NURS 6710 Week 9 priority setting paper example

Asthma First, the Highway Second: A Weighted Criteria Ranking of Three Corridor Health Problems, With the Residents' Dissent on Record

Student Name

College of Nursing, Walden University

NURS 6710: Public Health Nursing Theory and Practice

Instructor Name

Month Day, Year

Asthma First, the Highway Second: A Weighted Criteria Ranking of Three Corridor Health Problems, With the Residents' Dissent on Record

The Three Problems

Eight weeks of assessment in the composite corridor have narrowed attention to three problems. Pediatric asthma appears in the emergency visit figure, in the school nurse's caseload and in the diesel exposure at the park's fence line. Pedestrian injury appears in the crash reports, in the mid-block crossings seen during the windshield survey and in the residents' own accounts. Lost pharmacy access followed the closure of the corridor's only pharmacy, leaving the nearest one four miles away for households without cars. All three are real, and a public health nurse with limited hours cannot lead on all three at once. This paper ranks them using criteria fixed before any scoring began, so that the ranking can be checked, argued with and, if the evidence changes, redone.

Criteria and Weights

Five criteria were chosen, each with a weight set before scoring. Magnitude, weighted 20%, asks how many people are affected. Seriousness, weighted 25%, asks how severe the consequences are, including death, disability and lost school or work days. Community concern, weighted 20%, asks how strongly residents themselves rank the problem. Fit with the public health nursing role, weighted 15%, asks whether nursing can act on the problem directly or can only advocate for others to act. Equity effect, weighted 20%, asks whether action would narrow the gap between the corridor and the county described in the disparity analysis.

Seriousness carries the most weight because the purpose of ranking is to prevent the worst outcomes first. Role fit carries the least, because a problem nursing cannot solve alone may still be the most important, and a low weight keeps convenience from deciding the ranking. Equity is weighted as highly as magnitude because the assessment's starting point was a disparity; a choice that improved the county average while leaving the corridor behind would miss its purpose. Each problem is scored from 1, low, to 5, high, on each criterion. The score is multiplied by the weight and the products are summed, giving a maximum of 5.

How Community Concern Was Scored

Community concern was scored from an illustrative advisory group session run as a nominal group process, a structured method in which members first list problems silently and independently, then share them one at a time without debate, discuss each for clarity and finally rank them privately, with the rankings pooled (Delbecq et al., 1975). The method was chosen because it keeps the most confident speaker from setting the group's view and gives the pantry coordinator's quiet list the same weight as the association chair's. In the session, six of the eight members ranked pedestrian injury first. Two ranked asthma first; both were parents of children with asthma. No member ranked pharmacy access first, although four placed it second, and several described trips of more than an hour to collect a prescription.

The Matrix

Table 1

Weighted Criteria Scores for Three Corridor Problems

Weighted total equals the sum of each score multiplied by its weight. Scores are illustrative, drawn from the composite corridor's earlier weekly analyses.

Score Notes

Pediatric asthma scores 4 on magnitude because the school nurse's records and the ZIP-level emergency figure point to a large group of affected children, although the epidemiology brief warned that the figure counts visits, not children. It scores 4 rather than 5 on seriousness because deaths from asthma in children are rare, but missed school days and repeat emergency visits are common. It scores 5 on role fit because asthma action plans, home visits and school coordination are core public health nursing work. It scores 5 on equity because the diesel exposure that plausibly contributes to asthma falls on the corridor and not on the subdivision to the north; pooled studies tie children's exposure to traffic pollution to new cases of asthma (Khreis et al., 2017).

Pedestrian injury scores 5 on seriousness because a pedestrian struck at highway speed may be killed or permanently disabled. It scores 3 on magnitude because injuries, although severe, involve fewer people than asthma. It scores 2 on role fit because the solution is engineering, a crossing, a refuge island or a moved bus stop, which nursing can advocate for but cannot install. Traffic engineering evidence shows that measures separating pedestrians from vehicles reduce crashes (Retting et al., 2003), so the answer is known; the question is who will build it.

Pharmacy access scores 4 on magnitude because older residents with several prescriptions and families managing a child's asthma both depend on it. It scores 3 on seriousness because the harm is indirect, missed doses and longer trips, rather than acute. It scores 3 on role fit because nursing could help organize a delivery arrangement or a mobile clinic stop, but cannot reopen a store.

The Ranking and the Dissent

Pediatric asthma ranks first with 4.15, pedestrian injury second with 3.95 and pharmacy access third with 3.40. The result differs from the residents' own first choice. Six of eight advisory group members ranked pedestrian injury first, and the paper does not hide that. When the ranking was shared, the association chair said that residents had watched people cross the highway for years and that no one had counted them. That point is recorded here as it was made. The ranking stands because asthma scores higher on role fit and equity, and because a public health nurse can start work on it next month, but the dissent changes how the next step is planned: the asthma work will include the highway, since children walking to the bus stop cross it too.

The public health nursing competencies expect nurses to use data to set priorities and to engage communities in that process (Campbell et al., 2020). Recording the disagreement is part of meeting that expectation, not a departure from it.

Sensitivity Check

A ranking that flips with a small change in weights is not a strong ranking. Two alternatives were tested. If community concern is raised to 30% and role fit lowered to 5%, pedestrian injury rises to 4.25 and asthma falls to 3.95, and the two exchange places. If seriousness is raised to 35% and magnitude lowered to 10%, the two tie at 4.15. The result, then, depends on how much weight residents' concern is given relative to nursing's ability to act. That is a value judgment, and the paper states it: this ranking gives the nurse's capacity to act meaningful weight, and a different decision maker could reasonably choose otherwise.

What Happens to the Other Two

Pedestrian injury is not set aside. The nurse will bring the crash reports, the windshield survey notes and the advisory group's ranking to the county transportation office, with the residents' association as a partner, and ask for a crossing study. Pharmacy access will go to the county's aging services office and the health system's community benefit staff, with a request to explore a delivery arrangement or a regular mobile clinic stop at the church on Tuesdays, when residents already gather for food distribution. A ranking decides where nursing leads, not which problems deserve attention.

References

Campbell, L. A., Harmon, M. J., Joyce, B. L., & Little, S. H. (2020). Quad Council Coalition community/public health nursing competencies: Building consensus through collaboration. Public Health Nursing, 37(1), 96-112. https://doi.org/10.1111/phn.12666

Delbecq, A. L., Van de Ven, A. H., & Gustafson, D. H. (1975). Group techniques for program planning: A guide to nominal group and Delphi processes. Scott, Foresman.

Khreis, H., Kelly, C., Tate, J., Parslow, R., Lucas, K., & Nieuwenhuijsen, M. (2017). Exposure to traffic-related air pollution and risk of development of childhood asthma: A systematic review and meta-analysis. Environment International, 100, 1-31. https://doi.org/10.1016/j.envint.2016.11.012

Retting, R. A., Ferguson, S. A., & McCartt, A. T. (2003). A review of evidence-based traffic engineering measures designed to reduce pedestrian-motor vehicle crashes. American Journal of Public Health, 93(9), 1456-1463. https://doi.org/10.2105/AJPH.93.9.1456