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Community Health Nursing Essay

Identification of Community

Nestled in Southern Indiana just west of Louisville, Kentucky and south of Indianapolis, Indiana is Dubois County, Indiana. Dubois County is comprised of the towns of Birdseye, Ferdinand, Holland, Huntingburg and Jasper. Of those towns, Jasper is the largest and is the county seat (Kelly School of Business, 2014). Over fifty-two percent of the population consists of adults ranging from 25-64 years of age (Kelly School of Business, 2014). The leading cause of mortality in this county is heart disease, cancer, suicide and injuries (Memorial Hospital and Health Care Center & Dubois County Health Department, 2011). According to the 2011 health rankings of the county, Dubois County was higher in the benchmark of poor health, adult obesity, adult smoking, excessive drinking, motor vehicle crash death rate and teen birth rate than the national benchmarks (Memorial Hospital and Health Care Center & Dubois County Health Department, 2011).

Industry overview consists of manufacturing, transportation/warehousing, health care, and finance/insurance with manufacturing providing the majority of the jobs at an average wage per job of $54,000 in 2010(Memorial Hospital And Health Care Center & Dubois County Health Department, 2011). Obesity in the county grew to 28.9% in 2008 compared to 26.8% in 2006(Memorial Hospital and Health Care Center & Dubois County Health Department, 2011). Physical inactivity also increased in the two year span growing from 20.9% in 2006 to 24.5% in 2008(Memorial Hospital And Health Care Center & Dubois County Health Department, 2011). Summary of Tools

Population Economic Status Assessment

The Population Economic Status Assessment of the county was utilized to obtain the population estimates, cultural diversity, income levels, poverty among children and unemployment rates. In 2013 the population estimates of 42, 361 were found in Dubois County (United States Census Bureau, 2014). Of these, the cultural demographics of 98% were white and 6.4% were Hispanic or Latino (United States Census Bureau, 2014). In 2011, Dubois County provided only 0.6% of the births in Indiana and 0.7% of the deaths (Kelly School of Business, 2014). The median household income was $54,168 and 7.9% were below poverty level wen the span of 2008-2012 was studied (United States Census Bureau, 2014). The rate of poverty among children in Dubois County was under 10% in 2010(Memorial Hospital and Health Care Center & Dubois County Health Department, 2011). A 7.5% unemployment rate in 2010 was seen as well as an increase in families receiving temporary assistance (Memorial Hospital and Health Care Center & Dubois County Health Department, 2011).

Neighborhood/Community Safety Inventory

Environmental safety hazards present in Dubois County range from air pollution, invasive animal species, climate, and resources. Air pollution is a byproduct of the manufacturing industry. The Particulate Matter measurement in 2010 was 27.2ug/m3 which contributes to the asthma and cancer rates in the community (Air Quality, 2012). Another environmental concern is the possible conversion of a coal-fired plant into an incinerator of biomass which also threatens to worsen the respiratory issues of the population (Healthy Dubois County, 2014). Invasive animal species of the county include the Emerald Ash Borer and Gypsy moth who could deforest the trees and shrubs thereby threatening our environment (Dubois County Soil and Water Conservation District, 2014). The climate is humid and the annual precipitation is spread throughout the year (Federal Emergency Management Agency, 2014). The soil is flat and provides poor drainage thus placing the county at risk for flooding (Federal Emergency Management Agency, 2014).

Cultural Assessment Tool

The primary cultural groups of Dubois County are whites with German ancestry and a growing Latino population. The numbers of females to males of both cultures is approximately 50:50(Dubois County, n.d.) Religious affiliations of the community include Catholics, Lutheran, Methodist and Mormon with Catholics being approximately 71% of the population (Onboard Informatics, 2013).

Disaster Assessment & Planning Guide

Dubois County’s disaster preparedness plans and resources are maintained by the county health department. The four major areas of focus include: acts of nature, such as floods and tornados; disease outbreaks, such as influenza and Hepatitis; accidents, including chemical spills; and terrorist acts (Dubois County Health Department, 2012). With such disasters the most vulnerable populations are the young and old, who are the most likely to be affected by a disaster. Public agencies such as the Red Cross, Memorial Hospital and Health Care Center, Dubois County Health Department are a few of the local agencies that can offer resources and aid to those individuals during times of crisis. Ethnicity issues related to disaster are language barriers of those who have recently traveled to the area.

