Running head: COMMUNITY AS PARTNER 1

Community as Partner Plan of Care for Census Tract 004026

Kelly Conrad, Melina Miller, Sydney Reed

University of Arizona College of Nursing

COMMUNITY AS PARTNER PLAN OF CARE 2

Community as Partner Plan of Care for Census Tract 004026

This paper will focus on the information gathered from the community assessment conducted

on Census Tract (CT) 004026 to create a nursing diagnosis and nursing plan. The information

was gathered by windshield surveys, interviews, and online resources from October 5th to 26th.

The information was used to create an education plan about preventing influenza infection to

educate 65-year-old and up community members at a local church. Church members filled out a

post-evaluation survey to determine the effectiveness of the educational session.

Community Nursing Assessment

Core

The core of the CT had a higher percentage of white community members than the percentage

of Pima County; additionally, the population of the CT had less than half of the percentage of

Hispanic ethnicity than the percentage of the Pima County community. Most of the households in

the CT spoke English only and there was a significantly smaller portion of Spanish-speaking

households in the CT than the portion of Pima County. There was a higher population in the CT

of community members above 45 years of age than Pima County. The CT had 10 places of

worship, including five religions (Pima County Health Department Public Health Nursing

Community Profile CT 4026, 2017).

Physical Environment

The CT was located between Broadway Boulevard and Escalante Road, and between Freeman

Road and Harrison Road. Most of the houses were built between 1960 and 1979, a higher

percentage than Pima County. Almost all the houses in the CT were single family houses (99.5%

of houses in the CT compared to 66.7% of Pima County) with no multiplex houses or mobile

homes. Additionally, there was a large amount of new housing developments being built (Pima
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County Health Department Public Health Nursing Community Profile CT 4026, 2017).

Health and Social Services

The CT was somewhat limited for health and social services directly inside of the boundaries.

The closest hospital was Carondelet St. Josephs Hospital and there were no senior centers directly

inside the CT. The CT did have access to three urgent cares, two of which bordered the CT. There

was a Walgreens Pharmacy inside of the CT with five other pharmacies that surrounded the CT,

including a CVS Pharmacy which had a Minute Clinic inside. There were three social and health

services in the CT: Rescue Helpers Inc., Save the Cord Foundation, and Adventures in Awareness

(Pima County Health Department Public Health Nursing Community Profile CT 4026, 2017).

Education

The CT community was very well educated, exceeding the Pima County community with their

educational levels. 97% of the CT community members had a high school degree or above and

36.9% of the CT community had a bachelors degree or above, compared to 30.3% of Pima

County. The students of the CT attended the Tucson Unified School District and Tanque Verde

Unified School District. There were two schools located inside of the CT, Academy of Tucson

High School and Dunham Elementary School. There was no library inside of the CT, but Miller-

Golf Links Library bordered the CT (Pima County Health Department Public Health Nursing

Community Profile CT 4026, 2017).

Economics

The median household income of the CT was higher than Pima County median, and there was

a significantly lower percentage of female householders without husband and people living in

poverty in the CT compared to the Pima County percentage. There was only one strip mall inside

the CT with a variety of different stores. Also, there was a farmers market inside the CT which
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was open on Saturdays (Pima County Health Department Public Health Nursing Community

Profile CT 4026, 2017).

Transportation and Safety

Transportation inside of the CT was limited. While there were 10 bus stops and 2 bus routes

that were located inside the CT, those bus stops only went along the west side of the CT. Some of

the neighborhood streets inside the CT were not well lit and not in the best condition. Furthermore,

some of the intersections in the CT might have been possible road hazards at night (Pima County

Health Department Public Health Nursing Community Profile CT 4026, 2017).

Safety was a concern inside the CT. While some community members stated that the CT was

safe enough to leave houses unlocked, other community members said that shoplifting and petty

crimes were a problem. There were 27 registered sex offenders living inside the CT and over 300

crimes reported in the last 6 months. There were no security guards noticed during a windshield

survey as well as there were no fire stations or police stations within the CT (Pima County Health

Department Public Health Nursing Community Profile CT 4026, 2017).

Recreation

The CT was in a great area for recreational activities. The CTs east boundary of Saguaro

National Park provided the CT with access to many trails. Inside of the CT, there were two trails

and two green spaces. Some of the streets inside the CT had nicely paved sidewalks and bike paths

(Pima County Health Department Public Health Nursing Community Profile CT 4026, 2017).

Politics and Government

During the windshield survey, numerous political posters were seen. Half of the CT was inside

the city limits and half was outside the city limits. The CT was in two different City of Tucson

Wards, Wards 2 and 4, and had two Democratic members. The CT was in County District 4,
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supervised by a Republican. There were two State Legislative Districts in the CT. District 10 was

comprised of a Democrat Senator and two Democrat and Republican Representatives. District 14

was comprised of three Republicans. Representative Martha McSally (Republican) ran U.S.

