WINDSHIELD SURVEY OF NASHVILLE-HYPERTENSION IN AFRICAN AMERICAN
My Focus for this course is incidences of hypertension in african american populatons, nashville tn is my focus city.
Comments from Customer
these are additional instructions from the instructor
I wanted to provide more clarity to the expectations for week 3 writing assignment. You are required to use at least 3 scholarly sources (references). Websites do NOT count as scholarly sources. You can use websites especially for collecting the demographic data, but they do not count as scholarly sources. Do let me know if you have any questions.
You all have aptly described the populations to be discussed for this course. Do be sure to also review the refereed literature for your identified problem.
How will the exploration of your chosen population and the depth of discovery impact your own nursing practice? Will you be able to apply a broader nursing perspective within your current practice?
Conduct a “Windshield Survey” in a section of your community. Instructions for the survey can be found in Stanhope and Lancaster (2016) on page 416, Table 18-6. As you notice, conducting a Windshield Survey requires that you either walk around or drive around a particular section of the community and take notes about what you observe. A Windshield Survey cannot be conducted by reviewing websites or Google Earth only. It requires actually taking a look at the selected area of the community. This survey should be focused on the problem and population you have selected for your practicum project. If you choose, for example, obesity among Hispanic schoolchildren, you might want to locate a section of the community where many Hispanic children live, or you might want to conduct the Windshield Survey around where Hispanic children attend school. If Hispanic children are not found in a specific section of your community (e.g., Chinatown in San Francisco or Harlem in New York), then you may select the section of the community where you live or work but pay particular attention to your practicum population and practicum problem as you conduct a survey of the community as viewed through the eyes of the public health nurse.
By Day 7 of Week 3
Submit a 3- to 4-page paper including:
- Introduction to the community, including the name of the community and any interesting or historical facts you would like to add about where you live
- Photographs of the selected area of the community that serve as evidence of your observations and hypotheses
- Windshield Survey findings, including a description of the section of your community that you chose to survey
- Description of the Vulnerable Population and Available Resources
- Demographics of the vulnerable population
- What social determinants create their vulnerable status?
- What community strengths exist to assist this population?
- Conclusions based on Nursing Assessment of the Community
- Based on what you have found, what conclusions can you draw about your community and your selected population for your practicum?
- Select at least 5 scholarly resources to support your assessment. Websites may be included but the paper must include scholarly resources in its development.
For this Assignment, review the following:
- AWE Checklist (Level 4000)
- BSN Program Top Ten Citations and References
- Walden paper template (no abstract or running head required)
- The Assignment 3 Rubric
See below for additional instructions from our text book
Community Systems: Potential Measures
|Safety and Transportation|
|• Crime rates and trends
• Traffic accidents and fatalities
• Fire stations and emergency responders and response times; publicly paid or volunteer?
• Police protection and public perception thereof
• Highway system and road conditions
• Availability of public transportation in, out of, and around the community
• Commuters to and from the community and methods of commute
• Child car seat assistance
|Politics and Government|
|• Type of local government
• Budgets for public services/systems
• Diversity in government offices match to community diversity (e.g., mayor, board of supervisors, etc.)
• Local tax base and taxes levied
• Party affiliation of county majority
|• Average income
• Percentage of families who own their homes
• Automobile ownership
• Number of children eligible for free lunches
• Unemployment figures/types of jobs available
• Families on unemployment compensation
• Percentage of food stamp recipients
• Poverty statistics
• Industries in place/largest employers/size of most businesses
• Available child care
|• Number and types of primary and secondary schools (public vs. private)
• Number and access to community and four-year colleges or universities
• Preschool classes available
• Early intervention home visiting programs
• Average educational achievement of population
• Primary and additional languages of community
|• Local parks and park management
• Safe playgrounds
• Type of recreational businesses (bowling alleys, adult bookstores, movie theaters)
• Sports teams, youth and adult; sports arenas/fields
• Biking trails/lanes
• Track or running trails, tennis courts
• Activity clubs (garden, hiking)
• Senior center(s)
• Local festivals/fairs
|Health and Social Services|
|• Hospitals, health clinics/medical offices, specialists
• Health department and programs
• Free clinic
• Social service department
• In home care provision (i.e., hospice, maternal child programs)
• Statistics on child and elder abuse, sexual assault
• Immunization status of community members
• Home health care team
• Percentage of Medicaid families in community
• Percentage of population on disability and ages of those disabled
• Obesity rate: adults and children
• Mental health clinic(s)
• Cell phone carriers and availability of service
• Internet connections
• Radio and TV stations
• Community bulletin boards (check post offices and central places)
• Informal sources of information and communication
|• Age and condition of housing
• Physical terrain and potential for environmental disaster (hurricanes, tornadoes, etc.)
