Professional Documents
Culture Documents
University of Arizona
2
CAP REPORT FOR 45.05
A community nursing assessment was completed for the census tract (CT) 45.05 in
Tucson, Arizona on February 19th, 20th, and 26th of 2018. The assessment was completed by
data collection from Pima Maps and American Community Survey (ACS) Census, windshield
surveys, and key informant interviews. Following the community nursing assessment, the student
nurses developed a community nursing diagnosis specific for this CT. A community nursing plan
was created, and a community nursing intervention was implemented and evaluated. All of the
findings from the community nursing assessment, diagnosis, plan, intervention, and evaluation
were then shared with the local public health nurse who oversees CT 45.05.
Core
communication, February 26, 2018), is a melting pot of cultures and ethnicities. According to the
ACS Census, CT 45.05 is comprised mainly of the Caucasian (75.9%) and Hispanic (48.5%)
race with sparse amounts of Native Americans (4.6%), Asian (4.2%), and African-Americans
(1.2%). With regard to age, a large majority of individuals from CT 45.05 were between the ages
of 20-44 years-old (32.6%) and 45-64 years-old (24.5%). Although many of the people within
the community speak English, 32.2 % are Spanish-speaking only, with the inclusion of 26.1% of
the total census not having a high school degree (Pima County Health Department Public Health
Education
The CT 45.05 community had access to public education at Flowing Wells High School,
Walter Douglas Elementary School, and the Academy Adventures Primary School. Per a key
informant from Walter Douglas Elementary School (personal communication, February 26,
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CAP REPORT FOR 45.05
2018), the school provides a safe environment for children to learn and grow, as well all provide
educational facilities included New Discoveries Preschool, Precious Moments Daycare, Tucson
College of Beauty School, and Amphi Head Start (Pima County Health Department Public
Tucson Police Department (TPD) was located at the Southwest corner of the CT 45.05 on
Flowing Wells Road and West Miracle Mile. There was no fire station within the CT, but the
closest fire station was at 250 West King Street, about two miles from the center of the CT. From
January 29 to March 12, there were a total of 117 reported incidents within the CT, in regard to
Quality of Life. There are also 11 registered sex offenders living in the community and five
working within it. All roads within the community had a designated bike route and a total of 19
bus stops (12 covered and 7 uncovered), however, the streets have been under major construction
leaving them with multiple potholes, cracks, construction cones, signs, and equipment (Pima
County Health Department Public Health Nursing Community Profile CT 45.05, 2018).
The CT was located in city ward three, having Council Member Karin Uhlich from 2005-
2017 and electing Paul Duram in 2018 as the new Council Member. CT 45.05 is in county
district three under the supervision of Sharon Bronson. The community is also in state legislative
district three with legislators: Olivia Cajero Bedford (Senator), Sally Ann Gonzales
district two, being represented by Martha McSally. The only sign of political activity that was
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CAP REPORT FOR 45.05
observed in the community was a We Stand with Rosa sign posted in a front lawn (Pima County
The nearest hospital would be Northwest Medical Center, as there was not one in the CT.
The only pharmacies in the community were in a Walgreens and Food City. Due to frequent
robberies, however, the Food City no longer has opiates. Other health services included Marana
Healthcare Center (MHC), Straight Smiles Orthodontics, and Robert Wu Acupuncture. Social
resources available included Turn Your Life Around Recovery Center, which is an organization
aimed to help individuals who are suffering from homelessness, addiction, mental illness, and
poverty by providing them support and education. Other social services within the community
include a Goodwill Thrift Store and La Paloma Family Services (Pima County Health
Communication
and advertising space. The newspaper companies observed were the Arizona Daily Star and the
Arizona Republic. There were only three payphones located at major street intersections and
outside of Circle K. In addition, there were billboards advertising Lerner and Rowe, Tucson
Medical Center (TMC) Mega Raffles, and We Buy Ugly Houses. Upon observation, it was noted
that that there was no free public access to the internet from the local businesses (Pima County
Economics
Overall, the economics of CT 45.05 did not meet the average numbers for Pima County.
The median household income in the CT was $30,732 compared to $46,764 in Pima. The same
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CAP REPORT FOR 45.05
trend was seen in the percentage of individuals in poverty and with no health insurance, 31.1%
and 19.1% within the CT compared to 19.1% and 12.3% for Pima County, respectively. While
the community did have many small businesses, such as restaurants, laundry/dry-cleaners, and
supermarkets, a majority of them included liquor stores, fast food restaurants, and smoke shops
(Pima County Health Department Public Health Nursing Community Profile CT 45.05, 2018).
