Running Head: N470 PAPER 1

N470 Community Health Paper

Brannon, Green, Khosla, Lenox, Luther, McLean, Murphy, Penn, Ragaza, Wineland
Old Dominion University

N470 Community Health Paper

The objective of this paper is to discuss and identify the substance abuse issues in

Hampton Roads and the aggregate, and assess the needs for the betterment of the community as a

whole. The aggregate is the individuals accepted into the Norfolk Drug Court Program. A survey

was created as a tool to collect data on the background and needs of the aggregate. The results

verified the need for interventions on substance abuse. The nurse's role is to provide resources

found in the community and prioritize interventions that will address the objective.

Assessment
Aggregate Identification
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The participants of the Norfolk Drug Court Program were selected as the aggregate. This

program is an alternative to incarceration for individuals who are non-violent, adult felony drug

or alcohol offenders who fall under the diagnostic criteria for Psychoactive Substance Abuse

Disorders, which are defined by the current Diagnostic and Statistical Manual of Mental

Disorders (DSIMV) for alcohol dependence. This aggregate can also include those with co-

occurring substance abuse and mental health disorders as well as veterans (Norfolk Drug Court,

2016). The aggregate is comprised primarily of males in their 30s and 40s. Most have little

education beyond high school and belong to a low socioeconomic class (National Center for

State Courts, 2012). Through the nurses interaction with the aggregate, it was self-reported by

most members that they have a genetic predisposition to addiction, were raised in a less than

ideal house hold (often with only one parent), and began abusing substances in their early teens.

Most have been placed in some sort of drug treatment program in their life time and some have

accumulated substantial amounts of time free from drugs and alcohol.

The responsibility of a nurse to the community is to identify issues and begin to treat

them at the source. This aggregate was chosen due to the high rates of alcohol and drug abuse in

the Norfolk area, according to the Norfolk City Council (2016). Current statics show that 85% of

Norfolk residents over 18 drink alcohol and 44% of those who use mental health services for

health problems have abused alcohol (Gummerson, 2013). Working with this aggregate allows

for treatment of the disease of addiction before it becomes fatal or requires extensive

hospitalization. By treating the issue out in the community, large sums of money, resources, and

time are saved. Student nurses can assume the role of providing education and support through

the establishment of working therapeutic relationships. This relationship allows for treatment of

addiction and also allows for the screening and prevention of diseases that are caused by
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hypertension, poor nutrition, poor decision making, poor coping and stress management, and

lack or resources (Appendix B, Appendix C).

To build rapport with the aggregate, the student nurses provided weekly blood pressure

checks (recorded in a log), regularly attended group meetings and the Norfolk Drug Court, and

actively participated in scheduled events. The student nurses would arrive before group meeting

to take blood pressures and assess risk factors. Teaching was provided on hypertension and how

to reduce it to a healthier level. Additional teaching was done on medication management,

smoking cessation, diet and exercise impact on blood pressure, and when to seek immediate

medical attention. Once a week, the aggregate was required to present in front of the judge

presiding over the Norfolk Drug Court program and were brought up as compliant or

noncompliant. The student nurses attending these court appearances to build rapport and show

support for the aggregate. Drug Court participants are required to take part in certain events such

as the annual scavenger hunt and the Halloween costume party. Attendance to these events by the

student nurses further solidified the sense of partnership and the therapeutic relationship

established from the beginning. All means of gaining entry to the aggregate were done with the

purpose of establishing rapport in an effort to develop a therapeutic working relationship.

Aggregate Characteristics

Socio-demographics. The members of drug court primarily reside and work in Norfolk,

Virginia. The unique demographics that make up Norfolk, as well as the entire Hampton Roads

area, directly impact the men and women who make up the aggregate. While the economy of

Hampton Roads as a whole is a stable and growing economy, the per capita income has

historically been lower than the national average (Hampton Roads Performs, 2009). This is true

of the aggregate as evidenced by self-reporting in an anonymous survey in which participants

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listed money as what stands in the way of them being as healthy as possible and financial

support as being what was needed the most in terms of their health (Appendix A; Appendix

B). Most members of the aggregate enter Drug Court without a job, therefore, having limited

financial resources. As they gain employment, they are often able to afford only the absolute

necessities and have little, if any, left over for things such as education, health improvement,

self-care, and recreation. Furthermore, they often work hours exceeding a traditional work week

in order to make ends meet. According to the Census Bureau, the per capita income for Norfolk

is $24,252 with 23.4% of the residents of Norfolk living in poverty (U.S. Department of

Commerce, 2016).

The aggregate self-reported in an anonymous survey to be primarily high school

graduates with some completing some college, but no one completing a bachelors degree

(Appendix A; Appendix B). According to the Census Bureau, only 25.6% of adults over the age

of 25 have completed a bachelors degree or higher in Norfolk, Virginia (U.S. Department of

Commerce, 2016). There is a large correlation between level of education and income since

higher skill level jobs often pay significantly more (Hampton Roads Preforms, 2009). Norfolk is

a typical metropolitan housing demographic with members of higher socioeconomic status with

houses typically ranging from $150,000 and $299,999, and members of lower socioeconomic

status typically residing in public housing units (Norfolk Department of Development, 2014).

The Drug Court aggregate typically is from lower socioeconomic status where many of them live

in the public housing units around the Norfolk area assessed in the Windshield Survey (Appendix

D).

Hampton Roads has a typical metropolitan transportation system consisting of a complex

interstate system and many means of public transportation (Hampton Roads Performs, 2009).
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Due to the legal situation of the members of our aggregate, many of the men and women do not

have a valid driver's license which creates a reliance on public transportation. In an anonymous

survey given to the aggregate, transportation was one of the top factors that was listed as

stand[ing] in the way of them being as healthy as possible (Appendix A; Appendix B). The

predominant races and sex of Norfolk is white (47.1%) and African American (43.1%) males

(51.8%). Approximately half the population is between the ages of 20 and 55 (Norfolk

Department of Development, 2014). This is consistent with the demographic of the aggregate.

Drug court is composed primarily of African American men ranging from early twenties to late

sixties.

In research published in the American Journal of Public Health (2016) it was found that

in the U.S., African American males ages 15 to 67 have a higher instance of IV drug use from

1993 to 2007 than other population. One of the main predictors of this pattern was

socioeconomic status. African American males of lower socioeconomic status were more likely

than their white counterpart to have not completed high school which is also a contributing factor

to this drug abuse issue. While this pattern has been identified and established since the early

1990s, the rate of IV drug use in this population continues to increase drastically. It has been

proven that the same age group of African American males from higher socioeconomic and

educational status have substantially lower rates of drug use (Cooper, West, Linton, Hunter-

Jones, Zlotorzynska, Stall, & Friedman, 2016).

