Discrepancies in learning needs assessments: whose needs are being assessed?
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Children and adolescents recently have become a group targeted for health promotion efforts. It is argued that early behavioral intervention will alter patterns of behavior that might place young people at increased risk for chronic diseases later in life. The Minnesota Heart Health Program is a longitudinal, community-based research and demonstration project to improve cardiovascular health in three north central communities. Reductions in cigarette smoking, improved eating and exercise patterns, and hypertension management are targeted objectives. To design educational interventions for children and adolescents in these areas as part of this program, a behavioral needs assessment was conducted in the communities prior to program implementation. This needs assessment focused on existing behavior patterns, skills related to the targeted behaviors, and environmental influences. This article describes that needs assessment, the results from two of the communities, differences due to gender and age of student, and the implications of the results for designing intervention activities for children and adolescents.
What are the mental health status and active treatment needs of nursing home residents? A stratified random sample of 828 residents in 25 facilities serving Medicaid recipients was assessed for levels of physical and psychosocial functioning. Although 91.2% had sufficiently high levels of medical and physical care needs to justify nursing home placement, 79.6% also had moderate to intense needs for mental health care. Older residents, relative to their younger counterparts, had more intense medical and mental health care needs. It was also found that psychiatric diagnosis was a poor indicator of mental health service needs, particularly among elderly individuals.
A needs assessment for a hospital-based dysphagia program was conducted to determine incidence, management procedures, and outcome for stroke patients with swallowing disorders. Using a chart review of 225 patients, it was found that 28% had documented evidence of dysphagia. When dysphagia co-occurred with stroke, significantly more functional problems and medical complications were reported, as well as increased need for dietary modifications and alternative feeding methods. The dysphagic patients were more often aphasic and dysarthric and less able to communicate. Mental status was more likely to be reduced and the need for staff supervision during mealtime was increased. Dysphagic patients had significantly longer hospital stays, thus increasing the cost of their care. At discharge, almost half of them continued to need feeding modifications, which may have delayed rehabilitation or transfer to facilities with other levels of care. The dysphagia group clearly displayed a wide range of clinical symptoms that would alert staff to their risk for medical complications because of swallowing problems. We believe that this needs assessment clearly showed that a multidisciplinary dysphagia management program has the potential to enhance patient care while decreasing the cost of health care delivery for the hospital.
Nurse educators routinely are asked to assess learning needs. Step-by-step guidelines for formulating and implementing an educational needs assessment are provided. The nurse educator who is familiar with conducting a needs assessment can obtain required baseline information to make decisions in various situations.
Giving of information to cancer patients and their family members regarding the disease, the treatment procedures and the adaptation process for living with the uncertainty inherent in a diagnosis of cancer, is as reported often not effective due to peoples' failure to understand. The impact of emotional stress creates communication difficulties. Information not based on assessed learning needs and considered individual differences as to learning militates against proper understanding. In developing an educational programme a study has been carried out aiming to assess learning needs. Cancer patients (n = 50), their family members (n = 20) and staff members within cancer care (n = 30) were asked to answer a need assessment questionnaire. The patients/family members indicated an extensive desire to learn about cancer and its ramifications, whereas staff members indicated that they seldom were approached regarding some questions in the area. The findings support the appropriateness for providing a structured patient education programme based on assessed needs and planned to meet individual differences in learning readiness and learning capabilities, that would complement the information currently given by staff members.
Confusion in defining needs assessment is discussed. A tripartite model of needs assessment is proposed: an identification of a problem; a statement about priorities; and a chosen solution. The parts can be used independently or linked together to plan new or altered services. Various needs assessment techniques are examined for their usefulness in each area. Two examples of needs assessment processes are given.
The advantages of census data-based needs assessment cannot be fully realized in the absence of demonstrated relationships between area characteristics and aggregate individual service need. This study sought to ascertain these relationships by using tract characteristics from the 1980 census to predict tract aggregate levels of individually measured social, physical, and psychological functioning. A census tract stratified sample of 3,465 permanent households in eastern Long Island, New York was used for the study. In each household, a randomly selected adult was surveyed regarding physical functioning, depressed mood, and social isolation. Stepwise multiple regression was used to determine which census variables best predicted the tract distributions of each of the functioning measures. Census variables explained from 23 to 30 percent of the variance in tract need level. Study findings have immediate utility for efficient needs assessment and suggest avenues for future improvement of needs assessment methods.
Mental health needs assessment has been encouraged by federal and state agencies for many years, and became a statutory requirement for some federally funded programs. There is still, however, no consensus on definitions of mental health need, methods for its assessment, or criteria to define successful needs assessment efforts. This review considers the separate components of needs assessment, together with techniques suitable for the measurement of each. Problems in defining the scope and boundaries of mental health need are reviewed, and then two general methods of assessment are described; epidemiologic surveys and social indicator analysis. Techniques, methodological issues, applications and limitations are discussed. Methods for assessment of current services which are needed to derive estimates of unmet need are reviewed. Finally, consideration is devoted to assessment of community desire for services, based on key informant interviews and surveys. In a concluding comment, the use of multiple data sources is recommended, selection of which should be determined by the goals of the particular study being conducted.
