POD Paper Immunity fo rthe Community

Running head: IMMUNITY FOR THE COMMUNITY 1
POD Paper
Immunity for the Community
Alpha POD: Jordan Anderson, Amy Berry, Cheyenne Boyd, Casey Brown, Hannah Burress,
Caitlyn Cloy, & Megan Curry
Patty Hanks Shelton School of Nursing
Community and Public Health Nursing
NURS 435/4335
Tammie Coffman, RN, MSN, OCN-C
December 2, 2014

IMMUNITY FOR THE COMMUNITY 2
Immunity for the Community
Community Defined
The purpose of childhood immunizations, as well as adult vaccinations, is to protect
people from contracting and spreading vaccine preventable diseases that historically have caused
lethal epidemics across the United States (U.S.) (Stanhope & Lancaster, 2014). From January 1,
2014 through May 23, 2014, 288 cases of measles were reported by the states (Gastanaduy et al.,
2014). In addition, a study conducted by the Journal of American Medical Association (JAMA)
Pediatrics (2013) found that “72 children received a confirmed diagnosis of pertussis from a total
of 1,522 tested children across the United States,” during a designated time period (Glanz et al.,
p. 1060). JAMA also stated, “The United States is currently experiencing the largest outbreak of
pertussis in 50 years” (p. 1063). Dr. Mark Thoma, of Americablog News (2014), reports data
retrieved from the Centers for Disease Control and Prevention (CDC) that confirmed 50,000
cases of pertussis in 2013 and approximately 50-60 cases of measles in 2014. In 2012, pertussis
claimed the lives of 20 people, along with measles killing approximately two people in every
1,000 cases (Thoma, 2014). The mentioned sources all relate the increase of these disease
outbreaks to the increased number of under-vaccinated or unvaccinated children and adults in
America.
Measles and pertussis, along with other vaccine preventable diseases, are increasingly
causing the health of Americans to decline, potentially causing deaths. In many cases, the
disease outbreaks are beginning with people traveling into the U.S. from countries where these
diseases are more prevalent and where people are highly under-vaccinated. Once the disease
enters the U.S., it is then contracted by the under-vaccinated, and an outbreak occurs
(Gastanaduy et al., 2014). Since the recent rise in the occurrence of vaccine preventable

diseases, public health officials and nurses have made it their goal to promote the Healthy People
2020 objective calling for “the sustained elimination of indigenous cases of vaccine preventable
diseases” (Stanhope & Lancaster, 2014, p. 301). The best way to reach this goal is for the
community to simply get vaccinated. In 2013, the CDC released an article stating that, “In the
U.S., among children born during 1994-2013, vaccinations will prevent 322 million illnesses and
732,000 deaths during their lifetime” (Elam-Evans, Yankey, Singleton, & Kolasa, 2013, p.
741). The same article reported that during 2013, 83.1% of children had received the full doses
of the diphtheria, tetanus, and pertussis vaccine (DTaP), and 91.9% had received the first dose of
the measles, mumps, and rubella vaccine (MMR) (Elam-Evans et al., 2013). Though these
numbers are high, coverage rates may vary at the local level. Often under-vaccinated children
tend to cluster in geographical locations therefore decreasing the effectiveness of community
immunity (Gastanaduy et al., 2014). Community immunity is resistance of a group of people to
an infectious agent based on a high proportion of individual members who are protected with
immunity who therefore provide protection for individuals who are not immunized (Stanhope &
Lancaster, 2014). A decrease in immunization coverage of a group of people (community
immunity) results in an increase in the incidence of disease outbreak. As stated by the CDC in
an article titled “Measles” (2014), “encouraging timely delivery of vaccinations and sustaining
high vaccination coverage in the U.S. is essential to limit the spread of disease” (Gastanaduy et
al., 2014, p. 498).
Nurses and other community health providers are being challenged to create a change
regarding the lack of vaccinations among the community. According to the American Nurses
Association Immunizations website (2014), public health nurses “work to enhance the health of
the community through education and service. They deliver services, conduct disease

