Hernando County is located in the Tampa Bay area and is surrounded by the Gulf of Mexico to its West, Pasco County to its South, Sumter County to its East, and Citrus County to its North. Hernando County has a population of 172,778 people (Hernando County Profile, 2012). According to Justia. com Hernando County is about seventy-six percent urban setting and the rest rural non-farming. The size of Hernando County is 53,927 square miles (County Information, 2012). The three major private sector employers are Wal-Mart Distribution Center, Oak Hill Hospital, and Spring Hill and Brooksville Regional Hospitals.
Oak Hill Hospital, Spring Hill Regional Hospital, and Brooksville Regional are the major health care systems in the county (Hernando County Profile, 2012). The age group range of forty- five to sixty- four years old comprises the largest percentage of residents in Hernando County (Florida Charts, 2012). Five percent of the population is black people, and ninety- three percent is white people (Florida Charts, 2012). Nine percent is Hispanic, while ninety- one percent is non-Hispanic (Florida Charts, 2012).
Twelve percent of families in Hernando County and fourteen percent of families in Florida are below the poverty level (Florida Charts, 2012). Eighty- six percent of the population in Hernando County greater than age twenty- five have a high school diploma. Eighty- five percent of the population in Florida greater than age twenty- five have a high school diploma (Florida Charts, 2012). Two percent of the population greater than age five in Hernando County do not speak English, and seven percent of the population greater than age five in Florida do not speak English (Florida Charts, 2012).
Overview of Healthy People 2020 “Healthy People 2020 provides science-based, 10-year national objectives for improving the health of all Americans (Healthy People 2020, 2012, p. 2). ” The United States Department of Health and Human Services manages the site. Healthy People 2020 was developed to improve the nation’s health among all socioeconomic groups by monitoring the effects of prevention methods, educating people on healthy lifestyle decisions, promoting healthy environments, and establishing what research should be conducted.
The goals of Healthy People 2020 include: Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages. (Healthy People 2020, 2012) The Leading Health Indicators come from the list of Healthy People 2020 objectives.
The Leading Health Indicators of Healthy People 2020 are the issues of our nation’s health given the greatest priority in resolving (Healthy People 2020, 2012). The Leading Health Indicators were made to communicate high- priority health concerns and measures that can be taken to deal with them. According to Healthy People 2020, “The indicators will be used to assess the health of the Nation, facilitate collaboration across sectors, and motivate action at the national, State, and community levels to improve the health of the U. S. population” (Healthy People 2020, 2012, p. 7).
The Leading Health Indicators of Healthy People 2020 are the issues of our nation’s health given the greatest priority in resolving. They include the following: access to health services; clinical preventive services; environmental quality; injury and violence; maternal, infant, and child health; mental health; nutrition, physical activity, and obesity; oral health; reproductive and sexual health; social determinants; substance abuse; and tobacco (Healthy People 2020, 2012).
Healthy People 2020 suggests that organizations who are working towards making the goals a reality, submit their LHI success stories to the Healthy People 2020 website so that Healthy People 2020 can use them to their benefit. These stories can give other people and organizations hope for success to attain their own goals. Furthermore, Healthy People 2020 proposes to MAP-IT in order to implement indicators in a community or population. The MAP-IT strategy can be used in any community to ultimately achieve Healthy People 2020 goals.
One must mobilize supporters, assess the needs of the community, plan how to address these needs, implement the plan, and track the progress (Healthy People 2020, 2012). Analysis of Strengths and Needs The three leading health indicators of strength for Hernando County are maternal, infant, and child health; nutrition, physical activity, and obesity; and tobacco (Indicators for county: Hernando, 2012). For maternal, infant, and child health, Hernando County is in the first quartile (most favorable) for early prenatal care (care began first trimester), infant death rate, and neonatal death rate.
Hernando County is also better than the state of Florida by having less premature births, births to teens fifteen to nineteen years old, and repeat births to mothers fifteen to nineteen years old and a lower post neonatal death rate. Regarding nutrition, physical activity, and obesity, Hernando County beats the Healthy People 2020 goals of thirty- three percent of the adult population engaging in no leisure-time physical activity with a percentage of twenty- seven percent and thirty- one percent of the adult population being obese (Indicators for county: Hernando, 2012).
