How to write a nursing Community Assessment (Solved)

How to write a nursing Community Assessment (Solved)

Today, chronic diseases are a major public health problem that requires a proper assessment of communities and formulating plans to reduce their burden. One of the most effective ways to identify health problems is through performing community health assessments. A community health assessment refers to a state, local, tribal, or territorial health assessment that identifies key health needs and issues of a community through systematic and comprehensive data collection and analysis (Centers for Disease Control and Prevention (CDC), 2018). This aspect of health monitoring is recommended by the Institute of Medicine (IOM) whereby public health agencies are supposed to regularly and systematically assess the health of communities including aspects of health needs, health status, and epidemiological health data.

A community health assessment is the practical application of the IOM report recommendation. The purpose of the assessment is to enable public health agencies to identify and describe population health needs, factors contributing to health outcomes, and the community resources available to address observed challenges (CDC, 2018). A community health assessment informs the development of a community health improvement plan that involves long-term systematic efforts to address health problems in a given community. Portland City, Oregon is the area of focus in this discussion. The focus of this assessment is to identify the burden of obesity among adults in the community and the available resources to address this challenge. This assessment will observe the community environment, factors contributing to increased obesity among adults, preventive strategies available, and collaborative measures that can promote the prevention of the disease in the community.

Social Determinants of Health

Efforts to improve population health have traditionally focused on the health care system as a key determinant of health. However, evidence suggests that broader approaches addressing social, economic, and environmental factors can greatly improve the health of populations. Social determinants of health represent conditions in which people grow, live, work, and age that influences their health (Lakerveld & Mackenbach, 2018). They broadly include factors like neighborhood and physical environment, economic stability, food, education, social and community context, and health care system.

Resources that enhance the quality of life of individuals have a significant impact on population health outcomes. For example, economic stability factors like income, cost of living, and socioeconomic status that influences how people access essential services. Low socioeconomic status areas in the community may be faced with challenges like poverty that limits access to healthcare and food (Lakerveld & Mackenbach, 2018). The economic status also influences neighborhood and built environment that is a key determinant of health. Factors like poor access to transportation, fresh air, water, and neighborhoods with high incidences of crime affect an individual’s health. The availability of social support in communities mainly through civic groups and workplace cohesion influences the health of individuals (Lakerveld & Mackenbach, 2018). Regarding education access and quality, communities with well-educated individuals understand the importance of maintaining health alongside crucial elements like health literacy.

Health Problem Background

The increasing prevalence of obesity creates a growing burden for people, healthcare systems, and societies. Nearly 35% of the US population has obesity and this has increased stress on the health care system and the US economy. In Portland community, Oregon, the rate of obesity is 32.3% while adults account for 37% of all the affected individuals (America’s Health Rankings, 2021). The most affected population in the region are the Non-Hispanic blacks with a rate of 36.4%. These statistics are consistent with the national data because obesity is a challenge that cuts across the country. For instance, the rate of obesity among Non-Hispanic blacks is 36.6% nationally (America’s Health Rankings, 2021). The adults are the most affected group and this has led to a huge burden in the healthcare sector and the economy. Obesity is a condition that is associated with other chronic conditions like diabetes and heart disease making its prevention crucial.

Definition of Community

Portland City is generally organized into neighborhoods recognized by residents. The neighborhood I chose for this discussion is Old Town, the city’s oldest neighborhood. The neighborhood had a total population of 4758 in 2019 with 74% living in urban settings (NICHE, 2022). The neighborhood has approximately 49.3% male and 50.7% female population. The average resident age in the town is 36.9 years compared to which is 45.1 years. The estimated median household income in this region is $25,708 compared to a national average of $62,843 (NICHE, 2022). According to statistics, the largest ethnic group in the region are Non-Hispanic Whites who occupy 92.3% followed by the Non-Hispanic and American Indians with 421%. The Non-Hispanic Black or African Americans occupy a small percentage, 0.669% while the Asians constitute 1% of the total population.




