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Running head: COMMUNITY-AS-PARTNER REPORT 1

Community-As-Partner Report

Christina Etchart, Lauren Austin, and Jen Riedel

The University of Arizona


COMMUNITY-AS-PARTNER REPORT 2

Introduction

We are students at the University of Arizona, College of Nursing who constructed a

project based on the Community-As-Partner (CAP) model within the Census Tract (CT) 38.01.

This project enabled us to assess the community and implement a needed nursing intervention

based on our findings. We began our assessment of the community at the end of January, by

conducting a windshield survey and key informant interviews, along with the use of nursing

informatics. We analyzed the information we gathered to develop a community nursing

diagnosis and created a program plan for an intervention based on the major stressor we

identified. This paper provides in-depth descriptions of each step of our community assessment

process, our intervention, and our conclusions.

Community Nursing Assessment

To assess the Core of the CAP Model within this community, we implemented the use of

nursing informatics to identify that the total population within CT 38.01 is 3,486 people. This

community has over twice the number of Hispanic or Latino residents than Pima County, and

Spanish is the predominant language spoken within this area. Compared to Pima County, almost

four times the number of people in this CT speak only Spanish at home. In the small community

that is CT 38.01, there are various ethnic food stores and restaurants, such as meat markets and

Hispanic food trucks. When completing our windshield survey, we observed a few community

members dressed in cowboy boots and hats, and many others in jeans and a T-shirt (Pima County

Health Department Public Health Nursing Community Profile CT 38.01, 2018).

When assessing the Physical Environment of this community, it is important to note that

the boundaries of CT 38.01 are West President St, South 7th Ave, West Irvington Rd, and South

12th Ave. This CT has a larger percentage of older homes compared to Pima County. There is
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also a larger percentage of 1-unit structures and a smaller percentage of three or more unit

structures or mobile homes in this CT than in Pima County. From our windshield survey we

noted that there were a few vacant and boarded up structures on each street, trash in the yards of

some of the homes, and a few abandoned cars. Not only were there trees at the small park located

in the middle of the CT (Rodeo Wash Park), but there were also some trees within people’s

yards. However, there is more concrete than plants within the landscape of the Rodeo Wash

Park. (Pima County Health Department Public Health Nursing Community Profile CT 38.01,

2018).

The next subsystem of the CAP model being discussed is Health and Social Services. The

closest hospital to CT 38.01 that is available to the public is Banner University Center South,

which provides a large array of services, such as mental health and women’s health. Located at

the Richard Ortiz Barker Regional Complex, there are many health and social services available

to this community including a Senior Center, El Rio Health Center, and Clinica Amistad. The

Senior Center provides socialization, nutrition services, and support to senior citizens. El Rio

Community Health Center is a medical clinic that provides various services, including behavioral

health. Clinica Amistad is a free medical clinic for low-income and uninsured members of the

community. Other social services available at this complex include the City of Tucson

Community Services Department, Emerge Center, and the Department of Economic Security.

Within one to two miles outside of this CT this community has access to an urgent care,

pharmacy, dentist, and a food bank. Another resource for this community is the Theresa Lee

Public Health Office (Pima County Health Department Public Health Nursing Community

Profile CT 38.01, 2018).


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When assessing the subsystem of Education, it was identified that there is a greater

percentage of people living in CT 38.01 with an education less than ninth grade, than in Pima

County. This CT is within the Tucson Unified School District. For kindergarten through eighth

grade, half of this CT goes to CE Rose Elementary School, while the other half goes to Hollinger

Elementary School. All of this CT is in the attendance zone to attend Pueblo High School. One

of the many educational resources for the people in this community is the El Pueblo Library,

which is located right across the street from this CT (Pima County Health Department Public

Health Nursing Community Profile CT 38.01, 2018).

There are several resources within this CT that fall into the Recreation subsystem of the

CAP Model. The El Pueblo Activity Center, located in the Richard Ortiz Barker Regional

Complex, contains multiple indoor basketball courts, a gym with a weight room, an indoor track,

a pool, and other various sport rooms, all of which are open to the community. The El Pueblo

Center also contains the Senior Center which provides recreation for seniors. In addition, El Rio

Community Health Center offers various exercise classes. Located across the street from the El

Pueblo Center, the Rudy Garcia Park has several play structures, baseball fields, softball fields,

soccer fields, picnic areas, and ramadas. In addition to this park, there is also the Rodeo Wash

Park that is right in the middle of CT 38.01. This is a very small park with only one play

structure, a half-court basketball court, and a water fountain that does not work (Pima County

Health Department Public Health Nursing Community Profile CT 38.01, 2018).