Windshield Survey

The environment of Dubois County is a mix of urban and rural areas that are rich in history. In Jasper, IN there are eighteen parks located in this county seat of Dubois County. They are well maintained by the Parks and Recreation Department of the town. The homes in Jasper overall are well maintained and landscaping includes a mix of trees, shrubs and flowers. The home lot size ranges from small to large as you progress away from the downtown area. Older homes are more focused in the downtown area and newer homes are being developed in the outer areas of town. Not all of the homes have access to sidewalks or walking trails within walking distance. The Patoka River flows through the town and a recreational railway also passes through the town. Residents take advantage of the river front area with a river walk pathway that passes 2.1 miles along the river. The river walk and pavilion area along the river and parks provide common areas for families and fitness enthusiast.

Other gathering places include a number of restaurants and bars in town. These restaurants are fast food, fast-casual and bar/grill type establishments. Transportation includes personal vehicles and public transportation. Schools include five primary education schools, one high school and one community college. There are over 50 dentists, 18 family practice, 5 pediatricians and 38 nursing homes/skilled/assisted living agencies in Jasper. The community business owners work hard to build up the town and county through such organizations as Dubois Strong and Greater Downtown Jasper Business Association. Dubois Strong’s focus is to support business growth through marketing to access to capital to help new and existing business to thrive. Diversity can be seen in the growth of Hispanic churches/mass times, Hispanic food stores, and restaurants.

Population Health Scavenger Hunt

The Dubois County Health Department’s target population is the residents of Dubois County and to support the health of the county. The county website promotes the health department and the health department advertises in the local news media with regards to upcoming events and programs. The Jasper Chamber of Commerce promotes local businesses, new resident information, recreation activities, recycling programs, and more. The director of the chamber is also active in promoting the improvement and activities within the city through news media and working with various committees. Both the fire and police department are housed within the city center of Jasper and both provide programs for children in addition to keeping our city safe. The police department provides schools with the DARE program for drug prevention. The City of Jasper, through the service of various agencies, houses a community food bank, energy assistance program, foreclosure prevention services and health family promotion program for those who qualify.

Description of Selected Community

Dubois County is a community built with German ancestry that has diversified over the years to include a Hispanic/Latino population. Individuals within the population are proactive in keeping the community thriving in this ever changing environment. Growth of the various cultures can be seen in the development of Hispanic churches and food stores. Cardiovascular disease was the leading cause of mortality in 2006-2008(Memorial Hospital and Health Care Center & Dubois County Health Department, 2011). Health disease prevention is provided through programs through the hospital and availably of outside activities found in the river walk and parks in the area.

Interpretation of Data

When comparing the number of births and deaths in Dubois County to Indiana as a whole, the numbers are even, in comparison. Yet in international migration, the county ranks 23 out of 92 counties (Kelly School of Business, 2014). In examination of the leading causes of death in the county, most
young people die due to injury and older people die from either cancer or heart disease. Conclusions could be made from this data. A population who is primarily employed by manufacturing facilities could be the source of the accidents in the young and the environmental agents from these plants may cause death in the elderly after multiple years of exposure. Also, another causative factor to consider is the availability of fast food linked to the increased mortality from heart disease.

Problems in the Selected Community

When the leading causes of mortality in Dubois County with regards to the Healthy People 2020 goals are examined, the topics of Heart Disease and Stroke, Nutrition and Weight Status and Cancer appear to be the top three problems for this community. Heart disease and stroke are leading causes of mortality in America and therefore lend themselves to an increase in healthcare cost (U.S. Department of Health and Human Services, 2013). Prevention of these events can start with control of blood pressure, cholesterol, tobacco use, improved diet and increase in physical activity (U.S. Department of Health and Human Services, 2013). Controlling these risk factors is therefore one of the goals of Healthy People 2020 as they attempt to ameliorate the health of the nation through health promotion and prevention.

Not only does improving one’s nutrition and weight decrease the risk of heart disease and stroke, but it will also aid in the prevention of other diseases including cancer. The Healthy People 2020 goal of Nutrition and Weight Status not only looks at an individual’s diet, but increasing household food security and eliminating hunger (U.S. Department of Health and Human Services, 2013). With the accessibility of fast food, increased physical inactivity and environmental safety concerns over the past few years, these goals for health promotion and prevention are applicable to this community. The resources in the community along with the community’s desire to care for its members should help this community thrive.

Problem in Relation to Goals

Healthy People 2020 are science based goals for “improving the health of all Americans” (U.S. Department of Health and Human Services, 2012). It “established benchmarks and monitored progress over time in order to encourage collaboration across communities and sectors, empower individuals
toward making informed health decisions, and measure the impact of prevention activities” over a ten year period( U.S. Department of Health and Human Services, 2012). Through the identification of a community’s health needs, a community can determine the health priorities and opportunities for improvement” (U.S. Department of Health and Human Services, 2012). This process helps the community to live “longer lives free of preventable disease, disability, injury and premature death” (U.S. Department of Health and Human Services, 2012).