In addition to the pertinent socioeconomic demographics, the crime rate in the city of

Norfolk must be considered. In a 2016 article, the city of Norfolk was ranked number three in the

United States for homicide to population ratio. This means that per the number of citizens,

Norfolk has proportionally more homicides than Chicago, Philadelphia, and New York City
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(Marks, 2016). This has to be taken into account to best understand the true living conditions of

the men and women in the aggregate.

Health status. Hampton Roads is made up of seven independent cities with people

whose health and education are vital to ensure that the community thrives. Norfolk, Virginia is

the primary focus of the Hampton Roads community in which health status was assessed.

Perceived health problems in this community consist of obesity, drug and alcohol use, poor

nutrition, as well as limited access to healthcare. The Norfolk Department of Public Health in

collaboration with a community advisory board within the past several years has led a new

program to improve the health in the local community. MAPP (Mobilizing for Health through

Planning and Partnerships) is a nationally recognized tool developed by the Center for Disease

Control. The purpose of MAPP is to engage community members and partners in conducting a

series of four assessments to identify significant issues that affect the health and quality of life in

Norfolk (Public Health, n.d.). Through these assessments, the board concluded that several health

problems existed that can be fixed by within the community. Common health problems found in

this study throughout Norfolk included unsafe communities, lack of access/transportation to

places and services, workforce and economic development, communication and collaboration

issues among partners and the public, mental health, disease prevention, smoking, drugs, and

alcohol abuse. Participants described health as affecting many aspects of their lives such as their

independence, ability to work and take care of their family, and overall ability to enjoy and take

advantage of the life they led. As one participant said, [Health means] to be mentally, socially

and physically happy and satisfied. To have the opportunity to be as active as you want to be in a

community where you feel safe (Virginia Department of Health, p. 2, 2016). By recognizing the

specific needs of the Norfolk community, individuals who live there may be able to live longer,
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healthier lives through the MAPP program. By recognizing Norfolks most pertinent needs, the

community may come together to reduce health risks/problems related to decreasing the amount

of deaths related to alcohol and drugs as well as major health problems.

The majority of individuals in the aggregate study believed that blood pressure

management is one of the most important health problems that was important to them (Appendix

A; Appendix B). The individuals that participated throughout the study indicated that they

needed to receive further self-care management to enhance healthier lifestyles (Appendix B).

One of the main problems that the aggregate faces that decrease their chances of living healthier

lifestyles included implied lower salary (Appendix B). Many of the individuals have no means of

a solid income, and many do not have means of transportations to the meetings. The actual needs

of the group revealed by the survey results indicate that the teaching needs include blood

pressure management followed by heart attack prevention (Appendix B). Financial support is

another important need, inhibiting many health promotion activities, that the aggregate study

revealed (Appendix B). Finding financial opportunities with this aggregate group can start within

the drug court and spread out to the local communities by initiating programs like MAPP.
Internal and external influences. The focus aggregate is tasked with obtaining and

maintaining a sober life. Internal and external factors add to the pressure our focus aggregate

feels, and any patient feels, to relapse. External factors that create the influential environment

include family, peers, and lack of intellectual stimulation. Internal factors that contribute to the

importance for a maintained mental health are comprised of anxiety, depression, and drug

cravings. The breakdown of these factors will aid in understanding how they affect the focus

aggregate in recovery.
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External influences are factors that pertain to the environment that the aggregate resides

in, or the surrounding stimulus in which they choose to reside. A significant consideration is the

socioeconomic status of the environment in which any aggregate is located. Groups residing in

an environment with a higher risk have easier access to drugs, impaired neighborhoods, and

barriers that impede treatment. An aggregates proximity and ease to access drugs makes seeking

out their next high more tempting, ready access to substances lowers the barriers to acquiring,

using, and abusing substances (Mennis, Stahler, & Mason, p. 3, 2016), all facilitated by the

environment, probes the aggregate to relapse. This unbarred accessibility perpetuates the

continued use of either their drug of choice or whatever drug is readily available. The

availability of the drug can be directly related to the integrity and socioeconomic standing of the

neighborhoods. These neighborhoods are highly concentrated with poverty, poor educational

systems or achievements, low economic income, and an increasing unemployment rate (Mennis,

Stahler, & Mason, 2016). The depravation of resources within in the community prepares the

aggregate for a less than maintainable sobriety. These poor conditions of neighborhoods feed the

depravity of drug usage and sets the aggregate up for unforeseen failures. Our aggregate resides

within these parameters of neighborhood conditions and are limited to boasting opportunities that

could aid in their recovery.

Another challenge these impoverished environments provide is difficulty at maintaining

the criteria need to be compliant with the program. Due to the lack of economic opportunities,

the aggregated is tempted to repeat the cycle of abuse (Mennis, Stahler, & Mason, 2016). These

external influences are continued barriers for the aggregated and their treatment progress. They

may lack the ability to provide or obtain transport necessary to abide by treatment needs, which

hinders their education on substance abuse and how to handle factors that can impede recovery.
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Internal influences are situated within the aggregate, defined by Allen as, subjective

phenomena-beliefs or perceptions arising from within the person (Xu, Wang, Rapp, & Carlson,

p. 2, 2007). This can be biological predispositions, cognitive thinking, or mental disorder. These

internal barriers cause the aggregate to fail in treatment or not seek any at all. Individuals most

of the time do not want to feel as though they failed so they conjure up this mental ideal that they

can handle recovery themselves, which leads to a further spiral downward. This form of denial

fuels the internal desires to seek out the substance that they struggle to avoid and without the

proper intervention, relapse occurs. Along with cognitive mishaps, the aggregate also is plagued

by biological standpoints that predispose them to addiction. Normally seen within a family, if

one member of the family is abusing drugs, this further increases the chances of the aggregate

abusing drugs.

Literature Review

Substance abuse and related morbidity and mortality is increasing (Clossick &

Woodward, 2014; Joseph, 2013; McPeak, ONeill, & Kinsella, 2013). Current literature

consistently indicates a correlation between substance abuse and lack of education, low income,

and unemployment (Notara et al., 2013; Abreu et al., 2012). There is also correlation between

criminal arrest and concurrent substance abuse (Holmes & Currid, 2013; Vandermause et al.,

2012). Campbell-Heider and Baird wrote, in regard to drug and alcohol abuse, More than 80%

of individuals behind bars have a serious history of abuse and approximately half of them meet

criteria for a clinical diagnosis of dependency (2012). Literature suggests that if an individual is

of low income, lacks education, and/or is unemployed they are at a predisposition for substance

abuse, which, subsequently, predisposes them to criminal arrest and incarceration.

