Overall Health in Fargo North Dakota

Care of Vulnerable Populations

COMMUNITY ASSESSMENT, ANALYSIS, and NURSING INTERVENTION

• Week 1: Windshield Survey and Key Informant Interviews. Complete the First Section of the course template and submit. (Keep this section attached to Weeks 2 and 3 assignments.)

• Week 2: Statistical Analysis of Community Health Problem. Complete the Second Section of the course template and submit. (Keep this section attached to Weeks 1 and 3 assignments.)

• Week 3: Community Health Nursing Intervention. Complete the Third Section of the course template and submit. By now, you should have Sections 1-3 as one whole document.

• Each section of the course template is submitted on a WEEKLY basis, depending on which week you are working on. DO NOT wait to submit all three sections at the end of the third week.

• Please note that students are not to make any changes to the content of the course template, for example, removal of questions or examples imbedded in the response box of the template.

• Removal of the questions or examples imbedded in the response box of the template is considered tampering with the content and will result in a 10-point grade deduction per assignment.

Should removal of the questions or examples imbedded in the response box of the template persist by the student, in addition to the 10-point deduction, the student will be referred to the Office of Student Conduct for final disposition. You are strongly encouraged to be mindful of this course policy.

• The ONLY change students may make to the template is to enlarge the space to make their entries in the response boxes.

• Should you encounter any difficulties with any aspect of these assignments, please consult with your Academic Coach. We are glad to assist you!

Windshield Survey and Key Informant Interviews

Student Name: _Date: _

Name of Community or Zip Code: _

Module One (Week One): Part One Windshield Survey and Key Informant Interviews

Please complete the following information on this template about the community you have selected. If you do not use this template there will be a 10- point grade penalty per assignment, and you will be required to resubmit within 48 hrs. You may increase the size of the blocks on the template by continuing to type within each section. Use as much space as necessary to provide your answers.

Elements

Descriptors

Physical Environment

Make sure you address fully what you observed, and NOTE if something was not found within your community area.

• Boundaries

What defines the boundaries? Roads, water, railroads. Is the area known for a particular name? What area is this community located in?

This area has become famous in pop culture because of a film called "Fargo" by the Coen Brothers, which is now a TV show. It is a crime show but the actual town is far less surreal. The boundaries consist of: Red River, which divides North Dakota from Minnesota and runs North-South on the eastern half of the town. Fargo as a whole sits in North Dakota. I-94 runs East-West through the southern half of the town, and I-29 runs North-South through the western half of the town. Hector International Airport is on the northern half of the town.

• Housing and Zoning

What is the age of the houses? Describe type of construction material, appearance, and general condition. Do you see single family housing? Multi-family housing?

The houses are mid-century in many neighborhoods. There are many single family houses but also many multi-family houses as well. Houses are ranch, bi-level and two-story, as well as apartment buildings (brick, siding mostly).

• Common Meeting Places

Where do people in the neighborhood hang out? Who hangs out there and what hours of the day?

North Dakota State University is in the center of town, so students will hang out on campus or at the local establishments (Bison Turf, Deeks Pizza -- open late night, El Zagal Par 3 Golf Course on Red River). The pizza place gets late night young people, the golf course sees all ages during the day time hours. Bison Turf is a night time and weekend hang out.

• Indicators of Growth or Decline

Is this a "thriving" community or does it look "run down?" Is there new or ongoing construction? Businesses and Industries coming to the area? Are buildings, roadways, and public areas clean and well-kept. Do you see dirt, trash, or graffiti?

The community is well-established and is neither thriving nor run down. Parts look poorer than others. And one block or section of the neighborhood may appear wealthier than another just a couple of blocks away. There is ongoing construction on the main roads through town. There is no sign of graffiti or trash. Things are relatively clean.

• Employment Opportunities

What places for employment are there is this area? Name the businesses and industries in this area.