Therefore looking at the Dubois County community’s health concerns for heart disease and stroke, the goal of nutrition and weight status is a great starting point for improving the health of the community. As the individual lives of the community members improve so will the county. A healthy community is a thriving community. Poor nutrition has been linked to heart disease, diabetes and some cancers. Not only is nutrition an individual’s choice, but resources must be accessible for proper nutrition and exercise. Fresh produce through Farmer’s Markets, health promotion through work, and accessible healthy activities for the public are a few solutions to support the community as they strive to ameliorate their lives.

Availability of Community Resources

A variety of organizations throughout the community provide services to improve the nutrition and health of those it serves. The Greater Downtown Business Association hosts a Farmer’s Market every Saturday morning from May through October. Not only does this provide locally grown produce to the community, but it also offers a positive social gathering for families and those interested in improving their nutrition. Many of the local churches and organizations offer 5K run/walk opportunities throughout the county as well. Memorial Hospital and Health Care Center offers fitness and nutrition classes for the community as part of their mission to ‘Be for others.’

Primary Prevention Topic

My primary prevention topic is the prevention of overweight and obesity by means of healthy nutrition and physical activity. Amelioration of health will reduce the disease risk for heart disease, stroke, diabetes and cancer in our community. A successful community starts with healthy individuals.

Use of Questions

The largest contributor to morbidity and mortality in Dubois County is poor nutrition either through lack of education or resources. The businesses and organizations are trying to improve the nutrition/physical fitness of the community by offering classes, walk/runs and other means of health promotions through media promotion. The local physicians have discussed services on local radio programs, through seminars at the hospital and in articles in the local papers. There is also a community food bank and farmer’s market. The most recent controversial community health concern published by the news media is that of the proposed biomass plant to be initiated in the old power plant location. There has been community involvement by community leaders and individuals to keep this from happening due to the concern of air quality. As it stands, the company that was going to initiate the transition to biomass has recently revoked their commitment to the project.

Most people in the community are concerned about staying healthy for a better quality of life, but they may just not realize all the free or low cost resources available to them. Local news media advertise the hospital programs available and promote the local fitness activities available. Education needs to remain a constant to inform the community of the opportunities available to them. As mentioned previously, most of the emergency room visits are due to injuries/accidents, but cardiology issues is the top hospital inpatient discharge diagnosis (Memorial Hospital and Health Care Center & Dubois County Health Department, 2011). Therefore focus on prevention and treatment of heart disease is of paramount importance. Focusing on prevention will improve the longevity of this community. Quality of life in the community is reduced by the prevalence of multiple factories in the area. As previously mentioned, the air quality has impacted the community’s rate of asthma and cancer. Improving quality of life needs to include improving air quality.

2011 Dubois County Health Needs Assessment (Memorial Hospital and Health Care Center & Dubois County Health Department, 2011) Retrieved from www.duboiscountyin.org/stories/2011dchealthassess.pdf Air Quality. (2012). Indiana County of Dubois Government Website. Retrieved from
www.duboiscountyin.org City Data: Dubois County, Indiana. (Onboard Informatics, 2013). Retrieved April 22, 2014 from www.city-data.com/county/Dubois_County-IN.html Dubois County. (n.d.). In Wikipedia. Retrieved April 22, 2014 from http://enwikipedia.org/wiki/DuboisCounty,Indiana Dubois County Health Department (2012). Indiana County of Dubois Government Website. Retrieved from www.duboiscountyin.org Dubois County Indiana Profile (Kelly School of Business, 2014). Retrieved from www.stats.indiana.edu Flood Insurance Study: Dubois County, Indiana and Incorporated Areas (Federal Emergency Management Agency, 2014). Retrieved from in.gov Healthy Dubois County (Healthy Dubois County, 2014). Retrieved from www.healthyduboiscounty.org Invasive Animal Species Information (Dubois County Soil and Water Conservation District, 2014). Retrieved from www.duboisswcd.org State & County Quick Facts: Dubois County, Indiana (United States Census Bureau, 2014). Retrieved from www.quickfacts.census.gov. U.S. Department of Health and Human Services. (2012). About Healthy People. HealthyPeople.gov. Retrieved from http://www.healthypeople.gov/2020/about. U.S. Department of Health and Human Services. (2013). Nutrition and Weight Status. HealthyPeople.gov. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=29 U.S. Department of Health and Human Services. (2013). Heart Disease and Stroke. HealthyPeople.gov. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=21

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