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Compare-and-Contrast
In Virginia, the typical Drug Court participant is a young male between the ages of 21

and 30 who is unemployed with limited education. In Norfolks Drug Court program, most

participants are male with the average age being in the 30s-40s with education for the majority

ending at a high school level as reported by the aggregate (Appendix B). Most programs in the

state last for twenty months while Norfolks lasts for eighteen months (National Center for State

Courts, 2012). Throughout the nation, Drug Court uses incentives and sanctions to achieve

maximum benefit to the participant. Sanctions for breaking protocols, put in place by the drug

court, include more frequent court status hearings, cleaning up after recovery meetings, writing

an essay, a brief jail stay, community service, or even termination from the program leading to

incarceration. Incentives include praise from the judge, certificates for milestones reached or

phases completed, job interview preparation classes, reduction in sentence, or drawing for

rewards (National Drug Court Resource Center, 2012).

In the Norfolk Drug Court, annual scavenger hunts and costume parties are held as well

as other events to reinforce positive experiences and ability to have fun without the influence of

drugs or alcohol. Those who actively participated were praised and won various prizes such as

bus tickets. If anyone stated that they wished not to participate, they were given the option to sit

in the front room and write a paper for the duration of the activity. This positive-negative

reinforcement of behavior technique is used nationwide to produce desired effects.

Nationwide, the most frequently abused substance was alcohol followed by marijuana

and opiates (Absolute Advocacy, 2014). In Virginia and Norfolk, heroin was the most abused

drug (Jones & Powers, 2016). Drug court programs allow for education on effective coping

mechanisms, healthy support, and increased accountability versus incarceration.

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One article discusses two different types of social support on Drug Court aggregates and

their effectiveness in isolation of one another. The article states that directive support

(constructive criticism and trying to direct the behavior of the aggregate) leads to increased

alcohol use. This is opposed to unconditional support which decreased alcohol use.

Unconditional support is being utilized in the Drug Court program. The positive environment

that exceeds expectations and this research backs up this practice of unconditional support even

if someone had a relapse. It is important to provide that unconditional support, which is different

than enabling, to have a better outcome than trying to direct behavior which they tend to have

enough of in their home lives. Providing an environment that allows for the Drug Court family

to thrive is imperative, as this research shows support from others heavily influences outcomes

as a risk or benefit to decreasing alcohol consumption (Mendoza et al., 2015).

Population Needs

The foremost health issue identified early on in the research is the knowledge deficiency

related to substance abuse. This is commonly related to the denial of abuse or misuse, lack of

education, cognitive impairment, or generalized apathy to the misuse of drugs and alcohol. The

Addictive Disease Model and the Behavior/Environmental Model are the theories used in

conjunction to prioritize the diagnosis of knowledge deficit (United Behavioral Health, n.d.). The

Addictive Disease Model is the theory that looks at addiction as a chronic disease in which the

person addicted needs to make lifelong changes and continuously work on their addiction. Many

people do not realize that addiction is a disease and need education about the changes that need

to be made in order for a recovery to be made. The Behavior/Environmental Model looks at the

environmental factors that contribute to the persons addiction. Teaching needs to also focus on

changing behavior and, often times, the environment they live or socialize in regularly. The goal
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for this intervention would be to gain a population who verbalized acceptance and understanding

of substance abuse and treatment. Objectives to meet this requirement include assessment of

local substance abuse trends and assessment of current financial, social, and familial

consequences of abuse. While medically assisted detoxification is an important step in recovery,

nursing implications towards the interventions include a behavioral aspect such as individual or

group counseling and 12-step programs. Teaching objectives towards both the focus groups and

families of patient focus groups should include the health risks associated with substance abuse

including liver disease, cardiovascular disease, and neurological issues. Families of patients

should also be referred to group therapy, counseling, and support groups near them. Teaching

objectives for the patient should also include the recognition of symptoms that would necessitate

emergent care. Paranoid feelings, delirium tremens, and audio or visual hallucinations can all be

withdrawal symptoms that indicate a need for immediate attention (Gulanick & Myers, 2014).

While prioritizing this diagnosis, others should be considered as well. Ineffective

individual coping related to personal vulnerability, inadequate support systems, and a previous

history of ineffective coping skills related to the misuse of a substance. Outcomes to be

considered would be to identify and assess the current coping behaviors (including the misuse of

substances), identify and assess the current problem solving skills, and to introduce the teaching

and lifestyle changes necessary. Another key diagnosis is powerlessness related to substance

addiction. The desired outcomes for this would be for the patient to first admit the inability to

control the misuse of a substance and to verbalize the need for treatment. Further outcomes

would be for peer support to be engaged, active participation in a program demonstrated, and for

a healthier state both mentally and physically to be maintained (Gulanick & Myers, 2014).
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While doing research on the trends of alcohol and drug abuse, a study was found based

on the premise of alcohol effects through the decades on a specific population. This study

followed a group of approximately 15,000 people with follow ups 30 years after their selection

into the study. To compare the results, a control group was naturally created by selecting and

studying trends in same-sex monozygotic twins with no overt comorbidities, in which one twin

self-reported heavy drinking status. Measurements for drinking status included the number of

heavy drinking occasions and alcohol-induced blackouts. This was viewed against their twins

who reported low to no alcohol consumption and gave a controlled comparison. Their findings

suggested that more incidences of heavy drinking occasions and alcohol-induced blackouts

related to a higher mortality rate that could not be explained through genetic or familial means.

This shows that alcohol cessation therapy is truly a need, as alcohol consumption increases

mortality significantly (Sipil, Rose, & Kaprio, 2016).

Planning
Health Planning and Needs
As noted above, the priority nursing diagnosis for the aggregate is knowledge deficit

related to lack of education, cognitive impairment, information misinterpretation, or generalized

apathy to the misuse of drugs. The nurses role for this aggregate is to continuously formulate

goals specific to the population and revise these after evaluation of progress. One of the

objectives that would be very important for the aggregate is to verbalize understanding of disease

process and the prognosis, therapeutic needs, and potential complications. This can be measured

by asking the individuals directly or in conversation each of these factors because this will be

different for every person. Ideally, the aggregate would verbalize understanding of each of these

factors before entering into phase two of the Drug Court program to allow for more focused

teaching in later stages.

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Another objective would be to identify and initiate lifestyle changes necessary for

maintaining a clean and sober life. Lifestyle changes are specific to the individual, but can

include moving out of a living situation where drugs are used, getting a job, spending time with

children and family, and going to school. Identifying and planning theses lifestyle changes

should take place in phase one and two, and should be initiated in phase three and four of the

Drug Court program.

