
the western coast of Cape Breton Island from Pleasant Bay to East
Margaree (Appendix C) .
This area is sandwiched between the
National Park and the Gulf of St. Lawrence.
Cheticamp itself is predominantly an fAcadian community with
well over 90% of the residents of Acadian descent.
----Pleasant Bay is
predominantly English speaking and is distanced from the larger
community of Cheticamp by the Highlands.
2
Interim Report- PHC Project 04/93
2.2 Organizational Considerations
On behalf of the P.H.C. project stakeholders, a tripartite
Steering Committee was formed with representation from RNANS, the
Community and SHH.
The project coordinator attends all the
meetings as an ex-officio member. Roles/Responsibilities and Terms
of Reference were established in collaboration with the project
coordinator (Appendix D).
A community representative from
Cheticamp was elected as President and Chair of the Steering
Committee. It is intended that the Steering Committee maintain an
"arms length" relationship with the Project's day to day operations
but remain informed through interim progress reports three times a
year.
The Steering Committee sought legal council in the early
stages of its development to become an incorporated society. The
Administrator of Public Health Services for the DOH will receive
interim reports three times a year.
A Management Committee consisting of the Executive Director
from RNANS, the Administrator of Sacred Heart Hospital and the
President of the Steering Committee, was formed to aid in dealing
situations
requiring
immediate
with
financial
matters
and
attention.
The project coordinator was employed August 1992 , began
orientation September 1992 and presently resides in the community.
A part-time support staff was hired March 1993 to assist the
coordinator with clerical and organizational activities.
Sacred
Heart Hospital's Director of Finance, is responsible for the
accounting management of the project. The Nova Scotia DOH is
responsible for the external summative evaluation.
The Cheticamp PHC Advisory Board has been set up composed of
twelve people representing different districts and organizations.
The Board began its formation in November 1992 and subsequent
meetings have been held. The Board continues to develop as a vital
mechanism for community participation.
3
Interim Report- PHC Project 04/93
3. Project as Proposed
3.1
Overarching Goal
The Primary Health Care Project in Cheticamp and surrounding
area is to assist individuals, families, and communities to
take responsibility for their health. This will be achieved
by involving citizens at a local level in all aspects of
assessment, planning and implementation of services that best
meet their perceived health needs.
The project has three phases which
focus
on health
development: Phase 1 - needs assessment, Phase 2
intervention ,
and Phase 3
evaluation.
This report will address the present status of Phase 1 in the
following five areas:
1.
Completing a Community needs assessment.
2.
Forming a community advisory board which will direct the
overall program development process.
3.
Preparing a community profile report which will identify
the community's capacities and assets and provide
knowledge of past processes that may generate present
conditions.
4.
Creating strategies to raise the level of awareness about
the project and the principles of primary health care.
5.
Design a framework for process evaluation with the P.H.C.
Advisory Board which is participant focused.
4
Interim Report- PHC Project 04/93
4. What has been Accomplished
4.1
Community Needs Assessment
The community needs assessment consists of:
A.
B.
C.
Key
Informant
(Nurse/Non-nurse)
Questionnaire
Focus Groups
Kitchen table discussions
A.
Key informant/General Public Questionnaires
and
General
Public
Design
The community assessment uses a descriptive design to provide
source information about the population within the Primary Health
Care project catchment area.
This area consists of fifteen
districts:
Pleasant Bay, Cheticamp Island,
La Prairie, Petit
Etang, Cheticamp North and South, Belle Marche, Redman, Plateau,
Point Cross, Cap Lemoine, Grand Etang, St. Joseph du Moine, Terre
Noire,
Belle Cote and East Margaree.
The population is
approximately 3100 according to the 1991 Statistical Profile for
Cape Breton.
The Tool for assessment was obtained with permission from the
Newfoundland/Danish Primary Health Care Project. The instrument is
based on the Duke Older American Resources and Services Strategy
Questionnaire2 and was revised, face validated and pilot tested for
readability, clarity and understanding by the Association of
Registered Nurses in Newfoundland.(Appendix E).
The Cheticamp
Advisory Board approved the survey for pilot testing in December
1992.
5
Interim Report- PHC Project 04/93
Objectives of the Survey
The objectives of the General Public and Key Informant Survey are:
information which would
of the community health
assist with
programs or
1.
To provide source
effective planning
services.
2.
To contribute to base line data against which changes in
health-directed lifestyles in the community could be measured.
3.
To contribute to the base line data against which changes in
knowledge held by the public regarding health and health
services could be measured.3
4.
To generate awareness of the Primary Health Care Project.
Survey Method
As envisaged by the coordinator, a key aspect of the survey is
community participation. Community volunteers have been recruited,
trained in interview technigues and supervised to ensure that
quality data will be obtained for analysis. The Ladies Auxiliary
of Sacred Heart Hospital and Pleasant Bay Home and School Group
have been instrumental in launching the survey.
Each woman was
assigned a district to distribute her five surveys. An information
fact sheet was provided for each interviewer to assist with answers
to questions that may arise from the respondents' concerns.
The
responsibility of delivering and picking up the survey was given to
the interviewers. It was suggested that a time limit of two weeks
be given to the respondents to ensure a adequate return rate, The
sample is stratified by age and sex and a percentage of each
district will be obtained to provide a profile of needs which
represents this population base.
Sample Selection
The sample will include a total household survey of 360
individuals from the catchment extending from Pleasant Bay to East
Margaree.
The sample will be stratified by age and sex of
individuals 19 years or over with a reasonable balance of
respondents from each district (fifteen districts in total).
Consent may be obtained from parents of individuals less than 19
years to complete the survey, Nonrespondents are replaced as they
occur to ensure that the sample size of 360 individuals.
6
Interim Report- PHC Project 04/93
The gualitative and guantitative data from the four lines of
evidence will then be triangulated which will ensure valid results
in determining the self-perceived health needs of the community.
Challenges
The survey has been described as "long and tiring", especially
The font is small and some guestions reguire lining
for seniors,
up the answer with a paper or ruler to ensure that the correct
It has been noticed that many people are
response is checked,
This means that, in
erasing responses; or checking a box twice.
guestionable cases, possible responses will have to be eliminated
from the analysis.
Successes
The length of the survey prompted the planning of a social
event for a seniors group.
Surprisingly, this social event
garnered valuable information regarding the extremely high rate of
Of the fifteen
seniors who
illiteracy in the elderly population. 01
Ilf-completed the survey, an overwhelming majority did not have an
By discussing health in a
opportunity for formal education,
relaxed manner the group completed the surveys with discussion
around issues relating to seniors.
An early achievement of the project was to put in place
mechanisms for community participation in the initial stages of
project development by having community involvement in the survey
distribution, focus groups and kitchen table.
These mechanisms
will allow for control over the process of determining the health
services for this area and ultimately increasing the chances for
sustainment.
Survey Distribution and Return
(as of May, 1993)
SURVEY TYPE
OUT
IN
%
KEY INFORMANT
103
51
50
GENERAL PUBLIC
165
126
76
7
Interim Report- PHC Project 04/93
B.
Focus Groups
This method for collecting information on perceived needs has
been effective in bringing together target groups to discuss their
unigue concerns. The goal and objectives are:
Goal: To determine the interests, needs, attitudes and opinions of
a homogeneous sample of community members concerning the planning
of programs revolving around health and PHC.
Objectives:
*
to determine the attitudes and opinions of
participants about what they believe constitutes a
healthy individual and community.
*
to determine the participants1 ideas, attitudes
and opinions about primary health care.
*
to determine the resources in the community that
will promote health.
* to determine the participants' ideas, interests,
and opinions on how to improve the health of their
community and what would make the primary health
care project successful.
Method
Groups are brought together to the location of their choice,
information is gathered and later coded into themes.
Groups contacted and interviewed to date:
Month
Group
Number
Seniors x 2
29
Feb/Mar,
Fishermen-Pleasant Bay
18
Apri1 15
Firemen-Cheticamp
17
April 21
Nurses/SHH Staff
22
January
Single mothers/Belle C
5
April 20
Youth Group ST.JDM
12
March 22
Senior Admin. Foyer
9
Apri1 27
Total people reached
112
8
Interim Report- PHC Project 04/93
Challenges
In the early stages of information gathering the coordinator
performed the dual task of recorder and facilitator. This did not
always allow for the recording of comments verbatim which is
important for precise collection of qualitative data.
Each group requires :special skills of facilitation to
encourage an honest exchange, The session with the youth group was
difficult at first. It was only after incorporating three " icebreaker" games that increased participation and feedback were
obtained.
The leader of the youth group reported to the
coordinator that overall the youth group "enjoyed it". Efforts
will be made to provide a creative process to encourage feedback
from the youth before going into the schools.
Meeting with a
smaller group was a good opportunity to learn what worked and what
did not.
Successes
The community feedback has been very encouraging for
continuing this method of collecting data. The information is rich
with personal experiences, The unique community features and the
spirit of people are more apparent through this informal
personalized approach.
C.
Kitchen Table Discussions
Goal/Objectives:
Refer to focus groups
Method
The kitchen table discussions are an informal method for
gathering information from a broad range of community members. The
notion of "grassroots" democratic participation, a key principle of
PHC is demonstrated with this methodology.
A community member is approached and the concepts behind the
kitchen table discussion are explained. The individual is asked to
invite up to 10 people to sit around the table and discuss issues
of concern in their community that may affect their health.
The
discussion begins by exploring a broader vision of "health" then
follows a loosely structured format focused around three questions:
9
Interim Report- PHC Project 04/93
1.
2.
3.
If you were floating in a balloon over your community,
what would a healthy community look like to you?
What prevents your community from being as healthy as it
could be?
What strengths does your community have to promote
health?
Challenges
The biggest challenge is to keep the discussions under two
hours! The group is informed from the onset that generally one hour
of their time is required.
The second challenge is to involve more men in the group
discussions. Women have been much more willing to participate in
discussion groups.
Earnest attempts are being made to encourage
men to participate more fully. The coordinator returned to people
in the community to ask them what would be the most effective
manner to reach the men.
It was suggested that the coordinator
should go to the locations where the men tend to gather--gas
stations, wharf,
wharf, restaurants and predominantly male community
groups such as the firemen.
This suggestion has proven to be a
useful mechanism for getting men involved with discussions around
their health concerns. On one occassion the coordinator went to the
local gas station in Pleasant Bay at 8:00 am before the men left to
work on their boats and spoke with seventeen men--this was a
positive and rewarding experience.
Successes
The kitchen table discussions demonstrate an effective method
for "reaching the hard to reach". So often, people who are willing
to participate in the decision making process are already actively
involved with the community, The dilemma was to make contact with
those who did not volunteer and were generally isolated from
community life,
This method provides an opportunity for
participation in a forum that is non-threatening and enabling for
many people who do not feel they have a voice in the community.
At the outset, before the community network was known, groups
that were familiar to the coordinator were approached and
interviewed.
With increased knowledge of the community's
infrastructure, more creative ways of making initial contact have
been found.
This method of collecting qualitative data provides
the encouragement and impetus for community people who are not
often invited to participate to actively get involved.
10
Interim Report- PHC Project 04/93
Kitchen Table Discussions Conducted
Number of People
Reached
Number of Discussions
Held
8
Total=59 ind.
Female
73%
Male
27%
Total Male / Female ratio for the discussion groups (focus,
kitchen table) from a total of 216 individuals is:
MALE
FEMALE
31%
69%
4.2 Community Advisory Board
A Primary Health Care Advisory Board has been set up
composed of 10 members of the community representing different
The roles/responsibilities are
communities and organizations.
included in Appendix D. A profile of the committee is provided in
detail in Appendix F. The first meeting was held November 16, 1992
with subsequent meetings every month.
Challenges
Initially many people who would have been appropriate for the
Advisory Board reconsidered due to their over extended schedules.
Those people included clergy, a social worker, and a public health
nurse. Pleasant Bay was the last member to join the team, mainly
due to geographic isolation and treacherous winter driving
conditions. It has become known that residents of the community of
Pleasant Bay are not often members of a committees in Cheticamp for
many reasons, some being distance, language differences, and a
perceived sense of "not belonging" as indicated by some members of
the community.
11
Interim Report- PHC Project 04/93
To_provide a profile of individuals representing a fair and
equitable voice for
(
-- the community
was a formidable task.
Many
people wanted to be involved but not in a formalized structure such
as a board, which could be intimidating.".
It was suggested they
remain part of a ?larger network which could be consulted on a
regular basis.
t'116 growth and development of the group has been
prolonged by the staggered joining of members to
the Board.
Reading materials regarding the principles of PHC,
, community
development
and. background
information
.r
, to
-»
—
--project haveJ been
distributed
facilitate
the
1 on * the process,
learning
but little time has
been spent to discuss the material
---- L_1 together.
Successes
Recognizing these challenges early has provided an opportunity
to make the necessary corrections. The Advisory Board has decided
to take advantage of the resources from within the community and
as requested that the " Institut de Developpement Communautaire”
facilitate the policy and strategic planning for the Board.
A
tentative date is scheduled for May.
The Board recognized early that a clear message would have to
be given to the community to avoid anger, suspicion or confusion.
This will be considered a priority in the planning session.
The board members are committed to primary health care; three
members are currently registered for the "Making it Work"
conference in Halifax.
This opportunity will facilitate the
knowledge and growth of the group.
Funds have been budgeted to
allow for further educational sessions that would enhance group
development.
Finally, the Board has agreed to assist with raising the level
of awareness around the project. A standardized slide presentation
is in the final stages of completion. The guidelines will ensure
consistency of information and promote the confidence of the
presenters.
The presentation will be pilot tested by the
Coordinator and Assistant April 14, 1993.
4.3
Community Profile
The community profile is well underway with data being
collected from a variety of sources. Types of information compiled
for this report are provided in the Critical Pathway Appendix B.
12
Interim Report- PHC Project 04/93
4.4 Raising the Level of Awareness
The following strategies are being used:
Fifty-five letters have been sent to organizations in the
1.
catchment to encourage the membership to place the Primary Health
Care Project on their agenda (Appendix G).
In retrospect it has
been noted that letters were not sent to committees in Pleasant Bay
and Margaree, contacts are presently being made to rectify this
oversight.
To date presentations
organizations:
* Cheticamp Coordinated
* Resource Committee
it
it
it
it
it
it
it
it
it
it
it
it
it
it
it
it
it
it
it
it
have
been
given
to
the
following
Community Care Committee
Ladies Axillary
Pleasant Bay School and Home Committee
SPACE Youth Group
ST.J.D.M. RAP Youth Group
Kinettes
Parish Council St. JDM
Co-op Council
Social Action Committee St. J.D.M
Alcohol and Drug Awareness Committee
Knights of Columbus - Date for meeting TBA
Cheticamp Seniors Club -Date for meeting TBA
Cheticamp Parent/ Teacher- Scheduled for the fall
Cheticamp Development Commission
Volunteer Fire Department
Les Filles de Jesus
Pleasant Bay Fishermen
Belle Cote Single Parents Support Group
Municipal Councillors Meeting - TBA
Knights of Columbus- Margaree
Clergy- Margaree / Cheticamp
2. Media Coverage
The media coverage for the project launch in November 92 was
not well attended despite efforts by the RNANS. Seventy-two press
releases and contacts were made with the media and only one local
newspaper attended.
13
Interim Report- PHC Project 04/93
The following has been the total media
project before and after the official launch:
coverage
for
the
*
The Chronicle-Herald November 30, 1991 Cheticamp focus of
health study.
* The Oran December 4, 1991
primary health care project
*
The Oran Sept. 23,
signs.
Cheticamp hospital will pilot
1992 Health project showing promising
*
CNA Today Nov/Dec Volume 2 No. 3 A community approach to
health care in Cape Breton.
*
The Oran, November 18,1992 Parent to coordinate primary
health care project in Cheticamp
*
CIGO Radio Port Hawksbury November 25, 1992
*
Le Courrier, December 4,
primaire a Cheticamp
1992 Pro jet en soins de sante
* Sacred Heart News Bulletin, December 11, 1992 The launch of
the Cheticamp Primary Health Care Project.
* Nurse to Nurse, January 1993 The launch of the Cheticamp
Primary Health Care Project
*
Channel 28 Community Channel Cheticamp Health Survey to
take place in Cheticamp and surrounding area.
Information Morning CBC Sydney, March 9, 1993
*
The Oran, March 3, 1993 Primary Health Care begins new
phase.
* Sacred Heart News Bulletin, March 1993 Community Health
Survey to take place in Cheticamp and surrounding area.
*
Partici-paper March 1993, Le projet "Soins fondamentaux de
la sante".
*
Radio Cheticamp, 10- 60 second spots during Mi-careme week.
14
Interim Report- PHC Project 04/93
3.
Educational Sessions
*
*
★
*
*
*
*
*
*
St F.X. Nursing Students November 18, 1992
RNANS Chapter Meeting, Inverness, November 4, 1992
RNANS Chapter Meeting, Cheticamp, December 2, 1992
SHH Staff inservice, January 7, 1993
Foyer Staff inservice, January 21, 1993
1993
Inverness Hospital, Head of Dept., Feb.
RNANS Chapter Meeting, Sydney, Feb. 10. 1993
Atlantic Health Promotion Meeting Feb. 12, 1993
RNANS Chapter Meeting, Strait Richmond, April 30, 1993
St. F.X. Nursing Student Placement for 20 Hours January
4-8, 1993.
Two fourth year nursing students requested placement for
their senior seminar. These students were exposed to every aspect
of the needs assessment phase. Positive feedback was obtained from
the students and the Professors. Interested students in the future
are encouraged to request a forty hour week to allow enough time to
cover the aspects of PHC in greater detail. The students will also
be encouraged to write about their experiences.
4.
4.5 Educational Opportunities
Educational opportunities provided to the coordinator
promote personal growth and skill development were:
I
November 92
March 93
April 93
May
93
* Board Development Workshop- Halifax
* Site Visit to the Nfld/Danish PHC Project
* Building For Health CSIH /Tatamagouche
* Making it Work Conference /Halifax
15
to
Interim Report- PHC Project 04/93
5. Process Evaluation
5.1 Keeping on Track
As part of the Advisory Board strategic planning exercise,
standards against which the Boards work can be judged will be
developed. This will allow the evaluation to be built in from the
beginning of the project work.
To date the Board has not been
cohesive enough to begin developing questions for evaluation. The
participant focused evaluation will provide a description of what
the actual work is, the context in which the work is being done,
and how well the work is progressing.
The coordinator has mechanisms in place for describing the
process of developing the project. A journal is kept with detailed
accountsof proceedings, communications, meetings, etc., as well as
an organized file system. Advisory Board Meetings are evaluated at
the end by requesting verbal feedback to the coordinator. The
process of community development is considered in every aspect of
planning andJ program . development.
It is recognized that the
development of a framework for evaluation requires the input of the
community board to be successful and meaningful.
6. Cooperation among Sectors
6.1 What partnerships are being developed?
The PHC project has developed a strong link with the
Industrial
Adjustment
Strategy Group or
"Community Action
Committee". This committee is
:
presently studying the potential
impact of the fishing crisis,
Project visibility in the early
discussions has provided an opportunity for exploring the
implications of the crisis on the health of the community. The
collaborative efforts will be ongoing.
Cheticamp
The
Coordinated
Care
Committee
is
an
interdisciplinary group of health professionals who meet once a
month to discuss particular issues of concern in the community
regarding health. . This committee offers an excellent opportunity
to collaborate with existing resources to foster
foster aa healthier
community and avoid replication of services,
This link will be
developed further in the future.
16
Interim Report- PHC Project 04/93
A network of individuals in government, business, education,
religion, social services, and industry is being formed which will
help develop mutual aid and social support mechanisms for
individuals and communities to sustain the initatives of the PHC
project.
