POD Paper Immunity fo rthe Community

Running head: IMMUNITY FOR THE COMMUNITY 1

POD Paper

Immunity for the Community

Alpha POD: Jordan Anderson, Amy Berry, Cheyenne Boyd, Casey Brown, Hannah Burress,

Caitlyn Cloy, & Megan Curry

Patty Hanks Shelton School of Nursing

Community and Public Health Nursing

NURS 435/4335

Tammie Coffman, RN, MSN, OCN-C

December 2, 2014

IMMUNITY FOR THE COMMUNITY 2

Immunity for the Community

Community Defined

The purpose of childhood immunizations, as well as adult vaccinations, is to protect

people from contracting and spreading vaccine preventable diseases that historically have caused

lethal epidemics across the United States (U.S.) (Stanhope & Lancaster, 2014). From January 1,

2014 through May 23, 2014, 288 cases of measles were reported by the states (Gastanaduy et al.,

2014). In addition, a study conducted by the Journal of American Medical Association (JAMA)

Pediatrics (2013) found that “72 children received a confirmed diagnosis of pertussis from a total

of 1,522 tested children across the United States,” during a designated time period (Glanz et al.,

p. 1060). JAMA also stated, “The United States is currently experiencing the largest outbreak of

pertussis in 50 years” (p. 1063). Dr. Mark Thoma, of Americablog News (2014), reports data

retrieved from the Centers for Disease Control and Prevention (CDC) that confirmed 50,000

cases of pertussis in 2013 and approximately 50-60 cases of measles in 2014. In 2012, pertussis

claimed the lives of 20 people, along with measles killing approximately two people in every

1,000 cases (Thoma, 2014). The mentioned sources all relate the increase of these disease

outbreaks to the increased number of under-vaccinated or unvaccinated children and adults in

America.

Measles and pertussis, along with other vaccine preventable diseases, are increasingly

causing the health of Americans to decline, potentially causing deaths. In many cases, the

disease outbreaks are beginning with people traveling into the U.S. from countries where these

diseases are more prevalent and where people are highly under-vaccinated. Once the disease

enters the U.S., it is then contracted by the under-vaccinated, and an outbreak occurs

(Gastanaduy et al., 2014). Since the recent rise in the occurrence of vaccine preventable


diseases, public health officials and nurses have made it their goal to promote the Healthy People

2020 objective calling for “the sustained elimination of indigenous cases of vaccine preventable

diseases” (Stanhope & Lancaster, 2014, p. 301). The best way to reach this goal is for the

community to simply get vaccinated. In 2013, the CDC released an article stating that, “In the

U.S., among children born during 1994-2013, vaccinations will prevent 322 million illnesses and

732,000 deaths during their lifetime” (Elam-Evans, Yankey, Singleton, & Kolasa, 2013, p. 741).

The same article reported that during 2013, 83.1% of children had received the full doses of the

diphtheria, tetanus, and pertussis vaccine (DTaP), and 91.9% had received the first dose of the

measles, mumps, and rubella vaccine (MMR) (Elam-Evans et al., 2013). Though these numbers

are high, coverage rates may vary at the local level. Often under-vaccinated children tend to

cluster in geographical locations therefore decreasing the effectiveness of community immunity

(Gastanaduy et al., 2014). Community immunity is resistance of a group of people to an

infectious agent based on a high proportion of individual members who are protected with

immunity who therefore provide protection for individuals who are not immunized (Stanhope &

Lancaster, 2014). A decrease in immunization coverage of a group of people (community

immunity) results in an increase in the incidence of disease outbreak. As stated by the CDC in

an article titled “Measles” (2014), “encouraging timely delivery of vaccinations and sustaining

high vaccination coverage in the U.S. is essential to limit the spread of disease” (Gastanaduy et

al., 2014, p. 498).

