Community Health and Population-Focused Nursing C228: Task 1
In the United States, most people look for healthcare services by visiting their primary care doctor or specialists. However, this may change in future as health institutions increasingly adopt the concept if population focused nursing in place of preventing and treating health care problems on an individual level. Population-focused nursing refers to the evaluation of health care needs of a particular population and making health care decisions for this entire population instead of making decisions for individuals (Stanhope & Lancaster, 2014). The populations in question comprise of individuals who have some common environmental or personal traits. An example of population-focused nursing is when healthcare professionals using treatment guidelines for populations. In order to come up with the guidelines, a community assessment needs to be conducted so as to identify the health issues that the community faces.
Community assessment is a systematic process where the individuals involved want to become acquainted with the community (DuFour&Dufour, 2013). The purpose of the process is for one to become familiar with a community and the population by investigating factors that affect the health of the population. Health care practitioners including nurses are one group of professionals who conduct community assessments. This investigation allows them to identify capacities and strengths as well as risks and gaps. Health care professionals get insight and useful information that is needed to guide work with the population by carrying out community assessments. Such an assessment will allow us, students, to establish professional interventions in a collaborative way and in so doing contribute to community empowerment and change which is acceptable and appropriate for the concerned population. This essay is a community assessment of Sentinel City leading to the identification of problems that this community faces and recommending the best ways to address the issues.
Assessment of Needs and Risks
Sentinel City is made up of four neighborhoods namely Industrial Heights, Nightingale Square, Acer Tech Center, and Caper Park District. The whole city has a population of 663,862 persons with a median household income of 135,104. Industrial Heights has a population of approximately 28,855 with Latinos or Hispanic having the highest percentage of 46.8% followed by African Americans accounting for 13.1%. Persons under the age of 18 years are about 20.8% while those above 65 years are 0.9%. The median household income in this area is $24,672. The percentage of people without insurance in Industrial Heights is 37.5%. Nightingale Square has a population of about 103974 with the primary ethnicity being whites with 81.3% followed by Hispanic or Latino with 3.7%. Persons below 18 years account for 2.9% of the population while those above 65 years account for 13.9% of the population. The median household income of people in this locality is $269,550. The percentage of people without insurance in Nightingale Square is 0.7%.
Acer Tech Square neighborhood has a population of 168,390 with whites being the majority ethnic group with 70.2% followed by Hispanic with 13.7%. The proportion of persons under 18 years is 7.0% while those above 65 years is 19.8%. The median household income of Acer Tech Center is $166,300. The percentage of people without insurance in the neighborhood is 1.5%. The final locality is Casper Par district with a population of 352,643. The primary ethnic group is whites with 63% followed by Hispanic with 24%. Persons under the age of 18 years make up 33.8% of the population while those over 65 years are 6.5% of the population. The median household income of Casper Park District is $80,134. The percentage of people without insurance in the neighborhood is 22.7%.
Neighborhood/Community Safety Inventory
The community safety inventory is a tool used to explore the different possible hazards that are present in a given area. Using this tool was very interesting as it made me consider my surroundings from a different perspective. The air quality of Sentinel City is considerably clean as compared to most industrial cities in the country. The reason for this is the few industries present in Sentinel City. However, there is still some air pollution as the available industries located at Industrial Heights emit fumes into the atmosphere. The industries also contribute to water pollution in the area. Some of these industries release wastes and untreated water into water bodies near them. Run-off from heavy rains is another source of water pollution. Overflow from old septic tanks also pollutes water sources. The only form of radiation that is present in Sentinel City is that from intense sun rays.
The parks within the city have some pools of stagnant water that are suitable breeding grounds for mosquitoes. Mosquito-borne viruses have caused a significant health impact for the people living in Sentinel City. The built environment of Sentinel City also presents a risk to the population. The architecture in the older houses presents a risk of exposure of people to lead or asbestos and mold. The people may also be injured due to the general disrepair state of the buildings. The roads are also a source of potential harm to the population. There are some areas with potholes on the road surface, and this increases the risk of accidents. Poor lighting on the streets also creates a source of potential injury.
High rates of crime also pose a risk to the emotional and physical well-being of the community. The Sentinel City area has many common arrests, violent crimes, and gang-related crime incidents. In the crime arrests group battery, reckless conduct, possession of cannabis, criminal trespassing and public intoxication are examples of crimes committed by perpetrators. Although violent crime rates in the city have been on a decline over the past three years, they are still present with females accounting for a larger proportion of the victims. Cases of violent crimes including homicide, aggravated assault, simple assault, and robbery are also prevalent according to data from the city’s police department. The response of the emergency medical service (EMS) in Sentinel City is not at standards that it ought to although it ranks better than most cities in the country. More improvements to this department will help provide the community with better services.
According to Davison et al. (2013), a windshield survey is a systematic observation of an area made from a moving vehicle. Using the windshield survey technique on Sentinel city allowed me to view the area from a different perspective. It allowed me to make observations that I had overlooked many times during my duration in the city. The choice of this tool enabled me to traverse the whole area viewing aspects of town that could be seen from the roads. The windshield survey allowed me to examine various facets of the community including physical, economic, and social character. Below is a report of the windshield survey of Sentinel City that I conducted.