Congressional District 2 (Pima County Health Department Public Health Nursing Community

Profile CT 4026, 2017).

Communication

There were no payphones or billboards seen in the CT during the windshield survey.

Starbucks and McDonalds, both directly outside the CT, had newspapers for sale, free WiFi, and

bulletin boards for community events (Pima County Health Department Public Health Nursing

Community Profile CT 4026, 2017).

Community Nursing Diagnosis

Strengths

One strength of the CT was that multiple trails were present throughout, including bike paths,

sidewalks, and a nearby trailhead, promoting the community to live an active lifestyle.

Additionally, a key informant described the community as safe and supportive (Server at

Saguaro Corners Caf, personal communication, October 12, 2017). Another strength was the

adequate access to healthcare in the community, including the Minute Clinic inside the CT and

the Walgreens Healthcare Clinic and Next Care Urgent Care directly outside of the CT (Pima

County Health Department Public Health Nursing Community Profile CT 4026, 2017).

Stressors

One stressor of the CT, as stated in key informant interviews, was the lack of vaccinations in

the community, particularly in the elderly population (Minute Clinic Nurse, personal

communication, October 5, 2017). Another stressor, as stated by key informant interviews, was
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that the elderly population in the community was extremely large in the wintertime (snowbirds).

This population tended to have many health issues, including prescriptions to numerous

medications, frequent falls, and a declining mental health (Pharmacist, personal communication,

October 5, 2017). Finally, the minimal street lighting on rural roads at night seen in the

windshield survey could have led to dangerous driving conditions (Pima County Health

Department Public Health Nursing Community Profile CT 4026, 2017).

Priorities of Care Table

The Priorities of Care Table was used to help rank which health concern would be of highest

priority for the community (see Appendix A for the Priorities of Care Table).

Nursing Diagnosis

The nursing diagnosis for the CT was risk for influenza infection amongst elderly population

within CT related to lack of flu shot coverage, lack of knowledge, misinformation, and age as

evidenced by key informant statements supporting poor flu shot coverage in CT.

Community Nursing Plan

Good Goal

The proposed Good Goal was to reduce flu among the 65 year and older population in

Census Tract 4026.

Proposed Intervention

The intervention that we implemented was an educational session targeted at a population of

adults ages 65 years and older that emphasized general education about the flu and the flu

vaccine. This intervention included a poster board with associated information and a 10-minute

presentation about the information (see Appendix B for pictures of the poster boards). The

guiding information came from the Center for Disease Control (CDC). The education session
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was presented by Kelly Conrad, Melina Miller, and Sydney Reed to a Bible study group

comprised of adults 65 years and older at Pantano Christian Church on Friday, November 3,

2017. It included a short game of Myth Versus Fact that attempted to debunk common flu

myths and provided information on the virus, the vaccine, and the symptoms (see Appendix C

for the educational handouts). Following the education session, we answered questions from the

audience and gave the audience evaluation forms and handouts on the flu.

Evidence-based Support from the Literature

In a study conducted by Worasathit et al (2015), attitude about the influenza vaccine was an

important determining factor for elderly to willingly receive the vaccination. The researchers

conducted a quasi-experimental study in Bangkok, Thailand among an elderly population of

2,693 older adults (80% female and 20% male) all older than 60 years (24% were 60-64, 55%

were 65-74, and 21% older than 75). The population had a low education level about the

influenza. The study conducted an education program using a video to inform the adults about

the facts of influenza, that used simple and intriguing graphics with simple phrases and easy to

use words. After the interventions, the group had a more positive outlook on the influenza

vaccine and showed to have an improved level of knowledge about the flu as stated in the article,

promoting a positive attitude toward influenza infectionis a potentially effective method of

increasing vaccination acceptance and immunization coverage (Worasathit et al, 2015).

Our intervention was built off the idea to improve knowledge and attitude about the flu. As

previously state, our key informant interviews with health care workers identified a general lack

of knowledge and a negative outlook on vaccinations in the CT. The goal was to reduce the flu

in the elder population and this article revealed that education about influenza and the vaccine is

an essential part in improving the attitude about the vaccine; thus, reducing the flu amongst this
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population. Additionally, our population had an increased knowledge about influenza in general,

which could have led to decreased transmission and occurrence in this population. Like the

study, we used simple graphics and short phrases to improve education.

