| Course | NU704 Biostatistics, Epidemiology, and Social Determinants of Population Health |
|---|---|
| Unit | Unit 3 |
| Paper type | Social determinants analysis |
| Length | About 1,100 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | October 2026 |
Free sample paper for NU704 Unit 3
The Last Week of the Month on Insulin: A Unit 3 Social Determinants Analysis for Patients Leaving Two Dubuque Units
[Student Name]
Purdue University Global
NU704: Biostatistics, Epidemiology, and Social Determinants of Population Health
Unit 3 Social Determinants Analysis
[Instructor Name]
[Date]
The hospital, population and local figures are composite and illustrative; the studies and framework cited are real.
The Population
The analysis concerns adults discharged from 5 West and 6 West on insulin started or changed during their stay. Over twelve months there were 214 such patients. Ninety-one lived in the three ZIP codes with the lowest median household income in the hospital's service area, and 123 lived elsewhere. The 30-day return rate for glucose problems was 21 percent among the first group, 19 of 91, and 10 percent among the second, 12 of 123. All figures here are illustrative of the project setting.
Why Social Determinants
Braveman and Gottlieb (2014) argue that income, schooling, neighborhood and similar circumstances sit upstream of behavior and access, which is why they call them the causes behind the causes of illness. For a patient going home on insulin, those conditions decide whether there is food to match the dose, whether the pen and needles can be refilled, whether someone at home can help and whether the clinic is reachable.
The analysis below follows the five domains used by Healthy People 2030, which appear as its headings (Office of Disease Prevention and Health Promotion [ODPHP], n.d.).
Economic Stability
Food insecurity is the most direct link between income and insulin safety. Seligman and colleagues found, using national survey data on lower-income adults, that households short of food carried more chronic disease, diabetes included, even after adjustment (Seligman et al., 2010). For people already on glucose-lowering treatment, timing matters as well. Among low-income Californians, hospital admissions for hypoglycemia were 27 percent higher in the last week of the month than in the first, a pattern not seen in higher-income patients, consistent with food budgets running out before the next payment (Seligman et al., 2014).
A correct insulin dose becomes a dangerous one when the pantry is empty on the twenty-fifth.
Locally, seven of the 19 returns from the lower-income group occurred in the last ten days of a month, a pattern worth watching though too small to confirm.
Education Access and Quality
Schooling feeds into health literacy, and literacy affects how patients learn from written instructions and numbers on a pen. Among the 91 patients from lower-income ZIP codes, a larger share left school before graduating, according to admission records. The insulin bundle's reliance on demonstration rather than reading, and its plain-language materials with pictures, are responses to this domain.
Health Care Access and Quality
Access determines whether patients leave with what they need and can get help afterward. Chart review showed that 23 percent of all patients left without the pen in hand, most often because of insurance authorization or pharmacy hours; patients without a car or with Medicaid plans that required a specific pharmacy were overrepresented. Follow-up appointments were scheduled for most patients, but the nearest clinic for some is a bus ride with a transfer.
Neighborhood and Built Environment
Two of the three ZIP codes include areas the city has identified as having limited access to full-service grocery stores. Patients there depend more on convenience stores, where food choices and prices make it harder to eat consistent meals around insulin doses. Unreliable winter transportation compounds the problem, since icy sidewalks and reduced bus service make a mile to the grocery store a real obstacle for an older patient.
Social and Community Context
Living alone and limited social support affect who notices early signs of a low. Among returning patients, more than half lived alone. The city's Marshallese and Spanish-speaking communities have strong informal networks, which could support patients if materials and teaching reached family members in their languages.
What Three Patients Described
Brief conversations with three composite patients who returned within a month made the domains concrete. A 59-year-old man who works seasonal construction said his SNAP benefits ran out around the twentieth and that he skipped supper rather than lunch, not knowing that his evening insulin depended on it. A 71-year-old widow said she could not get to the pharmacy for new needles until her daughter's day off and reused one for a week. A 44-year-old Marshallese mother said the discharge papers were in English, so she followed what she remembered from a hurried explanation. None of these problems was about motivation or understanding in the usual sense. Each was a collision between a reasonable insulin plan and the conditions of a particular life, which is exactly what a social determinants lens is meant to reveal. Their stories also pointed to specific moments where the unit could have intervened: a question about food, a check on supplies and materials in the right language.
Actions a Hospital Unit Can Take
Units cannot change income or grocery locations, but they can respond to them. The analysis supports five actions. Screen for food insecurity at admission with a validated two-question screen, and refer positive screens to the hospital's social work team and local food resources before discharge. Teach patients on insulin how to adjust when meals are missed, including when to call, rather than assuming regular meals. Use bedside pen delivery and case management to remove pharmacy and authorization barriers before discharge. Schedule the 72-hour call and, for patients who live alone, ask about someone who can check on them. Provide materials in Spanish and Marshallese and include family members in teaching.
Measures
The project will report 30-day returns by ZIP code group and by food insecurity screen result, and will note the day of the month of each return. If the bundle reduces returns overall but not in the lower-income group, the team will know that clinical teaching alone is not enough for these patients.
