1. Running Head: COMMUNITY ASSESSMENT PAPER1 A Community Heath Nurses Role With Cardiopulmonary Resuscitation (CPR)David Theobald-RNEmpire State College

2. Running Head: COMMUNITY ASSESSMENT PAPER21. IntroductionPurposeA. The purpose of this community assessment paper is to increase awareness of theimportance of Automatic External Defibrillators (AEDs) and CardiopulmonaryResuscitation (CPR) training in the City of Saratoga Springs New York.Population Aggregate/ StatisticsB. Population Aggregate- Saratoga Springs has population of 26,727 people. Thecommunity is involved with youth sports teams. Statistic Heart disease is the leadingcause of death for both men and women. More than half of the deaths due to heartdisease in 2009 were in men. About600,000 Americans die from heart disease eachyearthats 1 in every 4 deaths. Coronary heart disease is the most common type ofheart disease, killing more than 385,000 people annually(CDC 2012 Web).Community Health Nursing ModelD. For this Project we will be using the Interventions Wheel Model. The model consistsof 17 identified community health nursing interventions that cross over three levels ofpopulation-based practice: individual-focused, community-focused, and systems-focusedpractice. Individual-level interventions are focused on change in individual health status,knowledge, or skills (Clark, 2008 p 75).Community Health Nurse RoleE. Community Health Nurse Role in promoting heart health and implementing CPR andAED programs. 3. Running Head: COMMUNITY ASSESSMENT PAPER3 COMMUNITY OVERVIEW A. Saratoga Springs NY is small city rich with history and culture. There are manyPopulation by GenderMale 12,837 48.28% 12,433Female 13,749 51.72% 13,753Population by AgePersons 0 to 4 years 1,087 4.09%1,395Persons 5 to 17 years3,43012.90%3,672Persons 18 to 64 years17,88167.26% 17,380Persons 65 years and over4,18815.75%3,739community sports programs and recreation leagues in the community. The setting is recreation fields and youths sports complexes. One target population is the Saratoga Lacrosse League. B. Demographics based on 2010 US Census Bureau Total 26,586 C. Education Retrieved from National Center for Educational Statistics Population 25 years and over 17,127 100.0% Less than 9th grade 5883.4% 9th to 12th grade, no diploma 1,297 7.6% 4. Running Head: COMMUNITY ASSESSMENT PAPER 4 High school graduate (includes equivalency) 4,011 23.4% Some college, no degree3,009 17.6% Associate degree 1,557 9.1% Bachelors degree3,595 21.0% Graduate or professional degree3,070 17.9 D. Ethnicity 2010 CensusPopulation by RaceAmerican Indian and Alaska native alone 550.21% 63Asian alone5211.96%271Black or African American alone7012.64%815Native Hawaiian and Other Pacific native alone 70.03%8Some other race alone1700.64%168Two or more races5892.22%368White alone 24,543 92.32% 24,493 E. Poverty Level, Unemployment ratethe data is based upon 2010 estimates. Saratoga Springs employment informationIndex Saratoga Springs New YorkIncome per capita $31,762$31,957Median household income $54,607$67,635Median household income owner occupied$74,316$79,472Median household income renter occupied $32,481$41,550 5. Running Head: COMMUNITY ASSESSMENT PAPER5Median earnings male $35,233 $45,665Median earnings female $19,281 $26,443Unemployment rate (2000) 4.3%4.5%Unemployment rate (2010) n/a 8.2%Unemployment rate (2012) n/a 8.0%Poverty level8.8%8.8%F. Employers Many people that live in Saratoga Springs either work for small businesses or commute to larger employers in out lying areas. Below are some of the largest employers in Saratoga Springs NY. 1000+ employeesTown # of employees Stewarts Ice Cream Co. Saratoga Springs1550 500-999 employees Saratoga Springs City School District Saratoga Springs 988 Quad Graphics, Inc. Saratoga Springs825 Saratoga HospitalSaratoga Springs 823 G. Type of Government For The City Of Saratoga Springs NY Commission Form: The Saratoga Springs charter specifies a commission form of city government. In the news there have been efforts to amend the charter. The charter change proposal will appear on the ballot of the November 2012 election. H. Safety Fire, Police 6. Running Head: COMMUNITY ASSESSMENT PAPER 6Fire Department: Paid DepartmentThe Saratoga Springs Fire Department is dedicated to the protection of life, property andthe environment for those who live, work, or visit our community. We will accomplishthis by using well trained and dedicated personnel pledged todeliver the highest qualityfire suppression & prevention, public education, advanced emergency medical services,which are capable of responding to all disasters, natural or man-made.(City SaratogaSprings.org)Police Department: City Paid DepartmentWe are a team of law enforcement professionals committed to setting the benchmark forquality police service by promoting strong community partnerships and upholding thehighest ethical standards. Our mission is to provide a professional, effective, and timelyresponse to crime and disorder, and to enhance traffic safety in our community.