NSG 323 Unit 5 community assessment example

Uncontrolled Hypertension Among Adults Aged 45-64 in a Composite Rural County: A Population Assessment

Student Name

Department of Nursing, Herzing University

NSG 323: Community and Public Health Nursing

Unit 5 Assignment

Instructor Name

Month Day, Year

The Population, the Boundary, and What the Drive Shows

I work as a registered nurse in an outpatient clinic serving a mixed rural and small city population, and the county described here is a composite. Its name, its borders, its clinics, and every figure below are assembled from ordinary community practice so that no employer, no site, no colleague, and no patient can be identified from this paper. The composite is called Fairmont County: 214,000 residents by the most recent annual estimate, spread across one small city of about 61,000 and eleven townships. Adults aged 45 to 64 number 52,300 of those 214,000 residents, or 24 of every 100 people in the county, and that age group is the population this paper assesses.

A windshield survey at midday shows what the figures later confirm. Three full service grocery stores serve the whole county, two of them inside the city limits, and housing in the eastern townships sits 14 to 22 miles from the nearest one. Eleven fast food outlets line the two mile commercial strip on the north side. One fixed bus route runs every 45 minutes and stops at 6:30 in the evening, which matters because four of the county's five primary care sites close their clinic hours at 5:00. Nine pharmacies operate countywide and seven of them are in the city. Sidewalks run continuously downtown and are absent along the county roads where most township housing stands.

The county is not short of assets, and an assessment that lists only deficits misreads it. Two congregations run blood pressure checks after services on the first Sunday of every month, the senior center opens a walking group at 8:00 on alternate mornings, and the extension office already reaches farm households the clinic never sees. The assessment that follows treats health outcomes as the product of health behaviors, clinical care, social and economic conditions, and the physical environment, weighted as the county rankings model weights them (University of Wisconsin Population Health Institute, 2024). That model is the reason the drive comes before the data rather than after it.

Rates, Each With Its Denominator and Its Window

Four figures describe the problem, and each is reported with what it was divided by and the period it covers. In the composite clinic records for the 12 months ending in June, 3,560 of 8,900 adults aged 45 to 64 seen at least once carried a diagnosis of hypertension, which is 40 per 100 adults seen in that period. Of those 3,560 diagnosed adults, the most recent recorded blood pressure was at or below 140/90 for 1,780, which is 50 per 100 diagnosed adults across the same 12 months. The denominators differ, and confusing them is the commonest error in a community paper: the first is adults seen, the second is adults already diagnosed.

The other two figures come from countywide counts rather than clinic records. Emergency department visits carrying a primary diagnosis of hypertensive urgency numbered 880 across the same 12 months, which is 411 visits per 100,000 residents in one year on a base of 214,000. Stroke deaths numbered 96 in that year, a crude rate of 44.9 deaths per 100,000 residents. That last comparison is weaker than it looks. The national figure usually quoted beside it is age adjusted, and this composite county is older than the country as a whole, so a crude local rate sitting above a national age adjusted rate raises a question rather than settling one (Centers for Disease Control and Prevention, 2024b).

Set against national data, the control figure is the finding that carries. About 48 of every 100 adults in the United States have hypertension, and only about 22 of every 100 adults with hypertension have it controlled, measured in national survey data collected across 2017 to 2018 (Centers for Disease Control and Prevention, 2024a). The county's 50 per 100 looks better than that until the measurement is compared: the national figure counts adults whose hypertension has never been diagnosed, while the local one counts only adults already in the clinic records. The honest reading is that 1,780 adults in this county held a diagnosis and an uncontrolled pressure in a single 12 month period, and the county has no count at all for those never seen.

Two conditions sit underneath the control figure. Distance is the first, since township residents travel 14 to 22 miles to a grocery store and a similar distance to a clinic, on the one bus route that stops before evening clinic hours would help them. Interval is the second. Screening standards call for confirmation of a raised reading outside the office before treatment starts, and for regular rechecking afterward, which turns into a transport problem rather than a clinical one in a county shaped like this one (U.S. Preventive Services Task Force, 2021). Blood pressure control also remains among the national heart disease and stroke objectives, which fixes the direction of travel here (Office of Disease Prevention and Health Promotion, n.d.).

From These Findings to a Population Level Nursing Diagnosis

A population level nursing diagnosis names the population, the state to be changed, the conditions producing it, and the data showing it (Anderson & McFarlane, 2019). Stated in that form, the diagnosis for this composite county reads: risk for ineffective self management of hypertension among adults aged 45 to 64 in Fairmont County, related to distance from primary care and pharmacy services, transport that ends before evening clinic hours, and long intervals between blood pressure rechecks, as evidenced by 1,780 of 3,560 diagnosed adults recorded at or below 140/90 across 12 months, 411 emergency department visits per 100,000 residents for hypertensive urgency in the same year, and a crude stroke mortality of 44.9 deaths per 100,000 residents.

Two other diagnoses were considered and set aside for stated reasons. Deficient community health knowledge was rejected because nothing collected here measures knowledge, and the blood pressure checks at two congregations plus the reach of the extension office argue that information already moves through this county. Ineffective community coping was rejected as too broad to be measured by anything this assessment gathered. A diagnosis a community cannot measure is a sentence, not a plan. The retained diagnosis was kept because each of its three evidence clauses already carries a counting rule and a denominator, so the same figures can be counted again in a year and the diagnosis can be shown to be wrong.

That commits this assessment to one measurable outcome rather than a list of intentions: within 12 months, the proportion of diagnosed adults aged 45 to 64 recorded at or below 140/90 rises from 50 per 100 to 60 per 100, counted on the same records with the same denominator. What the assessment cannot do is assign a cause, since it is descriptive and drawn from a composite. What it does is state where a public health nurse would look next, which is the eastern townships, the hours after 5:00, and the interval between recheck visits. A real county would need its own counts before one sentence of this applied to it.

References

Anderson, E. T., & McFarlane, J. (2019). Community as partner: Theory and practice in nursing (8th ed.). Wolters Kluwer.

Centers for Disease Control and Prevention. (2024a). High blood pressure facts. U.S. Department of Health and Human Services. https://www.cdc.gov/high-blood-pressure/data-research/facts-stats/

Centers for Disease Control and Prevention. (2024b). Underlying cause of death, 1999-2022 [Data set]. CDC WONDER. https://wonder.cdc.gov/ucd-icd10.html

Office of Disease Prevention and Health Promotion. (n.d.). Heart disease and stroke. Healthy People 2030, U.S. Department of Health and Human Services. https://health.gov/healthypeople/objectives-and-data/browse-objectives/heart-disease-and-stroke

U.S. Preventive Services Task Force. (2021). Hypertension in adults: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hypertension-in-adults-screening

University of Wisconsin Population Health Institute. (2024). County health rankings and roadmaps: 2024 national findings report. https://www.countyhealthrankings.org