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The authors discuss the concept of Needs Assessment within the context of the planning process for chemical dependency treatment programs. The five basic Needs Assessment approaches are critically reviewed, and their application in specific forecasting models is addressed. Practical guidelines for the clinical planner using Needs Assessment techniques are discussed, and recommendations made for the type, timing, and frequency of assessment. The authors note the problems inherent in the multiplicity of methods used by various states, and call for a uniform approach to Needs Assessment.
Dental needs assessment surveys were completed in three Florida counties (1987 - Lee County), (1988 - Pasco County) and (1989 - St. Lucie County). The data collected were then compared with the results from the national caries prevalence surveys in 1979-80 and 1986-87, by individual county and with the combined three-county total. Visual tactile examinations were done using the Radlike criteria for the DMFS index and the WHO Treatment Needs Index. Schools were selected based on the percent of students enrolled in the free or reduced lunch program and by geographic distribution. Although there were age group differences within individual counties, the combined data showed every age group except the seven year olds at a lower DMFS mean level than the data from the 1986-87 national survey for Region IV. The differences range from -.20 surfaces in 8-year-olds to -.57 surfaces in 13-year-olds. None of the differences were statistically significant from the national surveys. This indicates that these small scale surveys are a reliable method for needs assessment.
A 21-item observation tool developed by one of the authors was used to assess learning needs of 30 registered nurses who regularly suction intubated patients. Of the nurses observed, 97 percent had excellent regard for proper equipment utilization and 91 percent for maintenance of sterile environment. These high percentages were responsible for pulling the overall average scores to 65 percent, thus partially disguising the acute need for patient assessment (38 percent), psychological support (57 percent), and procedure (62 percent). Scores for subgroups of nurses--associate degree (group 1), diploma (group II), And baccalaureate (group III)--were 72, 69, and 65, respectively. Of particular concern were low scores in the assessment and psychological support categories. Despite increased emphasis on both of these areas in nursing programs in the last decade, AD graduates received scores of 52 and 57 percent while diploma graduates received scores of 38 and 58 percent and baccalaureate graduates received scores of 26 and 55 percent.
Learning needs assessment is a major concern of nursing staff development educators. This contact hour feature provides nursing staff development educators with information necessary to understand the needs assessment process.
This article describes the process of developing a learning needs assessment. The process includes developing a tool, collecting data, and analyzing results. Understanding the needs assessment process and the pitfalls to avoid may assist educators in implementing their own learning needs assessments.
A marketing needs assessment was undertaken as a community health project for baccalaureate nursing students. The objective of the project were: (1) to conduct a needs assessment utilizing the concepts of marketing in health planning, and (2) to identify health needs of a community based on active participation by members of the community. Through a collaborative effort with a community health agency, students were able to integrate the principles of marketing and participative decision-making into a learning experience. The results of the needs assessment provided the agency with valuable information for strategic planning.
Competency-based needs assessment surveys can be useful in assessing worker training needs in child welfare. Worker and supervisor surveys, consisting largely of task-based ability statements, constitute the core of this approach. Additional information can also be obtained from supervisors and allied professionals. Data from a study of 276 frontline child welfare workers in Alaska and Oregon are used to illustrate the utility of this approach.
A nutritional needs assessment was conducted among rural agricultural migrant women (target group) and children (less than 5 years). The study was conducted in Vila Diogo, a slum located on the periphery of Nuporanga, a village in Sao Paulo state, Brazil. A nutrition education program was designed on the basis of evidence obtained from demographic/socioeconomic information of the study population and a nutritional needs assessment of women (target group) and children less than 5 years of age. The nutritional needs assessment consisted of anthropometry, dietary assessment, and nutrition knowledge, attitudes, and beliefs questionnaires. Formative and summative evaluation of the nutrition education program, using appropriately selected criteria and comparisons of nutrition knowledge scores before and after the program, were used to determine program effectiveness. Major findings of the study were: Diets of Vila Diogo residents were generally simplistic, consisting primarily of rice, beans, and coffee with sugar. Vila Diogo women appeared to be at a relatively high risk for vitamin A, iron, calcium, ascorbic, and riboflavin deficiencies, based on comparisons of 24-hour dietary intake data with FAO recommendations. Children (2-5 years) appeared at high risk for vitamin A, iron, and ascorbic acid deficiencies, based on comparisons of 24-hour dietary intake data with FAO recommendations. All children less than 5 years of age had been breast-fed at birth, but more than one half of children had been weaned by the third month. Infant feeding practices during fever and diarrhea were nutritionally detrimental. Women generally recognized a relationship between dietary intake during pregnancy and fetal nourishment. Using weight-for-height index, a significant number of women were probably undernourished; a small percentage of women, however, were overweight or obese. Although children less than 5 years of age did not generally appear malnourished, a relatively large number were stunted in growth. Although Vila Diogo women reported many food taboos during various physiological states (menstruation, pregnancy, immediately post partum, lactation), relatively few food taboos had potentially negative nutritional consequences. For women who participated in the nutrition education program, nutrition knowledge scores after the program showed improvement which was statistically significant at alpha = 0.05, using Wilcoxon signed rank test.