Running Head: CAP REPORT 1

Community as Partner Report: Census Tract 3704

Abbey Brodeur, Nicole Baginski, Alyssa Pato, Jalina Vidotto

University of Arizona
CAP REPORT 2

Community as Partner Report: Census Tract 3704

The student nurses collaborated with Pima County Health Department (PCHD) public

health nurses to apply the Anderson and McFarlanes (2015) community as partner model when

assessing Census Tract (CT) 3704. The nursing process was used during the community

assessment through windshield surveys, key informant interviews, and data gathering informatics

between February 23rd and March 3rd of 2017. The following report will review the student

nurses assessment findings, identified nursing diagnosis, implemented community intervention,

and evaluation.
Community Nursing Assessment

CT 3704 has several differences in its core demographics from that of Pima County.

Foremost, the CT has a much higher Hispanic/Latino population than compared to Pima County.

The CTs population is 84.4% Hispanic as compared to 35.7% in Pima County. There is also a

higher percentage of American Indians living within the CT at 8.9% compared to the 4.4% in

Pima County. The CTs populations age is more concentrated in the younger age groups,

especially in the 5-19 years old age group, which is 29.5% of the population. In the county, this

age group is 19.2% of the population. However, there is a much lower concentration of those 65

years and older with only having 11% compared to the county, which has 17.2% of its population

in this age group. Compared to the county where 71.4% only speak English, only 30.9% of the

population of the CT speaks only English. There are more Spanish-speaking households in the

CT (67.8%) compared to the county where only 23.7% of the population speaks Spanish at

home. The windshield survey also revealed a strong Hispanic culture within the community, as

evidenced by 3 ethnic food stores. The CTs culture was further demonstrated on the mural on

the Valencia Library and the abundance of Our Lady of Guadalupe statues in front yards (Pima

County Health Department Public Health Nursing Community Profile CT 003704, 2017).
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The CTs physical boundaries are W. Drexel Rd. to the north, E. Valencia Rd. to the

south, S. 6th Ave. to the east and S. 12th Ave. to the west. The age of homes is generally older

within the CT compared to the county. Only 10.6% of homes were built in 2000 or later

compared 20.6% in Pima County. Almost half of the homes (48.2%) in the CT were built in

1960 compared to in the county where about a third (29.4%) of the homes were built in those

years. There were no new constructions, and many neglected homes and vacant lots (Pima

County Health Department Public Health Nursing Community Profile CT 003704, 2017).

As far as health and social services go, the CT leaves much to be desired. The closest

hospital is the VA Hospital. However, the general public is only seen in the emergency room.

The next closest hospital open to the general public is Banner Health University Medical Center

South Campus. Within the CT, there is no long-term care, urgent care, pharmacy, medical/dental

offices, integrative care, mental health services, social service agencies, food banks or other

health/social services providers. Several of these services are located long distances away from

the CT. The nearest public health nursing office is Teresa Lee Public Health Center (Pima

County Health Department Public Health Nursing Community Profile CT 003704, 2017).

In terms of education, the CT is less educated than Pima County. For example, 15.6% of

the population has less than a 9th grade education compared to 5.1% in the county. Also, only

8.5% of the CT has a bachelors degree or higher compared to 30.3% of Pima County. There are

no schools located in the CT, but there are several in neighboring CTs. Valencia Library is

located within the CT. According to the windshield survey and key informant interviews,

community members frequently visit the library. For more recreation, community members can

visit the well-maintained park in the CT named Manuel Herrera Jr. Park. There is also a very
CAP Report 44

large park, Mission Manor Park, across 12th Ave. Most shopping and eating can be done in the

main shopping area around Food City. All restaurant options are fast food (Pima County Health

Department Public Health Nursing Community Profile CT 003704, 2017).

There are many safety and transportation services within the CT. Fire Station-14 is

located within the CT and there is a police station near the CT. At the time of the windshield

survey, there was one security guard in Food City, two security guards and three undercover

police officers at Valencia Library. There have been 1,677 crimes since January 1, 2016. Bus

routes #24 and #29 serve the CT and have 12 bus stops total. There is limited street parking, few

sidewalks in poor condition, and the roads are also in poor condition as they have many potholes

(Pima County Health Department Public Health Nursing Community Profile CT 003704, 2017).

In terms of economics, CT 3704 battles rampant poverty. In Pima County, 19.3% of the

population lives in poverty and in the CT, 46.2% of the population lives in poverty. A quarter

(24.9%) of the population is without health insurance, compared to 13.3% in the county. There

is no indication of political activity within the CT. Communication services are also maintained

in the CT via newspaper stands throughout many businesses. There are bulletin boards in

Valencia Library and free Wi-Fi on buses, Peter Piper Pizza, Valencia Library and McDonalds

(Pima County Health Department Public Health Nursing Community Profile CT 003704, 2017).

