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An Academic Nursing, Clinical, and Community Partnership to
Identify and Meet Rural Community Needs
Sheila Q. Hartung, PhD, RNBloomsburg University
Bloomsburg, PA
Presenter Disclosures
(1) The following personal financial relationships with commercial interests relevant to this presentation
existed during the past 12 months:
Sheila Q. Hartung
No relationships to disclose
IntroductionResearch and collaboration focus of key players
Geisinger Center for Health Research, Dr. Sharon LarsonSullivan County SHIP, Joan GruverBloomsburg University, Department of Nursing, Dr. Sheila Hartung
Approval and supportIntent – Identify perceived health status and barriers to accessThe project and research
Community Needs Assessment (including Focus Groups and Community Survey) – GMC, Center for Health Research
Community Assessment and Insight Interviews – BU, Community Health/Public Health Nursing course
Community Interventions – GMC, BU, and SHIP3
Collaboration of GMC Center for Health Research and Sullivan County SHIP
Summer 2009Responsibilities - Focus groups and community surveyFocus group meetings performed with
Sullivan County SHIP partners community health and human service agency
representatives educational institutional representatives mental health consumer support group members regional EMS council members County Commissioners’ office hospital representatives
4
Intent of Focus Group Discussions
Characteristics of a good community
Areas of community need Preventative health care
programs available Noted health problemsAccess to health and
human services
Employment and resources both within and surrounding the county
Access to and availability of transportation services
Demographic profile of county residents
Intended resident survey questions
5
Bloomsburg UniversityDepartment of Nursing
Community/Public Health Nursing courseResponsibilities – General Community
Assessment and Insight InterviewsCourse overview
Classroom and clinical componentsPublic health approach
Health promotionDisease preventionEpidemiology
6
Community Assessment Framework
Systems approachObjective data
Morbidity and mortality dataSecondary data (i.e., School Health Index)
Subjective dataObservation (i.e., windshield surveys)Key informant interviews and Insight InterviewsAttendance at community meetings
7
Students as leaders and collaboratorsGroup process, theory, techniques, rolesLeadership principlesFollowership principles
Collaboration with faculty, community groups, key informants in the community
8
Analysis of DataInferencesProblem identificationCommunity nursing diagnosisHealthy People Objectives
9
InterventionHealth Promotion Project
implementationEvaluation
ContentProcess
Community/Public Health Nursing courseFall 2009 & Spring 2010
Course focus in Fall semester BU IRB approval, contacts and collaboration with Sullivan County
SHIP, recruitment of Insight Interview participants, Insight Interview data collection, collection of abbreviated CA parameters (Physical Environment, Demographics, Vital Statistics, Behavioral Risk Indicators, Economics)
Course focus in Spring semester Insight Interview analysis, dissemination of Insight Interview
results to collaborating partners, collection of abbreviated CA parameters (Physical Environment, Demographics, Vital Statistics, Behavioral Risk Indicators, Health and Social Services, Education, Politics and Government)
10
Community Assessment Highlights of County
Windshield Surveys
Spring semesterDushoreLaporteLopezBernice/SatterfieldMildredEstellaColley
Fall semesterDushoreLaporteLincoln Falls, Shunk,
WheelervilleHillsgroveEagles Mere, Muncy
Valley, Beech GlenMillviewForksville
12
Community Assessment Parameters
Physical EnvironmentDemographicsVital StatisticsBehavioral Health
IndicatorsEconomics
Health and Social ServicesPolitics and GovernmentEducation
13
Leading Cause of Death per County Annual Average Rate per 1000 Residents 2003-2008
14
Heart Disease Death Rates Per 100,000 (2007) (Age Adjusted)
258.2
214.9200.9
212.7
166
0
50
100
150
200
250
300
Death Rates for Heart Disease
Sullivan County
Pennsylvania
Bradford County
Forest County
Healthy People 2010
(Pennsylvania Department of Health, 2007, a2)
15
211.7
156.6
197.6205.5 198.7
194181188.4
189.5219.4
177.6 172.3159.9
0
50
100
150
200
250
1999-2001 2002-2004 2005-2007
Sullivan Co
PA
Bradford Co
Forest Co
HP 2010
Mortality: All CancersMortality Rate from cancer among All Ages across 3
different 3 year time spans per 100,000.