surveillance, and provide education, all in support of the public health mission” (para. 1). One
way community nurses can begin to tackle the issue of under-vaccinations is by starting at the
beginning- with children. The immunization process begins at birth and continues on throughout
early childhood with children receiving the recommended immunizations for seventeen diseases,
(Stanhope & Lancaster, 2014, p. 300) with most of them given by the age of two (ACIP, 2013).
Children are unable to decide and execute the process of getting vaccinated, so the power lies in
the authority of parents or guardians (caregivers). In this situation, nurses often use the health
promotion theory of social support. This theory emphasizes the idea that social support, in this
case the support of parents and guardians, can be “instrumental, informational, emotional, and
appraising” in regards to health promotion (Riverside Community Health Foundation, 2010, p.
1). Therefore, vaccines result in the incorporation of health promoting behaviors. Nurses can
utilize this framework to guide them as they promote the health of the greater community
through the vaccination of children. This can be accomplished by targeting their social support,
the caregivers, in order to prevent the increase in vaccine preventable diseases in America. This
area of need has many opportunities for nurses to practice and promote the health of the
population at risk.
Community as Client
The focus of this project will be placed on the community of Texas and the number of
under-vaccinated school-aged children. Texas law requires children to be vaccinated before
entering school.
Exclusions from compliance are allowable on an individual basis for medical
contraindications, reasons of conscience, including a religious belief, and active duty with
the armed forces of the United States. Children and students in these categories must

submit evidence for exclusion from compliance as specified in the Health and Safety
Code, §161.004(d), Health and Safety Code, §161.0041, Education Code, Chapter 38,
Education Code, Chapter 51, and the Human Resources Code, Chapter 42, Texas
Administrative Code, 25 Tex. Stat. Ann.§§ 97-97.62. (Exclusions from Compliance,
2004/2007)
However, in recent years, rates of refusal among caregivers have increased. According to a
current study, twenty percent of school-aged children did not receive the recommended
immunizations before beginning the school year (Chi, 2014). Since children do not have the
power to make their own health decisions, the lack of immunizations is a likely result of
multifactorial causes including; underinsured Texas families and parents’ deliberate refusal to
follow the recommended vaccination schedule. Currently, there is a rampant amount of
underinsured and uninsured Texas families, which results in parents not being able to afford
vaccines for their children. In other situations, parents ignore vaccine recommendations because
of fear of adverse effects, lack of education on the benefits, and busy schedules that prevent
timely immunizations. The importance of getting vaccinations in childhood is especially
important because of children’s developing immune systems and their increased susceptibility to
preventable diseases.
Unvaccinated children also put unprotected people in their communities at risk. This risk
is especially important for people who cannot be vaccinated, such as “those who are too young to
be vaccinated, those who cannot be vaccinated due to medical reasons, and especially those who
do not develop adequate immunity to the disease from the vaccines” (“Reducing vaccine-
preventable disease,” 2012, p. 40). In order to protect the community at large, it is the public
health nurse’s responsibility to make the community the client. The nurse may then focus on a

smaller group to initiate a health status change. For the purpose of this project, the public health
nurse’s priority clients are children in Texas. While the child may be the ultimate target, the
nurse must also consider the child’s caregivers when planning solutions. By defining this target,
the nurse can begin to assess, plan, implement, and evaluate a course of action to create a
significant health transformation among the community.
Community Health
Children in Texas are becoming victim to declining health as a result of being under-
vaccinated. As vaccination rates drop, once-rare diseases, such as measles, come roaring back
into the community. In 2013, Texas experienced one of the most rampant measles outbreaks
since the 1950’s. In school-aged children alone, there were 3,621 reported cases of which more
than 400 people were hospitalized and five children died (Hannaford, 2014). Trends are shifting
from increased childhood life expectancy as a result of advancements in medicine including
immunizations, to an increase in childhood morbidity and mortality as a result of caregivers’
refusal to immunize. It is evident that there is a need for a solution in hopes to protect the health
of children in Texas and the community of the United States.
Community-oriented nursing practice is defined as “the provision of disease prevention
and health promotion to populations and communities” (Stanhope & Lancaster, 2014, p. 16).
This type of nursing practice is applicable when addressing the issue of under-vaccinated Texas
children. In this situation, the nurse can play a major role in creating appropriate nursing
diagnoses and investigating the issue of why caregivers are denying their child immunizations.
When planning outcomes, the nurse can be motivated by the Healthy People 2020 outcome
calling for “awareness of disease and completion of prevention and treatment courses, which are
essential components for reducing infectious disease transmission” (U.S Department of Health