There are many restaurants and bars (Boiler Room, JL Beers, Spicy Pie Pizza, Cafe Aladdin) that are perfect for students and service workers. There is a senior center and several health care facilities for health care professionals. The college is there plus secondary education schools for education professionals, and there are two golf courses for those who prefer working outdoors. Sanford Health is the largest employer, followed by North Dakota State University and Fargo Public Schools.

•Transportation

How to people get from one place to another? Is public transportation available? How timely is it? Personal autos? Bikes? Walking?

Public transportation is available and is timely as there is not a lot of traffic. There are many personal automobiles lining the streets. Some people bike, and some walk.

People

Make sure you address fully what you observed and NOTE if something was not found within your community area.

• Race and Ethnicity

What is the majority racial group represented? What is the majority ethnic group represented? Describe the distribution of gender, approximate ages, single families, multiple families, generational families?

The major racial group represented is Caucasian. The majority ethnic group represented is white American. The population is evenly divided according gender and age. Because of the college, there is a good mix of young and old. Single families, multiple families and generational families can all be found in the neighborhoods.

• Cultural Characteristics

What cultural similarities or differences do you observe? Languages spoken? Clothing? Ethnic eating places? Culturally-based celebrations? Signs in languages other than English?

Everything is typically American here. Clothing is like that seen online or worn by people on TV. Older people dress less trendily but students all have the latest styles of dress and hair styles. There are some ethnic diners -- Aladin's Cafe is Mediterranean, and there is a Chinese restaurant. There are no signs in other languages, however. Everything is in English.

• Lifestyle Healthy Behaviors

What healthy lifestyle behaviors do you observe? Do you see people exercising, wearing helmets when biking, seat belt usage, using trash cans for garbage disposal, healthy eating practices?

I see people walking, riding bikes. Only a few people on bikes wear helmets though. People driving do wear their seat belts. There is not much litter, so people are using trash cans for garbage disposal. I do not see evidence of any healthy eating practices, although there are health food stores in town and people shop there.

• Lifestyle Risk Behaviors

What unhealthy lifestyle behaviors do you observe? Do you see people practicing risky lifestyle behaviors such as drinking alcoholic beverages, smoking, fighting? Do you see signs of violence, gang activity, drug use, criminal activity, and bars on doors and/or windows? Do you see overweight/underweight persons? Do you see children unattended playing out in the streets? Do you see any signs of homelessness? Street people? Describe gender, age, and race/ethnicity of persons observed.

I see many overweight people, especially older ones. Younger persons tend to be fit and thin. I do not see signs of violence or gang activity. Few people are seen smoking. I do not see children playing unattended out in the streets. I do not see signs of homelessness.

• Poverty Indications

Do you see any signs of homelessness? Street people? Describe gender, age, and race/ethnicity of persons observed.

I do not see any signs of homelessness.

Services in the Community

Make sure you address fully what you observed and NOTE if something was not found within your community area, how far away it is and how people will access it.

• Social Services

Do you see evidence of recreation centers, parks, and social services? For services that are not available, how far must persons travel to access these services? Describe each.

There are some recreation centers, parks and social services. All of these are within a ten mile radius of the center of town and people do not have to travel far. There are parks to the east, west, north and south of town. The campus has a park. Social services are located in town for seniors and for families. There are many churches that also offer services.

• Health Services

Do you see evidence of health (Hospitals, Dr.'s Offices, Clinics) and mental health services? Describe each. Are there any signs of alternative services in the area, such as healers (curanderos), herbalists, herbal stores, palm readers, acupunctures, chiropractors. For services that are not available, how far must persons travel to access these services?

There are many health and mental health services. There are a few herbal stores. There are no palm readers. There are some chiropractors.

• Fire and Police Services

Do you see any fire and police services/equipment/officers? Where are the closest fire and/or police stations?

There are four fire stations in town -- two in the west, one in the north and one in the south. Across the river are two more, but they are technically in Minnesota. There are five police stations around town.

• Educational Resources

Where is the nearest public library? Discuss the Schools and Universities/Community colleges?

