Community Health Nursing Practicum
• Cover sheet
• A written summary/narrative of the Field Project that will include:
o Community assessment
o Community genogram
o Description and context of the health issue
o Population description
o Community resources and partnerships
o Community diagnosis
o Outcomes and goals
o Plan to address the need
o Evaluation plan
o Conclusion and reflection
• Supplemental materials such as maps, graphs, etc. (in the appendices of the narrative)
• References
• A time log
2.1. Primary Prevention Focus
The first step in choosing a topic for your Field Project is to understand that the focus of the project must be primary prevention. Primary prevention is the prevention of disease, injury, disability or premature death. Before selecting a topic, consider what might be an issue of public health concern in your own community and answer the following questions.
What are the biggest contributors to disease (morbidity) and premature death (mortality) in your community? (Provide references.)
What are the controversial issues written about in your local newspaper?
What do you believe people in your community are most concerned about related to health?
What is generating the most visits to the emergency department ER or hospital admissions? (Provide references.)
What do you believe is reducing the quality of life in your community? ?
2.2. Choosing Your Field Project Topic with a Primary Prevention Focus
What is a Primary Prevention?
The HGT practicum requires a field project. The project focuses on primary prevention. Primary prevention is the prevention of disease, injury, disability or premature death before they occur.
First Steps in Choosing a Field Project Topic
First, consider what might be an issue of public health concern in your own community. The pertinent questions to consider are:
What are the biggest contributors to disease (morbidity) and premature death (mortality) in your community?
What are the controversial issues written about in your local newspaper?
What are people concerned or worried about?
What is generating the most ER visits or hospital admissions?
What is reducing the quality of life in your community?
Possible Topic Areas to Choose for HGT Field Project
Child Health
Prevention of neonatal mortality
Prevention of unintentional childhood injuries
Including: sudden unexpected infant death (SUID), poisoning, drowning, motor vehicle related (child safety seat and seat belt use), sports related, pedestrian related
Prevention of child abuse
Promotion of vaccination
Women’s and Maternal Health
Prevention of unintended pregnancies
Lack of breastfeeding/promotion of breastfeeding
Promotion of vaccination
Seniors
Prevention of falls
Prevention of social isolation
Promotion of vaccination
Disabled
Promotion of health and well-being
Including: access to disability related services and devices, limit barriers to participating in home, work, school, or community activities
Alcohol and Drug Use
Responsible alcohol consumption
Prevention of drug abuse
Including: IV drug use, prescription drug use, etc.
Physical Environment
Promotion of healthy physical environment
Including: air quality, land quality, water quality
Tobacco
Prevention of tobacco use
Prevention of smoking
Violence
Prevention of domestic violence/intimate partner violence
Prevention of dating violence
Prevention of gang violence
Prevention of bullying/Cyber-bullying
Prevention of Suicide/depression
Unintentional Injuries
Prevention of workplace injuries
Prevention of motor vehicle related death/injuries
Prevention of pedestrian injury and death (includes bicyclists)
HIV/AIDS
Prevention of HIV/AIDS
Including: sexual transmission, prenatal transmission, IV drug use transmission
Oral Health
Prevention of dental caries
Overweight and Obesity
Prevention of overweight and obesity through healthy nutrition and physical activity
Social Environment
Safe, affordable, quality housing (prevention of homelessness)
Disaster Preparedness
Prevention of adverse health consequences caused by natural and human caused disasters
Access to Healthcare
Access to mental health services
Access to dental health services
Access to health services
Resources to Start Your Topic Choice Process
Task Force on Community Preventive Services
Healthy People 2020
Describe the health topic you will address. Remember your focus needs to be on primary prevention (health promotion or disease/injury prevention).
2.3. Target Population
You have already selected the health issue focused on primary prevention (needs to be in terms of health promotion and disease/injury prevention) but please briefly describe it here.
Describe the target population (geography, age, gender, ethnic group, etc) of interest you have chosen.
Describe the health issue at the national level.
Describe the health issue at the state level.
Describe the health issue at the local level.
