Manue, ella
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: Date:
Online Data Collection
1. Community Information
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Your Community Data |
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Name of city or town and state |
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Population |
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Nature of this community (rural, suburban, urban) |
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Describe your community in 2-3 sentences |
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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
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County Data |
State Data |
U.S. Data |
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Population total |
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Male (subtract female % from 100) |
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Female |
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Persons under 5 |
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Persons over 65 |
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Race and origin data |
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County Data |
State Data |
U.S. Data |
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White alone |
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Black or African American alone |
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American Indian and Alaska Native alone |
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Asian alone |
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Native Hawaiian and other Pacific Islander alone |
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Two or more races |
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Hispanic or Latino |
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White alone, not Hispanic or Latino |
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Significant population characteristics |
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County Data |
State Data |
U.S. Data |
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Veterans |
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Foreign born persons |
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Housing overview |
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County Data |
State Data |
U.S. Data |
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Housing units |
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Owner-occupied housing unit rate |
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Median selected monthly owner costs with a mortgage |
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Median selected monthly owner costs without a mortgage |
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Median value of owner-occupied housing units |
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Median gross rent |
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Family and living arrangements |
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County Data |
State Data |
U.S. Data |
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Households |
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Persons per household |
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Living in same house 1 year ago |
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Language other than English spoken at home |
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Computer and Internet Use |
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County Data |
State Data |
U.S. Data |
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Households with a computer |
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Households with broadband internet subscription |
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Education |
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County Data |
State Data |
U.S. Data |
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High school graduate or higher |
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Bachelor’s degree or higher |
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Health |
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County Data |
State Data |
U.S. Data |
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With a disability under age 65 years |
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Persons without health insurance under age 65 years |
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Economy |
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County Data |
State Data |
U.S. Data |
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Civilian labor workforce ages 16+ |
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Transportation-mean travel time to work (minutes) |
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Income and poverty |
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County Data |
State Data |
U.S. Data |
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Median household income |
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Persons in poverty |
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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**
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County Data |
State Data |
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Health Outcomes Percentile |
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N/A |
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Health Factors Percentile |
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N/A |
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Premature death |
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Low birth weight |
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Adult smoking |
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Adult obesity |
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Physical inactivity |
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Excessive drinking |
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Alcohol impaired deaths |
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STIs |
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Teen births |
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Drug overdose deaths |
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Uninsured |
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Unemployment |
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Children in poverty |
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Violent crime |
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Air pollution |
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Drinker water violations |
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Long commutes |
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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:
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State Average |
Regional Average |
National Average |
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Tobacco use |
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Marijuana |
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Marijuana use disorder |
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Heroin use |
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Misuse of prescription pain reliever |
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Opioid use disorder |
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Illicit drug use disorder |
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Alcohol use disorder |
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Substance use disorder |
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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.
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Look at the people in your community.
Did you observe: |
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Yes |
If Yes, provide number or state “many” “some” or “few” |
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· *pregnant women |
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· *pregnant adolescents |
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· *infants (under the age of 1 year old) |
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· *young children (1-5 years old) |
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· *school-age children (6-18 years old) |
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· adults (18 – 60 years old) |
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· *older adults (over the age of 60 years old) |
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· people exercising |
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· people driving |
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· people walking |
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· people biking |
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· people congregating in groups on the street |
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· *people that had hygiene issues or were unkempt |
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· people that were appropriately dressed |
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· people that were physically fit |
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· people that were obese |
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· *people that were undernourished, thin |
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· people that appear healthy |
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· *people that have obvious physical disabilities, such as those using walkers or wheelchairs |
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· *people with apparent mental/emotional disabilities |
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· *people who appeared homeless or unemployed |
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*Represents vulnerable populations
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Social and Economic Conditions
Did you observe: |
No |
Yes |
If Yes, provide number or state “many” “some” or “few” |
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· housing that was run down or dilapidated |
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· areas undergoing renewal |
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· public housing |
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· public transit (subway, train, buses, taxis, etc) |
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· transportation to health care resources |
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· landfills |
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· restaurants |
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· any political signs |
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· any evidence of health education on billboards, advertisements, or signs |
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· any efforts to improve the neighborhood’s health such as advertisements for health-related events, health fares, clinics, or lectures |
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· any group efforts in the neighborhood to improve the living conditions or the neighborhood |
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· churches, synagogues, and other places of worship |
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Health Resources
Did you observe: |
No |
Yes |
If Yes, provide number or state “many” “some” or “few” |
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· hospitals |
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· community clinics |
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· family planning clinics |
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· generalist doctors |
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· dentist offices |
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· pharmacies |
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· urgent care clinics |
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· skilled nursing facilities |
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· mental health or counselling clinics |
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· homeless or abuse shelters |
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· public health department office |
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· substance abuse treatment center |
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· alternative medicine practices, botanicals, or herbal medicine shops |
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Answer the following question: |
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If some of the above health resources were not observed, approximately how far away would a person need to travel to find these resources?
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Environmental Conditions
Did you observe: |
No |
Yes |
If Yes, provide number or state “many” “some” or “few” |
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· evidence of anything that might make you suspicious of ground, water, or air pollutants |
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· poor road conditions with potholes, or poor drainage |
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· adequate traffic lights, signs, sidewalks, and curbs |
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· railroad crossings fitted with warnings and barriers |
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· streets and parking lots well lit |
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· handicapped access to buildings, sidewalks, and streets |
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· recreational facilities, playgrounds, and/or facilities like the YMCA |
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· children playing in the streets, alleys, yards, or parks |
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· evidence of nuisances such as ants, flies, mosquitoes, or rodents, or stray animals observed |
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Problem
Identify a nursing problem based on your data and observations. The problem must be related to substance use. Example: Alcohol use
Problem Identification: _________________
Vulnerable Population
Identify the vulnerable population that is most impacted by this problem. Example: Adolescents
Vulnerable Population Identification: _________________
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____________(problem from above) among ____________ (vulnerable population from above) related to ___________(etiological statement) as demonstrated in _______(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/