Community Nursing Diagnosis

Strengths

After conducting 12 key informant interviews, the student nurses identified several

strengths within the community that include unity within the community and a strong sense of
CAP Report 55

culture and family. Each one of our key informant interviewees stated that the communitys core

strength was their tight knit community. Donie Gignac, Branch Manager at Valencia Library, has

been working at Valencia Library for 32 years and has noticed that this community is very

strong (Personal communication, March 3, 2017). She explained that community members

really support each other (Personal communication, March 3, 2017). Rodrigo, a worker at

Super Carniceria y Pescaderia El Ranchito described a time when a teenager in the community

was diagnosed with cancer and the entire community came together to raise money for the

family (Personal communication, March 3, 2017). Another identified strength was the strong

sense of culture within the community. According to PCHD, 84.4% of census tract (CT) 3704 is

Hispanic or Latino (Pima County Health Department Public Health Nursing Community Profile

CT 003704, 2017). This primarily Hispanic culture is seen throughout the community. For

example, Our Lady of Guadalupe statues are commonly seen in the front yards of homes and

sold at the local Food City. Lea, the school nurse at Apollo Middle School stated, The

communitys traditions and cultural practices keep the community unified and connected

(Personal communication, March 3, 2017). In the Hispanic culture, family is very important and

most interviewees explained that a community strength is how family oriented it is. Dan,

firefighter at Fire Station 14, explained that This community is very family orienteda lot of

houses are passed down from generation to generation and I think that shows a lot about this

community (Personal communication, March 3, 2017). Mary Francis, public health nurse,

stated that families in this community are very supportive of each other (Personal

communication, March 3, 2017).

Stressors
CAP Report 66

The student nurses identified the most critical stressors within the community, which

include poverty, substance abuse, and lack of knowledge on available resources and services.

Forty-six point two percent of the people living within this CT live in poverty with a median

household income of $27,899 (Pima County Health Department Public Health Nursing

Community Profile CT 003704, 2017). Colorina, a school health clerk at Mission Manor

Elementary School, explained that because of high poverty rates in some of the neighboring

communities, some kids are malnourished. We see kids with poor quality shoes and clothes. We

also see many kids with stomach aches because they arent having proper nutritious meals

(Personal communication, March 3, 2017). Substance abuse was one of the biggest concerns the

interviewees emphasized during the key informant interviews. Dan stated, Drugs are the main

issue in this areawe get a lot of calls for overdoses (Personal communication, March 3, 2017).

Gignac supported this community stressor by explaining that Drugs are a major concernoften

times we catch teens using drugs in the bathrooms. Young drug users also come to the library to

use the computers to communicate for drug deals (Personal communication, March 3, 2017).

During the interview with David, a security guard at Valencia Library, he stated, I found three

used heroin syringes this morning in the bookshelves (Personal communication, March 3,

2017). Lack of knowledge on available resources and services is another concern that was

consistently brought up during key informant interviews. Crystal, a school health clerk at

Mission Manor Elementary School explained, There are a lot of resources in the community.

The problem is getting people to use themSometimes I dont think parents can understand all

the information we give them, so they dont come to these events. I do think parents want access

to these available resources, I just dont think they know how or where to go (Personal

communication, March 3, 2017). Mary Francis, public health nurse, stated that Many people in
CAP Report 77

this community are uneducated about resources (Personal communication, March 3, 2017).

There are many resources and services available to community members, however, they are not

being utilized due to lack of education. See appendix A for the priorities of care table.

Nursing Diagnosis

The student nurses created the following nursing diagnosis once identifying the most

critical stressors seen in the community: Risk for drug/substance abuse, illness and injury, and

low literacy among residents in South Tucson related to lack of knowledge of resources as

evidenced by crime statistics, key informant interviews, and windshield survey.

Community Nursing Plan

Proposed Intervention with Good Goal and Research Article

A good program goal is to increase the percent of community members at the Valencia

Library who are knowledgeable about resources in the community related to drug abuse,

insurance coverage, and literacy. The planned intervention is for nursing students to present

information on available community resources to community members. Valencia Library is the

setting and the audience is community members of CT3704.

The purpose of Cyril, Smith, Possamai-Inesedy, & Renzahos (2015) study was to

examine the effect community engagement has on health and health inequalities among

underprivileged populations. A systematic review was conducted using the Preferred Reporting

Items for Systematic reviews and Meta-Analysis finding 24 articles meeting inclusion criteria

(Cyril et al., 2015). 17 of the 24 studies were conducted in the United States (Cyril et al., 2015).

