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W08 Assignment: �Data Collection Instrument EXAMPLES

PUBH 381

Ashley Suker

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Observer Name:_________________

Assessment Date:__/__/__

Observed Community Name and Location:_________________

Observed Location (ex. park, shopping center, school): ________________

Which of the following best describes the community?

◻︎ Rural

◻︎ Urban

◻︎ Suburban

◻︎ Other

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Never

Occasionally

Often

Very Often

Always

  1. Children under 5 appear to be visibly malnourished.

0

1

2

3

4

  1. Children aged 6-18 and under appear to be visibly malnourished.

0

1

2

3

4

  1. Adults over 65 appear to be visibly malnourished.

0

1

2

3

4

  1. Adults, ages 18-60, report skipping at least one meal per week because food supplies were limited.

0

1

2

3

4

  1. Children 18 and younger report skipping at least one meal per week because food supplies were limited.

0

1

2

3

4

  1. Adults, 18-60, can legally obtain inexpensive or free food within their community

0

1

2

3

4

  1. Children, 18 and younger, can legally obtain inexpensive or free food within their community.

0

1

2

3

4

  1. There are consistent places to buy fresh food in the community

0

1

2

3

4

Scoring Information:

Total Score Questions 1-3:________

Total Score Questions 4-6:________

Total Score Questions 7-8:________

Grand Score Total: _____________

Scoring Information:

Score: 25+ High Risk for Food Insecurity: :________

Score 20-24, Potential Risk for Food Insecurity: :________

Score Less than 20+ Potential Risk for Food Insecurity Low Risk for Food Insecurity: :________

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Those communities with scores of 25+ or higher will receive additional assistance and reviews from researchers Until their status changes.

SAMPLE W08 Assignment: Community Hunger Assessment Scale

Observation Start Time:_________________

Observation End Time:_________________

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Observer Name:_________________

Assessment Date:__/__/__

Employee Position:

◻︎ Physician (MD, DO)

◻︎ Advanced Practice Provider (NP, DNP, PA)

◻︎ Nurse (MSN, BSN, RN, LPN)

◻︎ Aides (CNA, MA)

◻︎ Other ___________________

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Yes

No

Comments

  1. Hand hygiene procedures performed according to facility protocol

1

2

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  1. Gown securely fastened at neck and waist

1

2

​

  1. Correct mask, respirator, or facial covering selected

1

2

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  1. Mask, respirator, or facial covering worn according to facility protocol

1

2

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  1. Correct eye protection worn (if appropriate)

1

2

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  1. Correct size gloves selected

1

2

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  1. Gloves securely covering gown cuffs

1

2

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Scoring Information:

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​

​

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Total Score:______________

Yes: 1, No: 2

Scoring Information:

Score: 10+, Incorrect PPE use, retraining required

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Score 8-9, most PPE donned correctly, educational materials provided for review

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Score 7, PPE donned correctly, no retraining needed

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Supervisor Signature: ____________________________

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Employee Signature: _____________________________

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SAMPLE W08 Assignment: PPE Direct Observation Checklist (Donning)

Observation Start Time:_________________

Observation End Time:_________________

Unit:_____________

Employee Name: ____________________

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Last, First

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Annotated Bibliography, TOPIC X

Citation:

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Source:

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Summary:

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Notes:

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Relevant to topic

Yes No

Keywords:_____________

Subtopic: _____________

Secondary Data Collection

This non-survey data collection instrument does NOT meet the Module 8 assignment requirements, but it frequently seen in public health practice.

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Annotated Bibliography, TOPIC X

Citation: (Kevern & Primrose, 2020)

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Source: Kevern, P., & Primrose, D. (2020).

Changes in Measures of Dementia Awareness in UK Church Congregations Following a ‘Dementia-Friendly’ Intervention: A Pre–Post Cohort Study. Religions, 11(7), Article 7. https://doi.org/10.3390/rel1107033

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Summary: The Dementia Friendly Church program (DFCh), a variation of the Dementia Friendly Community program, has been implemented in various dioceses throughout the UK. The church setting was selected because it is an existing part of the social structure of most communities, particularly rural communities, the church community is involved in supporting the family and individuals with dementia, knows the family support system, and tends to be stable over periods of time.

Notes: How can this be applied to our delivery method? How are our sites and presentations selected? Are we going through churches in rural areas? The US lacks a centralized church, is a state church necessary to push this information into the community?

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Relevant to topic

Yes No

Keywords:_____________

Subtopic: _____________

Secondary Data Collection

This non-survey data collection instrument does NOT meet the Module 8 assignment requirements, but it frequently seen in public health practice.