COMMUNITY AS PARTNER PROGRAM PLAN CENSUS TRACT-3400 1

Community as Partner Program Plan Census Tract 3400

Adriana Gamez, Megan Malanowski, and Rachel Moses

University of Arizona
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Community Analysis and Nursing Diagnosis

Census Tract (CT) 3400 is a diverse community with many complexities. We identified

three strengths of this community as the abundance of community involvement, the presence of

political activity within the community, and the availability of green space and parks. According

to the firefighter with Tucson Fire Department (personal communication, October 25, 2019),

many of the residents of this community have been around for quite a long time, which allows

engagement between the members of the community to flourish. Additionally, our windshield

survey found many signs of political activity throughout the community, as well as several well-

maintained parks available for residents to visit. Furthermore, this community is well-

represented by the city government, further benefiting the community (Pima County, 2019).

These factors benefit the community by encouraging healthy behaviors and relationships.

Our team identified three critical stressors in CT 3400: the lack of healthy food options,

the limited health care options, and the high rates of mental illness. According to the U.S.

Census, 6.9% of people in CT-3400 do not have health insurance, and 14.5% live in poverty,

which naturally limits healthcare options (U.S. Census Bureau, n.d.-a). As we conducted our

windshield survey, we noticed that there was a marked lack of primary care provider (PCP)

offices and no urgent care within the community, which limits the options from which people

can receive healthcare. We also noticed that the nearest grocery store was outside of the census

tract. An employee at the Randolph Recreation Center (personal communication, October 25,

2019) as well as a librarian at the Eckstrom-Columbus Library (personal communication,

October 25, 2019) noted that many of the youth they see do not eat healthy snacks and lean

towards junk food. Additionally, the police officer at the City of Tucson Police Substation

(personal communication, October 25, 2019) explained that mental health issues are involved in
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70% of the calls they receive. Overall, these three stressors put a great deal of burden on the

individuals within the community and on the community itself.

Based on our community assessment, we identified several pressing issues within this

community to focus on. Our priorities of care for CT 3400 included the three primary stressors

mentioned above: poor health care options, lack of healthy food options, and high rates of mental

illness. In addition to these, we also added the high rates of drug abuse and low health literacy.

Drug abuse is a significant problem that the librarian, police officer, and firemen mentioned

(personal communication, October 25, 2019). Health literacy was a problem noted by the

pharmacist, the librarian, and the school nurses we interviewed (personal communication,

October 25, 2019; personal communication, November 1, 2019). Additionally, 4.3% of the

population of this community does not speak English very well, which impacts health literacy

(U.S. Census Bureau, n.d.-b). The Priorities of Care Table, which summarizes the community’s

priority problems, is listed in Appendix A.

We decided that health illiteracy was one of the biggest problems for us to focus on due

to the current cold and flu season, and the wealth of information we received from the school

nurses and the librarian (personal communication, October 25, 2019; personal communication,

November 11, 2019) about how the cold and flu impacts the students and youth around the

community. Based on this, we decided to narrow in on education regarding cold and flu season.

We created the following diagnosis for CT 3400: risk for cold and flu infection among school-

aged children related to low health literacy and insufficient resources for healthcare and

childcare, as evidenced by the school nurses stating that children will come to school sick and

the parents refuse to pick them up from the nurse’s office.

Community Nursing Program Plan

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The community health goal for our intervention was to improve handwashing practices of

school-aged children to prevent the spread of infection. This goal aimed to address the nursing

diagnosis we formulated by improving the community’s health literacy through the means of

health teaching.

We used evidence from a study by Buck, Greenway, Hoffman, Wittman, & Kim (2018)

to develop our project. The purpose of this study was to determine the best ways to teach

handwashing to children ages kindergarten through 5th grade. Teachers repeatedly reported

absenteeism due to illness and wanted to educate on handwashing to eliminate the spread of

germs. In this study they used a sample size of 313 children and the setting took place in 8

different schools (Buck et al., 2018). This was similar to our health education project as our

target population were children ages 3-14. Our project took place in a library; however, it was

similar to the study in that both settings were a familiar learning environment for the children.

The strength of this article was a level III (well-designed controlled trial without randomization).

These studies help in reaching a target population without randomization. The purpose was to

see how this education impacted all children in the group and it was more practical to do than an

experimental study (Buck et al., 2018).

The overarching goal of Healthy People 2020 (2014a) that applied to our project the most

was the 1st goal: “attain high-quality, longer lives free of preventable disease, disability, injury,

and premature death”. The most applicable topic area is Immunizations and Infectious Disease,

and the goal for this topic is “increase immunization rates and reduce preventable infectious

diseases” (Healthy People 2020, 2014b). The objective we are focusing on Objective IID-1:

“Reduce, eliminate, or maintain elimination of cases of vaccine-preventable diseases.” (Healthy

People 2020, 2014b).

