Академический Документы
Профессиональный Документы
Культура Документы
Abstract
eliminate barriers to reach optimal health. Previously collected data of Walnutport, PA revealed
a lack of nutritional resources and health seeking behaviors. This paper focuses on the
relationship of these determinants and the incidence of chronic disease within the community.
The host, environment, and agent relationship within the community is examined to help
these interventions are aimed towards assisting the public health nurse in creating a more
favorable environment throughout the community and to help break the cycle of disease.
Public health nursing is a scientific study focused on the health distribution and
determinants of a community including their illness and disease (Stanhope & Lancaster, 2016).
Stanhope & Lancaster (2016), epidemiology is, the study of the occurrence and distribution of
health-related states or events in specified populations, including the study of the determinants
influencing such states, and the application of this knowledge to control the health problems. By
utilizing epidemiology, community health nurses can identify frequency of diseases, recognize
patterns, eliminate barriers to disease control, provide education, and most importantly, develop
community-based interventions in order to provide optimal health and disease prevention for all
Priority Problem
The completion of the Data Collection Paper brought attention to the lack of nutritional
resources and healthcare available to residents of Walnutport, PA. The deficiency of nutritional
resources hinders health maintenance of the community thus having negative repercussions.
Substantial data supports the lack of nutritional resources and access to healthcare as the priority
problem. The supporting statistics are related to factors such as transportation, income level,
poverty rates, unemployment rates, education level, and preventable co-morbidities including
Transportation plays a key role in the ability to access nutritious foods and healthcare.
While 90.6% of the population possess or operates a car, truck, van, or motorcycle as their
transportation, specifically buses, relies on a set route with pre-determined stops forcing the
COMMUNITY INTERVENTIONS FOR WALNUTPORT 4
travelers to utilize what stores are available. It is common for bus routes to follow main roads
where chain food restaurants typically exist, making them more accessible to those who use
public transportation. The ability to collect groceries and then successfully travel with them
poses as another obstacle to those using public transportation. In addition, 8.7% of the population
did not report using any mode of transportation. Research revealed the walkability score of
Walnutport, PA to be 31, proving that most errands require a car (Walk Score, 2017). This chain
of events creates a barrier to the individuals ability to access nutritious grocery stores and
healthcare centers. The community health nurse should consider how these individuals have
Income level influences a persons ability to afford wholesome groceries and healthcare
insurance. It is more financially reserved to purchase a pre-prepared meal from the McDonalds
on Main Street or utilize the local Dollar Store grocery selection than it is to travel to the
farmers market, which is approximately 15 miles away. Although the median household income
for Walnutport is $64,310, a portion of the community suffers financially. Those with income
below poverty level is 7.3% and those with income below fifty percent of the poverty level is
3.2%. It is also important to consider that the unemployment rate of Walnutport is 7.7%.
Husband-wife households comprise 53% of the community, with 17.5% of those households
having children under 18 years old. Therefore, more than half of the community has a family to
feed and over a quarter of those families include children and adolescents. Without sufficient
funds, a person simply cannot manage to pay for healthful foods, especially if there are many
family members to feed. There may be pressure on the family to purchase a higher quantity of
resources and related health care in Walnutport, PA. If an individual is not educated on healthy
eating habits and does not understand the importance of choosing nutrient dense foods, that
resources were available. In Walnutport, 7.04% of the community has less than ninth grade
education. Those individuals may never have had the opportunity to learn about the impact of
consuming the required dietary allowance, putting themselves at increased risk for developing
health problems.
Considering this data, the individuals of the community who are uneducated, financially
unstable, have existing disease processes, and rely on public transportation are the most
vulnerable. These factors interplay to contribute to the communitys lack of positive health
behaviors. For example, 17% of individuals admit to tobacco use and 88.8% admit to some
degree of alcohol use. In terms of exercise, 26% of families deny leisure time physical activity.