Limitations
The local figures are small and illustrative, ZIP code is a crude measure of individual circumstances and the analysis relies on records not designed to capture social conditions. Asking patients directly, through screening and interviews, will provide better information than inference from addresses.
Conclusion
Patients from the hospital's lower-income ZIP codes returned more often after going home on insulin, and the evidence suggests why: food budgets that run out, barriers to supplies and care, and living alone. Organizing the problem by Healthy People 2030 domains makes it possible to choose actions a unit can take now, from food insecurity screening to bedside pen delivery, and to measure whether they reach the patients who need them most.
References
Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It's time to consider the causes of the causes. Public Health Reports, 129(Suppl. 2), 19-31. https://doi.org/10.1177/00333549141291S206
Office of Disease Prevention and Health Promotion. (n.d.). Social determinants of health. Healthy People 2030. U.S. Department of Health and Human Services. https://health.gov/healthypeople/priority-areas/social-determinants-health
Seligman, H. K., Bolger, A. F., Guzman, D., Lopez, A., & Bibbins-Domingo, K. (2014). Exhaustion of food budgets at month's end and hospital admissions for hypoglycemia. Health Affairs, 33(1), 116-123. https://doi.org/10.1377/hlthaff.2013.0096
Seligman, H. K., Laraia, B. A., & Kushel, M. B. (2010). Food insecurity is associated with chronic disease among low-income NHANES participants. The Journal of Nutrition, 140(2), 304-310. https://doi.org/10.3945/jn.109.112573
NU704 Unit 3 instructions, in plain terms
Unit 3 puts social conditions under the microscope for one defined group of patients, often using the Healthy People 2030 framework. Prompts tend to expect the population described with data, each relevant domain examined with evidence linking it to the outcome, local observations where available and actions that a nurse leader or organization could take. Instructors favor analyses that move from general statements about poverty or access to specific mechanisms, such as how food budgets interact with insulin dosing. Limits of the data, such as using ZIP codes as a proxy for income, should be acknowledged. Many sections also want measures that would show whether actions reach the affected group. Sources usually include the framework, a conceptual paper on social determinants and studies tying particular determinants to the outcome. Illustrative local figures should be labeled clearly as such.
How the NU 704 Unit 3 example is put together
The analysis opens by describing 214 patients split by ZIP code group, with return rates for each, labeled as illustrative. A section on why social determinants matter uses Braveman and Gottlieb's argument and introduces the five Healthy People domains as headings. Economic stability links food insecurity to chronic disease and to month-end hypoglycemia through Seligman and colleagues, under a highlighted line about an empty pantry late in the month, with a margin note on local clustering. Education, access, neighborhood and social context each get a section with a specific mechanism. Three composite patients describe their returns in their own terms. Five actions a unit can take follow, flagged by a second margin note. Measures stratify outcomes by ZIP group, screen result and day of the month, and limitations address small numbers and the crudeness of ZIP codes.
NU704 Unit 3 rubric: what earns full points
Social determinants analyses earn marks for defining the population with data, using a recognized framework, linking each determinant to the outcome with evidence, adding local insight, proposing feasible actions and measuring their reach. Population credit requires numbers, even illustrative ones clearly labeled. Framework use is scored on whether each domain is applied to this population rather than defined in the abstract. Evidence should connect a determinant to the specific outcome, as month-end food budgets connect to hypoglycemia. Local insight from records or patient conversations strengthens the analysis considerably. Actions should be within the student's or unit's influence while acknowledging larger forces. Measures that stratify results by the affected group show equity thinking. Honest limitations and correct APA citations for the framework, the conceptual paper and the empirical studies complete the criteria in most NU704 sections.
NU704 Unit 3 help: mistakes that cost points
The weakest submissions talk about social determinants for the whole country and never return to the population in the assignment. Another frequent weakness is listing all five domains with equal attention instead of focusing on the ones that drive the outcome. Some students propose actions such as raising wages that no unit can implement, without also proposing steps it can take. Others present ZIP code differences as if they described each patient, ignoring that individual circumstances vary. Leaving out how results will be measured by group means no one will know whether the actions helped. Start by comparing your outcome between two groups that differ in one social condition, then read a few charts from the group with worse results. Patterns usually appear. Your population and any local data are enough to begin a custom analysis.
Get an NU704 Unit 3 example written to your instructions
Send the population, any data you have and the analysis instructions with the rubric. A custom analysis organizes the determinants by domain, links each to the outcome with evidence and proposes action. The first is free, back within 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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NU704 Unit 3 questions, answered
Which framework organizes social determinants?
Healthy People 2030 groups them into five domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context.
Does a social determinants analysis need data?
Yes, ideally for the specific population. Census, survey and county data are common sources, and illustrative data should be labeled.
Should the analysis propose interventions?
Usually, with each tied to a determinant you identified.
Where can I find a free NU704 Unit 3 sample paper?
The full NU704 Unit 3 social determinants analysis appears on this page. It organizes the causes of glucose-related returns among patients from low-income ZIP codes by the Healthy People 2030 domains and proposes five unit-level actions.
What does the NU704 Unit 3 analysis say about the end of the month?
Studies in low-income populations show hypoglycemia admissions rising when food budgets run out late in the month, and several of the units' own returns fell in that period, so the analysis adds food insecurity screening and teaching about missed meals.