Nurses and other community health providers are being challenged to create a change

regarding the lack of vaccinations among the community. According to the American Nurses

Association Immunizations website (2014), public health nurses “work to enhance the health of

the community through education and service. They deliver services, conduct disease


surveillance, and provide education, all in support of the public health mission” (para. 1). One

way community nurses can begin to tackle the issue of under-vaccinations is by starting at the

beginning- with children. The immunization process begins at birth and continues on throughout

early childhood with children receiving the recommended immunizations for seventeen diseases,

(Stanhope & Lancaster, 2014, p. 300) with most of them given by the age of two (ACIP, 2013).

Children are unable to decide and execute the process of getting vaccinated, so the power lies in

the authority of parents or guardians (caregivers). In this situation, nurses often use the health

promotion theory of social support. This theory emphasizes the idea that social support, in this

case the support of parents and guardians, can be “instrumental, informational, emotional, and

appraising” in regards to health promotion (Riverside Community Health Foundation, 2010, p.

1). Therefore, vaccines result in the incorporation of health promoting behaviors. Nurses can

utilize this framework to guide them as they promote the health of the greater community

through the vaccination of children. This can be accomplished by targeting their social support,

the caregivers, in order to prevent the increase in vaccine preventable diseases in America. This

area of need has many opportunities for nurses to practice and promote the health of the

population at risk.

Community as Client

The focus of this project will be placed on the community of Texas and the number of

under-vaccinated school-aged children. Texas law requires children to be vaccinated before

entering school.

Exclusions from compliance are allowable on an individual basis for medical

contraindications, reasons of conscience, including a religious belief, and active duty with

the armed forces of the United States. Children and students in these categories must


submit evidence for exclusion from compliance as specified in the Health and Safety

Code, §161.004(d), Health and Safety Code, §161.0041, Education Code, Chapter 38,

Education Code, Chapter 51, and the Human Resources Code, Chapter 42, Texas

Administrative Code, 25 Tex. Stat. Ann.§§ 97-97.62. (Exclusions from Compliance,

2004/2007)

However, in recent years, rates of refusal among caregivers have increased. According to a

current study, twenty percent of school-aged children did not receive the recommended

immunizations before beginning the school year (Chi, 2014). Since children do not have the

power to make their own health decisions, the lack of immunizations is a likely result of

multifactorial causes including; underinsured Texas families and parents’ deliberate refusal to

follow the recommended vaccination schedule. Currently, there is a rampant amount of

underinsured and uninsured Texas families, which results in parents not being able to afford

vaccines for their children. In other situations, parents ignore vaccine recommendations because

of fear of adverse effects, lack of education on the benefits, and busy schedules that prevent

timely immunizations. The importance of getting vaccinations in childhood is especially

important because of children’s developing immune systems and their increased susceptibility to

preventable diseases.

Unvaccinated children also put unprotected people in their communities at risk. This risk

is especially important for people who cannot be vaccinated, such as “those who are too young to

be vaccinated, those who cannot be vaccinated due to medical reasons, and especially those who

do not develop adequate immunity to the disease from the vaccines” (“Reducing vaccine-

preventable disease,” 2012, p. 40). In order to protect the community at large, it is the public

health nurse’s responsibility to make the community the client. The nurse may then focus on a


smaller group to initiate a health status change. For the purpose of this project, the public health

nurse’s priority clients are children in Texas. While the child may be the ultimate target, the

nurse must also consider the child’s caregivers when planning solutions. By defining this target,

the nurse can begin to assess, plan, implement, and evaluate a course of action to create a

significant health transformation among the community.

Community Health

Children in Texas are becoming victim to declining health as a result of being under-

vaccinated. As vaccination rates drop, once-rare diseases, such as measles, come roaring back

into the community. In 2013, Texas experienced one of the most rampant measles outbreaks

since the 1950’s. In school-aged children alone, there were 3,621 reported cases of which more

than 400 people were hospitalized and five children died (Hannaford, 2014). Trends are shifting

from increased childhood life expectancy as a result of advancements in medicine including

immunizations, to an increase in childhood morbidity and mortality as a result of caregivers’

refusal to immunize. It is evident that there is a need for a solution in hopes to protect the health

of children in Texas and the community of the United States.