Healthy People 2020 Support

The most applicable overarching Healthy People 2020 goal related to this community project

was attain high-quality, longer lives free of preventable disease, disability, injury, and

premature death because in our intervention we tried to decrease the occurrence of flu in the

population (Office of Disease Prevention and Health Promotion, 2017). This intervention falls

under the topic for Older Adults and targets the goal of improv[ing] the health, function and

quality of life of older adults (Office of Disease Prevention and Health Promotion, 2017). The

intervention was related to the second objective for older adults, OA-2, that states increase the

proportion of older adults who are up to date on a core set of clinical preventative services due

to our educations focus of the preventative measure of influenza vaccination (Office of Disease

Prevention and Health Promotion, 2017).

Current Policy

Currently, the CDC, the Advisory Committee on Immunization Practices (ACIP), and the

Healthcare Infection Control Practices Advisory Committee (HICPAC) officially recommend

that all U.S. health care workers get vaccinated annually against influenza (Center for Disease

Control and Prevention, 2017).

SMART objectives

Our first SMART objective was that 75% of church members ages 65 and older that we

spoke to during the education project will state that they support the flu vaccine by the end of the

presentation. Our next SMART objective was that of the church members ages 65 and older that
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we spoke with who did not previously plan to receive the flu vaccine, 25% will state that they

plan to or will consider receiving it this flu season by the end of the presentation. Our final

SMART objective was that of the church members ages 65 and older that we spoke with, 75%

will be able to complete a question and state one population that is at risk and two symptoms of

the flu vaccine by the end of the presentation.

Program Plan

Activity statements provided: On October 6th, 2017, we will get into contact with a pastor at

Pantano Christian Church to discuss the possibility of interviewing them. On October 26th, we

will interview the pastor as a key informant and discuss the possibility of an educational project

on the importance of the flu vaccine. On October 27th, we will get into contact with the leader of

the 65-year-old and up church group that meets on Fridays. On November 3rd, we will present to

the senior church group on the importance of the flu vaccine and what the flu is.

To evaluate our health education project, we handed out a survey the attendees of our

presentation. The survey was handed out after the presentation is over to see if the church

members opinions on the flu vaccine changed (see Appendix D for the evaluation form).

Collaborative Efforts

During the community assessment we were able to collaborate with a variety of community

partners. Our Public Health Nurse from the Pima County Health Department did not have a lot

of experience with our CT, which limited our ability to use her as a resource. One of our most

useful resources were the firefighters located outside of our CT; they gave us valuable

information on the age of our community and common calls they receive concerning elders

falling in the community. Another helpful resource was the pastor of Pantano Christian Church.

He told us more about the community, some of its strengths, and helped us organize our
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community health presentation. Additional community partners ranged from the minute clinic

nurse, Walmart cashier, postal worker, and librarian. The main challenge we encountered was

finding community patterns that were located inside our CT.

Level of Prevention

Promoting the influenza knowledge and encouraging the vaccine was a primary prevention

intervention, as it targeted the flu before its onset. This could also be categorized as the stage of

susceptibility because the risk for the disease was present, yet the disease was not currently

present.

Resources and Constraints

Required resources for our education project consisted of a group of people representative of

the community, a location, a time slot, funds to create a display, handouts providing educational

information, the survey, pens, and awards for the question and answer section of the

presentation. The available resources for the education project consisted of a group of 65 and

older adults at a Pantano Christian Church. This church provided us with the time to present our

project to the group after the weekly Bible study. Our instructor provided us with a poster board

and College of Nursing table cloth and printed out copies of our survey. The Pima County

Health Department printed out handouts for us and the students split the funds of purchasing

mini hand sanitizers as prizes. Constraints for the project consisted of the lack of a table to place

the table cloth on for the presentation and that we did not provide pens to fill out the survey.

Implementation of Community Nursing Intervention

For the education session on influenza, we came at the end of the older adult Bible study

group on Friday, November 3, 2017. We began the session by playing the Myth Versus Fact

game that highlighted some common myths about the flu. Sydney Reed presented on what the
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flu is, who is at risk, and what can be done to prevent transmission. Kelly Conrad presented on

the flu vaccine and Melina Miller present on the symptoms of the flu. As questions were

answered, brochures and handouts about the flu and an evaluation form were passed out. There

were 30 older adults during the presentation. The group was engaged and enjoyed the

presentation. The Myth Versus Fact game was lively and drew attention from the group.

One success was the receptiveness of the members as they were happy to have us there and

worked with us to find a time slot. The education session went smoothly and was very engaging.

One unanticipated challenge was the amount of questions that were asked. There were quite a

few people with questions about the flu that we did not expect. There were some questions that

led us to use the assistance of our professor, Patty Goldsmith. We did not expect most of the

attendees to have already received the flu vaccine. Having the session at the end of the Bible

study was difficult since about half of the people left before the educational session started.