The public library is on 1st Ave. The University is a couple blocks northwest of that. The public school is a few blocks southwest of the library.

• Religions

What signs of religion do you see? Discuss the types of churches, mosques, temples? What services are offered by these churches, for example, Day Care, Mother's Day Out, Summer Camps, Languages Classes, Citizenship Classes, Food Banks, Clothing, other.

There are numerous Protestant and non-denominational churches. There are a few Catholic churches, too. There are a couple day cares. The churches offer some counseling for mental health.

Business & Industry

Describe stores and shops available in the community, e.g., grocery stores, gas stations, department stores. What type of business climate exists? Manufactures? Light or heavy industry? Large employers? Small business owners? Retail? Hospitality industry? Do people have to seek employment elsewhere? Is this considered a "bedroom community"- where people work outside this community but live here? Make sure you address fully what you observed and NOTE if something was not found within your community area.

There is not much industry in the city. The biggest employers are the health care facility and the college. There are some retail shops and many restaurants downtown.

• Politics

What indicators do you see about politics? Posters? Headquarters? Make sure you address fully what you observed and NOTE if something was not found within your community area.

There are not many indicators about politics.

• Media

Do you see indicators of what people read? Listen to the radio? Watch TV? Are there any signs of media language other than English? Make sure you address fully what you observed and NOTE if something was not found within your community area.

There are not many indicators of what people read. The radio has some classic rock stations, some modern rock, some easy listening music, country, and oldies.

• Key Informants

Interview a fireman or police office.

Also interview a librarian, school teacher, school nurse or administrator.

Ask each person interviewed to share their perceptions of the following and cite personal communication as appropriate:

1. Interview with fireman or police officer

> Community's Health issues

The police officer said the biggest health issue is the use of drugs. He said young people are using too many drugs -- heroin, marijuana. This corresponds with what the City of Fargo (2017) has reported regarding the explosion of heroin use.

> Community's Safety issues

The officer cited heroin use as the biggest safety issue because it threatens the stability of the community.

> Strengths of the Community

The officer said the biggest strength of the community was the families and the schools. People were basically good but some bad people were trying to harm others.

2. Interview with librarian, school teacher, school nurse or administrator

> Community's Health issues

The librarian said that homelessness is an issue and that while rates are down, she cited the latest research (Wilder Research, 2016), she said the library still received a fair amount of homeless patrons.

> Community's Safety issues

The librarian said that the heroin epidemic is an issue that needs to be addressed.

> Strengths of the Community

The librarian said the community is strong because there are a lot of groups that are active in supporting one another -- churches, the hospital, the college. The young people are aware and out working to make things better. She was really positive about the future.

Enter the information about your interviews with Key Informants in this space in your template. You will not receive credit if the Key Informant interviews are inserted elsewhere on this template.

Analysis of Windshield Survey

Analyze and summarize your observations and the input from key informants. Write a 3 paragraph summary of community health (2) and safety (1) issues for this community and strengthens of the community. Remember to cite personal communication as appropriate:

The community of Fargo, ND, is stable. There is a big college in town and a big health care center. These two provide most of the employment for the city. There are a lot of shops and restaurants downtown. People walk and bike and drive. There is no evidence of gang activity or of violence. But drug usage, even if it is not apparent, is clearly a problem, as the interviews revealed.

Homelessness is also a problem but this is being worked on, according to the librarian. The cause of homelessness was identified by the librarian as usually being something related to drugs, mental health or economic issues. There are groups that work with the homeless to help them find shelter and counseling, she said.

The college and the churches and health care centers are viewed as vital strengths for the community. The college is full of young people who look fit and healthy. They can be seen in the parks or in the shops and restaurants downtown. The students typically study health care or business (North Dakota State University, 2017). They are looked at as being the ones who will lead the coming generation, so a lot of respect is shown them.