Community-oriented nursing practice is defined as “the provision of disease prevention

and health promotion to populations and communities” (Stanhope & Lancaster, 2014, p. 16).

This type of nursing practice is applicable when addressing the issue of under-vaccinated Texas

children. In this situation, the nurse can play a major role in creating appropriate nursing

diagnoses and investigating the issue of why caregivers are denying their child immunizations.

When planning outcomes, the nurse can be motivated by the Healthy People 2020 outcome

calling for “awareness of disease and completion of prevention and treatment courses, which are

essential components for reducing infectious disease transmission” (U.S Department of Health


and Human Services, 2014, para. 3). The nurse could also conduct health monitoring and

research to observe trends related to vaccination refusals. Finally, the nurse can implement and

then evaluate the solution to tackle the issue at hand. Ultimately, the nurse’s goal would be to

generate a change that would result in “maintaining the community’s health to create conditions

in which people can be healthy” (Stanhope & Lancaster, 2014, p.16).

Partnerships

Our goal is to ensure that more children are vaccinated and that parents are educated

about the risks associated with under-vaccination. In order to successfully meet this goal, there

must be collaboration and allocation among established nursing organizations, guardians,

healthcare providers, and the government.

Immunizing children depends upon initiative from their adult caregivers, many of whom

may be “highly anxious about the safety of immunizations, or anxious about subjecting their

children to painful procedures” (Plumridge, 2009, p. 1188). Effective teaching from certified

registered nurses regarding immunizations can reduce anxiety among parents and ensure that fear

is not a factor in the under-vaccination of children in Texas. Should they need more information,

the child’s healthcare provider can direct caregivers to online resources regarding the importance

of vaccinating their children. Resources may be found through the Texas Health and Human

Services Commission and the Center for Disease Control and Prevention. By educating

caregivers, the expected outcome is the increase in children receiving vaccines as a result of

parents agreeing to immunize based on their new knowledge about vaccines.

In addition to correcting caregiver knowledge deficit, we plan to partner with the Texas

Nurses Association (TNA) to propose the enacting of stricter laws regarding refusal of

vaccinations. By partnering with local state representatives, in addition to the TNA, we will help


to ensure that parental refusal of vaccinations are relegated to medical contraindications and

reasons of consequence as deemed appropriate by each child’s primary care physician. These

partnerships are discussed in more detail in further sections. With the cooperation of caregivers,

the Texas Nurses Association, health care providers across the state of Texas, and the state

government, we will work to prevent the recurrence of epidemics of vaccine preventable diseases

as a result of under-vaccination.

Data

As stated in “Community Defined,” there are many statistics verifying the increase in

vaccine preventable diseases. The data gathered for this study was retrieved from the Center for

Disease Control and Prevention (CDC), the Journal of American Medical Association (JAMA)

Pediatrics, and Dr. Mark Thoma of Americablog News. The CDC is a government entity whose

purpose is to “protect lives and improve health through health promotion, disease surveillance,

implementing disease prevention strategies, maintaining health statistics, and providing services”

