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COMMUNITY AS PARTNER REPORT CENSUS TRACT 4068

Community as Partner Report Census Tract 4068

Dalia Lis, Jennie Miller, & Mikayla Reuter

University of Arizona

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Community Analysis and Nursing Diagnosis

We identified three strengths in census tract (CT) 4068 as roads kept in good condition, a

high number of available health resources, and a very connected and supportive community of

residents. During our windshield survey we saw both the condition of the roads and the health

resources in the area; we located one hospital, ten assisted living facilities, two urgent cares,

three pharmacies, eleven outpatient specialty clinics, one integrative service modality, one

mental health clinic, and one home health service. Finally, the source of evidence for the

supportive community was personal communication with key informants.

Our team found three critical stressors in CT 4068 as a fundamental lack of resources for

the homeless population, high crime, and little to no support for mental health for both adults and

children. According to the Neighbor Support Network, from February 22nd to current there have

been a total of twelve reports of theft and/or robbery, three reports of interpersonal conflict,

fifteen reports of mental health and/or welfare (including suicidal calls), five reports of

trespassing, and one sexual offense report (Neighborhood Support Network, 2019).

According to our community assessment, the priorities of care for CT 4068 were high

crime, homelessness, isolation, and high-speed traffic. A table, which prioritizes the

community’s problems, is listed in Appendix A.

Based on our analysis of community assessment findings, we formulated the following

diagnosis for CT 4068: Risk of anxiety and depression among eighth graders related to

ineffective coping with stress and isolation related to the COVID-19 pandemic, government

mandated closure of public spaces, as well as increasing expectations in their academic and

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social environments as evidenced by St. Michael’s nurse reports of increasing anxiety amongst

the sixth, seventh, and eighth graders.

Community Nursing Program Plan

We set the community health goal for our intervention as increasing awareness

surrounding mental health in the middle school population and increasing understanding of ways

to reduce stress and anxiety among the middle school population.

We used evidence from a study by Wang and Lv (2020), titled Application of Positive

Psychology in Mental Health Education to develop our project. The purpose of this article was to

create a mental health teaching model that is easily implemented and can effectively improve

students’ mental health. It is a realistic article to use for the chosen health education topic

because the trial was conducted using students who were in the eighth grade, between the age of

14 to 16 years old, who were receiving education about mental health during class time. The

level of evidence of this article was level III, because there was an experimental and control

group, but it did not mention randomization. The article was specifically chosen as a basis for the

education regarding mental health because the authors discuss how positive psychology

emphasizes positive power within three aspects of an individual’s life: a subjective level, an

individual level, and a group level (Wang & Lv, 2020). We designed our mental health education

to focus on each of these areas. At the subjective level, past happiness and personal satisfaction

was addressed by the daily journaling exercise. The individual level was addressed by teaching

the five senses box, as it encouraged students to collect personalized items that remind them of

feelings such as love and creativity. Finally, the group level was addressed through the education

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on how to reach out to others for help by involving members of the family, social setting, or

educational setting.

We identified the most applicable overarching Healthy People 2030 goal as “Promote

quality of life, healthy development, and healthy behaviors across all life stages.” We identified

the most applicable overarching Healthy People 2030 topic as Mental Health and Mental

Disorders. We identified the most applicable overarching Healthy People 2030 objective as

MHMD – 03, “Increase the proportion of children with mental health problems who get

treatment” (Office of Disease Prevention and Health Promotion [ODPHP], n.d.). The baseline for

this objective is “73.3 percent of children aged 4 to 17 years with mental health problems

received treatment in 2018” (ODPHP, n.d.). The target for this objective is 82.4 percent of

children in the United States. This objective was also set with the understanding that a significant

percentage of children in the United States are struggling with mental health problems, but do

not receive treatment or lack the fundamental resources to cope with stress and anxiety (ODPHP,

n.d.).

We selected The Mental Health Services for Students Act as an example of a policy that

relates to our community health goal, otherwise known as an institutional policy. This policy

provides funding for public schools to be able to partner with mental health professionals to

create on-campus mental health care services for students (Napolitano, 2020). While the purpose

of our health education project (HEP) was to increase a student’s understanding of ways to

personally manage everyday stress and anxiety, the hope was that the school would also want to

make strides in helping students with their mental health.

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We planned the following health education project for middle school students at St.