Concerning tobacco, Hernando County is in the first quartile (most favorable) for the percentage of adults who are current smokers (Florida Charts, 2012). The three leading health indicators of need in Hernando County are injury and violence, social determinants, and oral health (Indicators for county: Hernando, 2012). In regards to social determinants, Hernando County is in the fourth quartile (least favorable) for unemployment rate and is in the third quartile for median income (in dollars) (Florida Charts, 2012).
Unemployment rate is a social determinant as it describes the conditions that the community is living in. For injury and violence, Hernando County is in the fourth quartile (least favorable) for unintentional injuries age-adjusted death rate and for suicide age-adjusted death rate. Additionally, Hernando County is in the third quartile for motor vehicle crash age-adjusted death rate and for domestic violence offenses (Florida Charts, 2012).
There is a need to lower the injury and violence rate in the county because as compared to the state of Florida, Hernando is one of the most violent counties in Florida (Florida Charts, 2012). In concern of oral health, Hernando County is in the fourth quartile (least favorable) for adults who had a permanent tooth removed because of tooth decay or gum disease (Florida Charts, 2012). Oral health is designated as the priority health indicator.
Oral health care is extremely important because people need to prevent infections of the mouth, cavities that cause pain, and cancer. But the primary concern is periodontal disease and how it can lead to more severe diseases. Such diseases caused by periodontal disease range from diabetes to heart disease. Previously stated, Hernando County is in the fourth quartile (least favorable) for adults who had a permanent tooth removed because of tooth decay or gum disease (Florida Charts, 2012).
Community Health Models Determinants of Health “are broad categories of factors that influence health and illness” (Clark, 2008, p. 66). The Determinants-of-Health Model is a combination of other models such as the producing health, consuming health care model and the mandala model. The Determinants-of-Health Model can help the Community Health Nurse develop interventions that address a population based health concern because it has different categorical determinants with topics imbedded in each determinant.
The Community Health Nurse could use this model to figure out which determinant is applicable for a certain health issue and use the model to narrow down topics for immediate intervention (Clark, 2008). Human biology, the health system, environment, and lifestyle are factors that can contribute to oral health and are part of the Determinants-of-Health-Model (Clark, 2008). Human biology, like one’s gender, can predispose a person to a certain quality of oral health.
A study done in South Asia revealed that women were more likely to get dental caries than men due to genetic and hormonal factors (Lukacs, 2011). The utilization part of the health system also plays a role in oral health, which is shown in research done by the National Survey of Children’s Health 2007. This research showed that children with poor oral health care are more likely to utilize dental health services when they are young, but less likely to go to the dentist when they are older than those that with adequate oral health (Bell, Huebner, & Reed, 2007).
Furthermore a study in Australia proves that the addition of fluoride to public water, which is a part of built environment and the environmental determinants, has a positive correlation with the quality of oral health (Armfield, 2010). The lifestyle choice of smoking significantly lessens oral health quality, as confirmed by a study performed in Croatia (Zajc, I. , Brajdic, D. , Biocic, J. , Bosan-Kilibarda, I. , Kopic, V. , Siber, S. , & Macan, D. , 2011). Population Diagnosis The population diagnosis for the priority health issue of oral health is that large adult population in Hernando County is at risk of oral health degradation related to lack of knowledge in proper dental care, evidenced by:
(a) Hernando County is in the fourth quartile (least favorable) for adults who had a permanent tooth removed because of tooth decay or gum disease, (b) Hernando county is in the second quartile for adults who had their teeth cleaned in the past year, and (c) Hernando County is in the second quartile for adults who visited a dentist or a dental clinic in the past year (Florida Charts, 2012).
