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Capstone Community Aggregate

Capstone Community Aggregate Paper

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NSG 4075 Holistic Professional Nursing

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Capstone Community Aggregate

The purpose of this paper is to discuss the creation and implementation of a health promotion project by synthesizing all information collected throughout the RN to BSN completion program. Complex issues are involved with implementing effective health programs.  These issues arise from the unique barriers that exist in culturally-stricken communities as well as from the inherent complexity of the health care field.

 

Introduction & Problem Statement

In order to catalyze behavioral changes at a societal scale, health education programs must address the cultural and social dimensions of health care. This means that healthcare necessities will not be used unless accompanied by effective and culturally appropriate education.  When working in a different cultural and social context, it is necessary to engage with a community “from within” in order to build an environment of trust.  Culturally appropriate education efforts are tailored and framed from the perspective of the target community.  Thus, to develop a culturally relevant education program, one must engage strategically with local culture to look at the way in which culture influences lifestyle and behavior.

Trends and Statistics

Hillsborough County has a diverse population in terms of race and ethnicity, age, and

 

income. Chronic diseases continue to be a concern in terms of their incidence, prevalence, and

 

the impact they have on the quality of life of individuals, families, and communities. Various

 

health conditions continue to disproportionately impact minority populations. According to

 

current data from the Florida Community Health Assessment Resource Tool Set (CHARTS), of

 

residents who reported being of one race, about 78% were White and about 17% were Black or

 

African American. Collectively, Asian, Native American Indian, Native Alaskan, Native

 

Hawaiian, and Pacific Islander accounted for 3.7% of the population. About 23.4% of the

 

population also reported being of Hispanic or Latino origin. Approximately 14.5% of people

 

residing in Hillsborough County in 2015-2016 were foreign born; 85.5% were native, including

 

39.0% who were born in Florida. Among those, 24.2% spoke a language other than English in

 

the home.

 

Related Sources

Implementing a healthcare education initiative without an adequate understanding of the local culture can be counter-productive, giving rise to more problems than solutions. For example, when working in a new cultural environment, health workers cannot assume that other cultures readily share, or are ready to submit to, their philosophies and belief systems. Diversity: is a word that means something different to each and every person. The changing demographics and economics of our growing multicultural world and the long-standing disparities in the health status of people from culturally diverse backgrounds have challenged health care providers and organizations to consider cultural diversity as a priority. Peer reviewed and research articles have demonstrated that there is a direct relationship between culture and health practices. In fact, of the many factors that are known to determine health beliefs and behaviors, culture is the most influential (Hardwood, 1981).

 

The Client: Objective & Subjective Assessment

Mr. J.P is a 75 years old, male client, diagnosed with Dementia, Diabetes Mellitus and

Obesity. J.P resides in a small ALF in Town and Country area. Client’s general health: Patient

diagnosed with HTN.DMII and Dementia. Cigarette smoker for 15 years and does not like to

exercise or been in a diet, complaining of feeling tired, fatigued and mild headache. Blood

pressure: 160/90.

 

Case Study

The following Functional Health Pattern assessment is based on a 75 year old Spanish man who lives in an ALF at Town and Country Community. Some of the issues found during this assessment were the lack of knowledge, cultural barriers and the resistant to change his behaviors. For subjective and objective data please see above. The purpose of this case study is to present a model that will be helpful in providing culturally competent care.

 

Aggregates’ Demographics

The physical boundaries include Memorial Hwy and clear boundaries that indicates where the community ends and begins. The economic boundaries in this community are very distinct. The rural areas contain a mix of both high-low income housing. The age of the housing range from 1965-1990. The urban area has several new retail centers that keep themselves busy and well maintained. Very few people have been seen walking around or on the street. The majority of the community is Hispanics and a small American influence is noted too. Most of the religious establishments are Catholics but the community shows homogeneity in religious preferences. The primary method of transportation is the car, with a very few sidewalks so walking is not a viable mean. Few political campaign posters were posted on houses or in store windows. Party affiliations were not readily apparent.

 

Gordon’s 11 Functional Health Pattern

J.P is aware of the need to maintain his health and undertakes preventative measures in order to have a fair health record. The diagnosed hypertension he experiences is appropriately monitored, but he is not compliant with his medication, diet and activity as reflected by his assessment.

 

Health Perception and Health Management

J.P perceives his health to be reasonably fair, not 100%, but fairly well for his age. Although J.P takes medication for the management of Hypertension (High Blood Pressure), he complaints of blurred vision and headaches frequently. When not controlled, Hypertension puts strain on the heart, damages blood vessels in the kidneys and damages the retina, resulting in a loss of vision (Herlihy 2007, p.331).