Recreation
The main recreational areas of the community were Jacob's Park and the Jacob’s YMCA.
Per a YMCA employee (personal communication, February 26, 2018), the local YMCA provides
a place for adolescents to spend their time and keep out of potential trouble. Jacobs park also
provides an area for the neighborhood to come and spend time. The park has access to a pool and
multiple sport fields, such as baseball, soccer, basketball, tennis, and football. The park also
includes a playground and fenced dog park. Another recreational location for the community
would be Golden Pin Lanes, which is the largest bowling center in Tucson with 48 lanes, state of
the art scoring system, and availability to host several bowling leagues and events. As stated
from a key informant bowling alley employee, “Golden Pin Lanes has been a community staple
opened to the public for more than a decade and will continue to be for many more” (personal
communication, February 26, 2018) (Pima County Health Department Public Health Nursing
Physical Environment
Based from the observations made from the student nurses’ windshield survey, the outer
perimeter of the CT appeared to meet the expectations of a lower income community. The
sidewalks that were not under construction were in poor condition and damaged due to weather
factors (cracks and potholes). There was also a notable amount of trash, debris, and shopping
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CAP REPORT FOR 45.05
carts off to the side of the main roads. Within the neighborhoods of the community, the roads
were kept under adequate conditions, with front yards were well maintained, and all but a few
houses were still occupied by homeowners (Pima County Health Department Public Health
Based on the community assessment of CT 45.05 via Pima Maps, ACS Census,
windshield surveys, and key informant interviews, strengths and stressors for this area were
identified. The top three strengths of this community that were identified included the La
Frontera Sonoran House, free or reduced priced breakfast and lunches to low-income students,
and the Golden Pin Lanes and the charities they host. The La Frontera Sonoran House is the
home of the Casa de Vida, which is a 53-bed housing facility available to individuals with
alcohol addictions, drug addictions, and trauma and mental health histories. This facility provides
a warm bed, medical and case management, and therapy for substance abuse and post-traumatic
stress syndrome (PTSD) to individuals of any age and gender (La Frontera Arizona, 2018). In
the Flowing Wells Unified School District, students are able to receive free breakfast and lunch if
the household receives aid from programs such as Supplemental Nutrition Assistance Program
for Needy Families (TANF) (Flowing Wells Unified School District [FWUSD], 2018). Children
in foster care, children participating in the school’s Head Start Program, and children who are
homeless, runaway, or migrant are also eligible for free meals (FWUSD, 2018). Reduced-priced
meals are available for families with a gross income that falls at or below the limits on the
Federal Income Eligibility Guidelines (FWUSD, 2018). The Golden Pin Lanes is a local bowling
alley that not only provides recreation, but also hosts a variety of community activities and
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CAP REPORT FOR 45.05
fundraisers. A Golden Pin Lanes employee (personal communication, February 26, 2018) stated
that the bowling alley hosts events and fundraisers for the community, such as Youth on Their
Own fundraisers, back-to-school supply drives for low income families, and Big Brother Big
Sister events. The bowling alley is a safe haven that brings people together and is a valuable
The top three stressors that were identified for this community included substance abuse,
crime and theft, and homelessness. A local firefighter (personal communication, February 26,
2018) stated that this CT has a large amount of drug use, the most common being meth and
heroin. In a six-week time period, from January 29 to March 12, 2018, there were 226 crimes
reported within this CT. 56 were related to drugs and possession, 28 related to violent crimes
such as assault, and 19 related to property crime such as break-ins and theft (CrimeReports,
2018). A local Food City pharmacist stated that there has been many incidents of individuals
breaking into their pharmacy to steal drugs. He stated that they no longer carried oxycodone for
this reason (personal communication, February 26, 2018). There has been a recent increase in the
homeless population within this CT. A police officer (personal communication, February 26,
2018) stated that with the homeless population is being pushed out of downtown Tucson. This
has led to many people begging for money outside of stores and on street corners, especially at
designed to address the drug problem within this area, specifically opioids. The following
community nursing diagnosis was created for this CT that was used to address this issue: Risk of
chronic pain, addiction, and experimentation, as evidenced by multiple key informant interviews
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CAP REPORT FOR 45.05
indicating abuse and 56 drug-related police incidents within a six week period in that area A
Priorities of Care Table was also created for this CT which identified population stressors, and is
In order to address the community nursing diagnosis for the CT, the student nurses
developed the following good goal: Increase the knowledge of how to properly dispose of
opioids and other prescribed medications among residents of CT 45.05 to decrease substance
abuse and injury. Consequently, this could eliminate injuries from opiates, related to individuals
who have chronic pain, who may suffer from addiction, or who may participate in
experimentation.
