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Running head: CAPSTONE SUMMATIVE

Capstone Summative
Melissa R. Roy
University of South Florida

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Capstone Project: Indian River County

Indian River County is located on the east coast of Florida, covers an area of 503 square
miles, and has an urban setting that consists of approximately 139,000 residents. According to
the Indian River County Chamber of Commerce (2014), three major employers of the county
includes Indian River Medical Center, Publix supermarkets, and Piper Aircraft, which provide
anywhere between 800-1600 jobs per facility. The countys health care systems include two full
service hospitals and a rehabilitation hospital in the center of the county. According to the
Florida Department of Healths County Health Profile (2014), the percent of families below
poverty level between the years of 2006-2010 was 8.9% as compared to the state at 9.9%. The
population over the age of 25 that does not have a high school degree is 13.7%, whereas the
average for the state of Florida is 14.7%. The population of residents above the age of 5 that
speaks English less than well is on 6.6% as compared to 11.8% for the state of Florida.
Throughout the paper an analysis of Indian River County will be completed, an area of weakness
will be explored, and several interventions will be developed in order to improve a health
indicator that falls below the state average.
According to the County Health Profile (2014), the following strengths have been
identified in Indian River County. First is the rate of communicable diseases. Over a three year
period, the number of cases for each category of sexually transmitted diseases, vaccine
preventable diseases, and AIDS and other diseases are lower in Indian River County as
compared to the state of Florida. Indian River County is ranked in the first quartile, which
indicates a low occurrence of the communicable diseases identified. The rationale for this
selection is that the rates of infection for the county indicate that the community members are
most likely following appropriate health precautions to prevent disease. The second strength is

CAPSTONE SUMMATIVE

social and mental health. According to County Health Profile (2014), the number of cases for
crime, domestic violence, and alcohol related motor vehicle crashes are lower in Indian River
County than the state. Indian River County is ranking above average in quartiles, with low
occurrences of crime and violence. The rationale behind this selection is that social and mental
health is important for a community as it has the potential to greatly influence the way a
community functions, the impression of safety, and quality of life. The final strength is the
availability of health resources. According to County Health Profile (2014), Indian River County
has greater rates for every type of provider, facility, and county health department as compared
to the state of Florida. Again, Indian River County is ranking above average in quartiles which
indicates great access to health care resources. The rationale behind this selection is that the
amount of health resources available to community members increases the opportunity for
residents to receive early screening and interventions for diseases.
Three areas that need improvement in the county have also been identified. The first area
is maternal and child health. According to the County Health Profile (2014), Indian River County
has a greater amount of babies born to teenagers and unwed mothers, has greater incidences of
infant death, low birth weight, and late or no prenatal care as compared to the state. Indian River
County is in the bottom quartiles for a majority of these topics indicating a need for
improvement. The rationale behind this selection is that the health status of infants is a direct
reflection of the health of its community. The second area of weakness is behavioral risks. Based
on the 2010 percentage, 15.3% of the population has either had a heart attack, angina, or
coronary artery disease as related to the 10.2% for the state. According to the County Health
Profile (2014), Indian River County is in the lowest percentile for cardiovascular disease
indicating the need for improvements. The rationale behind this selection is that cardiovascular

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disease is still the number one killer in the world and it is important for people to make healthy
lifestyle decisions to reduce their risk of disease. The final area in need of improvement is the
socioeconomic indicator related to civilian labor force which is unemployed. In Indian River
County, 10.9% of the civilian labor force is unemployed whereas the state is at 8.9%. Indian
River County is in the third quartile for this topic which indicates a need for improvement. The
rationale behind this selection is that it is important for civilians to have jobs not only to stay out
of poverty, but for their overall well-being. Many people who are unemployed do not have
insurance, live with stress or other chronic illnesses that negatively affect their health and quality
of life.
The health indicator under review is the high rate of infant deaths per 1,000 live births in
Indian River County. This is an important topic to focus on because according to the Centers for
Disease Control and Prevention [CDC] (2013a), infant mortality is often used to determine the
overall health and well-being of a community, as factors affecting the general health of the
population will ultimately impact the mortality rate for infants. It is important to explore
different interventions to improve healthy behaviors in women of child bearing ages, increase the
amount of women who receive proper screenings throughout pregnancy, and provide resources
for those who are affected by infant mortality or other adverse health events involving their
infants after birth.
The determinants of health model addresses different social factors that are thought to
impact a persons health status. According to the Department of Health and Human Services
[HHS] (2013a), the model focuses on the relationship between where a person lives, their access
to clean air, fresh food and water, education, and other circumstance of the environment in
relation to their current health status. This model assists community health nurses develop