Some of the top ranked food establishments in Walnutport include pizzerias, ice cream parlors,
and fast food restaurants like Burger King, McDonalds, and Dunkin Donuts. These top ranked
favorites prove that the community enjoys dining at food establishments that lacks nutrient dense
food options. These health behaviors, along with lack of nutritional resources and healthcare
access have an impact on the communitys morbidity and mortality rate. An individual who does
not have prime access to nutritious food options and engages in negative health behaviors is at an
increased risk of developing chronic diseases. In Walnutport, heart disease comprises 30% of the
mortality rate and Diabetes Mellitus makes up 5% of the mortality rate. These two examples are
Nursing Diagnosis
knowledge regarding basic health practices, reported or observed inability to take responsibility
for meeting basic health practices in any or all functional pattern areas, and deficient financial
Goals
Healthy People 2020 identified one overarching goal that is congruent with the goal of
Walnutport, PA which is to attain high quality, longer lives free of preventable disease,
disability, injury, and premature death (U.S. Department of Health and Human Services, 2017).
Due to the prevelent ineffective health maintence expressed by this community, a multitude of
inteventions are required. The American Public Health Association made a formal statement in
2009 supporting community health workers to increase health access and reduce health inequities
Interventions
Primary Prevention
The primary level of prevention aims at preventing the occurrence of disease, injury, or
disability (Stanhope & Lancaster, 2016). Primary preventions for Walnutport, PA will be
focused on breaking the cycle of the disease process and reducing the incidence within the
community as a whole. The community health nurse helps people make lifestyle changes by
group/individual education and gathering the necessary resources to achieve optimum health
(Sommers, Johnson, Roberts, Redding, Churchill, & Elkins, 2013). Data obtained for
COMMUNITY INTERVENTIONS FOR WALNUTPORT 7
Northampton County. The importance of physical activity and proper nutrition has been
established in reducing rates of deaths from chronic diseases and should be a primary focus in
epidemiology interventions (Macera, 2010). Posting signs for healthy nutrition classes and
websites such as My Plate in various places throughout the community will prompt the
community to connect with the proper resources. Group classes and counseling can inform
individuals about low-fat diets and how the positive impact of physical activity can greatly
reduce the incidence of chronic disease (Stanhope & Lancaster, 2016). Community health nurses
can work with partners to create exercise programs, sporting events, daily walks, and other
physical activities to be held within the community. Healthy People 2010 concluded that healthy
lifestyles which include regular physical activity and appropriate dietary intake greatly reduce
the chances of developing heart disease, diabetes, stroke, osteoporosis, and obesity (Stanhope &
Lancaster, 2016).
most residents rely on walking as their main means of transportation and 7.3% live below
poverty level. Partnerships can be created with neighboring communities, local farmers, or other
programs to bring the necessary nutritional items to Walnutport for utilization. This primary
intervention will assist familys chances of purchasing quality food items and aid in consumption
Another area that primary prevention can offer specialized protection from unwanted
disease is water sanitation and supplemental fluoridation of those water supplies (Stanhope &
COMMUNITY INTERVENTIONS FOR WALNUTPORT 8
Lancaster, 2016). Scientific research has shown supplementing a water supply with fluoride is
safe and effective in the prevention of tooth decay by 25% (American Dental Association, 2017).
Fluoride is a major benefit to adults and children in decreasing tooth extractions, infections, and
pain (Center for Disease and Control, 2017). Fluoridation of the communitys water supply is a
cost effective way to help ensure good oral/dental health throughout Walnutport.
Educating children and adolescents about the dangers of smoking can help reduce the
chances of developing a chronic respiratory disease later in life (Sommers et al., 2013). Smoking,
second hand smoke, and any inhaled irritant can increase the chance for developing a multitude
of respiratory and heart disease (Ignatavicius & Workman, 2016). Data collection revealed that
individuals residing in Walnutport have a 43.2% chance of developing cancer based on the poor
air quality. This data confirms the residents are at risk even without practicing risky health
behaviors, such as smoking. Primary interventions should be aimed towards reducing the
initiation of tobacco and alcohol use among children, teens, and young adults (Stanhope &
Lancaster, 2016). These substances are proven to increase incidence of acute and chronic heart
disease or illness (Ignatavicius & Workman, 2016). The community health nurse can connect
with this aggregate group through school programs and youth groups. Coordinated school health
programs have the potential to help the younger population resist peer pressure and getting
All of these interventions reiterate the goal of primary prevention, which is to prevent the
initial occurrence of risky behaviors, disease, and/or illness (Sommers et al., 2013).