Reference

City of Fargo. (2017). Fighting the Heroin and Opiate Epidemic. Retrieved from https://www.cityoffargo.com/CityInfo/Departments/Police/CitizenResources/HeroinOpiateCampaign/

North Dakota State University. (2017). NDSU. Retrieved from https://www.ndsu.edu/

Wilder Research. (2016). Homelessness in Fargo, North Dakota and Moorhead, Minnesota.

Retrieved from http://mnhomeless.org/minnesota-homeless-study/reports-and-fact-sheets/2015/2015-homeless-fargo-moorhead-9-16.pdf

Module 2 (Week 2) Part Two: Statistical Analysis of Community Health Problem

Please complete the following information on this template. If you do not use this template there will be a 10-point grade penalty per assignment, and you will be required to resubmit within 48 hrs. You may increase the size of the blocks on the template by continuing to type within each section. Use as much space as necessary to provide your answers.

Name of Community or Zip Code:

Instructions: Enter your response in each category marked below. Provide objective, statistical support for your subjective findings.

• Include all the data listed in the Objective Data Criteria listed below.

• Add supplemental data as needed for your community.

• All statistical data must be reported in NARRATIVE form only. Tables and graphs will not be accepted.

• Compare objective data for your community with local (city), state, and national data.

You may increase the size of the block by continuing to type. Use as much space as necessary to provide your answers

General Objective Data Criteria for the Community-at-Large

1. Demographics: Total population; age distribution; gender distribution; family characteristics (single parent, multi-family, etc.). Remember compare objective data for your community with local (city), state, and national data. Remember to cite sources as appropriate.

2. Racial/Ethnic Characteristics: Remember compare objective data for your community with local (city), state, and national data. Remember to cite sources as appropriate.

3. Economy: poverty rate, unemployment rates, median income. Remember compare objective data for your community with local (city), state, and national data. Remember to cite sources as appropriate.

4. Education: High school completion rates; higher education statistics. Remember compare objective data for your community with local (city), state, and national data. Remember to cite sources as appropriate.

5. Identify two Morbidity and Mortality/Risk Problems: (Based on your observations from Week 1 subjective assignment, windshield survey and key informants provide Morbidity, Mortality (M&M) and risk data for your community . . . Example 1: if you observed obesity in your community then present obesity rates and health conditions associated with obesity [i.e. CVD, HD, Depression, etc.). Example 2: smoking/drinking rates and health conditions associated with smoking [i.e. Lung Cancer, COPD, other]. These variables may include the following: gender (who does this problem affect the most, men or women); age distribution; ethnicity or racial group(s) mostly-affected; morbidity and mortality rates; any data related to life-expectancy in light of the health issues; is there a geographic area where the health problems mainly exist; is there a relationship between the health issue(s) and environmental health hazards; are these life-threatening health issues? Remember compare objective data for your community with local (city), state, and national data. Remember to cite sources as appropriate.

6. Other data as needed (air, water quality, crimes rates). Remember compare objective data for your community with local (city), state, and national data. Remember to cite sources as appropriate.

Analysis of Data

1. Based on your subjective and objective review of your findings, what conclusions have you arrived at? Remember to cite sources as appropriate.

• What impressions from your subjective observations were unfounded/invalid?

• Given the objective data, what impressions were validated/substantiated?

• What cause-and-effect relationships did you discover/identify?

2. Problem Analysis for Community/Zip Code:

Problem: List two (2) problems within your community (for example, Infant Malnutrition, CVD, Lung Cancer, Obesity, Alcoholism, Violence) NOTE: These problems need to be something the Community Health Nurse can impact (for example, a CHN cannot build a sidewalk, repair a street, implement a new bus route, etc.). Remember to cite sources as appropriate.

Select one of these problems and complete the Problem Analysis chart.

Problem Correlates*

Relationship of Correlate to Problem

Data Supportive of Relationship +

Ex. Inadequate diet

Ex. Diets lacking in required nutrients contribute to malnutrition

Ex. All infants and children seen at the local Public Health Clinic are referred to the nutritionist because of poor diets (X.Y. personal communication, date). Of infants measured, 60% were in the lower percent for their weight/height (X report, date).

