Community Health Assessment Tool

You will develop a proposed public health nursing intervention to meet an identified need and/ or gap in your own community.  This must be within the scope of the staff level public health/ community health nurse.  (Note: you cannot propose building facilities or purchasing a mobile health van).  The intervention should demonstrate your application of previous learning in the program related to process improvement and evidence based nursing practice.  Quality peer reviewed references are required to support the need as well as the structure, elements, and evaluation of the intervention.Focus on your own local community.  You will use resources found in CANVAS, FSW library, and the web to develop this project.  Note that census and other epidemiological data is not available down to zip codes or census tracts in Florida- only by county and/ or city & state. Community Data Collection Survey – THIS IS THE FIRST STEP IN TO COMPLETE YOUR FINAL PAPER.  Community Data Collection Survey Collect relevant data about your community covering the required areas in the survey tool. References are required to support the data.  The final part of the Survey is your summary of the identified gap/ need that will be the focus of a targeted public health nursing intervention in your Community Assessment Project.   The Data Assessment Form is in Course Resources in Modules.  The form is a tool to assist you collect your data and information.   This is a scholarly paper with appropriate use of tables (see APA Manual for how to format and label tables).  Utilize the resources and web sites located in Course Resources in Canvas.  In addition, Community Health Assessments are usually published by your county and/ city with relevant information.  The data is usually based on county and/ city information.  You can also look at Robert Wood Johnson Foundation information on public health issues that may be applicable to your area.  Many resources are provided in Course Resources as a starting point for your data collection.  DO NOT Submit the tool… this is a paper.NUR 4636C Community Health Nursing Assessment Tool v2-1.docx PAPER CONTENT:

  • Community Being Assessed
  • Vital Statistics
    • Births
    • Deaths
    • Causes of mortality and morbidity
    • Leading infectious diseases
    • Number of healthy days
  • 3. Social Determinants of Health
    • Access to health care
    • Housing
    • Employment
    • Environment -Water and Air quality, pollution
    • Safety- police, fire
    • Education systems
    • Recreation
    • Government role in health access/ provision
  • Issue/ need identified.

includes at least 5 references from current peer-reviewed nursing journals and /or textbook or reliable education, government or organizational website.

This is for the Lee county area.

Community Health Nursing Practice

Community Data Collection Tool

Your Data Assessment Paper will cover Parts 1-7. This will provide the data and framework for the Community Assessment paper due later in the course. The data from the first paper will be synthesized for the final paper to support your initiative/ program you are proposing. The sources of evidence notes after each area will assist in developing your references for both papers. This Tool is for collection of information and should NOT be submitted for the paper.

Suggestions for Table Use:

1. Read all horizontal and vertical columns. These will give clues about the key questions to ask.

2. Fill in the vertical column for each table that requests information on the Seven A’s. When filling in these boxes, place the most pertinent information that you think informs the assessment.

3. In some instances, you need to consider collecting data on multiple years to identify trends. You can duplicate these tables and use them to collect the data on different years using census data.

4. Remember that this is a working document that you can adjust and revise to meet

the needs of the community you are assessing. The collection of data is more than filling in the boxes.

5. You may need to collect additional data in a particular area, depending on what you learn as you go. For example, you may fill in the boxes about the number of schools in a community, but you may also want to know the number of students per faculty member, if a community collaborator cited that as a concern.

6. In some instances, there will be overlap of data collection. In the analysis section, these data will provide a variety of perspectives.


Part 1: Population Data


Population: Vital Statistics

  Community County   State  
  # % # % # %
Live Births            
General Deaths            

Source of Evidence:


Population Mortality: 5 leading causes of death

Cause Community County State

Source of Evidence:



Population Morbidity: Top 5 causes of morbidity

Cause Community County State

Source of Evidence:


Population Life Expectancy:

Cause Community County State


Population: Healthy Life Expectancy

  Community County State

Source of Evidence:


Population: Physically and Mentally Unhealthy Days

  Community County State

Source of Evidence:


Population: Race Distribution

  Community County State
Black/African American      
Native American      


Population Gender Distribution:

  Community County State
Not specified      


Determinants of Health

Part 2: Social Determinants

The following Seven A’s questions can assist the public /community health nurse in analyzing his or her findings:

• Is the population aware of its needs and the services in the community?

• Can the population gain access to the services that it needs?

• Is the service available and convenient to the population in terms of time, location, and place for use?

• How affordable is the service for the population in question?

• Is the service acceptable to the population in terms of choice, satisfaction, and cultural congruence?

• How appropriate is the service for the specific population or is there a fit?

• Is there adequacy of service in terms of quantity or degree?


Housing Conditions

Characterisitics Total units # Owner Occupied Renter Occupied Vacant Housing subsidies/ Homeless Provisions

Source of Evidence:



Describe what resources for transportation are available in your community/ city/ county of assessment. Considering the Seven As, are they adequate or inadequate? Include public and private modes including volunteer services, road conditions, sidewalks, and those for special needs/ aging/ other issues.

Source of Evidence:



Workplace: Who are the top employers in your community of assessment?

Employer Number of employees Do they have workplace health initiatives in place?

Source of Evidence:


Recreational facilities:

Describe recreational facilities such as parks, playgrounds, swimming areas, amusement parks, athletic fields. Are they adequate to provide the services to the community?


Source of Evidence:


Educational Facilities:

Type Public Private
Middle/ Junior High    
Senior High    
College/ Universities    

Source of Evidence:


Educational Levels Over 25 yrs. age:

  Community County State
Ninth grade or lower      
High School Graduate      
Some College      
College Graduate (Assoc / Bacc)      
Median # yrs. schooling completed      

Source of Evidence:


Places of Worship:

Describe the variety of places of worship in your community of assessment. Include any pertinent information related to services provided by the worship place to the community.