People: At 4 p.m. there were mostly children and women on the street. Many of the children were students wearing uniforms and carrying backpacks. Most of the women were dressed modestly in long skirts, hats, and jackets. The few men that I encountered were in varying in dressing with some wearing suits and long coats, others in plain clothes and those around health facilities in the city were wearing scrubs. There were also a few teenagers on the streets carrying backpacks and walking in groups of two or more. The population that I observed was mostly comprised of white people. There were also some few Hispanic, African American as well as Asian people observed. The groups are residentially located with the highest concentration of whites in the residential areas of the city and other communities dispersed throughout the city. Distribution of the races in schools was observed to be distinct. In areas around state-funded schools, a mixture of the races was observed while mostly whites were seen around the private institution.
Environment: There are some industrial factories in Sentinel City emitting industrial fumes into the atmosphere. The city also has parks with trees, grass and lots of open space. The roads within the city are mostly concrete or paved. There is a considerably low noise made by cars and buses that use these roads.
Space Use: Land in Sentinel City is mainly for residential and commercial purposes. Most spaces are private, and there is little free space on private residences. However, I also saw several parks in Sentinel City.
Housing: I noticed that the housing and architectural style of buildings varies by section of the neighborhood. The most common types of buildings are apartments and multi-family homes. I saw many vacant houses with most apartments having vacant signs on them. The houses are in good condition with old as well as new structures. There were industrial buildings as well in Industrial Heights area of the city.
Common Areas: The main area that people in Sentinel City hang out is at the public parks.
Transportation: People of Sentinel City own cars and bicycle and use public transport so as to get around the city. The most common means of transportation is the use of buses, followed by cars, and bicycles. The roads and streets are able to facilitate transportation within the city.
Stores: Joe’s Grocery is the main store in Sentinel City where people are able to buy groceries from. The store sells organic and non-organic foods including dairy products, pork, beef, eggs, poultry products, and fish. The biggest restaurant in Sentinel City is Lily’s Restaurant. Most people in the city have meals in this restaurant.
Service Centers: There are many health facilities and social agencies in Sentinel City. I saw many offices for doctors, specialists, and dentists. I also saw many daycare facilities. Most of them were for-profit daycares while the others included work-site-funded, publicly-funded, and private or faith-based daycares.
Street Sense: the majority of people in the streets were women, children, and teenagers. The clothes people wore reflected their place of work or study. For instance, children around schools were mostly wearing uniforms and men around Industrial Heights were in overalls and boots. This is to say that the people I saw were dressed appropriately considering the location and time of day when I saw them. The animals I saw on the streets were doves and a few stray cats and dogs.
Religion: There community is predominantly Christian with several churches around the city.
Politics and Media: There were few political campaign posters along the streets or on walls of the buildings in Sentinel City. Party affiliations were not openly apparent from my windshield survey. Widely available newspapers include Sentinel City Times and Hispanic Press.
Race and Ethnicity: As I moved around the city, I observed that whites made up the majority of the population especially in Nightingale Square and Acer Tech center neighborhoods. Hispanics were also considerably more than African Americans in Sentinel City. I also noticed that Industrial Heights area was mainly comprised of Hispanics and African Americans.
Population Health Scavenger Hunt
The final community assessment tool I used was the population health scavenger hunt. I really learned a lot from using this tool as it mandated me to get to know all the services that were offered in my city. Population health scavenger hunt also gave me a better understanding of how communities could benefit from these services. The first office that I visited was the local Health Department. The hospital called Better Health Clinic offered services such as contraceptive services, pregnancy testing/counseling, achieving pregnancy, basic infertility services, preconception health, sexually transmitted diseases services, breast cancer screening, cervical cancer screening, and other preventive health services. The staffs in the clinic were very helpful and glad to point me in the direction of the various units during my visit.
From my visit to the Health Department, I also learned that Sentinel City has a Healthcare System made up of the following departments: dentistry, vision, emergency department, ambulatory care, integrated services, inpatient, pharmacy, and elderly. Specialty dental clinics in the city included orthodontist, endodontist, dental hygiene, and pediatric oral surgery. Vision services included optometry clinics, corporate-owned vision clinics, low vision rehab, and eyeglass stores. The specialist vision clinics in the city included ophthalmologist, neuro-ophthalmologist, and vision therapy centers.
My next visit was the Women, Infants, and Children (WIC) office where I looked at the status of women and infants in Sentinel City. I noticed that the trend of teen pregnancy, birth, and abortion rates in the area has been reducing over the past few years. I also visited the day care facilities around Sentinel City. I visited all the neighborhoods checking the different types of day care center in those vicinities. I observed that the day care facilities were very efficient and children got the best care available. I then visited the waste and water management services to see the processes carried out there. Sentinel City has a state of the art water recycling plant that produces clean drinking water and daily water for use by the population.