The Interventions Wheel The Interventions Wheel “consists of 17 identified community health nursing interventions that cross over three levels of population-based practice: individual-focused, community-focused, and systems-focused practice” (Clark, 2008, p. 75). The Intervention Wheel is supposed to integrate the idea of determinants of health as all factors that affect health, not just disease or health-related behaviors. The authors of the model also indicate that the model “emphasizes health promotion and illness prevention” (Clark, 2008, p. 7).
To apply the Interventions Wheel to the previously mentioned population diagnosis, the community-focused intervention of social marketing could be utilized. By using social marketing, the county could write a grant to fund a media campaign to spread the word about the importance of dental care (Clark, 2008). Levels of Prevention “Nursing interventions for identified health needs in the population are planned within the dimensions of health care.
The dimensions of health care derive from the public health concepts of levels of prevention and include primary prevention, secondary prevention, and tertiary prevention” (Clark, 2008 p. 72) If you perform an intervention that is designed to prevent a health issue from happening, then it is primary prevention. For instance, “Immunization is a protective measure for communicable diseases” (Clark, 2008, p. 73). If the intervention is supposed to fix an existing issue, it is secondary prevention.
This prevention includes “screening and early diagnosis as well as treatment for existing health problems” (Clark, 2008, p. 73). When a performed intervention is designed to prevent long-term consequences of a former problem, it is a tertiary prevention. An example of a tertiary prevention would be “exercise after a broken leg… to prevent muscle atrophy and contractures” (Clark, 2008, p. 73). All three of the preventions mentioned apply to the priority health issue of oral health. For instance, a primary prevention would be going to the dentist routinely for cleaning to prevent cavities and disease of the mouth.
A secondary prevention would be to use fluoride after the dentist identifies the degradation of tooth enamel. A tertiary prevention would be the use of a mouth guard after a hockey player lost their tooth and got it replaced by the dentist. Evidence Based Interventions For the primary level of prevention, a community-focused intervention could be utilized in support of the priority health issue of oral health. Health teaching could be done by working at local festivals and fairs promoting a teeth cleaning campaign. The campaign would be funded by local legislators in the county.
The community health nurse could have a booth set-up at these local festivals and fairs teaching the community about the importance of oral health care. An article in the International Journal of Cardiology 2011 says that oral health promotion activities seem to produce improvements in periodontal health (Lam, O. , Zhang, W. , Samaranayake, L. , Li, L. , McGrath, C. , 2011). For the secondary level of prevention, a system-focused intervention could be used in support of the population diagnosis previously mentioned.
By working with local health care providers to develop systems for screening, follow-up appointments, and treatment for cavities and gum disease, the rates of tooth loss in Hernando County could be lowered. The community health nurse would meet with other health care providers and help make these services available. An article in the American Journal for Public Health 2011 states that the dental practice is responsible for screening for disease in both oral and general health (Lamster & Eaves, 2011).
For the tertiary level of prevention, an individual-focused intervention could be employed in support of oral health. By working with local health care providers, the community health nurse could establish follow-up care for patients with gum disease. Compliance of the patient could be monitored by seeing how many follow-up appointments the patient attends out of the suggested amount of appointments scheduled by the dentist. The dentist could monitor the treatment effects with subsequent visits by the patient.
The patient could be educated on how to better his oral health care to prevent further negative impact and the spread of the disease. According to the Journal of Clinical Periodontology 2010, people that take better care of their teeth have a greater likelihood of showing up for follow-up care (Kakudate, N. , Morita, M. , Yamazaki, S. , Fukuhara, S. , Sugai, M. , Nagayama, M. , Kawanami, M. , & Chiba, I. , 2010). Conclusion Health policy plays a direct role on the health care received by patients. Health policy develops protocols on what procedures should be performed for certain situations.
The health policy proposal is a secondary level prevention with a system-focused approach. The health policy proposal is that people who have been diagnosed with gum disease should seek follow-up care during the next two years to prevent tooth loss. “Dental care is necessary to prevent and treat orofacial disease, infection, and pain, as well as restore form and function of dentition” (Policy on medically necessary care, 2011, p. 20). The health policy proposal will decrease the number adults who had a permanent tooth removed because of tooth decay or gum disease in Hernando County.
Courtney from Study Moose
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