sheila q. hartung, phd, rn bloomsburg university bloomsburg, pa

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

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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)

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Community Assessment Highlights of County

Windshield Surveys

Spring semesterDushoreLaporteLopezBernice/SatterfieldMildredEstellaColley

Fall semesterDushoreLaporteLincoln Falls, Shunk,

WheelervilleHillsgroveEagles Mere, Muncy

Valley, Beech GlenMillviewForksville

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Community Assessment Parameters

Physical EnvironmentDemographicsVital StatisticsBehavioral Health

IndicatorsEconomics

Health and Social ServicesPolitics and GovernmentEducation

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Leading Cause of Death per County Annual Average Rate per 1000 Residents 2003-2008

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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)

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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)

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Percentage of Healthy Weight Adults 2003-2005(BMI of 18.5-24.9)

(Pennsylvania Department of Health, 2005, b1)17

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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

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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

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Insight Interviews

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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

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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

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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

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Health Promotion Projects

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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

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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

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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.

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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

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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

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Thank You!

Questions??