Analysis of Collected Data
The designs of neighborhoods in Sentinel do not encourage physical activity. As was identified in the windshield survey, the residential houses have no spaces around them. Therefore, children do not have an opportunity to play around or engage in any form of physical activity while at home. One place with space to play is the parks in the town. However, the park is in poor conditions with many complaints raised by the residents. Some of the complaints include uncleanliness, a large number of homeless people, stray animals, the presence of drugs, crime incidences, and poor locations. Because of these issues, most people do not go to the park and hence do not partake in physical activities. Another contributor to obesity is the food consumption choice of the community in Sentinel City. Looking at Lily’s Restaurant, we see that the leading food consumed by members of the community has a high percentage of calories. This also contributes to the high number of people with obesity.
Top Three Problems in Sentinel City
Top Three Health Concerns/Problems in Relation to Healthy People 2020 Goals
The community assessment has shown that Sentinel City has health disparities that arise because of social, economic or environmental disadvantage. The health disparities affect the people in Sentinel city with systematically more obstacles to health based on their geographic location/environment; age; gender; socioeconomic status; cognitive, physical, or sensory disability; mental health; and gender identity or sexual orientation. For the case of Sentinel City, the following are the top three problems:
- Obesity: as is described in the scavenger hunt, Sentinel city has limited spaces for people to undertake physical activities as well as poor eating habits and this has led to obesity. Obesity is a health issue that affects most urban areas. Obesity is a serious health issue as it leads to contraction of other chronic ailments such as diabetes, some types of cancer, and cardiovascular diseases.
- Violence and crime: gang-related crime and other violent crimes have been reported in Sentinel City. Violence and crimes result in injuries and many deaths of people. Even though the number of crimes has been reducing, the rates are still high, and this warrants its inclusion in top three health concerns for the city.
- Prevention of STD prevalence: preventing STDs ad complications that arise from it is a goal of Healthy People 2020. The community assessment of Sentinel City has shown that there is a high prevalence of STDs in the community among students in higher education institutions
Availability of Community Resources to address obesity
The Healthy People 2020 initiative provides national objectives for improving the health of all people in America. Healthy People has established benchmarks and observed progress over time so as to encourage collaborations across sectors and communities, measure the impact of prevention strategies, and empower persons toward making informed health choices. In line with Healthy People objectives, this community assessment strives to improve the health of the society, in this case, Sentinel City. The health care problem that caught my attention is that of obesity in Sentinel City. There are very many stakeholders in Sentinel City that can help in tackling the issue of obesity. The resources include youth organizations, social and civic organization, businesses, restaurants, public health agencies, local government, grocery stores, businesses, recreation and fitness centers, and schools. All these are resources that the community can use in tackling obesity as will be shown in the next section.
Primary Prevention Topic
My primary prevention topic is encouraging physical activity and healthy diet as a means to combat obesity in Sentinel City. Prevention of obesity extends beyond individuals and families to the whole community at large. Many health professionals have acknowledged the need for involving the community in preventing obesity and promoting healthy lifestyles. The strategies that should be used to tackle obesity in the city are promoting physical activity and healthy nutrition. The specific strategies include:
- Community-wide campaigns: public health agencies, local governments, schools, and community organizations should collaboratively establish programs that encourage regular physical activities and healthy eating behaviors.
- Making the park safer and more conducive for people: the city should also make changes to the situation in the park. This is by reducing the number of homeless people and posting police there to reduce crime rates. Many more people will visit the park where they can play games and engage in other physical activities.
- Changing the diet in restaurant and grocery store: Lily’s Place and Joe’s Grocery in Sentinel City should be encouraged to serve healthy foods such as fruits and vegetables; and reduce offering those foods that lead to obesity.
- Providing spaces for children to play within residential neighborhoods: local governments should also work with private developers to revise comprehensive plans or subdivision and zoning ordinances to increase the number of free spaces in residential neighborhoods.
- Encouraging walking and cycling to school: the city should provide safe walking and cycling routes which would encourage students to walk or cycle between schools and homes.
Application of Learning from Simulation to Future Community Assessment Strategies
Simulation is usually used as a supplemental educational strategy to teach students of health care profession hands-on skills. It is a valued tool as it provides students with practical experiences of how they are expected to function in a real-world care setting. This situation analysis will help me in my future community assessment as it provides me with an idea of the places to get relevant information when assessing my community. For instance, I know that I should visit the health department so as to get information on health services that a community has access to. The simulation exercise also helped me appreciate the importance of involving everyone in the community in promoting healthy lifestyles.
Davison, K. K., Jurkowski, J. M., Li, K., Kranz, S., & Lawson, H. A. (2013). A childhood obesity intervention developed by families for families: results from a pilot study. International Journal of Behavioral Nutrition and Physical Activity, 10(1), 3.
DuFour, R., &DuFour, R. (2013).Learning by doing: A handbook for professional learning communities at work TM. Solution Tree Press.
Healthy People 2020. (2018). Retrieved January 16, 2018, from https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities
Sentinel City.(n.d.) Retrieved January 10, 2018, from http://citl.americansentinel.edu/twine/sc2.3_HealthcareSystem-Storylineoutput/story.html
Stanhope, M., & Lancaster, J. (2014). Foundations of nursing in the community: Community-oriented practice. St. Louis, Missouri: Mosby.