What has been the trend for this problem over the last 20 to 30 years? (Provide references.)
In your opinion, has the problem gotten better, worse, or stayed the same? Provide your rationale.
What are the improvement goals for the next 5 to 10 years?
How does your county compare on this issue to the state level? (Provide references.)
How does your county compare on this issue to the national level? (Provide references.)
Discuss the national level in terms of Healthy People 2020.
Describe why this level is an issue of concern.
In your opinion, what will happen if this issue is left unresolved?
What do you believe are the consequences for the individual and for the community related to this issue?
2.4. Helpful Websites and Resources
County Health Rankings
What We Rank
Ranking System
Find Your State
U.S. Department of Health and Human Services
Community Health Status Indicators
U.S. Census Bureau
American Fact Finder
Create Maps
City Data
Environment
Scorecard: The Pollution Information Site
WHO: Public Health and Environment (PHE)
American Public Health Association: Environmental Public Health
Departments of Public Health (cities, counties and states)
Search for the public health website you need
3.1. Steps to Planning Your Practicum
Typically, the fieldwork is done at the county level. Please consult your course mentor if you feel broadening or narrowing from the county level would be best for your field experience. Once you have selected your topic and your target population, you will want to create a plan that will guide you through your Field Project. The following is a general outline of the steps you will want to take:
Explore resources and access data in order to:
Describe the community in statistical terms
Describe the background of the health concern including how it has been addressed and how it relates to Healthy People 2020
Describe your target population in statistical terms
Select appropriate field activities (interviews, program visits, meetings, etc.)
To determine the perceived priority of the health issue
To determine what is currently being done to address the health issue
To understand the degree of effectiveness of current efforts
To understand how the health issue is or is not linked to other health inequities
Develop a plan to engage with individuals, agencies, and programs
Where will you find the key individuals within agencies, agencies, programs, etc., that are relevant to the health issue you have identified?
How will you approach organizations you wish to engage wit
What questions will you consistently ask when you interview people?
How will you keep track of everyone you engage with, their responsibilities, their thoughts, etc.?
The first step in assessing a community is to spend time there. Observe the surroundings and imagine that you live and work in the community you are assessing. Begin this section by reading the Community Assessment Windshield Guide and answering the questions. Time spent doing this assessment should go on your time log.
Describe the physical community:
Geographical area (e.g., county, city, town)
Area size
Population size
Demographics
Physical and social environment (see Community Assessment windshield survey guide, linked at left.)
COMMUNITY ASSESSMENT WINDSHIELD SURVEY
Instructions:
• The time that can be claimed as field work for this survey would be 5-6
hours total time during the practicum.
• Open your eyes to the county that is the home and the place of work for
the county residents.
• Stop for coffee or have lunch in a neighborhood. Find a place to eat where
you sit down as a part of the community.
• When you have observed the area, write about your impressions of the
county in your notes.
• Reflect on any surprises and whether the county looks different to you
now after taking the time and noting the various elements. What will you
want to learn more about related to your topic and population of interest?
• You may want to sketch a map related to your topic area for future
reference when writing your community description.
The Elements of the Survey
Take notes about the county using the following questions as a guide.
These questions are only a guide. You may discover other areas that you
want to note. Include your findings in the community description section of
your paper. You may also want to reference these results in the resources
and partners section of your paper.
ELEMENT DESCRIPTION
Housing and Commercial Buildings:
What is the age of the houses, architecture?
Of what materials are they constructed?
Are all houses similar in age, architecture?
How would you characterize their differences?
Are they detached or connected to others?
Are there solar panels? Windmills?
Do they have space in front or behind?
What is their general condition?
Are there signs of disrepair—broken doors, windows, leaks, locks missing?
Are there signs of neighborhood pride such as well tended yards?
Is there central heating, modern plumbing, air conditioning?
Open space:
Is the county primarily rural, suburban, urban or a mix? How much open space is
there?
What is the quality of the space—green parks or rubble-filled lots?
What is the lot size of the houses? Lawns? Flower boxes?
Do you see trees on the streets or a green island in the center of the streets?
