| Course | NUR 547 Community, Global and Population Health |
|---|---|
| Module | Module 6 |
| Paper type | Community plan of care worksheet |
| Length | About 915 words, 6 pages |
| Format | APA 7 student paper |
| School | Arizona State University |
| Program | MS in Nursing |
| Updated | October 2026 |
Free sample paper for NUR 547 Module 6
Content Worksheet 3: A Community Plan of Care for South Tarawa, From Diagnosis to Evaluation
Student Name
Edson College of Nursing and Health Innovation, Arizona State University
NUR 547: Community, Global and Population Health
Instructor Name
Month Day, Year
Content Worksheet 3: A Community Plan of Care for South Tarawa, From Diagnosis to Evaluation
Community Assessment Summary
Earlier worksheets described South Tarawa as a crowded urban atoll with a young population, high literacy, limited land and fresh water, and a small, nurse-led public health system. Two health problems stood out. Kiribati recorded roughly 945 new tuberculosis cases per 100,000 people in 2024, and diabetes prevalence among adults aged 20 to 79 was about 24.6% (World Bank, 2026). Crowded housing, limited safe water and sanitation, and an imported food supply contribute to both, and climate-driven flooding threatens land and fresh water (Storlazzi et al., 2018).
Community Diagnoses
1. Risk of ongoing tuberculosis transmission among residents of South Tarawa related to household crowding, delayed case detection and treatment interruptions, as evidenced by an incidence near 945 per 100,000.
2. Risk of type 2 diabetes and its complications among adults in South Tarawa related to an imported, processed food supply, limited space for food production and low screening coverage, as evidenced by adult diabetes prevalence of about 24.6%.
Goals and Objectives
Goal 1: Reduce tuberculosis transmission in South Tarawa. Objective 1a: Within 12 months, screen at least 80% of household contacts of newly diagnosed infectious tuberculosis cases. Objective 1b: Within 12 months, at least 90% of patients starting treatment will complete it.
Goal 2: Prevent type 2 diabetes and detect it early. Objective 2a: Within 12 months, screen 3,000 adults aged 30 and older for diabetes through church and maneaba sessions. Objective 2b: Within 12 months, establish 20 community container gardens supported by churches.
Interventions Using the Intervention Wheel
The Intervention Wheel describes population-based public health nursing interventions at community, systems and individual or family levels (Stanhope & Lancaster, 2020).
Surveillance and case finding (individual and community): nurses and trained community volunteers visit the household of every new tuberculosis case to screen contacts for symptoms and refer for testing.
Outreach and screening (community): diabetes screening sessions at churches and maneaba, with point-of-care glucose testing and referral for those with high results.
Health teaching (individual and community): tuberculosis and diabetes education in the I-Kiribati language, using local foods and stories.
Collaboration and coalition building (systems): partnerships among the Ministry of Health, church networks, schools and a nongovernmental organization supporting gardens.
Policy development and advocacy (systems): support for taxes on sugary drinks and for prioritizing water and sanitation in climate adaptation funding.
Case management (individual): treatment support, including home-based observed therapy and help with transport and food for patients at risk of stopping treatment.
Cultural Considerations
The plan is designed to fit I-Kiribati ways of organizing community life. Decisions in villages are often discussed in the maneaba, where elders speak first, so the program will be introduced to elders and church leaders before screening begins. Education will be delivered in the I-Kiribati language by local nurses and volunteers, and a handful of community members will try the materials before they are used widely. Tuberculosis carries stigma, so contact screening will be framed as protecting the family rather than investigating it, and patients will choose where observed therapy takes place. Diabetes education will build on traditional foods such as fish, coconut, pandanus and breadfruit rather than on imported diet plans that do not fit local food supplies or budgets.
Resources and Sustainability
The plan relies mainly on people and structures already present: public health nurses, church volunteers, meeting houses and Ministry of Health supply channels. New costs include glucose meters and test strips, sputum collection supplies, transport support for patients on treatment, garden containers and seeds, and small stipends for volunteers. Because the country spends only about US$238 a head on health each year (World Bank, 2026), the plan seeks support from regional partners for start-up costs and builds gardens and education into church activities so they can continue without outside funds.
Implementation
Implementation builds on existing structures. Public health nurses in South Tarawa clinics coordinate the program, supported by church volunteers trained in symptom screening and glucose testing. Screening sessions are scheduled after Sunday services and community events. Supplies are requested through the Ministry of Health and partner organizations. A small steering group of nurses, church leaders and a Ministry representative meets monthly.
Evaluation Plan
Process evaluation will track the number of contact screenings and diabetes screenings completed, sessions held and gardens started. Outcome evaluation will track treatment completion rates, contacts found to have tuberculosis, the number of new diabetes diagnoses and referrals completed. Long-term impact, such as tuberculosis incidence and diabetes complications, will be monitored through national data over several years. Program evaluation principles from our reading guide the selection of measures that match each objective (Stanhope & Lancaster, 2020). Results will be shared each quarter with the steering group and with the churches and communities taking part, in plain language, so that people who give their time can see what it achieved. If treatment completion or screening numbers fall short at six months, the group will ask volunteers and patients what is getting in the way and adjust the plan.
