Communication Health Focusing- Nursing Essay

(B) Needs Assessment

Demographics

Sentinel City is a simulated environment has a total population of 663,862 (Sentinel City, 2018). Within the city are four different neighborhoods; Nightingale Square, Acer Tech Center, Casper Park District, and Industrial Heights. The highest population within the neighborhoods is Casper Park District with 352,643 people, next is Acer Tech Center with 168,390, then Nightingale Square with 103,974, and the lowest population being in Industrial Heights with 38,855 people (Sentinel City, 2018). The majority of the population is Caucasian at 80.6%, followed by African American at 10.5%, Asian 3.7%, American Indian/Alaska Native 2.0%, Native Hawaiian/Pacific Islander 0.2%, and 3.1% of the population listed as being two or more races (Sentinel City, 2018). In Nightingale Square, Acer Tech Center, and Casper Park District the primary ethnicity is white and secondary is Hispanic or Latino. Percentages of each are as follows: Nightingale Square has 81.3% white and 3.7% Hispanic/Latino; Acer Tech Center has 70.2% white and 13.7% Hispanic/Latino; Casper Park is 63% white and 24% Hispanic/Latino (Sentinel City, 2018). In Industrial Heights the primary is Hispanic or Latino at 46.8% and secondary is African American 13.1% (Sentinel City, 2018). Communication Health Focusing- Nursing Essay

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As a whole, Sentinel City has a median household income of $49,091 and 18.9% live below poverty level(Sentinel City, 2018). Median household incomes were quite different between the four communities which seems to be directly related to the number of uninsured people. The highest median household income was in Nightingale Square with $269,550 and only 0.7% of them being uninsured (Sentinel City, 2018). Second was Acer Tech Center with median household income of $166,300 and 1.5% uninsured (Sentinel City, 2018). Third, Casper Park District, with median household income of $80,134 and uninsured rate of 22.7% (Sentinel City, 2018). The lowest income per household was in Industrial Heights at $24,672 and the highest percentage of people without insurance at 37.5% (Sentinel City, 2018). Industrial Heights also had the most disabled people with 12.9% (Sentinel City, 2018). The neighborhoods with the highest incomes also had older populations and the highest number of veterans. Nightingale Square has 13.9% of its population that is 65 or older and 5326 veterans (Sentinel City, 2018). Acer Tech Center has 19.8% over the age of 65 and 6208 veterans among them (Sentinel City, 2018). Casper Park District only had 6.5% over the age of 65 and 2016 veterans and Industrial Heights by far the lowest with only 0.9% over 65 years of age and 607 veterans (Sentinel City, 2018). Communication Health Focusing- Nursing Essay

Neighborhood Safety Assessment

Sentinel City is a urban environment with mostly brick buildings and most are adjoined. The biggest safety hazard I noticed in Sentinel City was the amount of garbage on the streets and pollution. These issues along with the number of buildings in disrepair became worse in the neighborhoods where income was less, particularly Industrial Heights. There were barrel fires, stray animals (dogs, cats, rats), broken down vehicles, graffiti, boarded up windows/doors, many chain linked fences with barbed wire, and sirens in the more low-income regions. When looking at the homeless population from year one to last year (a five-year span) the percentage went from 10% homeless to 35% according to the parks and recreation department (Sentinel City, 2018). The amount of garbage on the streets was significantly more in Industrial Heights but even in Nightingale Square they had the same problems just to a lesser degree. Outside of Joe’s Grocery was significant garbage on the sidewalk attracting rats. The same thing was found near the school, recreation areas, soup kitchen, etc. These environmental factors increase a persons risk of disease. Communication Health Focusing- Nursing Essay

Drug use in Sentinel City is a problem. According to the pharmacy within the healthcare system alcohol is the highest at about 26% of the population using, tobacco use is a close second at 24%, marijuana 12%, heroin use is 7%, cocaine and CNS depressants 5%, methamphetamines were 1%, and “other drugs” being 2% of the population (Sentinel City, 2018).