Safety was a common theme brought up in many of the key informant interviews, which

is another subsystem within the CAP Model that we assessed. The Tucson Police Department

(TPD) Sergeant, at the South Tucson Santa Cruz Substation, spoke about the high burglary rate

in the area. He said he has seen up to 13 homes get broken into in the same day. TPD and Tucson
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Fire Department (TFD) are both less than two miles from our CT. While conducting our

windshield survey, we noticed almost every house had at least one beware of dog sign, private

property sign, or no trespassing sign, and there were about two Neighborhood Watch signs on

each street. According to the CrimeReports website statistics, there were 11 violent crimes, 25

property crimes, and 29 quality of life crimes, in this CT between January 19, 2018 and February

2, 2018. Additionally, there are four registered sex offenders in this CT (Pima County Health

Department Public Health Nursing Community Profile CT 38.01, 2018).

In regard to the Transportation subsystem, this CT is located across the street from the

Roy Laos Transit Center. There are four bus routes along the south boundary of this CT,

including covered bus stops on the west and south boundaries. In the neighborhood, there are not

many sidewalks and no designated bike lanes. However, there are sidewalks and bike lanes on

the south and west boundaries of the CT. The roads within the neighborhood have many potholes

and roundabouts. Since this CT is bound by two major streets, Irvington Road and 12th Avenue,

there is a concern for pedestrian safety and motor vehicle accidents (Pima County Health

Department Public Health Nursing Community Profile CT 38.01, 2018).

The Economics subsystem greatly affects the community within this CT. The median

household income in Pima County is almost double the amount in this CT. Similarly, the

percentage of all people living in poverty in CT 38.01 is more than twice that percentage in Pima

County. In terms of businesses in this CT, we found that there are a large number of fast food

restaurants in or near this CT. There are also a number of convenience stores, gas stations, liquor

stores, bars, restaurants, and laundromats in or near CT 38.01. There are no farmers markets,

community gardens, or health food stores within a close distance to this CT (Pima County Health

Department Public Health Nursing Community Profile CT 38.01, 2018).


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When assessing the Politics and Government subsystem, we identified that CT 38.01 is

within Tucson city limits and the majority of the CT consists of the Wakefield Neighborhood.

During our windshield survey, we did not see any signs of political activity. This CT is within

US Congressional District 3 with the representative being Raul Grijalva (Pima County Health

Department Public Health Nursing Community Profile CT 38.01, 2018).

The last subsystem of the CAP Model that we assessed was Communication. From our

windshield survey we did not see any newspapers or payphones, however there is a free phone

tent on Irvington Rd. We noted one billboard along 12th Ave advertising for We Buy Ugly

Houses and Law Tigers and a billboard along MacArthur St advertising for the MacArthur Street

Apartments. The closest free Wi-Fi access is located at El Pueblo Library (Pima County Health

Department Public Health Nursing Community Profile CT 38.01, 2018).

Community Nursing Diagnosis

Community Strengths

While assessing the community, we identified three major strengths this community

encompasses including family, pride, and resources. A majority of the key informants mentioned

how important family is to this community. Many of the key informants also expressed how even

though the residents struggle with poverty, they take pride in what they do have and what they

have accomplished. One of the firefighters at the TFD stated that most of the people living in the

area are “resilient, family oriented, and take pride in what they do” (personal communication,

January 26, 2018). Through the windshield survey and some of the key informant interviews, we

found that the community has access to many resources. CT 38.01 is located right across the

street from the El Pueblo Center, El Pueblo Library, and El Rio Health Center, along with many

more services. The manager at El Pueblo Activity Center noted that there are “a lot of resources
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for the community, a little bit of everything for everyone” (personal communication, January 26,

2018). All three of the identified community strengths were common themes brought up in a

majority of the key informant interviews and validated while interacting with the community.