(CitySaratoga Springs.org)I. HospitalSaratoga Hospital Saratoga Hospitalis a 207-bed community hospital serving SaratogaCounty and the surrounding areas.J. Recreation-The Saratoga Springs Recreation Department offers sports leagues foryouth girls and boys. Currently, the City offers soccer, basketball, t-ball, and flag footballlacrosse, field hockey, and volleyball.K. Media Saratoga news paper,WNYT and capital district YNN news.I. Wind Shield Survey 7. Running Head: COMMUNITY ASSESSMENT PAPER7 Windshield Survey City Saratoga Springs, NY By David Theobald & Sully Empire State College 10-12-12 Party CloudyTemp. 68 degrees 8. Running Head: COMMUNITY ASSESSMENT PAPER 8Map of Saratoga Springs NYWindshield Survey City 29.0 Sq. miles Coordinates 43431N 73 4657W Saratoga Springs NY First Settled 1776 Area 29.0 Square Miles Population 26,586 Government Mayor Scott T. Johnson 9. Running Head: COMMUNITY ASSESSMENT PAPER9 Major Attractions Horse Racing, The Springs, Performing Arts, Arts andEntertainment Education Empire State College and Skidmore College The Saratoga City School district six elementary schools, one middle school andone high school grades 9-12 Private Schools Saratoga Central Catholic High School, St Clementss, WaldorfSchool and Saratoga Independent School Population Census by race 2000 White alone - 24,005 (90.3%) Hispanic - 839 (3.2%) Black alone - 661 (2.5%) Asian alone - 516 (1.9%) Two or more races - 505 (1.9%) American Indian alone - 41 (0.2%) Other race alone - 15 (0.06%) Native Hawaiian and Other Pacific Islander alone - 4 (0.02%) 10. Running Head: COMMUNITY ASSESSMENT PAPER 10HousingSaratoga Springs ranked 75 of the 100 best places to live in US. According to CNNMoney Saratoga Springs downtown district is a very sought after market. Houses are well kept and prices reflect that. 11. Running Head: COMMUNITY ASSESSMENT PAPER 11 12. Running Head: COMMUNITY ASSESSMENT PAPER 12 Affordable HousingWilliam FordJefferson Terrace Vanderbilt Terrace Neat and clean units both single and mul family apartments. Housing Windshield Survey The rules and regula ons for Public Housing and Sec on 8 program are determined by the U.S. Department of Housing and Urban Development (HUD). The purpose of both Public Housing and theSec on 8 Program is to provide affordable housing to eligible low- and moderate-income families. 13. Running Head: COMMUNITY ASSESSMENT PAPER13Public Parks & Open Spaces for the CommunityMany Public Parks and Recreation Areas for the Community to Use 14. Running Head: COMMUNITY ASSESSMENT PAPER14Open Spaces & Parks Saratoga Spa State Park, distinguished by its classical architecture and listed as aNational Historic Landmark, is noted for its diverse cultural, aesthetic and recreationalresources. In addition to the nationally-known Saratoga Performing Arts Center, the SpaLittle Theater, the National Museum of Dance, the Saratoga Automobile Museum, theGideon Putnam Resort and Roosevelt Baths and Spa, the park offers a multitude oftraditional recreation opportunities.The Peerless Pool Complex consists of a main pool with a zero-depth entry, separateslide pool with a 19 double slide and a childrens wading pool with a mushroom fountain.The Historic Victoria Pool is a smaller pool surrounded by arched promenades. Both poolareas include food and beverage areas. The Saratoga Spa State Park Golf 15. Running Head: COMMUNITY ASSESSMENT PAPER15Course offers two beautiful golf courses; a championship 18-hole course and achallenging 9-hole course, complete with pro shop and restaurant. The gentle terrainoffers picnic areas, shady streamside trails, suitable for the nature-lover or the casualwalker, as well as certified running courses used by joggers and high school and collegeathletes. Winter activities include: cross-country skiing on approximately 12 miles oftrails, ice skating, ice hockey.Many Public Parks with Natural SpringsThere are currently 17 public mineral springs in various locations throughoutSaratoga. Each one is naturally carbonated. 16. Running Head: COMMUNITY ASSESSMENT PAPER 16 TransportationSaratoga has Buses, Taxies, Amtrak, major highways and well maintained roads and plenty of traffic lights and easy to follow signs. 17. Running Head: COMMUNITY ASSESSMENT PAPER 17Quality Health CareSaratoga Hospital is a 207-bed community hospital serving Saratoga County and the surrounding area. Major employer for the areaGood Side Walks and Free Parking Saratoga has had challenges with parking especially with tourism. The city just built a large parking garage for the public to use. 18. Running Head: COMMUNITY ASSESSMENT PAPER18Many Services Available For Those in NeedAlthough not as bad as other areas Saratoga did suffer from the difficulteconomic times, which meant many individuals called upon the help and services of The Salvation Army.Four WindsHealth and Social ServicesFour Winds is a Private inpatient, partial hospital, intensive outpatient and outpatient for mental heath and substance abuse. 