EMS responsiveness is 7.46 minutes within Sentinel City which was compared to three other cities was ranked 2nd (Sentinel City, 2018).

Crime reported by the police department is categorized by common arrest charges and violent crimes reported within the last year. Common charges include public intoxication, reckless conduct, criminal trespassing, controlled substance, battery, warrant arrests, and those listed as “other.” The highest percentage of those being warrant arrests at 23%, battery at 17% and controlled substances at 16% (Sentinel City, 2018). The reported violent crimes were murder, rape, robbery, and aggravated assault. The total reported cases in the last year were 2,122 (Sentinel City, 2018). The largest number by far was aggravated assault with 1,231 reported cases (Sentinel City, 2018). According to police officer, Rodney Cooper, Nightingale Square has the lowest crime rate, while Industrial Heights and Casper Park District have higher rates. He said the most common crimes throughout the city in all neighborhoods were bicycle theft, property damage, shoplifting, and drunk/disorderly conduct (Sentinel City, 2018).

5. Is there gang violence? Describe.

Gang related crime has fluctuated over the five years it has been tracked in the city. Year one was the lowest incidence with 5 homicides, 95 aggravated assault, 20 simple assault, and 25 robberies (Sentinel City, 2018). Year five had 20 homicides, 100 aggravated assault, 38 simple assault, and 40 robberies (Sentinel City, 2018).

Scavenger Hunt

Sentinel City has a number of community resources available. The Parks and Recreation Department offered swimming lessons, nutrition courses, gardening, kids Summer programs, city sports leagues, adult fitness and after school programs. The Parks department is also working on common complaints such as park cleanliness, the homeless, stray animals, drugs, park location, and crime. The healthcare system has programs for the elderly, services include: senior transportation, service animals, meals on wheels, elder abuse prevention, community centers, government entitlement assistance, and medical care advocates. They also offer 3,472 senior living units providing different levels of care from independent living to short/long term care (Sentinel City, 2018). City Hall Social Services offers adult and child protective services, healthcare assistance (ACA, Medicare, Medicaid, charity care), WIC, and SNAP. The Community Center offers parenting classes. The have basic parenting 101, positive parenting techniques, stress free parenting, and dynamics and discipline in which they provide childcare during all classes for it to be more accessible to families. They also offer computer classes in basic computer skills, word processing, basic E-Mail skills, internet skills, and supplemental classes. They teach English Language by ages and levels of need. The community center is where they hold meetings for Alcoholics Anonymous. There is also the affordable housing project which tracks on-property crimes, common tenant complaints such as noise, factory smoke, loitering, and police activity. The housing project offers studios, one and two bedroom units. Communication Health Focusing- Nursing Essay