Community Stressors

The three most critical stressors we identified for CT 38.02 are diabetes, nutrition, and

poverty. Almost all of our key informants commented on diabetes being one of the major health

concerns in this community and how many of them struggle with managing their diabetes. A

firefighter at the local TFD commented that “someone could be missing a foot and they still

don’t check their sugars regularly,” (personal communication, January 26, 2018). Nutrition was

also identified to be a major stressor based on key informants reporting that unhealthy diets are

common in this community. The school nurse at CE Rose Elementary school noted that “we

have a kindergartner here that is 135 pounds,” (personal communication, January 26, 2018). This

stressor was further reinforced when we found a large number of fast food restaurants and no

health food/organic food markets in the area during our windshield survey. Poverty was

recognized as being a critical stressor by both the key informant interviews and the American

Community Survey. The percentage of all people living in poverty in CT 38.01 is more than

twice that percentage in Pima County and the median household income in CT 38.01 is half that

of Pima County’s median household income (U.S. Census Bureau, 2018).

Community Nursing Diagnosis

Using the stressors that we identified in our assessment, we completed a Priorities of

Care Table, which is included in Appendix A. Based on this table and our community

assessment, we identified diabetes as one of the most critical stressors in this community and one

that we have the ability to address. We formulated the following community nursing diagnosis
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for this stressor: risk for health complications from diabetes, among adults within the 38.01 Pima

County CT, related to lack of knowledge about diabetes management, insufficient funds to buy

healthy foods, and medication noncompliance, as evidenced by windshield survey data of 13 fast

food restaurants near/within the CT and lack of healthy food options within the immediate area, a

poverty level of 43% within the CT (compared to the Pima County poverty level of 19.1%), and

key informants reporting the community’s inability to afford necessary medications and an

increased number of calls to the Fire Department regarding hypo/hyperglycemia (U.S. Census

Bureau, 2018).

Community Nursing Plan

Good Goal

The Good Goal we developed to address this nursing diagnosis was to increase the

knowledge base about diabetes management among the adult population within the 38.01 Pima

County CT. The intervention for our goal was to educate adults on February 16, 2018, at the El

Pueblo Library right outside of the 38.01 Pima County CT about healthy food options in order to

better manage diabetes through diet modification.

Evidence-Based Article

Prior to implementing an intervention within the community, we researched what

approach would be the most beneficial way to educate adults about diabetes management.

According to Effect of a health literacy-considered diabetes self-management program for older

adults in South Korea conducted by Lee, Song, and Im (2017), “health literacy can help [...]

improve implementation of self-management programs,” (p. 224). This article discusses a

randomized controlled trial (RCT) in South Korea that was completed with 51 adults who were

diagnosed with diabetes. The purpose of this study was to determine how taking into
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consideration the participants’ health literacy level affects the amount of knowledge the

participants gain from diabetes self-management education (Lee et al., 2017). Out of the seven

Levels of Evidence presented in the Evidence-Based Public Health Nursing Practice

presentation, this RCT falls into the level II evidence category (Goldsmith, 2018). We applied

this evidence to our health education project by completing our poster board at a basic health

literacy level in order to target the population we were teaching.

Healthy People 2020 Support

Our project was directed towards Healthy People 2020’s (HP2020) overarching goal of

“promoting quality of life, health development, and healthy behaviors across all life stages”

(U.S. Department of Health and Human Services, 2018a). The topic area applicable to our

project is Diabetes with the goal being “to reduce the disease burden of diabetes mellitus (DM)

and improve the quality of life for all persons who have, or are at risk for, DM,” (U.S.

Department of Health and Human Services, 2018b). The HP2020 objective that supports our

project is D-14, which is to “increase the proportion of persons with diagnosed diabetes who

receive formal diabetes education,” (U.S. Department of Health and Human Services, 2018b).

Policy/Legislation

The Minority Diabetes Initiative Act H.R.2351, was introduced to Congress on May 4,

2017. This bill is currently being considered by committees before it is sent on to the House and

Senate as a whole. The purpose of this bill is to authorize grants to provide treatment and

education on diabetes prevention and management (Civic Impulse, 2018). Our health education

project correlates with bill H.R. 2351 since we provided education on diabetes management to

the public.

SMART Objectives
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We developed two SMART objectives in order to help us evaluate the impact of our

health education project. The first objective was to provide education on diabetes management

through diet modification to a minimum of 15 adults at the El Pueblo Library on February 16,

2018. Our second objective was to have 75% of the participants report that they learned

something new about diabetes management after the presentation on February 16, 2018.

Program Plan

In order to implement the health education project, we developed the following program

activity statements:

1. By February 12th, 2018, the student nurses will schedule a time with the manager

at El Pueblo library to provide the diabetes management presentation at the

library.

2. By February 14th, 2018, the student nurses will finalize the teaching plan for the

diabetes management presentation at El Pueblo library.