(Stanhope & Lancaster, 2014, p. 58). The articles we retrieved from the CDC are primary

sources, meaning the CDC conducted the research and the statistics from these sources are

considered more reliable and credible. The CDC’s article “Measles” (2014) explained the recent

outbreaks of measles primarily in the unvaccinated person and also updated national measles

data. The total 288 cases recorded over a five-month span indicated a need for emphasis on

awareness and the importance of vaccinations in communities. JAMA Pediatrics, a primary

source, (2013) also conducted an ongoing investigation to “examine the association between

under-vaccination and pertussis in children 3-36 months of age” (p. 1060). Between 2004-2010,

seventy-two children tested positive for pertussis out of 1,522 tested. Forty-seven percent of the

pertussis cases were a result of under-vaccination. The study concluded that there was a


significant increased risk for pertussis in under-vaccinated children and that approximately 36%

of the cases could have been prevented with on-time vaccination of the DTaP vaccine (Glanz, et

al., 2013, p. 1062). Finally, Dr. Thoma from Americablog News, a secondary source, (2014)

relays data gathered from the CDC to send a message to the United States regarding the increase

in vaccine preventable diseases. His purpose is to encourage children and adults to get

“vaccinated not only for their own protection, but to prevent the spread of these diseases to those

who may not be able to be vaccinated” (para. 18). Though no academic statistics were found

from the state of Texas, USA Today released an article in August 2013 titled “Texas Measles

Outbreak Linked to Church” which confirmed that Texas has been affected by the recent rise in

vaccine preventable diseases as a result of the unimmunized. In Newark, Texas, twenty-five

people contracted measles from attending a church where the pastor had been critical of the

measles vaccine. People from age four months to forty-four years old were sickened and at least

twelve of the total twenty-five people were not immunized against measles (Szabo, 2013).

Altogether, the data found for this study confirms the recent rise in outbreaks of vaccine

preventable diseases and verifies that there is a risk for infection in children particularly. The

data also validates the hypothesis that unvaccinated or under-vaccinated children play a large

role in the spread of infection of vaccine preventable diseases.

Additional data gathered for this study included the vaccination coverage rates for

children in the U.S. and the state of Texas. The CDC publishes a Morbidity and Mortality

Weekly Report, a primary source, and in August of 2014, the 2013 U.S. national and state

coverage rates were released. Since 1994, the CDC has monitored vaccine coverage rates in

children ages nineteen to thirty-five months with the ultimate goal of reaching and maintaining

high coverage rates in order to prevent the resurgence of vaccine preventable diseases. As stated


in “Community Defined,” national vaccination coverage rates were 83.1% for the full DTaP

series and 91.9% for one dose of MMR. DTaP coverage of 83.1% is below the Healthy People

2020 goal of greater than 90% coverage. Despite the 91.9% coverage rate for the MMR vaccine,

one in twelve children are not receiving their first dose of the MMR vaccine on time, therefore

increasing disease susceptibility across the country (Elam-Evans et al., 2013). More importantly,

for this study, are the statistics involving the community of Texas. The same article from the

CDC posted the coverage rates for all Texas children ages nineteen to thirty-five months, and the

results were 81.5% for DTaP and 92.7% for MMR. Texas exceeds the national coverage

percentage goal for MMR, but falls behind in comparison to the national DTaP coverage rates

(Elam-Evans et al. 2013). Another article posted from the CDC looked specifically at school-

aged children’s (particularly kindergarteners) vaccination coverage and refusal rates. During the

2013-2014 school year, Texas had the third highest amount of immunization refusals for

nonmedical reasons at 5,536 kindergarteners (Seither et al., 2013). This same article stated,

“High exemption levels and suboptimal vaccination coverage leave children vulnerable to

vaccine preventable disease” (Seither et al., 2014, p. 913). This data regarding vaccination and

refusal rates connects the incidence of vaccine preventable diseases with the trends of declining

immunization rates, as well as, increased vaccine exemptions for non-medical reasons.

Altogether, the data collected for this study points to a need for action from community nurses to

create change in light of public health and wellbeing.

Community Nursing Diagnosis

There is an increased risk for infection among school-aged children in the state of Texas.

The risk of vaccine preventable infections among school-aged children is highly related to

knowledge deficits of their caregivers. This is due to guardians’ misinterpretation of


information, unfamiliarity of resources, and the current inadequate laws regulating refusal of

vaccinations. An example showing evidence that a knowledge deficit and risk for infection is

occurring could be an increase in the rate of vaccine preventable disease among children and an

increase in vaccine refusal and exemptions in Texas.