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interventions that addresses population based health issues by not only assessing the patient, but
also assessing their physical and social environment.
Factors that contribute to the priority health issue include health systems, environment,
and lifestyle. Health systems are an important factor relating to infant mortality as many women
of childbearing age do not have access to adequate health care. According to HHS (2013b), those
who do receive care may still be affected by missed opportunities, lack of preventive services,
and inappropriate management of chronic conditions. The environment also plays a role in this
health issue as people affected by poverty may suffer from different disparities such as poorer
health status, decreased access to health care, and increased exposure to environmental insults,
all of which can impact infant mortality. Finally the mothers lifestyle is a major influence of
infant mortality. Health promotion topics should be discussed with all women of childbearing
ages.
The nursing diagnosis for the intervention is infants of Indian River County at risk for
mortality related to their mothers general health status before and during pregnancy as
evidenced by an increased rate of mortality (10.2) for the county as compared to an overall rate
of 6.3 for the state of Florida. In order to improve the Countys ranking of infant mortality cases,
interventions will be implemented to improve the overall health of the Mother, provide more
access to pregnancy screening, and provide support for those who are still affected by infant
mortality.
The primary intervention, based on the health teaching principle of the intervention
wheel, is preconception health. The intervention method is to collaborate with community
members and health care providers (primary care, OB/GYN) to implement a program that
provides preconception health information to women of childbearing ages to potentially increase

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the rate of healthy pregnancies, and decrease the risk for children born with severe disabilities or
diseases. The level of recipient for this intervention is system wide as all women can benefit
from learning about and implementing preconception health as it encourages women to get
healthy and stay healthy regardless of their plan of conceiving. As stated by the CDC (2013b), no
one expects unplanned pregnancy, but more than half of the pregnancies in the United States are.
Health promotion factors for this intervention includes women visiting their doctors for health
check-ups, taking folic acid daily, and to reach and maintain a healthy weight. Risk factor
modification includes not smoking or using street drugs, and avoid drinking excessive amounts
of alcohol. The stakeholders for this intervention are community members and health care
providers. It is important for all community members to achieve good health, especially women
of childbearing ages. Health care providers are also key as they should be talking to their patients
about preconception health and the importance of making lifestyle changes. The role of the
community health nurse is to coordinate meeting times, create a presentation covering topics of
preconception health, provide educational material and resources, and answer any questions
women may have related to preconception health.
The secondary intervention is screening for all pregnant women to identify potential risks
with the fetus. According to Stanford Childrens Health (2014), prenatal screening test can be
done in the first and second trimester to identify any potential birth defects or genetic
abnormalities of the fetus. It is recommended that women receive screening tests in both
trimesters as the ability of the tests to detect an abnormality is greater than using just one
screening tool on its own. The level of recipient for this intervention would be system-wide, as
all women deserve to have proper screenings to identify potential risks. Case finding and
surveillance involves identifying pregnant women in the community who do not have an

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established OB/GYN to perform regular screenings. Health screening will be performed on all
women who do not have access to a primary OB provider and will be provided a list of services
and providers who will be able to assist them with their care. A report of all women with who are
deemed high risk will be kept and will help coordinate follow up appointments that will be
maintained throughout the pregnancy and after birth. Identified stakeholders are community
members as it is a resource for all pregnant females and their babies regardless of their age,
health care providers as they are needed in order to perform screening and refer patients out, and
funding sources in order to provide funds to pay for the providers and screening services. The
role of the community health nurse is to begin community screenings to identify the target
population, complete baseline assessments, assist the provider with pregnancy screenings,
connect the patients with appropriate referrals and specialists, coordinate follow up appointments
and provide education to the patient.
The tertiary intervention is bereavement and support groups for parents who have a baby
who was born prematurely, has birth defects, or has been a victim of infant mortality. When
parents and family members are in this sort of crisis, simply connecting families together for
support, resources, and education can be extremely helpful in moving forward with their lives.
This is a system wide intervention as any parent who has lost an infant or who has been faced
with a disease can benefit from this program. The stakeholders involved would be community
members and health care providers. This intervention is a resource that anyone experiencing
these situations can utilize, specifically members of the community. Health care providers are
important as they can provide education, support, and connect families to available resources.
First Candle (2014), is a non-profit organization that supports safe pregnancies and strives to
achieve a healthy first year of life for babies. Organizations such as First Candle prove that