and Human Services, 2014, para. 3). The nurse could also conduct health monitoring and
research to observe trends related to vaccination refusals. Finally, the nurse can implement and
then evaluate the solution to tackle the issue at hand. Ultimately, the nurse’s goal would be to
generate a change that would result in “maintaining the community’s health to create conditions
in which people can be healthy” (Stanhope & Lancaster, 2014, p.16).
Partnerships
Our goal is to ensure that more children are vaccinated and that parents are educated
about the risks associated with under-vaccination. In order to successfully meet this goal, there
must be collaboration and allocation among established nursing organizations, guardians,
healthcare providers, and the government.
Immunizing children depends upon initiative from their adult caregivers, many of whom
may be “highly anxious about the safety of immunizations, or anxious about subjecting their
children to painful procedures” (Plumridge, 2009, p. 1188). Effective teaching from certified
registered nurses regarding immunizations can reduce anxiety among parents and ensure that fear
is not a factor in the under-vaccination of children in Texas. Should they need more information,
the child’s healthcare provider can direct caregivers to online resources regarding the importance
of vaccinating their children. Resources may be found through the Texas Health and Human
Services Commission and the Center for Disease Control and Prevention. By educating
caregivers, the expected outcome is the increase in children receiving vaccines as a result of
parents agreeing to immunize based on their new knowledge about vaccines.
In addition to correcting caregiver knowledge deficit, we plan to partner with the Texas
Nurses Association (TNA) to propose the enacting of stricter laws regarding refusal of
vaccinations. By partnering with local state representatives, in addition to the TNA, we will help

to ensure that parental refusal of vaccinations are relegated to medical contraindications and
reasons of consequence as deemed appropriate by each child’s primary care physician. These
partnerships are discussed in more detail in further sections. With the cooperation of caregivers,
the Texas Nurses Association, health care providers across the state of Texas, and the state
government, we will work to prevent the recurrence of epidemics of vaccine preventable diseases
as a result of under-vaccination.
Data
As stated in “Community Defined,” there are many statistics verifying the increase in
vaccine preventable diseases. The data gathered for this study was retrieved from the Center for
Disease Control and Prevention (CDC), the Journal of American Medical Association (JAMA)
Pediatrics, and Dr. Mark Thoma of Americablog News. The CDC is a government entity whose
purpose is to “protect lives and improve health through health promotion, disease surveillance,
implementing disease prevention strategies, maintaining health statistics, and providing services”
(Stanhope & Lancaster, 2014, p. 58). The articles we retrieved from the CDC are primary
sources, meaning the CDC conducted the research and the statistics from these sources are
considered more reliable and credible. The CDC’s article “Measles” (2014) explained the recent
outbreaks of measles primarily in the unvaccinated person and also updated national measles
data. The total 288 cases recorded over a five-month span indicated a need for emphasis on
awareness and the importance of vaccinations in communities. JAMA Pediatrics, a primary
source, (2013) also conducted an ongoing investigation to “examine the association between
under-vaccination and pertussis in children 3-36 months of age” (p. 1060). Between 2004-2010,
seventy-two children tested positive for pertussis out of 1,522 tested. Forty-seven percent of the
pertussis cases were a result of under-vaccination. The study concluded that there was a

significant increased risk for pertussis in under-vaccinated children and that approximately 36%
of the cases could have been prevented with on-time vaccination of the DTaP vaccine (Glanz, et
al., 2013, p. 1062). Finally, Dr. Thoma from Americablog News, a secondary source, (2014)
relays data gathered from the CDC to send a message to the United States regarding the increase
in vaccine preventable diseases. His purpose is to encourage children and adults to get
“vaccinated not only for their own protection, but to prevent the spread of these diseases to those
who may not be able to be vaccinated” (para. 18). Though no academic statistics were found
from the state of Texas, USA Today released an article in August 2013 titled “Texas Measles
Outbreak Linked to Church” which confirmed that Texas has been affected by the recent rise in
vaccine preventable diseases as a result of the unimmunized. In Newark, Texas, twenty-five
people contracted measles from attending a church where the pastor had been critical of the
measles vaccine. People from age four months to forty-four years old were sickened and at least
twelve of the total twenty-five people were not immunized against measles (Szabo,
2013). Altogether, the data found for this study confirms the recent rise in outbreaks of vaccine
preventable diseases and verifies that there is a risk for infection in children particularly. The
data also validates the hypothesis that unvaccinated or under-vaccinated children play a large
role in the spread of infection of vaccine preventable diseases.
Additional data gathered for this study included the vaccination coverage rates for
children in the U.S. and the state of Texas. The CDC publishes a Morbidity and Mortality
Weekly Report, a primary source, and in August of 2014, the 2013 U.S. national and state
coverage rates were released. Since 1994, the CDC has monitored vaccine coverage rates in
children ages nineteen to thirty-five months with the ultimate goal of reaching and maintaining
high coverage rates in order to prevent the resurgence of vaccine preventable diseases. As stated