 

Nutrition and Metabolism

During a 24 hour period J.P usually consumes three main meals and rarely has snacks during the day. He believes his culture influences his eating pattern. He has no food allergies but does not modify his diet regularly based on his body image and weight fluctuations. Research suggests people who potentially suffer from a binge-eating disorder have a history of weight fluctuations and obesity (Edlin et al. 1997).

 

 

 

Activity and Exercise

He does not like to exercise. The risks of developing cardiovascular disease are greatly decreased by regular exercises such as walking and aerobic activity in addition to increasing the benefits of physiological and psychological wellbeing (Crisp and Taylor 2005, p.920).

 

Cognition and Perception

The average brain shrinks approximately 5-10% in weight between the ages of 20 and 90 resulting in a decrease in working memory, however, the brain can adapt and grow new cells, but this is dependent on physical activity, stimulation and learning (Santrock 2006). J.P is AOX2, disoriented to time and becoming more forgetful.

 

Self-Perception and Self-Concept

Of the most interest and focus, and highlighted throughout this assessment, was J.P’s image of himself. Although he states he is reasonably satisfied with his current status in life and what he has achieved for himself and his family, his perception of how he looks demonstrates issues around physical dissatisfaction, possible low self esteem and a lack of confidence in social situations. Erikson (1965) theories maintaining a positive self image and feelings of self worth is essential in order to achieve a successful transition to old age despite changing abilities and limitations.

Values and Belief

An individual’s sense of spirituality can be influenced by culture, life experiences and religious beliefs (Brush 2000). J.P is a practicing Catholic and spiritual person. His family and faith have always been the most important part of his life.

Windshield Survey

The leading cause of death for Hillsborough County residents is heart disease. While

 

the heart disease death rate has shown some improvement, it has remained the leading

 

cause of death for years, mimicking national data. The two major forms of cardiovascular

 

disease that make the greatest contribution to mortality are stroke and coronary heart

 

disease. In 2017, 2,756 average annual deaths from cardiovascular disease occurred in

 

Hillsborough County, with 1,517 people who died of coronary heart disease, and 421 who

 

died from stroke.

 

 

Concept Map

 

 

Genogram: One Individual in Aggregate

 

 

 

 

Plan of the Project

Taking this into account, nurses must initiate case finding activities and then provide appropriate patient education. For instance, once and older adult is identified as being at risk for heart disease, the nurse can teach the patient or caregiver to reduce the chance by exercising regularly, reviewing medications with their doctors and following a proper diet. The primary care practitioners in Town and Country include physicians, physicians’ assistants, and nurse practitioners.

 

Community Stakeholder’s Identified

PHYSICAL HEALTH: Free or sliding-scale medical facilities and other similar programs provide a clear benefit for low-income people and can improve community health.

SAFETY AND SECURITY: Neighborhood watch or patrol programs, better policing in high-crime neighborhoods, work safety initiatives – all of these and many other efforts can improve safety for specific populations or for the community as a whole.

MENTAL HEALTH: Community mental health centers and adult day care can be extremely important not only to people with mental health issues, but also to their families and to the community as a whole

 

Financial and Political Implications

Recently, much policy attention has been focused on the use of personal financial incentives to effect changes in health related behavior. Examples include schemes aimed at helping smokers to quit, people to eat healthily, and to adhere to their medication. On the other hand, incentive schemes all place individual choice and responsibility for personal behavior at the center of policy, and it is arguable that they are more respectful of autonomy than alternative, more frankly coercive or structure‐ rather than agency‐focused approaches to population health.

 

 

 

 

Feasibility of the Project

Hypertension is a highly prevalent risk factor for cardiovascular disease, and its early identification and management results in reductions in morbidity and mortality. My objectives were to: (1) determine the extent to which the emergency department (ED) has been used to screen patients for undiagnosed hypertension; (2) estimate the incidence of undiagnosed hypertension in the Town and Country population; (3) identify and describe the programs for hypertension screening; and (4) determine the feasibility of hypertension screening programs and the requirements for further study. An online search of databases (i.e., OVID Search, CINAHL, Scopus, Web of Science), unpublished sources (i.e., ProQuest Dissertation & Theses and Papers First), and a manual search of the reference lists of relevant studies was also completed. Hypertension screening in the ED is feasible. Individuals with elevated blood pressure (BP) in the ED should be referred for follow‐up. Further study is needed to develop a screening tool that is predictive of persistently elevated BP in undiagnosed individuals.

