| Course | NR 442 Community Health Nursing |
|---|---|
| Week | 3 |
| Paper type | Community assessment paper |
| Length | About 1,130 words, 7 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | RN-to-BSN |
| Updated | October 2026 |
Free sample paper for NR 442 Week 3
Community Assessment of Garrison County After Its Labor and Delivery Unit Closed: Maternity Care Access as the Priority Gap
Student Name
College of Nursing, Chamberlain University
NR 442: Community Health Nursing
Instructor Name
Month Day, Year
Community Assessment of Garrison County After Its Labor and Delivery Unit Closed: Maternity Care Access as the Priority Gap
Geography Fixed to a Source
The assessed area is Garrison County, a composite rural county of about 19,400 residents. The county boundary was chosen because it is the geography at which the three main data publishers used here all report: census estimates from the American Community Survey (U.S. Census Bureau, n.d.), the state vital statistics office, which publishes births by county of residence, and County Health Rankings (University of Wisconsin Population Health Institute, 2024). The assessment was prompted by a change: two years ago, the county's only hospital closed its labor and delivery unit, and it now has no birthing facility. Where a figure is available only for a larger area, such as a multi-county region, the text says so.
Community Profile
Population and age: About 19,400 residents; about 3,300 women aged 15 to 44 (American Community Survey 5-year estimates).
Births: An average of 205 births per year to county residents over the last three years (state vital statistics, births by county of residence).
Income and insurance: Median household income about 20 percent below the state median; about 48 of every 100 births covered by Medicaid (state vital statistics).
Language: About 7 of every 100 households speak Spanish at home, concentrated near the county's meatpacking plant (American Community Survey).
Vehicle access: About 6 of every 100 households have no vehicle (American Community Survey); the margin of error for this estimate is wide at the county level.
Distance: The nearest hospital with labor and delivery services is 41 miles from the county seat by highway, about 50 minutes in good weather.
Indicators for the Same Ground
Three indicators describe the county's maternal and infant health, each chosen because it is published at the county level. First, the share of births with prenatal care beginning in the first trimester was 71 of every 100 in the most recent three years of state vital statistics, below the state figure of 78. Second, the low birthweight rate was 8.1 per 100 live births, compared with 7.9 statewide, a difference too small to call meaningful with 205 births a year. Third, since the closure, 9 births to county residents in two years occurred before arrival at a hospital, in a car or at home, compared with 2 in the two years before, according to the state birth certificate field for place of birth.
The county now meets the March of Dimes definition of a maternity care desert: a county with no hospital providing obstetric care, no birth center and no obstetric clinicians. Nationally, the 2024 report found that about 35 of every 100 U.S. counties met that definition and that about 2.3 million women of reproductive age lived in them (March of Dimes, 2024). The unplanned out-of-hospital birth count is small, but it is the indicator most directly connected to the closure, and its rise is the most important number in this assessment.
The Service Inventory
Prenatal care: A rural health clinic in the county seat, staffed by a family physician and a nurse practitioner, provides prenatal visits through about 32 weeks and then transfers care to an obstetric practice 41 miles away. Eligibility: open to all; accepts Medicaid.
Birth: None in county. Nearest labor and delivery unit, 41 miles, at a regional hospital.
Home visiting: The county health department sends nurses to the homes of women expecting a first baby who enroll before 28 weeks of pregnancy with Medicaid-eligible income, funded by a state grant. Eligibility excludes women with previous births and women above the income limit, so it reaches only some of the county's pregnant residents.
Nutrition: The Special Supplemental Nutrition Program for Women, Infants, and Children has a county clinic open two days a week. Eligibility: pregnant and postpartum women and children under 5 with income at or below the program limit.
Transport: Medicaid covers nonemergency medical transportation to prenatal visits when booked 48 hours ahead; no coverage for travel to the hospital in labor except by ambulance.
Emergency response: A county ambulance service with two staffed units; crews are trained in emergency childbirth but not stocked for neonatal resuscitation beyond basic equipment.
Gaps
Three gaps follow from the inventory. First, there is no plan for labor: prenatal care is available, and the regional hospital is available, but no service is responsible for getting a laboring woman across 41 miles, and Medicaid transportation requires two days' notice that labor cannot give. Second, late prenatal care is split across two sites, with a transfer at 32 weeks that some women do not complete; the clinic has no record of how many. Third, the home visiting program's eligibility rules exclude women with previous births, although women with previous births have faster labors and are more likely to deliver before reaching a hospital. None of the county's existing services was designed for a county without a birthing unit.
A fourth gap is information. The county has no count of women who begin prenatal care locally and never complete the transfer at 32 weeks, no record of how long laboring women take to reach the regional hospital, and no review of the nine births before arrival. The state birth certificate records where a birth happened but not why, so the assessment's most important figure cannot yet be explained. Any plan that follows will need to collect these facts from the clinic, the ambulance service and the regional hospital before it can show whether anything changed.
Priorities and the Responsible Bodies
The priority is unplanned out-of-hospital birth, ranked first because it is the gap most directly caused by the closure, carries the highest risk to mother and newborn, and was raised by residents in every interview. Its responsible bodies are several, and listing each one belongs in the assessment. The county health department can change who its home visiting program serves if its grant terms allow, and could include birth planning in its visits. The regional hospital decides whether to offer a scheduled induction or an overnight stay for women with long travel times. The state Medicaid agency sets transportation rules. The county ambulance service, funded by the county board, decides what neonatal equipment its units carry. No single office owns the problem, and the assessment recommends that the county health department convene these four bodies, since it is the one agency whose mission covers the whole population. Nies and McEwen (2019) describe this convening role as central to community health nursing when a problem crosses agency lines.