in “Community Defined,” national vaccination coverage rates were 83.1% for the full DTaP
series and 91.9% for one dose of MMR. DTaP coverage of 83.1% is below the Healthy People
2020 goal of greater than 90% coverage. Despite the 91.9% coverage rate for the MMR vaccine,
one in twelve children are not receiving their first dose of the MMR vaccine on time, therefore
increasing disease susceptibility across the country (Elam-Evans et al., 2013). More importantly,
for this study, are the statistics involving the community of Texas. The same article from the
CDC posted the coverage rates for all Texas children ages nineteen to thirty-five months, and the
results were 81.5% for DTaP and 92.7% for MMR. Texas exceeds the national coverage
percentage goal for MMR, but falls behind in comparison to the national DTaP coverage rates
(Elam-Evans et al. 2013). Another article posted from the CDC looked specifically at school-
aged children’s (particularly kindergarteners) vaccination coverage and refusal rates. During the
2013-2014 school year, Texas had the third highest amount of immunization refusals for
nonmedical reasons at 5,536 kindergarteners (Seither et al., 2013). This same article stated,
“High exemption levels and suboptimal vaccination coverage leave children vulnerable to
vaccine preventable disease” (Seither et al., 2014, p. 913). This data regarding vaccination and
refusal rates connects the incidence of vaccine preventable diseases with the trends of declining
immunization rates, as well as, increased vaccine exemptions for non-medical reasons.
Altogether, the data collected for this study points to a need for action from community nurses to
create change in light of public health and wellbeing.
Community Nursing Diagnosis
There is an increased risk for infection among school-aged children in the state of Texas.
The risk of vaccine preventable infections among school-aged children is highly related to
knowledge deficits of their caregivers. This is due to guardians’ misinterpretation of

information, unfamiliarity of resources, and the current inadequate laws regulating refusal of
vaccinations. An example showing evidence that a knowledge deficit and risk for infection is
occurring could be an increase in the rate of vaccine preventable disease among children and an
increase in vaccine refusal and exemptions in Texas.
Planning
The purpose of this research project is to decrease the amount of vaccine preventable
diseases by immunizing children before their enrollment in public school. Our intention is to
identify how caregivers’ knowledge deficits and inadequate laws regulating refusal of
vaccinations affect immunization of children in Texas.
The primary goal in planning is to ensure that every child attending public school in the
state of Texas be vaccinated. We created the following objectives to attain this mission: 1)
educate guardians and families on the importance of childhood vaccinations given in a timely
manner according to the Centers for Disease Control standards, 2) provide evidence against
myths that individuals of the community may believe about vaccinations causing other disease
processes, 3) implement required educational classes explaining the importance of vaccinations
to families who refuse immunizations, and 4) provide evidence to guardians, that by getting their
children vaccinated they will have decreased medical expenses in the future.
The second goal to be achieved is to update the existing law that requires all children
attending public schools in the state of Texas to be immunized prior to enrollment. The update
with allow for stricter regulations regarding vaccination refusals. The plan for accomplishing
this goal is stated in the following objectives: 1) contact the Texas Department of Health
Services in Austin to determine health risks due to children not being immunized, 2) partner with
the Texas Nurses Association to collaborate ideas in order to have a stronger platform for

implementation, 3) establish a bill containing the goal intended and the resolution to this
problem, and 4) present the bill to members of the Texas state Congress.
Implementation
Children are a vulnerable population when it comes to vaccinations. Whether children
get vaccinated or not is up to the discretion of their caregivers. This has been identified as an
increasing problem due to the accessibility of refusing vaccinations. Media in recent years has
misled some of the population about the safety and effectiveness of vaccinations. This has led to
an increase in under-vaccinated and non-vaccinated children. We believe the best solution is to
require caregivers be educated prior to being able to refuse vaccinations for their child.
Information that would be included would be vaccination safety, the importance of community
immunity, and addressing the autism scare. While there are potential side effects, according to
the website Vaccines.gov (2014), vaccinations are the best defense against serious, preventable,
and contagious disease processes. There are minor side effects that can occur, such as
tenderness, soreness, or redness. Some of the serious side effects, such as permanent brain
damage from the DTaP vaccine, occur in less than one out of a million doses. While on the other
hand, tetanus, one of the diseases DTaP prevents against, causes painful muscle tightness,
lockjaw and death in one out of every ten patients (Vaccines.gov, 2014). Another safety concern
caregivers have is regarding the yearly influenza (or flu) vaccination. Since the flu vaccine is a
weakened or inactive strain, it cannot cause the flu, and the chances of a serious reaction are less
than one in a million. Contracting the flu, on the other hand, is very common. To a healthy
person, the flu is a short lived illness that causes discomfort for a few days to weeks, but to an
immunocompromised person, such as someone very young or elderly, the flu could be deadly.
This is why community immunity through vaccinations is important in preventing disease