Is the open space public or private? Used by whom?
Boundaries:
What signs are there of where neighborhoods begin and end?
Are the boundaries natural—a river, a different terrain; physical—a highway, railroad;
economic—difference in real estate or presence of industrial or commercial units
along with residential?
Do the neighborhoods have an identity, a name? Do you see them displayed? Are
there unofficial names?
“Commons”:
What are the neighborhood hangouts? Area for what groups? At what hours? For
example: schoolyard, convenience store, bar, restaurant, park, 24-hour drugstore?
Do the “commons” areas have a sense of “territoriality,” or are they open to the
stranger?
Transportation:
How do people get in and out of the neighborhoods—car, bus, bike, walk?
Are the streets and roads conducive to good transportation and bicycle use and also
to community life?
Are there major highways through the county? Who do they serve? How frequently
is public transportation available? Are gas stations available? Is there a train station
or are there light rail stations.
Service centers:
Do you see social agencies, clients, recreation centers, signs of activity at the
schools? Are there offices of doctors, dentists, and other such services? Are there
parks? Are they in use?
Stores:
Where do residents shop—shopping centers, neighborhood stores?
How do they travel to shop?
People out and about:
If you are traveling during the day, who do you see on the street—an occasional
passerby, a father with a baby?
Do you see anyone you would not expect?
Can you spot the purpose of those that you see such as a door-to door salesperson
or postal worker?
Is the dress of those you see representative or unexpected?
Along with people, what animals do you see?—stray cats, pedigreed pets,
“watchdogs”, birds, wild life?
Signs of community vibrancy:
Is this neighborhood on the way up or down? Is it “alive”?
How would you decide? Do you see street vendors? Do you see trash, abandoned
cars, political posters, neighborhood-meeting posters, real estate signs, abandoned
houses, mixed zoning usage, people tending their yards, sidewalks in good repair?
Race:
Are the residents primarily Caucasian, African-American, Asian or of another group,
or is the area integrated?
Ethnicity:
Are there indications of ethnicity—food stores, churches, private schools, information
or signs in a language other than English?
Religion:
Of what religion are the residents? Do you see evidence of heterogeneity or
homogeneity? What denominations are the churches, temples, and mosques? Do
you see evidence of their use other than on days of worship?
Revised 8-22-12 Revised 8-22-12
Health:
Do you see evidence of acute or of chronic diseases or conditions? Of accidents,
communicable morbidity diseases, alcoholism, drug addiction, mental illness, etc.?
How far it is to the nearest hospital? Clinic?
Politics:
Do you see any political campaign posters? Is there a headquarters present? Do you
see an evidence of a predominant party affiliation?
Media:
Do you see indications of television use such as satellite dishes? What magazines,
newspapers do residents read? What media do you see being sold in the stores?
What media seem most important to the residents—radio, television, print or on line?
What languages are represented?
Physical environment:
Are there indications of an excess of certain types of activities such as stores that
sell alcohol or fast food outlets. What sorts of billboards are displayed and what do
they indicate? Are there many cell phone towers or is cell phone access limited?
3.3. Understanding Partnerships
Who is your client?
Generally in nursing we think of patients and families as our clients. In community/public health, the community is the client. Your focus is on assessing the community. What are the health issues for the community as a whole? What is currently being done for the ‘client’? What are appropriate interventions? How can the outcomes be measured once an intervention is implemented?
Understanding the health status and health issues of your client (the community)
You will need to contact and visit many different groups, organizations, services, and individuals within agencies to learn how your health issue is currently being addressed in your chosen community. Some, but not all, of these contacts may have the ability and resources to assist you in meeting your health promotion objectives.
Partnerships
Community-based nurses work with, and partner with, community organizations/agencies to be successful in achieving health promotion objectives. As you meet with the agencies and organizations that address your health issue, you need to identify what entities would be appropriate partners.
Questions to ask
It is important to have in mind what it is you will be asking as you meet with organizations and groups to assess the current programs in place that address your health topic. In the end, you will want consistent data and consistent data generally means asking consistent questions.
