Direct Care Project Part 1: Substance Use Assessment and Diagnosis Template

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Direct Care Project Part 1: Substance Use Assessment and Diagnosis Template

Directions: Collect the data outlined in this template. Fill in the blanks in the tables provided. There are two parts – online data collection and a modified windshield survey data collection. You will then identify a nursing problem in a vulnerable population and write a nursing diagnosis. See the assignment directions for suggestions and best practices. For full credit, all information in a category must be completed. This will be the topic of your Assessment and Nursing Diagnosis Template and also Parts 2 through 4 of your course project.


Name:                                                             Date:


Online Data Collection


  1. Community Information


  Your Community Data
Name of city or town and state Phoenix Arizona
Population As of 2019, the state had a population of 1,680,992
Nature of this community (rural, suburban, urban) Over the years it has become more of urban than suburban
Describe your community in 2-3 sentences Phoenix Arizona is known for its year round warm temperature and high-end spas and resorts. It is the fifth most popular city in the US. It has sophisticated urbanscapes. It is also known for its southwest culture and loads if outdoor adventures.


  1. Community Demographics
    1. Go to
      1. The US data should automatically populate
      2. Input your zip code or county/township name
  • Then input your state for comparison data
  1. Enter the data into the table below
  2. Compare the county, state, and US data


  County Data State Data U.S. Data
Population total 1,680,992 7,278,717 328,239,523
Male (subtract female % from 100) 49.8% 49.7% 49.2%
Persons under 5 7.4% 5.9% 6.0%
Persons over 65 10.3% 18.0% 16.5%
Race and origin data
  County Data State Data U.S. Data
White alone 72.3% 82.6% 76.8%
Black or African American alone 6.9% 5.2% 13.4%
American Indian and Alaska Native alone 2.1% 5.3% 1.3%
Native Hawaiian and other Pacific Islander alone 0.2% 0.3% 0.2%
Two or more races 3.8% 2.9% 2.8%
White alone, not Hispanic or Latino 43.0% 54.1% 60.1%
Significant population characteristics
  County Data State Data U.S. Data
Veterans 73,052 487,684 18,611,432
Foreign born persons 19.5% 13.4% 13.5%
Housing overview
  County Data State Data U.S. Data
Housing units        – 5,388,066 139,684,244
Owner-occupied housing unit rate 53.8% 63.6% 63.8%
Median selected monthly owner costs with a mortgage $1,417 $1,394 $1,558
Median selected monthly owner costs without a mortgage $443 $406 $490
Median value of owner-occupied housing units $2,140 $1,668 $1,585
Median gross rent $999 $1,009 $1,023
Family and living arrangements
  County Data State Data U.S. Data
Households 555,013 2,524,300 119,730,128
Persons per household 2.87 2.69 2.63
Living in same house 1 year ago 83.2% 82.2% 85.5%
Language other than English spoken at home 37.5% 27.2% 21.5%
Computer and Internet Use
  County Data State Data U.S. Data
Households with a computer 89.1% 89.9% 88.8%
Households with broadband internet subscription 79.9% 81.8% 80.4%
  County Data State Data U.S. Data
High school graduate or higher 81.5% 86.8% 87.7%
Bachelor’s degree or higher 28.2% 28.9% 31.5%
  County Data State Data U.S. Data
With a disability under age 65 years 7.7% 8.6% 8.6%
Persons without health insurance under age 65 years 16.1% 12.7% 10.0%
  County Data State Data U.S. Data
Civilian labor workforce ages 16+ 66.7% 59.2% 62.9%
Transportation-mean travel time to work (minutes) 25.7 25.3 26.6
Income and poverty
  County Data State Data U.S. Data
Median household income $54,765 $65,213 $60,293
Persons in poverty 19.4% 14.0% 11.8%




  1. Community Epidemiological Data
    1. Go to: https://www.countyhealthra/org
    2. Click on your state
      1. Start with Overall Rankings in Health Outcomes
      2. Then choose your county


**you will need to use the “+” to see all of the data**


  County Data State Data
Health Outcome Rank 3 N/A
Length of life rank 2 N/A
Premature death 7,100 6,700
Low birth weight 7% 8%
Adult smoking 16% 15%
Adult obesity 28% 30%
Physical inactivity 22% 22%
Excessive drinking 17% 21%
Alcohol impaired deaths 25% 32%
STIs 564.4 589.9
Teen births 27 21
Drug overdose deaths 16 21
Uninsured 12% 8%
Unemployment 4.8% 4.3%
Children in poverty 20% 16%
Violent crime 435 403
Air pollution 5.8 11.5
Drinker water violations
Long commutes 36% 41%










  1. Substance Use
    1. Go to:
      1. Find your state and download the report.
      2. Review the report and document the following:
        1. Go to Substance use, abuse and use disorders section. This will be the area that discusses those 12 and older (near end of report).
  • Find the following percentages:
  State Average National Average
Tobacco use 28.4% 28.9%
Marijuana 31.5% 33.0%
Marijuana use disorder 1.5% 1.5%
Heroin use 0.50% 0.33%
Misuse of Prescription pain reliever 4.8% 4.3%
Opioid use disorder 1.1% 1.3%
Illicit drug use disorder 3.3% 2.8%
Alcohol use disorder 6.2% 5.8%
Substance use disorder 7.6% 7.5%




Windshield Survey

It is recommended that you have someone drive you around your community at least 2 times, ideally at different times of day and weekend vs. weekday.

