E-folio- Essential VII The purpose of this paper is to give a brief synopsis of Essential VII- Clinical Prevention and Population Health at the level of a baccalaureate prepared nurse. The main focus of Essential VII is the importance of health promotion, disease and injury prevention across the lifespan. Assisting individuals, groups and communities with health promotion and disease prevention measures and access to affordable healthcare are some of the crucial element of baccalaureate prepared nurse. Collaborating with other healthcare workers to ensure patients receive the optimum possible care and distributing information to the entire community about available assistance for lifestyle modification and disease prevention are also part of nurses responsibilities (AACN, 2008). Exemplar During my Population-Focus Nursing class, we had an assignment to select an unfamiliar community and conduct a community assessment for the selected community. The community that I selected was Hancock Maryland. Hancock is a very exclusive community located in Western Maryland with a population of 1,545 people, 694 households, and 407 families residing in the town. A community assessment was conducted and some of the findings were this community had a lot of old homes that are infected with molds and high hazardous conditions, high obesity rate and residents living sedimentary lifestyle with lack of accessible health care facilities in the community. With the recognition of the above problems in this community, I was able to come up with at least three nursing diagnosis, goals and recommendations to help address the problems. Some of the goals were: Educate the community about the hazardous conditions that are present in the community and how to approach the issues; health promotion, disease E-FOLIO -ESSENTIAL VII 3
prevention, and easily accessible health care services in the community. These are some of the cornerstone of Essential VII. Reflection According to American Nurses Association, population-focus nursing involves identifying the contributing factors of health and disease prevention, then prioritize primary prevention when possible and reaching out to the community for overall health improvement not only the people that could benefit from the information provided, but the entire community (ANA, 2007). Some of the focal points of Essential VII is to assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities, and populations; conduct a health history, including environmental exposure and a family history that recognizes genetic risks, to identify current and future health problems; assess health/illness beliefs, values, attitudes, and practices of individuals, families, groups, communities, and populations; and use behavioral change techniques to promote health and manage illness (AACN, 2008).
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References American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education for professional nursing practice. Retrieve from: http://www.aacn.nche.edu/education/pdf/BaccEssentials08.pdf American Nurses Association (2007). Public health nursing: Scope and standard of practice. Silver Spring, MD: Author 2010 Census U.S. Gazetteer Files http://en.wikipedia.org/wiki/Hancock%2C_Maryland http://www.city-data.com/city/Hancock-Maryland.html#ixzz31HCYgYee
Community Assessment of Hancock Maryland Soibah K. Jalloh Frostburg State University
Project Objective E-FOLIO -ESSENTIAL VII 5
This purpose of this paper is to choose a small community and conducts a community assessment to demonstrate higher level of critical thinking ability at the degree of a bachelor prepare nurse. Nursing has a wide range of clinical settings, which makes it even more important for nurses to have a better understanding of all the clinical settings that are out there. But for the purpose of this paper, the focus would be on community assessment and recommendations. According to our text there are Six Components of Community Health Practice: Promotion of health, Prevention of health problems, Treatment of disorders, Rehabilitation, Evaluation and Research (Allender; Rector; and Warner). The community that I had chosen to conduct my assessment on is Hancock Maryland. My interest for Hancock heightened during my community clinical rotation. My preceptor and I paid home visits to three distinctive individuals in their homes in Hancock Maryland during my clinical rotation in the community. Some of these patients homes that we visited had moles, unhygienic, and smelled of smoke to the point it was difficult to breath. Community Overview The first time my preceptor and I visited a patient in Hancock Maryland I was taken aback by the community yet amazed at the same time. After the visit, my preceptor took around to observe the rest of the community. My preceptor told me that this community is so small that she had the most difficult time adhering to the Health Insurance Portability and Accountability Act (HIPPA) laws when she visited her patients, because pretty much every house whole she visited knows a thing or two about some of her other patients. These residents would ask questions about other patients shes seeing in the community because they already knew what was going on with some of her patients. E-FOLIO -ESSENTIAL VII 6