References
March of Dimes. (2024). Nowhere to go: Maternity care deserts across the US (2024 report). https://www.marchofdimes.org/maternity-care-deserts-report
Nies, M. A., & McEwen, M. (2019). Community/public health nursing: Promoting the health of populations (7th ed.). Elsevier.
University of Wisconsin Population Health Institute. (2024). County health rankings & roadmaps. https://www.countyhealthrankings.org/
U.S. Census Bureau. (n.d.). American Community Survey 5-year estimates [Data set]. Retrieved September 28, 2026, from https://data.census.gov/
What the NR 442 Week 3 assignment asks for
The Week 3 assessment has you assess a community and identify its priority health need. The assignment sheet tends to list the geographic boundary, a community profile with data, health indicators, available services, gaps, a prioritized problem and the responsible agencies, in APA. Fix your geography to a boundary your data sources report at, and flag any figure from a larger area. Put the source and year beside each figure. Choose indicators published at that geography and do not treat small differences as meaningful. Inventory services with their eligibility rules, since a service nobody qualifies for is not available. State the gaps, rank the priority with a rule and match it to responsible bodies.
Inside the NR 442 Week 3 example
The geography section explains why the county boundary works for the Census, state vital statistics and County Health Rankings. The profile lists population, women aged 15 to 44, births, income, Medicaid share, Spanish spoken at home near the meatpacking plant, households without vehicles with a wide margin of error, and the 41-mile distance. The indicators section reports first-trimester prenatal care and other county figures, and applies the March of Dimes maternity care desert definition. The service inventory covers the rural health clinic's prenatal care to 32 weeks, the absence of birth services, home visiting limited to first pregnancies, WIC, Medicaid transport and the ambulance. The gaps section begins with no plan for labor. The priority section names four bodies.
Where the points sit in the NR 442 Week 3 rubric
Community assessment rubrics for NR 442 typically score a defined geography, a sourced community profile, appropriate indicators, a service inventory, identification of gaps, prioritization with a rule, attention to responsible agencies and APA. Geography that stays put is what graders check first in NR 442 Week 3, and the paper holds it by fixing the county boundary and flagging larger-area figures. The profile is credited because each item carries its publisher and year. Indicators score when chosen for their geography and read cautiously. The inventory earns points because eligibility rules sit beside each service. Gaps and priority are credited for a stated ranking rule and four named bodies, with the health department as convener. March of Dimes and Census data support the assessment.
Common NR 442 Week 3 mistakes, and how to avoid them
Students drop the most points here with a geography that shifts, with tract figures in one paragraph and state figures in the next and nothing marking the change. Another is a service list copied from a resource guide without eligibility rules, which makes services look available when they are not. Students also treat small differences in rates as meaningful, rank problems by preference or name a priority without saying who could act on it. Resident interviews can support the data when placed beside it. Acceptable sources are usually federal, state and established data publishers. If your county or community is different, send its boundary and an NR 442 assessment can be built at one consistent geography.
Get a NR 442 Week 3 example written to your instructions
Send your section's heading list, the rubric and whatever field notes or data you have gathered, and we will write a fresh NR 442 Week 3 community assessment around your area and your sources rather than these. It comes back inside 24-48h in the format your instructor asked for, and the first is free.
More NR 442 papers and RN-to-BSN samples
- NR 442 Week 1: Public Health Authority Discussion
- NR 442 Week 2: Rural Town Windshield Survey
- NR 442 Week 4: Population Health Analysis
- NR 442 Week 5: Epidemiology Write-up
- NR 442 Week 6: Health Promotion Plan
- NR 442 Week 7: Community Teaching Plan
- NR 442 Week 8: Reflection
- NR 446 Week 1: Discussion Post
- NR 441 Week 3: Global Burden of Disease Brief
- NR 447 Week 3: Conflict Analysis
- NR 439 Week 3: Documented Literature Search Strategy
NR 442 Week 3 questions, answered
How large should the assessed area be?
Small enough that the boundary can be defended and large enough that data exists for it. A tract or a few adjacent tracts usually satisfies both. A whole county is far easier to source and much harder to say anything specific about, and assessments pitched that wide tend to close with recommendations no single office could ever act on.
What counts as an acceptable source?
Anything carrying a publisher, a year and a defined geography, which in practice means public health agencies, census products, state vital statistics and hospital community benefit reports. A number lifted from a news story is usable only once the originating agency has been traced. Sections vary on how many sources they want, and most rubrics reward range across levels of government.
Can what residents told me go in?
Informal conversation with residents or staff is commonly allowed as observation and reported without names or identifying detail. Anything that starts to resemble a survey instrument, a structured interview or access to records falls under a different rule and usually needs an approval the section will describe. Most rubrics ask only that the method used be stated openly.
Where can I find a free NR 442 Week 3 sample paper?
The complete Week 3 assessment of Garrison County, with the fixed geography, sourced profile, indicators, service inventory, gaps, the ranked priority and four references, is shown here.
Which bodies does the NR 442 Week 3 assessment say hold levers over out-of-hospital birth?
The county health department, the regional hospital, the state Medicaid agency and the county ambulance service, with the health department recommended to convene the other three.