This network is linked by the common desire to enhance
and strengthen the community health.
It is hoped that in the
summer months a newsletter will be developed to communicate
effectively with this network
7. Conclusion
This report has been formulated to assist the coordinator, co
funders, and the Advisory Board in determining the challenges and
successes experienced during the development of the PHC project.
It will inform people on what has been accomplished and whether the
goals and objectives are being met.
The implementation of the project has now completed seven
months. The next three months will concentrate on completing the
needs assessment, developing the board, developing an information
pamphlet and completing the community profile.
In September
another key player in the project, another Registered Nurse, will
be hired and orientated to the project.
Phase 2 involves the
implementation of activities to meet the perceived health needs as
identified in Phase 1 and is scheduled to begin in September 1993.
I
8. References
i.
The background of this project is described in detail in the
propo sal Cheticamp Primary Health Care Implementation,
Appendix A
2.
Multidimensional Functional Assessment: The OARS Methodology
Second edition. The duke University Centre for the Study of
Aging and Human Development, 1978
3.
Community Health Needs and Resources Assessment Package
ARNN, 1990
17
Appendix A
PROPOSAL
COMMUNITY PRIMARY HEALTH CARE IMPLEMENTATION PROPOSAL
Submitted by
Board of Directors
Registered Nurses Association of Nova Scotia
To Honourable G. Moody
Minister of Health
Government of Nova Scotia
May, 1991
This proposal was developed for the RNANS Board of
Directors at their request by a volunteer committee of
M.
H.
S.
D.
A.
Stewart, RN, PhD
Beanlands, RN, MN
Marshall, RN, BN
Orychock, RN, BA, MEd
Taylor, RN, PhD candidate
- RNANS Staff Resource
and two paid research assistants from
Dalhousie University School of Nursing.
The RNANS Board of Directors express their thanks to
all committee members for their efforts in this project.
EXECUTIVE SUMMARY
The World. Health Organization, the International Council of Nurses, and. the
Canadian Nurses Association recognize the urgency of involving nurses in primary
health care practice as a key to attaining health for all by the year 2000.
The
1990 "Health Strategy for the Nineties" report of the Government of Nova Scotia
recommends the promotion of primary health care throughout the province. The
three year project proposed by the RNANS is based on the five principles of
primary health care --accessibility to health and health care, increased disease
prevention and health promotion, public participation, appropriate technology
and intersectoral cooperation.
It is recommended that the project be initiated in two Nova Scotia communities
representing different regions, different patterns of health service provision,
different health concerns, and different sociodemographic characteristics. The
project will be conducted in three phases. All phases will be guided by a
Provincial Advisory Committee and Community Implementation Committees and will
involve community consultation. The initial assessment phase will focus on
identification of priority health-related concerns and of preferred
interventions. The intervention phase will coordinate and strengthen existing
services that address priority health concerns and create new professional and
non-professional support services as needed. The final evaluation phase will
evaluate the effect of the project on priority health concerns. Outcome
criteria will be identified through interviews with community members during the
assessment phase.
The project will emphasize primary health care principles and community
development. Thus citizen participation, self help, mutual aid, and optimum use
of local resources will be emphasized as nurses work in partnership with
community members. The community would need to be receptive to the project and
the project would have to be sustainable by the community after three years.
A primary health care nurse in each community would help provide direct primary
health care services, teach health personnel and community members, coordinate
primary health care services, and evaluate these services. Each nurse would
work in partnership with other nurses serving the community, with other health
care professionals, and with community members. They would also serve as exofficio members of the Community Implementation Committee in their region. The
provincial nurse project coordinator would oversee the implementation of the
project, coordinate the activities of the primary health care nurses,
collaborate with other professionals, and cooperate with an external evaluator
and with the Provincial Advisory Committee.
The short term outcome of community development and participation will be
evaluated at the end of the third year. The longer term outcome of improved
community health status or reduction of priority health concerns will be
evaluated after five years. The project would be continued by the community
residents now skilled in assessing health concerns, planning pertinent
interventions and evaluating the effectiveness of these interventions.
TABLE OF CONTENTS
Page
Introduction
1
Primary Health Care
The Changing Concept of Health
Current Canadian Examples
Models of Primary Health Care Nursing Practice
Objectives
Figure 1 - Preliminary Model of Project
2
4
4
5
5
6
Proposed Design
Summary
Phase I-.Assessment
Figure 2 - Structure of Project
Phase II:Intervention
Phase III:Evaluation
Time Line
7
7
7
8
9
10
10
Selection of Sites for Implementation Project
Selection Criteria
Selection Process
Hants Shore
L'Ardoise, Richmond County, Cape Breton
St. Ann's, Arichat, Cape Breton
Sherbrooke, St. Mary's Municipality, Guysborough County
Recommended Communities
11
11
12
12
14
17
19
20
References
21
Appendix A - RNANS Position Statement on Primary Health Care
23
Appendix B - Proposed Membership of Provincial Advisory Committee
24
Appendix C - Demographic Data for Hants County, Richmond County,
Guysborough County
25
L
INTRODUCTION
Nurses, have been and will continue to be leaders in promoting and practicing
primary health care. The World Health Organization (WHO) and the International
Council of Nurses (ICN) recognize the urgency of orienting nurses to primary
health care as the key to attaining health for all by the year 2000.
Significant strides have been made toward the goal internationally, nationally
and provincially. Nurses constitute the largest category of health personnel and
therefore have the greatest potential to contribute to health for all.
The Registered Nurses Association of Nova Scotia (RNANS) believes that
individuals, community groups, health professionals, health service institutions
and government must work together toward a health care system that contributes
to the pursuit of health for all. Around the world, primary health care is
being implemented to ensure that essential health care is universally accessible
to individuals and families in the community.
It must be acceptable, affordable
and allow full public participation. The RNANS also believes that individuals and
communities will be able to make more effective and appropriate use of the
primary health care services they need, if more than one group of health care
professionals are legally entitled to act as entry points to the system and make
referrals to other health professionals.
The Report of the Nova Scotia Royal Commission on Health Care: Towards a New
Strategy (1989) illustrates primary health care principles throughout its
supportive documentation, conclusions, and recommendations.
In fact,
recommendation 4.09 is specifically directed toward nursing: "that the policy
and administrative framework for an expanded role for nursing in the delivery of
primary health care in Nova Scotia be established.
That this process involve
collaboration of nurses and other health professionals, administrators,
government and educational institutions." Clearly, the RNANS had an important
impact on the thrust of these recommendations. At its June, 1990 Annual
Meeting, the membership of the RNANS passed a motion which resolved to "explore
the feasibility of implementing a project in Nova Scotia demonstrating primary
health care."
The RNANS Board in November 1990 adopted a position statement on
primary health care. (See Appendix A)
A 1990 survey of selected nurses working in different sites in Nova Scotia
elicited information about how nurses are putting the principles of primary
health care into practice in this province, and generated a vision of potential
primary health care roles and activities. The 30 respondents were employed by
the Nova Scotia Department of Health and Fitness, the Victorian Order of Nurses,
hospitals, and other multiservice or community settings. The nurses who were
surveyed understand the underlying premises of primary health care and seem to
implement some or all of these principles in their practice. This may not be
representative of all nurses working in all settings in the province; however,
the findings do seem to indicate that Nova Scotian nurses are interested, and
often involved in implementing primary health care. There seems to be explicit
acknowledgment, for example, of the importance of promoting public participation
through such mechanisms as empowerment of families, referral to self help
groups, and public education. Structural and funding barriers were noted by some
respondents.
2
These provincial nursing trends are consistent with the conclusions and
priorities of the November, 1990 Health Strategy for the Nineties: Managing
Better Health. RNANS commends the Government of Nova Scotia for its promise to
"adopt the primary health care approach and promote it throughout the province
and integrate primary health care delivery principles into its departmental
strategic plan." Therefore, we propose a project in which the community can have
prompt and ready access to health care through a variety of routes, a system
small enough to be humanly manageable and acceptable, and one that is truly
community oriented by encouraging citizen input throughout the development,
maintenance and evaluation.
It is intended that the proposed primary health
care implementation project will enhance the work of the Working Group on
Primary Health Care Delivery and the Task Force on Nursing. Hence, the
following objectives propose complementary strategies to recent Nova Scotian
reports and reflect the demonstrated potential of nurses to work with the
community to implement primary health care.
PRIMARY HEALTH CARE
Primary health care includes fundamental, basic health care which promotes not
only the health of individuals, but also families and communities to such a
level as to allow for more than mere survival. Economic and social
productivity are also enhanced. Primary health care incorporates promotion,
prevention, curative and rehabilitative services to provide a humane, rational,
and cost effective program of health care (ICN, 1988).
The World Health Organization (WHO) defines primary health care as:
Essential health care based on practical, scientifically sound and
socially acceptable methods and technology made universally accessible
to individuals and families in the community through their full
participation and at a cost that the community and country can afford
to maintain at every stage of their development in the spirit of selfreliance and self development (WHO, 1978).
The five principles of primary health care, based on the WHO definition include:
accessibility, public participation, prevention and promotion, appropriate
technology, and intersectoral cooperation. Nurses can play a key role in each
of these areas.
In fact, the WHO(1982) views primary health care as "a natural
extension of nursing practice.” Nurses provide continuity in the health care
system by providing care at all levels, thus forming the natural link between
individuals, families, communities and the formal health care system, Many of the
services necessary to form the essential elements of primary health care are
traditionally considered nursing services (ICN, 1988).
Accessibility
Within the context of primary health care, accessibility refers to care that is
geographically, financially, culturally and functionally accessible to the
community. While the federal-provincial medical care insurance program ensures
access to illness care, Canadians should also h^ave access to qualified
assistance in caring for, restoring, and promoting their health (Stewart, 1990).
3
Nursing strategies to promote accessible health care for the elderly, the poor,
and members of other cultures can include community-based education, personalized
services, environmental and structural changes, The type and amount of health
care services provided need to be sensitive to the specific needs of the
community being served.
Public Participation
Public participation is central to the concept of primary health care. This
premise emphasizes the partnership between individuals, families, communities
and the health care system in all phases of planning, intervention and
evaluation of care. Traditional views of the health care professional as expert
care provider are clearly inconsistent with a primary health care focus.
Inherent in this principle is the recognition of consumer advocacy and self-help
movements. Mutual aid and care by volunteers can provide cost effective and
acceptable means of promoting health and healthy behaviour. Professional
relationships with consumers are seen as ”facilitative rather than prescriptive,
consultative rather than authoritarian” (Canadian Nurses Association, 1988 p.5).
Nurses learn group process and community development skills in university
educational programs and have knowledge of resources required to meet health
care needs identified by communities.
Emphasis on Prevention and Promotion
This premise is consistent with the broad view of health care as opposed to
merely illness or medical care.
Elements of this focus include health
promotion, illness prevention, illness care and rehabilitation and education
directed at individual, family and community levels.
Increased emphasis on
health promotion and disease prevention can potentially reduce the high cost
associated with hospital-based illness care. Nurses are clearly prepared and
qualified to promote self-care practices, positive health behaviour and to
enhance strategies for coping with chronic illness.
Appropriate Technology
Appropriate technology refers to a reorientation to priority care for high-risk
groups and emphasizes the use of technology which is both acceptable and
maintainable by the community. Limits must be placed on expensive,
sophisticated technology which benefits few. The Canadian Nurses Association
(1988, 1989) recommends that alternatives to high-cost, high-tech services should
be explored to ensure that technology is both acceptable and appropriate for the
community and its resources.
Intersectoral Cooperation
This premise refers to the essential collaboration between various disciplines
within the health sector, as well as with social and economic policy planners.
Primary health care requires the coordinated use of available health care
resources working in concert with the community,. Nurses, as members of the
communities in which they practice, are a natural stimulus for bringing together
representatives from law, education, public policy, church, recreation, housing,
etc. to ensure health for individuals, families, and communities.
4
THE CHANGING CONCEPT OF HEALTH
Epp (1986) proposed the following concept of health as part of the Canadian
Framework for Health Promotion.
Health is thus envisaged as a resource which gives people the ability to
manage and even to change their surroundings. This view of health recognizes
freedom of choice and emphasizes the role of individuals and communities in
defining what health means to them. Viewed from this perspective, health
ceases to be measurable strictly in terms of illness and death.
It becomes
a state which individuals and communities alike strive to achieve, maintain
or regain, and not something that comes about merely as a result of treating
and curing illness and injuries.
It is a basic and dynamic force in our
daily lives, influenced by our circumstances, our beliefs, our culture and
our social, economic and physical environments, (p.3)
This perspective is consistent with the World Health Organization (1974)
definition of health which states that health is not only the absence of illness
but a state of physical, mental, and social well-being. This changing vision of
the concept of health lends itself to a transition from traditional illness care
to a more comprehensive form of health care which encompasses the principles of
primary health care.
CURRENT CANADIAN EXAMPLES
Primary health care nursing services have been demonstrated to decrease the use
of health care resources, improve accessibility to health care and improve
consumer knowledge, health behaviour and health maintenance (CNA,1988).
In
Manitoba, a nurse-staffed clinic had a significant impact on both weight loss
and a reduction in blood pressure.
In Quebec, nurses have influenced the health
of pre-school children and the health of their parents through the implementation
of primary care in both acute care and community settings.
Accessibility to health care is problematic for some members of Canadian society.
In response to the health needs of low income women, nurses have developed a
health promotion program in Ottawa called "Turning Point" which also provides
transportation, child care and lunch to facilitate and encourage attendance.
In
addition, a "Women in Crisis" program in Edmonton provides counselling, health
care and referral services for abused women and their children.
The need to involve the consumer in health promotion activities is reflected in
a Toronto nursing project. Participants in a parenting group choose from a
variety of topics and speakers to meet their specific needs and interests. This
approach ensures maximum participation and sensitivity to the parents' ability
to identify and meet their learning needs.
As evident in the above examples, Canadian nursing projects which encompassed
some or all of the principles of primary health care did have a positive impact
on the health of the communities involved.
5
MODELS OF PRIMARY HEALTH CARE NURSING PRACTICE
Canadian frameworks for the delivery of primary health care already exist. The
joint Newfoundland/Denmark project is based on six concepts derived from primary
health care premises and focuses on the delivery of promotive, preventative,
supportive, curative and rehabilitative services to individuals, families, and
communities.
Stewart's (1990) model for nursing, "from provider to partner" is derived from
social support theory and principles of primary health care. Central to this
model is the concept of "focal persons" who are defined as "individuals,
families, groups or communities that have... social, psychologic, spiritual, and
physical characteristics [who] participate as partners with nurses in promoting,
maintaining, and restoring health" (Stewart, 1990 p.12). This framework
particularly emphasizes the social dimension of health which is determined by
how it is embedded in a social network and integrated within the community.
Finally, the McGill model (Allen, 1981) conceives health as a "measurable and
modifiable characteristic shaped within the family, school, workplace, community
networks, and health care settings in which nursing is the primary health
resource" (Kravitz & Frey, 1989, p.316). This model is based on the assumptions
that the health of a nation is its most valuable resource and that individuals,
families, and communities aspire to and are motivated toward better health
(Kravitz & Frey, 1989).
The model for the proposed implementation project could draw on each of these
existing frameworks, linking the work done at McGill University related to the
concept of health and the focus of nursing on individual strength and potential,
with Stewart's notion of partnership and a social conceptualization of health.
The model could also incorporate themes central to the concept of community
development which include citizen participation, community self-help and selfreliance, mutual aid and support, local initiative, leadership development, and
optimum use of local resources (Campfens, 1983). Figure 1 depicts the
preliminary model which will be developed, tested and modified during this
project. Community development is based on the assumption "that people are
capable of both perceiving and judging the condition of their lives; that they
have the will and capacity to plan together in accordance with these judgements
to change that condition for the better" (Roberts, 1982, p.xv).
OBJECTIVES
I
To initiate a three year primary health care project in two communities in
Nova Scotia, representing different regions, different patterns of health
service delivery, different health status problems, and different
sociodemographic characteristics.
[These communities will have some
existing physician services and nursing services but will have perceived
needs for primary health care services to enhance their existing services.]
6
Figure 1
DEVELOPING
A
HEALTH
COMMON
Y
Partnership
Individuals,
Families &
Community
Inputs
Intersectoral Cooperation
Disease Prevention & Health
Promotion
Appropriate Technology
Public Participation
Accessibility
Output
HEALTH
Existing Health
Care: Delivery
System
7
Phase 1
Phase 2
Phase 3
II
a)
To assess the priority health concerns in each community by
consulting with community members and with potential and actual
health care providers.
b)
To identify one to three priority health-related concerns that the
community wishes to address during the project.
c)
To propose alternative interventions and elicit community and
professional feedback on selection of priority interventions.
a)
To coordinate and augment existing services that address these
priority health concerns
b)
to mobilize and create informal and formal support services
a)
To evaluate effect of projects on priority health concerns.
'l care model encompassing all five
To develop and apply a primary health
primary health care principles and hence to apply community development
and participatory research strategies throughout the project.
PROPOSED DESIGN
Summary:
The primary health care implementation project will be based on a composite
nursing model, the five principles of primary health care and community
development premises. The three phases of the project will focus on health
needs assessment, intervention and evaluation. All phases will be guided by
Community Implementation Committees and a Provincial Advisory Committee (see
Figure 2) and will involve community consultation. For the purpose of this
project, community development is viewed as the process by which a community
decides collectively on its needs and develops strategies to use its collective
capabilities to meet these needs. Community strength is built through community
development. For example, one community might focus on building community
consensus and strengthening community action concerning recreation, social
support and the environment. Another community might emphasize reducing suicide
levels among young people, substance abuse and motor vehicle accidents, and
promoting healthy aging.
Phase I:
Assessment
A health status assessment will be conducted to identify two to three priority
health concerns for each community. The data will be elicited from available
health status statistical information and from interviews. Individual and
separate focus group interviews will be conducted by trained interviewers with
community residents and professionals in the vicinity (eg. clergy, social
workers, health workers, teachers). This qualitative data will be content
analyzed to increase insight and to validate identified community health
concerns.
8
FIGURE 2
Structure for Proposed Community Primary Health Care Implementation Project
Community "A”
Community "B"
Implementation
Committee
Primary Health
Care Nurse
(ex-officio)
Implementation
Committee
Primary Health
Care Nurse
(ex-officio)
i
i
i
i
i
i
Project
Coordinator
i
i
i
i
i
i
i
i
i
i
i
i
i
External
Provincial Advisory
Committee
Project Coordinator
(ex-officio)
Evaluator
Guiding Principles
community control and development
different models may emerge
documentation of process will become a part of evaluation
funding agencies will receive on-going feedback but will allow the
Implementation Committees to fully control their segment of the project
- community development principles are followed throughout to ensure active
participation and ownership of the projects.
- the project should be viable after the third phase is completed
-
Terms of Reference
The Community Implementation Committees will focus on activities at the
community level and be responsible for management of project and community
development activities. They will be the decision making body which will hire
staff with assistance from the Provincial Advisory Committee and ensure
community control in determining priority health needs, preferred interventions,
and evaluation of success of the interventions.
Subcommittees of the Community
Implementation Committees would be formed to deal with specific priority health
concerns.
The Provincial Advisory Committee will serve a liaison function between the
committees and the external evaluator and will provide resource counselling to
It will also facilitate education
the Community Implementation Committees,
about the project as it moves forward, This committee will facilitate dialogue
with the communities and will be a support and resource for the community-based
projects.
It will assist each Community Implementation Committee with the
hiring of project staff. (See Appendix B for proposed membership of Provincial
Advisory Committees)
9
Furthermore, the interviews will be used to establish specific process and
outcome criteria for the evaluation phase and to identify preferred intervention
strategies. The open ended questions involved in this approach will yield
extensive, indepth information.