During the time spent in Hancock, my preceptor and I dine in at one of the local restaurant called Park and Dine; it gave me the impression of a very old building in desperate need of renovation and new serving plates and utensils. Inside the restaurant at the back, they had a little convenient store, an area with cars supplies such as: car oil, tires, antifreeze, etc. The waiters were very nice but yet unprofessional in my opinion. We noticed some of the waiters were dining with customers and smoking in front of the restaurant door while carrying very inappropriate conversation with some customers. The waiters seemed to know all the customers by name and their work place and families. I felt like a complete outsider with strange stare from some of the customers and waiters. The restroom had holes on the floor and I noticed some moles on the wall as well. The windows were very dusty, and some broken areas noted. I was lost for words that this restaurant is still in business given the condition that it was in. Photo of Hancock Community
Windshield Survey E-FOLIO -ESSENTIAL VII 7
Hancock is a very exclusive community located in Western Maryland along interstate 68 and 70. Some of the physical boundaries that are closest to Hancock are: Hagerstown, Boonsboro, Clear Spring, Funckstown, Keedysville, Sharpsburg, Smithburg, and Williamsport; just to name a few. States that are closest to Hancock Maryland are: Pennsylvania and West Virginia. Hancock is a very rural community located in Washington County with no clear boundaries indicating the start and or the end of the community. Windshield survey of Hancock Maryland was conducted during the day and at night to get a better understanding of the community. The initial impression that was received when the Windshield Survey of Hancock was conducted during the day and night both resemble a very old community with poor lighting at night. Majority of the houses appeared very old and falling apart; also noticed few new houses with ample amount of land, but these houses were located far up in the mountains. Many low-income housing noted with very few high income housing. The low-income houses are spread out throughout the community with a fair amount of houses located on farms. These developments have single family homes and few attached housing. The houses appeared as though it was constructed from brick, wood, and vinyl materials. I noticed a building that looks like a small apartment building, but it had busted windows and in a very bad shape that I could not imagine anyone living there; but to my surprise people where living there. There are lots of undeveloped open spaces and also many farm lands with plantation, horses and cows. In some areas they had fresh fruits and vegetables in the street with no one there but a sign of what the prices are. I later learned that the locals knew to pick the items they wanted and theres a spot to drop off the money under the table of the items. I found that very interesting that people can trust random strangers and or E-FOLIO -ESSENTIAL VII 8
neighbors to do the right thing by paying fairly for the items they took and not remove the money that other buyers had paid. There were many tall trees, mountains, and bushes. The roads were very narrow and some places are only one lane travel and youd have to wait your turn to proceed and be very cautious. There were obvious signs to inform individuals about precautions such as: watch out for deer, one way, wrong way and so on and so forth; however, there were no signs indicating I noticed one Sheetz, another gas station with no obvious name; local restaurants were Hardees Burger, Weavers Restaurant, Shives Pizza and Subs, Pizza Hut, Subway, Tri-angle Restaurant, Truck Stop, and Park and Dine. There were no noticeable sidewalks or bus signs; which lead me to conclude that majority of the people own a car. Several people were observed entering stores, pumping gas, and very few people were observed crossing the streets. The people observed were in street clothing and some in dirty torn clothing, they also appeared to be in their 30s to 60s. Some were observed smoking cigarette and weight a little bit on the obesity side. Only one physician practice Tri-state Community Health Center, Inc observed and one pharmacy. No signs of Urgent care, medical practices or hospital noticed. The nearest hospital is War Memorial Hospital located in West Virginia. There were obvious signs of chronic conditions in this community, given the fact that the residents were older, obese, smoking, farmer, industrial worker etc. One Catholic Church was observed. There were few industrial properties spread out through the community. No obvious young adults/kids attractions, Recreation Park, or kids play area noticed. There was a sign spotted for Little Tonoloway Campground however. The developments appeared to be very filthy, and abandoned. The only schools in this community are Hancock Elementary, Middle and High public school. E-FOLIO -ESSENTIAL VII 9