• Proximity to Superfund sites (pollution)
• Water and air quality
• Industrial pollution
• Natural environment
ADDITIONAL ON THE RECOMMENDED PAGE
The Seven “A’s”
Once the PHN has identified and cataloged the systems of the community, then it is most helpful to measure their effectiveness. One method that can be used to evaluate adequacy of services or systems in a community is the “7 A’s.” A series of queries about a service or system’s effectiveness in reaching the community can be used with any of the above listed community components. The 7 “A’s” are awareness, access, availability, affordability, acceptability, appropriateness, and adequacy (Truglio-Londrigan& Gallagher, 2003). Asking questions about an agency or service using the 7 “A’s” can help to identify how well the service or system is meeting the needs of the community. Box 18-4 explains how to use the 7 “A’s” to craft questions to assist in gauging the value of existing services, or in identifying assets in the community or opportunities for improvement.
Using the 7 “A’s”
- Is the community awareof its needs and of the service?
- Is it accessibleto community members?
- Is the service availablewhen the community needs it?
- Can the community members affordthe service?
- Does the community find the service acceptable?
- Is the service adequateto meet the needs of the community?
- Are the services appropriateto meet the needs of the community?
Once the data are assembled, you will have stacks of papers and multiple computer files. One systematic way to organize your data is to follow a pattern of collating the information according to the section of the assessment and the systems. Follow the model that you have chosen to order your information. You can create tables of census and demographic data, indicating a comparison of your community’s data to state data and national data. Identify ages, gender, marital information, births and infant deaths, race or ethnicity, and density of the population and assemble the information into a table. This helps you to see the information at a glance. Identify whether the population in your community is on the rise or declining and which age and ethnic/racial groups are increasing or decreasing. How many families live below the poverty level? These items of information can pinpoint areas where needs may be increasing. Census data provide rich information about how many people live in your community and historic data about population size, composition, and income. Be sure that your data are the most recent and that when you compare data that you are comparing data reported in the same format and from a reliable source.
Next, organize all data, primary and secondary, related to each of the systems. You may decide to make tables about these data as well and make a report on the data available for each system. Be sure to include the community assets you have identified for each system, as well as any observed deficiencies. Do the perceived issues of the community match your secondary data? Synthesize the data into a coherent report based on each system (See QSEN box).
Focus on Quality and Safety Education for Nurses
Targeted Competency: Client-centered Care
Recognizes the client or designee as the source of control and as a full partner in providing compassionate and coordinated care that is based on the preferences, values and needs of the client
Knowledge: understanding of multiple dimensions of client-centered care
Skill: for individual, family, aggregate, or community elicits values, preferences, and expressed needs as part of clinical interview
Attitude: support care for each client level whose values differ from one’s own
The Quad Council core competency of analytic and assessment skills indicates the beginning PHN should collect data, both quantitative and qualitative, to be used in community assessment. The PHN then assesses data collected as part of the community assessment process to make inferences about clients (values, culture, preferences for health care)
In order to develop, revise, or even improve community health care delivery, how would the PHN use the outcomes of the community assessment? What steps would the nurse take to make change based on client choice?
Morbidity and mortality data should be tabulated identifying the top three causes of morbidity and mortality and also comparing the local data to the state, national, and previous years’ local data. Are there conditions in the causes of illness or death that are rising or declining? Looking at this information and linking with the information derived from primary data 416will help focus priorities. Identifying health indicators such as obesity rates, smoking rates, and causes of morbidity and mortality can clarify the needs of the community.
Identification of Health Assets and Challenges
Once you have pulled together your data into an organized format, the community problems and strengths should emerge. Using a targeted form like Santa Cruz County’s “snapshot” (see Figure 18-6) will help you to see these in a clear way. While the “snapshot” addresses six systems, you can expand this to the size needed to reference your community. With the resulting “list” of identified problems and assets, you will be ready to prioritize your results.
FIG 18-6 Snapshot of Santa Cruz County. (http://www.appliedsurveyresearch.org/storage/database/quality-of-life/santacruzcap/cap15_2009/CAP15_Full_Report.pdf).
Once the data are collated and clarified on paper, the themes can be placed in the context of the earlier identified community priorities reflected in your primary data. In this way, community involvement and input in the assessment process will make your assessment and planning relevant to the community, and create the opportunity to meet the community’s identified needs. At the same time, try to identify within your secondary data a rationale for the community’s identified need. In other words, you might compromise. Attempting to implement programs that are not recognized as most relevant by the community can result in lack of community buy-in and ultimate program failure.