Phase II:
Intervention
Interventions will focus on priority health concerns identified by the
community. Essential health care, within the context of primary health care,
includes health promotion, disease prevention, restorative, rehabilitative, and
supportive care. The interventions may encompass each of these elements but
will emphasize health promotion and prevention of priority health problems
(reflected in a decrease in incidence and prevalence). Intervention based on
assessment data will be both formal (interdisciplinary) and informal (eg. selfhelp groups, volunteers). The community will select preferred intervention
strategies. Furthermore, the intervention must be feasible for the community to
implement during the project and to maintain following the conclusion of the
project.
Nurses have a key role to play in primary health care as individuals and as
members of an interdisciplinary effort to make primary health care a reality in
the future of this province. Nurses, as first contact primary health care
workers, provide comprehensive care and assist individuals and families to make
appropriate use of formal and informal health care resources available in the
community. Nursing's contribution is not substituting or replacing, but rather
complementing the work of other health professionals (Gottlieb & Rowat, 1987).
There are four main aspects of the primary health care nurse's role in this
project: direct care provider, educator of health personnel and the public,
supervisor and manager of primary health care services, and researcher and
evaluator of health care. The two primary health care nurses in this project
will: (1) initiate health promotion activities and facilitate the involvement of
individuals, families and communities in their own health development and
decision-making; (2) assume a partnership approach and work more effectively
with the community in coordination of the activities of health development; (3)
provide assessment and treatment; (4) assist the community to participate
actively in developing and implementing health services; (5) provide health
education and strengthen self-help techniques; (6) collaborate with other
primary health care workers; (7) maintain epidemiological surveillance; (8)
evaluate effectiveness of services; and (9) monitor progress in primary health
care .
10
The project's nurse coordinator, prepared at the masters' level, with skills in
community health, community development, and health promotion will: (1) oversee
the implementation of the model of primary health care nursing; (2) ensure that
the principles of primary health care remain the focus of the project; (3)
educate the communities regarding primary health care; (4) coordinate the
activities of the project's primary health care nurses during the assessment and
intervention phases of the project; (5) work with currently employed community
health nurses to ensure that ongoing community health programs and activities
are continued while the project is developed; (6) collaborate with other health
care professionals in or adjacent to the community; (7) collaborate with the
communities; (8) administer the budget in cooperation with the Community
Implementation Committees; (9) provide access to project information
documentation as requested by the external evaluator, Provincial Advisory
Committee and the funding sources; and (10) serve as a resource person,
consultant, and liaison with the formal health care system.
Phase III:
Evaluation
Evaluation will emphasize community feedback throughout the process and will
also be based on the objectives and outcome criteria established through
interviews with members of the community in the assessment phase. An external
evaluator contracted at the beginning of the project will work with the
provincial advisory and community implementation committees (see Figure 1)
to clarify respective roles and relationships.
Since public participation is a vital element of the primary health care
implementation project, the program implementation will be community-based and
encompass all five principles of primary health care; that is,
accessibility, public participation, prevention and promotion, appropriate
technology, and intersectoral cooperation. The evaluation will need to include
a variety of process (eg. community development) and outcome (eg. health status)
measures. The evaluator will provide feedback to the Provincial Advisory
(See
Committee, Community Implementation Committee and the funding sources.
Fig. 2, p.8).
Time Line It is proposed that this three year primary health care
implementation project would adhere to the following time line.
Assessment:
Phase I
Phase II Intervention:
Evaluation:
Phase III
September 1991 to June 1992 (9 months)
March 1992 to September 1994 (30 months)
October 1994-short term outcomes (at 3 years)
October 1996-long term outcomes (at 5 years)
11
SELECTION OF SITES FOR IMPLEMENTATION PROJECT
SELECTION CRITERIA
1.
The community will have physician's services but not have a full
range of health care professionals currently in place.
The rationale for this criterion is to select a community with a high
level of need relative to the rest of Nova Scotia while ensuring a
minimum level of involvement by health and related professionals
located in the immediate area.
2.
There will be receptivity on the part of the community
This will be demonstrated in a variety of ways including the following:
a)
b)
c)
d)
e)
3.
expressed awareness of unmet health needs related to health
status
expressed acceptance of the primary health care concept as .an
approach to improving the health status of the community
participation in meetings during site selection process
expressed willingness to participate in the project model proposed
by RNANS
specific offers to provide assistance and to facilitate the
projects, time, information, space/facility, introduction to the
community and financial commitment.
Demographic information will be available
Data is available for all of Nova Scotia from Statistics Canada
relative to population, social and economic patterns and mortality and
(some) morbidity data. For most communities, more extensive
information related to formal and informal programs and services is
also available.
4.
The project will be sustainable by the community
a)
b)
c)
It would be ideal to recruit a nurse who is a resident of the
community or surrounding area
community participation and ownership is seen as a key to the
continuation of primary health care activity as the project
continues
a number of community representatives will be involved in a variety
of ways, eg. Provincial Advisory Committee, Community Implementation
Committees, and a number of subcommittees related to community
priorities.
12
SELECTION PROCESS
Four communities were visited during the selection process, specifically Hants
Shore, Sherbrooke, St. Ann's and L'Ardoise. During these visits, health care
professionals and community residents were consulted. A list of those consulted
in each community; a sociodemographic description; a preliminary description of
priority health concerns and present health services; and, a preliminary
assessment of each community in terms of the five primary health care principles
and the selection criteria follows. (Detailed demographic data are summarized in
Appendix C.)
A)
HANTS SHORE COMMUNITY HEALTH CENTRE
1.
Persons Consulted
Kathy Aldous, Board Chairperson of the Hants Shore Community Health Centre
Clinic and Dr. Michael Cussens, the senior physician, both of whom live in
the community served by the health clinic were interviewed on site. Cheryl
Harvey, nursing supervisor, Anne Marie Maloney, social worker, and Susan
Fulton, mental health nurse were consulted at a later meeting in Windsor.
Community health nursing was also consulted.
2.
Socio-Demographic Description
Fourteen communities, which includes 1000 families or approximately 4,420
persons are served by the clinic.
East Hants has an approximate population
of 17,500 or 4,750 families, while the entire Hants County has a total
population of 36,548. As this is primarily a rural, non-farming district
many wage earners commute to the city daily, and isolation of many elderly
and young families is an existing problem. There is a total labour force of
16,410 in Hants County, and most jobs are in the pulp and paper industry,
construction, trade or community, business and personal services. There is
a high incidence of unemployment (9% for men; 15% for women) in East Hants.
Poverty (9.9% of families are low income) and its many associated problems
exist here, (see Appendix C)
A review of mortality rates indicates a high incidence of: ischemic heart
disease and breast cancer for women; trachea, bronchus and lung cancer,
cerebrovascular disease, pneumonia and influenza, and suicide for men, as
well as motor vehicle accidents, intestinal cancer, bronchitis, emphysema
and asthma for both sexes.
13
3.
Findings
Primary Health Care Principles:
a)
b)
c)
d)
e)
Accessibility - was a problem for some members of the community:
isolation and lack of transportation are existing problems which would
verify the need for a visiting nurse.
Public Participation - is evident in the community effort which
established the clinic administration five years ago through
volunteer efforts and through membership in the Federation of Nova
Scotia Community Health Clinics.
Increased Emphasis on Prevention and Promotion - the programs
currently provided and planned for were indicators of an increased
emphasis on health promotion as well as concern for social
programs.
Appropriate Technology - the technology (a computer and copier)
used by the clinic appears appropriate for its purposes, [i.e.,
there is a newsletter produced at the clinic, which is delivered to
every household within the catchment area for the clinic].
Intersectoral Cooperation - there was evidence of interdisciplinary
collaboration - the physician interviewed clearly sees the need for a
registered nurse for the clinic and expressed the opinion that a second
physician was not necessary.
It was suggested that a registered nurse
at the clinic could act as liaison with the health professionals in the
town of Windsor, as well as provide programming at the clinic and
visiting clients throughout the community.
Preliminary Health Needs:
a)
b)
c)
d)
This area has a high incidence of cancer, diabetes, and renal colic
Suicide is a
and people are subject to cardiovascular risk factors.
problem.
A visiting nurse for the 14 communities is cited as the first priority
by the clinic administration. The registered nurse's role would include
programming, assessment screening for health problems, indentifing risk
factors and providing health education.
A coordinator of programs was needed as well.
There is a need for the following types of clinics: prenatal, breast
feeding, well-baby, diabetic and foot care.
14
Present Health Services
a)
b)
c)
A variety of community based programs are available. They range
from preschool to general educational development programs, parenting,
cross country ski club, literacy, health education programs and health
promotion activities as well as a medical clinic, where a physician is
on duty 12 hours a day and Saturday mornings.
The nearest hospital has 106 beds and is in the town of Windsor, 20
miles away; it offers a variety of outreach programs and clinics.
The community mental health nurse visits along the shore.
Assessment Against Selection Criteria
a)
b)
c)
d)
It is an underserved rather than unserved area. There is a
community health nurse, but the inability to reach many residents
because of their isolation remains a problem.
The community demonstrates a desire to participate. It has taken
initiative in the past to approach government for funding for a
nursing position, which indicates there would be receptivity on the
part of the community.
There is available demographic information, but not specifically
health status data.
There was some question about the sustainability of the project within
the community. The financial resources of the community and space at
the clinic are limited.
B)
DR. W.B. KINGSTON MEMORIAL CLINIC, L'ARDOISE, RICHMOND COUNTY, CAPE BRETON
1.
Persons Consulted
Four volunteer members of the administrative committee of the clinic, and
Dale Orychock, member of the RNANS Ad Hoc Committee on Primary Health Care,
visited with the health care personnel.
2.
Socio-Demographic Description
The clinic has an active patient file of 8,000.
It serves those within a 50
km radius, including the communities of L'Ardoise, St. Peters, Grand River
and area, Sampsonville-French Cove area, River Bourgeois, Barra Head, Hay
Cove, Soldier's Cover, Johnstown, as well as outlying areas. Richmond
County is primarily a rural, non-farming area with a population of 11,840.
There is a large percentage of the populatioin on fixed incomes
(ie. senior citizens and unemployed persons).
Poverty and isolation exist
as social problems. Alcohol & drug abuse with associated deaths are evident
in the high school population. Teenage pregnancies and an increasing
incidence of AIDS are also noted.
,
15
Mortality rates were higher, or equal to, the provincial rate/100,000 for
the following: trachea, bronchus and lung cancer, cerebrovascular disease;
breast and intestinal cancer; suicide, diabetes mellitus, bronchitis,
emphysema, asthma and congenital anomalies for women. For men - motor
vehicle accidents, intestinal cancer, suicide and congenital anomalies
(see Appendix C).
3.
Findings
Primary Health Care Principles
a)
b)
c)
d)
e)
Accessibility - this clinic appears to be accessible to and well-used by
the surrounding communities. While there is reportedly a large elderly
population, transportation was not seen as a problem because people
readily offered drives to those who did not have their own means of
travel
Public Participation - this was not only the driving force behind the
development of the clinic but also has been the mainstay of its
renovations, expansion and future plans. This clinic is a member of the
Federation of Nova Scotia Community Health Clinics.
Increased Emphasis on Prevention - the administrative committee
expressed a continuing interest in health promotion and prevention
programs; for example, they mentioned nutrition counselling as a real
concern and have recently acquired the services of a nutritionist one
day per week. It was interesting to note that, while the professional
staff is not represented on the committee, they are included as advisors
for health promotion activities.
Appropriate Technology - the clinic has technical equipment valued at
approximately $100,000 - most of which was bequeathed by Dr. Kingston.
They are well prepared for primary health care procedures such as
initial health assessments and early treatment methods, and the clinic is
also well equipped for initial emergency procedures.
There is evidence of inter-sectoral cooperation between the community
health nurse, nutritionist, and social worker which could be greatly
enhanced by the addition of a registered nurse in the clinic.
The clinic is in effect owned by the parish, to whom the administrative
committee, which is comprised of volunteers, reports. They are able to
raise between $15-20,000 annually. The administrative committee and the
present staff of certified nursing assistants are receptive to the idea
of a baccalaureate-prepared, registered nurse. They have the space
needed for such a person and are willing to help finance some aspect of
the position.
16
Preliminary Health Needs - Priorities Identified by Individuals in the Community
a)
A registered nurse who could help develop a home visiting program for
the elderly.
b)
The need for self-help groups and other primary health care services
such as health teaching and counselling; genetic counselling (in light
of the high incidence of congenital anomalies in Richmond County);
respite care for those caring for elderly at home; pre- and post-natal
care; additional nutrition counselling; sexuality education and drug and
alcohol abuse counselling.
Present Health Services
The staff of the clinic is composed of two physicians, two certified nursing
assistants, one full-time dentist and his assistant, and two clerical staff.
The clinic is open 9-5 p.m., Monday to Friday. Physicians are on call after
hours and CNA's frequently make home visits on a volunteer basis.
In 1989,
21,400 patient visits were reported by the physicians. The nearest
hospital, Strait-Richmond, which is 50 km., or an hour away, has a 50-bed
capacity. Two community health nurses are located in the town .of St.
Peter's.
Assessment Against Selection Criteria
a)
It can be considered an under-served rather than an unserved area.
b)
There would be receptivity by the community and real evidence of a
desire to participate (financial support). The philosophy of the
administrative committee of the L'Ardoise clinic is compatible with that
of the concept of primary health care. The committee's proposal to the
Department of Health approximately two years ago for funding for a
registered nurse was not granted.
The committee has already expressed an interest in gathering data to
demonstrate how their clinic could reduce health care costs while
increasing the quality and accessibility of health care.
c)
Demographic information is readily available, with the exception of
specific health status data (Appendix C).
17
d)
Sustainability within the community appears well-assured. The existing
CNA nursing staff would be receptive to a registered nurse, There is
a good probability of finding someone from the area for the position.
The community has demonstrated ownership, and commitment to the clinic.
It has a strong history of financial and volunteer support and has
indicated a willingness to assist with financial commitment in the
proposed project. There is an administrative committee in place which
could mobilize community representatives.
C)
ST. ANN'S COMMUNITY CENTRE, ARICHAT, CAPE BRETON
1.
Socio-Demographic Description
This community centre serves a rural population of approximately 5,500
within a 25 mile radius. The catchment area consists of several small
communities within Richmond County. The population consists of a large
number of elderly persons and many people on low or fixed incomes.
Mortality rates for Richmond County are higher or equal to the provincial
rate for all the following: trachea; bronchus and lung cancer;
cerebrovascular disease; breast and intestinal cancer; suicide; diabetes
mellitus; bronchitis; emphysema and asthma; congenital anomalies - for
women. For men - motor vehicle accidents, intestinal cancer, suicide and
congenital anomalies.
2.
Persons Consulted
William Blire, Administrator of St. Ann's Community Centre; Dr. Robert
Martell, Medical Director of the Centre; Karen Marchand, R.N., day charge
nurse at the centre.
3.
Findings
Primary Health Care Principles
a)
Accessibility - although centrally-located within this small community,
transportation for many elderly population in the outreach areas of the
serviced group poses somewhat of a problem. Hence, great emphasis was
placed on the need for a home visiting nurse.
18
b)
Public Participation - there is a sense of cohesiveness in the
community. When a previous small hospital closed in the area in 1985,
intensive lobbying on the part of the community convinced the Department
of Health to open this existing centre to meet the needs of the
population.
c)
Increased emphasis on prevention - great concern was expressed over the
need for programs in health prevention and promotion; for example, blood
pressure clinics, well-women clinics, healthy aging programs, and back
care and accident prevention.
d)
Appropriate Technology - this particular centre is equipped with the
necessary technology and equipment for the laboratory and x-ray
departments, for emergency services, and also for diagnostic testing by
the consultant medical specialists who visit monthly.
e)
Inter-sectoral Cooperation - there is evidence of developing cooperation
- a dietitian visits twice a week for the diabetic clinic, a podiatrist
once a month, and the community health nurse is very involved with the
centre.
Preliminary Health Needs - Priorities Identified by Individuals in the Community
a)
A visiting community nurse primarily to: (1) develop a support and
ongoing assessment program for cancer patients, and (2) provide follow-up
for hospital-discharged patients.
b)
Development of health promotion clinics, for example, blood pressure, wellwomen's, back care, family planning education, etc.
c)
Establishment of self-help groups.
Present Health Services
The nearest hospital is 40 km. away, The centre provides out-patient,
laboratory, and x-ray services with a registered nurse available at all times
from the adjoining nursing home, Five physicians serve the centre - two
hours each morning and then on an on-call basis. A diabetic clinic, a
chemotherapy clinic, pediatric clinic, and monthly clinics by medical
specialists are components of the centre's services.
Assessment Against Selection Criteria
a)
It is an under-served rather than an unserviced area.
<
19
b)
c)
The community appears to be very receptive to the proposed project, as
evidenced by varied suggestions as to the role of this nurse in health
promotion and prevention and also allocation of space for such person at
the centre. In the past, the community has demonstrated its commitment
to maintaining and improving health care services to its population.
Demographic information is available with the exception of specific
health status data.
D)
SHERBROOKE, ST. MARY'S MUNICIPALITY, GUYSBOROUGH COUNTY
1.
Socio-Demographic Description
This mainly rural, non-farming area has a total population of 3,091. The
percentage of elderly is 14%, as compared with the provincial average of 11%.
The unemployment rate in the region is also higher than the provincial
average (11.3% compared with 9.9% provincial).
The mortality rates in Guysborough County were discussed as a method of
focusing on the prevalent health problems in the area, The causes of death
which stood out as particularly high for this county were breast cancer (the
highest rate in the province), bronchitis, emphysema and asthma, (second
highest) suicide and diabetes (which were each third highest in the
province). Others noted were ischemic heart disease in women and
cardiovascular disease in men.
2.
Persons Consulted
Mahnaz Farhangmehr, Supervisor, Community Health Nurse (CHN), Northeastern
Region; Alice Hewitt, CHN, St. Mary's Municipality; Ethel Gunn, Director of
Nursing, St. Mary's Hospital, Sherbrooke; Betty MacNeil, Women's Institute;
Rev. George Micklewiate; Keith Glenn, Canadian Cancer Society.
3.
Findings
Primary Health Care Principles
a)
b)
Accessibility - it was agreed that a non-institutional site would be
preferred and that there were vacant buildings owned by the municipality
that could be potential sites for the primary health care implementation
project. These were in the vicinity of Sherbrooke.
Public Participation - the community would have to be mobilized. Those
professional and community representatives present were receptive and
felt that the entire community would respond in the same way. They have
supported a variety of programs for seniors in the past.
20
c)
d)
e)
Increased Emphasis on Prevention - concern was expressed over the
mortality rates and causes, A need for health promotion and prevention
programs was identified.
Appropriate Technology - to be identified further.
Inter-sectoral Cooperation - was obvious in the existing health care
program. Consultation with a nutritionist occurs on a weekly basis and
with physiotherapists and occupational therapists as needed. Support of
the community health nurse appeared assured.
iininHiry Health Needs - Priorities Identified by Individual s in the Community
Increased health promotion activities for mothers. These included pre- and
post-natal care (including promotion of breast feeding), well-baby care,
expanded well-women's clinic (breast screening), nutrition and drug and
alcohol counselling and smoking cessation.
Present Health Services
The local hospital, St. Mary's Memorial, Sherbrooke, has 15 beds. There is
one physician who has office hours during the work week from 9 to 1 p.m. and
some evenings. The out-patient department, where a nurse is on duty, is
reportedly used as an extension of the physician's office. Obstetrical
patients travel an hour to either Antigonish or Sheet Harbour, or to
Halifax, which is almost four hours away. Seniors are well-served through
a variety of existing programs. There are no community mental health nurses
or clinics in Guysborough County. There are no day care facilities for pre
school children.
