Running head: COMMUNITY AS PARTNER REPORT 1

Community as Partner Report

Census Tract 43.12

Alexandra A. Cole, Tatiana R. Facer, Cadence E. Williams

The University of Arizona

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Community as Partner Report

Introduction

The student nurses at The University of Arizona [SNUA] were assigned to Drexel

Heights, Census Tract [CT] 43.12. From October 5th, 2017 to November 3rd, 2017, the student

nurses completed a windshield survey, multiple key informant interviews, and an education

project within the community. This comprehensive community health assessment utilized the

community-as-partner [CAP] model. After evaluating the information collected, the SNUA

recognized that the priority concerns of the community were the lack of knowledge regarding

resources, limited access to health care, language barriers, and substance abuse. Based on

feedback from the key informants, the SNUA identified that the communitys lack of knowledge

regarding resources was the number one community stressor. Through an education project that

informed the community of available resources, the student nurses hoped to improve the overall

health of the Drexel Heights Community.

Community Nursing Assessment

Based on the CAP model, the SNUA assessed the eight subsystems, including the

communitys core, economics, recreation, physical environment, health and health services,

education, safety and transportation, politics, and communication. These assessments were

conducted with the utilization of PimaMaps, the American Community Survey, and community

interactions. The CT 43.12 has a larger percentage of Hispanics and/or Latinos and American

Indians, compared to Pima County. Drexel Heights has a lower median household income,

compared to Pima County, as well as a higher percentage of single mothers, compared to Pima

County. The CT 43.12 also has a higher percentage of individuals without health insurance. The

percentage of high school graduates, along with individuals with a bachelors degree, is lower in
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the CT 43.12, as compared to Pima County. The CT 43.12 has a percentage of people living in

poverty that is 10% higher than that of Pima County. The percentage of mobile homes in the CT

43.12 is more than double the amount within Pima County (Pima County Health Department

Public Health Nursing Community Profile, CT 43.12, 2017).

There is one park, one gym, and one community center within the CT 43.12. Drexel

heights is serviced by the Pima County Sheriffs Department and Drexel Heights Fire District,

even though their stations are located outside the CT. The community has access to the city bus

system, however, there are many dirt roads within the CT 43.12 and the bus does not service

these roads. The majority of homes within the CT 43.12 had No Trespassing and Private

Property signs posted on their land. Raul Grijalva is the Congressman for the CT 43.12, and

Olivia Cajero Bedford is the Senator for the district. The nearest hospital that services the

general population is Banner University Medical Center South Campus. There is one urgent care

in the community, but there are no other health offices or therapeutic modalities. There are no

billboards or payphones in the area, and there are minimal sidewalks and street lamps (Pima

County Health Department Public Health Nursing Community Profile, CT 43.12, 2017).

The SNUA interviewed a total of ten key informants, who were all members of the

community, and these informants provided vital information regarding the needs of Drexel

Heights. After conducting these interviews, the SNUA narrowed down the prevalent strengths

and stressors. The identified strengths were a strong religious and cultural identity, close knit

community, and a respectful relationship between first responders and community members. The

stressors emphasized were the lack of knowledge regarding resources available, substance abuse,

language barriers, the need for job assistance, and primary prevention services (Pima County

Health Department Public Health Nursing Community Profile, CT 43.12, 2017).

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Community Nursing Diagnosis

Based on the information provided by key informants, the SNUA discovered that a major

strength of the community was that it is very close-knit (SouthWest Community Center

President, Police Officer, convenient store employee, librarian, health assistant, personal

communications, October 13, 2017). The key informants explained to the SNUA that since the

families have resided here for generations, they are very supportive of each other. In addition, an

interview with one of the key informants - the Safeway manager - revealed that the community

has a deep-rooted respect for the first responders of Drexel Heights, such as police and fire

department officials (Grocery store manager, personal communication, October 13, 2017).

During the windshield survey, the SNUA observed a strong religious influence in the CT. There

were multiple Catholic shrines in front yards of many homes, and several churches within the

neighborhoods.