Peer Review of a Classmate's Plan
I reviewed Jordan's plan for an informal settlement in Nairobi focused on childhood diarrhea. Strengths include clear objectives tied to latrine construction and handwashing, and a strong partnership with a community-based organization. Two suggestions: the plan could add a measure of water availability, since handwashing depends on it, and could involve mothers' groups directly in designing the education. Overall, the plan uses the Intervention Wheel well at community and systems levels.
References
Stanhope, M., & Lancaster, J. (2020). Public health nursing: Population-centered health care in the community (10th ed.). Elsevier.
Storlazzi, C. D., Gingerich, S. B., van Dongeren, A., Cheriton, O. M., Swarzenski, P. W., Quataert, E., Voss, C. I., Field, D. W., Annamalai, H., Piniak, G. A., & McCall, R. (2018). Most atolls will be uninhabitable by the mid-21st century because of sea-level rise exacerbating wave-driven flooding. Science Advances, 4(4), eaap9741. https://doi.org/10.1126/sciadv.aap9741
World Bank. (2026). World development indicators: Kiribati [Data set]. Retrieved October 4, 2026, from https://data.worldbank.org/country/kiribati
What the NUR 547 Module 6 instructions ask for
The posted syllabus places Content Worksheet 3 and a peer review of Worksheet 3 in Module 6, whose topics are planning interventions and evaluation, with Stanhope and Lancaster chapters on population-based public health nursing practice through the Intervention Wheel and on program management and evaluation. The syllabus describes the project as designing a plan of care for the community using the nursing process, with each student reviewing one peer's plan. Expect the worksheet to ask for community diagnoses, goals and measurable objectives, interventions, implementation and evaluation, and the peer review to ask for strengths and suggestions. Download the template and review form from Canvas before starting. Use the community diagnoses and problems from your first two worksheets so the plan follows from the assessment; faculty notice when a plan of care introduces problems the assessment never raised.
Inside the NUR 547 Module 6 example
The worksheet summarizes the assessment briefly, then writes two community diagnoses in a risk, related-to, as-evidenced-by format with data. Each goal has measurable objectives with targets and time frames. Interventions are organized by Intervention Wheel strategies and levels, from case finding to policy advocacy. Implementation uses existing nurses, churches and partners, and the evaluation plan separates process, outcome and long-term impact measures. A short peer review names two strengths and two suggestions for a classmate's plan. Three sources support the data and frameworks. Writing interventions under the Intervention Wheel's names lets the grader map each one to the model quickly, and naming the level in brackets shows the plan spans community, systems and individuals.
Reading the NUR 547 Module 6 grading rubric
Plans of care are commonly graded on community diagnoses supported by assessment data, measurable objectives, interventions appropriate to the problems and levels of the Intervention Wheel, feasible implementation, an evaluation plan that matches the objectives, and a constructive peer review. Faculty look for alignment: each objective should have interventions and measures. Using existing community structures shows feasibility. Peer reviews are graded for specific, actionable feedback rather than general praise. Consistency with earlier worksheets, realistic targets and attention to resources the community actually has are frequent comment areas in faculty feedback on this worksheet.
NUR 547 Module 6 help with common mistakes
Plans often lose points for objectives no one could measure, such as improve awareness. Add a number and a time frame. Another is interventions that do not match the diagnosis or level. Use the Intervention Wheel's terms and levels. Make implementation realistic for the community's resources. Separate process and outcome evaluation. In the peer review, give suggestions your classmate can actually use. For help turning your earlier worksheets into a plan of care, send them to the desk. Keep targets realistic; an objective that doubles a national screening rate in a year is harder to defend than one with a modest, explained target.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Arizona State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
More NUR 547 and MS in Nursing sample papers
- NUR 547 Module 1: Cultural Competency and Social Determinants Discussion
- NUR 547 Module 2: Global Community Content Worksheet 1
- NUR 547 Module 3: Ethics in Community Health Discussion
- NUR 547 Module 4: Global Community Content Worksheet 2
- NUR 547 Module 5: Health Promotion Models Discussion
- NUR 547 Module 7: Final Global Community Presentation
- NUR 521 Module 4: Technology Solutions to a Practice Issue Presentation
- NUR 593 Module 4: Intervention, Innovation and Evaluation Plan
- NUR 673 Module 2: Assessment Portfolio, Part 1: Test Blueprint
- NUR 670 Module 4: Checkpoint: How Do Beliefs Become Structure?
NUR 547 Module 6 questions, answered
Where can I find a free NUR 547 Module 6 sample paper?
The plan of care worksheet is on this page in full: community diagnoses, objectives, Intervention Wheel interventions, implementation and evaluation for South Tarawa, plus a peer review and references.
What is the Intervention Wheel in NUR 547?
A model of population-based public health nursing interventions, such as surveillance, outreach, health teaching and policy development, at community, systems and individual levels.
How do I write a community diagnosis for NUR 547?
State the risk, the population, the related factors and the evidence, for example risk of diabetes among adults related to food environment as evidenced by prevalence data.
What should a NUR 547 peer review include?
Specific strengths and one or two actionable suggestions for your classmate's plan, tied to the project criteria.
How do I evaluate a community plan of care?
Track process measures that show the plan was carried out and outcome measures that show whether objectives were met, plus long-term impact where possible.