Community-based application of the clinical judgment measurement model in nursing education

To assess the adopted ZIP code, students conducted a community assessment through observation while walking and driving through the community that enabled them to identify key environmental and individual factors. These observations included housing conditions, population demographics, cultural elements, available resources, environmental factors, transportation, recreational spaces, businesses, and safety concerns. In addition to observation, students spoke with key informants, such as law enforcement, emergency responders, local business owners, housing managers, and residents about community strengths and areas of need. Students gathered information on demographics, biostatistics, and epidemiological data through the Florida Department of Public Health [FDPH] and U.S. Census Bureau systems.

Students identified cues based on their community assessment, talks with key informants, and demographic, biostatistical, and epidemiological data over the course of one week. In analyzing the cues, it was identified that the community was predominantly Hispanic (95.0%), with Spanish as the primary language spoken. A significant portion of residents (21.7%) lived below the poverty line, and 21.0% of individuals aged 65 and older reported having a disability.^{[5, 6]} Additionally, 19.9% of adults indicated limitations due to physical, mental, or emotional conditions.^{[5, 6]} The area was classified as high-risk for flooding and prioritized for evacuation.^[7] Emergency services reported repeated interventions during Hurricane Ian and the community had not yet fully recovered structurally. This information was reflected in similar comments from law enforcement, emergency responders, store owners and residents. Most hurricane preparedness information was disseminated in English only, creating a language barrier for many residents. Several residents expressed a lack of awareness regarding necessary supplies, and due to high poverty levels, many verbalized an inability to afford extra items to keep on hand for emergencies.

Three primary concerns emerged from the assessment: (1) language barriers that limited residents’ understanding of hurricane preparedness; (2) lack of awareness regarding where to access hurricane preparedness information; and (3) high poverty levels that prevented residents from acquiring essential emergency supplies. These factors were hypothesized to contribute significantly to the community’s vulnerability during hurricanes.

Potential solutions were collaboratively brainstormed amongst the seven students, and appropriate interventions were selected based on time and resources, that included people, money, and space. Using a Gantt chart (see Figure 1) as a project management tool, students outlined the tasks to be completed, established timelines, and assigned responsibilities to individual team members. They identified potential community partners, including first responders, the local housing authority, and nearby food pantries. To guide their planning, students referenced the Federal Emergency Management Agency’s recommended emergency supply list, available at https://www.ready.gov/kit.^[8]

Figure 1.

Gantt chart

Partnerships were established with the Sheriff’s Department Community Liaison and the housing development manager to support the initiative. After explaining verbally and in writing the purpose of the community-based service-learning activity, students solicited donations from family members, friends, and local businesses to assemble emergency kits containing FEMA recommended supplies of non-perishable food, bottled water, flashlights, batteries, first aid kits, and hygiene items.^[8] A bilingual brochure, written at a third grade reading level, was developed to provide essential information on hurricane preparedness, emergency contacts, and available resources. The brochure was initially written in English, translated into Spanish, and then retranslated into English to ensure accuracy. Reading level was checked through Microsoft Word.

To promote the distribution event, fliers were posted throughout the community in the local housing management office, laundry mats, gas stations, and grocery stores one week in advance. On the day of the event, free snow cones were offered as an incentive to attend, tables were set up in a central location, and supplies—including a three-day supply of non-perishable food for a family of four, flashlights with batteries, first aid kits, toilet paper, and brochures—were distributed in cloth bags by the seven students. Students provided verbal explanations about needed supplies and resources in both English and Spanish, answering questions and clarifying information as needed. The county sheriff’s department supported the event by having two community liaisons help distribute cases of water. The emergency medical technicians (EMTs) brought an ambulance and spoke with residents.

Approximately 300 people live in the focus area. Of that, a total of 73 families received hurricane preparedness kits and educational materials.

The objectives of improving people’s access to hurricane preparedness items and improving people’s understanding of what to do to prepare for a hurricane were achieved. During the weekly debriefing process, students reported a deeper understanding of how social determinants influence health and safety. Weekly reflection logs revealed increased empathy and heightened awareness of the challenges faced by future patients. Additionally, students expressed greater confidence in navigating real-world situations by assessing cues rather than relying on superficial information and following the process of identifying cues, prioritizing, developing and implementing interventions, and doing process and summative evaluation.

The population health clinical is only seven weeks during the summer months. This limited timeframe forced students to develop interventions that could be coordinated and implemented in a short period of time and did not allow for a thorough follow up after the next hurricane.