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Nurses who are residents of Johnson County, IN, were invited to attend a parish nurse course at a local university in the fall of 1996 to learn how to deliver holistic primary health care in centers of faith. In exchange for tuition, each agreed to develop a parish nurse practice at their own local church that would promote wellness and screen for possible health problems.
The nurses are taught to survey their church population to determine the needs of members. For example, if there are a lot of asthma cases, the nurse would focus education efforts on that disease.
"We recognize that people can’t always come to the hospital for services, so we are trying to find places where we can take health promotion to people in the community," says Janette Helm, MA, RN, director of education and training at Johnson Memorial Hospital in Franklin, IN.
To identify areas of need in the community and create avenues for outreach such as the parish nurse program, the board of trustees at Johnson Memorial formed a community alliance in 1994. Previously, community service and education classes were based on request. "The trustees wanted to determine if the hospital was reaching the community or if there were other, more valuable, services people would be more likely to participate in," explains Helm.
The alliance began with the formation of two advisory groups. One group consisted of professionals in businesses unrelated to health care. The other consisted of health care professionals from such institutions as the county health department and long-term care facilities.
A year later, the groups were joined to form Partnership for a Healthier Johnson County. The purpose of the partnership was to determine what types of health promotions, health education, and community services were needed. A local businessman heads the partnership. "We wanted it to be a community effort. Therefore, we thought it best to have a leader in place that was not affiliated or employed by the hospital," Helm explains.
Several programs have been initiated as a result of the partnership. Seniors were given free flu shots at convenient sites around the county. Roughly 1,200 flu shots were administered in 1995 and 1,500 in 1996.
A low-income clinic was set up in a church. It is open every Saturday morning and is staffed by volunteer doctors and nurses. Also, a program was established to provide free mammograms to women without health insurance who can’t afford the out-of-pocket expense. "We’re trying to reach people who don’t have access to services. That’s been a real problem," says Helm.
Shortly after the partnership was created, committees were formed to help identify and gather information in areas of concern. "Some people involved in the partnership were interested in reviewing data from state and local health departments to determine community needs; others were interested in issues involving youth," explains Helms. Also, the core group of about 40 people was too large to effectively put plans into place and could work more efficiently in small committees. Committees included:
• dependent care including elderly as well as children;
• maternal and child health concerned with keeping pregnant women, as well as children, healthy; they worked on the low-income clinic project specifically designed to meet the needs of women with children;
• publicity and legislative issues;
• health promotion and disease prevention;
• substance abuse;
• research reviewed data and supplied the other committees with their findings.
When proposing a project, committees must create a budget and submit the proposal to the executive steering committee that is made up of all the committee chairs and the person who heads the partnership.
The Johnson Memorial Hospital Foundation initially pledged $100,000 to form the partnership and get projects started. The trustees later voted to commit 10% of the hospital’s net profit to funding the projects created by the partnership. Although participation in the partnership is volunteer, funds for projects such as the free flu shot campaign and low-income clinic are needed.
"The hospital foundation knew they would have to put some money into these projects upfront to get some results so people could see what the partnership was capable of doing, and once we had some success stories, we would be more likely to get money from other sources. Now we are asking other organizations to financially support the foundation," says Helm.
To verify that they were on the right track and gather more data to obtain outside funding, the partnership contracted with the Indiana University School of Public and Environmental Affairs for a formal community needs assessment. The university used focus groups and telephone surveys to compile the information.
"Although we spent $10,000 on the assessment, I think it is important for people to understand that there are other ways of getting the information without going to the expense that we did," says Helm. "I wouldn’t want people to be discouraged if they can’t afford to have such massive data collection done. There are other sources you can look at to get information."
She suggests inserting surveys in hospital newsletters as well as reviewing data from state and local health departments. Creating a community alliance garnered much of the information Johnson Memorial needed. They had proof of the partnership’s success when the assessment showed no great need for much change in the committee structure.
Although the existing committee structure was basically sound and addressed most of the needs in the community, the formal assessment showed that mental health issues were a major concern. The partnership was surprised to learn that psychosis was the leading admitting diagnosis for Johnson County residents in the 5- to 14-year-old age group, and the number three and four admitting diagnosis for other age groups. "It kept reappearing in these different groups of people and in the telephone survey when [university surveyors] asked questions about mental health. Twenty-five percent of the respondents reported they had one or more symptoms of depression some time during the last month," says Helm.
After the university issued its report in August 1996 on the needs of the community, the substance abuse committee began discussing ways to improve the mental health of the community. An eight-week course offered during lunch on how to manage stress is being considered. Providing mental health education through the parish nurse programs or local schools also is an option.
To date, there has been no analysis of the effectiveness of the community programs initiated by the partnership. However, the formal needs assessment will provide the baseline information to determine the success of these educational programs and services. The partnership now can look at future data from local health departments to see if there have been any improvements from their efforts, says Helm.
[For more information on creating a partnership to improve community outreach efforts, contact Janette Helm, director of education and training, Johnson Memorial Hospital, 1125 West Jefferson St, Franklin, IN 46131. Telephone: (317) 736-3239. Fax: (317) 736-2692.]