Think about the questions in relation to the mission of the organization or the job title and responsibilities of the person you are questioning. In other words, how does the role, mission, responsibilities influence the responses to questions?
Here are two questions you should always ask:
From the agency/staff perspective, what are the gaps in primary prevention efforts related to the topic/issue?
What would be their recommendations to improve efforts?
In your summary paper, you will need to aggregate the responses you get to the questions you ask. It is very helpful to create a table and use it as one of the appendices in your paper with the analysis in the narrative.
DO
Create a list of consistent questions you will ask
Questions for Focus
List twenty or more agencies, organizations, or entities (public and private) that impact the health issue you are addressing. Include a brief rationale for each.
List four additional questions you will consistently ask that will help you determine the contribution or perspective of the organization, individual, business, or agency you are interviewing or visiting related to primary prevention efforts.
3.4. Outlining Your Field Work Project
Your findings in your fieldwork will guide you in creating your Action Plan. However, it is a good idea to outline your Action Plan before you begin your fieldwork. Your final Action Plan should closely resemble the nursing process.
Complete your community assessment
Identify your goals and objectives
Create a schedule of activities you plan to engage (where you will go and when)
Outline the interventions you propose to address your goals
Create a timeline needed to implement your interventions
Determine the method you recommend to evaluate the success of your interventions
The written summary of your project requires a description of your Action Plan and includes a community assessment, goals and objectives, a timeline for implementation, and method of evaluation.
3.5. Appropriate Health Interventions
You will need to plan appropriate health interventions for the health concern that you have identified for your target population and recommend specific nursing actions. You will be required to use the Public Health Nursing Intervention Wheel (Minnesota Model) to select your nursing action. You should already be familiar with the Intervention Wheel, and understand the definitions of each of the public health interventions found on the wheel:
Example Interventions
Coalition building
Collaboration
Social marketing
Education
Case Management
3.6. Creating a Community Genogram
Create a community genogram/diagram that provides an overview of your Field Project. This will be placed in your appendix. Your written paper needs to include a short interpretation of your genogram and refer to the appendix.
A community genogram includes the following:
Identify the physical location of the population (example: Del Rio, Texas). NOTE: It is often helpful to include a map to facilitate the description of the area of concern.
Describe the population/economic demographic data (example: population 36,676, 51% female, median age 31.7 years, median household income $32,040, 82% Hispanic, 15.2 % White, 2.8 % Other).
Describe the highlights of the target population (example: low-income adults between the ages of 21 and 70 with a BMI greater than 25).
Describe the health issue of interest (example: pre-diabetic condition).
List the highlights of the assessment findings (here you list general findings such as blood sugar results, range of BMI, family history of diabetes, cultural influences on diet, etc.).
Identify and describe the community diagnosis (example: low-income adults in Del Rio have a higher rate of pre-diabetic conditions that the general population in the state of Texas. Findings indicate that this is related to obesity, a genetic predisposition and lack of education about the relationship between diabetes and obesity.).
3.7. Preparing for a Conclusion and Reflection
You will be expected to write a conclusion and to reflect on your experience. It will be helpful to write down your observations and thoughts as you move through your practicum.
The written summary of your project requires a comprehensive evaluation, a conclusion and a personal reflection.
5.1. Requirements for Students in Non-Regulated States
1. COMPLETE SECTIONS 1-3: Students need to understand the fieldwork project, select a topic and a population with a primary prevention focus. Develop a plan to complete their project. See Section 1. Introduction to Field Project, Section 2. Field Project Topics, Section 3. Practicum Guidance.
2. COMPLETE CLINICAL HOURS AND TIME LOG: You are required to complete a minimum of 90 clinical hours and to keep a time log that will be submitted to TaskStream along with your field project summary. See Hours Required and Maintaining a Time Log for Non-Regulated States.
3. SUBMIT HGT1 TASK 1 TO TASKSTREAM: Of course you will need to submit your project summary and follow all the instructions in TaskStream. You are also required to sign and upload your completed time log verifying your clinical hours.
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