For example, though secondary data may document that increased mortality due to heart disease should be the community’s highest priority, as evidenced by higher than average mortality from heart disease, the community might see a different need, such as elder care or child care, as the highest priority. There is no clear guide in this prioritizing process, but testing ideas about perceived need and actual data-driven information with community stakeholders and key informants helps the PHN come to an optimal way to prioritize problems and identify target areas for improvement. Just as in the hospital setting, make the patient (in this case the community) the center of your focus. Box 18-5 can assist you in steps to prioritize the community problem list. Identifying the top three community 418problems or needs should then lead to creating the priority nursing diagnoses (see Use of Secondary Data Sources).
Problem Priority Criteria
Criteria that have been helpful in ranking identified problems include the following:
- Community awareness of the problem
- Community motivation to resolve or better manage the problem
- Nurse’s ability to influence problem solution
- Availability of expertise to solve the problem
- Severity of the outcomes if the problem is unresolved
- Speed with which the problem can be solved
Shuster, G: Community as client” assessment and analysis. In Stanhope and Lancaster (editors), Public Health Nursing, Population-centered health care in the community, ed 8, 2012 Elsevier, St. Louis, Mo.
The ethical concepts of utilitarianism and justice can help you navigate the negotiations and advocacy inherent in prioritizing one health problem over another. Utilitarianism means doing the most good for the most people, so a priority problem would ideally be one that affects a large proportion of the community. However, justice focuses on the fair distribution of resources among all people. Social justice means advocating for the most vulnerable populations in a community, to ensure that their problems receive higher priority than the problems found throughout the general population. For example, secondary data might find that infant mortality occurs rarely in the community; but if there is a wide disparity among racial groups in infant mortality rates, social justice would call for this problem to be given higher priority in order to address underlying determinants of health that may cause the disparity.
The community health nursing diagnosis in this phase of the process helps clarify the prioritized problems and is an important first step to planning. Community diagnoses clarify the target population for care and identify the factors contributing to the identified problem. As the analysis of the data proceeds, the nursing care plan can be formed. In the planning phase, community-focused interventions are identified, along with ways to measure outcomes.
There are several standardized classification systems to accommodate this diagnosis formation. North American Nursing Diagnosis Association (NANDA) and the Omaha system are two prominent systems of classification. NANDA may require some adaptation to the community for certain diagnoses; Carpenito’s Nursing Diagnosis: Application to Clinical Practice (based on NANDA) does recognize several community diagnoses and health seeking behaviors that can apply to communities (Carpenito, 2013, pp. 797-816). The Omaha system includes domains and problem classifications that are specific to community health.
The NANDA system outlines the systematic nursing diagnosis process by identifying the (1) problem or potential problem; (2) its relation to factors, stressors, or health issues; and (3) then supporting data that document the problem. The identification of the problem in the NANDA classification has strict parameters dividing problems into categories and systems. This can be confining when working within the community as client, since even though the NANDA classification system does offer several community-based diagnoses, it is more focused on individuals or families. For more information on NANDA nursing diagnosis, please consult Carpenito (2013), http://www.nanda.org or the nursing diagnosis text recommended by your faculty.
The Omaha system was developed by visiting nurses and expands beyond the physiological domain and includes environmental, psychosocial, and health-related behaviors domains. In addition to the problem, the Omaha system addresses the intervention scheme and the problem rating scale for outcomes. Omaha-based computer software applications are available to streamline electronic records (Omaha System, 2014). The Omaha system website, http://www.omahasystem.org, contains case studies and full explanation of the use of its standardized taxonomy and problem oriented approach.
Community nursing diagnosis language must describe at the aggregate level—in other words, the community level—responses to actual and potential illnesses and life processes. This also means that the defining characteristics for community diagnoses must be observable and measurable at the aggregate level. To do this, community-level data must be used. Epidemiologic supporting data or community survey data are two examples of community-level data. The comparison of local data with state, regional, or national data, as rates and across multiple years, is one key means of identifying community-level problems, as well as patterns and trends.
The community nursing diagnosis, no matter which classification system the PHN uses, then leads to expected outcomes and evidence-based health promotion strategies to address and improve the problem identified in the diagnosis. This becomes the nursing care plan. The expected outcomes and evaluations derived from the nursing diagnosis systems suggest subsequent evaluation measures for identified needs or problems. Just as problems are recognized and prioritized, so can strengths be identified that may offer avenues through which the PHN can address existing challenges facing the community.