Secondary Prevention
People living with prevalent chronic conditions such as heart disease, cancer, diabetes,
stroke, and chronic lung disease account for 75% of healthcare expenditures in the United States
COMMUNITY INTERVENTIONS FOR WALNUTPORT 9
(Ahn, Basu, Smith, Jiang, Lorig, Whitelaw, & Ory, 2013). It is possible that some individuals
living in Walnutport, PA may be unaware that they have one or more chronic diseases because
they have not yet been diagnosed. An important role of the community health nurse is early
interventions intended to increase the likelihood that an individual with a disease will have that
condition diagnosed at a stage when treatment is likely to result in cure (Stanhope & Lancaster,
2016). Blood pressure screenings for individuals within the community, especially children and
in children and adolescents may provide community health nurses with early identification of
primary hypertension, leading to further interventions to reduce blood pressure during childhood
and adolescence, resulting in a reduced risk for cardiovascular events and death in adulthood
(Moyer, 2013).
improve the quality of life for women. The aggregate group of women age 40 and over who live
in Walnutport have the potential to benefit from regular mammograms because early detection
and diagnosis of breast cancer has immense benefits. According to Starting (2012), women
whose breast cancer was not diagnosed by mammography were more likely to be diagnosed with
a stage II or higher tumor than were women in whom breast cancer was diagnosed by
mammography and were more likely to have a mastectomy, undergo surgery, radiation therapy,
prevention in the form of education on self-care techniques in order to address the continued
COMMUNITY INTERVENTIONS FOR WALNUTPORT 10
needs and demands of their chronic disease. According to S. Shrivastava, P. Shrivastava, &
Ramasamy (2013), there is a four-fold increase in diabetic complications for those individuals
with diabetes who had not received formal education concerning self-care practices. Examples of
education topics for those with diabetes include healthy eating, being physically active,
monitoring of blood sugar, compliant with medications, good problem-solving skills, healthy
community health nurses have the resources available for early detection and/or prevention of
Tertiary Prevention
rehabilitation from disease, injury, or disability (Stanhope & Lancaster, 2016). As previously
stated, a significant portion of Walnutport, PA residences currently suffer from existing disease
processes which have the potential to be controlled and/or resolved with proper interventions. A
crucial aspect of disease management is medication therapy this is where the link between lack
missed appointments, delayed care, and missed or delayed medication use. These consequences
may lead to poorer management of chronic illness and thus poorer health outcomes, (Syed,
Gerber, & Sharp, 2013). Walnutport, PA may benefit from a community health center that
focuses on management of chronic diseases proved to impact communities greatly. The health
center may other services such as delivery of medications to the patients home, clients without
insurance can speak to a case manager directly, and proper dietary nutrients can be easily
sourced. By eliminating the barrier public transportation causes, chronic diseases can be
COMMUNITY INTERVENTIONS FOR WALNUTPORT 11
managed by a local healthcare professional, as opposed to seeking care outside of the district.
Additionally, an increase in healthcare access and nutrient rich grocers enhances the advantages
vocational rehabilitations in the community setting has immense health benefits while urging
patients to return to work. Occupational therapy (OT) aims to expedite maximum use of physical
individuals return to work, pain-level and emotional well-being needs to be assessed with these
physical improvements (Desiron, Rijk, Hoof, & Donceel, 2011). By having a nursing
intervention based around collaboration, the community can connect with additional services
specific to their disease process. The ability to work is the driving force behind any economic
system.
