A.
Community health nursing is a concept that seeks to identify and analyze all vital data in relation to a community or a group of people to assist in the development of appropriate interventions that can improve the health status of the community or group. It is a concept that recognizes the importance of the social-health determinants and their influence on the quality of health and be quality of life depicted by the community (Stanhope, Lancaster & Stanhope, 2014). If applied, the community health nurse has to focus on the needs of the community across the economic, social, cultural and environmental levels so as to accomplish an all round understanding of the issues that limit or influence the health of the community.
I focused on Palm Beach County as a community of interest. It is an area that I have worked as a health volunteer for up to six months and within this period, I recognized that the region has specific health needs that need be addressed otherwise the healthy status of the population in Palm Beach County would be significantly affected in the next few years. However, there was a need to identify the actual health issues within the region and that meant making a detailed analysis across the various domains to determine the areas of weakness and strengths for this community.
B.
Utilizing the Population Economic Status Assessment, I checked the QuickFacts data updated as of April 2015. The QuickFacts indicated that Palm Beach has an estimated population of up to 1,422,789 people, which is equivalent to about 7.02% of the entire population of the State of Florida (U.S. Department of Health and Human Services, 2016; 2). Palm Beach County has an average population growth rate of up to 7.8% per annum, which is slightly lower than the population growth rate for Florida (7.93%). The Whites are the dominant racial group (73.5%) followed by the African Americans (17.3%) while 19% of the population identify as Hispanics (U.S. Department of Health and Human Services, 2016; 2). Within Palm Beach County, 14% of the population lives below the poverty level, but the county indicates a higher per capita income ($31, 696) as compared to the larger Florida with a PCI of $25, 187.
Apparently, there are wide disparities across this PCI with the Whites indicating a more than double PCI as compared to the African Americans while on the other hand, the PCI of the Hispanics was 60% above that of the African Americans (U.S. Department of Health and Human Services, 2016; 2). The unemployment rate in the county is as high as 8.8% which is a figure above the State rate of about 8.6% as well as the national rate at 8.4%. Palm Beach County depends mainly on the educational services, healthcare services and social assistance services as the three main industries for the region (U.S. Department of Health and Human Services, 2016; 2).
Further, utilizing the Cultural Assessment tool, I identified that up to 23% of the population is above 65 years old, 20.4% are above the age of 18 years and children below the age of five years comprise a partly 5.1% of the population (U.S. Department of Health and Human Services, 2016; 2). Despite the elderly population being the majority within the region, there are not apparent cases of neglect and the younger generation is tasked with tasking care of the elderly. They take up the roles of caregivers as part of a cultural agreement. This is a prevalent culture across all ethnic groups, but the African Americans seem more concerned about the issues of the elderly with minimal cases of preference for nursing homes or care centers for the elderly. However, the culture within Palm Beach County is diverse and integrated as indicated by the approaches to the care for the elderly, which seems to be taking a similar approach across all the existing ethnic and racial groups.
I conducted a Windshield survey for Palm Beach County on the 28th and 29th of June 2016 to assess the general appeal of the region and the observable characteristics of the community that can be related to the prevailing health status. The area is significantly based on a rural setting but the housing in the region is pretty decent and sustainable. A majority of the houses within the region are not refurbished and there are many visible cases of broken windows and extremely old iron sheets in irreparable state especially in the areas closer to the beach. Up to 60% of the housing in the region that I visited was either rented-housing units or public housing schemes by the government.
The sanitation, drainage, sewerage and general cleanliness of the these majority housing units was poor and the number of people per housing unit was seemingly high as indicated by the number of people around each housing unit as compared to the number of units. The rate of obesity and overweight in the region is extremely high across the age groups. Up to 50% of the elementary and middle school going children that I saw on each of these days were obese. The adults in the age category of between 25 and 40 years also had many cases of obesity and overweight.
There are many pubs in the region with the youth being the majority persons in these joints. The rates of cigarette smoking is high as seen by the number of cigarette sticks on the pathways and the number of people having a joint in the public places. There are many beer bottles in the flower beds and the roadsides. The parks are also characterized by many beer bottles, which is an indication of high alcohol consumption on the region. Most of the youthful generation is an idol and can be seen in the pubs or along the pathways. Most of them can be seen in the parks, playing cards and other gambling games.