outbreaks. If the majority of the general public is vaccinated against a certain disease process,
the risk of outbreak and spread of disease is low. This helps to protect those who are not eligible
for vaccination such as those immunocompromised individuals listed above (Vaccines.gov,
2014). Every person who is not vaccinated increases the risk of disease and epidemic.
According to the CDC, even though measles has been eradicated from the United States, it is still
very important to get the vaccination for personal protection, as well as community immunity.
Outbreaks of measles are continuing to increase as a result of people traveling abroad to regions
with highly under-vaccination populations (Gastanaduy et al., 2014). “For every 1,000 children
who get measles, one or two will die from it” (Thoma, 2014, para. 13). Lastly, the biggest
concern in recent years seems to be the scare that some vaccines cause autism. Many famous
people, such as Jenny McCarthy, host on The View, have spoken out against vaccinations
without proper knowledge about them and their effects. Due to the strength of their public voice,
many people were led to believe poorly conducted studies linking the MMR vaccination to
autism. A study from the Journal of Psychosocial Nursing & Mental Health Services (2010)
confirmed, “There is no scientific evidence supporting a causal relationship between childhood
vaccination and disorders such as autism” (p. 18). More recently, after continuous studies, the
CDC website also found there to be no connection with vaccines given during the first two years
of life to autism spectrum disorders. The CDC also indicated their commitment to ensuring the
safety of vaccines and that parents should expect that their child’s vaccines are effective and safe
("Vaccines not associated," 2013). By requiring caregivers to receive and learn this information
regarding the safety and importance of vaccinations, we believe parents will be more apt to
vaccinate their children, resulting in a decrease in the incidence of vaccine preventable diseases.

In order to require caregivers to receive the education regarding vaccines, we need to
push the state of Texas to enact stricter laws regarding the refusal of childhood vaccinations.
The new laws need to still allow for medical and religious refusal of vaccines, but add extra steps
to the process to help deter uncalled for lack of vaccinations in the state. The new law would
ideally require caregivers to consult with their physician or other medical professional to receive
education before being able to refuse vaccinations. This meeting between caregivers and health
care providers should consist of the debunking of vaccine related myths that were stated above
and explaining the information about vaccines and the diseases they prevent. The health care
professional should also explain whom vaccine refusals are geared towards and the population
that is affected when children do not receive vaccinations.
To begin the process of getting a law passed in the state of Texas we must first initiate the
writing of a bill. A bill is typically written by congress members, but can also be written by
lobbying groups. To get this bill written, there are two routes. First, we can plan to launch a
grassroots campaign to communicate to representatives directly, in the hope that they will
spearhead our campaign and write the bill themselves, or secondly, we can get in touch with a
lobbying group to persuade them to write the bill. In the first scenario, we will focus on
contacting local representatives, representatives on the Public Health Committee in the Texas
House of Representatives, and representatives on the Texas Senate Committee on Health and
Human Services (Dewhurst, Straus, & Irvine, n.d.). We plan to contact these officials using the
contact information provided on these two websites: www.house.state.tx.us (Texas House of
Representatives, n.d.), and www.senate.state.tx.us (The Texas state Senate, n.d.). In option two,
we will focus on contacting a lobby group or other organizations of power, like the Texas Nurses

Association, Texas Office for the Prevention of Developmental Disabilities, or the Texas Health
and Human Services Commission, to aid us in writing a bill.
After the bill is written it will be placed in Congress’s hands. A committee will review
the bill and vote to reject or accept the bill before it even hits the floor of Senate and House of
Representatives. We would use both a lobbying strategy and a grassroots campaign to help the
representatives understand the goals and benefits of the bill regarding the regulation of vaccine
refusals. After passing through the committees, the bill will go before a vote where it will have
to be passed in both houses and approved by the governor before it can become a law (Dewhurst,
Straus, Irvine, n.d.). We believe that educating parents and creating stricter laws regarding
vaccination refusals is the most effective way to provide a solution to the issue of the increased
incidence of vaccine preventable diseases as a result of under-vaccinated children.
Evaluation
The main purpose of evaluating this project is to measure the effectiveness of the
research study and our proposed solution. In order to do so, we must commit to doing the
following: 1) continue studying the percentage of children in Texas who have been vaccinated
according to the Center of Disease Control guidelines, 2) appraise coverage rates, 3) determine
the incidence of vaccine preventable diseases in Texas, 4) monitor the effectiveness of caregiver
education, 5) discuss with healthcare providers about the overall benefit of a bill that enforces
mandatory vaccinations for all children prior to attending public school, 6) monitor Texas
vaccine refusal rates, and 7) explain how current vaccinations have eradicated preventable
diseases in children. The predicted effect on the community will be an increase in health and
well-being as a result of an increase in vaccination coverage rates. As the final step of the
nursing process, the evaluation phase is important in reaching the ultimate goal of decreasing the