Planning

The purpose of this research project is to decrease the amount of vaccine preventable

diseases by immunizing children before their enrollment in public school. Our intention is to

identify how caregivers’ knowledge deficits and inadequate laws regulating refusal of

vaccinations affect immunization of children in Texas.

The primary goal in planning is to ensure that every child attending public school in the

state of Texas be vaccinated. We created the following objectives to attain this mission: 1)

educate guardians and families on the importance of childhood vaccinations given in a timely

manner according to the Centers for Disease Control standards, 2) provide evidence against

myths that individuals of the community may believe about vaccinations causing other disease

processes, 3) implement required educational classes explaining the importance of vaccinations

to families who refuse immunizations, and 4) provide evidence to guardians, that by getting their

children vaccinated they will have decreased medical expenses in the future.

The second goal to be achieved is to update the existing law that requires all children

attending public schools in the state of Texas to be immunized prior to enrollment. The update

with allow for stricter regulations regarding vaccination refusals. The plan for accomplishing

this goal is stated in the following objectives: 1) contact the Texas Department of Health

Services in Austin to determine health risks due to children not being immunized, 2) partner with

the Texas Nurses Association to collaborate ideas in order to have a stronger platform for


implementation, 3) establish a bill containing the goal intended and the resolution to this

problem, and 4) present the bill to members of the Texas state Congress.

Implementation

Children are a vulnerable population when it comes to vaccinations. Whether children

get vaccinated or not is up to the discretion of their caregivers. This has been identified as an

increasing problem due to the accessibility of refusing vaccinations. Media in recent years has

misled some of the population about the safety and effectiveness of vaccinations. This has led to

an increase in under-vaccinated and non-vaccinated children. We believe the best solution is to

require caregivers be educated prior to being able to refuse vaccinations for their child.

Information that would be included would be vaccination safety, the importance of community

immunity, and addressing the autism scare. While there are potential side effects, according to

the website Vaccines.gov (2014), vaccinations are the best defense against serious, preventable,

and contagious disease processes. There are minor side effects that can occur, such as

tenderness, soreness, or redness. Some of the serious side effects, such as permanent brain

damage from the DTaP vaccine, occur in less than one out of a million doses. While on the other

hand, tetanus, one of the diseases DTaP prevents against, causes painful muscle tightness,

lockjaw and death in one out of every ten patients (Vaccines.gov, 2014). Another safety concern

caregivers have is regarding the yearly influenza (or flu) vaccination. Since the flu vaccine is a

weakened or inactive strain, it cannot cause the flu, and the chances of a serious reaction are less

than one in a million. Contracting the flu, on the other hand, is very common. To a healthy

person, the flu is a short lived illness that causes discomfort for a few days to weeks, but to an

immunocompromised person, such as someone very young or elderly, the flu could be deadly.

This is why community immunity through vaccinations is important in preventing disease


outbreaks. If the majority of the general public is vaccinated against a certain disease process,

the risk of outbreak and spread of disease is low. This helps to protect those who are not eligible

for vaccination such as those immunocompromised individuals listed above (Vaccines.gov,

2014). Every person who is not vaccinated increases the risk of disease and epidemic.

According to the CDC, even though measles has been eradicated from the United States, it is still

very important to get the vaccination for personal protection, as well as community immunity.