Assessment Against Selection Criteria
When measured against the criteria used for previously-visited clinics:
a)
b)
c)
this is an under-served rather than unserved area
demographic data (not specific health status data) is available
it appears on first contact as if the community would be receptive and
has a desire to participate (they asked what they could do next to show
support for such a project).
RECOMMENDED COMMUNITIES
The RNANS would recommend that the primary health care project be conducted in
the communities of Sherbrooke, Guysborough County and L'Ardoise, Richmond
County, Cape Breton. As described in objective 1, these two communities
represent different regions of Nova Scotia, different service delivery providers
and patterns, different health status problems and different socio-demographic
characteristics.
21
BIBLIOGRAPHY
Allen, M. (1981).The health dimension in nursing practice: Notes on nursing
in primary health care. Journal of Advanced Nursing, 6., 153-154.
Barker, R.G. (1968). Ecological psychology: Concepts and methods for
studying the environment of human behaviour. Stanford, CA: Stanford
University Press.
Campfens, H. (Ed.).(1983). Rethinking community development in a changing
society; Issues, concepts and cases. Guelph, Ontario: Ontario
Community Development Society, University of Guelph.
Canadian Nurses Association. (1988). Health for all Canadians; A call for
health care reform. Ottawa: Author.
Canadian Nurses Association. (1989). Position statement on primary health
care. Ottawa: Author.
Department of Health and Fitness. (1990). The ten leading causes of
mortality. Nova Scotia: Author.
Department of Social Services. (1987). Child abuse register. Nova Scotia:
Author
Epp, J. (1986). Achieving health for all: A framework for health promotion.
(H39-102/1986). Ottawa: Minister of Supply and Services.
Gottlieb, L. and Rowat, K. (1987). The McGill model of nursing: A practicederived model. Advances in Nursing Science, July, p.51-61.
Hall, D.C. (1989). Primary health care-a nursing model; A DanishNewfoundland (Canada) project.
International Council of Nurses. (1988). Nursing and primary health care; A
unified force. Geneva: Author.
Kravitz, M., & Frey, M.A. (1989). The Allen nursing model. In J.J.
Fitzpatrick & A.L. Whall (Eds.), Conceptual models of nursing:
Analysis and application (pp. 313-329). East Norwalk, Conneticut:
Appleton & Lange.
Lalonde, M. (1974). A new perspective on the health of Canadians. Ottawa:
Minister of Supply and Services.
Nova Scotia Royal Commission on Health Care,. (1989). The report of the Nova
Scotia royal commission on health care; Towards a new strategy.
Halifax, N.S.: Author.
22
Nova Scotia Royal Commission on Health Care. (1990). Health strategies for the
pintles; Managing better health, Halifax, N.S.: Author.
Powell, D.R. (1988). Client characteristics and the design of community
based intervention programs. In A. Pence (Ed.), Ecological research
with children and families; From concepts to methodology (pp. 122142). New York: Teachers College, Columbia University.
Registered Nurses Association of Nova Scotia. (1990). Position statement on
primary health care. Halifax, N.S.: Author.
Roberts, H. (1982). Community development: Learning and action. Tor onto:
University of Toronto Press.
Nova Scotia Department of Industry, Trade and Technologoy (July,1990).
Statistical profiles. Halifax: Statistics and Research Services,
World Trade and Convention Centre.
Statistics Canada. (1986). Census profiles. Ottawa: Author.
Stewart, M.J. (September, 1990). Primary health care: Impact on nursing
practice. Paper presented at the ANPEI conference on Primary Health
Care, Charlottetown, PEI.
Stewart, M.J. (1990). From provider to partner: A conceptual framework for
nursing education based on primary health care premises. Advance?ui
Nursing Science, 12.(2), 9-27.
World Health Organization. (1974). Community health nursing. Geneva: Author.
World Health Organization. (1978). Report of the International conference on
primary health care Alma-Ata, USSR. Geneva: Author.
World Health Organization. (1982). Division of health manpower development:
Nursing in support of the goal of health for all by the year 2000.
Geneva: Author.
23
Appendix A
RNANS Position Statement
on Primary Health Care
Adapted from Canadian Nurses Association Position Statement
The Registered Nurses Association of Nova Scotia, in accordance with the World
Health Organization, believes that "primary health care is essential health care
made universally accessible to individuals and families in the community based
on practical, scientifically-sound and socially/culrurally acceptable methods
.... and through their full participation and at a cost that the community and
country can afford". Essential health care includes health promotion, disease
prevention, restorative, rehabilitative and support care. The Registered Nurses
Association of Nova Scotia believes that primary health care is the first level
of contact with the health care system and should form the basis of any
comprehensive health care system.
Canada has endorsed the view that primary health care is the key to a healthy
society. The Registered Nurses Association of Nova Scotia supports initiatives
to move in the direction of primary health care. The Registered Nurses
Association of Nova Scotia recognizes and supports the growing emphasis on the
need for individuals, families and communities to be active partners in their
health care. Nova Scotians should have access to assistance for self-care
through community-based services that focus on prevention and promotion rather
than on curative care alone.
The Registered Nurses Association of Nova Scotia recognizes the need to develop
alternatives to expensive, highly-technical health care services. More
effective utilization of health care resources and health care providers would
enhance primary health care. A primary health care approach will necessitate
maxi mum community and individual involvement. A need exists for communitybased/multi-service centres to serve as the nucleus of local health care
delivery.
The Registered Nurses Association of Nova Scotia believes that a re-orientation
of health care policies and health care professionals is needed to meet the
challenges of the future.
Approved by the RNANS Board of Directors
November, 1990
24
Appendix B
Proposed Membership of the
Provincial Advisory Committee
Members
*
4 Representatives from each of the two communities where implementation will
occur (to achieve primary health care objective of community participation)
*
RNANS Board representative (to provide link with RNANS the initiating body)
*
Director - Community Health Nursing (to provide linkages with existing
formal system of community health care)
Medical Society of Nova Scotia - representative - (for joint collaboration
during the project).
2 Representatives from other related health profession or agencies eg. Canadian Mental Health Association, Nutrition Council of Nova Scotia,
Nova Scotia Association of Health Organizations, Victorian Order of Nurses
and Nova Scotia Public Health Association (to provide linkages with
provincial resources that may not currently exist in local communities)
Evaluation expert (with community development evaluation experience)
Ex-officio members
RNANS Resource Persons: Executive Director and Consultant, Community
Development.
Primary Health Care Project Coordinator - Manager of Project
(*
Links with Funding Sources)
25
Appendix C
DEMOGRAPHIC INFORMATION RELATED TO SITES VISITED
DEMOGRAPHICS OF HANTS COUNTY (Hants Shore)
1.
Actual Population - 36,548 (1986)
82.4% of which is described as rural, non-farming
total number of families - 9,830
East Hants - 17,501 (16.75 growth since 1976 census)
2.
Strata by age and sex
15-24
0-14
16.9
24.6
1986 male
16.0
female 23.0
Total
18,270
18,275
493
502
497
521
546
511
292
274
278
. 291
293
274
Average Family Incomes
% of N.S, Average
% Low Income Families
12.6
9.9
94.6
98.7
Average Income/Income Tax Filer
$ 9,968
$16,446
Labour Force Activity
Population 15+
Labour Force
Employed
Unemployment Rate*
1989 Unemployment Rate
% Average Income of N,S
90.1
92.1
1986 East Hants
Males
Females
■^unemployed as % of labour force
7.
65+
9.7
12.1
1982
1983
1984
1985
1986
1987
1980
1987
6.
45-64
17.7
17.3
Number of Deaths
1985
Hants: $31,145
East H: $32,521
5.
35-44
17.7
14.1
Live Birth Rate
3.
4.
25-34
16.6
17.5
13,125
8,140
7,225
13.3%
13.1%
Annapolis Valley - 9.9%
Nova Scotia
- 9.9%
Average
26
8.
Labour Force with Industry Divisions
Hants County-
Primary
Manufacturing
Construction
Trans., Comm., Other Utilities
Trade
Finance/Insurance/Real Estate
Community, Business & Pers. Services
Public Admin, & Defence
Not Applicable
1,720
1,995
2.305
1,320
2,595
710
4,080
1,365
325
1989
16,410
Total Experience Labour Force
9.
Mortality Rates - The outstanding causes of death in Hants County as
reported by the Nova Scotia Department of Health & Fitness , 1985.
Males
Cause of Death/100.000
Ishchemic Heart Disease
Trachea, Bronchus, & Lung Cancer
CVA
Breast Cancer
MVA
Intestinal Cancer
Suicide
Bronchitis, Emphysema & Asthma
Pneumonia & influenza
Nova Scotia
Females
123
60
43(44)
29
26(9)
19
17
9(4)
23
146
65
52
(49)
31
(21)
23
48
20
22
15
23
( 6)
II
DEMOGRAPHICS OF RICHMOND COUNTY (L'Ardoise and St. Aim's)
1.
Actual Population - 11,841 (1986)
Ii
99% of which is described as rural/ non-farming
population growth from 1976-1986 was -3.7% change
2.
Strata by age and sex
1986 male
female
0-14
23.7
23.0
15-24
17.5
16.0
25-34
14.1
17.5
Live Birth Rate
3.
1982
1983
1984
1985
1986
1987
146
164
154
127
151
123
35-44
13.3
14.1
45-64
18.0
17.3
65+
13.5
12.1
TOTAL
5,960
5,880
Number of Deaths
91
109
95
116
95
81
27
4.
% of N.$
Average Family Incomes
6.
% Average Income of N,S
Average Income/Income Tax Filer
1980
1987
15.7
81.4
1985 $26,824
5.
Labour Force Activity
1986 East Hants
8,995
4,560
3,375
23.4%
29.9%
Males
Females
*unemployed as % of labour force
7.
1989 Unemployment Rate
8.
Industry
Average
80.5
75.7
$ 8,902
$13,518
Population 15+
Labour Force
Employed
Unemployment Rate*
Cape Breton = 17.7%
Nova Scotia = 9.9%
Primary
Manufacturing
Construction
Trans., Comm., Other Utilities
Trade
Finance/Insurance/Real Estate
Community, Business & Pers. Services
Public Admin. & Defence
Not Applicable
480
795
365
360
635
105
1,385
260
175
1986
4,560
Total Experienced Labour Force
9.
% Low Income Families
Average
Mortality Rates - The outstanding causes of death in Richmond County as
reported by the Nova Scotia Department of Health &
Fitness, 1985. (taken from a report prepared by Research
& Statistics Systems, Nov. 1990).
CAUSE OF DEATH/1Q0.000
Males
Trachea, Bronchus, Lung Cancer
CVA
Breast Cancer
26
MVA
26
Intestinal Cancer
25
Suicide
Diabetes
Bronchitis, Emphysema & Asthma
13
Congenital Anomalies
*highest rates/100,000 in province
Females
Nova Scotja
*29
46
31
20
44
29
26
19
17(3)
12
4
6
*27
(6)
12
7
12
28
III DEMOGRAPHICS OF GUYSBOROUGH COUNTY (Sherbrooke)
1.
Actual Population - 12,721 (1986)
80.0% of which is described as rural, non-farming
St. Mary's Municipality - 3,091; + 2% change since 1981
total number of families =■ 815
2.
Strata by age and sex
1986 male
female
0-14
23.2
23.1
3.
5.
186
189
182
190
158
179
125
141
108
134
128
129
6.
% of N.S
$25,249
$23,867
Population 15+
Labour Force
Employed
Unemployment Rate*
% Average Income of N.S
1989 Unemployment Rate
Average
78.7
74.9
1986 St
Males
Females
^unemployed as % of labour force
7.
21.8
21.9
$ 8,701
$13,371
Labour Force Activity
TOTAL
6,455
6,265
% Low Income Families
Average
76.7
72.5
Average Income/Income Tax Filer
1980
1987
65+
13.6
15.2
45-64
18.2
18.0
Number of Deaths
Average Family Incomes
1985
Guysborough
St. Mary's
35-44
12.3
12.5
Live Birth Rate
1982
1983
1984
1985
1986
1987
4.
25-34
13.9
13.7
15-24
18.7
17.6
Mary's Municipality
2,390
1,230
1,055
9.9%
22.1%
Northeastern Region - 11.3%
Nova Scotia
—
9.9%
29
8. Labour Force with Industry Divisions - Guysborough County
9.
Primary
Manufacturing
Construction
Trans., Comm., Other Utilities
Trade
Finance/Insurance/Real Estate
Community, Business & Pers. Services
Public Admin. 6c Defence
Not Applicable
1,125
1,445
205
325
505
55
1,095
270
155
Total Experienced Labour Force
5,190
1986
Mortality Rates - The outstanding causes of death in Guysborough County as
reported by the Nova Scotia Department of Health 6c Fitness, 1985.
CAUSE OF DEATH/100.000
Males
Females
Nova Scotia
Ishchemic Heart Disease
Trachea, Bronchus, 6c Lung Cancer
CVA
Breast Cancer
MVA
Intestinal Cancer
Suicide
Bronchitis, Emphysema, 6c Asthma
Pneumonia 6c influenza
* highest rate in province
209
60
54
(146)
(17)
(58)
38*
208
60
43
29
26
19
17
9
23
430
23
(3)
(9)
24
9
23
i
(123)
(20)
(44)
(3)
(4)
Appendix B
CRITICAL PATHWAY
CHETICAMP PRIMARY HEALTH CARE PROJECT
Goals and Objectives
October 1991 - October 1992
GOAL #1
Review budget requirements for the Primary Health Care Project and
match resources to health needs.
ACTIVITIES:
1.
October 23, 1991 a meeting took place with B. Montgomery and
V. Maddalena to discuss matching resources to health needs.
2.
Budget requirements were drafted and forwarded to Ms. MacNutt
at the Department of Health for approval.
3.
A letter to Ms. MacNutt was written December 19, 1991 to
request release of the funds from the Department of Health.
GOAL #2
Begin initial linkages with the community to develop a tri partite
Steering Committee.
ACTIVITIES:
1.
Tri partite Steering Committee formed consisting of Jean
Roland Aucoin of Cheticamp, Victor Maddalena of Sacred Heart
Hospital and Elaine Shuttleworth of the Registered Nurses
Committee in place March 20, 1991.
Association of Nova Scotia.
GOAL #3
Develop terms of reference and further define the role of the
Steering Committee.
ACTIVITIES:
1. Tentative terms of reference were developed for the Steering
Committee December 13, 1991.
Terms of reference defined as the following:
*
liaison between the community,
and assist the PHC
coordinator in counselling/education for the catchment area.
* coordinator will report to Steering Committee on a regular
basis, at least three times per year,
*
administer budget
and approve
operational
spending
guidelines.
* liaison with the external evaluator.
GOAL #4
Develop a critical pathway for project implementation.
ACTIVITIES:
1.
Recommended critical pathway drafted and forwarded to Ms .
MacNutt at the Department of Health December 23, 1991.
GOAL #5
Develop job descriptions for the project coordinator and secretary.
ACTIVITIES:
1.
January 27, 1992 job description was prepared.
GOAL #6
Prepare advertisements for the Globe and Mail and Montreal Gazette.
ACTIVITIES:
1.
Advertisement prepared and placed in the above papers May 1,
1992 and closed to applicants June 1 , 1992.
It read as
follows:
"Project Coordinator, Cheticamp Primary Health Care Project.
The project coordinator is required for the Cheticamp PHC
Project, which is co-sponsored by the RNANS, SHH, and the Nova
Scotia D.O.H.
Responsibilities and Qualifications followed.
GOAL #7
Arrange interview time, place and technique.
ACTIVITIES:
1.
2.
3.
Newfoundland Project contacted to attain screening tool,
and interview guide.
Candidates contacted and interviews arranged for August
92 in Cheticamp.
Project Coordinator was selected --Karen Parent was
contacted August 17 , 1992 to agree to the terms of
employment pending negotiation.
GOAL #8
Restructure Steering Committee composition.
ACTIVITIES:
1.
the
Steering restructured March 20r 1992 .
composition:
The following will be
* 2 RNANS , 2 SHH, Community Representative and the Project
Coordinator will be an ex officio member.
GOAL #9
Initial work to begin on legal agreement
contract and the formation of a Society.
regarding
employee
ACTIVITIES:
1.
The legal counsel of Kathryn Raymond of BOYNE CLARKE was
obtained to prepare the employee contract and form the Society
for the Cheticamp Primary Health Care Project.
2.
The Cheticamp Primary Health Care Society was incorporated
September 4, 1992.
3.
The legal contract between Karen Parent (Project Coordinator)
and the Funding bodies was signed September 16, 1992 .
GOAL #10
Orientate the Cheticamp Primary Health Care Project Coordinator in
two stages: 1. Nova Scotia perspective, RNANS, government etc. and
2. Cheticamp
ACTIVITIES:
1.
Karen Parent orientated September
introduced to key players.
28
-October
2
GOALS #11
Have a coordinator on site by October 1992.
ACTIVITIES:
1.
Coordinator relocated to Cheticamp October 5, 1992 .
1992
and
CRITICAL PATHWAY FOR THE CHETICAMP PHC PROJECT
THE ENTRY PHASE- MAPPING OUT THE COMMUNITY
Time Frame : 6 TO 9 MONTHS
October 1992 to July 1993
Overarching Goal:
To apply a primary health care model encompassing all five
principles and community development strategies throughout.
The Entry Phase objectives :
1.
To determine the community’s capacities and assets.
2.
To determine the areas of unmet need.
3.
To form a working Community Primary Health Care
Committee to act in an advisory capacity to the project
coordinator.
4.
To raise the level of awareness about the project.
5.
Begin the development of a framework for process evaluation.
DRAFT REVISED 31/05
LOOKING MORE CLOSELY AT EACH OBJECTIVE
OBJECTIVE 1
To determine the community’s capacities and assets
How ?
By developing a description of the community.
What information will be gathered ?
A. Epidemiological data
★
Demographic data (age. sex. cultural, morbidity and
mortality etc.). Population-based data
* government (type, location, libraries, other).
* Environmental data (housing, geographic,
transportation, handicapped access, stores,recreational
facilities, pollution, sanitation).
B. Occupational data
★
*
★
★
★
*
★
Number of persons employed/ unemployed
Type of occupation
Location of occupation site
Kind of work done
Safety concerns
Health concerns
other
2
DRAFT REVISED 31/05
C. Schools
*
number of schools
*
elementary, junior high, high, community
college, university
* !Special education programs (sex education, drug and
alcohol education etc.)
★
Daycare services
D. Health facilities / services/ others
* number of health care providers (nurses, physicians,
dentists, social workers, physical therapists)
* ambulance
* pharmacies
* cost of health services /method of funding
E. Community Safety Services
★
★
*
*
★
*
Fire
Police
Emergency
Educational services
Types of crimes committed
other
F. Churches
*
denominations represented
*
location of churches
*
membership
★
educational services offered
3
DRAFT REVISED 31/05
G. Communications
* How do people find out about services and programs?
H. Entertainment / recreation
★ dining facilities
★ theatres
* movies
* sports arenas
I. List of Community Officials
* updated on a regular basis
J. List of all the voluntary organizations in the community
How will this information be obtained ?
1. Key informants (general public, clergy, police, social workers store
owners etc.)
2. Governmental agencies for health status statistical data
* Cheticamp Development Commission
* Stats Canada
* Dept, of Health
* Municipal planning dept.
★ Health studies
★ Public health departments
* Workmens compensation
★ Police reports, municipal traffic departments
4
DRAFT REVISED 31/05
Additional information required to complete the profile
How has the community historically handled social change?
eg. The closing of the operating room at the local hospital.
The impact of a declining fishing industry.