Lastly, the main objective for all of the aggregate is to complete the Drug Court program

and live a clean and sober life. This is a long term goal that is broken up into phases in which

different requirements are to be met regularly. Each individual will go through the program at a

different pace, but with the same end objective of program completion.
Alternative Interventions

Primary interventions are the strongest to combat the rise in deaths associated with

substance abuse. Primary interventions include legislation acting to put parameters on the

alcohol industry advertisements and educating children in school through the Drug Abuse

Resistance Education (D.A.R.E.) program. Secondary interventions are next in effectiveness.

Employers and corporations hosting informational sessions about the effects of alcohol and

getting the employees effective resources they need to get help. Tertiary interventions are the last

line of defense to encourage members of the community to control their alcohol abuse. The

community has an array of pro bono meetings held in churches and community centers for

addicts to gather together lending support in the direction of recovery (Miller, et. al., 2011).

The alcohol industry is funded off building up the publics desire to purchase and

consume alcoholic beverages. One way policy makers are attempting to decrease the numbers of

alcohol addiction and death in the country is through policy that places parameters on alcohol

advertising. Policy rests heavily on alcohol industries to follow through with the changes and it is
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a conflict of interest. Restricting the market for alcohol advertising has had no results that it

decreases the amount of alcohol abuse in the population. Despite no concrete evidence of this,

policy makers still feel it is a better alternative to spending money and will help stop abuse at the

forefront (Miller, et. al., 2011).

The D.A.R.E. program reaches children of all ages by covering a wide variety of

curriculum needs. The programs objective is to provide kids with the basic skills and tools they

need to develop healthy, free from drugs. The tools they practice is educating self-awareness,

responsible decision making, understanding others, relationships, communication skills, and

handling responsibilities. The education practiced is based off the Socio-Emotional Learning

Theory. The decline of driving intoxicated and children starting to abuse substances at a young

age prevents them from abusing it later in life (Keepin it REAL Elementary School Curriculum,

2016).

The aggregate would benefit from the implementation of education and services that will

support them. A year-round clothing drive can be placed in the facility for anyone in the building

to donate clothing. The recycling of childrens clothes and professional attire provides necessary

resources for the aggregate. The clothing drive makes having appropriate clothing for themselves

and their family financially possible. Educational needs provided by the feedback in Appendix B,

show the aggregate wants to learn more about health issues. Blood pressure management, stroke

prevention, heart attack prevention, and mental health are all of the areas that they would like to

learn more about. The workshop can include how to measure blood pressure and appropriate

ranges, signs and symptoms of a stroke, signs and symptoms of a heart attack, and lifestyle

changes to improve physical and mental health.

Conclusion
N470 PAPER 16

Through consistent meetings with and support of the aggregate, the group was able to

assess and begin to plan how to improve the aggregates overall health and well-being. Education

will likely be the center of many of the interventions that will be provided since knowledge

deficit is identified as the priority diagnosis for the aggregate. Mental health issues and coping

skills were identified as needs for more education by the aggregate (Appendix B), so the group

will continue participating in activities to gain trust and rapport in order for the aggregate to be

receptive to teaching on emotional topics. Overall, the goal for this aggregate is to develop and

carry-out new healthy habits after educating about different aspects of health.
N470 PAPER 17

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Census Bureau. Retrieved from

http://www.census.gov/quickfacts/table/PST045215/51710

Vandermause, R., Altshuler, S., Baker, R., Howell, D., Roll, J. M., Severtsen, B., & ... Wu, L. J.

(2012). A Research-Practice Partnership for Enhancing Drug Court Effectiveness.

Journal Of Addictions Nursing (Taylor & Francis Ltd), 23(1), 14-21.

doi:10.3109/10884602.2011.645252

Virginia Department of Health. (2016). City of Norfolk community themes and strengths

assessment. Retrieved November 15, 2016 from

http://www.norfolk.gov/DocumentCenter/View/25300
Xu, J., Wang, J., Rapp, R. C., & Carlson, R. G. (2007). The Multidimensional structure of

internal barriers to substance abuse treatment and its invariance across gender, ethnicity, and

age. National Institute of Health, 321-340. Retrieved November 17, 2016 from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2168036/pdf/nihms-29635.pdf.
N470 PAPER 21

Appendix A
Community Health Part 1 Survey

1. What is your highest level of education?

a. Elementary/ Grammar school
b. High School
c. Some College
d. Bachelors degree or higher

2. What health issue is most important to you?

a. Blood pressure management
b. Stroke prevention
c. Heart attack prevention
d. Mental/ social health

3. What would you like the student nurses to do teaching on?

a. The health issue mentioned in question number 2
b. Social issues/ relationships
c. Diet and nutrition
d. OTHER:

4. Select ALL the answers that apply to you personally (there is no right or wrong answer)
a. I what to quit smoking, I just need help
b. I have a hard time connecting with people and forming relationships in recovery
c. I feel very anxious and/or fearful more than 3 times a week
d. I wish I had more fun in recovery
e. My family/ Friends do not understand what recovery means to me and Im not
sure how to explain it to them
f. Now that I am in recovery I am focused/ concerned with my physical health

5. What would you like to learn more about?

a. Diseases
b. Medications and medication labels
c. Vaccinations
d. Self-care of health

6. How do you view your health?

a. I am generally healthy
b. I feel healthy, but there are things I need to work on
c. I feel that there is a lot more I can do to be health or I do not feel as healthy as
I could be
d. I do not feel healthy at all or I am very concerned for my health
N470 PAPER 22

7. What do you think stands in the way of you and being as healthy as possible? (you may
select all that apply).
a. Money
b. Transportation
c. Lack of information/ does not know about the issue
d. You do not care/ no one else cares

8. What do you need the most in terms of your health? (you may select all that apply)
a. Information
b. Financial support
c. Help getting your medicine
d. Help finding healthy foods/ places to exercise

Is there anything you would like to tell/ ask/ talk about with the student nurses?
N470 PAPER 23

Appendix B
Survey Results
Number of replies: 20
Not everyone answered every question
Not every question only had one answer (multiple answers for one question)

Question 1:
A: 2
B: 12
C: 6
D: 0
Question 2:
A: 9
B: 6
C: 8
D: 6
Question 3:
A: 15
B: 1
C: 6
D: 1
Question 4:
A: 12
B: 0
C: 4
D: 7
E: 2
F: 15
Question 5:
A: 8
B: 6
C: 2
D: 13
Question 6:
A: 5
B: 13
C: 4
D: 0
Question 7:
A: 12
N470 PAPER 24

B: 4
C: 9
D: 0
Write in: time
Question 8:
A: 13
B: 15
C: 10
D: 8
Replies we got for the last/optional question:

I am happy that you all are here helping us with our health!!! Thank you, Love Gary and
Family!