There are many cases of teenage pregnancy within the region as seen by the number of young pregnant ladies or those carrying babies. There are few but just enough healthcare facilities in the region, mostly aligned to a church or a faith-based group but open to all the persons. The level of activity in these facilities is minimal with the elderly being the most visible users of these facilities as compared to the other age groups. The transport system in the region is poorly done especially that which serves the housing units that are approximately 4 kilometers away from the Highway.
In assessing the region’s general preparedness to disasters, I utilized the Community Disaster Preparedness Checklist. I identified that the County has a special office that deals with disasters such as floods and accidents which is attached to the police department and the fire fighting departments. The police and fire fighting departments are located in strategic places, especially midway between housing units to help increase the level of response to serious disasters.
The region is however at risk of a cholera and typhoid outbreak, especially for the residents living close to the beach due to the extremely degenerated sewerage and drainage systems and the children are not controlled while playing or walking in these areas. Further, to make an assessment of the widespread safety, I recognized that the boat industry in the beach has led to serious encroachment of the trees and vegetation in the areas near the ocean and the risks of floods in periods of high water levels is high. On the other hand, the uncontrolled release of waste matter into the sea poses a serious danger to the community and the life that is dependent on this sea water.
Further, with the use of the Population Health Scavenger Hunt I identified that there is a public toll-free line that the public can use to contact the disaster response teams in case of instant problems. The online links to the offices/departments are inactive with the last activity on the log being close to six months away. However, the Florida Department of Law Enforcement (FDLE), the Highway Patrol, the Palm Beach County Department of Health and Human Resource as well as the Palm Beach emergency Services work in tandem to provide necessary service to this population in times of need.
C1. Problems
The Health People 2020 describes several issues that determine or influence the health of the populations whole also providing ways and strategies through which they can be handled and managed. In reference to Palm Beach County, I prioritized three main issues that I considered pertinent to the health of the population this county. These include Nutrition and weight status, substance abuse and adolescent Health. on the aspect of nutrition and weight status, the Health people 2020 seeks to place emphasis on the importance of healthier diets as well as the need for physical activity and exercise as part of a health plan and regimen (U.S. Department of Health and Human Services, 2016; 1).
Within Palm Beach, the levels of obesity and overweight across the age groups are a case for worry and there is need to help avert the current trends. Apparently, these rates of obesity and overweight can be associated with poor dietary techniques, lacking education on appropriate dietary methods as well as pressing economic issues that limit the access to healthy foods. These three factors are, however modifiable or each of them can be resolved by substituting with an alternative that can assure better health outcomes (Stanhope, Lancaster & Stanhope, 2014).
Secondly, there is the issue of substance abuse which is a dominant problem amongst the younger adults and teenagers. The use of alcohol and cigarettes is considered as a first step that initiates one to other hard substances and the risk on health is high. The use of these drugs and substances can also lead to serious economic, social, emotional and family problems, all which have an impact on the health of the individual involved as well as the close relatives or family members(U.S. Department of Health and Human Services, 2016; 1). The use of drugs and substances gradually leads to a break in the normal chain of social and emotional life of an individual rendering them less useful within the community over time. This then builds the perfect platform on which issues of mental and emotional health begin to affect the individual. However, appropriate health education and health promotion ideologies coupled with legislative and regulatory mechanisms can help minimize these issues at the individual, family and community levels (Stanhope, Lancaster & Stanhope, 2014).
Thirdly, the issue of adolescence health is a major concern within Palm Beach County. The high rates of teenage or adolescence pregnancies as well as lower rates of utilization of health services within the community by these groups point to a gap between the healthcare sector and the adolescent groups. The high rates of teenage pregnancies can be associated partly to the incidences of drug and substance abuse and their apparent effect on behaviors and mind functioning. The risk of sexually transmitted illnesses for these youths is high within such conditions especially with the apparent lack of knowledge as visible within this generalized setting (Stanhope, Lancaster & Stanhope, 2014).
C2.
