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Running Head: CAP REPORT FOR CT 45.05

Community as a Partner (CAP) Report for Census Tract 45.05

Lizzy Hammond, Lauren Hoyos, Brandon Harvison, Miguel Nava

University of Arizona
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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.

Community Nursing Assessment

Core

The community of CT 45.05, as described by an Autozone employee (personal

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

Nursing Community Profile CT 45.05, 2018).

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

routine maintenance on the school grounds to maintain an aesthetic appearance. Other

educational facilities included New Discoveries Preschool, Precious Moments Daycare, Tucson

College of Beauty School, and Amphi Head Start (Pima County Health Department Public

Health Nursing Community Profile CT 45.05, 2018).

Safety & Transportation

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).

Politics & Government

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

(Representative), and Macario Saldate (Representative). The community is in U.S. Congressional

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

Health Department Public Health Nursing Community Profile CT 45.05, 2018).

Health & Social Services

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

Department Public Health Nursing Community Profile CT 45.05, 2018).

Communication

Forms of public communication included newspaper publications, payphones, billboards,

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

Health Department Public Health Nursing Community Profile CT 45.05, 2018).

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

Community Profile CT 45.05, 2018).

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

Nursing Community Profile CT 45.05, 2018).

Community Nursing Diagnosis

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

(SNAP), Food Distribution Program on Indian Reservations (FDPIR), or Temporary Assistance

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

resource to this community.

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

night (Goodwill cashier, personal communication, February 26, 2018).

Based on these assessments, the student nurses decided to focus on an intervention

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

injury from prescription opiates among residents of CT 45.05 related to mismanagement 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

located in the appendices of this paper.

Community Nursing Plan

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

through the disposal of the substance (U.S. Department of Justice, 2018).

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.

This proposed intervention is vital to the enhancement of the CT, as it is plagued by

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).

SMART Objectives and Evaluation

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

effectiveness or impact method of evaluation.

Level of Prevention and the Natural History of Disease

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.

Resources and Constraints

While collaborating to schedule the education project, the student nurses required many

resources, such as information on Dispose-A-Med, a location to present at, and materials to

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-

medicating, taking expired medications, and prescription drug abuse.

Implementation of Community Nursing Intervention

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

evaluating what the community members learned post teaching.

Evaluation of Community Nursing Intervention

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

CrimeReports. 2018. Retrieved from https://www.crimereports.com/home/#!/dashboard?

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&current_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

La Frontera Arizona. (2018). Casa de vida. Retrieved from http://lafronteracenter.org/program-1/

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

Priorities of Care Table For CT 45.05

Community Identified in Severity of

Community Nursing Availability Applicable
health concern Pima outcome(s)

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

Social Advocacy**: Write a letter to a legislative

Homelessness 0 4 0 1 2 Factors representative supporting existing 7
job/housing initiatives to address
homelessness.

Individual Health Teaching**: Sharing needles can

Substance Behavior spread bloodborne illness, but programs,
2 4 1 0 2 9
Abuse such as Lifepoint, allow for the exchange of
used needles for clean, new needles
addressing substance abuse.

Safety Social Policy Development and Enforcement**:

(Theft/ 2 2 1 1 2 Factors Defining a resident's role in the 8
Violence) "Neighborhood Watch" and steps for how
to enforce it.
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Running Head: CAP REPORT FOR CT 45.05