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Running head: E-FOLIO- ESSENTIAL VII 1

E-folio- Essential VII


Soibah K. Jalloh
Frostburg State University







E-FOLIO -ESSENTIAL VII 2

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
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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.
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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
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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
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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.
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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%)
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Females: 818 (52.3%)
Median resident age: 40.7 years
Estimated median household income in Hancock: $36,853
A1

- 1,503 (97.3%)
- 15 (1.0%)
Indian alone - 8 (0.5%)
- 7 (0.5%)
- 6 (0.4%)
- 6 (0.4%)




A2
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A3


Other production occupations including supervisors (13%)
Most Common Industries 2007-2011 (%)
Manufacturing
Retail Trade
Educational Services
Public Administration
Transportation & Warehousing
Construction
Whole Trade
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(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)
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A5


A6
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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
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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
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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