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We selected Infectious Disease Society of America (IDSA) as a policy that relates to our

community health goal. This is an organizational policy, the purpose of which is “to improve the

health of individuals, communities, and society by promoting excellence in patient care,

education, research, public health, and prevention relating to infectious diseases” (IDSA, 2019).

In order to meet our chosen community health goal, we planned a health education

project to educate children on handwashing and hand hygiene. The health education project took

place at the Eckstrom-Columbus Library, and it aimed to target children ages kindergarten

through middle school. Each of the group members taught a portion of the visual aid: a poster

that was created to educate on germs and hand hygiene. This poster can be found in Appendix B.

After the poster was presented the group members lead a craft on how to make soap to further

engage children in the handwashing activities. We also did a Glo Germ activity to show how

germs spread and how they can look like on an individual's hands. The health education project

ended with an evaluation of a crossword puzzle and a coloring worksheet, which can be found in

Appendices C and D.

During our planning phase, we developed the following SMART Learning Objectives to

use as goals for this project:

 By the end of the teaching session 75% of the students will be able to explain what a

germ is based on the evaluation worksheet.

 By the end of the teaching session 75% of students will be able to identify how germs

can be spread based on the evaluation worksheet.

 By the end of the teaching session 75% of the students will be able to effectively

demonstrate the 6 steps of handwashing by using the crafted soap.

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In order to implement the teaching project in a timely manner, we planned out the

following three program goals leading up to the project, all of which were met on time:

 By November 7th, the nursing students will confirm a date, time, and place for doing the

HEP with the Eckstrom-Columbus Library.

 By November 15th, the nursing students will complete a visual aid for the HEP project in

the form of an educational poster board. See Appendix B for our completed poster.

 By November 15th, the nursing students will find post-teaching evaluation worksheets

that will be used to test the students’ knowledge.

Our plan for evaluating our goals effectively and comprehensively included the three

following strategies:

 The children will be handed a crossword puzzle to complete, which addresses what a

germ is. This will evaluate their knowledge of the first learning objective.

 The children will be handed a germ coloring worksheet, which addresses how germs

spread. This will evaluate their knowledge of the second learning objective. See

Appendix C and Appendix D for copies of the worksheets we used.

 The children will wash their hands at a sink in the room with the crafted soap they made.

This will evaluate how well they can wash their hands and address the third learning

objective.

We collaborated with several people for this health education project. This included the

librarian, the craft program organizer at the library, our public health nurse, and our clinical

instructor. The librarian and craft program organizer helped to accommodate us by arranging the

time and location; they also provided some supplies such as a table for our poster board, outlets

for the Glo Germs, and a sink. Our public health nurse was a resource we could always contact
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for ideas and was a great support during the process. Lastly, our instructor supplied us with many

of the resources for our project, including the Glo Germs, the ingredients for the soap, and the

supplies for the poster. She truly made this project possible. It was a very successful project and

turned out great due to wonderful collaboration efforts.

Our intervention addressed the stage of susceptibility, due to handwashing being an

intervention that aims to prevent the start of an illness. The level of prevention was primary

prevention because we taught the children how to prevent the spread of germs by handwashing.

This targets the spread of a disease before it even can begin, such as a cold or the flu.

We required a number of resources for our health education project including a poster

board, print out pictures, tape, construction paper, pure castile soap, grape seed oil, cornstarch,

food coloring, plastic bowls, plastic spoons, plastic bags, the Glo Germ supplies, printouts of

evaluation worksheets. We were able to obtain all of the materials that were needed. The group

members as well as the teacher provided the materials.

Implementation of Community Nursing Intervention

We held our teaching project on November 21, 2019, at 3:30 pm. This was done at the

Eckstrom- Columbus Library, specifically in a large activity room they use for various events.

We had a total of eleven participants, which was less than anticipated. This was most likely due

to the bad weather outside. We started with teaching the participants about germs, how they

spread, and handwashing techniques. Then, the participants made the soap with the ingredients

we provided. Afterwards, participants were taught about Glo Germs and given the chance to put

the lotion on and see the fake germs under a black light. They then washed their hands with the

soap they made and came back to see if the germs were gone. Finally, our evaluation sheets were

passed out. Both the children and the parents who attended seemed to enjoy the project and
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reported learning a few new things. Overall, the project very successful and we are satisfied with

our project as a whole.

Evaluation of Community Nursing Intervention

Although our intention was to evaluate the teaching by watching them wash their hands

and then having our participants complete the evaluation worksheets, time constraints prohibited

us from doing so. Instead, we improvised a few different techniques in order to evaluate our

participants’ learning. However, because we had to come up with new evaluation methods on the

spot, these new methods did not exactly fit our goals, and therefore did not accurately test for

each of our goals.