*These are factors that contribute to problem and outcomes.

+ Refer to appropriate sections of the database and relevant research of the findings in current literature. Data in the third column could be local, state, or national statistics.

3. Community Health Nursing Diagnoses:

Based on your subjective and objective assessment findings above for both Weeks 1 and 2, write TWO priority community health nursing diagnoses.

NOT use NANDA. Use the following format for the community health nursing diagnoses:

• Risk of (State the health problem or risk.)

• Among (Identify the population group affected.)

• Related to ( State factor(s) contributing to the health problem or associated risk.)

Health Risk/problem of (specific injury, illness, or potential of, complication of, etc.) among (specific population) related to (supporting evidence from your assessment findings). Reference: Shuster, George F., (2014). Community as Client: Assessment and Analysis. In Stanhope,

Marcia and Lancaster, Jeanette, Public Health Nursing (8th ed., pg. 413). Saint Louis,

MO: Elsevier.

.Your CHN Diagnoses MUST be something that a community/public health nurse can do something about. See example below.

• Note: Poverty is NOT a CHN diagnosis.

• Remember do NOT use NANDA Nursing Diagnoses.

For example: Risk of asthma complications among children in SE Dallas County related to observations of overcrowded living conditions, lack of public transportation (may result in inability to access health care), high number of animals observed living in homes, poverty indications (may result in lack financial resources to purchase medications.)

Community Health Nursing Diagnosis #1

Community Health Nursing Diagnosis #2

Reference

Module 3 (Week 3) Part Three: Community Health Nursing Intervention

Directions: Please complete the following information on this template. If you do not use this template there will be a 10- point grade penalty per assignment, and you will be required to resubmit within 48 hrs. You may increase the size of the blocks on the template by continuing to type within each section. Use as much space as necessary to provide your answers.

Introduction: Purpose of the paper, synopsis of community, two CHN diagnoses with supporting evidence, for example, observations, reports from Key Informants and Statistical data. Remember to cite sources as appropriate.

Based on the 2 CHN Diagnoses you developed in Assignment 2 or modified, select ONE problem and develop a CH Nursing intervention. Remember to cite sources as appropriate.

1. CHN Diagnosis/Problem you selected:

2. Why did you select this problem? Provide your rational for selecting this problem in 1-2 comprehensive paragraphs (Consider the problem priority criterion on page 417 Box 18-5). Provide supporting community and scientific/authoritative evidence, for example, Healthy People 2020, CDC, AHA, other. Remember to cite sources as appropriate.

3. Identify two (2) Goals. For example, goals indicate where you want to go.

Then, identify two to three (2-3) objectives per goal. For example, objectives should indicate how you plan to get there, or how you plan to accomplish the goal(s).

Goal 1:

1. Objective:

2. Objective:

3. Objective:

Goal 2:

1. Objective:

2. Objective:

3. Objective:

4. Intervention Objectives Timeline

Present Date

Objective ( Number and Statement)

Anticipated Completion Date

Enter Date

Ex. Eighty-percent (80%) of infants seen by health department, neighborhood health center, and private physicians will have developmental levels assessed.

Enter Date

5. Plan of Intervention and Evaluation

Intervention Activities

Responsible Agency/Person

Evaluation Measures

Target Date of Completion

Enter start date.

Ex. Community Health Nurse identifies and trains lay advisors in community as case finders

Ex. Community Health Nurse

(CHN)

Ex. • Lay advisors will be able to verbally describe case-finding methods to CHN

• Number of new WIC cases will be tracked by CHN on monthly basis for 1 year to determine if goal of 80% has been met

Ex. Lay advisor training completed by enter date of estimated completion.

Summary/Conclusion: Summarize your assessment findings, your proposed community health nursing intervention, and the community public health outcomes that you anticipate as a result of the intervention. This can be one or two brief paragraphs. Remember to cite sources as appropriate.