A proposed intervention for this target population (CT 45.05) is a health education project
on the “Dispose-A-Med” program at a Pima County Public Library. This location would be
chosen because of its diverse population, ranging from children to seniors. This location also has
a high traffic flow around noon, which is when this proposed intervention would take place. In
terms of details, the intervention would entail the creation of an engaging trifold and a variety of
handouts. It would also include the advertisement of the national Prescription Drug Take-Back
Day on April 28th, which is an example of community partners, such as law enforcement and
pharmacists, coming together and creating a policy to decrease potential for substance abuse
The trifold would describe the three main steps of Dispose-A-Med, which are 1) Collect
unused and/or expired medication, 2) Take them to a Dispose-A-Med location, and 3) Protect
children, seniors, pets, and the environment. It would also include information on what can or
cannot be disposed and a home remedy for liquid medications. In addition, there would be a
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CAP REPORT FOR 45.05
variety of handouts describing the locations, what can be disposed, and alternative disposal
methods. The materials would all utilize color, large fonts, and pictures for understanding.
stressors, especially substance abuse. This is the main reason an intervention like this should take
place, as it could decrease injuries from prescription drugs in the census tract. This most applies
to the Healthy People 2020 overarching goal of “Attain high-quality, longer lives free of
preventable disease, disability, injury, and premature death.” This best topic area is “Medical
Product Safety” and relates to the topic area goal of “Ensure the safe use of medical products.”
The objective number would be MPS-2.4, which states: “Reduce drug overdose deaths involving
opioids, excluding heroin” (U.S. Department of Health and Human Services, 2018).
The SMART objectives for this education project would be 1) By the end of the proper
medication disposal teaching on March 26th, 2018, 75% of residents of CT 45.05 will be able to
demonstrate a proper disposal technique of medications and 2) By the end of the proper
medication disposal teaching on March 26th, 2018, 75% of residents of CT 45.05 will be able to
verbalize one reason as to why it is important to properly dispose of opioids and other
prescription medications. To address these objectives, the student nurses would ask the residents
if they could demonstrate a proper disposal technique or if they could provide a reason as to why
it is important to properly dispose of opioids. Both of these questions are considered to be of the
This education project would address the primary level of prevention, as it targets the
“disease” or chance of injury before the onset. This would be considered the Stage of
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CAP REPORT FOR 45.05
Susceptibility, as there is risk for injury, but no current injury. To be more specific, education on
Dispose-A-Med prevents injury from opiates and other medications by decreasing access.
While collaborating to schedule the education project, the student nurses required many
create the trifold. Luckily, there was a significant amount of information available online,
materials to create the trifold, and success with the staff at the Pima County Public Library for a
location. Working with a source for supplies and resources, however, was a challenge, as the
specific materials needed were not properly communicated. This meant receiving only a small
number of materials on a very short notice. This was the biggest constraint.
Evidence-Based Intervention
A study conducted in 2017 by Akici, Aydin, and Kiroglu, analyzed employees of a health
organization in Turkey that oversees safe medication use, storage, and disposal. This study was
an online-based descriptive study that was completed on a voluntary basis, which ended up
receiving 1121 responses. The goal was to evaluate employees personal behaviors regarding drug
storage, use, and disposal (Akici, Aydin, and Kirglu, 2017). The study found that despite the
population's proper knowledge, a little over half of the participants still kept their unused
medications at home or disposed of them via garbage, sink, or toilet. One interesting finding,
however, was that employees over the age of 30 and with less than four household members took
full advantage of their organizations drug-box (Akici, Aydin, and Kirglu, 2017). Weaknesses of
this article would be the small sample size, the lack of diversity in the population, and that this
study was conducted in Turkey, as opposed to the U.S. Strengths include the fact that this article
was able to evaluate individuals that had knowledge of proper medication use and disposal.