Outbreaks of measles are continuing to increase as a result of people traveling abroad to regions

with highly under-vaccination populations (Gastanaduy et al., 2014). “For every 1,000 children

who get measles, one or two will die from it” (Thoma, 2014, para. 13). Lastly, the biggest

concern in recent years seems to be the scare that some vaccines cause autism. Many famous

people, such as Jenny McCarthy, host on The View, have spoken out against vaccinations

without proper knowledge about them and their effects. Due to the strength of their public voice,

many people were led to believe poorly conducted studies linking the MMR vaccination to

autism. A study from the Journal of Psychosocial Nursing & Mental Health Services (2010)

confirmed, “There is no scientific evidence supporting a causal relationship between childhood

vaccination and disorders such as autism” (p. 18). More recently, after continuous studies, the

CDC website also found there to be no connection with vaccines given during the first two years

of life to autism spectrum disorders. The CDC also indicated their commitment to ensuring the

safety of vaccines and that parents should expect that their child’s vaccines are effective and safe

("Vaccines not associated," 2013). By requiring caregivers to receive and learn this information

regarding the safety and importance of vaccinations, we believe parents will be more apt to

vaccinate their children, resulting in a decrease in the incidence of vaccine preventable diseases.


In order to require caregivers to receive the education regarding vaccines, we need to

push the state of Texas to enact stricter laws regarding the refusal of childhood vaccinations.

The new laws need to still allow for medical and religious refusal of vaccines, but add extra steps

to the process to help deter uncalled for lack of vaccinations in the state. The new law would

ideally require caregivers to consult with their physician or other medical professional to receive

education before being able to refuse vaccinations. This meeting between caregivers and health

care providers should consist of the debunking of vaccine related myths that were stated above

and explaining the information about vaccines and the diseases they prevent. The health care

professional should also explain whom vaccine refusals are geared towards and the population

that is affected when children do not receive vaccinations.

To begin the process of getting a law passed in the state of Texas we must first initiate the

writing of a bill. A bill is typically written by congress members, but can also be written by

lobbying groups. To get this bill written, there are two routes. First, we can plan to launch a

grassroots campaign to communicate to representatives directly, in the hope that they will

spearhead our campaign and write the bill themselves, or secondly, we can get in touch with a

lobbying group to persuade them to write the bill. In the first scenario, we will focus on

contacting local representatives, representatives on the Public Health Committee in the Texas

House of Representatives, and representatives on the Texas Senate Committee on Health and

Human Services (Dewhurst, Straus, & Irvine, n.d.). We plan to contact these officials using the

contact information provided on these two websites: www.house.state.tx.us (Texas House of

Representatives, n.d.), and www.senate.state.tx.us (The Texas state Senate, n.d.). In option two,

we will focus on contacting a lobby group or other organizations of power, like the Texas Nurses


Association, Texas Office for the Prevention of Developmental Disabilities, or the Texas Health

and Human Services Commission, to aid us in writing a bill.

After the bill is written it will be placed in Congress’s hands. A committee will review

the bill and vote to reject or accept the bill before it even hits the floor of Senate and House of

Representatives. We would use both a lobbying strategy and a grassroots campaign to help the

representatives understand the goals and benefits of the bill regarding the regulation of vaccine

refusals. After passing through the committees, the bill will go before a vote where it will have

to be passed in both houses and approved by the governor before it can become a law (Dewhurst,

Straus, Irvine, n.d.). We believe that educating parents and creating stricter laws regarding

vaccination refusals is the most effective way to provide a solution to the issue of the increased

incidence of vaccine preventable diseases as a result of under-vaccinated children.

Evaluation

The main purpose of evaluating this project is to measure the effectiveness of the

research study and our proposed solution. In order to do so, we must commit to doing the

following: 1) continue studying the percentage of children in Texas who have been vaccinated

according to the Center of Disease Control guidelines, 2) appraise coverage rates, 3) determine

the incidence of vaccine preventable diseases in Texas, 4) monitor the effectiveness of caregiver

education, 5) discuss with healthcare providers about the overall benefit of a bill that enforces

mandatory vaccinations for all children prior to attending public school, 6) monitor Texas

vaccine refusal rates, and 7) explain how current vaccinations have eradicated preventable

diseases in children. The predicted effect on the community will be an increase in health and

well-being as a result of an increase in vaccination coverage rates. As the final step of the

nursing process, the evaluation phase is important in reaching the ultimate goal of decreasing the


incidence of vaccine preventable diseases among children in the state of Texas, as well as the

entire population of the United States.