19. Running Head: COMMUNITY ASSESSMENT PAPER 19Crime Rates Comparison From Area ConnectSaratoga Springs is one of the safest Cities in the Capital Region.Economics Saratoga Springs is a growing community. There are many new buildings andbusinesses under construction. The major employers are Stewarts Shops, Quad Graphic, Saratoga Hospital 20. Running Head: COMMUNITY ASSESSMENT PAPER 20 Challenges Although Saratoga Springs is doing well in this economic climate and there appears to be quality health care delivery systems in place some challenges could be identified. The challengesidentified, More low income housing. More agencies may be needed to support the increasenumber of mentally ill and chemical dependent residents. SchoolsEducation Empire State College and Skidmore College The Saratoga City School district six elementaryschools, one middle school and one high school grades 9-12Private Schools Saratoga Central Catholic High School, St Clementss, Waldorf School and Saratoga Independent School 21. Running Head: COMMUNITY ASSESSMENT PAPER 21 Saratoga Protective services for its residentsFire Department, Police Station, much of the cities public servicesare located in the down town district. Many officers patrol on foot. 22. Running Head: COMMUNITY ASSESSMENT PAPER22Down Town Saratoga has many Shops and stores that are tailored to Tourism. Down town has grocery stores, drug stores, clothing shops and many restaurants.Saratoga many dog friendly stores. Religion In Saratoga SpringsThe Saratoga region has a number of faith-based organizations and places to worship. The area houses numerous churches, temples and missions, alongwith many other organizations. 23. Running Head: COMMUNITY ASSESSMENT PAPER 23Thank You! 24. Running Head: COMMUNITY ASSESSMENT PAPER 24 Key Informants Key Informant (KI) number one is a Registered Nurse that works and lives in Saratoga Springs New York. The informant is 46 years old and has been working in the Emergency room at Saratoga Hospital for the last 5 years. The Key Informant is a married white female whos native language is English. Highest level of education: Bachelors of Science in Nursing. During tis interview the informant will be asked a series of questions about the community. Key Informant number two (KI2) is a 28-year-old white male from Schenectady NY. He is a bartender at a local restaurant now living in Saratoga Springs NY. (KI2) has his high school diploma and speaks English. 1. What are the strengths and assets of the community?(KI)- Saratoga Springs is a safe place to raise a family. Lots of community eventsand activities. Our community has quality healthcare and cares about our residents.(KI2) Fun city many good restaurants and clubs. I like the race track and Saratogaperforming arts center. 2. Areas of Improvement for the community?(KI) Improving services that expand job growth in the community.(KI2) Better jobs and more businesses. 3. Concerns of Community Members?(KI)-Saratoga springs has increasing number of residents that have chemicaldependencies and mental illness. The increasing number of patients being seen for 25. Running Head: COMMUNITY ASSESSMENT PAPER25drug abuse and mental illness is increasing. Having more resources to handle theinflux is essential.(KI2)- Expensive to live here. 4. Do patients have access to quality healthcare?(KI)- The people of Saratoga Springs have a community hospital that is expandingits services to meet the need of the community.(KI2)- I cant afford health insurance even if they offered it to me its difficult tolive in this city unless your have a good job. 5. What do you think it is like for the working poor living in this community?(KI)- Given the demand for real estate there is a much higher cost of living. Theworking poor are struggling to buy the essential items needed to live. Minimumwage workers have a very tough time getting by in this community.(KI2) Its hard and everyone is struggling to make ends meet. 6. How safe do you believe your community is?(KI)- Saratoga Springs is very safe. We have dedicated and professionalfirefighters, EMT and police that keep our residents safe.(KI2) Pretty safe we have an occasional bar fights or petty crimes but all in all safecompared to my home town. 7. Who has political power in the community?(KI) Saratoga has a commission form of Government. The Mayor and the electedofficials have the political power.(KI2) The mayor of Saratoga all the city spend sits money on is making it looknice for the tourists. 26. Running Head: COMMUNITY ASSESSMENT PAPER 26 8. Are there opportunities for the poor and vulnerable population to become involvedin the political process? Do you believe there voices are heard?(KI) During the city elections all city residents that own homes and are registerwith the city can vote. No I feel most of the poor probably dont own propertiestherefore are not allowed to vote on city issues.