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CAP REPORT FOR 45.05
While planning an intervention, the student nurses felt that Dispose-A-Med would be a
great teaching opportunity for the CT community members. In addition to the results from Akici,
Aydin, and Kirglu’s study, the student nurses believed that teaching would be effective, as the
study found that the participants developed knowledge of proper medication storage, use, and
disposal. By teaching the community members about the free Dispose-A-Med services, they
would be more inclined to get rid of their unused/expired medications as they would then have
knowledge of where to do so. This in turn would lead to a significant reduction in self-
To implement the student nurses’ intervention, the authors of this paper spent one hour at
the Pima County Public Library where they spent their time educating community members as
they walked by on the Dispose-A-Med program that is offered in Tucson. Education included
what Dispose-A-Med will take back, the various locations that they had, and various home
remedies that they could do to safely dispose of the medications that Dispose-A-Med would not
take back as well. The group of students did so by leading a discussion with the individuals,
handing out several pamphlets/flyers, showing them an example of a home remedy, and by
20 individuals visited the table in which the student nurses were conducting the
medication disposal education. Of those 20, twelve individuals asked questions and were able to
answer the evaluation questions. Of those twelve, ten individuals took additional educational
information. The first SMART objective was partially met. Those who attended the education
were able to verbally discuss the necessary steps of proper medication disposal, but did not
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CAP REPORT FOR 45.05
physically demonstrate the procedure with the supplies that were present. The second SMART
objective was met. Those who attended the education were able to identify and verbalize at least
one reason why it is important to properly dispose of opioids and other prescription medications.
A challenge that was met during the evaluation process was a lack of engagement. Many of
individuals wanted the informational pamphlets, but did not want to participate in conversation.
During the evaluation of the intervention as a whole, the student nurses found that the
Pima County Public Library was a good venue due to the large amount of foot traffic. The tri-
fold poster board caught the eye and drew people in. The pamphlets and flyers were plentiful and
educational. Some areas for improvement included selecting a venue that does not discourage
loud speaking. An ideal venue would be at a health fair or an elderly center, where individuals
are actively seeking health information to improve engagement. The student nurses also noted
that there could have been a more engaging conversation starter to draw people in.
The CAP project was a very enlightening experience that allowed the student nurses to be
able to consider and identify the different social determinants of health in the local community,
and how they impact a community as well as an individual’s health. During the community
assessment conducted through Pima Maps and American Community Survey (ACS) Census,
windshield surveys, and key informant interviews, the student nurses were able to identify
strengths and stressors for CT 45.05. Areas for improvements were identified, and a community
nursing diagnosis was created. A community nursing intervention with a good goal and SMART
objectives were designed, implemented, and then evaluated. The findings from the community
assessment and intervention were then presented to the local public health nurse who oversees
CT 45.05. It is the student nurses’ hope that with the assessment data collected and the
recommendations given, the needs of CT 45.05 will be met and conditions improved.
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CAP REPORT FOR 45.05
References
Akici, A., Aydin, V., & Kiroglu, A. (2018). Assessment of the association between drug disposal
practices and drug use and storage behaviors. Saudi Pharmaceutical Journal, 26(1), 7-13.
doi:10.1016/j.jsps.2017.11.006
incident_types=Assault%252CAssault%2520with%2520Deadly%2520Weapon%252CBr
eaking%2520%2526%2520Entering%252CDisorder%252CDrugs%252CHomicide%252
CKidnapping%252CLiquor%252COther%2520Sexual%2520Offense%252CProperty%2
520Crime%252CProperty%2520Crime%2520Commercial%252CProperty%2520Crime
%2520Residential%252CQuality%2520of%2520Life%252CRobbery%252CSexual%252
0Assault%252CSexual%2520Offense%252CTheft%252CTheft%2520from%2520Vehicl
e%252CTheft%2520of%2520Vehicle&start_date=2018-01-29&end_date=2018-03-12&
days=sunday%252Cmonday%252Ctuesday%252Cwednesday%252Cthursday%252Cfrid
ay%252Csaturday&start_time=0&end_time=23&include_sex_offenders=false&lat=32.2
76257095024526&lng=-110.98852157592772&zoom=16¤t_tab=list&shapeIds=
&position_id=5e96-55x5-row-wedi__3cqa_b9vz&shape_id=false
Flowing Wells Unified School District. (2018). Dining services. Retrieved from
http://flowingwellsschools.org/our_district/dining_services
U.S. Department of Health and Human Services. (2018). Healthy People 2020. Retrieved from
https://www.healthypeople.gov/2020/topics-objectives/topic/medical-product-safety
U.S. Department of Justice. (2018). National Prescription Drug Take Back Day. Retrieved from
https://www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html
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Running Head: CAP REPORT FOR CT 45.05
Appendix A
Total score
expression students’ of resources HP2020 Ideas for nursing intervention
or problem, County’s without
of interest in ability to relevant for Determinant (Use Minnesota Wheel)
(stressor, risk Health effort to
addressing address addressing of Health
factor, need, Needs address
problem2 problem problem category
determinant) Assessment1 problem