Community Windshield Survey Form

Caring for Populations: Milestone1: Community Windshield Survey Form
Directions: Please refer to the Milestone 1: Community Windshield Survey Guidelines
Type  your answers below directly on this form. Click Save as and save the file with the assignment name and your last name (e.g., “NR443 Windshield Survey

Form_SmithYour Name:     Date:
Your Instructor’s Name:
Criteria    Your response
1. Community introduction:
Identify the community you will be using for this assignment. It should be the area where you live or the area surrounding your work setting.
2. Windshield survey
a. vitality
b. Indicators of social and economic conditions
c. Health resources
d. Environmental conditions related to health
e. Social functioning
f. Attitude toward healthcare
3. Conclusion:
Provide a summary of your findings and your conclusion. What problems did you identify?
4. References:
OPTIONAL: List any references that you cited.

NR443 Guidelines for Caring for Populations
Milestone 1: Community Windshield Survey
The purpose of this assignment is to complete a direct observational assessment of a community in your area. This windshield survey will be the initial step in

uncovering a community health problem in your area and identifying community dynamics. This problem will be further assessed in the following two assignments.
This assignment enables the student to meet the following course outcomes.
CO #2. Integrate clinical judgment in professional decision-making and implementation of the nursing process through analysis of community health nursing practice. (PO

CO #5. Analyze the nursing roles in the community health setting. (PO #7)
CO #7. Accept accountability for personal and professional development as part of the life-long learning process. (PO #5)
.    DIRECTIONS . You will type your answers directly onto this Word document. Your form does NOT need to follow APA formatting; however, you are expected to use

correct grammar, spelling, syntax and write in complete sentences.
1.    Introduction to the Community: Identify the community you will be using for this assignment and provide a brief one to two paragraph description of the

community. Your community should be the area where you live or the area surrounding your work setting.
2.    Windshield Survey: Assess your community by doing an informal windshield survey. Information about the components of a windshield survey is located in your

textbook, Nies & McEwen (2011) on page 97 (Box 6-2). Drive through the area and report your observations by describing each of the following six areas using the

questions in the text as your guide (one to two paragraphs each):
a.    Community vitality
b.    Indicators of social and economic conditions
c.    Health resources
d.    Environmental conditions related to health
e.    Social functioning
f.    Attitude toward healthcare

It is helpful to conduct this assessment at least two different times: during the day or evening, on a weekday and/or on the weekend. If possible, plan on asking

someone to drive during your survey so that you can take notes.
3.    Conclusion: Provide a summary of your findings. The information gathered during the windshield survey should assist you to identify a community health problem

that will be further assessed in the next assignment.
4.    References: The purpose of this assignment is to document your observations of your community. Outside sources are not required. However, if sources are used,

these sources must be cited within the form and listed in the Reference section.
The following are best practices in preparing this project:
•    Make sure all elements of the form are included.
•    Review directions and grading rubric below thoroughly.
•    Cite any outside references as above (these are optional).
•    Proofread prior to final submission.

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