Conclusion

Vaccines are recognized as one of the top ten public health successes of the twentieth

century. Even with medical advances, school-aged children in Texas die every year from

vaccine preventable illnesses or suffer excruciating consequences from their complications. In

order to protect the community, Texas consistently strives to recognize barriers in the

immunization system and proactively implements changes to eliminate those obstacles, such as

misinformation and lack of knowledge. Unvaccinated individuals put themselves and their

population at risk. Registered nurses (RNs) can serve in many roles in the fight against

infectious diseases. Nurses can work within the public health system to heighten the overall

community well-being through education and service. RNs directly administer vaccinations to

clients, perform disease surveillance, and provide education. School nurses, guardians,

stakeholders, and policy makers have made childhood immunizations a priority in Texas. Also,

community collaboration is essential in order to prevent the spread of vaccine-preventable

diseases. The systematic approaches discussed throughout this paper, such as increasing

caregiver education, promoting timely injections, and partnering with various associations is

designed to eliminate deterrents to vaccinations and maximize available resources to the

immunization delivery system in Texas. Ultimately, the projected result would be a decrease in

the incidence of vaccine preventable diseases among children and Americans.


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http://www.cdc.gov/vaccinesafety/Concerns/Autism/antigens.html

Vaccines.gov. (2014). http://www.vaccines.gov/


RUBRIC

PHSSN

CPH14Communi

ty and Public

Health Nursing

Ms. Murphy & Mrs.

Coffman

Community Assessment Paper

*POD Paper

*Point of Directed Study

Performance Element

Level A 276-300 ptsAwesome!

Level B249-275 ptsRight On!

Level C225-248

ptsPass

Level D224 pts and below

Community Defined

50 points

- As introduction this section should include clear, concise description of why the health issue being addressed is of importance to the larger community. Include supporting data in DATA below.- Analysis of community includes identification of networks of interpersonal relationships, residence in a common locality, examples of

Evidence that most, but not all Level A criteria are addressed(EXAMPLE: community is defined but people, place, and function dimensions are not mentioned.EXAMPLE: Resources are all medically focused with no nurse-authored referencesEXAMPLE: group process is deficient but group does not seek facilitation assistance (from faculty)

Minimal evidence that Level A or B criteria are addressed.

- No evidence of community analysis or specification- Missing conceptual frameworks and development of definition of assigned community- Lacks evidence of group process skills- Inappropriate written presentation

http://www.teach-nology.com/


emotional solidarity. - Clear definition of community includes a conceptual framework of approach for nursing service. Dimensions of community in terms of people, place, and function are clearly delineated-Provide the defined geographic location of chosen population.-Inclusion of supporting resources (other than text) which focus on community-oriented nursing practice- Clear evidence of group process in completing project- Paper written in correct APA format

Community as Client

30 points

- Client is defined as the community of interest and as the target for specific nursing service- Healthy change for community is clearly delineated.

Major points are outlined with only minimal support sketchy overviews, or incomplete information

Stated but unclear or poorly defined community as client

No evidence of identification of community as client

Community Health

30 points

- Goal of community-oriented practice is defined in terms of community health

Dimensions of status, * structure, and

Dimensions are listed but not fully developed related to selected community/population

Major points are outlined but given only thin support.

No evidence of community’s overall health, or status, structural, or process dimensions


process are clearly delineated.

*Status includes physical, social, emotional condition, social parameters; morbidity and mortality, etc.

Partnerships

30 points

-Partnerships for collaboration in community-oriented practice are identified, defined, justified, & utilized.Examples of possible partners include: school nurses, public health officer, police, Lions Club president…

- Partnerships are listed but not discussed in relationship to a collaborative approach to addressing defined community health deficit.