(KI2) Are beeping kidding me? No only the rich folks have say. 9. What housing is available to people with limited resources? Do you believe it isAdequate? (KI) a waiting list for housing assistance in Saratoga and not enoughnew low income housing being built.(KI2) I share an apartment with two roommates because its expensive to livehere.10 Is Public transportation available? (KI) Yes we have a good bus system. (KI2) Everything is close in the city and if you need a bus there are stops.11. What do you perceive as environmental hazards in the community?(KI)Saratoga Springs is a clean community that is recycling minded. I do notperceive any environmental hazards in the community at this time. (KI2) Acid rain and other pollution from surrounding areas.12. Do you believe the public education system meets the needs of the working poor In this community How? 27. Running Head: COMMUNITY ASSESSMENT PAPER27(KI) Saratoga Springs public schools are ranked in the top 10% in the area. Every studentregardless of social class or wealth can receive the same quality education.(KI2) I hear the schools are good. I graduated from Schenectady where we ranked poorlyfor academics. Saratoga is made up of a bunch of rich kids with no worries.13. Are English as a second Language classes available to the working poor?(KI) I do believe that there is a growing need especially during the Racetrack. Saratogasprings has many Spanish-speaking workers during the summer months. Many times theworkers come in to the ER because they are ill or injured. This creates a languagebarrier.(KI2) I am not sure but sounds like a good idea.14. Are there vocational/technical programs available for the working poor? (KI) I doknow of a group called Unlimited Potential that provides training to over 50 people withmental disabilities. I am not aware of all the programs for the working poor.(KI2) I am not aware of any programs other than the ones offered by the library but Ithink those are not free.15.Describe your perceptions of the health of the community? (KI) The communityoverall is very health conscious. Many people exercise and are active. On the other scalewhile working in the emergency room unhealthy health issues are more apparent.Obesity, mental illness, and substance abuse are frequently associated with the workingpoor.(KI2) I see a lot of active people running, walking, biking. It seems like a healthy place. 28. Running Head: COMMUNITY ASSESSMENT PAPER2816. How adequate and accessible are health services? (KI) For the most part veryaccessible. The hospital has outpatient centers and urgent care centers located in the cityand neighboring communities. Our hospital also has a 16-bed inpatient mental healthunit. Four winds is a large chemical dependency and mental health treatment centerlocated in Saratoga Springs. Not all patients can go there because it is a private. Thisdoes pose a problem for the working poor.(KI2) Thankfully I never had to us the local health services. I hear the hospital sucks. Myfriend was there for a broken foot and he was there for six hours before someone evenlooked at him.17.How is the community information transmitted? Is it effective and is it in otherlanguages? (KI) Mostly all the community news is posted in the Saratogian our local newpaper. Other areas include bulletin boards and news radio. The language is English and Ifind it to be largely effective.(KI2) Papers and TV18.How do the working poor and vulnerable population get important health information?(KI) All emergency room patients revive discharge instructions along with the necessaryreferrals for follow-up. These can be for primary care, mental health, chemicaldependency to social services.(KI2) I am not sure but guess from the community health centers? 29. Running Head: COMMUNITY ASSESSMENT PAPER2919. How does the economy of the community affect the health and social well being ofthe community? Poor? Is healthcare affordable? (KI) I feel the economy is doing wellbut this doesnt tickle down to affordable healthcare. The good thing is that ourcommunity is caring. Many people donate time and money to the local shelters and foodbanks especially during the holidays.(KI2) There are not enough high paying jobs for individuals that do not have a goodeducation. The poor just collect welfare and other free things while the rest of communityworks hard to support them. I have no tolerance for lazy people.20.What opportunities for fun and recreation are available for the working poor and arethey utilized? (KI)Our city has many public parks and recreation areas around the city. From myexperience I believe parks and community areas events are utilized by all the socialclasses.(KI2) Public Saratoga State Park. There are also lots of walking paths and other coolthings. Not much is free anymore and expect many things to go up.21. Can you tell me something about the cultural and spiritual/religious aspects of thepoor population an their family? (KI) There are many churches and community outreachcenters located in the city. The religious leaders in the community especially the salvationarmy provide supportive services through ministry and faith.