Source of Evidence:


Social Services:

  Services provided Adequate/ Inadequate
Food banks    
Homeless Shelters    
Adult Day care    
Child Care services    
Social Service Agencies ( list)    

Source of Evidence:


Other Social Determinants:

  Services provided Adequate/ Inadequate
Law Enforcement    
Fire Services    
Special Services (SWAT, Emergency response teams, bomb squads)    
Neighborhood watches    
Radio Stations    
TV Stations    
Internet Providers    

Source of Evidence:


Family Income:

  Community County State
Over $100000      
  100% 100% 100%

Source of Evidence:


Part 3: Physical Determinants of Health

Complete a windshield survey. See directions in CANVAS.

· The windshield survey reflects what the public health nurse can view from a car window while driving through a community and contains observations of various components in the community such as housing, open spaces, transportation, race, ethnicity, restaurants, and stores.

· The built environment describes the man-made structures in the community including the kinds of stores, buildings, and sidewalks that facilitate healthy behaviors (or not). Describe your observations about this built environment and how it may be a determinant of health.

· Include data on factors such as topography, climate, terrain, topographical features, geographical boundaries and man-made boundaries other factors in the community.


Physical Determinants: Environmental/Sanitation/Toxic Substances

  Description – city/ county or state level Adequate/ Inadequate
Water supply    
Sewage supply    
Solid waste disposal    
Air contaminants    
Vector control (Deer, ticks, mosquitoes, rabid animals, rodents, and other animals    

Source of Evidence:

Part 4: Health Services

The health services are more than a listing of the physical, social, and mental health programs offered to an individual/family or a population in a particular community. It also includes an assessment of access to these services and uses the Seven A’s. The Seven A’s address more than the single concept of access. Whether or not there is access frequently depends on additional concepts of awareness, availability, affordability, acceptability, appropriateness, and adequacy of the service. Each of these is essential to assess and analyze for whether individuals or populations can access essential services that can influence their health and well-being.

In your assessment you are looking for a gap that the STAFF level community/ public health nurse could address through an initiative/ program within that scope of practice. Building a new facility/ hospital or providing a mobile health van is beyond that scope of practice. Refer to the Henry Street Competencies found in CANVAS resources.


Acute Care:

List the agencies for acute care, services provided and assess for adequacy based on 7As and above information.


Home Care:

List the agencies for home care, services provided and assess for adequacy based on 7As and above information.


Complete as above for

· Primary care

· Mental Health Care

· Long term care

· Rehabilitation services

· Assistive living

· Occupational Health

· Dental Care

· Palliative Care

Sources of evidence:


Part 5: Policy Making

The community /public health nurse needs to assess the policies that influence the health of the

community, system, and population under study. Examples include policies on seat belt use, helmet use, phone use and texting while driving, and child car seats. Each of these policies has had a positive influence on the health and wellbeing of individuals and the population at large, resulting in a decrease in disabilities and injuries.

The community /public health nurse needs knowledge about how his or her community functions with regard to the political infrastructure and assess this infrastructure to be familiar with how it works: who are the formal and informal political leaders? How can they be reached? What initiatives have they supported in the past? What are the laws that affect the population and community with regard to the public’s health? Are these laws upheld? Are there issues that have not been addressed, and, if so, what can be done to address these issues?

The data collected in this section include the organizational structure of the community, a description of the political issues in the community, and an identification of some of the public health laws that affect the community and its members’ health. As the community /public health nurse conducts this portion of the assessment, it is important to explore what the local newspapers report, to meet with the local government, and to check out the school boards or any of the governing bodies in that area. Meet the candidates if it is an election year and listen to what the community is saying. Check websites, social networking sites, and local blogs. Using the Internet, here and throughout the assessment process, assists the community /public health nurse in obtaining the necessary data and learning about your community.

Assess the structure of the governing bodies in your community. What are the top 3 political issues in your community at this time? What actions have been taken? Are there specific policies/ laws/ regulations regarding the issues?

Are there specific policies related to health issues- i.e. seat belt laws, motorcycle/ bicycle regulations, texting / phones in car usage/ tobacco/ smoking regulations?

Sources of evidence:


Part 6: Health Disparities

According to Healthy People 2020 a health outcome is seen in a greater or lesser extent between populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health. Frequently, community/ public health nurses see disparities as he or she observes within the community and analyzes the data gathered. This foundational health measure much of the information

needed is gathered throughout the previous parts of the Community of Assessment. Summarize your finding in a narrative form.


Part 7: Prioritizing Health Issues (in order of Priority)

In determining the priority health issues, the community/ public health nurse, using a population based focus, collaborates with other public health practitioners, key informants in the community, and any organization or agency that may have a voice with regard to the population and public health issue. In population-based care, partnerships form the necessary bonds that make sustainable change for health in particular targeted populations. Those involved in the partnership work together to form a common

understanding of the issue. All involved, including the population of interest residing in the community, agree on the priority issue identified. This is essential for a positive outcome. Once the priority is noted, then the partnership will confer with the Healthy People 2020 topic areas and corresponding objectives (U.S. DHHS, 2010).

Top 5 Priorities:

ISSUE Targeted Population Short term Goal(s) Long term Goal(s)


Decide on your priority issue that you will propose an initiative/ program for at the level of the STAFF nurse in your community. Describe briefly (will be expanded upon in your final assessment paper).

You can use the information in Table 35-1 in Lundy & Janes, 2016) to frame your identified gap and the basic information that will be expanded in the final assessment paper.

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