How to find out more about diet and eating healthy

Why do addicts/ recovering addicts get pushed to the back when visiting hospital. Seems as
though as soon as you tell them you are or that youre in recovery they sort of shun you.

How do I get Obama Care

N470 PAPER 25

Appendix C
Date Patient BP Notes Initial
s
Ex) 6/10/16 J. Doe 142/86 smoked 2 cigarettes 5 min prior to taking BP BAL
6/13/16 L. G. 140/90 JLS
T.B. 138/78 DW
L. J. 150/90 BB
J.H. 130/90 JLS
J. W. 170/80 Smoked one cigarette prior to BP DW
J. B. 150/98 BB
E. H. 130/95 VO
R. B. 130/80 Smoked one cigarette prior to BP DW
6/15/16 R. H. 130/10 Retook BP after allowing to sit for 5 mins and DC
0 switched to right arm=160/100
K.W. 124/76 TA
G.M. 130/80 EL
E.S. 140/90 SM
S.C. 150/82 Retook BP on same arm=124/70 SM/T
A
J.B. 150/10 DC
0
J.H. 138/90 EL
6/20/16 T.B. 120/90 Smoked one cigarette 30 min. prior
J.W. 160/90
E.H 120/90

7/11/16 M.W. 140/95 Smoked 10 min. ago JS

S.A. 115/75 Smoked 10 min. ago JS
L.G. 140/90 JS
C.B. 135/90 Smoked 10 min. ago JS
E.S. 130/90 Smoked 5 min. ago JS
B.B. 120/95 JS
T.R. 119/91 VS
7/27/16 P. B. 100/70 JS
T. P. 110/70 JS
H. H. 120/80 Smoked 1 cigarette 10 minutes ago JS
P. S. 130/90 JS
M. L. 170/11 JS
0
M. C. 122/86 JS
N470 PAPER 26

L. B. 158/98 JS
A. W. 170/10 JS
0
E. H. 132/72 JS
8/1/16 J. A. 110/80 Smoked prior JS
R. B. 130/70 Smoked prior EL
M. W. 150/10 Smoked prior JS
0
L. G. 145/10 EL
0
M. H. 130/70 Smoked prior JL
T. B. 120/70 Smoked 1 hr ago EL
8/17/16 R.H. 162/10 Smoked right before BL
1
A.S. 138/78 BL
J.C. 108/68 No hx of HTN/HBG BL
A.O.B 120/80 Just smoked JS
M.C. 130/90 JS
K.W. 140/80 Just Smoked JS
J.O. 122/72 Just Smoked BL
R.H. 142/92 Recheck BL

8/31/16 L.G. 120/80 JS

R.H. 155/11 JS
0
T.P. 110/75 JS
W.W. 150/11 Right arm JS
0
145/10 Left arm 15 minutes later JS
5
160/11 Right arm after meeting, advised to leave and JS
0 take BP meds.
T.B. 135/10 JS
5
J.H. 150/11 JS
0
A.S. 180/12
0
188/11 After meeting
2
W.B. 162/11 Just smoked
0
N470 PAPER 27

G.P. 130/80
J.B. 142/85
T.R. 142/10
0

9/12/16 T.P. 120/80 Smoked 20 minutes ago JS

M.I. 130/90 smoked JS
M.L. 150/10 smoked JS
0
T.B. 160/90 smoked JS
J.A. 135/95 JS
J.B. 140/10 1 energy drink prior SM
0
A.B. 122/86 BL
L.J. 150/96 smoked JS
J.H. 159/10 smoked BL
1
T.N. 122/82 BL
J.C 116/64 EH
T.R. 123/78 BL
A.S. 142/88 BL
9/21/16 P.B. 100/70 JS
T.P 110/70 JS
H.H. 120/80 1 cigarette JS
P.S. 130/90 JS
M.L. 170/11 JS
0
M.C 122/86 JS
L.B. 158/98 JS
A.W. 170/10 JS
0
E.H. 132/72 JS
9/28/16 M.I. 135/90 JS
T.N. 115/85 JS
J.A. 122/90 1 hr ago smoked BB
J.B. 134/82 DW
P.B. 120/82 BB
G.M. 165/90 DW
10/3/16 T.P. 118/78 EW
M.I. 136/86 SK
A.S. 140/10 EW
N470 PAPER 28

4
S.C. 138/82
J.C. 144/76
10/5/16 T.P. 117/80 RM
L.G. 146/10 EW
4
M.I. 178/11
8
M.I. 140/92 Retest EL
K.H. 130/84 EW
J.B. 142/11
0
J.A. 140/90
J.C. 122/80
J.H. 140/10 EW
6
10/12/16 J.A. 142/90 BL
Nurse 140/90 Recheck after meeting SM
Teaching T.N. 140/86 BL
BP
T.P. 128/84 SM
M.B. 140/90 Smoked BL
S.G. 146/84 Smoked SM
W.B. 138/10 BL
0
T.B. 107/78 Smoked SM
S.S. 142/94 Smoked BL
K.W. 140/10 Smoked SM
2
135/80 Recheck 15 min. later BL
K.H. 112/76 Smoked SM
J.B. 138/10 BL
0
L.B. 122/74 SM
P.W. 130/78 Smoked BL
P.B. 128/90 Smoked SM
L.G. 156/84 BL
160/10 Recheck after meeting SM
0
P.C. 134/85 Smoked BL
138/84 Smoked SM
T.W. 150/98 Smoked BL
N470 PAPER 29

A.S. 148/10 SM
0
138/84 Recheck after meeting BL
J.C. 112/72 SM
J.C. 116/76 Smoked BL
(JOE)
S.A. 108/70 Smoked SM
S.P. 132/92 Smoked BL
B.H. 152/94 Smoked SM
148/88 Recheck after meeting BL
J.H. 160/10 Smoked SM
0
162/98 Recheck after meeting BL
10/17/16 E.S. 130/90 JS
Nurse L.J. 160/10 Smoked JS
Teaching 0
Smoothie T.P. 125/80 Smoked JS
Demo T.B. 110/75 Smoked JS
K.H. 120/80 JS
P.C. 140/90 JS
130/90 Recheck after meeting JS
J.A. 140/90 Smoked JS
M.B. 155/11 Smoked JS
5
A.C. 120/75 Smoked JS
J.B. 140/11 JS
0
139/80 Recheck after meeting JS
10/19/16 J.H. 160/10 Smoked; Rechecked 150/90 EW
Scavenger 5
Hunt W.W. 130/98 Smoked EW
K.W. 140/90 Smoked EW
V.K. 160/11 Smoked; Rechecked 160/100 EW
0
S.A. 112/82 EW
M.C. 130/90 EW
J.B. 120/78 EW
C.P. 126/76 EW
J.C. 106/68 EW

11/7/16 T.P. 118/80 SM

N470 PAPER 30

Stress management/Relationships teaching J. B. 130/84 SK

J.A. 160/100 SM

11/16/16 J.A. 160/95 S

Nutrition & Label Reading M
Teaching R.H. 180/10 Did med teaching/not taking BP JS
0 meds
G.M 150/88 EH
.