Key informants also described to SNUA that substance abuse is a prevalent issue in the

community (Drexel Heights Community Center employee, convenient store employee, Grocery

store manager, Police Officer, Drexel Heights Fire Department firefighter, personal

communication, October 13, 2017). SNUA were informed that needles have been found in

public spaces, and law enforcement often responds to overdose and intoxication calls. During

windshield survey, the SNUA also observed that there were very few health care services within

the CT. This health care disparity is detrimental to the wellbeing of the community, and can lead

to poor health outcomes. Moreover, according to every key informant, the widespread stressor

in the community is the lack of knowledge regarding free and affordable health services in

Tucson. The key informants expressed that the community is not aware that there are services

available that can improve their health and wellbeing (SouthWest Community Center President,
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Police Officer, convenient store employee, librarian, health assistant, pastor, Drexel Heights

community center employee, grocery store manager, Drexel Heights Fire Department, public

health nurse, personal communications, October 13, 2017). These stressors were organized in a

table (see Figure 2 to examine the priorities of care table), where they were ranked according to

priorities of care.

After a thorough assessment of the community and its stressors, the SNUA formulated a

nursing diagnosis that emphasized the priority problem: Risk of poor health outcomes among

Drexel Heights community related to lack of knowledge about available health resources as

evidences by every key informant expressing their concern regarding this.

Community Nursing Plan

In order to address the poor health outcomes within Drexel Heights, the SNUA developed

a goal to guide an intervention. The good goal was to increase the knowledge of available

resources through outreach to improve the overall health of the Drexel Heights community. To

promote health within Drexel Heights, the SNUA created an education project with information

regarding free and affordable resources available to the community. The SNUA presented

information to the community about utilization of wellness services. The intervention was

implemented at the Southwest Community Center on November 3rd, during the Happy Food

Program.

According to an article by Schaffer and Tembreull (2005), the intervention of outreach is

effective in improving the health of identified communities. The SNUAs method of developing

a health education project and presenting it directly to the at-risk population, enabled SNUA to

effectively spread information about services to the community, as well as a method to build

relationships within the community (Schaffer & Tembreull, 2005). The purpose of the article by
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Schaffer and Tembreull (2005) was to educate public health nurses [PHN] about evidence based

practices for implementing and evaluating outreach within a community. This descriptive

qualitative study, which established a level six of evidence, involved interviewing ten Minnesota

PHNs employed by a city or county public health agency, in order to identify how the

intervention of outreach was being implemented (Schaffer & Tembreull, 2005). The article

supported the SNUAs method of outreach by demonstrating how PHNs effectively target health

disparities through dissemination of information regarding resources to the population (Schaffer

& Tembreull, 2005).

Healthy People 2020 has established evidence-based objectives aimed at identifying

nationwide health improvement priorities, preventing disease onset, and promoting health among

the population (Office of Disease Prevention and Health Promotion [ODPHP], 2017). The most

applicable overarching goal for this community is to promote quality of life, healthy

development, and healthy behaviors across all life stages (ODPHP, 2017). To achieve this goal

within Drexel Heights, it is critical to improve the access to health services by improving

access to comprehensive, quality health care services (ODPHP, 2017). The Healthy People

2020 objective number AHS-6.1 identifies the need to reduce the proportion of persons who are

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

medicines (ODPHP, 2017).

The Pima County Arizona Adopted Budget for the fiscal year 2017/2018 provides policy

for the allocation of resources within the community (Dommer et al., 2017). This budget serves

as a guide for developing wellness programs, calculating revenues, authorizing expenditures,

establishing goals, and compensating employees within specific branches at the Pima County

Health Department (Dommer et al., 2017). This active policy enables the health department to
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provide invaluable resources for the community to utilize within Pima County. The services that

the SNUA presented within the education project are available to members of Drexel Heights

due to this policy.