3. By February 15th, 2018, the student nurses will finalize the diabetes management

presentation poster board, handouts, and surveys.

To evaluate the project, we counted the number of adults who stopped at the booth,

counted the number of people who took handouts, and asked each participant “have you learned

anything from this booth?” on February 16, 2018. This form of evaluation includes the

evaluation methods of observation and survey (Anderson & McFarlane, 2015). This evaluation

tool is included in Appendix B.

Collaboration

Throughout this project, we collaborated with multiple community partners. For example,

after every week we emailed our assigned Public Health Nurse (PHN) with updates on our
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progress and project presentation details. Additionally, we conducted key informant interviews

by coordinating set appointments and walk-ins with various members of the community without

difficulty. We encountered some challenges when scheduling the location and time of our health

education project. The information on resources that we distributed to those who stopped at our

poster board was provided to us from multiple PHNs at the Public Health Department.

Levels of Prevention

Our project was directed to prevent further health complications in individuals with

established diabetes. Therefore, our intervention is considered to be a form of tertiary prevention

(McFarlane & Gilroy, 2015). This level of prevention correlates with the recovery or disability

stage of the natural history of disease (Centers for Disease Control and Prevention, 2012).

Resources and Constraints

To complete our health education project, the required and available resources were

 student nurses to gather information on diet modification for diabetes management;

 student nurses to utilize the gathered information to create educational materials;

 a physical space to teach the diabetes education; and

 knowledgeable student nurses to educate the public about diabetes management.

Some constraints that we encountered were

 lack of a Spanish-speaking translator;

 insufficient number of flyers; and

 inability to accommodate a sit-down class.

Implementation of Community Nursing Intervention

For our health education project, we educated the public about small diet modifications

for diabetes management utilizing a poster board and including handouts. We ended up
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interacting with 16 community members. It was a challenge to catch people’s attention at first,

but after moving closer to the entrance of the library, we were able to engage with more people

than we anticipated. The community was open and willing to learn about diabetes management,

and was respectful. The visual aids that were used during our health education project are

attached in Appendices C-I.

Evaluation of Community Nursing Intervention

Following the health education that we provided, we evaluated the impact of our

intervention by asking the participants “Have you learned anything from this booth?” and

keeping record of their responses. Additionally, we kept a running tally of the number of

participants that visited our project, and those who took a handout. There were 16 people who

attended our project, 15 of which who stated that they learned something. This means that

93.75% of the 16 participants gained knowledge from our project, and therefore both of our

objectives were met. Since our evaluation method was face to face, one challenge that we

encountered was the possibility of acquiring skewed data due to response bias.

Throughout the completion of the CAP project, we gained insight on PHN as a whole. By

completing the windshield survey and key informant interviews, we learned that place truly does

matter. We also identified that while the CT of 38.01 has multiple stressors affecting the

community, there are also many strengths that have a lasting impact on the residents. If we were

to repeat the health education project, we would recommend establishing a sit down class rather

than a booth in order to provide health education. After completing our Community Profile and

evaluating our health education project, we emailed the results to our assigned PHN and the PHD

Nurse Manager.
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References

Anderson, E. T. & McFarlane, J. (2015). Evaluating a community health program. In E. T.

Anderson & J. McFarlane (Eds.), Community as partner: Theory and practice in nursing

(pp. 267-269). Philadelphia, PA: Wolters & Kluwer.

Centers for Disease Control and Prevention [CDC]. (2012). Lesson 9: The natural history and

spectrum of disease. Retrieved from

https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section9.html

Civic Impulse. (2018). H.R. 2351 — 115th Congress: Minority Diabetes Initiative Act. Retrieved

from https://www.govtrack.us/congress/bills/115/hr2351

Goldsmith, P. N. (2018). Evidence-based population health nursing practice [PowerPoint

slides]. Retrieved from

https://d2l.arizona.edu/d2l/le/content/640851/viewContent/5589434/View

Lee, S. J., Song, M., & Im, E. O. (2017). Effect of a health literacy-considered diabetes self-

management program for older adults in South Korea. Research in Gerontological

Nursing, 10, 215-225. doi:10.3928/19404921-20170831-03

McFarlane, J. & Gilroy, H. (2015). Epidemiology, demography, and community health. In E. T.

Anderson & J. McFarlane (Eds.), Community as partner: Theory and practice in nursing

(pp. 31). Philadelphia, PA: Wolters & Kluwer.