Windshield Survey

Housing and Commercial Buildings

As I drove through the neighborhood starting from Portland Union Station, I observed that most houses were built in the middle 1990s. There were few buildings with modern designs with the majority of the people living in rental houses. From the car, I would see solar panels and large water tanks in most houses. The majority of the houses had adequate space in front and behind them with a few demonstrating signs of disrepair. As I drove down to 6th Avenue, I noted that most houses were connected. Many of the buildings in this area were for business purposes and had much more modernized designs. I could observe well-tended yards and modern plumbing in most areas.

Open Space and Boundaries

One key feature of Old-Town is plenty of space between houses to allow movement and other recreational facilities. For instance, I observed lush green parks in between streets with plenty of space for flowers. The lawns were spacious to allow easy movement for pedestrians and cyclists. I could see several trees on the streets especially along Burnside Bridge and Swine Pine street. Although most of the free space observed was private, public open spaces were available in the streets to allow free walking and playing. The largest park I observed was Governor Tom McCay Waterfront Park located at the rear part of the town. The boundaries for the city were clear and distinct with the two neighboring communities being Pearl District and Lloyd District. The key feature separating the old town from other neighborhoods is the Willamette River. I observed that the steel bridge and Burnside bridge provided entry into close neighborhoods in the Lloyd District.



Driving around the neighborhood, I observed that Old Town is a bustling entertainment district for many people. Common places for people included hotels and open spaces. For example, I could see several individuals entering and leaving the red Robe tea house and Deadstock Coffee and Gallery. Local footwear employees enjoyed these places probably because of their good dishes and services. I could see several restaurants and doughnut shops across the streets where people enjoyed their meals. The majority of the people in these places were adults, roughly 35 to 50 years, although teenagers and young adults enjoyed the recreational free spaces. The availability of many people in the restaurants and hotels in the evening meant that majority enjoyed their evening meals in these places.


During the windshield survey, I observed that most people move around using cars and buses. I could see several parking spaces across the streets while buses moved around to collect people. The roads and streets were conducive for transportation including the use of bicycles and motorcycles. I could see a few people cycling to work apart from those in parks who seemed to be doing exercise. Major highways run through the town to allow easy access to places while subways and streets provide direct access to town places and buildings. I could see various gas stations down the streets along with Portland Union railway station passing through the town. Despite the availability of these transport modes, I observed people moving up and about on foot. I could see students walking from schools and several other people moving by foot down the streets.



Service Centers and Stores

One of the key features of this neighborhood that I observed was plenty of recreational areas. I could notice parks at least every 800 meters along major highways. For example, most people occupied the waterfront Park near SW Pine Street while others enjoyed Stillwater river recreational facility, river trail and Pavillion Park, and Peace Pole park among many others. These parks were full of people with various activities going on. However, I observed that some parks were poorly maintained leaving only a few people interested.

Apart from these centers, I could see social agencies and schools across the streets. I could see clients lined up in the service centers like Community Aging in Place and the Housing Authority of the city. Another crucial element of the town was healthcare services provided by pharmacies, clinics, and hospitals. I noticed the availability of general hospitals for the public and medical centers like Providence medical center and OHSU Hospital. I could also see doctor’s offices probably used for consultations and pharmacies to sell drugs to the people. There were numerous stores distributed across the town to provide easy access to food services. Shopping centers like Old Town shopping mall and Pioneer Place were available to provide a variety of food choices to the public. Most malls and shopping centers were open from Monday to Friday depending on their preferences. Additionally, market places like the Portland Saturday Market and Portland Night Market provided a variety of fresh products to the people.

People Out and About

As I drove around the neighborhood, I observed that people were moving from one place to another. majority of the people I saw were women, some with children while those going to the market places carried shopping bags. I could see movements to and from restaurants, recreational parks, and students with bags walking in the streets as they went home. I could see several hawkers in town selling products to people and most moved around buying fast foods in the small established food centers. All the individuals I saw represented the demographics of the community. The majority of those moving around were Whites and they usually moved in groups. I could see older adults walking in the parks with dogs while the youths sited or walked in groups discussing. I noted that most people including adults and children were overweight and obese. I could barely drive 100 meters without seeing big-bodied men and women stalling down the streets. However, I was unable to identify racial similarities and differences among the individuals with obesity since the majority of the people seen were Whites.