Data Collection According to the United states Census Bureau of 2010, there were 1,545 people, 694 households, and 407 families residing in the town. The population density was 565.9 inhabitants per square mile (218.5 /km 2 ). There were 821 housing units at an average density of 300.7 per square mile (116.1 /km 2 ). The racial makeup of the town was 97.7% White, 0.4% African American, 0.5% Native American, 0.4% Asian, and 1.0% from two or more races. Hispanic or Latino of any race were 0.5% of the population. Out of the 694 households, 28.5% had children under the age of 18 living with them, 37.6% were married couples living together, 15.1% had a female householder with no husband present, 5.9% had a male householder with no wife present, and 41.4% were non-families. 36.7% of all households were made up of individuals and 14.3% had someone living alone who was 65 years of age or older. The average household size was 2.23 and the average family size was 2.86. The median age in the town was 40.7 years. 22.2% of residents were under the age of 18; 8.8% were between the ages of 18 and 24; 23.5% were from 25 to 44; 27.6% were from 45 to 64; and 17.7% were 65 years of age or older. The gender makeup of the town was 47.7% male and 52.3% female. (http://www.city- data.com/city/Hancock-Maryland.html)
Data Analysis
Males: 745 (47.7%) E-FOLIO -ESSENTIAL VII 10
Females: 818 (52.3%) Median resident age: 40.7 years Estimated median household income in Hancock: $36,853 A1
Other production occupations including supervisors (13%) Most Common Industries 2007-2011 (%) Manufacturing Retail Trade Educational Services Public Administration Transportation & Warehousing Construction Whole Trade E-FOLIO -ESSENTIAL VII 12
(9%) drivers (8%) (5%) (5%) (4%) (4%)
A4
Unemployment in July 2013: Here: 8.4% Maryland: 7.0% According to city-data: Air Quality Index (AQI) level in 2010 was 39.5. This is worse than average. Percentage of residents living in poverty in 2011: 11.7% (11.4% for White Non-Hispanic residents, 12.3% for Black residents, 0.0% for American Indian residents, 100.0% for two or more races residents) E-FOLIO -ESSENTIAL VII 13
A5
A6 E-FOLIO -ESSENTIAL VII 14
A7 A8 A9 A10 0% 20% 40% 60% Fuel oil, Kerosene, etc. Electricity Utility gas Bottled, Tank, or LP gas Most commonly used house heating fuel: Most commonly used house heating fuel: 0% 20% 40% 60% Other United Methodist Catholic Church Evangelica Lutheran United Church of Christ Religious Practices in Hancock Religious Practices in Hancock E-FOLIO -ESSENTIAL VII 15
A11
Conclusion It was a real eye opener to experience the culture and environment in Hancock Maryland. Given that I have lived in the city majority of my life, I was in a complete culture shock. Ive watched movies about small communities before, but to actually experience it was surreal. One of the major concern about the community health and well being for me would be hazardous condition such as asbestos and Mesothelioma, moles infected homes and the poor air quality. The next concern would be fire incidences in this community. During data collection, it was noticed that majority of the population uses fuel oil and kerosene for heating, which could be contributing to the high percentage of fires in this community. Also there are many older adults Incident types - Hancock Fire Hazardous Condition Good Intent Call 0% 20% 40% 60% 80% 100% Adult Diabetes Adult Obesity Maryland Hancock E-FOLIO -ESSENTIAL VII 16
living in this community that are farmers and with chronic conditions and limited access to proper health care. The first part of tackling the above issues would be to raise awareness and the hazardous conditions that are present so that people would start making informed decisions and coming with plans to reed/contain the hazardous conditions. The next issue to tackle would be to analyze the most common cause of fires in this community and come up with solutions to fix them. The final issues would be the lack of accessible health care facilities in the community. This community would benefit from proper healthcare services, especially given the obesity rate and sedentary lifestyle in the community. Nursing Diagnosis: Ineffective health maintenance related to lack of health care service as evidence by high obesity rate based on data collected. Goals: Health promotion, weight management, disease prevention Nursing Diagnosis: Lack of safety awareness related to poor living conditions as evident by mole infected homes, and high level of hazardous conditions Goals: Educate the community about the hazardous conditions thats are present in the community and how to tackle the issues. Nursing Diagnosis: Deficient Community Health related to lack of accessible health practices as evidence by only one physician office in the entire community Goals: Easily accessible health care services in the community, health promotion and education
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B1
Reference: Allender, J.A., Rector, C., & Warner, K.D. (2012). Community health nursing: Promoting and protecting the publics health (8th ed.). Philadelphia, PA: Lippincott, Williams, and Wilkins. 2010 Census U.S. Gazetteer Files http://en.wikipedia.org/wiki/Hancock%2C_Maryland http://www.city-data.com/city/Hancock-Maryland.html#ixzz31HCYgYee
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Appendix Data Analysis information were obtained from city-data website Images A1-A11 were all obtained from city-data website Image B1 obtained from Google images