Direct Care Project Part 2

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Direct Care Project Part 1

Substance Use Assessment and Diagnosis Template

Maria I Perez Garcia

RN Community Health Nursing

Directions: Collect the data outlined in this template. Fill in the blanks in the tables provided. There are two parts - online data collection and a modified windshield survey data collection. You will then identify a nursing problem in a vulnerable population and write a nursing diagnosis. See the assignment directions for suggestions and best practices. For full credit, all information in a category must be completed. This will be the topic of your Assessment and Nursing Diagnosis Template and also Parts 2 through 4 of your course project.

Name: Date: May 16, 2021

Online Data Collection

1. Community Information

Your Community Data

Name of city or town and state

Miami, Florida.

Population

454, 279 in Miami.

Nature of this community (rural, suburban, urban)

Urban.

Describe your community in 2-3 sentences

The community is cosmopolitan, comprising of all races, social, and political classes. The community flourishes in terms of business. However, t suffers significant challenges including high levels of poverty and substance abuse.

2. Community Demographics

a. Go to https://www.census.gov/quickfacts/fact/table/US/PST045218

i. The US data should automatically populate

ii. Input your zip code or county/township name

iii. Then input your state for comparison data

iv. Enter the data into the table below

v. Compare the county, state, and US data

County Data(Miami Dade)

State Data(Florida)

U.S. Data

Population total

2,716, 940

21,477,737

328,239,523

Male (subtract female % from 100)

48.6

48.9

49.2

Female

51.4

51.1

50.8

Persons under 5

5.8

5.3

6.0%

Persons over 65

16.7

20.9

16.5%

Race and origin data

County Data

State Data

U.S. Data

White alone

79.0%

77.3%

76.3%

Black or African American alone

17.7%

16.9%

13.4%

American Indian and Alaska Native alone

0.3%

0.5%

1.3%

Asian alone

1.6%

3.0%

5.9%

Native Hawaiian and other Pacific Islander alone

0.0%

0.1%

0.2%

Two or more races

1.3%

2.2%

2.8%

Hispanic or Latino

69.4%

26.4%

18.5%

White alone, not Hispanic or Latino

12.9%

53.2%

60.1%

Significant population characteristics

County Data

State Data

U.S. Data

Veterans

48, 104

1,440, 338

18,230,322

Foreign born persons

53.7%

20.7%

13.6%

Housing overview

County Data

State Data

U.S. Data

Housing units

1,040,666

9,673, 682.

139,684,244

Owner-occupied housing unit rate

51.2%

65.4%

64.0%

Median selected monthly owner costs with a mortgage

$1, 825

$1, 503.

$ 1,595

Median selected monthly owner costs without a mortgage

$ 627

$ 505

$ 500

Median value of owner-occupied housing units

$289, 600

$ 215, 300

$ 217, 500

Median gross rent

$1, 328

$ 1,062

Family and living arrangements

County Data

State Data

U.S. Data

Households

883, 372

120, 756, 048

120, 756, 048.

Persons per household

3.00

2.65

2.62

Living in same house 1 year ago

88.0%

84.5%

85.8%

Language other than English spoken at home

74.9%

29.4%

21.6%

Computer and Internet Use

County Data

State Data

U.S. Data

Households with a computer

89.9%

91.5%

90.3 %

Households with broadband internet subscription

76.9%

83.0%

82.7%

Education

County Data

State Data

U.S. Data

High school graduate or higher

81.4%

88.2%

88.0%

Bachelor’s degree or higher

29.8%

29.9%

32.1%

Health

County Data

State Data

U.S. Data

With a disability under age 65 years

5.8 %

8.6%

8.6%

Persons without health insurance under age 65 years

19.5 %

16.3%

9.5%

Economy

County Data

State Data

U.S. Data

Civilian labor workforce ages 16+

62.6%

58.5%

63.0%

Transportation-mean travel time to work (minutes)

32.8

27.8

26.9

Income and poverty

County Data

State Data

U.S. Data

Median household income

$51, 347

$55, 660

$ 62,843

Persons in poverty

15.7

12.7%

10.5 %

3. Community Epidemiological Data

a. Go to: https://www.countyhealthrankings.org/

b. Click on your state

i. Start with Overall Rankings in Health Outcomes

ii. Then choose your county

**you will need to use the “+” to see all of the data**

County Data

State Data

Health Outcome Rank

Healthiest

N/A

Length of life rank

50%

N/A

Premature death

5,200 per 100,000

7200 per 100,000

Low birth weight

8%

9%

Adult smoking

16%

15%

Adult obesity

22%

27%

Physical inactivity

23%

26%

Excessive drinking

19%

20%

Alcohol impaired deaths

22%

22%

STIs

486.8 per 100,000

499.2 per 100,000

Teen births

15 per 1,000

20 per 1,000

Drug overdose deaths

10.9

25.5%

Uninsured

20%

16%

Unemployment

2.4%

3.1%

Children in poverty

21%

18%

Violent crime

602

484

Air pollution

7.7%

7.7%

Drinker water violations

No

No

Long commutes

57%

42%

4. Substance Use

a. Go to: https://www.samhsa.gov/data/report/behavioral-health-barometer-state-barometers-volume-6?page=0

i. Find your state and download the report.

ii. Review the report and document the following:

1. Go to Substance Use, Misuse, and Use disorders section. This will be the area that discusses those 12 and older (near end of report).

iii. Find the following percentages:

State Average

Regional Average

National Average

Tobacco use

24.6%

29.0%

26.8%

Marijuana

14.6%

14.0%

16.2%

Marijuana use disorder

1.3%

1.3%

1.6%

Heroin use

0.28%

0.25%

0.30%

Misuse of prescription pain reliever

4.1%

3.9%

3.7%

Opioid use disorder

0.9%

0.8%

0.7%

Illicit drug use disorder

2.7%

2.7%

2.9%

Alcohol use disorder

4.2%

4.5%

5.3%

Substance use disorder

6.3%

6.4%

7.4%

Windshield Survey

It is recommended that you have someone drive you around your community at least 2 times, ideally at different times of day and weekend vs. weekday.

Look at the people in your community.

Did you observe:

No

Yes

If Yes, provide number or state “many” “some” or “few”

· *pregnant women

yes

Few

· *pregnant adolescents

No

· *infants (under the age of 1 year old)

yes

some

· *young children (1-5 years old)

yes

many

· *school-age children (6-18 years old)

yes

many

· adults (18 – 60 years old)

yes

many

· *older adults (over the age of 60 years old)

yes

many

· people exercising

yes

some

· people driving

yes

many

· people walking

yes

many

· people biking

yes

some

· people congregating in groups on the street

yes

few

· *people that had hygiene issues or were unkempt

yes

few

· people that were appropriately dressed

yes

many

· people that were physically fit

yes

some

· people that were obese

yes

some

· *people that were undernourished, thin

yes

Some

· people that appear healthy

yes

Many

· *people that have obvious physical disabilities, such as those using walkers or wheelchairs

yes

Few

· *people with apparent mental/emotional disabilities

yes

some

· *people who appeared homeless or unemployed

yes

few

*Represents vulnerable populations

Social and Economic Conditions

Did you observe:

No

Yes

If Yes, provide number or state “many” “some” or “few”

· housing that was run down or dilapidated

yes

Few

· areas undergoing renewal

yes

few

· public housing

yes

some

· public transit (subway, train, buses, taxis, etc)

yes

many

· transportation to health care resources

yes

many

· landfills

yes

few

· restaurants

yes

man

· any political signs

yes

many

· any evidence of health education on billboards, advertisements, or signs

yes

many

· any efforts to improve the neighborhood’s health such as advertisements for health-related events, health fares, clinics, or lectures

yes

some

· any group efforts in the neighborhood to improve the living conditions or the neighborhood

yes

few

· churches, synagogues, and other places of worship

yes

many

Health Resources

Did you observe:

No

Yes

If Yes, provide number or state “many” “some” or “few”

· hospitals

yes

many

· community clinics

yes

some

· family planning clinics

yes

About three

· generalist doctors

yes

some

· dentist offices

yes

some

· pharmacies

yes

many

· urgent care clinics

yes

About 2

· skilled nursing facilities

yes

some

· mental health or counselling clinics

yes

some

· homeless or abuse shelters

Yes

some

· public health department office

yes

some

· substance abuse treatment center

yes

some

· alternative medicine practices, botanicals, or herbal medicine shops

No

Answer the following question:

If some of the above health resources were not observed, approximately how far away would a person need to travel to find these resources?

Environmental Conditions

Did you observe:

No

Yes

If Yes, provide number or state “many” “some” or “few”

· evidence of anything that might make you suspicious of ground, water, or air pollutants

Yes

Few

· poor road conditions with potholes, or poor drainage

No

· adequate traffic lights, signs, sidewalks, and curbs

Yes

Many

· railroad crossings fitted with warnings and barriers

Yes

Many

· streets and parking lots well lit

Yes

Many

· handicapped access to buildings, sidewalks, and streets

Yes

Some

· recreational facilities, playgrounds, and/or facilities like the YMCA

Yes

Many

· children playing in the streets, alleys, yards, or parks

Yes

Many

· evidence of nuisances such as ants, flies, mosquitoes, or rodents, or stray animals observed

No

Problem

Identify a nursing problem based on your data and observations. The problem must be related to substance use. Example: Alcohol use

Problem Identification: Tobacco use.

Vulnerable Population

Identify the vulnerable population that is most impacted by this problem. Example: Adolescents

Vulnerable Population Identification: Youth

Diagnosis

Write a nursing diagnosis based on your problem from above. Fill in the blanks below.

Example: Increased risk for alcohol use among adolescents related to lack of sufficient knowledge about the long and short-term impacts demonstrated in increased county data compared to state/national averages.

*See chapter 6 in the Nies and McEwen (2019) textbook for more examples of composing a community health nursing diagnosis.

Nursing Diagnosis: Increased risk of Tobacco use among the youth related inadequate knowledge about the side effects and ease of tobacco availability in the area as demonstrated in the high state average of tobacco use.

References

Substance Abuse and Mental Health Services Administration (SAMHSA). (2020). Behavioral health barometer, volume 6. https://www.samhsa.gov/data/report/behavioral-health-barometer-state-barometers-volume-6?page=0

County Health Rankings and Roadmaps. (2018). Explore rankings. http://www.countyhealthrankings.org/

U.S. Census Bureau. (2018). State and county QuickFacts.  https://www.census.gov/quickfacts/

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3/10/21