Instead of collecting the worksheets, we asked a few questions at the end to evaluate the

participants’ knowledge. We asked them how to prevent getting sick, what they could sing while

washing their hands, and where they could find germs. Our first goal of 75% of students

identifying what a germ was not be met. This could not be met because we did not collect the

evaluation worksheet that specified what germs are, and the verbal questions did not address this

objective. The questions partially address our second objective of how germs can be spread;

however, only a few children answered our questions. While the few children who answered did

answer correctly, it was not enough to meet our goal of 75% of students demonstrating an

understanding of our topics. Therefore, our second goal was only partially met.

To meet our third goal about effective handwashing, we looked at each child’s hands

under the black light to see how much Glo Germs were left on their hands after washing. This

was to evaluate the efficacy of their hand hygiene. 10 out of 11 students had no “hot spots” of

Glo Germs left on their hands, meaning more than 75% of students were able to effectively wash

their hands, therefore meeting our third goal.

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Dissemination of Findings

As a group, we chose to disseminate our findings by compiling our assessment and

evaluation of CT 3400 into a community profile. We shared this with our instructor, the Pima

County Health Department, and our public health nurse. In addition to this, we shared our

community profile findings along with an overview of our teaching project in a PowerPoint

presentation at the Pima County Health Department in front of the staff. Our findings were

received well and we hope that our evaluation of CT 3400 can be a benefit to the community in

the future.
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References

Buck, Julie., Greenway, S., Hoffman, K., Wittman, G., Kim, H. J. (2018). Educators teach

effective hand washing with a simplified method. Journal of Extension, 56. Retrieved

from: https://joe.org/joe/2018october/pdf/JOE_v56_6iw2.pdf

Healthy People 2020. (2014a). About healthy people. Retrieved from

https://www.healthypeople.gov/

Healthy People 2020. (2014b). Immunizations and infectious disease. Retrieved from

https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-

diseases

Infection Disease Society of America. (2019). Retrieved from https://www.idsociety.org/

Pima County. (2019). Board of supervisors. Retrieved from

https://webcms.pima.gov/government/board_of_supervisors

U.S. Census Bureau. (n.d.-a). Selected economic characteristics. 2013-2017 American

Community Survey 5-year estimates [Census Tract 3400, Pima County, Arizona].

Retrieved from http://factfinder2.census.gov

U.S. Census Bureau. (n.d.-b). Selected social characteristics. 2013-2017 American Community

Survey 5-year estimates [Census Tract 3400, Pima County, Arizona]. Retrieved from

http://factfinder2.census.gov
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Appendix A

Priorities of Care Table

Community Identified Community Nursing Availability Severity of Applicable Ideas for nursing Total
health in Pima expression students’ of outcome(s) HP2020 intervention score
concern or County’s of interest ability to resources without Determinan (Use Minnesota Wheel)
problem, Health in address relevant for effort to t of Health ** The interventions listed
(stressor, risk Needs addressing problem addressing address category below are just examples.
factor, need, Assessment problem2 problem problem Students can use any of the
1
determinant) interventions from the
wheel.

Lack of 2 0 1 1 2 Health Referral & Follow Up: 6

health care Services Refer people to free clinics

options or income-based clinics,

such as El Rio, Fatima

Women’s Center, or the

Shubitz Family Clinic.

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Lack of 2 4 1 1 2 Social Community Organizing: 10

healthy food Environ Assist the community in

options creating a community

garden and a neighborhood

food pantry.

High rates of 2 2 1 2 1 Health Coalition Building: Work 8

mental Services with the local first

illness responders as well as case

management resources such

as COPE and CODAC to

form better practices for

dealing with emergency

psychiatric patients.
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Lack of 1 4 2 0 1 Health Health Teaching: Educate 8

health Services people at the local library on

literacy the importance of vaccines

and handwashing to prevent

getting the flu.

High rates 2 2 1 2 2 Individual Advocacy: Draft a letter to 9

of drug behavior the Arizona Legislature to

addiction advocate for the

implementation of safe

injection sites or needle

exchange programs in

Tucson.

Note. 1 Score 1 point if consistent with report findings as a concern in Pima County. Score 2 points if 1 of Pima County’s 3 priority areas: Behavioral Health;

Obesity & Related Chronic Diseases; Access to Services. 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, Community-Oriented Practice, 3rd ed., p. 232. St. Louis: Mosby/Elsevier/Evolve.
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Appendix B

Visual Aid Poster Board

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Appendix C

Evaluation Tool: Germ Search Coloring Sheet

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Appendix D

Evaluation Tool: Hygiene Crossword Puzzle