NR 436 Week 8 Population Health Nursing Reflection Example

The Crosswalk That Was Not There: Reflecting on a Term Spent Treating a Neighborhood

Student Name

College of Nursing, Chamberlain University

NR 436: Community, Public, and Population Health Nursing

Instructor Name

Month Day, Year

The Crosswalk That Was Not There: Reflecting on a Term Spent Treating a Neighborhood

A Parent, a Stroller and a Four-Lane Road

The moment I keep returning to happened at 0750 on a Thursday in October, during the windshield survey of the Eastgate corridor. A parent with two school-age children and a stroller stood at the edge of the arterial road for almost two minutes, waiting for a gap in traffic, at an intersection with no signal and no marked crosswalk. The nearest signalized crossing was a quarter mile back. When the gap came, they ran. I wrote it down as an observation, one line among many, and moved on to count storefronts.

At the time I thought of it as scenery, the kind of detail that makes a survey feel real. It was only three weeks later, when I pulled the county's pedestrian crash data for the assessment, that the line became a finding. The corridor accounted for a share of pedestrian injuries far out of proportion to its population, and most occurred at unsignalized intersections during the morning and afternoon school travel windows. The parent had not been unlucky or careless. They had been doing what the design of the street required them to do.

How the Community Changed as the Rates Came In

At the start of the term I drew my boundary too wide. My first post described the whole east side of the city, and my instructor asked, reasonably, what those 60,000 people shared. I narrowed it to the corridor and its side streets, about 0.9 square miles, and the narrowing changed what I could see. A whole city has averages; a corridor has a bus route that runs every 30 minutes, a pharmacy and no clinic, a laundromat where people talk, and three signalized crossings in nine intersections.

The published data then changed the corridor again. From the car, Eastgate looked like a neighborhood with a food problem, because there was no grocery store. The census tables showed that one in three households in the corridor had no vehicle, which made the missing grocery store a transportation problem as much as a food problem. The crash data showed that the same residents without cars were the ones walking along a road designed for vehicles. By the end of the assessment, the three impressions I had written as separate hunches after the drive, food access, pedestrian risk and clinic access, had turned into one finding about a street built for people passing through rather than for people who live there. Braveman and Gottlieb (2014) describe the causes of the causes of poor health, and the design of the arterial road was one of them.

What the Population View Cost

I want to be honest about what this way of working took away. On my medical-surgical unit, I know whether I helped someone before the end of a shift. A patient's pain goes down, a wound looks better, a family understands the discharge plan. In this course, the closest I came to a person was that parent at the curb, and I never spoke to them. The program I proposed, a crossing guard and a temporary signal during school travel hours paid for through a partnership with the school district and the city traffic department, would, if it worked, prevent injuries to people whose names nobody would ever know. A rate cannot thank you, and it cannot tell you whether it felt safer.

That distance also made it easier to be wrong without noticing. My first impression of the corridor, a food desert, was plausible and partly incorrect, and nothing in the survey itself corrected me. Only the data did. At the bedside, a patient will usually tell you when you have misunderstood them. A population says nothing unless you go looking. The American Nurses Association (2022) describes population-focused practice as assessment that is continuous rather than a single event, and I understand now why: the community does not correct you, so the assessment has to.

What I Will Do Differently at Work

Two changes are concrete enough to check. First, on my unit I discharge many older adults who walk or take the bus home from the hospital. Starting next month, I will add one question to my discharge conversation, how are you getting home and how will you get to your follow-up appointment, and document the answer. If the answer involves a long walk along a road like the arterial, I will ask the case manager about transport assistance before the patient leaves. Second, I will join the hospital's community health needs assessment committee, which meets quarterly and has asked for nurse members. I can bring the corridor's crash data and the observation that the hospital's main entrance faces away from the neighborhood it sits in.

Neither change will show up in a population rate. They are what one nurse can do with what the course taught, which is to look at where a patient goes when they leave the building as part of the assessment rather than as someone else's problem. I will know the first change is working if, three months from now, my discharge notes show the transport question answered for most of the older adults I send home, and if I can name at least a few patients for whom the answer changed what happened next. The second change will be harder to measure, but attendance at four quarterly meetings over the next year is a commitment I can keep and my manager can check.

What Remains Unsettled

The question I have not answered is who should own the corridor's problem. The traffic department owns the road, the school district owns the travel window, the city owns the budget, and the hospital owns the building that faces away. Nurses see the injuries in the emergency department and on the orthopedic unit. The course taught me to name a community diagnosis, but it did not tell me what a nurse does when the diagnosis belongs to five organizations and none of them is a health agency. Nies and McEwen (2019) describe the public health nurse as a coalition builder, and I suspect that is the answer, but I have not yet seen it done, and I am not sure I would know how to begin.

References

American Nurses Association. (2022). Public health nursing: Scope and standards of practice (3rd ed.).

Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It's time to consider the causes of the causes. Public Health Reports, 129(Suppl. 2), 19-31. https://doi.org/10.1177/00333549141291S206

Nies, M. A., & McEwen, M. (2019). Community/public health nursing: Promoting the health of populations (7th ed.). Elsevier.