Potential Strategies for learning more about community change
patterns.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Tracking important issues in the newspaper.
Looking at the editorials--Do the same people write in?
Asking long-time residents for their stories.
Attending public meetings. What comments are made? Issues
raised? Who attends?
Attending local government meetings.
Looking at past major events. How long did social change take?
What was public reaction?
Speaking with key people in the community.
Looking at programs presently in place-- successes, failures,
conflicts, resolutions, as well as people’s perceptions about the
programs
Who are the volunteers ? Are they usually the same? Are they over
extended?
5
DRAFT REVISED 31/05
Outcomes of objective 1
1.
2.
3.
4.
Provide a clear profile of the community.
Begin to raise the level of awareness about the Primary
Health Care Project,
Identify potential networks for coordination and
collaboration for future activities and services.
Provide baseline information for process evaluation.
6
DRAFT REVISED 31/05
OBJECTIVE 2
To determine the areas of unmet needs
How?
Qualitative Research Methods
1.
2.
3.
Key informant interviews ( general public, nurse , physician,
seniors, clergy, etc.).
Focus group discussions with various homogeneous groups .
Kitchen table discussions .
Quantitative Research Methods
1.
Broad based community health needs assessment (general
public).
Sample size: Population base 5,000 (sample size based on 95
% Cl with a 5% margin of error) sample size = 360 people.
Sample : The sample will be stratified to represent the various
segments and subpopulations in the area (this will be
determined by the community profile).
7
DRAFT REVISED 31/05
Instrument: Several instruments are available.
The
Nfld/Danish needs is one instrument that will be brought
forward to the advisory committee for consideration.
Methodology: Although not scientifically rigorous. I envisage
using several community groups in participating with data
collection. By providing the appropriate training (a clear
understanding of the importance of confidentially would be
stressed )and coordinating activities, community people may
be more appropriate for accessing the community. This
methodology would increase the level of community
participation, raise the level of awareness regarding personal
lifestyle and community issues and decrease the cost of the
needs assessment. Finally this process would be legitimized
by well established community members assisting with data
collection.
This "POT LUCK" approach offers many
advantages worth considering.
What next ?
1.
All the information collected by the various methods (key
informant, kitchen table discussion, community health needs
assessment and the profile will be tallied and categorized
providing a picture of the unique features of the community
as well as the existing and potential unmet needs.
2.
Public presentation of the results for the following reasons:
to allow people to see the collective outcome of the
a.
results,
to allow the community to see what is being done,
b.
to provide an overview of the needs in the community,
c.
8
DRAFT REVISED 31/05
d.
e.
to empower the community with the control to say what
health services and activities they would like to see,
to adhere to the principles of community development
and PHC.
Outcomes of objective 2
1.
2.
3.
4.
5.
6.
7.
Provide a clear set of needs determined by the community.
Provide a number of priorities for activities and services
as determined by the community through public forum, key
informant, and focus groups to discuss findings from data
collection phase.
Continue to educate the community by raising the level of
awareness regarding lifestyle, through discussion and the
needs assessment.
Data for process and possible outcome evaluation.
Increased community participation and community ownership.
Gain legitimization to work on health issues by working with
members of the community.
Obtain a commitment to act by individuals in the community.
9
DRAFT REVISED 31/05
Objective 3
To form a Community Primary Health Care Committee to act in an
advisory capacity to the project coordinator.
How?
1.
By making contact with key people in the community to
suggest potential candidates for this advisory group.
After initial recruitment of the first few members, the group
will nominate the remaining people to form a group of
between 8-10 people who will represent the community.
2.
Group development will be an important responsibility for the
program coordinator, ensuring that pertinent information is
available and that the roles and responsibilities are clearly
delineated for all the members. The group will not have a
governing role at this time, but it is hoped that some
members will assume this role on as the project develops.
Outcome of objective 3
1.
A cohesive group of 8- 10 people who would represent the
different groups in the community ( seniors, single parents,
health, fishing, homemakers,etc.) with a common vision and
a loyalty to the community. The membership will be carefully
monitored by establishing criteria and terms of reference.
Reasons for not having representation from a particular
segment of the population will be recorded.
2.
Commitment from the community to act and sustain the
project.
io
DRAFT REVISED 31/05
OBJECTIVE 4
To raise the level of awareness about the project
How?
1.
Media strategy
★
Introduction of the project in the two local papers
Ministers visit and official launch - invitations sent
*
Articles in nursing newsletters etc.
★
Speaking engagements (RNANS chapter meeting, 5 C
Meeting, St.F.X. University etc.)
*
* Continue to update the public through the most visible
productive and cost effective means of communicating.
2.
Meeting the community
* informal networking with community people
* meet and speak with the community influentials
Outcomes of objective 4
1.
2.
3.
To have a positive profile in the community.
The education of the community about PHC- "A different way
of thinking about your health"
Support for the project developing in the community.
11
DRAFT REVISED 31/05
Objective 5
Establish framework for process evaluation
How ?
1.
Creating a framework for review of program development
which will serve as a tool for decision making.
**** This framework will be developed in collaboration with the advisory
committee.
12
DRAFT REVISED 31/05
THE PLANNING PHASE : RESPONSE TO THE COMMUNITY
TIME FRAME : 2 MONTHS
July 1993 to September 1993
OBJECTIVES :
1.
2.
3.
4.
5.
Consider the efficacy and feasibility in creating informal
and formal support services by approaches which will
involve forming self-help groups.
The advisory committee formed in the early stages of the
project’s development should not be looking at a change
in roles, that is to a role of governance. This committee
is a key element for sustaining the activities after the 3
year period of funding is over.
Begin to consider the potential partnerships in the
community that could be linked together and working
towards a common vision.
Review data collected in the mapping out phase for
services that exist, be sure that duplication is not an
issue. In keeping with the concept of partnership
building and collaboration, the coordination of services
that have a common link will be ongoing.
With the working group develop an initial plan
* Mission Statement
* Project Values
* Develop goals/objectives
* terms of reference
* consider summative evaluation
13
DRAFT REVISED 31/05
6.
7.
8.
Review plan with the community through most effective
ways (forum, church bulletin, focus groups , individuals
etc.)
Reinforcement of a "bigger picture" for community
people involved in the project will be achieved by team
building at all levels. Distant funding bodies will be
invited to meet with local people involved in the project
to discuss the expectations each stakeholder may have
regarding the outcome of the project.
Explore ways a nurse can work in partnership with the
community.
14
DRAFT REVISED 31/05
THE ACTIVITY PHASE - PUTTING THE PROGRAM / ACTIVITIES
IN PLACE
TIME FRAME : October 1993 to October 1995
OBJECTIVES :
1.
2.
3.
4.
5.
To begin cooperation with the "at arms length evaluation
team."
Incorporate the five elements of essential health care within
the context of PHC which include: health promotion, disease
prevention, restorative, rehabilitative and supportive care.
All strategies for interventions will be approved by the
community representatives.
Strategies will be put in place to address priority health needs.
Nurses will be working in partnership with the community
itself and other sectors to improve the health status. :
15
Appendix C
MAP
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60°
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•
Appendix D
ROLES/RESPONSIBILITIES AND
TERMS OF REFERENCE
Roles and Responsibilities /DRAFT DEC.1992
Revised copy/ January 1993
Management Committee
Primary Health Care Project
Duties and Responsibilities;
1.
2
3.
4.
5.
6.
7.
8.
Fiduciary Trust.-"due care and regard to the purposes of the
project."
Signing authority for chegues. Two signatures are required on
all the cheques. One must be Karen Parent and the other can be
any other member of the Management Committee
Deal with issues arising re management of the project
Linkage to the External Environment.
Meet 3 times/year or on an ad hoc basis.
"Arm's Length" relationship with the Community.
Have a common understanding of the principles and direction of
the project.
Review financial statements at every meeting
Members:
Elaine Shuttleworth : Executive Director -RNANS
Victor Maddalena -Administrator SHH
Karen Parent - Project Coordinator
Jean Roland Aucoin - Community Representative
Lines of Communication:
The Management Committee will communicate
Committee and the Project Coordinator.
with
the
Steering
Steering Committee
Primary Health Care Project
Duties and Responsibilities:
1.
2.
3.
4.
5.
6.
7.
Hiring and assessment of Community Coordinator
Will serve to dialogue the overall progress of the project vis
a vis the approved critical pathway.
Provide direction and support to the Project Coordinator by
being a resource.
"Arm's Length" relationship with the Community.
Budget approval. Review financial statements every second
meeting.
Meet every 3-4 months.
Have a common understanding of the principles and direction of
1
Roles and Responsibilities /DRAFT DEC.1992
8.
the project.
Financial dispersement of funds will be the responsibility of
the Steering Committee at this time.
Members;
Jean Roland Aucoin
Barbara Downe-Wamboldt
Victor Maddalena
Laurie Lauzon
Paul Joe Deveau
Note:
Jean Roland is the President and Secretary,
correspondence should be directed to Mr. Aucoin.
All
Lines of Communication:
The Steering Committee will communicate with the Management
Committee , Project Coordinator and the Funding parties.
The Coordinator and the Community Representative will be in the
unique position of having open lines of communication with
everyone. Eventually, the Coordinator will have provided a :secure
enough base for leadership and sustainability in the community that
her role will diminish.
Cheticamp Primary Health Care Community Committee
Advisory
Duties and Responsibilities:
Purpose:
To provide expertise and to participate in the project
development.
Duties and Responsibilities;
1.
2.
3.
4.
5.
No legal or fiduciary responsibilities.
Terms of reference, mission statement, goals and objectives
will be developed by this group.
Linkage with the external environment.
Have a common understanding of the principles and direction of
the project.
Work on tasks related to the project.
2
Roles and Responsibilities /DRAFT DEC.1992
Members:
Leonard Buckles - Cheticamp Development Commission
Shirley Bourgeois- Director of Nursing - The Foyer
Teresa Aucoin- retired nurse, President of the Ladies Axillary
Cyril Camus- High School teacher
Barbara Leblanc- retired school teacher
Lines of Communication:
The Advisory Committee will communicate with the community and the
sectors they represent and the project coordinator.
3
PRIMARY HEALTH CARE PROJECT
STEERING COMMITTEE
Mr. Victor Maddalena
SACRED HEART HOSPITAL
P.O. Box 129
Cheticamp, Nova Scotia
BOE 1HO
Office:
Home:
Fax:
224-2450
224-1607
224-2903
Mr. Jean Roland Aucoin
P.O. Box 482
Cheticamp, Nova Scotia
BOE 1HO
(Chair)
Home:
224-2929
Mr. Paul Joe Deveau
P.O. Box 486
Cheticamp, Nova Scotia
BOE 1HO
Barbara Downe-Wambolt
17 Wheatstone Hts.
Dartmouth, Nova Scotia
B2Y 4E1
Home:
Office:
Home:
Fax:
224-3690
Ms. Elaine Shuttleworth
OR
Laurie Lauzon
RNANS
Suite 104
120 Eileen Stubbs Avenue
Dartmouth, Nova Scotia
B3B 1Y1
Office:
Fax:
468-9744
468-9510
494-2535
463-0189
494-3487
Karen Parent
Primary Health Care Project
Coordinator
P.O. Box 129
Cheticamp, Nova Scotia
BOE 1HO
Office:
Home:
Fax:
224-1792
863-6927
224-2903
CHETICAMP PRIMARY HEALTH CARE PROJECT
ADVISORY COMMITTEE BOARD MEMBERS
NAME
ADDRESS
Therese AuCoin
P.O. Box 482
Cheticamp , N.S.
BOE 1H0
Home
Shirley Bourgeois
P.O. Box 310
Cheticamp, N.S.
BOE 1H0
Home - 224-2250
Work - 224-3114
(Foyer)
Leonard Buckles
Belle Cote
Nova Scotia
BOE ICO
Home - 235-2261
Work - 224-3349
(CDC)
Cyril Camus
P.O. Box 839
Cheticamp, N.S.
BOE 1H0
Home - 224-2516
Work - 224-2303
(NDA)
Jeannine Cormier
P.O. Box 562
Cheticamp, N.S.
BOE 1H0
Home - 224-3738
Work - 224-2450
(SHH)
Roger J.A.Deveaux
P.O. Box 83
Cheticamp, N.S.
BOE 1H0
Home
vv
2^-
Barbara LeBlanc
P.O. Box 22
Margaree Harbour,N.S.
BOE 2B0
Home
235-2700
Karen Parent,
Coordinator
P.O. Box 129
Cheticamp, N. S.
BOE 1H0
Home - 224-3680
Work - 224-1792
(PHC)
Albertine Roach
P.O. Box 112
Cheticamp, N.S.
BOE 1H0
Home
PHONE #
224-2929
224-2298
224-3450
Audrey MacPherson
Pleasant Bay, N.S.
BOE 2P0
Home
224-2363
Yolande LeVert
P.O. Box 129
Cheticamp, N.S.
BOE 1H0
Home
Work
224-3001
224-2450
Appendix E
SURVEY - KEY INFORMANT/GENERAL
PUBLIC
PRIMARY HEALTH CARE:
A CHETICAMP, N.S.
A NURSING MODEL
(CANADA) PROJECT
COMMUNITY HEALTH NEEDS AND
RESOURCES ASSESSMENT TOOL'S
KEY INFORMANT
NURSE
Note:
Items 10,
from:
11/ and 19 have been modified with permission
The Centre for the Study of Aging and Human Development.
(1978). Multidimensional Functional Assessment The OARS
Methodology A Manual (2nd Edition) .
Author:
Duke
University Medical Centre, North Carolina.
Project:
Primary Health Care - A Nursing Model
C-2b, page 1
COMMUNITY HEALTH NEEDS AND RESOURCES ASSESSMENT TOOL
KEY INFORMANT (NURSE)
AREA
1.
Which of the following health workers are available to provide
services to your community/area? Mark appropriate box (x).
0
v/
v
3
0
a
.u
c
0
Q
Public Health Nurse....
Home Care Nurse
Nursing Assistant
Doctor
Dentist
Dental Hygienist
Home Maker, Home
Support Worker
1.8
Physiotherapist
1.9 Social Worker
1.10 Psychologist
1.11 Occupational Therapist.
1.12 Chiropodist
(foot doctor)
1.13 Chiropractor
1.14
1.21
1.22 Nutritionist
1.15
1.20 Pharmacist
1.16 Midwife
Health Inspector
Other,1.17
specify:
1.18 Opthalmologist/
Optometrist(eye doctor)
1.19 Speech Therapist
1.1
1.2
1.3
1.4
1.5
1.6
1.7
Project:
2.
C-2b, page 2
Primary Health Care - A Nursing Model
Please rank the following services according to how satisfactory you
and members of your household feel they are, using the scale 1
(satisfactory) to 5 (not satisfactory).
If you do not know anything about the service, mark ’’don't know".
a service
. — — is
— not available to your community or area, mark "not
available". Mark appropriate box for each service (x) .
If
0^
o
o
0
0
3
o
a
*
0
a
o
1
2
3
4
5
Community Planning
(town, rural development)....
2.2 Water & Sewage Disposal
2.3 Telephone
2.4 Garbage Disposal
2.5 Fire Protection
2.6 Police
2.7 Correctional/Prison
2.8 Preschool Day Care
2.9 Primary School
2.10 School-Age Day Care
2.11 Junior High School
2.12 High School
2.13 Trade School
(Community College)
.
2.14 Shopping
.
2.15 Public Transportation
.
2.16 Recreation
.... .
2.17 Library
2.18 Postal
2.19 Mental Health Services
2.20 Occupational Health
(Health Services on-the-job)
2.21 Family Counselling
2.22 Family Planning
2.23 Ambulance
2.24 Emergency Services
2.25 Hospital...................
2.2 6 Home Care Services.........
2.27 Sheltered Housing
(Personal Care Home).......
2.28 Nursing Home...............
2.29 Services for Pregnant Women.
2.30 Services for New Mothers
and Babies.................
2.31 Services for the Elderly....
2.32 Services for the Chronically
Ill........................
2.33 Services for the Disabled...
2.34 Availability of equipment
needed for rehabilitation...
2.1
Q
to
<0
>
o
z
Project:
Primary Health Care - A Nursing Model
C-2b, page 3
0^
o
o'
2
3
4
2
.a
o
5
4Z
4J
>
C
4J
5
Q
X
o
o
2.35 Personne
(eg. physiotherapy services)..... ....................
2.36 Drug, Alcohol Abuse Servi
2.37 Services for Victims of A
2.38 Adult Day Care
2.39 Meals on Wheels
2.40 Dental Health Services
2.41 Health Inspection Service
2.42 Pharmaceutical (Druggist)
Services.............................................
2.43 Immunization Services
2.44 Health Information Services
(eg., AIDS, Smoking, Nutrition,
etc . )............................ ....................
2.45 School Health Services
2.46 Respite C
Other existing services in your community/area, please specify:
2.47
2.49
2.51
3.
3.1
Are there existing services you think could be improved?
Yes
No
Don't Know
If yes, list and describe:
3.11
3.12
3.13
Project:
3.2
Primary Health Care - A Nursing Model
C-2b, page
Are there existing services you think could be discontinued?
Yes
No
Don't Know
If yes, list and describe:
3.21
3.22
3.23
3.3
Are there additional services you think should be available to
your community/area?
Yes
No
Don't Know
If yes, list and describe:
3.31
3.32
3.33
4
Project:
Primary Health Care - A Nursing Model
C-2bz page
5
The next few questions are about health-related self-help groups.
These groups can be of two types: formal and informal. Examples
of forma 11 y organized groups are Cancer Support Groups, Weight
Watchers or Alcoholics Anonymous. Examples of more informal groups
are local fitness classes, "weigh-in" clubs, groups of friends going
for regular walks or some church groups. Both types of groups - the
forma 1 and the informal — are considered to be health-related selfhelp groups.
4.
4.1
Do you know of any health-related self-help groups in
your community/area?
Yes
If yest list the group(s):
4.11
4.12
4.13
4.2
Do you now participate in any health-related self-help groups?
Yes
If yes, list the type of group(s):
4.21
4.22
4.23
Project:
4.3
Primary Health Care - A Nursing Model
C-2b, page
6
Are there health-related, self-help groups that you would like to
see established in your connnunity/area?
Yes
If yes, list the type of group(s);
4.31
4.32
4.33
4.4
If you do not now participate in a health-related, self-help group
would you be willing to give time to such a group?
Yes
If yes, list the type of group(s):
4.41
4.42
4.43
Project:
5.
Primary Health Care - A Nursing Model
C-2a, page 7
Please indicate below how much influence you feel the following
have in promoting the health of the community. Rank them from
1 (great influence) to 5 (no influence). Mark the appropriate
box (x).
&
■p
c
1
2
3
4
5
0
Q
5.1 Health-related self-help groups....
5.2 Municipal government
5.3 Service organizations
(i.e. Kinsmen, Knights of
Columbus r etc.)
5.4 Churches
5.5 Sports and recreation clubs
(i.e. minor hockey, softball,
card games, bingo, etc.)
Other, please specify:
5.6
5.8
5.10
Project:
6.
C-2a, page 8
Primary Health Care - A Nursing Model
Please indicate the degree to which you feel the following are problems
in your community. Rank them from 1 (Not a Problem) to 5 (Major
Problem).1Mark the appropriate box for each problem listed (x).
o3
&
a
o
Q
1
2
3
4
5
6.1 Marital Problems
6.2 Waste disposal
6.3 Unemployment
6.4 High blood pressure
6.5 Water pollution
6.6 Parenting difficulties
6.7 Overweight
6.8 Suicide
6.9 Smoking............... . • •
6.10 Occupational risk/injuries.
6.11 Poverty................. 6.12 Alcohol abuse
...... .
6.13 Teenage pregnancy
.
6.14 Loneliness
.