Look at the people in your community.


Did you observe:

No Yes If Yes, provide number or state “many” “some” or “few”
·       *pregnant women   Yes some
·       *pregnant adolescents   Yes few
·       *infants (under age of 1 year old)   Yes some
·       *young children (1-5 years old)   Yes many
·       *school-age children (6-18 years old)   Yes many
·       adults (18 – 60 years old)   Yes many
·       *older adults (over the age of 60 years old)   Yes few
·       people exercising   Yes few
·       people driving   Yes some
·       people walking   Yes many
·       people biking   Yes few
·       people congregating in groups on the street No
·       *people that had hygiene issues or were unkempt   Yes few
·       people that were appropriately dressed   Yes many
·       people that were physically fit   Yes some
·       people that were obese   Yes some
·       *people that were undernourished, thin   Yes few
·       people that appear healthy   Yes many
·       *people that have obvious physical disabilities, such as those using walkers or wheelchairs   Yes Few
·       *people with apparent mental/emotional disabilities No
·       *people who appeared homeless or unemployed   Yes few

*Represents vulnerable populations

Social and Economic Conditions


Did you observe:

No Yes If Yes, provide number or state “many” “some” or “few”
·       housing that was run down or dilapidated   Yes Few
·       areas undergoing renewal   Yes Some
·       public housing   Yes Many
·       public transit (subway, train, buses, taxis, etc)   Yes Many
·       transportation to health care resources   Yes Few
·       landfills No
·       restaurants   Yes Many
·       any political signs   Yes Few
·       any evidence of health education on billboards, advertisements, or signs No
·       any efforts to improve the neighborhood’s health such as advertisements for health-related events, health fares, clinics, or lectures   Yes Few
·       any group efforts in the neighborhood to improve the living conditions or the neighborhood   Yes Few
·       churches, synagogues, and other places of worship   Yes Few




Health Resources


Did you observe:

No Yes If Yes, provide number or state “many” “some” or “few”
·       hospitals   Yes Few
·       community clinics   Yes Few
·       family planning clinics   Yes Some
·       generalist doctors No
·       dentist offices   Yes Few
·       pharmacies   Yes Some
·       urgent care clinics No
·       skilled nursing facilities   Yes Some
·       mental health or counselling clinics   Yes Few
·       homeless or abuse shelters   Yes Some
·       public health department office   Yes Some
·       substance abuse treatment center   Yes Few
·       alternative medicine practices, botanicals, or herbal medicine shops   Yes Few

Answer the following question:


If some of the above health resources were not observed, approximately how far away would a person need to travel to find these resources?


For some of the health services like generalist doctors, which were not found within the area, one has to travel about 93.34km to Arizona town where the services are available. This would take approximately one hour while using private means.






Environmental Conditions


Did you observe:

No Yes If Yes, provide number or state “many” “some” or “few”
·       evidence of anything that might make you suspicious of ground, water, or air pollutants   Yes        Many
·       poor road conditions with potholes, or poor drainage   Yes Some
·       adequate traffic lights, signs, sidewalks, and curbs   Yes many
·       railroad crossings fitted with warnings and barriers   Yes Many
·       streets and parking lots well lit   Yes some
·       handicapped access to buildings, sidewalks, and streets No    
·       recreational facilities, playgrounds, and/or facilities like the YMCA   Yes Some
·       children playing in the streets, alleys, yards, or parks   Yes Some
·       evidence of nuisances such as ants, flies, mosquitoes, or rodents, or stray animals observed   Yes Few



Identify a nursing problem based on your data and observations. The problem must be related to substance use. Example: Alcohol use



Problem Identification: Marijuana Use


Vulnerable Population

Identify the vulnerable population that is most impacted by this problem. Example: Adolescents



Vulnerable Population Identification: Youth




Write a nursing diagnosis based on your problem. Fill in the blanks below.

Example: Increased risk for alcohol use among adolescents related to lack of sufficient knowledge about the long and short-term impacts demonstrated in community epidemiological data.



Nursing Diagnosis: Increased risk of marijuana use among the youth aged 12-17years related topeer pressure, curiosity and lack of adequate knowledge on its effects on health as demonstrated in County health rankings data.




Substance Abuse and Mental Health Services Administration (SAMHSA).(2019). Behavioral health barometer, volume 5.

County Health Rankings and Roadmaps.(2018). Explore rankings.

U.S. Census Bureau.(2018). State and county QuickFacts