Michael’s to meet our community health goal, as well as to address the elevated risk for anxiety

and depression among this population. To raise awareness surrounding mental health, the myths

and the typical signs and symptoms, in the middle school population, we gave a Prezi

PowerPoint presentation. To increase understanding of ways to reduce stress and anxiety among

the middle school population, each one of us presented on a different type of evidence-based

stress reduction technique. Dalia Lis presented on the five senses box, which is a box that holds

tangible items representing each sense. For example, the box may contain candy for taste and/or

a blanket for touch. The five senses box helps children and/or youth focus on something other

than what is making them stressed. Mikayla Reuter presented on pursed lip breathing, the 4-7-8

technique, as well as mindful stretching. These two interventions help someone focus on their

breathing rather than what is worrying them. Additionally, Mikayla had the middle schoolers

write down one friend, one adult, and one phone number for a mental health hotline, for the

purpose of identifying people in their life they could trust to go to for their anxiety and stress.

Jennie Miller presented on journaling and ideas for how they could journal to help the middle

schoolers recognize a healthy way to channel those inner thoughts if they ever do not want to

talk. In the end, Mikayla had the class hold up a heavy object to simulate the feeling of taking on

the burden of stress and anxiety alone, emphasizing the importance of talking to or reaching out

to someone. We then distributed a post-presentation survey to evaluate our SMART learning

objectives.

We developed the following SMART Learning Objectives for the project. After the

health education project, 100% of eighth-grade students will be able to identify five myths about

mental health. After the health education project, 100% of eighth-grade students will be able to

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list three symptoms of anxiety or stress. After the health education project, 100% of the

eighth-grade students will be able to list at least one method for stress reduction.

The plan for implementation included three of the following program activities:

· Nursing students will present a Prezi presentation on what mental health is, five myths

related to everyday stress and anxiety, and the signs and symptoms of everyday stress and

anxiety.

· Nursing students will have eighth graders hold up something heavy to feel the weight of

dealing with mental health on their own.

· Nursing students will present on four stress management techniques, including pursed lip

breathing, mindful stretching, journaling, and the five senses box.

We created a written three-item survey to evaluate our three learning goals. We

distributed the survey at the end of our presentation to evaluate the students’ ability to meet our

HEP project learning objectives. See Appendix B for a copy of the post-presentation survey.

We initially performed a key informant interview with St. Michael’s Director of

Communications and Faculty Support. She provided us with the contact for the school

nurse. We then collaborated with the school nurse to develop a health education project for

middle school students on mental health, the stigma surrounding occasional stress and anxiety,

and ways to best manage anxiety and stress. Unfortunately, the only challenge we faced was

setting up a date to give the presentation, otherwise it went very smoothly. It is important to also

mention that we were in frequent contact with the Pima County Health Department public health

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nurse throughout the development of the education project. Printed materials such as the surveys

were provided by one of the University of Arizona College of Nursing Public Health professors.

Our intervention addressed the Subclinical Disease stage in the Natural History of

Disease. The subclinical disease stage was addressed because the students were already exposed

to mental health challenges but were not necessarily aware of symptoms nor are they actively

seeking treatment. The level of prevention was secondary, as the education addressed mostly

asymptomatic mental health challenges to begin treating the challengers early and prevent

disability.

We required several physical resources to deliver our health education project including

stress balls, pencils, printer paper, computer, and a projector. Due to the various policies and

procedures St. Michael’s has already put in place for COVID-19 and the safety of their students,

there were no constraints other than wearing a mask throughout the entirety of the presentation.

Implementation of Community Nursing Intervention

We held our teaching project on April 15, 2021. We gave one presentation at 11:30 AM

and another at 12:25 PM to two separate groups of eighth graders, around sixteen in each group.

The school nurse, head of St. Michael’s, and writing teacher also attended the presentation. The

student nurses delivered a Prezi presentation on mental health, and then informed the students

about four ways to help manage occasional stress and anxiety. Additionally, the student nurses

provided various resources, organizations, and hotlines, on a handout. The middle school

students were engaged, polite, and respectful throughout the entirety of the presentation. The

head of the school gave positive feedback about the presentation per Professor Goldsmith, as

well as took part by answering questions and looking at the handout. The school nurse asked us

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if we could come back to present to the seventh graders as she enjoyed our presentation and felt

that this is something they could also benefit from. Overall, the HEP teaching was very well

received. While it was challenging putting this topic into language that could be understood by

this population, we did not encounter any major unanticipated challenges related and/or

unrelated to COVID-19. See Appendix C for a link to the Prezi PowerPoint presentation.

Evaluation of Community Nursing Intervention

Our survey results indicated that participants met all three of our learning objectives.

Every student correctly identified that all of the true or false statements were false, listed three

warning signs of stress, and gave an example of how to deal with stress. The only

limitation/barrier we faced with our evaluation strategy was having difficulty reading the hand-

written responses from some students.