Evaluation of Community Nursing Intervention

To evaluate our project, we used a survey to ask the participants about the efficacy of the

education. Only 13 out of the 30 attendees completed the evaluation. 11 people had already

received the vaccine and two had not yet received it but planned to get one after this

presentation. None of the attendees that completed the evaluation reported that they did not

support the vaccine. In evaluating the surveys, all the attendees that completed the survey stated

that they learned about who is at risk and the symptoms.

These results show that the educational session was successful in a few areas. First, the

session was successful in convincing two people to consider getting the vaccine after the

presentation. This met our second SMART objective in that 100% of those who did not

previously receive the vaccine and completed the survey, are considering getting the vaccine.
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Second, 100% of those who completed the survey learned who is at risk and two symptoms of

the flu which meets our second SMART objective. Third, 100% of those who completed the

survey stated that they support the flu vaccine after this presentation which meets our first

SMART objective.

One challenge with the evaluation was how many of the attendees completed the evaluation.

One reason this could have been is that we did not have pens to give out for people to complete

the survey. Additionally, because it was at the end of their Bible study, many people were in a

hurry and may not have had time to fill out the survey.

Conclusion

In our project we learned that while the CT may have at first appeared wealthy and well

taken care of, our key informant suggested that the CT had many health issues. Common

problems included the misuse of urgent care for the common cold as well as the lack of

knowledge and hesitation regarding vaccines.

When assessing the population and considering the time of year, we identified flu education

as an appropriate topic for the older population. We partnered with Pantano Christian Church

and their adult Bible study to teach about the flu vaccine. Overall, many people were receptive

and showed a change in knowledge about the flu. These results supported our goal of reducing

the flu among the 65 years and older population.

We recommend widening the audience to include families. Future education projects

could take place on a Sunday or during different Bible study times to receive a larger range of

people. Additionally, we would suggest changing the time to the beginning of Bible study to

have a more captive audience and less disruption.

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References

Center for Disease Control and Prevention (2017). Influenza Vaccination Information for Health

Care Workers. Retrieved on October 21, 2017 from

https://www.cdc.gov/flu/healthcareworkers.htm

Office of Disease Prevention and Health Promotion. 2017. Healthy People 2020: Older Adults:

Objectives. Retrieved from: https://www.healthypeople.gov/2020/topics-

objectives/topic/older-adults/objectives

Office of Disease Prevention and Health Promotion. 2017. Healthy People 2020: Older Adults:

Overview. Retrieved from: https://www.healthypeople.gov/2020/topics-

objectives/topic/older-adults

Office of Disease Prevention and Health Promotion. 2017. Healthy People 2020: About Healthy

People. Retrieved from: https://www.healthypeople.gov/2020/About-Healthy-People

Pima Maps. (2015). Pima County MapGuide Maps. Retrieved October 20, 2017, from

http://gis.pima.gov/maps/mapguid

Worasathit, R., Wattana W., Okanurk K., Songthap A., Dhitavat J., Pitisuttithum P. 2015. Health

education and factors influencing acceptance and willingness to pay for influenza

vaccination among older adults. BMC Geriatrics, 15:36. doi: 10.1186/s12877-015-0137-6

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Appendix A

Priorities of Care Table

Community Identified in Severity of

Community Nursing Availability Applicable Ideas for nursing intervention

Total score
health concern Pima outcome(s)
expression students of resources HP2020 (Use Minnesota Wheel)
or problem, Countys without
of interest in ability to relevant for Determinant ** The interventions listed below are just
(stressor, risk Health effort to
addressing address addressing of Health examples. Students can use any of the
factor, need, Needs address
problem2 problem problem category interventions from the wheel.
determinant) Assessment1 problem

Physical Policy Development & Enforcement **: Write

Crime 2 1 1 1 1 Environ a letter to a legislative representative 9
supporting community groups proposal to
address Stressor 1

Physical Health Teaching**: Provide education at the

Flu Season 1 2 2 2 2 Environ/ local church about what to do to prevent flu, 8
Indiv. flu symptoms, and medication/home remedy
Behavior options.

Social Counseling **: Provide one on one counseling

Falls 2 1 1 1 2 9
Environ about trauma associated to falls at local
assisted living facility. ?

EMS
1 2 2 2 2 Health Health Teaching**: Teach a class at the library 4
Education
Services addressing Stressor 4
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Appendix B

Pictures of Poster Boards

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Appendix C

Educational Handouts
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Appendix D

Presentation Evaluation

1. Do you support the flu vaccine?

2. Before this presentation did you get the flu vaccine this flu season?

3. If the answer above was no, after this presentation would you consider/plan on getting
the flu vaccine?

4. Please list one population at risk and two symptoms of the flu.