Windshield Survey

Sentinel City is a urban environment with mostly adjoined brick buildings. For the most part they seem similar in age and architecture with the differences being the amount of upkeep between the four neighborhoods. All of them had some degree of graffiti but Nightingale Square was the nicest and Industrial Heights was in the most disrepair. There isn’t a lot of open space in the city but the areas that are tend to have a lot of garbage. The parks in Casper Park and Industrial Heights have overgrown grass and many people loitering and homeless. Nightingale Square and Acer Tech had better upkeep of public areas. There was no distinct boundaries or signage between the neighborhoods but there were economic differences that made it apparent we were moving into a new neighborhood. For example, Acer Park had fruit stands, families outside, people riding bikes and running and then as you got into Casper Park there were check cashing stores, the neighborhood became more diverse, the parks were rough with work release crews and increased pollution. As we got closer to Industrial Heights this all became worse. Common areas in Nightingale/Acer Park were areas with tables, fruit/vegetable stands, and people were dressed nicely. Overall, it gave a better sense of safety with it being mostly clean and was near the hospital, city hall, and business center providing a more professional demographic. The community felt alive with a lot of people out and about, protesters outside of city hall, people exercising, etc. Casper Park was more diverse. There were some nice things such as the art gallery, restaurants, senior center but it also had chain linked fences with barbed wire, barrel fires in the park, increased graffiti, boarded windows, more stray animals/rats, and homeless. Industrial Heights is where the school and church are located which were well maintained but all surrounding areas were in disrepair. Many fires, broken down cars, graffiti, sewage spilling out of pipes, garbage everywhere, and the sound of sirens. The stray animals were in abundance. The food kitchen was busy and had a diverse group of people waiting in line. There were street performers doing juggling and playing music for tips, construction workers, disabled people, and people loitering outside businesses. The bodega was absolutely filthy and when walking inside I was surprised to see the area with the register was behind a protective barrier. Right outside was a fence with biohazard barrels behind it. Transportation in the city includes bus, car, bike, walking, running, and motorcycle. The nicer regions were more contusive to walking, running, biking because the sidewalks were cleaner with less garbage and debris. Joe’s grocery was the largest store but other areas had small grocery stores and convenience stores that looked to have less of a selection. Nightingale Square and Acer Tech had a more Caucasian presence and as you got closer to Industrial the demographic was more diverse with a greater Hispanic population. The Catholic church was in Industrial Heights which also helped serve the food kitchen. They did a lot of outreach to the underserved individuals in the community so I think it was important this was located in the neighborhood of Industrial Heights. Overall, Sentinel City is a diverse community that demonstrates many of the common issues most large cities face. Communication Health Focusing- Nursing Essay

(B1) Data Analysis

Interpretation of Data Analysis

Through collecting and analyzing data in Sentinel City, the largest determinant of health that I found was disease process due to environmental factors. Garbage spilled on the streets contributes to stray animals and rat infestation. Diseases directly transmitted by rodents include: hantavirus, hemorrhagic fever, Lassa fever, leptospirosis, plague, rat-bite fever, and salmonellosis (Center for Disease Control, 2017). Educating the community and business owners about proper disposal by keeping garbage in thick plastic or metal containers with tight, animal proof lids would make great impact in the prevention of disease within Sentinel City. This is a larger issue in the less affluent communities of Industrial Heights and Casper Park which to their detriment the population also has more homelessness, less people with insurance, and lower levels of education which shows how the determinants of health are really intertwined in many problems. To help the environmental factors we also need to consider personal health practices, education, physical environment, health services, and income/social status. Communication Health Focusing- Nursing Essay

Sentinel City Health Concerns

(C1) Three Problem Areas

The three problem areas I have chosen are access to healthcare, sexually transmitted disease, and environmental health. Access to healthcare is a big issue within Sentinel City due to the number of uninsured individuals under the age of 65. Industrial Heights had the largest percentage at 37.5%, Casper Park was next at 22.7%, then Acer Tech Center 1.5%, and Nightingale Square with only 0.7% (Sentinel City, 2018). According to Healthy People 2020 goals they are trying to improve access to quality healthcare services. The barrier of not having health insurance leads to “unmet health needs, delays in receiving appropriate care, inability to get preventive services, financial burdens, and preventable hospitalizations” (Healthy People 2020, 2018, p.5). People who are uninsured are also more likely to not seek medical care and more likely to have premature death. Healthy People 2020 states, “access to care often varies based on race, ethnicity, socioeconomic status, age, sex, disability status, sexual orientation, gender identity, and residential location” (p.6) Improving the number of uninsured individuals in Sentinel City may help in many ways. It could allow people who are homeless, sick, or disabled to gain care needed to possibly acquire employment. I feel this would really help Industrial Heights get back on track. Communication Health Focusing- Nursing Essay

The second problem identified in Sentinel City is sexually transmitted diseases. According to Healthy People 2020, “untreated STD’s can lead to serious long-term health consequences, especially for adolescent girls and young women. CDC estimates that undiagnosed and untreated STDs cause at least 24,000 women in the United States each year to become infertile” (Healthy People 2020, 2018, p. 4). Education is a huge factor in STD prevention as they are largely preventable. Sentinel City had 607 total reported cases of STD’s and only 4 of those were marked as congenital (Sentinel City, 2018). Healthy People 2020 also notes that there are factors that affect the spread of sexually transmitted disease that would pertain to the more uninsured areas of Sentinel City. These factors include: poverty where it is more common for high-risk sexual behavior, substance abuse, and lack of access to healthcare (Healthy People 2020, 2018). Communication Health Focusing- Nursing Essay