Dissemination of Findings

We would have disseminated our findings at the poster presentation in Abrams Public

Health Center, but we did not present our health education project until after this event.

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References

Napolitano, G. (2020). Text - H.R.1109 - 116th Congress (2019-2020): Mental health services

for students act of 2020. Retrieved from https://www.congress.gov/bill/116th-

congress/house-bill/1109/text

Neighborhood Support Network. (2019). Police event and incident listings. Retrieved

from https://www.neighsupport.net/topics-2/crime-and-disorder/police-incident-listings/

Office of Disease Prevention and Health Promotion. (n.d.). Increase the proportion of children

with mental health problems who get treatment – MHMD-03. Healthy People 2030. U.S.

Department of Health and Human Services. Retrieved

from https://health.gov/healthypeople/objectives-and-data/browse-objectives/diabetes

Pharmacist. (2021, March 16). Personal communication [Phone interview].

Resident. (2021, March 16). Personal communication [Phone interview].

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Appendices

Appendix A

Priorities of Care Table

Related Severi
Availa
communit Comm ty of Ideas for nursing
Comm bility
y stressors Identifi unity outco intervention
unity of
(SDOH ed in express Nursing me(s)
health resour (Use Minnesota Wheel)
and/or Pima ion of students witho
vulnera ces
human County’ interest ’ ability ut ** The interventions Total
bility releva
behavior) s Health in to effort listed below are just score
or nt for
Needs address address to examples. Students
stressor addres
Assess ing problem addres can use any of the
sing
ment1 proble s interventions from
proble
m2 proble the wheel.
m
m
Crime 2 4 2 2 2 12
Public
roads, lack
Community
of
organizing**: Bring
socializati
together block or
on,
neighborhood
substance
associations to
abuse.

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identify patterns in
crime and key
problems with crime.

Lack of
Health Teaching**:
socializati
Teach a class about
on and 2 4 1 1 2 10
Isolatio mental health and
confineme
n finding ways to cope
nt due to
at heightened periods
COVID-
of stress and anxiety.
19.

Mental Collaboration**:
health Collaborate with
challenges local health and
Homel 2 4 1 1 2 8
, drug social institutions to
essness
abuse, job provide resources
loss. and create events for
the homeless
community.

Wreckless Social Marketing**:

High- drivers, Create brochures,
speed lack of 1 4 0 1 1 radio and/or 7
Traffic speed television
enforceme advertisements, and
nt. billboards to market
safety while driving.

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.

Community Strengths

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Community Assets or As evidenced by … How might the asset or strength

Strengths help address a vulnerability or
stressor
High number of available Key informants One of the biggest stressors in
health resources. Resources directly stating that it this community is the large
are close in proximity to is easy to get to the homeless population. It makes it
each other, making it easy to resources throughout easier for the homeless to move
move around the area to the area just because around and find what they need
access them. everything is decently to find, even though the census
connected. tract itself lacks a lot of
fundamental resources for them.
The quality of the road A windshield survey A challenge in the area is that
conditions was very good, was performed in there is a high number of
allowing for more reliable which students only assisted living facilities,
transportation. saw a single area that healthcare settings, and
had potholes, and this residential areas in which elderly
area was a road that individuals and families with
was behind multiple young children live. Good road
buildings. conditions allow for the driver to
have more control of the vehicle
and makes transportation to and
from these multiple settings
much more accessible.
A very connected and Key informants Isolation and an increased
supportive community of directly stating that frequency of mental health
residents, in which neighbors they felt the challenges are predominant
help monitor the areas, community within the stressors in the area. Having a
check in with one another, neighborhoods was connected and supportive
and support a united very close-knit, and community that can still
community through multiple that their neighbors communicate via electronics to
gatherings throughout the always kept each ensure everyone is doing well
year. other updated via during the pandemic helps
online chats as well relieve some of the stressors
as in person causing these feelings of
communication to isolation or increased stress.
discuss neighborhood
crime, safety, etc.

Appendix B

Post-survey

1. True or false

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a. T or F: Having stress and anxiety means you are “crazy.”

b. T or F: Stress and anxiety are uncommon.
c. T or F: Stress and anxiety are signs of weakness.
d. T or F: Stress and anxiety are permanent.
2. List 3 warning signs of stress
a.
b.
c.
3. What is 1 way you deal with your stress?
a.

Appendix C

HEP Visual Aid

The following presentation was used as a visual aid for our HEP:

https://prezi.com/p/1_nvz2hu2bqe/?present=1.

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