 

Provision of Alternate Plan and Interventions

Create coalitions and pursue health promotion education with community leaders to create health initiatives that teach chronic disease prevention strategies. The following elements should be included: Create education programs and materials for older adults to make necessary changes in diet. Teach patient to ask about medications that have been prescribed for him or her.

Refer patient and family to community resources that may offer assistance to the patient when

 

needed.

 

 

Role of Change Agent

Communication is at the center of all advocacies, getting the message out there, gaining the support of stakeholders and the public and putting pressure on decision makers will make the difference.

 

Implementation

Encourage patient to maintain a diary of food intake, including when and where eating takes place and the circumstances and feelings around which the food was eaten. Refer to dietitian as indicated. Instruct and assist in appropriate food selections, such as a diet rich in fruits, vegetables, and low-fat dairy foods referred to as the DASH Dietary Approaches to Stop Hypertension) diet and avoiding foods high in saturated fat (butter, cheese, eggs, ice cream, meat) and cholesterol (fatty meat, egg yolks, whole dairy products, shrimp, organ meats).

 

Evaluation of the Project

Health resource utilization was collected by self-report as the number of hospitalizations, emergency room (ER) visits, and physician office visits during the study period. Pharmacist recommendations were collected, categorized, and evaluated for physician acceptance. From the patient perspective, nurses provided tailored educational services and home BP monitoring equipment to engage them in their hypertension care. From the physician perspective, nurses provided information regarding medication use and home BP measurements and collaborative patient care occurred. Importantly, physicians were willing to work with nurses to improve patient care. Clearly, this strategy would not be effective if either the physician or nurse was not willing to collaborate.

 

Implications to Nursing Practice in the Local Community

A community health nurse can reach out to the president, council members, and

community leaders of Town and Country in an effort to reach out to the community via meetings, seminars, and school presentation, which will facilitate community education and bring about awareness about major community issues. The need for more accessible health insurance and screening clinics, as well as increased health education needs to be

implemented. Similarly, the importance of regular doctor’s visits and health screenings should

be emphasized through community health initiatives. The elderly may be in need of services

like home health aides, assisted living, or tele-health technology. Utilizing community

resources and health initiatives would enable the neighborhood to be educated as well as be

involved in disease management which will bring about positive changes.

 

Implications to Nursing Practice and Global Health

Global health work is complicated by a variety of factors.  First, the local environment of each target community varies widely, each presenting unique challenges to the delivery of health care.  This means that education efforts must be locally conceived, tailored, and implemented.  Secondly, barriers to accessing care are widespread and require innovative strategies to overcome them.  Third, the healthcare field is complex in nature, requiring trained professionals and follow-up care to ensure adherence to drug regimens. In order for global health programs to be effective, these complexities must be recognized, understood and addressed.

 

 

 

Summary, Recommendations and Conclusion

Continued improvement and increased participation in health initiatives, improved cleanliness, increased income, community safety, and continued access to healthcare are all long term elements that should continue to be addressed.

 

 

 

References

Campinha-Bacote, J., (January 31, 2003). “Many Faces: Addressing Diversity in Health Care”.

Online Journal of Issues in Nursing. Vol. 8 No. 1, Manuscript 2. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContent

Volume82003/No1Jan2003/AddressingDiversityinHealthCare.aspx

 

The Provider’s Guide to Quality and Culture http://erc.msh.org/quality&culture

 

National Center for Cultural Competence (NCCC) www.georgetown.edu/research/gucdc/nccc/

 

Transcultural and Multicultural Health Links http://web.nmsu.edu/~ebosman/trannurs/index.shtml

Thomas, Stephen B., Michael J. Fine, and Said A. Ibrahim. “Health Disparities: The Importance of Culture and Health Communication.” Am J Public Health Dec 2004 Web.23 Jun 2009.

Edward O’Neil Jr., A Practical Guide to Global Health Service (American Medical Association, 2006), 24.

Running head: CAPSTONE COMMUNITY AGGREGATE PAPER 16

 

Running head: CAPSTONE COMMUNITY AGGREGATE PAPER 21

 

 

N:\3. RN-BSN Completion Program\RN to BSN Curriculum\RN to BSN WPB\NSG4075\2015_4 – Fall\Items to Upload to eCompanion\4-TEMPLATE.Capstone Project Paper.docx

 

 

 

 

Appendices

Appendix A

Housing

 

The age of the housing range from 1965-1990. The urban area has several new retail centers that keep themselves busy and well maintained. Very few people have been seen walking around or on the street. The majority of the community is Hispanics and a small American influence is noted too.
Public Spaces Pollo Tropical. KFC. Taco Bell. Joe¶s Sports Bar and Grill appeared crowed.

