Caring for populations: assessment and diagnosis

Caring for Populations: Assessment and Diagnosis
Krystle Gonzales
Chamberlain
Community Health Nursing
443
Prof Schoenberg
November 20, 2014

Introduction
A community health nurse must be effective in targeting the population as a whole. The nurse will determine the needs for the community by using the data compiled from a windshield survey. As stated in the text, “A population focus also involves a scientific approach to community health nursing: an assessment of the community or population is necessary and basic to planning, intervention, and evaluation for the individual, family, aggregate, and population levels” (Nies & McEwen, 2011). The purpose of this paper is to establish a priority health problem of the community of Harlingen, based on demographic, epidemiological data and a windshield survey of the area. Community The community assessment for this project is Harlingen, Texas. According to the 2010 United States Census Bureau, its population is about 64,918 of which 47.8% are male and 52.2% are female. The density is approximately 1629.1 residents per square mile. The racial makeup is 1.0% Black or African American, 79.5% Hispanic or Latino, 18.0% White, 1.9% from two or more races, 1.3% Asian, 0.1% Native American. The median household income, 2008-2012 was $34,096 in Harlingen, compared to $51,563 in the state of Texas. The percentage of persons below poverty level from 2008-2012 was 33.2% in Harlingen, compared to 17.4% in Texas. The city of Harlingen is in the center of the Rio Grande Valley. It is a community which has a transient population of “Winter Texans.” These Winter Texans are generally retirees from the northern states, who come to the warmer climates to escape the winter weather of their home states, usually between November and March. Harlingen has one mall, two medical hospitals and one mental health state facility, two libraries, one community college and numerous schools from primary to high school levels.
Demographic and Epidemiological
According to the website, County Health Rankings & Roadmaps, for Cameron County in 2014, teen pregnancy is measured by the teen birth rate per 1,000 female population, ages 15-19. The number for Cameron county teen births is 80, the number for Texas as a state is 57. There is poor quality of life in relation to health in Cameron County. 30% of the population has poor or fair health, compared to 18% in Texas. Cameron County also has an adult obesity rate of 27%, 21% of physical inactivity while there is 69% of access to exercise opportunities. 16% of the population suffers from excessive drinking and 396 counts of sexually transmitted infections. 36% of the population is uninsured, 86% graduated high school, 10.5% are unemployed and there are a whopping 48% of children in poverty, which has increased from the 2008-2012 numbers. The top causes of mortality in Texas are diseases of the heart, followed by Cancers and Respiratory diseases. Windshield survey During the observation of Harlingen for the Windshield Survey project, overweight residents were visible. The majority of the population is Hispanics, most were slightly overweight and appear relatively healthy. There are nursing homes and assisted living facilities in the community and they are mainly Hispanic and White older adults who are a mix of thin and frail to obese and unhealthy. Women are seen pushing strollers on the jogging trails, while the young children play in the parks. There are groups of teens who play football and basketball in the same area. In the residential areas, some people can be seen outside maintaining their properties, while other properties are dilapidated. The general appearance of the residents are healthy, with some being overweight. I have seen a few multimedia billboards for the local hospital, which is displaying an ad for bariatric surgery, which is appropriate for the current overweight population. Harlingen has some city parks and Boys and Girls clubs and numerous gyms in the area that are heavily utilized. The restaurants in the area are mainly along the expressway and lining the few main streets around town. There is no food sold along the street, but people can be seen sitting in the parks eating meals. In Harlingen, the population is overweight Hispanics and Whites who have access to healthcare and wellness measures, as it is advertised constantly. There is adequate transportation and resources available for the population. Problem
As stated before, Cameron County has an adult obesity rate of 27%, 21% of physical inactivity while there is 69% of access to exercise opportunities. While the averages for the state of Texas are 29%, 24% and 74%, respectively. Cameron County also has a limited access to healthy foods, 16% and 21% food insecurity and a mere 17% of children are eligible for free lunch. Since Harlingen and Cameron County have high obesity rates compared to the rest of the state, the Healthy People 2020 objectives applicable for Harlingen include: NWS-11 (Developmental) Prevent inappropriate weight gain in youth and adults and NWS-9 Eliminate very low food security among children. (Healthy People 2020, 2014)
While these are two distinct objectives they are connected, much education will be need to be done to ensure change. The community needs to be educated and held accountable for their actions, at times they are unaware of how much damage an unhealthy diet can do. The Community Health Nurse must prepare for these challenges and have a good understanding of how to present information that will gain the interest of the population. A community health nurse must be well versed in the numerous efforts that are starting to prevent childhood obesity. There are new physical education requirements, nutrition standards for beverages and foods sold in school, to community initiatives to expand bike paths and improve recreational facilities (Koplan, Liverman &Kraak, 2005). “Families need to make their homes to more conducive to a healthful diet and daily physical activity (Koplan, Liverman &Kraak, 2005). The nurse will need to get out to the community via health fairs, school assemblies, media outlets, etc. to get the message out there. Education on making healthy choices, getting adequate exercise and making small adjustments to their daily lives will help. According to the article, Relative and Absolute Availability of Healthier Food and Beverage Alternatives Across Communities in the United States, there was a study that was conducted on 3 years of data from the Bridging the Gap Community Obesity Measures Project. It stated the mean healthier food and beverage ratio was 0.71, meaning that stores averaged 29% fewer healthier than less healthy products. There were less availability of healthy alternatives in Hispanic communities (2014).
Summary
The community health nurse needs to be an expert in assessing and diagnosing health concerns in the community to be able to set realistic goals that will maintain the health of the population. Health promotion, education and community involvement are crucial. “Nutritional education is essential and must include parents, teachers, and the child” (Nies & McEwen, 2011). The community should know and understand the food pyramid, how to make healthy choices and the importance of balancing intake and exercise.