incidence of vaccine preventable diseases among children in the state of Texas, as well as the
entire population of the United States.
Conclusion
Vaccines are recognized as one of the top ten public health successes of the twentieth
century. Even with medical advances, school-aged children in Texas die every year from
vaccine preventable illnesses or suffer excruciating consequences from their complications. In
order to protect the community, Texas consistently strives to recognize barriers in the
immunization system and proactively implements changes to eliminate those obstacles, such as
misinformation and lack of knowledge. Unvaccinated individuals put themselves and their
population at risk. Registered nurses (RNs) can serve in many roles in the fight against
infectious diseases. Nurses can work within the public health system to heighten the overall
community well-being through education and service. RNs directly administer vaccinations to
clients, perform disease surveillance, and provide education. School nurses, guardians,
stakeholders, and policy makers have made childhood immunizations a priority in Texas. Also,
community collaboration is essential in order to prevent the spread of vaccine-preventable
diseases. The systematic approaches discussed throughout this paper, such as increasing
caregiver education, promoting timely injections, and partnering with various associations is
designed to eliminate deterrents to vaccinations and maximize available resources to the
immunization delivery system in Texas. Ultimately, the projected result would be a decrease in
the incidence of vaccine preventable diseases among children and Americans.

References
Advisory committee on immunization practices (ACIP) Recommended immunization schedule
for persons aged 0 through 18 years-United states. (2013). American Journal of
Transplantation, 13(4), 1098-1105. doi:10.1111/ajt.12233
American Nurses Association (ANA). (2014). Public health. American Nurses Association
Immunize. Retrieved from
http://www.anaimmunize.org/vaccine/settings/PublicHealthNursing/default.aspx
Chi, D. L. (2014). Caregivers who refuse preventive care for their children: The relationship
between immunization and topical fluoride refusal. American Journal Of Public Health,
104(7), 1327-1333. doi:10.2105/AJPH.2014.301927
Dewhurst, D., Straus, J., & Irvine, D. (n.d.). Guide to Texas legislative information. Retrieved
from http://www.tlc.state.tx.us/lege_ref.htm.
Elam-Evans, L., Yankey, D., Singleton, J., & Kolasa, M. (2013). National, state, and selected
local area vaccination coverage among children aged 19-35 months-United States.
Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report,
63(64), 741-748. Retrieved from
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6336a1.htm
Exclusions from Compliance, 25 Texas Administrative Code § 97.62 (2004 & Suppl. 2007).
Gastanaduy, P., Redd, S., Fiebelkorn, A., Rota, J., Rota, P., Bellini, W., ... Wallace, G. (2014,
June 6). Measles-United States, January 1-May 23, 2014. Centers for Disease Control
and Prevention: Morbidity and Mortality Weekly Report, 63(22), 496-499. Retrieved
from http://www.cdc.gov./mmwr/preview/mmwrhtml/mm6322a4.htm

Glanz, J. M., Narwaney, K. J., Newcomer, S. R., Daley, M. F., Hambidge, S. J., Rowhani-
Rahbar, A., & ... Weintraub, E. S. (2013). Association between under vaccination with
diphtheria, tetanus toxoids, and acellular pertussis (DTaP) vaccine and risk of pertussis
infection in children 3 to 36 months of age. JAMA Pediatrics, 167(11), 1060-1064.
doi:10.1001/jamapediatrics.2013.2353
Hannaford, A. (2014, March 6). Worth a shot. Texas Observer. Retrieved from
http://www.texasobserver.org/worth-shot/
McGuinness, T., & Lewis, S. (2010). Update on autism and vaccines. Journal Of Psychosocial
Nursing & Mental Health Services, 48(6), 15-18. doi:10.3928/02793695-20100506-02
Plumridge, E., Goodyear-Smith, F., & Ross, J. (2009). Nurse and parent partnership during
children’s vaccinations: a conversation analysis. Journal Of Advanced Nursing, 65(6),
1187-1194. doi:10.1111/j.1365-2648.2009.04999.x.
Reducing vaccine-preventable diseases in Texas: Strategies to increase vaccine coverage levels.
(2012, September). Texas Department of State Health Services. Retrieved from
https://www.dshs.state.tx.us
Riverside Community Health Foundation. (Cartographer). (2010). Theories and models
frequently used in health promotion. Retrieved from http://www.rchf.org/pdf/theories-
and-models-frquently-used-in-health-promotion.pdf
Seither, R., Masalovich, S., Knighton, C. L., Mellerson, J., Singleton, J. A., & Greby, S. M.
(2014, October 17). Vaccination coverage among children in kindergarten-United States,
2013-14 school year. Center for Disease Control and Prevention: Morbidity and
Mortality Weekly Report, 63(14), 913-920. Retrieved from
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6341a1.htm