Support groups are often utilized by patients with chronic diseases, as well as their family
members and/or caregivers. Within the community, supportive peer interventions range greatly
in format from small groups to cyber-based chats. Regardless of the format, all groups focus on
similar goals, including the emotional strain of chronic illness, disease management techniques,
and positive role modeling. The combined data concluded that clients and mentors with chronic
disease benefited from peer groups by expressing a sense of connection, experiential knowledge,
changed behavior, and changed knowledge (Embuldeniya et al., 2013). It is crucial for all the
Evaluation
Although there will not be an evaluation completed for the goal of attaining a high
quality, longer life free of preventable disease, disability, injury, and premature death, this step is
important to improve and account for public health actions by using methods that are useful,
feasible, ethical, accurate (Stanhope & Lancaster, 2016). The aspects of evaluation include
relevance, adequacy, progress, efficiency, effectiveness, impact, and sustainability (Stanhope &
Lancaster, 2016). These aspects assist the community health nurse to evaluate the need for the
program, examine how well the program addresses the extent of the need, tracks the program
activities to meet program objectives, assesses the relationship between the program outcomes
and the resources present, considers the ability to meet program objectives and the results of
program efforts, analyzes the long-term changes in the client population, and judges whether or
not there is enough resources available to continue the program (Stanhope & Lancaster, 2016).
Conclusion
resulting from absence of reliable transportation, insufficient income, low educational status,
negative health behaviors, and unhealthy food options. The goal of attaining high quality, longer
lives free of preventable disease, disability, injury, and premature death can be accomplished
though primary, secondary, and tertiary prevention interventions. Through these interventions,
the community of Walnutport, PA has the potential to flourish into a healthy, active community.
COMMUNITY INTERVENTIONS FOR WALNUTPORT 13
References
Ahn, S., Basu, R., Smith, M. L., Jiang, L., Lorig, K., Whitelaw, N., & Ory, M. G. (2013). The
http://www.biomedcentral.com/1471-2458/13/1141
American Dental Association. (2017). Fluoride in water. Retrieved July 19, 2017, from
programs/advocating-for-the-public/fluoride-and-fluoridation
American Public Health Association. (2009). Support for community health workers to increase
health access and to reduce health inequities. American Public Health Association.
statements/policy-database/2014/07/09/14/19/support-for-community-health-workers-to-
increase-health-access-and-to-reduce-health-inequities
Bauer, U. E., Briss, P. A., Goodman, R. A., & Bowman, B. A. (2014). Prevention of chronic
disease in the 21st century: Elimination of the leading preventable causes of premature
death and disability in the USA. National Center for Chronic Disease Prevention and
6736(14)60648-6
Desiron, H. A., Rijk, A. D., Hoof, E. V., & Donceel, P. (2011). Occupational therapy and return
https://doi.org/10.1186/1471-2458-11-615
Embuldeniya, G., Veinot, P., Bell, E., Bell, M., Nyhof-Young, J., Sale, J. E.M., & Britten, N.
(2013). The experience and impact of chronic disease peer support interventions: A
COMMUNITY INTERVENTIONS FOR WALNUTPORT 14
https://doi.org/10.1016/j.pec.2013.02.002
Macera, C. A. (2010). Promoting healthy eating and physical activity for a healthier nation.
https://www.cdc.gov/healthyyouth/publications/pdf/pp-ch7.pdf
Ralph, S. S., & Taylor, C. M. (2014). Nursing diagnosis reference manual (9th ed.).
Shrivastava, S. R., Shrivastava, P. S., & Ramasamy, J. (2013). Role of self-care in management
Sommer, S., Johnson, J., Roberts, K., Redding, S. R., Churchill, L., & Elkins, C. B. (2013). RN
Stanhope, M., & Lancaster, J. (2016). Public health nursing (9th ed.). St. Louis, MO: Elsevier.
Syed, S. T., Gerber, B. S., & Sharp, L. K. (2013). Traveling towards disease: Transportation
https://doi.org/10.1007/s10900-013-9681-1
U.S. Department of Health and Human Services. (2017). About healthy people. Retrieved July
Healthy-People
COMMUNITY INTERVENTIONS FOR WALNUTPORT 15
Walk Score. (2017). South lincoln ave. Retrieved July 18, 2017, from
https://www.walkscore.com/score/s-lincoln-ave-walnutport-pa-18088