Appendix D
Windshield Survey Form
Observers: Sareena Khosla, Elizabeth Wineland, Elizabeth Luther, Ashleigh Brannon, Selena
Penn, Miecha Green, Sarah Ragaza, Meredith Lenox, Ryan Murphy, Anna McLean
N470 PAPER 31

Weather: Cloudy; overcast with no rain Temperature: Mid 70s

City: Norfolk VA. Neighborhood: 816 Monticello Ave. Norfolk VA, surround area (including
Young Terrace)
Day/Date/Time: 09/26&28/2016; Monday and Wednesday night; 1700 and 1900

A. Neighborhood Boundaries
What are the boundaries of the neighborhood? The boundaries for the closest
neighborhood, Young Terrace, is well defined because it consists of houses packed together in a
very small area surrounded by major roads. It is obvious where the neighborhood begins and
ends.
Are there commercial streets or areas? The entire area in which the center and
neighborhood is surrounded is a commercial area. The canter shares a parking lot with an auto
repair shop. Down Monticello one way is a few fast food restaurants and commercial buildings.
And down the road the other way is a large commercial center including an entertainment center,
a mall, multiple places to eat, a Greyhound station, and small businesses.
Does the neighborhood have an identity, a name visible? There is not a visible sign to
Young Terrace. It has an identity because it is very obviously the public housing projects. It is a
large area consisting of the same stereotypical row single-family homes that are brick and have
the same chain linked fence around them. Down the road (about 4 blocks) once you enter Ghent,
A large, very nice apartment complex is located off Granby which has a large sign declaring the
complexes name and luxury apartments. However, across from this complex is a rundown play
area with rusted and broken equipment.

B. Housing
What is the age of the houses, type of architecture, construction material of houses? How
many stories?
There are mainly brown brick townhouses that encircle and intersect in one general area. They
consist of two stories.
Are there single, multifamily dwellings, mobile homes? There are predominantly single
family homes, except for the one apartment building.
Do houses have space/lawns around them? Are they well groomed?
Each town housing has a small front lawn spacing separated by fences, and small backyards that
are connected. All lawns were mowed and well-groomed.
What is the general condition of the houses? Are there signs of disrepair (broken doors,
windows, railings)?
The general conditions of the townhouses were intact with a clean anterior. There were some
bent fences, otherwise the doors and windows were all in place.
Are there cars in the driveway? Does it appear everyone is at work? This area has mainly
street parallel parking which is full.
Are there vacant houses, boarded up or dilapidated buildings?
There were no vacancies or boarded up houses in sight.
Are there many houses for sale? The clear majority of houses in the area appear to be the
public housing projects which do not generally display For Sale signs, so this is unknown.
However, by the looks of them, most appear to be occupied.
N470 PAPER 32

Are there streetlights, sidewalks, curbs, gutters, open drainage ditches?

There were only sidewalks and curbs sporadically in the area. There were only streetlights in the
outer perimeters of the area. There were no open drainage ditches in sight.

C. Open Spaces
How much open space is there? Practically none. The largest open space is directly across
from the center and it is a bus station.
Are there parks and recreational areas in the neighborhood? Are they lighted? There do
not appear to be what one would typically consider a park or recreational area. There are back
yards and front yards in housing that are of adequate size, but they are surrounded by major
roads. They do not seem like the safest place for child to play unsupervised. The small park
across from the apartments does not look safe at all due to no lighting, unsafe play equipment,
and proximity to major roads.
Is the open space public or private? Who uses it?
N/A. Refer to the first question.
Is there trash, rubble, or abandoned cars in the open spaces?
N/A. Refer to the first question.

D. Shopping Areas
What types of stores are in the area (shopping centers, neighborhoods stores, grocery
stores, drug stores, laundries, etc.)? While there are shopping centers with more expensive
boutiques nearby, the area immediately surrounding has many convenience stores, drug stores,
and fast food restaurants. The grocery stores are more expensive brand stores and a few streets
away, while the closer stores to buy food are convenience stores.
How are these resources distributed in the area? Are they spread throughout? The
immediate area is surrounded by fast food restaurants and convenience stores, while the larger
grocery stores and gyms are spread out blocks away.
Are there ethnic stores, ones that display other than English language? There was a lack
of stores displaying languages other than English.
Do signs advertise tobacco, alcohol? Yes, ABC liquor stores were common and every
convenience store advertises cigarette prices.

E. Schools
Are there schools in the neighborhood? Are they public or private?
Yes, there are several schools located around the Monticello, Norfolk area. There are public
schools such as Maury High School, Larchmont Elementary School, and the Norfolk Day School
Co-educational Academy.
Are there play areas, sports fields connected to the schools?
Around Maury High School, there are sports fields that surround the school. Around Larchmont
Elementary school there is a playground in the back of the school for children to play in. The
Norfolk day School Academy does not have any outdoor sports fields or play areas connected to
the school.
Is graffiti evident in the schools?
N470 PAPER 33

Graffiti was mainly located on the back side of Maury High school, as well as their football
stadium press box. Larchmont or the Norfolk Day School did not have any graffiti.
Do the school grounds appear to be well-kept?
Around Maury High School, there is a lot of trash lying around the sidewalks and baseball fields.
Larchmont was well kept. Norfolk Day School was kept clean by city workers cleaning the area
during the time of completing this survey.
Are there school bus stops or crossing guards?
Maury High School has bus stops and crosswalks surrounding the school as well as Larchmont
Elementary. The Norfolk Day School did not have a crosswalk or bus stop nearby.

F. Religion
What churches to do you see? Who uses the churches? Presbyterian, Unitarian, Baptist,
Episcopal, Catholic, and Methodist churches, an Orthodox Israeli Synagogue, and a Jewish
Temple. These churches help to provide a faith or form of support to the community.
Do you see evidence of their use for other than purely religious purposes? Many of the
churches also had signs advertising the churches as a meeting space for various organizations
and support groups. They also had regular meetings of Adult Faith Formation in their building
after hours.