(KI2) I am not religious but everywhere you turn there are churches. 30. Running Head: COMMUNITY ASSESSMENT PAPER3022. In your opinion, do cultural beliefs of the population affect delivery of health careservices? How? I feel that our community is composed of many different believesystems that are supportive of the poor and vulnerable. I see this the most during theholiday season. The community uses their beliefs to do more good for the less fortunate.(KI2) I dont see that as a factor.23. Is there anything else you would like to tell me that influences the health of thecommunity(KI) I believe the culture of Saratoga springs is rich in culture and history.The city was founded on its healing waters and natural springs. I feel that history stillrings true to this day.(KI2) The number of fast food restaurants.3.Epidemiology-is the study of the distribution of health and illness within a population,factors that determine the populations health status, and use of the knowledge generatedto control the development of health problems(Clark 2008 p.62). During my windshieldsurvey of the City of Saratoga Springs Ive identified a community need based on thepopulation groups. According to Healthy People 2020 Heart disease remains the highestpercentage of all mortality rates in the nation. Although the city of Saratoga Springs is ahealth conscious community the people are still at risk for heart disease and suddencardiac arrest. Chart 1.3 is from Healthy People 2020 and shows the greatest amounts ofdeaths of all ages in the United States of America. 31. Running Head: COMMUNITY ASSESSMENT PAPER 311.3 Source: Centers for Disease Control and Prevention, National Center for Health Statistics;data from the National Vital Statistics System (2006). Data are not age-adjusted.Based on the vital statistics from the CDC New York State including Saratoga CountyNY is not immune to heart disease and sudden cardiac arrest. Developing a CPR andAED teaching plan the community health nurse can have a significant impact on thepeople of Saratoga Springs NY and the surrounding community. Community healthnurses employ knowledge attitudes, and skills, in application of several specific processeswhen providing care to individuals, families, and population groups(Clark 2008 p.74).The health problem of heart disease and cardiac arrest affects all communities and doesnot discriminate against populations groups, racial/ethnic, rich or poor. In this communityassessment project I have identified nursing actions that will increase life savinginterventions for sudden cardiac arrest associated with heart disease. 32. Running Head: COMMUNITY ASSESSMENT PAPER 324. Population aggregate and developmental stage-According to the population aggregate ages 18-65 years old make up 67.2 % of thepeople in the community. Using Eric Eriksons eight stages of life we will examine theearly adulthood and middle age community members. Sudden cardiac arrest can impactpeople of all ages but this population is the most at risk. Erikson describes earlyadulthood as development of ones capacity for reciprocal relationships(Clark 2008p.497). The community involvement with CPR and AED training is a perfect preventiontool for the community. Young and old people can make to make a difference in theircommunity. Being certified in CPR is helping both early adulthood and middle agecitizens participate in life having strategies to help any one suffering from sudden cardiacarrest.As a community nurse I will use this information to increase awareness about the risks ofheart disease and sudden cardiac arrest. Community health nurses help resolve healthproblems through teaching and services.Nursing services may include activities such ashealth related education and influenza immunizations for older adults in an adult day carecenter, blood pressure screenings and nutritional counseling at a community health fair,stress management group discussion at a local church, or a cardiopulmonary resuscitation(CPR class in a school(Blais & Hayes 2011 p.348). 33. Running Head: COMMUNITY ASSESSMENT PAPER335.Political, Cultural, Economic and lawsThe City of Saratoga currently teaches CPR to the community through local EmergencyMedical Services, Fire Departments, American Red Cross and the American HeartAssociation. The economical issues are the cost for the training, which can be between$25 to $50 dollars per person. Although some CPR training & AED is free most isprovided of a fee. This could inhibit community members from getting trained. Themedia and community do support CPR training and offer training through communitycenters and the American Red Cross. Recent laws in NYS are increasing awareness ofCPR and its importance in the community.Currently, CPR is gaining national attention with bill S2491. This act is to amend theeducation law, in relation to requiring schools to provide instruction for CRP as part