Direct Care Project

Direct Care Project Part 1
Substance Use Assessment and Diagnosis Template

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: Kaleeagh Thomas Date: 05-15-22

Online Data Collection

1. Community Information

Your Community Data
Name of city or town and state San Diego, California
Population 1,386,932
Nature of this community (rural, suburban, urban) Urban
Describe your community in 2-3 sentences The population of Sen Diego city is multiethnic with a majority of the population belonging to White ethnicities. The city is often described as one of the best neighborhoods in the US to live in.

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 State Data U.S. Data
Population total 3,286,069 39,237,836 331,893,745
Male (subtract female % from 100) 50.3% 49.7% 49.2%
Female 79.7% 50.3% 50.8%
Persons under 5 6.1% 6.0% 6.0%
Persons over 65 14.5% 14.8% 16.5%
Race and origin data
County Data State Data U.S. Data
White alone 75.4% 71.9% 76.3%
Black or African American alone 5.5% 6.5% 13.4%
American Indian and Alaska Native alone 1.3% 1.6% 1.3%
Asian alone 12.6% 15.5% 5.9%
Native Hawaiian and other Pacific Islander alone 0.6% 0.5% 0.2%
Two or more races 4.6% 4.0% 2.8%
Hispanic or Latino 34.1% 39.4% 18.5%
White alone, not Hispanic or Latino 45.0% 36.5% 60.1%
Significant population characteristics
County Data State Data U.S. Data
Veterans 210,611 1,525,746 17,835,456
Foreign born persons 22.9% 26.6% 13.5%
Housing overview
County Data State Data U.S. Data
Housing units 1,233,777 14,366,336 139,684,24
Owner-occupied housing unit rate 53.9% 55.3% 64.4%
Median selected monthly owner costs with a mortgage $2,653 $2,422 $1,621
Median selected monthly owner costs without a mortgage $642 $618 $509
Median value of owner-occupied housing units $595,600 $538,500 $229,800
Median gross rent $1,732 $1,586 $1,096
Family and living arrangements
County Data State Data U.S. Data
Households 1,130,703 13,103,114 122,354,219
Persons per household 2.86 2.94 2.60
Living in same house 1 year ago 85.0% 87.6% 86.2%
Language other than English spoken at home 37.0% 43.9% 21.5%
Computer and Internet Use
County Data State Data U.S. Data
Households with a computer 95.9% 94.3% 91.9%
Households with broadband internet subscription 91.8% 88.9% 85.2%
Education
County Data State Data U.S. Data
High school graduate or higher 88.0% 83.9% 88.5%
Bachelor’s degree or higher 39.5% 34.7% 32.9%
Health
County Data State Data U.S. Data
With a disability under age 65 years 6.2% 6.8% 8.7%
Persons without health insurance under age 65 years 8.9% 8.9% 10.2%
Economy
County Data State Data U.S. Data
Civilian labor workforce ages 16+ 63.1% 63.3% 63.0%
Transportation-mean travel time to work (minutes) 26.5 29.8 26.9
Income and poverty
County Data State Data U.S. Data
Median household income $82,426 $78,672 $64,994
Persons in poverty 9.5% 11.5% 11.4%

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 Outcomes Percentile N/A
Health Factors Percentile N/A
Premature death 4,900 5,700
Low birth weight 7% 7%
Adult smoking 11% 10%
Adult obesity 24% 26%
Physical inactivity 22% 22%
Excessive drinking 20% 19%
Alcohol impaired deaths 27% 28%
STIs 686.6 599.1
Teen births 14 16
Drug overdose deaths 17 17
Uninsured 9% 9%
Unemployment 9.2% 10.1%
Children in poverty 11% 15%
Violent crime 382 421
Air pollution 12.9 12.9
Drinker water violations Yes
Long commutes 38% 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 19.8% 21.1% 26.8%
Marijuana 19.4% 19.1% 16.2%
Marijuana use disorder 2.1% 2.0% 1.6%
Heroin use 0.18% 0.22% 0.30%
Misuse of prescription pain reliever 3.8% 3.9% 3.7%
Opioid use disorder 0.6% 0.6% 0.7%
Illicit drug use disorder 3.4% 3.4% 2.9%
Alcohol use disorder 6.0% 5.9% 5.3%
Substance use disorder 8.3% 8.1% 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 Some
• *pregnant adolescents No
• *infants (under the age of 1 year old) Yes Few
• *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 Few
• people exercising No
• people driving Yes Many
• people walking Yes Some
• people biking Yes Few
• people congregating in groups on the street No
• *people that had hygiene issues or were unkempt No
• people that were appropriately dressed Yes Many
• people that were physically fit Yes Many
• people that were obese Yes Some
• *people that were undernourished, thin No
• people that appear healthy Yes Some
• *people that have obvious physical disabilities, such as those using walkers or wheelchairs Yes Few
• *people with apparent mental/emotional disabilities No
• *people who appeared homeless or unemployed No
*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 No
• areas undergoing renewal No
• public housing No
• public transit (subway, train, buses, taxis, etc) Yes Some
• transportation to health care resources Yes Few
• landfills No
• restaurants Yes Many
• any political signs Yes Few
• any evidence of health education on billboards, advertisements, or signs Yes Few
• any efforts to improve the neighborhood’s health such as advertisements for health-related events, health fares, clinics, or lectures No
• any group efforts in the neighborhood to improve the living conditions or the neighborhood No
• churches, synagogues, and other places of worship Yes Some

Health Resources

Did you observe: No Yes If Yes, provide number or state “many” “some” or “few”
• hospitals Yes Some
• community clinics No
• family planning clinics No
• generalist doctors No
• dentist offices Yes Few
• pharmacies Yes Some
• urgent care clinics Yes One
• skilled nursing facilities No
• mental health or counselling clinics No
• homeless or abuse shelters No
• public health department office Yes One
• substance abuse treatment center Yes One
• 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?
Answer: Approximately 5 miles.

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 No
• 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 Two
• streets and parking lots well lit Yes Some
• 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 Few
• evidence of nuisances such as ants, flies, mosquitoes, or rodents, or stray animals observed Yes Some

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

Problem Identification: _________Marijuana use________

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

Vulnerable Population Identification: _______Adolescents and Young adults__________

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 _marijuana use_ (problem from above) among adolescents and young adults (vulnerable population from above) related to lack of awareness related to the potential long term impacts and support services (etiological statement) as demonstrated in increased prevalence in San Diego county as compared to the national prevalence__ (health indicators/community data from above)

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/