6.15 Dental health
.
6.16 Air pollution
6.17 Young people in trouble
with the law............
6.18 Care of the elderly
6.19 Child abuse.............
6.20 Noise pollution.........
6.21 Road accidents..........
6.22 AIDS...................
6.23 Housing conditions......
6.24 Mental health problems....
6.25 Heart disease (circulatory
problems)...............
6.26 Day care problems (for children)..
6.27 Drug abuse.....................
6.28 Nutritional problems............
6.29 Violence in the home............
6.30 Sexually transmitted diseases.
6.31 Crime................
Other problems in your community/area, please specify:
6.32
6.34
6.36
Project:
7.
Primary Health Care - A Nursing Model
C-2a, page 9
When serious health or social problems occur to individuals or families
in your community, who do you think they turn to for help? (Do not
name specific individuals).
7.1
7.2
7.3
8.
Are you a health professional?
Yes
No
8.1
8.11
8.12
8.13
8.14
8.15
8.16
8.17
8.18
9.
9.1
If yes, what in your experience,
experience are the groups of drugs (both
non-prescription)
most commonly used by members
prescription and
Please
list.
of the community?
i
Do you smoke tobacco?
Yes
No
9.2
Do you consider smoking to be:
Good for health/well-being
Bad for health/well-being
10.
Do you :regularly participate in any planned physical activity (eg.
walking, hiking-, jogging, tennis, swimming, dancing, etc.)?
Yes
No
Project:
11.
Primary Health Care - A Nursing Model
C-2a, page 10
11.1 How would you rate the overall health of the members of the
community at present time?
Excellent
Good
Fair
Poor
11.2 Is the health of members of the community better, about the same,
or worse than it was five years ago?
Better
About the same
Worse
12.
Do you think that drinking alcohol leads to problems in your community?
Yes
No
Don't Know
12.1 Please explain:
12.11
12.12
12.13
Project:
13.
Primary Health Care - A Nursing Model
C-2b, page 11
Generally/ do you think that people living in the community eat a
healthy diet?
Yes
No
Don't Know
13.1 In what way do you think the eating habits of community members
could be improved? (Be specific).
13.11
13.12
13.13
14.
14.1 In your opinion/ what are the major concerns about health in the
community now? List and describe:
14.11
14.12
14.13
14.2 What do you think community members do to keep themselves healthy?
List and describe:
14.21
14.22
14.23
Project:
Primary Health Care - A Nursing Model
C-2b, page 12
14.3 What do you think community members do that might hurt their
health? List and describes
14.31
14.32
14.33
Now we would like to ask you some specific questions about yourself.
15.
What is your gender?
16.
What is your age range?
Mark with (x).
Male
Please mark appropriate age category (x).
10-14 years..
15-19 years..
20-24 years..
25-34 years..
35-44 years..
45-54 years..
55-64 years..
65-74 years..
75-85 years..
over 85 years
17.
How many years have you resided and/or worked in the community?
Less than 5 years.
6-10 years
11-20 years
More than 20 years
Project:
18.
Primary Health Care - A Nursing Model
C-2b, page 13
Please indicate the highest level of education you have completed.
Please mark (x).
Less than grade 10
Some high school
High school graduate
Trades certificate/diploma/apprenticeship....
University degree
Other, please specify:
19.
Please indicate your present employment status:
Full-time employment (35 hours or more a week
Part-time employment (less than 35 hours
a week
Seasonal employment
Unemployment (more than 40 weeks
Disability pension
Retirement pension
Full-time homemaker
Full-time student
Other, please specify:
20.
What is your key informant capacity?
Mark appropriate line (x).
Elected Official - Provincial
- Municipal.
Educator
Health Professional - Nurse....
- Physician
- Other....
Lawyer
Law enforcement officer
Businessman
Day care director
Consumer advocate
City/town planner
Social
Recreational director
Clergy
Representative from Seniors groups
Representative from Youth groups..
Other;
Project:
21.
Primary Health Care - A Nursing Model
C-2bz page 14
21.1 Briefly describe the services you/your agency provide to the
community.
21.11
21.12
21.13
22.
Do you think there is room for closer collaboration/coordination
between you/your agency and community health-related services or
other community services?
Yes
(Go to question 23, 24)
No
23.
23.1 If you answered yes to the above question, indicate (in order of
priority) the agencies/services with which you wish to have closer
ties.
23.11
23.12
23.13
Project:
24.
Primary Health Care - A Nursing Model
C-2b, page 15
24.1 What, if any, existing barriers do you see as impeding
collaboration between you/your agency and those other
agencies/services you have identified in question 23?
24.11
24.12
24.13
25.
25.1 As a key informant, please identify the issues/trends which you
believe will have an important impact on the health of the
community in the future.
25.11
25.12
25.13
26.
26.1 As a person highly knowledgeable about health issues in your
community, are there any further comments you wish to make?
26.11
26.12
26.13
©
Copyright 1989 by the Association of Registered Nurses of Newfoundland
and the Danish Nurses' Organization - not to be reproduced or used
without the written permission of the ARNN and the DNO.
Revised by DCH, VR, SL and BeS, January 30, 1990
Revised by SL, MO-H, GD, February 22, 1990
Revised by MO-H, CK, September, 1992
PRIMARY HEALTH CARE:
A CHETICAMP, N.S.
A NURSING MODEL
(CANADA) PROJECT
COMMUNITY HEALTH NEEDS AND
RESOURCES ASSESSMENT TOOL'©
KEY INFORMANT
NON NURSE
Note:
Items 10, 11, and 19 have been modified with permission
from:
The centre for the Study of Aging and Human Development.
(1978). Multidimensional Functional Assessment the OARS
Methodology A Manual (2nd Edition).
Author:
Duke
University Medical Centre, North Carolina.
Project:
Primary Health Care - A Nursing Model
C-2a, page 1
COMMUNITY HEALTH NEEDS AND RESOURCES ASSESSMENT TOOL
KEY INFORMANT (NON-NURSE)
1.
Which of the following health workers are available to provide
services to your community/area? Mark appropriate box (x).
0
3
0
7
O
5
p
c
0
Q
Public Health Nurse....
Home Care Nurse
Nursing Assistant
Doctor
Dentist
Dental Hygienist
Home Maker, Home
Support Worker
Physiotherapist. ...
1.8
1.9 Social Worker
1.10 Psychologist
1.11 Occupational Therapist.
1.12 Chiropodist
(foot doctor)
1.13 Chiropractor
1.14 Nutritionist
1.15 Pharmacist
1.16 Midwife
1.17 Health Inspector
1.18 Opthalmologist/
Optometrist(eye doctor)
1.19 Speech Therapist
Other, specify:
1.20
1.21
_ __ ____ ______
1.1
1.2
1.3
1.4
1.5
1.6
1.7
C-2a, page 2
Project: 'Primary Health Care - A Nursing Model
2.
Please rank the following services according to how satisfactory you
and members of your household feel they are, using the scale 1
(satisfactory) to 5 (not satisfactory).
If you do not know anything about the service, mark ’’don't know”.
a jservice is not available to your community or area, mark ’’not
available”. Mark appropriate box for each service (x).
If
/
0
0
3
o
s
Xi
-p
1
2
3
4
Community Planning
(town, rural development)....
2.2 Water & Sewage Disposal
2.3 Telephone
2.4 Garbage Disposal
2.5 Fire Protection
2.6 Police
2.7 Correctional/Prison
2.8 Preschool Day Care
2.9 Primary School..
2.10 School-Age Day Care
2.11 Junior High School
2.12 High School
2.13 Trade School
(Community College)
2.14 Shopping
...........
2.15 Public Transportation
.
2.16 Recreation
2.17 Library
2.18 Postal
2.19 Mental Health Services
.
2.20 Occupational Health
(Health Services on-the-job)
2.21 Family Counselling........
2.22 Family Planning
2.23 Ambulance
2.24 Emergency Services
2.25 Hospital
2.26 Home Care Services
2.27 Sheltered Housing
(Personal Care Home)
2.28 Nursing Home..............
2.29 Services for Pregnant Women.
2.30 Services for New Mothers
and Babies
2.31 Services for the Elderly....
2.32 Services for the Chronically
Ill......................
2.33 Services for the Disabled...
2.34 Availability of equipment
needed for rehabilitation...
5
ao
Q
■P
i
0
2.1
J
Project:
Primary Health Care - A Nursing Model
C-2a, page 3
/
/
I 3
jP
p
4
5
3
2
1
2.35 Personnel for rehabilitation
(eg. physiotherapy services)
2.36 Drug, Alcohol Abuse Services...
2.37 Services for Victims of Abuse..
2.38 Adult Day Care
2.39 Meals on Wheels
2.40 Dental Health Services
2.41 Health Inspection Service
2.42 Pharmaceutical (Druggist)
Services
2.43 Immunization Services
2.44 Health Information Services
(eg., AIDS, Smoking, Nutrition,
etc.).......................
2.45 School Health Services.......
2.46 Respite Care Services........
Other existing services in your community/area, please specify:
2.47 .................
ao
a
4J flJ
o >
—--- ---r~ZTT
2.49..................... ......... .... ..............
2.51 .................... .......... ...................
3.
3.1
Are there existing services you think could be improved?
Yes
No
Don't Know
If yes, list and describes
3.11
3.12
3.13
Project:
3.2
Primary Health Care - A Nursing Model
C-2a, page
4
Are there existing services you think could be discontinued?
Yes
No
If yes, list and describes
3.21
3.22
3.23
3.3
Are there additional services you think should be available to
your community/area?
Yes
No
If yes. list and describes
3.31
3.32
3.33
Project:
Primary Health Care - A Nursing Model
C-2a, page
5
The next few questions are about health-related self-help groups.
These groups can be of two types: formal and informal. Examples
of formally organized groups are Cancer Support Groups, Weight
Watchers or Alcoholics Anonymous. Examples of more informal groups
are local fitness classes, "weigh-in" clubs, groups of friends going
for regular walks or some church groups. Both types of groups - the
formal and the informal - are considered to be health-related selfhelp groups.
4.
4.1
Do you know of any health-related self-help groups in your
community/area?
Yes
If yes, list the group(s):
4.11
4.12
4.13
4.2
Do you now participate in any health-related self-help groups in
your community/area?
Yes
If yes, list the type of group(s):
4.21
4.22
4.23
Project:
4.3
Primary Health Care - A Nursing Model
C-2a, page 6
Are there health-related, self-help groups that you would like to
see established in your community/area?
Yes
If yes, list the type of group(s):
4.31
4.32
4.33
4.4
If you. do
not now participate in a health-related, self-help group
— „would ’you be willing to give time to such a group?
Yes
If yes, list the type of group(s):
4.41
4.42
4.43
Project:
5.
Primary Health Care - A Nursing Model
C-2ar page 7
Please indicate below how much influence you feel the following
have in promoting the health of the community. Rank them from
1 (great influence) to 5 (no influence). Mark the appropriate
box (x).
§
&
JJ
■u
c
1
2
3
4
5
0
Q
5*1 Health-related self-help groups....
5.2 Municipal government
5.3 Service organizations
(i.e. Kinsmen, Knights of
Columbus, etc .)
........
5.4 Churches
5.5 Sports and recreation clubs
(i.e. minor hockey, softball,
card games, bingo, etc.)
Other, please specify:
5.6
5.8
5.10
Project:
6.
C-2a, page 8
Primary Health Care - A Nursing Model
- ■ •
- ; feel the following are problems
Please indicate the degree to which you
v
Problem) to 5 (Major
in your community^
for each problem listed (x).
Problem) . Il—
HsW1
ihe
§
&
u
oa
Q
1
2
3
4
5
6.1 Marital Problems
6.2 Waste disposal...........
6.3 Unemployment............
6.4 High blood pressure
....
6.5 Water pollution.
Parenting difficulties....
6.6
Overweight
6.7
Suicide
..........
6.8
Smoking.
6.9
Occupational risk/injuries
6.10
6.11 Poverty......
6.12 Alcohol abuse
6.13 Teenage pregnancy
6.14 Loneliness.
6.15 Dental health
6.16 Air pollution.
...
6.17 Young people in trouble
with the law.............
6.18 Care of the elderly
’ 6.19 Child abuse..............
'6.20 Noise pollution
6.21 Road accidents
’6.22 AIDS........................................................
’ 6.23 Housing conditions
’6.24 Mental health problems....
”6.25 Heart disease (circulatory
problems)
6.26 Day care problems (for children)..
"6.27 Drug abuse....... ........
- 6.28 Nutritional problems.......
" 6.29 Violence in the home.......
” 6.30 Sexually transmitted diseases
”6.31
Crime
....
community/area,
please specify:
Other problems in your
6.32
6.34
6.36
—
Project:
7.
Primary Health Care - A Nursing Model
C-2af page 9
When serious health or social problems occur to individuals or families
in your community, who do you think they turn to for help? (Do not
individuals).
name specific individuals).
7.1
7.2
7.3
8.
Are you a health professional?
Yes
No
8.1
8.11
8.12
8.13
8.14
8.15
8.16
8.17
8.18
9.
9.1
If yes, what in your experience,
experience are the groups of drugs (both
non-prescription)
most commonly used by members
prescription and
Please
list.
of the community?
i
Do you smoke tobacco?
Yes
No
9.2
Do you consider smoking to be:
Good for health/well-being
Bad for health/well-being
10.
participate
in any planned ~physical activity
(eg.
Do you regularly
— — j g—————f;
—
_
walking, hiking, jogging, tennis, swimming, dancing, etc.)?
Yes
No
Project:
11.
Primary Health Care - A Nursing Model
C-2a, page 10
11.1 How would you rate the overall health of the members of the
community at present time?
Excellent
Good
Fair
Poor
11.2 Is the health of members of the community betterr about the same.
or worse than it was five years ago?
Better
About the same
Worse
12.
Do you think that drinking alcohol leads to problems in your community?
Yes
No
Don't Know
12.1 Please explain:
12.11
12.12
12.13
Project:
13.
Primary Health Care - A Nursing Model
C-2a, page 11
Generally, do you think that people living in the community eat a
healthy diet?
Yes
No
Don't Know
13.1 In what way do you think the eating habits of community members
could be improved? (Be specific).
13.11
13.12
13.13
14.
14.1 What are the major concerns about health in the community now?
List and describe:
14.11
14.12
14.13
14.2 What do you think community members do to keep themselves healthy?
List and describe:
14.21
14.22
14.23
Project:
Primary Health Care - A Nursing Model
C-2a, page 12
14.3 What do you think community members do that might hurt their
health? List and describe:
14.31
14.32
14.33
Now we would like to ask you some specific questions about yourself.
15.
What is your gender?
16.
What is your age range?
Mark with (x).
Male
Please mark appropriate age category (x).
19-34 years..
35-54 years..
55-64 years..
65-74 years..
75-85 years..
over 85 years
17.
How many years have you resided and/or worked in the connnunity?
Less than 5 years.
6-10 years
11-20 years
More than 20 years
18.
Please indicate the highest level of education you have completed.
Please mark (x)♦
Less than grade 10
Some high school
High school graduate
Trades certificate/diploma/apprenticeship ....
University degree.
....................
Other, please specify:
Project:
19.
Primary Health Care - A Nursing Model
C-2az page 13
Please indicate your present employment status:
Full-time employment (35 hours or more a week
Part-time employment (less than 35 hours
a week
Seasonal employment .....................
Unemployment (more than 40 week
Disability pension
Retirement pension
Full-time homemaker
Full-time student
Other, please specify:
20.
What is your key informant capacity?
Mark appropriate line (x).
Elected Official - Provincial
- Municipal.
Educator
Health Professional - Nurse....
- Physician
- Other....
Lawyer
Law enforcement officer
Businessman
Day care director
........
Consumer advocate
City/town planner
.........
Social........ • • •
Recreational director
Clergy.
.....................
Representative from Seniors groups
Representative from Youth groups..
Other:
21.
21.1 Briefly describe the services you/your agency provide to the
community.
21.11
21.12
21.13
Project:
22.
Primary Health Care - A Nursing Model
C-2a, page 14
Do you think there is room for closer collaboration/coordination
between you/your agency and community health-related services or other
community services?
Yes
(Go to question 23, 24)
No
23.
23.1 If.you answered yes to the above question, indicate (in order of
priority) the agencies/services with which you wish to have closer
ties.
23.11
23.12
23.13
24.
24.1 What, if any, existing barriers do you see as impeding
collaboration between you/your agency and those other
agencies/services you have identified in question 23?
24.11
24.12
24.13
Project:
25.
Primary Health Care - A Nursing Model
C-2a, page 15
25.1 As a key informant, please identify the issues/trends which you
believe will have an important impact on the health of the
community in the future.
25.11
25.12
25.13
©
Copyright 1989 by the Association of Registered Nurses of Newfoundland
and the Danish Nurses' Organization - not to be reproduced or used
without the written permission of the ARNN and the DNO.
Revised by DCH, VR, SL and BeS, January 30, 1990
Revised by SL, MO-H, GD, February 22, 1990
Revised by MO-H, CK, September, 1992
PRIMARY HEALTH CARE:
A CHETICAMP,
A NURSING MODEL
(CANADA)
N.S.
PROJECT
COMMUNITY HEALTH NEEDS ANIL.
RESOURCES ASSESSMENT TOOL<>
GENERAL PUBLIC
note:
Items 8, 9, 10, 13,
permission from:
14,
and 24, have been modified with
The Centre for the Study of Aging and Human Development.
(1978). Multidimensional Functional Assessment The OARS
Methodology A Manual (2nd Edition).
Author:
Duke
University Medical Centre, North Carolina.
p-rimar-y Health Care - A Nursing Model
Form C— 1 — Comnninity Health. Needs and Resources Assessment Tool
Introductory Letter (General Public)
Dear Resident:
Your household has been selected as one of approximately two
hundred households in our community to complete the enclosed
Questionnaire.
Community Health Needs and Resources Assessment
a.
In preparation for the implementation of new community-based health
services,
the enclosed guestionnaire has been developed to
determine the community's own perception of its health needs and
- - will
resources. Your thinking regarding these needs and res°urces
make
decisions as to the services.
be most valuable when we come to
1---h- i-.L-i
which will be provided.
I therefore, would be most grateful, if you together with members
of your household would take the tine to complete the enclosed
questionnaire. The interview will take approximately 30-60 minutes
of your time.
The questionnaire has been designed so that the persons completing
it cannot be identified.
Thus, your involvement will be kept
confidential.
-- j of
The information collected will be used solely for the PurP°se
'>
of
the
community
for
health
making decisions regarding the needs c_ -services and what those health services should be.
Your co-operation is greatly appreciated.
Yours sincerely,
Project Co-ordinator
Primary Health Care - A Nursing Model
C
copyright 1990 by the Association of Registered
be
Newfoundland and the Danish Nurses' Organizatiotobe
reproduced or used without the written permission of the ARNT
and the DNO.
Project:
Primary Health Care - A Nursing Model
C-l, page 1
CO^WHXTY HEAIZTH NEEDS AND RESOURCES ASSESSMENT TOOL
GTHERM, PUBLIC
NUMBER:
DATE:
z
COMMUNITY:
((2hc--biccu-nfy / PCezJicurrt
6>(A.t
V/hich of the following health workers are available to provide
services to your community/area? Mark appropriate box (x).
1.
/
V
a”
1.1
1.2
1.3
1.4
1.5
1.6
1.7
___
Public Health Nurse....