The third problem identified is environmental health based on the amount of garbage and pollutants in Sentinel City. In all the neighborhoods, even the more well taken care of areas, was garbage spilled on the streets attracting stray animals and rats. Healthy People 2020 defines environmental health as “preventing or controlling disease, injury, and disability related to the interactions between people and their environment” (p. 1). In Industrial Heights there was sewage spilling out of pipes into the street, they had biohazard barrels near the food bank, and trash all over the sidewalks. The people in this area are already at a disadvantage due to low economic status, a high uninsured rate, and homelessness and these are the ones who are at greatest risk of the poor environmental quality. “Maintaining a healthy environment is central to increasing quality of life and years of healthy life. Globally, 23% of all deaths and 26% of deaths among children under age 5 are due to preventable environmental factors” (Healthy People 2020, 2018, p. 5).

(C2) Discussion of Community Resources

There are many community resources that could help assist in the prevention of sexually transmitted disease. The U.S. Preventative Services Taskforce recommend school based reproductive and sexual health education as an approach to reduce high-risk sexual behavior. Teaching adolescents about reproductive and sexual health in the school system helps by reducing misinformation and increase their knowledge allowing them to make more informed decisions which in turn would hopefully decrease the number of STD’s. It is also recommended to perform STD screening among sexually active men and women who are at increased risk of infection. When talking to some of the citizens in Sentinel City a couple mentioned prostitution as a means to get by. Lower income levels have higher incidence of prostitution and lack of healthcare which put them at higher risk. There are many groups that help uninsured as well such as Planned Parenthood, homeless agencies, school health nurse, and the health department. Sentinel City has the Better Health Clinic who could be actively involved in screening and improving awareness. They already provide the screening so I think the biggest thing is to increase community awareness that this is likely done at little to no cost depending on income. The school district and public health department could also increase involvement in teaching about the risks associated with STD’s. Raising awareness and making resources more available would make a great deal of difference. Communication Health Focusing- Nursing Essay

(C3) Primary Prevention Topic

I chose reproductive and sexual health and the prevention of sexually transmitted diseases to reduce the number of infectious disease and infertility from the approved topic list.

(D) Application of Assessment Strategies between Simulation and My Community

Using the demographic information for the community and doing a windshield survey provided very valuable in doing my assessment. If I were doing an assessment of my own community I would start out by doing the same things. Going to our state and city websites to gather demographic information would be my first step followed by a neighborhood and safety assessment. I learned how to find and analyze problem areas within a community, how to find resources, and help to provide education to a community.

References

Centers for Disease Control and Prevention (CDC). (2017, January 20). Rodents.

Retrieved February 23, 2018, from https://www.cdc.gov/rodents/index.html

Healthcare Learning Innovations (Sentinel City) [Computer Software]. (2018). Aurora, Co.

Retrieved from http://wgu.ucertify.com/

Office of Disease Prevention and Health Promotion. (2918). Access to Health Services.

In Healthy People 2020. Retrieved from

https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services

Office of Disease Prevention and Health Promotion. (2018). Environmental Health.

In Healthy People 2020. Retrieved from

https://www.healthypeople.gov/2020/topics-objectives/topic/environmental-health

Office of Disease Prevention and Health Promotion. (2018). Sexually Transmitted Diseases.

In Healthy People 2020. Retrieved from

https://www.healthypeople.gov/2020/topics-objectives/topic/sexually-transmitted-diseases

U.S. Preventative Services Task Force. Gonorrhea and Chlamydia: Screening final recommendation statement (Internet). 2014, Sept. Retrieved from

http://www.uspreventiveservicestaskforce.org/Page/Docum

Communication Health Focusing- Nursing Essay