U.S. Census Bureau. (2018). Selected Economic Characteristics. 2012-2016 American

Community Survey 5 year estimates [Census Tract 38.01, Pima County, Arizona].

Retrieved from

https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?fpt=table

U.S. Department of Health and Human Services. Office of Disease Prevention and Health
COMMUNITY-AS-PARTNER REPORT 14

Promotion. Healthy People 2020. (2018a). About health people. Retrieved from

https://www.healthypeople.gov/2020/About-Healthy-People

U.S. Department of Health and Human Services. Office of Disease Prevention and Health

Promotion. Healthy People 2020. (2018b). 2020 topics and objectives. Retrieved from

https://www.healthypeople.gov/2020/topics-objectives/topic/diabetes
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Appendix A

CT 38.01: Priorities of Care Table

Community Identified in Severity of


Community Nursing Availability Applicable

Total score
health concern Pima outcome(s)
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

Health Teaching: Teach a class at El Pueblo


Diabetes 2 4 2 1 2 Biology and Senior Center addressing diabetes 11
Genetics management, taking into consideration
health literacy levels.

Social Community Organizing: Invite local businesses


Poverty 1 2 1 0 2 6
Factors to participate in a job fair for the
community.

Social Coalition Building: Work with Tucson Police


Crime 1 2 0 1 1 5
Factors Department and neighborhood watch to
brainstorm effective preventative measures.

Outreach: Provide community with


Nutrition 1 4 2 1 2 Social information about how healthy, low cost 10
Factors foods can be obtained.

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 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.
Running head: COMMUNITY-AS-PARTNER REPORT 16

Appendix B

Evaluation Tool

Number of People Who Stop at the Booth

√√√√√√√√√√√√√√√√

Number of People Who Take a Handout

√√√√√√√√√√√√√√

Have you learned anything from this booth?

Yes: √ √ √ √ √ √ √ √ √ √ √ √ √ √ √

No: √
COMMUNITY-AS-PARTNER REPORT 17

Appendix C

Help for Diabetes Control


 DEEP – Diabetes Education and Exercise Program at El Rio
Health Center.
o Pima Community College – Desert Vista 5901 S. Calle
Santa Cruz Tucson, AZ 85709, AZ 85709 United States
o Mondays and Wednesdays from 11-12
o 520-206-5030
 El Rio Health Center
o 101 W. Irvington Road
o Building 10, Tucson, Arizona 85714
o Monday through Friday 8am – 9pm
Saturdays 8am – 5pm
o (520) 670-3909
 Clinica Amistad
o 101 W Irvington Rd. Building #3, Tucson, AZ 85714
o Wednesday and Thursday from 5:00pm – 9:00pm and
first Saturday of every month from 10:00am – 2:00pm.
o (520) 305-5107
 Produce on Wheels
o 1255 N. Stone Ave., Tucson 85709
o Saturday, February 17th from the hours of 8:00am –
11:00am
o 520-287-2627
 City Wide Produce
o 6221 S. Campbell Ave, Tucson, AZ 85706
o Monday to Friday 9:00 AM - 6:00 PM, Saturday 9:00 AM -
4:00 PM, closed Sunday
o (520) 295-9000
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Appendix D

Ayuda Para el Control de la Diabetes

 DEEP – Diabetes Education and Exercise Program at El Rio


Health Center.
o Pima Community College – Desert Vista 5901 S. Calle
Santa Cruz Tucson, AZ 85709, AZ 85709 United States
o Lunes y Miércoles de 11am-12pm
o 520-206-5030
 El Rio Health Center
o 101 W. Irvington Road
o Edificio 10, Tucson, Arizona 85714
o Lunes hasta el Viernes 8am – 9pm
Sábados 8am – 5pm
o (520) 670-3909
 Clinica Amistad
o 101 W Irvington Rd. Edificio #3, Tucson, AZ 85714
o Miércoles a Jueves de 5:00pm – 9:00pm y primero
Sábado de cada mes desde 10:00am – 2:00pm.
o (520) 305-5107
 Produce on Wheels
o 1255 N. Stone Ave., Tucson 85709
o Sábado, Febrero 17th 8:00am – 11:00am
o 520-287-2627
 City Wide Produce
o 6221 S. Campbell Ave, Tucson, AZ 85706
o De Lunes a Viernes 9:00 AM - 6:00 PM, Sábado 9:00 AM -
4:00 PM, cerrado el Domingo
o (520) 295-9000
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Appendix E
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Appendix F
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Appendix G
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Appendix H
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Appendix I