 

Itwas located in Afton Park and is a place for sports fans to come together on the weekend or after work. It was advertising the NCAA basketball tournament. There were severalshopping plazas, with Concord Mills being themost popular. Many people (especiallyteenagers) walk around the mall as a way tosocialize. Children were observed playing onthe playground at the elementary schoo

Joe¶s Sports Bar and Grill appeared crowed.

 

Itwas located in Afton Park and is a place for sports fans to come together on the weekend or after work. It was advertising the NCAA basketball tournament. There were severalshopping plazas, with Concord Mills being themost popular. Many people (especiallyteenagers) walk around the mall as a way tosocialize. Children were observed playing onthe playground at the elementary school.The common areas, particularly located near Lowe¶s Motor Speedway and Concord MillsMall, appeared welcoming and open to the public. It was inferred that this is related to thedraw of people from all over the region, stateand country to these venues

Joe¶s Sports Bar and Grill appeared crowed.

 

Itwas located in Afton Park and is a place for sports fans to come together on the weekend or after work. It was advertising the NCAA basketball tournament. There were severalshopping plazas, with Concord Mills being themost popular. Many people (especiallyteenagers) walk around the mall as a way tosocialize. Children were observed playing onthe playground at the elementary school.The common areas, particularly located near Lowe¶s Motor Speedway and Concord MillsMall, appeared welcoming and open to the public. It was inferred that this is related to thedraw of people from all over the region, stateand country to these venues

Joe¶s Sports Bar and Grill appeared crowed.

 

Itwas located in Afton Park and is a place for sports fans to come together on the weekend or after work. It was advertising the NCAA basketball tournament. There were severalshopping plazas, with Concord Mills being themost popular. Many people (especiallyteenagers) walk around the mall as a way tosocialize. Children were observed playing onthe playground at the elementary school.The common areas, particularly located near Lowe¶s Motor Speedway and Concord MillsMall, appeared welcoming and open to the public. It was inferred that this is related to thedraw of people from all over the region, stateand country to these venues

Joe¶s Sports Bar and Grill appeared crowed.

 

Itwas located in Afton Park and is a place for sports fans to come together on the weekend or after work. It was advertising the NCAA basketball tournament. There were severalshopping plazas, with Concord Mills being themost popular. Many people (especiallyteenagers) walk around the mall as a way tosocialize. Children were observed playing onthe playground at the elementary school.The common areas, particularly located near Lowe¶s Motor Speedway and Concord MillsMall, appeared welcoming and open to the public. It was inferred that this is related to thedraw of people from all over the region, stateand country to these venues

Joe¶s Sports Bar and Grill appeared crowed.

 

Itwas located in Afton Park and is a place for sports fans to come together on the weekend or after work. It was advertising the NCAA basketball tournament. There were severalshopping plazas, with Concord Mills being themost popular. Many people (especiallyteenagers) walk around the mall as a way tosocialize. Children were observed playing onthe playground at the elementary school.The common areas, particularly located near Lowe¶s Motor Speedway and Concord MillsMall, appeared welcoming and open to the public. It was inferred that this is related to thedraw of people from all over the region, stateand country to these venues

Joe¶s Sports Bar and Grill appeared crowed.

 

Itwas located in Afton Park and is a place for sports fans to come together on the weekend or after work. It was advertising the NCAA basketball tournament. There were severalshopping plazas, with Concord Mills being themost popular. Many people (especiallyteenagers) walk around the mall as a way tosocialize. Children were observed playing onthe playground at the elementary school.The common areas, particularly located near Lowe¶s Motor Speedway and Concord MillsMall, appeared welcoming and open to the public. It was inferred that this is related to thedraw of people from all over the region, stateand country to these venues

 