G. Human Services
Where are hospitals and health services located in relation to the neighborhood? The
closest health care facilities are the Sentara Norfolk General/ CHKD area about a mile down the
road off Brambleton ave.
Are there physician offices, health clinics or centers, dentist offices? There is a physicians
office 16 minutes away walking and two minutes away driving, there are others a little further
away but still available to these individuals. There is a dentist 10 minutes away walking that
these individuals have access to.
Are there alternative medicine centers (acupuncture, massage, etc.)? There is a massage
and alternative medicine center 17 minutes away walking and four minutes away driving for
these individuals. There is also an acupuncture and herbal remedy clinic 12 minutes away via
walking.
Are spiritualists advertised? None visible.
Are social agencies (welfare, WIC, social services) available? The Norfolk Child and
Family Services center is a five-minute walk from our neighborhood. The Norfolk City WIC
center is a 17-minute walk from the neighborhood or a four-minute drive.
Are there senior centers and child care facilities? There are no senior centers within
walking distance of the neighborhood, but there are some an hour away by walking. There is a
child care center that is a 14-minute walk from the neighborhood and a 3-minute drive. There are
several other child care centers, but that is the closest center to the neighborhood.

H. Transportation
How do people get in and out of the neighborhood (car, bus, train, bike, walk)?
N470 PAPER 34

Individuals may use a variety of ways to get to their destination. Depending on the weather
sometimes, they may ride the bus, walk on the sidewalks, or take a car. Upon observing the area,
some individuals stood on the side of the road waiting for someone to pick them up.
Are the streets and roads conducive to good transportation and to community life?
The main boulevard streets are conductive enough to have maintain transportation. Although
some of the side streets, have pot-holes and could deter some people from getting to their
destination. For example, the Monticello areas side streets tend to flood when there is a heavy
amount of rain over a short period. This may hinder ones ability to get to where they need to be
if they can't physically get through the flooded streets.
Are the streets in good condition? Are they paved? Gravel? Brick? Dirt? The streets are
paved but we would not necessarily say that they are in good condition.
Are formal bus stops or public transportation signs visible? There is a large bus stop across
the street and a Greyhound station and bus stop signs are highly visible.
Is public transportation available? If so, how frequently?
Is this a high-traffic area? Are speed limit signs or speed zones posted? This is a very high
traffic area. There a few signs posted about the speed limit but there are multiple red lights not
far part so its very difficult to speed.
Is there a major highway near the neighborhood? Whom does it serve? This is very close
to Downtown Norfolk, so there are major highways going in and out of the city that individuals
with cars can drive on and those who can use public transportation. A few miles away are the
major interstates (64, 264, and 464) that go to the other cities in Hampton Roads. These are
traveled by car, taxi, and bus.

I. Protective Services
What evidence do you see of police, fire, and emergency services? There were quite a few
police cars in the area (mainly due to construction), but other than that, there was no evidence of
these services.
Are there fire station houses, fire hydrants? Fire hydrants are located on some of their street
corners but there are no fire houses.
Do houses have security systems? No. The houses located around the Drug Court building
are lower incoming housing and do not have evidence of traditional security systems. The closest
thing evident is some chain linked fences.
Is there evidence of Neighborhood Watch programs?
These is no evidence of this.
Are there emergency shelters for neighborhood use (e.g., tornado shelters)?
There is the Homeless Action Response Team and the Norfolk Emergency Shelter Team which
are both active during the winter months, but there seems to be no programs active for the
summer months.

J. Neighborhood Life
Whom do you see on the streets (women, men, mothers with children, teenagers,
elderly)? Elderly homeless people, and young teens were prominently seen on the sidewalks and
crossing in the middle of streets. Children are seen on bicycles, sometimes up to two on one bike,
and crossing sporadically in the street not in designated crossings.
N470 PAPER 35

What ethnic groups are part of the neighborhood? Bilingual signs? Ethnic groups were
not really apparent. This area is more marked by financial division. Its clearly starkly divided by
the lower middle class and the working and upper middle class. No Bilingual signs were
obviously visible.
Are there informal gathering places/hangouts? What are they? For whom (teens, men,
etc.)?
Many people gather around the bus stops and smoke shops; these people range from all ages but
are predominantly men who look to be in their 30s-50s.
Are there social clubs or cultural organizations? There are many small gyms such as 24
Hour Fitness, One Life and Anytime Fitness. There are many Baptist churches in the area with
signs on when their meeting times are.
Is there evidence of interaction among neighbors? There appear to be some people sitting
out in their front yards talking with their neighbors, but not many. Other than this there is no
much evidence of interaction.
Is there evidence of homelessness?
There are several areas where people tend to aggregate and some will ask for money. There are
other people sleeping on the streets and pushing around grocery carts with their belongings
What animals do you see (stray dogs, watch dogs)? There are not many animals. Few
people are walking dogs and here and there you will see a dog in one of the neighborhood homes
enclosed fences. Other than that, animals are not present.
Are there parks or other recreational facilities in the neighborhood? Public or private?
Private parks in apartment complex communities are seen. One park behind a church is observed
to have a group of young children playing on the equipment. There are also public dog parks
and several gyms seen along 21st street and Granby.

Adapted from Guidelines for a Windshield Survey, Indiana School of Nursing, Department of
Community Health Nursing.
N470 PAPER 36

I pledge to support the Honor System of Old Dominion University. I will refrain from any form
of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a
member of the academic community it is responsibility to turn in all suspected violators of the
Honor Code. I will report to a hearing if summoned.
Name: __ Brannon, Green, Khosla, Lenox, Luther, McLean, Murphy, Penn,
Ragaza, Wineland _
Signature: _ Brannon, Green, Khosla, Lenox, Luther, McLean, Murphy, Penn,
Ragaza, Wineland_
Date: ___11/17/16_____________________________________
N470 PAPER 37

Group Participation Record Form

revised May 5 2005

Assignment: ___Community Health Paper__________________

Group Members: _Brannon, Green, Khosla, Lenox, Luther, McLean, Murphy, Penn, Ragaza,

Wineland_

Activity Time Spent Responsible Party

Edit the paper,

compile the reference
17 hours Elizabeth Wineland
page, attach and
format the appendices

Describe specific
characteristics of the
aggregate. Socio-
demographic
Sareena Khosla
characteristics (must 17 hours
utilize a minimum of
four data collection
sources):

Include comparison
of chosen aggregate
with other similar
17 hours
aggregates, the Anna McLean
community, the state,
and/or the nation

Select one health

problem (Nursing
Diagnosis) and/or
need for intervention
and identify the goal
of the intervention.
17 hours
Identify specific, Elizabeth Luther
measurable objectives
as (mutually agreed on
by student and
aggregate, when
possible)

Describe alternative 17 hours

interventions
necessary to Ryan Murphy
accomplish objectives.
N470 PAPER 38

Select and validate

intervention (s) with
highest probability of
success. (Note:
Interventions may
include using existing
resources and/or
developing resources.)