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having the education, resources, and support of others truly makes a difference for parents who
are recovering from such a horrific event. The role of the community health nurse in this
intervention is to provide support to families by assisting them transition to life without their
child. The nurse will collaborate with the health care providers so the nurse can better answer
any questions the parents may have, collaborate with social workers who will help parents with
the next step after infant mortality, and can provide information on bereavement and support
group services that can assist the family into recovery.
Health policy has a huge impact on health care whether it be at a community based, state,
or national level. Health policy provides a system for improving the health of citizens as it is
developed based on the needs of those in the community (Anderson & McFarland, 2011). The
proposal to be implemented is a primary intervention that provides preconception health
education to young women of the community to hopefully increase the amount of women who
make healthy changes before becoming pregnant to decrease the odds of adverse events
throughout the pregnancy. The goal of this proposed health policy is to decrease the number of
babies born prematurely, with severe birth defects, and the probability of the infant becoming a
victim mortality. The stakeholders affected by this proposal are community members and health
care providers. As previously stated, it is imperative that all members of any given community
are in good health, and by introducing a policy to educate, provide resources, and begin a
program that discusses preconception health is a step in the right direction towards a healthier
population. Health care providers are involved as they can identify individuals who could benefit
from preconception health and educate them of the importance of making changes to their
lifestyle now. Supporters of the proposed health policy are community members, health care
providers and public officials. Community members support the proposal as they will only

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benefit from the intervention, and the influence they have is whether or not the intervention will
be effective based on their involvement and participation. Health care providers support the
policy as they would like to see healthier patients and influence the policy by referring their
patients in an effort to promote healthier mothers, pregnancies, and babies. Public officials
support this policy as every governing body wants their city or community to be healthy and
their influence is to advertise the importance of community health and publicize the policy so
more community members can be reached. There are no identifiable opposing forces to the
policy as it is primarily intervention based so it does not require much funding from the
community or state. To initiate the proposal, the person to approach would be public officials.
Once they are on board and willing to speak publically about the proposal, the community health
nurses and health care providers of clinics will begin advertising the educational seminars to
their patients. Educational presentations can be scheduled as often as needed. The preconception
health policy proposal will impact Indian River County as it is a step in the right direction of
improving the health of young women, pregnant women, and the babies that they carry. This
policy will enhance population health in general as not only is it encouraging women to get
healthy for themselves, but it also encourages them to be healthy for their babies. If the
community has healthier pregnancies, the chance of having healthier babies will increase, which
will hopefully decrease the occurrence of premature births, babies born with birth defects, and
the rate of infant mortality.

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References

Anderson, E. T., & McFarlane, J. (2011). Community as a partner: Theory and practice in
nursing (6th ed.). Philadelphia, PA: Wolters Kluwer Health | Lippincott Williams &
Wilkins.
Centers for Disease Control and Prevention (CDC). (2013a). Infant mortality. Retrieved from
www.cdc.gov/reproductive health/MaternalInfantHealth/InfantMortality.htm
Centers for Disease Control and Prevention (CDC). (2013b). Preconception health and health
care. Retrieved from www.cdc.gov/preconception/women.html
Department of Health and Human Services (HHS). (2013a). Determinants of health. Retrieved
from http://www.healthypeople.gov/2020/about/DOHAbout.aspx
Department of Health and Human Services (HHS). (2013b). Report of the secretarys advisory
committee on infant mortality (SACIM): Recommendations for HHS action and
framework for a national strategy. Retrieved from:
www.hrsa.gov/advisorycommittees/mchbadvisory/InfantMortality/Correspondence/reco
mmendationsjan2013.pdf
First Candle. (2014). Grieving families. Retrieved from http://www.firstcandle.org/grievingfamilies/
Florida Department of Health. (2014). County healthy profile: Indian river county. Retrieved
from
www.floridacharts.com/charts/viewrpt.aspx?ID=17013671&prompt0=31&Prompt1=201
3&tn=23

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Indian River County Chamber of Commerce. (2014). About us. Retrieved from
www.indianriverchamber.com/index.cfm?method=EconomicDevelopment.Geography
Sanford Childrens Health. (2014). Common tests during pregnancy. Retrieved from
http://www.stanfordchildrens.org/en/topic/default?id=common-tests-during-pregnancy85-P01241