Stanhope, M., & Lancaster, J. (2014). Public health nursing: Population-centered health care in
the community (8th ed.). Maryland Heights, Missouri: Elsevier Mosby.
Szabo, L. (2013, August 25). Texas measles outbreak linked to church. USA Today. Retrieved
from http://www.usatoday.com/story/news/nation/2013/08/23/texas-measles-
outbreak/2693945/
Texas House of Representatives. (n.d.). Retrieved from
http://www.house.state.tx.us/committees/committee/?committee=410&session=82
The Texas state Senate: Senate committee on health and human services. (n.d.). Retrieved from
http://www.senate.state.tx.us/75r/senate/commit/c610/c610.htm
Thoma, M. (2014, March 20). Whooping cough and measles are back, thanks to anti-vaccination
truthers. Americablog News. Retrieved from http://americablog.com/2014/03/whooping-
cough-measles-back-thanks-anti-vaccination-truthers.html
U.S. Department of Health and Human Services. (2014). Immunization and infectious diseases.
Healthy People 2020. Retrieved from https://www.healthypeople.gov/2020/topics-
objectives/topic/immunization-and-infectious-diseases
Vaccines not associated with risk of autism. (2013). Centers for Disease Control and Prevention.
Retrieved from http://www.cdc.gov/vaccinesafety/Concerns/Autism/antigens.html
Vaccines.gov. (2014). http://www.vaccines.gov/

RUBRIC
PHSSN
CPH14
Community and Public
Health Nursing
Ms. Murphy & Mrs.
Coffman
Community Assessment Paper
*POD Paper
*Point of Directed Study
Performance
Element
Level A
276-300 pts
Awesome!
Level B
249-275 pts
Right On!
Level C
225-248
pts
Pass
Level D
224 pts and below
Community
Defined
50 points
- As introduction this
section should include
clear, concise
description of why the
health issue being
addressed is of
importance to the
larger community.
Include supporting
data in DATA below.
- Analysis of
community includes
identification of
networks of
interpersonal
relationships,
residence in a
common locality,
examples of emotional
solidarity.
- Clear definition of
community includes a
conceptualframework
of approach for
nursing service.
Dimensions of
community in terms of
people, place, and
Evidence that most, but
not all Level A criteria
are addressed
(EXAMPLE: community
is defined but people,
place, and function
dimensions are not
mentioned.
EXAMPLE: Resources
are all medically focused
with no nurse-authored
references
EXAMPLE: group
process is deficient but
group does not seek
facilitation assistance
(from faculty)
Minimal
evidence
that Level
A or B
criteria are
addressed.
- No evidence of community analysis
or specification
- Missing conceptualframeworks and
development of definition of assigned
community
- Lacks evidence of group process
skills
- Inappropriate written presentation

function are clearly
delineated
-Provide the defined
geographic location of
chosen population.
-Inclusion of
supporting resources
(other than text) which
focus on community-
oriented nursing
practice
- Clear evidence of
group process in
completing project
- Paper written in
correct APA format
Community as
Client
30 points
- Client is defined as
the community of
interest and as the
target for specific
nursing service
- Healthy change for
community is clearly
delineated.
Major points are outlined
with only minimal
support sketchy
overviews, or incomplete
information
Stated but
unclear or
poorly
defined
community
as client
No evidence of identification of
community as client
Community
Health
30 points
- Goal of community-
oriented practice is
defined in terms of
community health
Dimensions of
status,* structure,
and process are
clearly delineated.
*Status includes
physical, social,
emotional
condition, social
parameters;
morbidity and
mortality, etc.
Dimensions are listed but
not fully developed
related to selected
community/population
Major
points are
outlined
but given
only thin
support.
No evidence of community’s overall
health, or status,structural,or process
dimensions
Partnerships
30 points
-Partnerships for
collaboration in
community-oriented
practice are identified,
defined, justified, &
utilized.
Examples of possible
partners include:
schoolnurses,public
health officer, police,
- Partnerships are listed
but not discussed in
relationship to a
collaborative approach to
addressing defined
community health deficit.
Minimal
evidence
that Level
A or B
criteria are
addressed.
No evidence of involvement between
health care providers and community
residents/leaders