Identify health
problems and/or needs
of specific population
based (Nursing
Diagnosis) on
comparative analysis
and interpretation of
2 hours
data collection and
literature review. Give Selena Penn
priorities to health
problems and/or needs
and indicate how these
priorities are
determined:

Provide relevant
information gained
from literature review,
especially in terms of
characteristics, 14 hours
Meredith Lenox
problems or needs that
one would anticipate
finding with this type
of population:
Identify aggregate
selected for study.
Provide a general
orientation to the
aggregate; Include 14 hours
why this aggregate Sarah Ragaza
was selected and the
method used for
gaining entry

Describe specific 14 hours

characteristics of the
aggregate- Health Ashleigh Brannon
status (actual and
perceived). Include
(when possible) input
from clients regarding
N470 PAPER 39

their perceptions of
needs:

Describe specific
characteristics of the
aggregate- Internal
12 hours
and external Miecha Green
influences affecting
the aggregate:

Honor Pledge:

I pledge to support the Honor System of Old Dominion University. I will refrain from any form
of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a
member of the academic community it is responsibility to turn in all suspected violators of the
Honor Code. I will report to a hearing if summoned.

Student:___Sareena Khosla_______________________________
N470 PAPER 40

Community Health Project Paper: Part I

Purpose: To allow students the opportunity to gain entry and assess a population
within their community. Students have an opportunity to work collaboratively to
complete this assignment.
Audience: Your audience are your peers. Imagine you are writing for yourself
before you had your CH I course and clinical experience. Use professional
language, but define terms.
Format: APA format. Provide examples of tables and graphs as appendices.
Task: Working with the community, students will identify and prioritize a
community diagnosis and develop a plan to address it. Students will be assigned to
a voluntary community based coalition, school, civic organization, occupational
health setting OR develop a new practice site for the duration Community Health I
and II. For the Health Planning Project, students will work together in small
groups to conduct the needs, as perceived by the community, will be identified.
Students will then complete a literature review, and investigate what resources are
currently available to meet these needs.
Due: One written Project due the final week of clinical rotation or at discretion of
the clinical faculty.
Criteria Poor Novice Proficient Excellent
Assessment
- Aggregate (10) Aggregate Aggregate Discusses Discusses
in not well identified introduction introduction
identified or but not to to
defined. defined. aggregate. aggregate.
Rationale Rationale Includes Includes
for for selection rationale for rationale for
aggregate not aggregate aggregate
selection thoroughly selection. selection
missing. discussed. Methods for and process.
Lacks Identifies gaining Methods for
discussion methods for entry to gaining
for how gaining community entry to
entry to entry to identified. community
N470 PAPER 41

community community (7-9) discussed,

is gained aggregate. including
(0-3) (4-6) any research
or tools
utilized.
(9-10)
- Aggregate Socio- Socio- Utilizes 2-4 Utilizes 4 or
Characteristics demographi demographi or more data more data
(25) cs not cs supported sources to sources to
supported by opinion define define
by data. and 2 or less socio- socio-
Health data demographi demographi
Status sources. c c
determined Health characteristi characteristi
by student Status cs. cs.
opinion, not determined Discusses Discusses
supported by student actual and actual and
by objective opinion, not perceived perceived
and supported health health
subjective by objective status. status.
data. and Identifies Identifies
Internal and subjective both both internal
External data. internal and and external
influences Internal and external influences
missing or External influences affecting
lacks influences affecting aggregate
accuracy. missing or aggregate health.(24-
(0-10) lacks health. (18- 25)
accuracy. 23)
(11-17)
- Literature Conducts Conducts Conducts Conducts
Review literature literature literature literature
- Resources (15) review of review of review of review of 5
less than 3 less than 4 less than 5 or more
current current current current
nursing nursing nursing nursing
research research research research
N470 PAPER 42

articles plus articles plus articles plus articles plus

utilizes utilizes utilizes utilizes
current current current current
research research research research
from other from other from other from other
professions. professions. professions. professions.
Research Research Applies Applies
not well not well research to research to
applied to applied to the the
the the characteristi characteristi
characteristi characteristi c, c,
c, c, problems/ne problems/ne
problems/ne problems/ne eds of eds of
eds of eds of aggregate aggregate
aggregate aggregate (11-13) (14-15)
(0-6) (7-10)
- Compare/Contr Lacks Compares Compares Compares
ast (10) comparison target and and
of target aggregate contrasts contrasts
aggregate with similar target target
with similar aggregates, aggregate aggregate
aggregates, the with similar with similar
the community, aggregates, aggregates,
community, the state the the
the state and/or the community, community,
and/or the nation the state the state
nation (4-6) and/or the and/or the
(0-3) nation nation.
(7-9) Provides
specific
examples
and/or
current
statistics.
(9-10)
- Population Nursing Nursing Appropriate Appropriate
Needs (Nursing Diagnoses Diagnoses Nursing Nursing
N470 PAPER 43

Diagnoses) (5) identified identified Diagnoses Diagnoses

but lacks 2 but lacks 1- (plural) with (plural) with
or more of 2 of the rationale rationale
the following and theory and theory
following components support and support and
components -lacks prioritizati prioritizati
-lacks rationale, on applied on applied
rationale, theory to to
theory support, aggregate. aggregate.
support, and or (4) Health
and or prioritizati problems/ne
prioritizati on (3) eds include
on( 0-2) comparative
analysis and
interpretatio
n of data
collection
and current
research.
(5)
Planning
- Health Lacks Identifies Selects and Selects and
Planning/Needs identifies one priority discusses discusses
(15) one priority Nursing one priority one priority
Nursing Diagnosis Nursing Nursing
Diagnosis which needs Diagnosis Diagnosis
which needs intervention.which needs which needs
intervention Provides intervention intervention.
. Provides generalized . Provides Provides
generalized objectives. specific, specific,
objectives. (7-10) measurable measurable
(0-6) objectives. objectives.
(11-13) (14-15)
- Alternative Does not Identifies Includes Includes
Interventions discuss but does not description description
(10) alternative discuss of of
intervention alternative alternative alternative
N470 PAPER 44

s, does not intervention intervention intervention

include s, does not s necessary s necessary
identificatio include to fulfill to fulfill
n of identificatio objectives. objectives.
resources. n of Lacks full Discusses
(0-3) resources. discussion either
(4-6) of existing,
resources. developing
(7-9) or
resources.
(9-10)
Format (10) Greater than 4-5 errors 2-3 errors 0-1 errors
APA, Spelling, 5 errors. (4-6) (7-9) (9-10)
Grammar (0-3)