Home Care Nurse
Nursing Assistant
Doctor
Dentist
Dental Hygienist
Home Makerr Home
Support Worker
Physiotherapist
Social Worker
1.8
1.9
1.10 Psychologist
1.11 Occupational Therapist.
1.12 Chiropodist
(foot doctor)
1.13 Chiropractor
1.14 Nutritionist
1.15 Pharmacist
1.16 Midwife
__
1.17 Health Inspector
J. .10 Opthalmologist/
Optometrist(eye doctor)
1.19 Speech Therapist
Other,, specify:
1.2 0
'
___ 1.. 21 _________________________________
1.2 2
___
_
o
5
©
p
a
Q
Q
Project:
C-l, page 2
A Nursing Model
Primary Health Care'-
yott
2.
Please
and members of your
(satisfactory) to f5 (not satisfactory).
about the service, mark ■‘don't know".
If you do not
know
anything to
is not
available
your community or area, mark " not
a service
Mark appropriate box for each service (x) .
available*1.
If
/
o
C
a
2a)
6
‘5
,.o <j
4J
2
Community Planning
(town, rural development)
2.2 Water & Sewage Disposal
2.3 Telephone......... ............
Garbage
Disposal
2.4
Fire
Protection
2.5
...................
2.6 Police
Correctional/Prison
------- 2.7
------- 2.8 Preschool Day Care
2.9 Primary School.....••••••.......
------- 2.10 School-Age Day Care...........
2.11 Junior High School..............
“ 2.12 High School.....................
2.13 Trade School
(Community College)
2.14 Shopping
Public Transportation'. 7. ’ ’ ’ ■ •
2.15 1----2.16 Recreation.
2.17 Library
2.18 Postal..-.
.............
2.19 Mental Health Services
2.20 Occupational Health
(Health Services on-the-job)....
---2.21
Family
Counselling.•••
2.21
~~ 2.22 Family Planning. ...•••
2.2 3 Ambulance
2.24 Emergency Services
---- 2.25 Hospital.
---- 2.26 Home Care Services...
”
2.27 Sheltered Housing
----(personal Care Home)
Home).
?2.29R8 Nursing
Nursing Home
Home.............
.......
---- women
' 2 29 Services for Pregnant
for 2.30
New Mothers
Services
and Babies........ ■• • • • • • ’
2.31 Services for the Elderly.••
2.32 Services for
Ill
Services
for the Disabled
2.33
2.1
I
3
4
'(
2;
5
rzr
T”
Z—jI
-i
4
the Chronically
____
Project:
Primary Health Care - A Nursing Model
C-l, page 3
/
/
1
2
3
4
5
2.34 Availability of equipment
needed for rehabilitation...
2.35 Personnel for rehabilitation
(eg. physiotherapy services)
___ 2.36 Drug, Alcohol Abuse Services............. ............
___ 2.37 Services for Victims of Abuse----------------------__
2.38 Adult Day Care........... ...... ...................
___ 2.39 Meals on Wheels................. ...................
___ 2.4 0 Dental Health Services.... ...... ...................
___ 2.41 Health Inspection, Service........ ...................
2.42 Pharmaceutical (Druggist)
Services . ............. .. ........................................... ......................
____ 2.43 Immunization Services................................................................................
2.44 Health Information Services
(eg., AIDS, Smoking, Nutrition,
etc .)..... .................... ...................
___ 2.45 School Health Services........... ...................
___ 2.46 Respite Care Services............ .... .... ... ... ..
Other existing services in your community/area, please specify:
2.47
2.49
2.51
3.
3.1
Are there existing services you and members of your household
think could be improved?
Yes
No
Don't Know
If yes, list and describe:
3.11
3.12
3.13
(D
s
nflj
c
AJ "fl
0 >
s z<
Project:
3.2
Primary Health Care - A Nursing Model
•1
C-l, pag^s
Are there existing services you and members of your housohoh:
think could be discontinued?
Yes
No
Don't Know
If yes, list and describe:
3.21
3.22
3.23
3.3
Are there additional services you and members of your houi-oho ■ 1
think should be available to your community/area?
Yes
CZZIJ
No
Don't Know
IZZZl
If yes, list and describe:
3.31
3.32
3.33
I
Project.:
Primary Health Care - A Nursing Model
C-l, page
5
Thes next few questions are about health-related self-help groups.
These groups can be of two types: formal and informal. Examples
of formally organized groups are Cancer Support Groups, Weight
Watchers or Alcoholics Anonymous. Examples of more informal groups
axe local fitness classes, “weigh-in" clubs, groups of friends going
for regular walks or some church groups. Both types of groups - the
formal and the informal - are considered to be health-related self
help groups.
4.
4.1
Do you know of any health-related self-help groups in
your community/area?
Yes
No
If yes, list the type of group(s):
4.11
4.12
4.13
4.2
Do you or members of your household now participate in any
health-related self-help groups?
Yes
No
If yes, list the type of group(s):
4 „21
4.22
4.2 3
Project:
4.3
Primary Health Care - A Nursing Model
C-l; page
u
Are there health-related, self-help groups that you or member-, of
your household would like to see established in your
c ommuni ty / are a ?
Yes
1
EZTJ
If yes, list the type of group(s):
4.31
4.32
4.33
4.4
If
i
’ \
ii you or members of your household do not now
participate
in
a health-related,/ self-help group,
group, would you or members of
your household be willing to give time to such a group?
Yes
If yes, list the type of group(s):
4.41
(
4.42
4.43
5.
Please indicate below how much influence you feel the following
have in promoting the health of your community.
Rank them frou
1 (great influence) to 5 (no influence). Mark the appropriate
box (x).
I
ci
1
2
4
3
5.1 Health-related self-help groups....
_ 5.2 Municipal government
.
5.3 Service organizations
(i.e. Kinsmen, Knights of
Columbus, etc.)
5.4 Churches
5.5 Sports and recreation clubs
(i.e. minor hockey, softball,
card games, bingo, etc.)
Other, please specify:
5.6
5.8
5.10
1
5
Project:
6.
Primary Health Care - A Nursing Model
C-l, page
7
Please indicate the degree to which you and members of your household
feel the following are problems in your community. Rank them from 1
(Not a Problem) to 5 (Major Problem) . Mark the appropriate box for
each problem listed (x).
A-/
1
6.1
6.2
6.3
6.4
6.5
6.6
6.7
6.8
6.9
Marital Problems
Waste disposal
Unemployment
High blood pressure
Water pollution
Parenting difficulties
3
4
•M
s
5
Q
...
....
Overweight
Suicide
Smoking
6.10 Occupational risk/injuries
6.11 Poverty
___ 6.12 Alcohol abuse
___ 6.13 Teenage pregnancy
6.14 Loneliness
2
8
5
.•
...
.
. . . . .................
...
6.15 Dental health
6.16 Adr pollution
...........
6.17 Young people in trouble
with the law
6.18 Care of the elderly
6.19 Child abuse
6.20 Noise pollution
......
6.21 Road accidents
........
6.22 AIDS
6.23 Housing conditions
.
6.24 Mental health problems
6.25 Heart disease (circulatory
problems)
6.26 Day care problems (for children)..
6.27 Drug abuse
6.28 Nutritional problems
.
6.29 Violence in the home
6,30 Sexually transmitted diseases
6.31 Crime
Other problems in your community/area,
please specify:
6.32
6.34
6.36
Project:
7.
Primary Health Care - A Nursing Model
C-l, page.1
• ’ •
: housmio] i,
If a serious health or social problem occurred wi• thinjour
(Do
not
name
spec like
to whom would household members turn for help?
(
.individuals).
7.1
7.2
7.3
8.
any member of your household take any of the following
Did you or
Ind non-prescription (over-the-counter) drugb in the
prescription
Check yes or no.
past r14 days?
'
NO
YES
Prescription Pain Killer
Aspirin/Acetaminophen ............
Aspirin/Acetaminophen with Codeine
Prescription Arthritis Medicine...
High Blood Pressure Medicine.....
Pills to make you lose water
Pills for the heart....... .....
Nitroglycerine for chest pain
Blood Thinner Medicine
(anticoagulants)................
8.10 Antibiotics......................
’8.11 Vitamins/Minerals.......................................
’8.12 Dietary Supplements
’8.13 Weight Loss Pills......................................
’8.14 Cold Remedies...
’8.15 Cough Medicine..
8.16 Asthma Medicine.
”8.17 Allergy Medicine
Nerve
”8.18Pills
Tranquilizers or
8.19 Prescription Sleeping Pills....
”8.20 Over-the-Counter Sleeping Pills
”* 8.21 Prescription Ulcer Medicine....
8.22 Antacids...............
~ 8.23 Insulin Injections/Pills for
Diabetes
8.24 Seizure Medication
“■8.25 Thyroid Pills
8.26 Cortisone Pills/Injections
“’8.27 Hormones, male/female
8.28 Birth Control Pill.................
8.29 Laxatives
8.30 Hemmorrhoid Medicine
____
“”8.31 Home Remedies............
Other/ please specify:
8.32____________ _____
8.33
______________ ___
8.34
—
8.1
8.2
8.3
8.4
8.5
8.6
8.7
8.8
8.9
I
Project:
Primary Health Care - A Nursing Model
9.
During the past year, have you
yuu ur
or anyone living in your house
been unable to carry on with usual activities
-• like going
■ 1
to school, going to work, or working around th© house:
9.1
C-l, page
9
because of an injury?
Yes
No
9.2
because of sickness?
Yes
No
10.
Please indicate the number of people in your household who have
been unable to do their usual activities for the following time
periods:
10.1 because of an injury
10.11 A week or less
10.12 More than a week but less than 4 weeks
10.13 1-3 months
10.14 4-6 months
10.15 More than 6 months
10.16 Not applicable
10.2 because of sickness
10.21 A week or less
10.22 More than a week but less than 4 weeks
10.23 1-3 months
10.24 4-6 months
10.25 More than 6 months
10.26 Not applicable
Project:
11.
Primary Health Care - A Nursing Model
C-l, page
Do you have a family doctor?
Yes
No
11.1 How many times have you and members of your household us&d
the services of a doctor in the last three months?
Never
Less than 3
3-10
More than 10
11.2 How many times have you and members of your household used
the services of a hospital and/or emergency department in
the past three months?
Never
Less than 3
3-10
More than 10
(
11.3 How many times have you and members of your household, usod
the services of a public health nurse either at home or in
the clinic in the past three months?
Never
Less than 3
3-10
More than 10
11.4 Have you or a member of your household received an alternate
therapy (e.g., massage therapy, acupuncture, hypnosis, etc.)
during the past year?
Yes
No
EZZZl
If yes, specify the type of therapy/therapist:
11.41
11.42
11.43
10
Project:
12.
Primary Health Care - A Nursing Model
C-l, page
12.1 Do you or members of your household smoke tobacco?
Yes
No
12.2 How many people in your household smoke tobacco?
12.3 Please list the ages of the "smokers" in your household.
12.4 Do household members consider smoking to be:
Good for your health
Bad for your health
13.
Do you or members of your household regularly participate in any
planned physical activity (e.g.z walking, hiking, jogging, tennis,
swimming, dancing, etc.)?
Yes
No
14.
14.1 How would you rate the overall health of members of your
household at the present time?
Excellent
Good
Fair
Poor
II
Project:
Primary Health Care - A Nursing Model
C-l, page
14.2 Is the health of household members better, about the same,
or worse than it was five years ago?
Better
About the same
Worse
14.3 How much do health troubles prevent household members from
doing the things they want to do?
Not at all
□ZTJ
A little (some)q
J
A great deal
□ZZI
15.
Do you and members of your household think that drinking alcohol
leads to problems in your community?
Yes
No
Don't Know
15.1 Please explain:
15.11
15.12
15.13
LTZTJ
ZZZ1
□ZZI
.1.2
Project:
16.
Primary Health Care - A Nursing Model
C-l, page
13
Do you think you and members of your household eat a healthy diet?
Yes
No
Don't Know
16.1 In what ways do you think the eating habits of you and members of
your household could be improved? (Be specific).
16.11
16.12
16.13
17.
17.1 What are the major concerns about health in your household now?
List and describe:
17.11
17.12
17.13
Project:
Primary Health Care - A Nursing Model
C~lz paga
14
17.2, What do household members do to keep healthy?
List and describe:
17.21
17.22
17.23
17.3 What do household members do that might hurt their health?
List and describe:
17.31
17.32
(
17.33
Now we would like to ask you some specific questions about you and members
of your household.
18.
Number of persons living in your household now
□ZZJ
18.1 Number of males in household
l:
□
18.2 Number of females in household
19.
Questionnaire filled out by:
Mark with (x) .
Male
Female
EZZJ
Project:
20,
C-l, page
Primary Health Care - A Nursing Model
15
Please indicate the munber of people in your household who are in
the following age categories:
MALE
20.1 Less than 1 year
20.3 1-4 years
20.5 5-9 years
20.7 10-14 years
20.9 15-19 years
20.11 20-24 years ....
20.13 25-34 years
20.15 35-44 years
20.17 45-54 years...
20.19 55-64 years
20.21 65-74 years
20.23 75-85 years
20.25 over 85 years...
FEMALE
0
21.
Age range of main person filling out questionnaire.
(Choose from list of age ranges in question #20).
22.
Years living in the community/area:
Less than 5 years
11-20 years
More than 20 years
23.
Please indicate the highest level of education completed by each adult
in your household. (Indicate the number of persons in each category).
23.1 Less than Grade 10
23.2 Some High School
23.3 High School Graduate
23.4 Trades Certificate/Diploma/Apprenticeship. ♦ . .
23.5 University Degree
Other, please specify:
....
23.6
Project:
24.
Primary Health Care - A Nursing Model
C-l, page
16
How many people in your household have the following employment
status:
14.1 Full-Time rEmployment (35 hours or more a week)..
24.2 Part-Time Employment
(less
t -- x--f than 35 hours a week)
•
3
Seasonal
Employment
......
___— 24
if*
... ...................
Unemployment (more than 40 weeks)
24.5 Disability Pension...........\
*
_24.6 Retirement Pension
’ ’ ’ ’ **’****’" ’
_ 24.7 Full-time Homemaker............................................ ... c .. a
,_24.8 Full-time Student
* ’ ’ ****** * ' * *. " . ’
Other, please specify:
24.9
25.
What are the occupations of the members of your household?
list:
[
Please
25.1
25.2
25.3
25.4
©
Copyright 1989 by the Association of Registered Nurses of Newfoundland
and the Danish Nurses9 Organization - not to be reproduced or used
without the written permission of the ARNN and the DNO.
Revised by DCH, VR, SL and BeS, January 30, 1990
Revised by SL, MO-H, GD, February 22, 1990
Revised by MO-H, CK, September, 1992
• t
Soins Fondamentaux de la Sante
Infirmier modele
Formule C-l - Un Outil pour Identifier et Evaluer les Besoins d'une
Region. Lettre d'Introduction (Au Public en General)
Cher resident:
Votre famille a ete choisie parmi deux cents families dans notre
communaute pour remplir ce questionnaire sur les besoins sante et
evaluer les ressources disponibles dans la region.
En preparation d'introduire de nouveaux services sante dans la
communaute, ce questionnaire a ete developpe pour determiner
1'opinion de cette communaute sur ces besoins sante et ressources.
Votre opinion concernant ces besoins et ressources sera de tres
grande valeur quand les decisions seront prises au sujet de quels
services seront offerts.
Moi done, je serai tres reconnaissante si vous, ensemble avec les
membres de votre famille accepteriez de prendre le temps de
completer ce questionnaire, Ceci prendera environ 30-60 minutes de
votre temps.
Ce questionnaire a ete planifie de sorte que les personnes qui le
repondent ne pourront pas etre identifiees.
Done,
votre
participation sera gardee confidentielle.
L'information rassemblee sera utilisee seulement dans 1'intention
de faire des decisions au sujet des besoins de services sante dans
la communaute et quels services pourrait etre offerts.
Votre cooperation est grandement apprieciee.
Sincerement votre,
Karen Parent
Coordonnatrice du projet
Soins Fondamentaux de la Sante
©
Infirmier modele
Droits exclusifs 1990 de 1'Association des Infirmiers et
Jnfirmieres de Terre-Neuve et de 1'Association des Infirmiers
et Infirmieres Danoise. Il est interdit de reproduire sans la
permission ecrite de 1'ARNN et de la DNO.
P .1''1 j p I. :
Soins Fondamentaux de la Sante - Infinnier modele
C-l,page 1
UP OUTIL POUR IDENTIFIER ET ^VALUER LES BESOINS D'UNE REGION
AU PUBLIC EN GENERAL
NUMfiRO:
DATE:
ADRESSE:
1
1.
REGION:
J
(P. fitang, Plateau etc.)
Solon vous, lesquels des travailleurs - sante ci-dessous sont la sur
placef prets a servir dans votre region,
Indiquez d'un (x) la case
appropriee.
.o
<5
J. . 1
Infinniere au service public
Infinniere aux soins A domicile....
Aide - infirmiere
Medecin
1 . 5
Dentiste
1 .6
Assistante au dentiste
1.7
Travailleurs aide aux
families
] .8
Physiotherapeute
1.9
Travailleur social
1.10 Psychologue(comportement humain)...
1.11 Ergotherapeute
1.12 Pedicure (specialiste aux soins des pieds)..
1.13 Chiropracteur(soins des os)
1.14 Nutritioniste(nourriture) .......
1.15 Pharmacien(druggist)
1.16 Sage-femme
1.17 Inspecteur de la sante
1 .18 Optoinetriste\Oculiste (specialistes de la vision)
1 . 19 Orthophoniste(speech therapist)....
Autres, lesquels?
1.20
1.21
~
'
1.22
~
~
'
1.2
1.3
1.4
.e?
.c?
I
Proj et:
2.
Soins Fondamentaux de la Sante
C - i , pug.:
Infirmier modele
Veuillez evaluer les services ci-dessous selon que vous et les vol-.rc.-,
les trouvez satisfaisants . Utilisez les numeros de 1 (satisfaisant)
5 (non-satisfaisant).
Si vous ne connaissez aucunement le service placez votre (x) dans 1
case ne connais pas; si ce service n'existe pas dans votre region,
placez votre (x) dans la case non-disponible.
.A.,
■<>
(/o
■
*_>
Oj
/
Cj
1
Planification
communautaire
2.2 Systeme d'eau et d'egout
2.3 Telephone
2.4 Debarras d'ordures
2.5 Brigade de feu
2.6 La Police
2.7 Maison de correction\prison .....
2.8 Garderie Pre-scolaire
2.9 ficole primaire
2.10 Garderie age scolaire
2.11 ficole niveau junior
2.12 6cole secondaire
2.13 fScole de metiers (College communautaire)
2.14 Boutiques - magasins
2.15 Transport public
2.16 Recreation
2.17 Bibliotheque
2.18 Bureau de poste
2.19 Services aux handicapes mentaux...
2.20 Services - sante
au travail
2.21 Conseille familial
2.22 Planification familial
2.23 Services d'ambulance
2.24 Services d'urgence
2.25 Hdpital
2.26 Services a domicile
2.27 Foyers - logements (maison de soins personnels)
2.28 Maison de convalescence
2.29 Services aux femmes enceintes
2.30 Services aux nouvelles
mamans et bebes
2.31 Services aux vieillards
2.32 Services aux personnes
serieusement malades
2.33 Services aux gens incapacites
2.1
2
3
4
5
</)
I'!
j el:
Soins Fondamentaux de la Sante - Infirmier modele
C-l,page 3
b
^9
b"
Q,
.
b
o
'O
b
/
QQ /.^
b
.^9
'O'
r
to
/
b
?
!<S
b
i
b
1
2
3
4
5
34 Equipement disponible pour
--rehabilitation(bequilles etc.).... ---2.35 Personnel de rehabilitation (services du physiotherapeute).... ---2.3G Services d'abus d'alcool et drogue---2.37 Services aux abuses.............. .....