oftheir high school curriculum. If this bill becomes law it will have a significant impact onsaving lifes from sudden cardiac arrest. In addition to measures of disease andmortality, changes in the composition of a population over time are also important inplanning for health services (Shi & Singh 2008 p.71). This bill will provide life savingmeasures that addresses the leading cause of death in the United States.6. Community DiagnosisDiminish risk of sudden cardiac arrests deaths in the City of Saratoga Springs throughexpanding initiation of community CPR & AED training in the community.7. Community Resource: Adirondack Health & Wellness 34. Running Head: COMMUNITY ASSESSMENT PAPER34Adirondack Health & Wellness is a nurse owned and operated PLLC with locations inClifton Park and Saratoga Springs NY.Company Mission: When it comes to employee health, it takes more than just offeringsick days to keep your employees healthy and productive. Prevention is the bestmedicine. Adirondack Health & Wellness and health educators can then help them makepositive lifestyle changes for the long term, improving their health and well being. We allneed positive reinforcement, especially when it comes to change.The philosophy of the company is doing good for the community you serve. AdirondackHealth & Wellness provides CPR & AED training to corporations and medicalprofessionals. Because of the corporate sponsors and members the company is able todonate free CPR and AEDs to community sports leagues. This organization is workingwith members of the community to identify area sports leagues in need of CPR & AEDtraining.8. Community Health Nursing RoleThe role of the community nurse in this setting is to become certified to teach CPR &AED certification classes. Community health nurses employ knowledge, attitudes, andskills in the application of several specific processes when providing care to individuals,families, and population groups(Clark 2008 p.74).The ideal nursing role for the community health-nursing model is the interventions wheelfig 1.4. The model consists of 17 identified community health nursing intervention thatcross over three levels of population-based practice: individual-focused, community-focused, and systems-focused practice(Clark 2008 p75). Using this model we can breakit down into primary, secondary, and tertiary prevention. 35. Running Head: COMMUNITY ASSESSMENT PAPER35fig. 1.4 Minnesota Department of Health, St. Paul,Minnesota 55164-0975, USA.Primary prevention method for this population base oneducating the community on theimportance of AEDs and trained members of the community to use them. Anotherprimary prevention is advocacy in the community for increased awareness of theimportance of CPR & AED training in the community.Secondary prevention can be accomplished with health teaching and diagnosticscreenings in the community. Free Blood pressure and cholesterol screening in thecommunity can help identify people more at risk for developing heart disease. 36. Running Head: COMMUNITY ASSESSMENT PAPER 36Tertiary prevention is the treatment if consequences through life saving CPR & AEDinterventions in the community. Another highlight is prevention of recurrence by use ofAEDs in public places and more people trained to use them. 10. Conclusion for Community Assessment Heart disease remains as the number one heath problem in the United States of America. The City of Saratoga Springs is not immune from this epidemic. The community assessment project gave me the skills to identify the dimensions of a health problem and skills on preventing recurrences of the problem. The focus in community nursing is the community: it is a practice that is comprehensive and continues, takes place in a wide variety of settings, is directed toward all age- groups, and commands the utilization of all professional nursing roles(Clark 2008 .344). In summery this project will provide a valuable benefit for the City of Saratoga Springs. Through collaboration and communication with community leaders more citizens will be trained in life saving CPR & AED. By creating this program community health nurses are creating a safer place to live, work, and play. 37. Running Head: COMMUNITY ASSESSMENT PAPER 37 References Blais, K.K. and Hayes, J.S. (2011). Professional Nursing Practice: Concepts and Perspectives, (6th ed.). Upper Saddle River, NJ: Prentice Hall The Center For Disease Control. (November 27,2012) RetrievedFrom:http://www.cdc.gov/heartdisease/ Clark, M., (2008). Community Health Nursing Advocacy For Population Health, (fifthedition.). Peasron, Upper Saddle, N.J.Minnesota Department of Health. (December 7, 2012). Retrieved from:(http://www.dhs.wisconsin.gov/phnc/InterventionWheel/index.htm Schuster, P. and Nykolyn, L (2101). Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety,(1st ed.) Philadelphia PA:F.A. DavisCompanyShi, L., & Singh, D. A. (2008). Delivering health care in America: A systems approach (4th ed.). Burlington, MA: Jones & Bartlett.