No evidence of involvement between health care providers and community residents/leaders

Data30 points

- Data sources are clearly identified and indicated to be primary or secondary.- Relevant information about the community is collected, analyzed.- Themes are noted, and community health problems, strengths, and needs for action are identified.-Methodology: informant interview, participant observation, secondary analysis of data collected previously by

-Data sources are listed but their value or importance r/t issue not thoroughly explored.


No evidence of data gathering or assessment from any source


another entity is described (Entities might include national, state, local data bases.)

Community Nursing Diagnosis

50 points

- One nursing diagnosis is established and addressed consistently throughout project- Diagnosis includes verbiage of “risk of”, “among”, and “related to” -Includes geographic location

- Nursing diagnosis does meet requirements established for structure and verbiage.- Nursing diagnosis is not the one approved by POD MASTER.


No evidence of 3-part community nursing diagnosis

Planning20 points

- Reflects scope of problem analysis and prioritization, establishing goals and objectives, and identification of intervention activities

- Plan is stated but does not reflect clear response to nursing diagnosis.


No evidence of analysis, prioritization, goals and objectives or planned intervention activities

Implementation

20 points

All factors influencing implementation are addressed (nurse’s preferred mode of action, role, nature of problem, community readiness to discuss problem, and characteristics of the social change process)

-The ‘what’ of the plan is stated but the “how” is not delineated or does not flow from the stated nursing diagnosis-Implementation does not reflect roles of the C/PHN - Implementation does not clearly delineate a collaboration between disciplines to address the community health deficit

No evidence of influencing factors, defined role of the nurse, or implementation mechanisms

Evaluation20 points

Evidence of discussion of the appraisal of the effects of the actual or proposed

Evaluation plan is stated but does state specifics as to time, place, and achievement of

Minimal evidence that Level A or B

- No appraisal of the effects of any organized activity or program- No evidence that evaluation began in the planning phase of


References20 points

(Minimum of 10 references of which 5 must be articles from

peer-reviewed nursing journals)

Attach a copy of this rubric to your final

submission for grading and faculty

comments.

activity or program, which begins in the planning phase of community action _________________References indicate a broad exploration of the topic including multiple discipline approaches, examples of multidisciplinary responses and descriptions of details of collaborative approaches with nurses. Nursing references exceeded the minimum of 5 articles from peer-reviewed nursing journals. Interdisciplinary sources may be included in the 5 peer-reviewed articles provided the author is a NURSE.

expected outcomes.

______________References indicate an overview of the topic including few multiple discipline approaches, with minimal discussion of interdisciplinary responses. The minimum 5 peer-reviewed nursing articles noted.

criteria are addressed.

_________Minimal evidence that Level A or B criteria are addressed.

community action

___________________________References do not reflect scholarly exploration of the topic from nursing and/or multidisciplinary approach.

POD (Point of Directed Study) Community Assessment Paper Notes

Here is some additional information about your POD (point of Directed Study) Paper. Your paper should:

1. Be written in APA format, 12- point font, double-spaced, Times New Roman.2. Contain Approx. 10 pages but no more than 20 including references and appendices.

We stop reading at page 20!3. Place your data in tables and charts and put it in the appendix. It should be referenced

in the paper in a paragraph that explains the table or chart. 4. Use the tools provided in Chapter 18- Don’t skip over the boxes, charts, and graphs.

They WILL provide examples that will help you develop your paper. 5. Reflect your use of the rubric related to the use of key words, terms and phrases.6. Identify the problems that you find in your community and then select one problem

to address providing a complete assessment of the problem and describe in detail why you chose it.


7. Contain at least ten references are required. Five must be from peer reviewed nursing journals written within the last 5 years. The other five may be from you your textbook, other textbooks, or websites such as those referenced in your chapter presentations. No WebMD or Wikipedia please.

Documents

POD Paper Immunity fo rthe Community