Diagnosing and treating communities is the dominant responsibility of the community health nurse, according to the American Nurses' Association Standards 1973. Fulfilling this responsibility demands first of all, skill in assessing a community and identifying real or potential health problems. In an earlier paper by Stein and Eigsti (1982) titled "Utilizing a Community Data Base System with Community Health Nursing Students," a description was given about a baccalaureate nursing program's method of teaching the concept "community-as-client." The method was selected to facilitate students obtaining the skill required to both assess and diagnose a community. Community health faculty developed a detailed outline for students to follow for their community diagnosis assignment. In an ongoing effort to improve and clarify the assignment, the outline was revised, utilizing the "Data Base Management System" explained by Stein and Eigsti to direct the data collection process and ultimately the analysis. This paper presents an evaluation of the use of the system for two academic semesters with 80 baccalaureate senior nursing students under the clinical supervision of five master's prepared community health nursing faculty.
Evaluating the DBMS
The Data Base Management System (DBMS) contained categories found to be "essential" sources of data about communities (Christiansen, 1977). One goal of creating the outline from the original DBMS was to develop an organizing set of major categories that would encompass the critical information about a geographic community of any size. Another goal was to develop a record "simple enough to be usable and clear enough to reveal actual organized community systems to students accustomed to individual-patient practice" (Christiansen, 1977). The third goal was to develop a system of data collection that would assist students to readily identify actual community problems and populations at risk. The method used to evaluate the DBMS included feedback from faculty discussion and evaluation of students' final papers and presentations on the three goals above.
Five different clinical groups of community health nursing students, comprised of six to seven students each, used the DBMS to record data they collected for their community study. The student groups began the study by collecting data about the physical environment primarily by observing the one to four census tracts comprising their "community" and noting the physical characteristics of how the land was used. Students noted the kind and condition of residences, industry, local commercial areas, and environment.
Following observations of the physical environment of their community, students gathered and analyzed data from the U.S. Census for the "social and behavioral systems" of the DBMS. The census tabulations assisted students to review their observations and improve their objectivity about the people of their community by examining and comparing their findings to previously tabulated large group data. Students also analyzed birth, death, morbidity, and mortality data from the local health department in their search for an identifiable problem for their community.
Positive Experiences in Using the DBMS
Many positive experiences were identified in the use of the DBMS by both faculty and students. The major benefit of the tool was it helped students organize, structure and limit the data examined. The categories gave students a logical framework to follow both in collecting data and presenting their findings.
Students were also able to share data and delineate the categories with other community workers, especially the community health nurses and supervisors who delivered service to particular communities. One student group received helpful data from a local police district about a particular community. In return, a copy of the data, analysis and suggested interventions was shared with the police. If students' conclusions and recommendations were controversial and inappropriate to share, the DBMS allowed the data to easily be separated from the conclusions and recommendations.
Use of the DBMS in all student groups also promoted consistency in data collection, which in turn allowed comparability of the data and analysis of one community to another. Contributing factors to health problems became clear with this format such as the relationship of lower socioeconomic areas to higher rates of illness and death. By using the DBMS all students were able to identify actual community problems either from the health statistics directly or from the sociodemographic or environment analysis.
Difficulties in the Use of the DBMS
In discussing the organization of the DBMS, Christiansen believed the DBMS provided only a mechanism for managing data that the nurse was already prepared to understand and collect. Since community health nursing students frequently did not have the expertise Christiansen mentioned, they sometimes experienced difficulty in interpreting the usefulness of certain data. Because the DBMS did encompass many general categories related to community systems, students sometimes "filled the list" of categories, without a clear understanding of the utility of the data. For example, many groups listed the legislators in their district but did not explore or know how the legislators functioned as leaders for the community. Given the constraints of completing the assignment in one semester, some depth of analysis had to be sacrificed. Students were directed to focus on the most accessible data in order to gain the overview of the relevant systems.
Students also found headings of some categories less clear than others and therefore difficult to interpret. For example, students interpreted "communication systems" very differently. Some discussed the formal newspaper, others discussed groups and organizations. Faculty concurred that some broad categories needed more specificity.
Christianson also proposed that the DBMS should allow data in the more intensely studied categories to be greatly expanded without sacrificing the holistic orientation of the system. Directions in the DBMS required collectors to be more specific in some categories than others (Stein & Eigsti, 1982). These directions not only expanded categories, but also added to the voluminous data already collected to "fill the list." Some faculty found themselves wading through pages of data, while critical interrelationships and interpretations of the data were sometimes ignored. Faculty determined that greater instruction was needed on interpreting some of the data to make the data more meaningful to students.
Beyond Reality Shock
Faculty members are well-acquainted with the dilemma of teaching students the "ideal" in the classroom and then having them face major differences in actual practice. Learning the concept of communityas-client with the DBMS was no exception. The traditional training of nurses who come to a community health setting is oriented to individual-as-client. This orientation remains even though most health professionals accept the theory of multiple causation of disease and the need for a holistic approach to solving community health problems and promoting health. There is little obligation for health professionals to gather even elementary community assessment data or prepare a written record as one does with individual clients. Consequently, professionals who work in the community, and particularly nurses and sanitarians, accumulate much knowledge that is simply lost because there is no means to systematically record it.
Nursing personnel in the agencies where students practice community health nursing have always been delighted to hear what has been done "with the community studies." The faculty members think that this is one small step in the process of teaching community health professionals about the urgency, the process, and the plain enjoyment of visualizing the community as a client. Nevertheless, students are being taught an important process that they generally do not witness in current practice. Motivation to continue to educate students in community diagnosis is based on faculty philosophy that we are preparing nurses for present and future practice roles.
Recommendations for Using the DBMS
When the entire community health faculty decided to use the DBMS as a method of helping students to gather community data, valuable dialogue regarding its pros and cons resulted. Faculty needed to reach consensus regarding what data were "essential" in order to communicate with students. Since faculty were committed to streamlining the process and assisting students to select critical data, decisions to clarify and omit some categories were agreeable to all. Categories of topography, geology, radio and television were consequently omitted from the original DBMS in order to pare the data down to absolutely critical categories. In order to make the DBMS useful and understandable to students, faculty must agree on category meaning and utility.
Experience with handling data helps the students to assess which data have the most meaning. Setting limits on the time and amount of data collected has helped students to more quickly define and evaluate relevant data. Faculty can help students understand that the data alone will not determine what course of action is necessary; rather, the nurse must make program decisions after analyzing the data and drawing on previous experience and expertise.
Within the context of the whole community structure, this particular data collection system provides a consistent framework in which comparisons can be made over time. The amelioration of health problems and continuous master planning occurs only when a model such as the DBMS is utilized by all community health agencies. Further data bases compiled in such a systematic manner can produce information to construct hypotheses and problem statements for research studies.
The Data Base Management System for community diagnosis was used during two academic semesters with 80 baccalaureate nursing students. At the end of the two semesters the DBMS was evaluated from feedback obtained through faculty discussions, final student papers and oral presentations. The DBMS met the goals established to evaluate the tool. The clarification of categories for essential data is an ongoing process.
- American Nurses' Association. (1973). Standards for Community Health Nursing Practice. Kansas City, Missouri.
- Christianson, J.Z. (1977, March). A Community Data Base Record. Unpublished master of public health thesis, University of Texas Health Science Center, Houston, Texas.
- Stein, KZ., & Eigsti, DG. (1982). Utilizing a community data base system with community health nursing students. Journal of Nursing Education, 21(3), 26-32.