Parks Trail
Culture and Entertainment AMC theater. Town and Country library
Street Use Very few people walking on the street.
Commercial Activity A mix of large and small businesses: grocery stores and supermarkets, pharmacies, and other stores that provide necessities in all parts of the community
Signs There are signs directing people to various parts of the community (downtown, museums, highways, etc.) in English and Spanish.
Industry Water plant.
Land Use Major roads or railroad tracks divide neighborhoods, but spaces are well distributed.
Infrastructure The community seems to be equally served by electricity, water, phone, fiber optic, wastewater treatment, waste disposal, and other infrastructure services.
Public Transportation The primary method of transportation is the car, with a very few sidewalks so walking is not a viable mean.
Traffic Private cars mostly
Environmental Quality The air does not smell of smoke, garbage, car exhaust, chemicals, industrial waste, etc… and the water in streams, ponds and lakes seem reasonably clear.
Race/Ethnicity. The majority of the community is Hispanics and a small American influence is noted too.
Faith Communities Most of the religious establishments are Catholics but the community shows homogeneity in religious preferences.
Health Services There are two main hospitals and several clinics in the community with easy accessibility.
Community And Public Services There are identifiable community service providers and organizations such as mental health centers, food banks, homeless shelters, welfare offices, etc…easily to reach by public transportation.
Community Safety Police and fire stations are located within the community, in good repair and the community in general is well-lit at night.
Public Schools Schools are in different neighborhoods in noticeably different states of repair.
Higher Education There are two- and four-year colleges and/or universities in the community located near to Dale Mabry. They seem open to the community.
Political Activity Few political campaign posters were posted on houses or in store windows.

 

Community Organizations Evidence is there of organizations in the community such as Masons.
Media No local media outlets found.
Differences Among Neighborhoods Or Areas Of The Community There are some differences among different parts of the community: stores, public and other buildings, streets, etc…in which the areas seem neglected, while others are clearly maintained.

 

Over-All Impression of the Community My overall impression of the community is good and safe.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix B

Gordon’s Functional Health Patterns

 

Client’s general health: Patient diagnosed with HTN.DMII and Dementia.

Any colds in the past year? Pneumonia

Most important things you do to keep healthy? None

Use of cigarettes, alcohol, drugs? Cigarette smoker for 15 years

Perform self-exams, i.e. testicular self-examination? No

Accidents at home, work, school, driving? None

In past, has it been easy to find ways to carry out doctor’s or nurse’s suggestions? (If

appropriate) – No

What do you think caused current illness? I do not like to exercise or been in a diet.

What actions have you taken since symptoms started? None

What things are most important to your health? No answer

Typical daily food intake? Rice, beans, pork, pasta, bread, buttermilk, juice

Typical daily fluid intake? 4 glasses (8oz) of water.

Appetite? Good

Food or eating: Discomfort, swallowing difficulties, diet restrictions, able to follow? Low

Sodium

Healing problems – None

Examination (examples of objective data):

Weight loss/gain? Weight gain (20lbs)

Height loss/gain? 5’6’’

Skin problems: Dryness

Dental problems? Dentures

Temp. 97.9F

Abdominal assessment.

Soft and non-tender. LBM 04/18/18. Protuberant. Problems with constipation.

Urine: yellow, clear. Denies any urgency, frequency or retention.

This pattern centers on activity level, exercise program, and leisure activities.

History (subjective data):

Sufficient energy for desired and/or required activities? I do not have energy to do anything

Exercise pattern? Type? regularity? None

Spare time (leisure) activities? I like to sleep most of the day

Perceived ability for feeding, grooming, bathing, general mobility, toileting, and home

maintenance, bed mobility, dressing and shopping? Minimal Assistance needed

Examination (examples of objective data):

Gait: Unsteady

Posture: Normal

Range of motion (ROM) joints: Good

Hand grip – Strong and equal

Respiration: 20

Blood pressure: 160/90

General appearance: Well groomed

Cardiac assessment: No murmurs. Regular heartbeat.

Respiratory assessment: LCTA

Assesses sleep and rest patterns.

History (subjective data):

Generally rested and ready for activity after sleep? Somnolence

Sleep onset problems? None

Sleep routine? 7 hours

Sleep apnea symptoms? None

Assesses the ability of the individual to understand and follow directions, retain

information, make decisions, and solve problems. Also assesses the five senses.

History (subjective data):

Hearing difficulty? Impaired

Hearing aid? None

Vision? Normal

Wears glasses? Yes

Last checked? I do not remember

Any change in memory? Disoriented to time. Confused. Forgetful.

Concentration? Easily distracted

Important decisions easy/difficult to make? Difficult to make

Easiest way for you to learn things? Visual

Pain? Arthritis

Examination (examples of objective data):

Language spoken: Spanish

Vocabulary level: 12 Grade

Attention span: Fair. Long term

How do you describe yourself? Most of the time, I feel good

Anxious? : Sometimes

Depressed? No

Eye contact: Yes

Voice and speech pattern: Calm and fluently

Body posture: Relaxed

Genogram

Mr. J.P resides in small ALF with 5 other residents. He is widowed, no children and family

history of cardiac problems.

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