2.38 Garderie pour adultes............ .....
2.39 Repas d domicile(meals on wheels). ---2.40 Services aux soins dentaires..... .....
2.41 Service d'inspection - sante..... .....
2.42 Services pharmaceutiques (pharmacien) ..................... .....
2.43 Services d'immunisation(vaccin)... ---2.44 Services d'information-sante (info, au sujet du fumage, du
cida, de la nutrition etc.)...... .....
2.45 Services - sante a 1'ecole....... .....
2.46 Services de repi(qui permettrait.. ---aux gens qui s'occupent des malades
de se reposer).
Autres services existants dans votre region. Lesquels?
2.47
2 . 49
2.51
3.
3.1
Y a-t-il des services que vous et les vdtres aimeriez rendre
meilleurs?
Oui
Non
Je ne sais pas
Si oui, lesquels?
3.11
3 . 12
3.13
Projet:
3.2
Soins Fondamentaux de la Sante
Infirmier modele
C -1, p<.il JC
Y a-t-il des services que vous et les votres aimeriez voir
disparaltre?
Oui
I
Non
Je ne sais pas
Si oui, lesquels?
3.21
3.22
3.23
3.3
Est ce que vous et les votres aimeriez voir d'autres servi o e :J
s'ajouter a ceux existent deja dans la region?
Oui
Non
Je ne sais pas
Si oui, lesquels?
3.31
3.32
3.33
4
Pi ' > j e I.:
Soins Fondamentaux de la Sante - Infirmier mod&le
C-l,page 5
lues quelques questions ci-dessous se rapportent aux groupements
cl'entraide dans le domaine sante, ces derniers peuvent etre soit
organises tels-le groupe soutien pour le cancer, le groupe "Weight
Watchers" qui s'interesse aux regimes amaigrissants, le groupe
alcooliques anonymes etc. ou encore des groupements plus simples telsla classe sante (forme physique), un groupe de gens qui se rencontrent
e I: se pesent regulierement, des amis qui font des promenades ensemble
ou encore des groupes de gens appartenant a une meme eglise.
4.
/I . 1
Connaissez-vous, dans votre region, de tels groupements d'entraide
qui se rapportent & la sante?
Oui
Non
Si oui, lesquels?
4.11
4.12
4.13
4.2
Est-ce que vous ou 1'un des votres appartenez a 1'un ou 1'autre de
ces groupements?
Oui
Non
Si oui, lesquels?
'1 . 21
A . 22
4.23
Proj et:
4.3
Soins Fondamentaux de la Sante
Infirmier modele
C 1,)
6
Est-ce que vous et les votres aimeriez voir d'autres groupeinenI
d'entraide (sante) s'ajouter a ceux qui existent deja dans vol i
region?
Oui
I
Si oui, lesquels?
4.31
4.32
4.33
4.4
Si ni vous ni les votres n'appartenez a aucun de ces groupemenls
d'entraide (sante), seriez vous prets a donner de votre temps?
Oui
Si oui, lesquels?
4.41
4.42
4.43
5.
Tons ces- services devraient normalement aider a la sante.
Selon viHis
combien d'influence chacun a-t-il sur la sante? Veuillez marquer d'lin
(x) la case appropriee. 1 (Beaucoup d'influence) a 5 (Aucune
■'O
influence).
f-r
o7
3
4
s
5
5.1 Groupements d'entraide - sante....
5.2 Gouvernement municipal
5.3 Organisations a buts non-lucrat
(Kinsmen, Chevaliers de
Colomb etc. )
5.4 figlises
5.5 Clubs - sports et recreation
(hockey mineur, softball,
parties de cartes, bingo etc.)....
Autres: Lesquels?
5.6
5.8
5.10
I’i
6.
jeL :
Soins Fondamentaux de la sante
Infirmier modele
C-l,page 7
Solon vous et les votres lesquels de ces derniers sont des problemes
qui existent dans votre region? Notez les de 1 (n'est pas un probleme)
a 5 (probleine serieux) .
1
6 . 1 Les problemes conjugaux(mariage)..
6.2 be debarras d'ordures
6.3 be chomage
6.4 ba haute pression (blood pressure)
6.5 La pollution des eaux
6 . 6 Les problemes familiaux
6.7 L'embonpoint (overweight)
6 . 8 be suicide
6.9 be fumage
6.10 Les dangers\accidents au travail..
6.11 La pauvrete
6.12 L'abus de 1'alcool
6.13 La grossesse chez les adolescents.
6.14 Lf ennui
6.15 La sante dentaire
6.16 La pollution de 1'aire
6.17 Les jeunes qui desobeissent
a la loi
6.18 Les soins aux vieillards
6.19 L'abus des enfants
6.20 La pollution du au bruit
6.21-Les accidents de la route
6.2 2 be cida (aids)
6.23 L'etat des logements
6.24 Les problemes de sante mentale....
6.25 La maladie du coeur circulation
6.26 Les problemes de garderie(enfants)
6.27 L'abus des drogues
6.28 Les problemes de nutrition
6.29 La violence au foyer (maison)
6.30 Maladies transmises sexuellement..
6.31 be crime
Au ties - dans la region:
Lesquels?
6.32
6.34
6.36
2
3
4
5
Proj et:
7.
Soins Fondamentaux de la Sante
C-l/page 8
Infirmier modele
Si vous ou les votres aviez un probleme-sante ou social serieux, a qu i.
iriez-vouz pour de 1'aide? (Ne nommez pas une personne).
7.1
7.2
7.3
8.
Durant les 14 derniers jours, est-ce que vous ou 1'un des votres avez
pris des drogues ci-dessous soit qu'elles aient ete ordonnees on
ou non?
OU I
NON
Des calmants ordonnes (pain killers)
Aspirines\Acetaminophenes
Aspirines avec codeine
Medicaments ordonnes pour 1'arthrite
Medicaments pour la haute pression
Pilules diuretiques (fluid pills)
Pilules pour le coeur
Nitroglicerines pour le mal de poitrine(chest)..
Anticoagulants (blood thinner
medication)
8.10 Antibiotiques
8.11 Vitamines\Mineraux
8.12 Supplements au regime alimentaire
8.13 Pilules pour maigrir
8.14 Remedes contre le rhume
8.15 Sirop a toux
8.16 Medicaments pour asthme
8.17 Medicaments pour les allergies
8.18 Calmants-pilules pour les nerfs(tranquilizers)..
8.19 Somniferes ordonnes (sleeping pills)
8.20 Somniferes sans ordonnance
8.21 Medicaments ordonnes pour ulcer
8.22 Antiacides
8.23 Piqure d'insuline\pilules pour
diabetiques
8.24 Medicaments pour convulsions (seizures)
8.25 Pilules pour glande thyroide
8.26 Pilules\piqures cortizones
8.27 Hormones, males\femelles.......................
8.28 Pilules limitation des naissances(birth control)
8.29 Laxatifs..........................
8.30 Medicaments contre les ha
8.31 Remedes familiaux (home reme
Autres: Lesquels?
8.32
8.3 3
8.34
_______________ __________
8.1
8.2
8.3
8.4
8.5
8.6
8.7
8.8
8.9
Pio j el::
9.
Soins Fondamentaux de la Sante - Infirmier modele
C-l,page 9
Durant la derniere annee, est-ce que vous (ou
_ 1‘1'un des votres a du
laisser tomber ses activites normales telles------ - aller a 1'ecole,
aller au travail ou vaquer aux soins du menage (working around the
house)?
9.1
A cause d'une blessure?
Oui
Non
9.2
A cause de maladie?
Oui
Non
10 .
Veuillez indiquer combien de personnes parmi les votres ont du laisser
tomber leurs activites normales durant les periodes de temps cir'l
r*’
dessous
.
m
10.1 A cause de blessures
10.11
10.12
10.13
10.14
10.15
10.16
Une semaine ou moins
Plus d'une semaine, moins d'un mois
1-3 mois
4-6 mois
Plus de 6 mois
Ne s'applique pas
10.2 A cause de maladies
10.21
10.22
10.23
10.24
10.25
10.26
Une semaine ou moins
Plus d'une semaine, moins d'un mois
1-3 mois
4-6 mois
Plus de 6 mois
Ne s'applique pas
Projet:
11.
Soins B’ondamentaux de la Sante
Infirmier modele
C-l)page 10
Avez-vous un medecin de famille?
Oui
Non
11.1 Combien de fois vous ou 1'un des votres avez visite un rnedecin
durant les 3 derniers mois?
Jamais
Moins de 3 fois
3-10 fois
Plus de 10 fois
11.2 Combien de fois vous ou 1'un des votres avez utilise les services
de I'hopital et\ou les services externes (emergency) durant 1. e: > 3
derniers mois?
Jamais
Moins de 3 fois
3-10 fois
Plus de 10 fois
11.3 Combien de fois vous ou 1'un des votres avez utilise les scrvi (:es
de 1'infirmiere au service public soit chez vous ou a la clinique
durant les 3 derniers mois?
Jamais
Moins de 3 fois
3-10 mois
Plus de 10 fois
11.4 Durant la derniere annee est-ce que vous ou i'un
1'un des votres avez
regu une therapie variee telle - massages, acupuncture, hypnose
etc. ?
Oui
Non
Si oui, laquelle?
11.41
11.42
11.43
ZZ1
]
Proj et:
12 .
Soins Fondamentaux de la Sante
Infirmier modele
C-l,page 11
12.1 Est-ce que vous ou les votres fumez le tabac?
Oui
Non
12.2 Combien d'entre vous fumez le tabac?
□
12.3 Veuillez noter I'age des fumeurs parmi vous et les votres.
12.4 Selon vous et les votres
fumer serait-il:
Bon pour la sant6?
Mauvais pour la sante?
13 .
Est-ce que vous et les votres participez regulierement a des activites
organisees telles- la promenade, la randonnee a pieds, le jogging,
faire du tennis, la natation (nager), la danse etc.?
Oui
Non
14 .
14.1 Diriez-vous que votre etat de sante et celui des votres est:
Excellent
Bon
Assez bon
Pauvre
Projet:
Soins Fondamentaux de la Sante
Infirmier modele
C-l, page 12
14.2 Votre etat de sante et celui des votres est-il mieux ou pire qu'il
1'etait il y a cinq ans?
Mieux
A pen pres pareil
Pire
14.3 Jusqu'a quel point des problemes - sante empechent-ils vous et les
votres de faire ce qui vous plairait?
Aucunement
Un pen
Beaucoup
15.
Est-ce que vous et les votres pensez que boire de 1'alcool pourrait
poser des problemes dans votre region?
Oui
Non
Je ne sais pas
15.1 Veuillez expliquer:
15.11
15.12
15.13
Proj et:
16.
Soins Fondamentaux de la Sante - Infirmier modele
C-l,page 13
Est-ce que vous et les votres suivez une diete saine?
Oui
Non
Je ne sais pas
16.1 De quelles manieres pensez-vous que vos habitudes de vous nourrir
pourraient devenir meilleures?(Expliquer clairement)
16.11
16.12
16.13
17 .
17.1 Quelles sont maintenant vos inquietudes familiales par rapport a
la sante?
17.11
17.12
17 . 13
Projet:
Soins Fondamentaux de la Sante - Infirmier modele
C-l,page 14
17.2 Que font les gens d'un menage(household members) pour rester en
sante?
17.21
17.22
17.23
17.3 Qu'est-ce que les gens d'un menage font qui pourrait nuire a leur
sante?
17.31
17.32
17.33
Les quelques questions ci-dessous s'adressent particulierement a vous et aux
votres.
18 .
Le nombre de personnes vivant chez vous?
18.1 Du sexe masculin?
18.2 Du sexe feminin?
19 .
Ce questionnaire est rempli par?
Indiquer avec un (x)
Homme
Femme
Projet:
20.
Soins Fondamentaux de la Sante
C-l,page 15
Infirmier module
Dans la case appropriee, veuillez indiquer combien d'entre vous et les
votres appartenez aux categories d'cLges ci-dessous:
MALE
FEMELLE
20.1
Moins d'un an
20.3 1-4 ans...
20.5 5-9 ans...
20.7
10-14 ans.
20.9 15-19 ans.
20.11 20-24 ans.
20.13 25-34 ans.
20.15 35-44 ans.
20.17 45-54 ans.
20.19 55-64 ans.
20.21 65-74 ans.
20.23 75-85 ans.
20.25 Plus de 85 ans
21.
Le groupe d'age de la personne qui rempli ce
questionnaire. (Choisissez ce groupe d'age d'apres
la question numero 20 plus-haut.
22 .
Combien d'annSe la personne qui rempli ce questionnaire a-t-elle v6cu
dans la region?
Moins de 5 ans
11-20 ans
Plus de 20 ans
23.
Votre niveau d'education et celui de chaque adulte parmi les votres.
(Indiquez le nombre d'adultes parmi vous et les votres qui appartenez a
chaque categorie).
23.1 Moins de la lOe annee
23.2 Une partie du secondaire(high
23.3 Diplome du secondaire
23.4 Diplome d'une ecole de metier
23.5 Degre universitaire
Autres, lesquels?
23.6
]
Projet:
24.
Soins Fondamentaux de la Sante - Infirmier modele
C-l,page 16
Combien d'entre vous et les votres etes employes:
ou plus la semaine)... 24.1 A plein-temps (35 h
la semaine)
24.235A heures
temps partiel
(moins de
24.3 A un emploi saisonnier...
24.4 Au chdmage (plus de 40 semaines•
24.5 A la pension d'invalidite (Disability Pension)
retraite(Retired) .....
24.6 A la pension de retraite(Retired)
24.7 Femme d'interieur-a plein-temps (Homemaker)...
~ 24.8 fitudiants a plein-temps......................
Autres, lesquels?
2 4.9—--
[
25 .
]
Quel genre de travail font les votres?
25.1
25.2
25.3
25.4
©
■
1989 de 1'Association des Infirmiers et Infirmieres de
Droits exclusifs 1989 de 1'Association des
Infirmieres Danoise.
_
3
et
de
Terre-Neuve c- - 1'Association des Infirmiers et
la
permission
ecrite de
de reproduire ce document sans
11 est interdit
—-- -- —
1'ARNN et de la DNO.
1990.
Revise par DCH, VR, SL et BeS, le 30 janvier,
Revise par SL, MO-H, GD, le 22 fevrier, 1990.
Revise par MO-H, CK, en septembre, 1992.
. .»
H
Ilf*.
i
,.mi.
'
,
•*
.--••»
—
--
-■—’•»€■•
■............................... ■
■
J'
Appendix F
I
I
1 ♦atb
,
i!'. ‘ ■Ja'\
I
■ t"
l‘
I
I
” “ '..i
! 1
,
IP'
I
ADVISORY BOARD PRORLE
I1’'
1
p:jI
*
IK
I
I
!
i
i'i-’
v;
PROFILE OF THE PHC COMMUNITY ADVISORY BOARD
ADDRESS
OCCUPATION
ORGANIZATIONS
INVOLVED WITH
Roger
Deveaux
Cheticamp
Carpenter
Drug/Alcohol
Awareness
Jeannine
Cormier
Petit Etang
CNA and
PHC support
staff
Weight Watchers
1993 School Reunion
Committee
Albertine
Roach
Belle Marche
Disabled
CNA
Parish Council
Church Maintenance
Pastoral Care
Centennial Comm.
Barbara
LeBlanc
Margaree
Harbour
Homemaker
Belle Cote
Community Centre
Margaree Drug
Awareness
Single Parents
Leonard
Buckles
Belle Cote
Director of
CDC
Community Action
Regional Fishing
International
Health Issues
Matthew Foundation
Cyril
Camus
Cheticamp
North
Educator
Drivers Education
Youth Hockey
Computer Courses
Educator
Yolande
LeVert
St. Jos. du
Moine
Head of
Finances
St.J.M. Playground
St.J.M. Playschool
Al-Anon
Matthew Foundation
Shirley
Bourgeois
Cheticamp
South
D.O.N.
Senior Home
Involved with
Senior Activities
in the Community
Audrey
MacPherson
Pleasant Bay
Full-time
homemaker
and
Caregiver
Handicapped
Child
Home and School
United Church Women
President of Cabot
Children Wish
Foundation
Therese
Aucoin
Petit Etang
Homemaker
Retired RN
Red Cross
Ladies Aux.(SHH)
Liturgy
Liturgical Comm.
Antigonish Diocese
NAME
APPENDIX G
LETTERS (FRENCH/ENGLISH TO COMMUNITY COMMITTEES)
Karen Parent
Project Coordinator
Primary Health Care Project
Cheticamp, N.S.
BOE 1H0
1~
2~
3~
Attention:5
January 18, 1993
Dear 6~:
The Primary Health Care Project is a three year demonstration
project sponsored jointly by the Department of Health, Registered
The project's
Nurses Association and the Sacred Heart Hospital,
overall goal is to assess, plan and evaluate a comprehensive
Primary Health Care Project which will improve the health status
of the citizens living in Cheticamp and the surrounding area.
The Primary Health Care Project is currently in the assessment or
information gathering phase.
This involves reaching out to the
community and asking as many people as possible what their health
issues are as well as what programs or services are needed to meet
these needs.
Community participation is a vital ingredient
necessary for the success of this project. It is with this in mind
that I am contacting you to approach your committee to consider
placing the Primary Health Care Project on their meeting agenda in
the near future. My purpose is threefold; firstly to generate a
greater awareness of the project in the community, secondly to
collect information from your general membership regarding their
health issues and concerns and finally to answer any guestions
people have regarding the project.
By linking with organizations such as yours that serve to improve
the health and well-being of the people in this community, the
Primary Health Care Project can develop partnerships which will
work together towards the common goal of a healthier community.
I look forward to hearing from you in the near future,
reached at the following number: 224-1792.
I can be
Thank you in advance for your attention and consideration in this
matter.
Sincerely,
Karen Parent
Project Coordinator
Karen Parent
Coordonatrice du projet
Soins Fondamentaux De La Sante
C.P. 129, Cheticamp, N.fi.
BOE 1H0
1~
2~
3~
4~
Attention: 5
le 18 janvier, 1993
Cher 6~:
Le projet soins fondamentaux de la sante est a 1'essai pour une
duree de trois ans; ce dernier, parraine jointement par le
Departement de
la
Sante,
1'Association des
Infirmiers
et
Infirmieres et I'Hopital Sacre Coeur, vise a etudier, a planifier
et a evaluer dans les moindres details les soins fondamentaux de la
sante de maniere a ameliorer 1'etat de sante des gens qui habitent
Cheticamp et les environs.
Le pro jet soins fondamentaux de la sante n'en est encore qu' a la
periode de recherche. Ceci suppose communiquer avec autant de gens
que possible a savoir quels sont les problemes qui existent dans le
domaine de la sante et quels programmes et services on pourrait
offrir pour rencontrer ces besoins. La participation des gens est
un element essentiel au succes de ce projet. Je vous invite done,
a voir a ce que les soins fondamentaux de la sante figure a
1'agenda d'une des prochaines rencontres de votre comite.
Mon
invitation repose sur trois raisons principales: en premier lieu sensibiliser les gens de la region au sujet de ce projet.
Deuxiemement - recueillir 1'information de vos membres concernant
les problemes de la sante de la region et leurs suggestions sur les
manieres de les resoudre. Enfin - de repondre aux questions qu'on
pourrait avoir face a ce projet.
En tant que responsable du projet soins fondamentaux de la sante
nous nous proposons d'entretenir des liens etroits avec des
organisations tel la votre, qui s'occupe du bien-etre des gens de
la communaute, afin qu'ensemble nous parvenions a rendre cette
region plus saine.
Il me fera plaisir d'entrer en contact avec vous dans un avenir
tres rapproche.
Pour me rejoindre veuillez signaler le numero 224-1792.
Merci de 1'interet que vous pretez a ce sujet.
Bien a vous,
Karen Parent
Coordonnatrice du projet
Position: 4644 (1 views)