Linking Content to Practice
In this chapter, the focus is placed on the partnership between the public health nurse and the community throughout the process of community assessment, problem identification, planning, intervention, and evaluation. One of the Institute of Medicine’s (IOM) three core functions of public health is assessment. The process of community assessment outlined and described in this chapter closely follows The Council on Linkages’ Core Competencies for Public Health (adopted June 11, 2011). This includes the need for public health nurses to “maintain partnerships with key stakeholders.” Among other identified competencies for public health providers, including public health nurses, is the ability to “assess the health status of populations and their related determinants of health and illness.” This chapter presents the means by which public health nurses can construct a composite database containing assessment data from a wide variety of sources. This initial community assessment phase also directly links with The Quad Council Domains of Public Health Practice: Domain #1: Analytic Assessment Skills; Domain #5: Community Dimensions of Practice Skills; and Domain #6: Basic Public Health Sciences Skills. The Council on Linkages: Core Competencies for Public Health also emphasizes the public health nurse’s ability to describe “the characteristics of a population-based health problem.” Development of goals and objectives along with their problem correlates as part of the community health assessment directly relates to this competency; whereas another Council on Linkages competency—“Develops a plan to implement policy and programs”—directly relates to the development of intervention actions described in this chapter.
Program Planning, Implementation, and Evaluation
Once interventions and evaluation measures are identified through the nursing diagnosis framework, the PHN arrives at a new step in the nursing process—the program planning phase. This includes analyzing and establishing priorities among 419community health problems already identified through nursing diagnosis, establishing goals and objectives, and identifying intervention activities that will accomplish the objectives. These interventions must be clearly supported by the community stakeholders in order for the community to buy in to the identified program plans. Intervention activities, the means by which objectives are met, are the strategies that clarify what must be done to achieve the objectives or the ways change will be effected. The next phase of the nursing process is program implementation. This involves enacting the plan for improved community health using the identified goals and objectives.
Finally, upon implementation of the program and by using the established evaluation measures, the PHN can measure the success of the program and determine community satisfaction with the outcome. These evaluation criteria will already be identified through the nursing diagnosis format chosen.
Program planning and implementation should be based on the community’s problems AND its strengths, as well as the priorities of the community members. If the identified problem is not resolved to the satisfaction of the community at large following program implementation, the PHN will return to the data-gathering phase and begin the process again using the updated data. As shown in Figure 18-2, this can be an ongoing, circular process, just like the nursing process. Program management, encompassing program planning, implementation, and evaluation is discussed in detail in Chapter 25.
Lily, a nurse in a small city, became aware of the increased incidence of respiratory diseases through contact with families in the community and the local chapter of the American Lung Association. During family visits, Lily noticed that many of the parents were smokers. Because most of the families Lily visited had small children, she became concerned about the effects of secondhand smoke on the health of the infants and children in her family caseload.
Further assessment of this community indicated that the community recognized several problems, including school safety and the risk of water pollution, in addition to the smoking problem that Lily had identified during her family visits. Talks with different community members revealed that they wanted each of these identified problems “fixed,” although these same community members were uncertain about how to start. In deciding which of the three identified problems to address first, which criterion would be most important for Lily to consider?
- The amount of money available
- The level of community motivation to “fix” one of the three identified problems
- The number of people in the community who expressed a concern about each of the three identified problems
- How much control she would have in the process
Answers can be found on the Evolve site.
- Most definitions of community include three dimensions: (1) networks of interpersonal relationships that provide friendship and support to members, (2) residence in a common locality, and (3) shared values, interests, or concerns.
- A community is defined as a locality-based entity, composed of systems of formal organizations reflecting societal institutions, informal groups, and aggregates that are interdependent and whose function or expressed intent is to meet a wide variety of collective needs.
- A community practice setting is insufficient reason for stating that practice is oriented toward the community client. When the location of the practice is in the community but the focus of the practice is the individual or family, the nursing client remains the individual or family, not the whole community.
- Population-centered practice is targeted to the community—the population group in which healthful change is sought.
- Community health as used in this chapter is defined as the meeting of collective needs through identification of problems and management of behaviors within the community itself and between the community and the larger society.
- Most changes aimed at improving community health involve, out of necessity, partnerships among community residents and health workers from a variety of disciplines.
- Assessing community health requires gathering existing data and interpreting the database.
- Five methods of collecting data useful to the nurse are analysis of existing secondary data, and primary data collection through informant interviews, participant observation, surveys, and windshield surveys.
- Nurses should identify and partner with gatekeepers, formal or informal community leaders, to gain entry or acceptance into the community.
- The planning phase includes analyzing and establishing priorities among community health problems already identified, establishing goals and objectives, and identifying intervention activities that will accomplish the objectives.
- Once high-priority problems are identified, broad relevant goals and objectives are developed; the goal is generally a broad statement of the desired outcome while the objectives are precise statements of the desired outcome.
- Intervention activities, the means by which objectives are met, are the strategies that clarify what must be done to achieve the objectives, the ways change will be effected, and the way the problem will be interpreted.
- Implementation, the next phase of the nursing process, means transforming a plan for improved community health into achieving goals and objectives. This essentially is the implementation of the program.
- Simply defined, evaluation is the appraisal of the effects of some organized activity or program.