The problem that has been selected for further investigation is that of Nutrition and weight status. The incidences of obesity and overweight within Palm Beach County are escalating at an alarming rate with all age groups having not been spared. The incidences have shown greater prevalence within the African American population with significant disparities as compared to the whites within the same region. Apparently there is a correlation between the poverty rates in the area and the incidences of obesity and overweight. Similarly, even across the racial groups, for those families or individuals with similar income levels, the incidences of obesity and overweight.
It is important to recognize that the Palm Beach County Division of Clinical Health Services manages and supervises all forms of managed healthcare services for the people in this region who meet the eligibility requirements. This Division of Clinical Health Services also documents and keeps records of the health status for the County and uses the same to develop responsive policies and regulations that can improve the health of individuals. This government department plays the key role in setting out the infrastructure at physical and ploy levels to enable other stakeholders to come through and build an effective health system for the people of Palm Beach County (FloridaHealth, 2016).
There are other health agencies most of them non-governmental that have paved focus on health promotion and health education. Such include the March of Dimes, which is an organization that works with mothers and their newborns to ensure good health through proper nutrition in pre and post birth periods. Mentor Center of Palm Beach County is another body that works with various organizations and community based agencies to facilitate referrals and linkages for individuals willing to work with communities as volunteers to promote health. This organization technically provides the valuable human resource that is necessary within a strained community where health education and health promotion is a necessity (FloridaHealth, 2016). The Opportunity of Palm Beach County and Operation Hope organizations work closely with the poor families and individuals by providing them with the necessary basic materials such as food and clothing (FloridaHealth, 2016). These two organizations also work to place these groups through health education and training sessions during which they are acquitted with the skills and knowledge to make appropriate decisions particularly on food choices (Stanhope, Lancaster & Stanhope, 2014).
C3.
The obesity and overweight issues within Palm Beach County are an indication of a missing link between the community and the existing health care resources and personnel. There is a sincere need to bridge this gap and help build a society that is healthy conscious and one that can make appropriate health decisions and choices. However, there is also the need for support at the infrastructural and policy levels. at the policy level, the authorities in Palm Beach County need to take a more proactive role in regulating the number of fast food restaurants that are growing daily within the area and turning out to be the primary source of food for a majority of the residents.
Secondly, in order to fill the gap left by the gradual phase out of the fast food joints, the government and authorities within Palm Beach County need to partner with farmers and producers of natural foods such as vegetables and fruits. The purpose is to ensure that even in the exit of these fast food joints as an obvious choice, the residents of Palm Beach County have an option which includes affordable healthy foods. Subsidizing the costs of these foods either by minimizing the taxation for the producers as well as providing them with free filed services would promote their availability to this market over time and therefore eliminate the need for fast food joints.
Thirdly, the government has to put in place legislative mechanisms to ban the use of alcohol, cigarettes and other drugs especially amongst the young generations or put in place regulatory mechanisms that can make it difficult to access these substances. On the other hand, there is a need to partner with schools and faith-based groups in the area to develop community-based health promotion and health education program that will target each respective age group. This is within the consideration that the incidences of poor health and risk of other illnesses is spread across the age groups. The community in Palm Beach County has many health issues and most of them are tied to particular missing socioeconomic health determinants. The level of disparity across the racial groups as well as the high levels of poverty and unemployment have played a significant paltry in the current patterns and trends on health that can be seen. Thus, with time, holistic and systematic approaches need to be combined to help handle the myriad of challenges encompassing this community (Stanhope, Lancaster & Stanhope, 2014).
References
FloridaHealth. (2016). Florida Department of Health in Palm Beach. Retrieved from http://palmbeach.floridahealth.gov/index.html
Stanhope, M., Lancaster, J., & Stanhope, M. (2014). Foundations of nursing in the community: Community-oriented practice (4th ed.). St. Louis, MO: Mosby Elsevier.
U.S. Department of Health and Human Services. (2016; 1). 2020 Topics and Objectives – Objectives A–Z | Healthy People 2020. Retrieved from https://www.healthypeople.gov/2020/topics-objectives
U.S. Department of Health and Human Services. (2016; 2). Palm Beach County, Florida. Retrieved from http://www.census.gov/quickfacts/table/PST045215/12099