Lions Club
president…
Data
30 points
- Data sources are
clearly identified and
indicated to be
primary or secondary.
- Relevant information
about the community
is collected, analyzed.
- Themes are noted,
and community health
problems, strengths,
and needs for action
are identified.
-Methodology:
informant interview,
participant
observation,
secondary analysis of
data collected
previously by another
entity is described
(Entities might include
national, state,local
data bases.)
-Data sources are listed
but their value or
importance r/t issue not
thoroughly explored.
Minimal
evidence
that Level
A or B
criteria are
addressed.
No evidence of data gathering or
assessment from any source
Community
Nursing
Diagnosis
50 points
- One nursing
diagnosis is
established and
addressed consistently
throughout project
- Diagnosis includes
verbiage of “risk of”,
“among”, and “related
to”
-Includes geographic
location
- Nursing diagnosis does
meet requirements
established for structure
and verbiage.
- Nursing diagnosis is not
the one approved by
POD MASTER.
Minimal
evidence
that Level
A or B
criteria are
addressed.
No evidence of 3-part community
nursing diagnosis
Planning
20 points
- Reflects scope of
problem analysis and
prioritization,
establishing goals and
objectives, and
identification of
intervention activities
- Plan is stated but does
not reflect clear response
to nursing diagnosis.
Minimal
evidence
that Level
A or B
criteria are
addressed.
No evidence of analysis,
prioritization, goals and objectives or
planned intervention activities
Implementation
20 points
All factors influencing
implementation are
addressed (nurse’s
preferred mode of
action, role, nature of
problem, community
readiness to discuss
problem, and
-The ‘what’ of the plan is
stated but the “how” is
not delineated or does not
flow from the stated
nursing diagnosis
-Implementation does not
reflect roles of the
C/PHN
No evidence of influencing factors,
defined role of the nurse, or
implementation mechanisms

characteristics of the
social change process)
- Implementation does
not clearly delineate a
collaboration between
disciplines to address the
community health deficit
Evaluation
20 points
References
20 points
(Minimum of 10 references
of which 5 must be articles
from peer-reviewed nursing
journals)
Attach a copy of this rubric
to your final submission for
grading and faculty
comments.
Evidence of
discussion ofthe
appraisal of the effects
of the actual or
proposed activity or
program, which begins
in the planning phase
of community action
_________________
References indicate a
broad exploration of
the topic including
multiple discipline
approaches,examples
of multidisciplinary
responses and
descriptions of details
of collaborative
approaches with
nurses.Nursing
references exceeded
the minimum of 5
articles from peer-
reviewed nursing
journals.
Interdisciplinary
sources may be
included in the 5 peer-
reviewed articles
provided the author is
a NURSE.
Evaluation plan is stated
but does state specifics as
to time, place, and
achievement of expected
outcomes.
______________
References indicate an
overview of the topic
including few multiple
discipline approaches,
with minimal discussion
of interdisciplinary
responses.The minimum
5 peer-reviewed nursing
articles noted.
Minimal
evidence
that Level
A or B
criteria are
addressed.
_________
Minimal
evidence
that Level
A or B
criteria are
addressed.
- No appraisal of the effects of any
organized activity or program
- No evidence that evaluation began
in the planning phase of community
action
___________________________
References do not reflect scholarly
exploration of the topic from nursing
and/ormultidisciplinary approach.
POD (Point of Directed Study) Community Assessment Paper Notes
Here is some additional information about your POD (point of Directed Study) Paper. Your paper should:
1. Be written in APA format, 12- point font, double-spaced, Times New Roman.
2. Contain Approx. 10 pages but no more than 20 including references and appendices.
We stop reading at page 20!
3. Place your data in tables and charts and put it in the appendix. It should be referenced
in the paper in a paragraph that explains the table or chart.
4. Use the tools provided in Chapter 18- Don’t skip over the boxes, charts, and graphs.
They WILL provide examples that will help you develop your paper.
5. Reflect your use of the rubric related to the use of key words, terms and phrases.

6. Identify the problems that you find in your community and then select one problem
to address providing a complete assessment of the problem and describe in detail why
you chose it.
7. Contain at least ten references are required. Five must be from peer reviewed
nursing journals written within the last 5 years. The other five may be from you
your textbook, other textbooks, or websites such as those referenced in your chapter
presentations. No WebMD or Wikipedia please.

POD Paper Immunity fo rthe Community

Recommended

Recommended

More Related Content

What's hot

What's hot (19)

Similar to POD Paper Immunity fo rthe Community

Similar to POD Paper Immunity fo rthe Community (20)

POD Paper Immunity fo rthe Community