There was one study in Canada, Bangladesh, United Kingdom, Africa, China, India, and Iran

(Cyril et al., 2015). 21 out of 24 studies positively affect health behaviors, health service access,
CAP Report 88

health literacy, public health planning, and a variety of health outcomes (Cyril et al., 2015). Due

to the studys method of systematic reviews of descriptive and qualitative studies, the study was

a level V level of evidence.

Healthy People 2020

The most applicable overreaching goal from Healthy People 2020 is: promote quality of

life, health development and healthy behaviors across a lifespan. Access to Health Services is

the most pertinent topic goal from Healthy People 2020. The goal for this topic is to improve

access to comprehensive, quality healthcare services (U.S. Department of Health and Human

Services Healthy People 2020, 2017). Objective AHS-6: Reduce the proportion of persons who

are unable to obtain or delay in obtaining necessary medical care, dental care, or prescription

medicines is the related objective to the teaching project (U.S. Department of Health and

Human Services Healthy People 2020, 2017).

Current Policy that Supports Teaching Intervention

The World Health Organizations [WHO] (2017) constitution preserves the highest

attainable standard of health as a fundamental right of every human being. Disadvantaged

populations within society are less likely to possess their right to health (WHO, 2017). Ensuring

that health policies, programs, and strategies are intended to improve satisfaction of all people to

the right to health is the goal of human rights (WHO, 2017). Availability, and accessibility are

two interventions to reach this goal (WHO, 2017). This supports the students teaching project

because the community within the census tract is primarily a disadvantaged population

unsatisfied with their available resources. The community has the right to healthcare; however,
CAP Report 99

there was a need to provide adequate education so individuals become more knowledgeable of

their available resources.

SMART Objectives

The following are two SMART objectives that reflect the impact of the health education project:

1. After the health resources teaching on March 29, 2017, 50% of the individuals entering

the Valencia library expressed interest in the community resources.

2. After the health resources teaching on March 29, 2017, 50% of the individuals who

participated in the health education teaching found a new resource that was helpful to

them.

Program Plan

The following are three program activities completed to implement the health education project:

1. By March 23nd, the student nurses confirmed date, time, and place to present their health

education project.

2. By March 24th, the student nurses will have gathered all content regarding community

resources and information.

3. By March 27th, the student nurses will have verified with the PHN and clinical instructor

that content is applicable and appropriate.

CAP Report 1010

4. On March 29th, the student nurses will hand out and collect 2-question surveys to

determine the effectiveness of the health teaching project at the Valencia Library.

Collaboration Efforts

All collaboration efforts were successful and positive. The key informants were pleasant

and were receptive to our interview questions. While they were sometimes suspicious at first,

they willingly provided a lot of valuable information once we explained the purpose of our

project. The public health nurse at Teresa Lee provided an immense amount of useful

information regarding characteristics of the community and sources of concern. The student

nurses instructor provided a poster board to present community resources and the Valencia

Library provided the perfect area to attract community members. There were no challenges in

gathering information and resources during the students collaboration efforts.

Level of Prevention

The health education project addressed all three levels of prevention because it included

resources that targeted a large range of health concerns. Examples of community resources

which demonstrated primary prevention included information on clinical sites offering

immunizations and brochures with tips on drug and poison safety. Secondary prevention was

demonstrated through resources such as the teen mobile clinic offering contraceptives and the

Pima County Health Department offering health screenings. Additionally, examples of tertiary

prevention in the health education project were the LifePoint needle exchange program and the

Women, Infants, and Children (WIC) Food Program. While many of the resources could serve

as more than one level of prevention, these were examples of how each resource could be

categorized as a different level of prevention. Since the community resources covered the entire

spectrum of levels of prevention, it also targeted all stages of the natural history of disease.
CAP Report 1111

Resources and Constraints for Teaching Project

The resources that were available to the student nurses for the health education project at

the Valencia Library included a spacious lobby area, small table, pencils, and additional

brochures and pamphlets describing community resources. The public health nurse also served

as a resource for information and suggestions regarding the project. Some of the constraints for

the health education project included that the table provided was small due to the abundant

number of brochures and flyers the students collected. Another constraint included that only one

person at a time was able to view the project board and collected resources due to the size of the

table provided. This prevented other passersby from collecting resources.

Implementation of Community Nursing Intervention

The student nurses provided community resources to members entering and leaving the

Valencia Library based on four topics: substance use, health insurance, health services, and

education/career services. During the one hour spent at the library, eighteen community

members took at least one community resource. The majority of those individuals were

adolescents who were highly interested in the Teen Mobile Clinic and Pima Teen Scene

activities. Several adults acquired resources from the project. They were mainly interested in an

advertisement for smart ways to handle money, an application for health insurance through the

Pima County Health Department, and the schedule for English classes and tax services. The

communitys response to the project was extremely positive. Many community members

thanked the students for providing resources and those who werent interested were still

respectful. This project was successful because the student nurses identified popular areas of

interest among community members, especially teens. Challenges for this project include that it

was difficult to narrow down which resources would be provided to the community members.
CAP Report 1212

While there were many more resources that could have been included, it was important to keep

the project organized and simple. See Appendix B for a picture of the students at the

presentation.