Two SMART objectives were formulated in order to reflect the impact of the health

education project among Drexel Heights community at Southwest Community Center. The first

SMART objective was the following: By the end of the outreach presentation on November 3rd,

2017, 70% of the participants will be able to identify at least two resources available. The second

SMART objective is: By the end of the outreach presentation on November 3rd, 2017, 70% of

the participants will be able to identify the best way to utilize the available resources.

The SNUA planned to develop a tri-fold board that presented multiple health services

available to the community at little to no cost. In addition, the SNUA designed a pamphlet that

compiled all of these previously mentioned services, including phone numbers and addresses.

The pamphlet also contained brief descriptions of what each service offered. Finally, the SNUA

obtained the calendar schedule for a mobile clinic and handed these out with the pamphlets.

Each interaction was personalized to what may have applied specifically to each participant.

In order to evaluate the completion of the SMART objectives, the SNUA planned to use

impact evaluation. This modality of evaluation assesses the immediate effect of the intervention

(Anderson & McFarlane, 2015). The two impact evaluations are as follows: The student nurses

will ask participants to verbalize at least two available resources and, the student nurses will ask

the participants to explain two services that the resources offer. The SNUA did not use a post-

test or survey to evaluate the SMART objectives, but instead used impact evaluations.

In order to effectively assess the community and complete the health education project,

the SNUA made efforts to collaborate with many community members. A comprehensive
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assessment was obtained through interviewing the fire department, a police officer, a PHN, a

convenient store employee, two community center employees, a pastor, librarians, a medical

assistant, and a grocery store manager. These interviews were almost always successful and

informative, however, there were times when the informant was unsure about the communitys

concerns. The president of the SouthWest Community Center was a valuable contact, because

she allowed the SNUA to present the education project in the community center during the

Happy Food Program food bank. The University of Arizona supplied the tri-fold board, and

each SNUA provided supplies to display the information on the board. The SNUAs public

health professor was a valuable source for expertise throughout the entire CAP project.

The community health education project involved primary, secondary, and tertiary

prevention modalities. The main topic of the project utilized primary prevention, because it

included targeting the stage of susceptibility (Anderson & McFarlane, 2015). The SNUA

educated the community about specific health promotion such as, the use of medical clinics for

risk factor screenings. The secondary and tertiary prevention modalities targeted the stages of

early subclinical disease, clinical disease, and the recovery or disability from the disease

(Anderson & McFarlane, 2015). These prevention levels were incorporated when services, such

as a needle exchange program for drug users and COPE community services for mental health,

were discussed.

The SNUA had to revise some of the original plans, based on issues with property

management. The original physical space where the SNUA were going to present was denied at

the last minute. Due to this constraint, the SNUA had to promptly find another location to

present their education project. In addition, the SNUA experienced a time restraint and arrived

towards the end of the food bank. This prevented the SNUA from speaking with a larger group
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of participants. There was no budget that the SNUA had to work with. Faculty from the

University of Arizona provided the tri-fold poster board, pamphlets, handouts and College of

Nursing tablecloth. Faculty from The University of Arizona also provided equipment necessary

to complete the project. There were no issues with staffing, due to the fact that the SNUA were

the only staff needed to complete this project. These aspects of the project were all positive

attributes.

Implementation of Community Nursing Intervention

The SNUA implemented their community nursing intervention at the Southwest

Community Center in Drexel Heights on November 3rd, 2017. The SNUA presented the

information during the community food bank, called the Happy Food Program, and talked to

community members as they were leaving the food bank. The community nursing intervention

presented by the SNUA consisted of a informative tri-fold poster (see Figure 1 for an image of

the tri-fold board and education project setup) along with pamphlets and handouts containing

information about available resources within the community. A total of 10 people were present

at the community food bank. The SNUA were able to effectively communicate with seven

people about said resources. These seven people not only took the pamphlets and handouts, but

also engaged in conversation with the SNUA by asking questions about the resources. These

seven community members stated that they had been looking for information about resources in

the community, so they were glad we had presented on it. Three people did not wish to hear

about the resources in the community when the information was offered to them by the SNUA.

This being said, the majority of the communitys response was positive.