(Pennsylvania Department of Health, 2008, e4, f4)
16
Percentage of Healthy Weight Adults 2003-2005(BMI of 18.5-24.9)
(Pennsylvania Department of Health, 2005, b1)17
18
Adults Who Admit to Currently Smoking:2005-2007 Results by Age Group
PA DOH, Epidemiologic Query and Mapping System. http://www.portal.state.pa.us/portal/server.pt?open=514&objID=596553&mode=2 (2005-2007)
Percentage of Suicide 2000-2007
(Pennsylvania Department of Health, g7)19
20
Educational Attainment: Population 18-24 years (US Census 2000)
Median Household Income 2007
0
10000
20000
30000
40000
50000
60000
48,562
36,241
PennsylvaniaSullivan CountyD
olla
rs
21
Insight Interviews
22
Data Collection – Fall 2009IRB approval for Insight InterviewConnection and presentation at SHIP meetingsRecruitment process
Health and human service partners approached residentsGave summary/intent of researchIf participant agreed, gave participant contact name and
number to study investigator
23
Data Collection – Fall 2009Study investigator gave contact name and number to BU
student pair to contact for interviewStructured and semi-structured interviews of 9 residents
performed by BU senior student pairs in the resident’s home or other convenient locationInterview guide and scriptRoles of interview pairField notesIdentifying informationSubmitted detailed field notes and beginning analysis
conclusions to study investigator 24
25
Analysis – Spring 2010Small group of 6 students within the course volunteeredOrientation meeting of small groupSmall group coded and analyzed one interview together
manually Coded remaining 8 Insight Interviews using QDA software
(ATLAS.ti)Themes and commonalities from data collected
Community, Family, Health, WorkDeveloped subcategories for each themeGave examples for each category
Conceptual model to illustrate life in Sullivan County
Bloom in
Sullivan County
26
Health Promotion Projects
27
Health Promotion ProjectsFall 2009
All collaborative partnersHealth Fair (Oct.)All populationsImmunizations, health
screenings, diet/nutrition, resources, chronic disease, exercise/activity
Location/venue: elementary school
BU, DONHealth Fair “Flurries of
Health” (Dec.)Adult to older adult
populationHeart disease, diabetes
and obesity, cancer, mental health and wellness, risky behaviors
Location/venue: church hall in conjunction with holiday craft fair
28
Health Promotion ProjectsSpring 2010
BU, DONRotating stations “Hunt for
Health” (April)Adolescent populationEnvironmental health,
mental health and wellness, safe sexual practices, drug and alcohol use and abuse, healthy lifestyles
Sullivan County Junior/Senior High School, Laporte
29
Lessons LearnedUndergraduate students can be active participants in
collaborative research or projects with specific delineated roles.
As an essential component of baccalaureate education, students are able to gain needed practical application of the core functions of public health, health promotion and disease prevention, leadership and management principles, and effective group process with large and small groups.
Illustrates for students the concepts basic to nursing practice: community and partnership for health.
Further solidifies the contribution and benefit to the community and its residents through a connection with both the academic institution and a major health system.
30
Lessons Learned (cont’d)Continued contact in the rural area beyond the research
timeframe is challenging due to the rural location and distance from educational and clinical institution
Planned and sustained contact for ongoing assessment and health promotion is needed during the planning phases of the partnership
31
RecommendationsContinue collaboration within the communityLook for “do-able” research and project componentsGreater student preparation for qualitative data analysis
and codingAccessible QDA software package and common files on-
campus for faculty and students during projectIncrease time allotted to analyze as a small groupAllow time to incorporate findings and analysis of
interviews into survey dataDisseminate analysis to collaborating partners more
quickly
32
33
Thank You!
Questions??