Evaluation of Community Nursing Intervention

The student nurses evaluated the health teaching project via a two-question post-survey

administered after community members approached the health education poster. The

information from these surveys was used to analyze the SMART objectives for the project. The

questions listed on the short survey were as follows:

1. Did you find a new resource that was helpful to you? Yes or No

2. How would you rate the information received? Excellent, Good, Poor, Very Poor

The first SMART Objective was to attract at least 50% of the community members

entering or exiting the Valencia Library to the community resources project. During the one-

hour period, 34 community members passed through the front lobby. Since 18 surveys were

conducted, this means that more than 50% of the community members passing through the front

lobby expressed interest in the board, meeting our first objective. The second SMART Objective

was to have at least 50% of the individuals who collected a resource express that the information

was helpful, which was demonstrated by a rating of excellent or good on the survey. All

surveys revealed that all community members found a helpful resource rated as excellent or

good. There were no challenges during the evaluation process.

Conclusion

The student nurses learned the various lessons from the CAP project: (1) effective data

gathering and data generation guide are crucial to implementing a successful intervention; (2)

although there are numerous resources available in Tucson for disadvantaged populations, many
CAP Report 1313

individuals are unsure of their available resources; (3) public health interventions, such as

providing available resources to the community, can greatly impact a community's health and

wellbeing. If the student nurses were to alter their intervention, they would have separated the

resources by age group in hopes of making the resources less intimidating. In addition, the

students would have created a survey to evaluate the intervention that was more anonymous to

get a more accurate evaluation. In conclusion, the student nurses learned the importance of

public health nursing and the impact it can make on a community.

References

Anderson, E. T., & McFarlane, J. (Eds.) (2015). Community as partner: Theory and practice
in nursing (7th edition). Philadelphia: Wolters & Kluwer

S. Cyril, B.J. Smith, A. Possamai-Inesedy, & A. M. Renzaho. (2015). Exploring the role of

community engagement in improving the health of disadvantaged populations: A

systematic review. Global Health Action, 8 (1), 1-12. doi: 10.3402/gha.v8.29842

U.S. Department of Health and Human Services Healthy People 2020 (2017). Access to Health

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

objectives/topic/Access-to-Health-Services/objectives

World Health Organization. (2017). Health and Human Rights. Retrieved from

http://www.who.int/mediacentre/factsheets/fs323/en/
CAP Report 1414

Appendix A

CT 3704: Priorities of Care Table

Community Identified in Severity of
Community Nursing Availability Applicable
health concern Pima outcome(s)
expression students of resources HP2020 Ideas fo
or problem, Countys without
of interest in ability to relevant for Determinant (Use
(stressor, risk Health effort to
addressing address addressing of Health
factor, need, Needs address
problem2 problem problem category
determinant) Assessment1 problem

Individual
Substance Counseling: Pro
2 4 1 2 2 Behavior
Abuse rehab service
and Social
community a
Environment

Lack of
Health Policy Develop
Health
1 4 1 1 2 Services Lobbying fo
Insurance
of Affordable
Coverage
policy

Social Community Org

Poverty 1 4 1 1 2 Environment and clothing
to provide co
suffering fro
Lack of
Knowledge on
Available Individual Health Teaching
Community Behavior the available
1 4 1 1 2 and Social
Health focusing on s
Resources Environment literacy, heal
(low health immunizatio
literary)

Note. 1 Score 1 point if consistent with report findings as a concern in Pima County. Score 2 points if 1 of Pima
Countys 4 priority areas: Anxiety and Depression; Substance abuse; Injuries and accidents; Diabetes. From Pima
County Health Needs Assessment Snapshot. 2Community Expression of Interest (second column) is double
weighted to emphasize its importance. Key: 0 = low, 1 = moderate, 2 = high. Adapted from Community Health
Diagnosis in Nursing by M. A. Muecke, 1984, Public Health Nursing, 1, p. 31; and Community Assessment and
Evaluation by G.F. Shuster, 2010, in M. Stanhope and J. Lancaster (Eds.) Foundations of Nursing in the
Community, Communitcy-Oriented Practice, 3rd ed., p. 232. St. Louis: Mosby/Elsevier/Evolve.
CAP Report 1515

Appendix B
CAP Report 1616