One unanticipated challenge was having to compete with the community food bank. The

community members had specifically come for the food bank, not to hear from the SNUA about
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resources. An unanticipated success was that multiple people stated they had been looking for

information about resources in the community.

Evaluation of Community Nursing Intervention

Impact evaluation was used to deduce the information about the community nursing

intervention presented by the SNUA. Impact evaluation is the process of determining the short-

term and immediate effect of an intervention (Anderson & McFarlane, 2015). The first SMART

objective was that by the end of the outreach presentation on November 3rd, 70% of the

participants will be able to identify at least two resources available. The first impact evaluation

was used to evaluate the immediate effect of the nursing intervention and is as follows: Student

nurses will ask participants to verbalize at least two available resources. The second SMART

objective was that by the end of the outreach presentation on November 3rd, 70% of participants

will be able to identify the best way to utilize the available resources. The second impact

evaluation is as follows: The student nurses will ask the participants to explain two services that

the resources offer.

These outcomes were not met due to the time constraints on the participants. Participants

were primarily at the Southwest Community Center for the Happy Food Program. Some

community members had to leave quickly after the food drive and were unable to speak with us

and therefore were not impacted by the information.

Other obstacles included having to reschedule the presentation on multiple occasions.

Issues arose in relation to insurance and property management rules. Due to prior obligations,

the SNUA arrived to Southwest Community Center toward the end of the Happy Food Program.

The Happy Food Program ran from 0830-1130 and the SNUA arrived at 1030. Due to missing
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the majority of the community food bank, many potential participants were also missed. This

decreased the amount of outreach the SNUA had in the community.

Conclusion

The SNUA were able to use outreach as a nursing intervention for this CAP project. This

involved educating the community of Drexel Heights about free and affordable services available

to them. If the project were to be repeated, the SNUA would suggest that the team be flexible

and adaptable to the challenges that public health nursing presents. Disseminating the

information collected is important, as well. During this project, the SNUA presented their

community assessment to the PHNs employed at the countys health department, and stressed the

importance of following up with this CT. Due to the fact that the CAP project was to be

performed after this meeting with the PHNs, the SNUA were unable to report the results of the

project. However, the handouts and tri-fold poster were presented to the nurses, and their

approval was received prior to the SNUA going into the community. The SNUA hope that the

nurses serving this area will be able to collaborate with clinics to establish the long-term goal of

establishing accessible preventative care services in the CT.

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References

Anderson, E. T., & McFarlane, J. (2015). Community as partner: Theory and practice in

nursing. Philadelphia: Wolters Kluwer.

Dommer, K., Johnson, R.W., Horn, C., Edwards, L. M., & Rodriguez, V. (2017). Adopted

budget fiscal year 2017/2018 [PDF document]. Retrieved from

http://webcms.pima.gov/UserFiles/Servers/Server_6/File/Government/Finance%20and%

20Risk%20Management/Adopted%20Budget/2017-2018%20Adopted%20Budget.pdf

Office of Disease Prevention and Health Promotion. (2017). Healthy People 2020: 2020 topics

and objectives- objectives A-Z. Retrieved from

https://www.healthypeople.gov/2020/topics-objectives.

Schaffer, M. A., & Tembreull, C. L. (2005). The intervention of outreach: best practices. Public

Health Nursing, 22, 347-353. Retrieved from

http://onlinelibrary.wiley.com.ezproxy2.library.arizona.edu/store/10.1111/j.0737-

1209.2005.220411.x/asset/j.0737-

1209.2005.220411.x.pdf?v=1&t=j9t0s7da&s=06e450e86de80ae82c0b6a1c75112f02f9c2

251d
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Appendix

Figure 1. Community Nursing Intervention for CT. 43.12 involved a tri-fold board and multiple

handouts. The board described health services that address family planning, nutrition, health

clinics, substance abuse, and job help.

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Figure 2. Priorities of Care Table for CT 43.12 organizes the stressors of the community. The

stressors are ranked according to severity of importance, consequences if the stressor is not

corrected and availability of resources.