Community Vibrancy

I noticed that the Old Town community was a vibrant community characterized by interconnectedness and innovation. The availability of diverse businesses, families, and opportunities demonstrated togetherness in the community. The town had large streets with good lighting, well-constructed roads, and signs all over the town to guide visitors. I could see people laughing and smiling with the elderly sited in the group giving stories. As I drove around the town, I noticed that small neighborhoods were defined by characteristics like housing indicating the different levels of economic stability. Some areas were overcrowded probably due to the availability of cheap housing while some had vacant houses. The neighborhood seemed to have different economic stability levels evidenced by shopping differences among ethnic groups. For example, I noticed that the whites were more into shopping in supermarkets while the Non-Hispanic Blacks or African Americans bought most of their products in open markets and streets. I noticed a few neighborhood meeting posters in town halls and political posters around the neighborhood. I observed a few people coming out of the gym, especially the young adults while others performed activities in the parks.

Health and Physical Environment

As I moved around the town, there was evidence of chronic conditions and health-related problems. For example, the majority of the population were overweight, moving around with cars and some tried to do evening walks as a strategy for addressing obesity. I could see posters on the streets advising people to eat healthily and do exercise. The achievements of the Communities putting Prevention to Work (CPPW) initiative were posted across the streets to encourage people to exercise. I did not see any signs of violence or accidents in the streets during the survey. Regarding the physical environment, I could see many restaurants and stores selling alcohol. Fast foods were available in several locations and people were queued waiting to be served.

Findings and Conclusion

Overall, I could say that Old Town is one of the desirable neighborhoods in Portland City. The community has a physical layout that is walkable with large streets and attractive buildings. The availability of different businesses demonstrates that the community is interconnected and values growth. I observed that Old Town is a vibrant neighborhood grounded in belief and the availability of affordable housing, commercial services, and retail activities makes it more interesting. The strengths of the community include safety, affordable housing, development, cohesiveness, and community vibrancy. The location of the neighborhood between two large districts provides room for growth and expansion. The availability of recreational parks provides an opportunity for leisure enjoyment and improvement of health through physical activity.

One thing that I noticed lacking in the community is adequate educational facilities, especially colleges. During my drive, I only came across Oregon College of Oriental Medicine and the Duck Store colleges. I could see several public schools serving the town but the unavailability of colleges was a key factor hindering its growth. Additionally, I observed that the town did not have modernized buildings to demonstrate growth and expansion. Most houses were from the middle 90s and the presence of museums indicated it was more of a traditional neighborhood.

A healthy community is not only characterized by factors related to health but also adequacy of housing, safe neighborhoods, employment, and transportation (Caffrey et al., 2018). Old Town neighborhood is generally a healthy community with adequate food supply, transportation, and affordable housing. Although most areas seemed to be overcrowded due to housing problems, I did not spot homeless individuals on the streets or any signs that people had housing problems. However, I observed that obesity among adults was a key issue in the community. Most restaurants and fast food points were full of people eating in the evening indicating unhealthy lifestyles. The majority of the people moved around in cars and buses indicating sedentary lifestyles that contributed to the problem. Despite the availability of parks and sidewalks, only a few people could be seen utilizing these services.

In conclusion, a community assessment seeks to gather accurate information representative of the needs of a community. The assessment identifies the strengths, assets, and challenges of a community to aid in planning for development (Caffrey et al., 2018). Old Town neighborhood in Portland City is generally a healthy community with good housing, average economic stability, and health care systems to address the needs of the population. The main health concern in this area is obesity that is related to poor eating habits and lack of physical activity among adults. A community development plan should focus on educating the community on the burden of the disease and the importance of early prevention through healthy eating and physical activity.




America’s Health Rankings. (2021). United Health Foundation annual report: Obesity, Oregon, United States.

Caffrey, A., Pointer, C., Steward, D., & Vohra, S. (2018). The role of community health needs assessments in medicalizing poverty. Journal of Law, Medicine & Ethics46(3), 615-621.

Centers for Disease Control and Prevention. (2018). Public health professionals gateway: Assessments & plans.

Lakerveld, J., & Mackenbach, J. (2017). The upstream determinants of adult obesity. Obesity facts10(3), 216–222.

NICHE. Portland: Old Town-Chinatown.

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