References
County Health Rankings & Roadmaps. (n.d.). Retrieved November 20, 2014, from http://www.countyhealthrankings.org/app/texas/2014/rankings/cameron/county/outcomes/overall/snapshot
Koplan, J., Liverman, C.T., Kraak, V.I., & Institute of Medicine, (.(U.S.). (2005). Preventing Childhood Obesity: Health in the Balance. Washington, D.C.: National Academies Press.
Nies, M. A., & McEwen, M. (2011). Community/Public Health Nursing (5th ed.). MO: Elsevier.
Nutrition and Weight Status. (n.d.). Retrieved November 20, 2014, from http://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status/objectives
United States Census Bureau. (n.d.). Retrieved November 20, 2014, from http://quickfacts.census.gov/qfd/states/48/4832372.html
Zenk,S.N., Powell, L.M., Rimkus, L., Isgor,Z., Barker,D.C., Ohri-Vachaspati,P., & Chaloupka, F. (2014). Relative and Absolute Availability of Healthier Food and Beverage Alternatives Across Communities in the United States. American Journal Of Public Health, 104(11), 2170-2178. doi:10.2105/AJPH.2014-302113

References: County Health Rankings & Roadmaps. (n.d.). Retrieved November 20, 2014, from http://www.countyhealthrankings.org/app/texas/2014/rankings/cameron/county/outcomes/overall/snapshot Koplan, J., Liverman, C.T., Kraak, V.I., & Institute of Medicine, (.(U.S.). (2005). Preventing Childhood Obesity: Health in the Balance. Washington, D.C.: National Academies Press. Nies, M. A., & McEwen, M. (2011). Community/Public Health Nursing (5th ed.). MO: Elsevier. Nutrition and Weight Status. (n.d.). Retrieved November 20, 2014, from http://www.healthypeople.gov/2020/topics-objectives/topic/nutrition-and-weight-status/objectives United States Census Bureau. (n.d.). Retrieved November 20, 2014, from http://quickfacts.census.gov/qfd/states/48/4832372.html Zenk,S.N., Powell, L.M., Rimkus, L., Isgor,Z., Barker,D.C., Ohri-Vachaspati,P., & Chaloupka, F. (2014). Relative and Absolute Availability of Healthier Food and Beverage Alternatives Across Communities in the United States. American Journal Of Public Health, 104(11), 2170-2178. doi:10.2105/AJPH.2014-302113