Community Health Nursing Essay

Course Description: Continued study of nursing models and application of relevant theories to guide nursing practice as it pertains to health promotion and risk reduction. Using the family as the essential unit of care across all environments within the community, critical thinking and clinical decision-making processes will facilitate the design, management, and provision of care to modify risk factors. It promotes engagement of healthy lifestyles among individuals and families within the community. Specific clinical activities are related to prevention and reduction of health disparities across the life span through the conduct of community assessment and the development and implementation of culturally appropriate nursing strategies reflecting professional values and behaviors.

Prerequisites or Co-requisite:NURS 3000, NURS 3020, SOC 2100

Course Objectives:

At the conclusion of the course, the student will be able to:

A.Describe the current focus of state, national and global health objectives. B.Define health promotion and population-focused nursing practice. C.Utilize principles of public health core functions and health education to formulate population focused health promotion interventions that address the goals of state, national and international objectives (outcomes). D.Function as patient/family advocate by designing, coordinating and managing the provision of nursing care focusing on health promotion and risk reduction in and across all environments. E.Demonstrate knowledge and sensitivity in the care of diverse populations in regard to age, gender, culture, race, religion, socioeconomic status and lifestyle preference. F.Facilitate active family participation in health assessment and the promotion of health lifestyles and health care decisions. G.Conduct comprehensive community assessment to determine family health risks/strengths.

H.Demonstrate effective use of information-based technology in planning health care promotion with families in the community. I.Design and implement an appropriate curriculum for health promotion of families in the community. Program Assessment Plans are located at the following link and can be accessed by clicking on the link in the first column for each program.

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Community Health Nursing Essay


As the school nurse role evolves, there are increasingly more health concerns for the school nurse. Does the locale make a difference in the problems, or are health problems in children and adolescents universal? In some inner-city areas, violence is a prevalent issue. What do you think are the biggest problems in your areas?

The role of the school nurse has definitely evolved since I was in school. I remember the school nurse in elementary school was very kind in her starched white uniform and when you went to the “clinic” you were told to lay down on a cot and put a cool washcloth on your forehead. According to Nies & McEwan, many of today’s health challenges are different from those of the past and include behaviors and risks linked to the leading causes of death such as heart disease, injuries, and cancer (p. 580). There is an increase among young people to participate in unhealthy behavior such as smoking, drinking, drugs, and poor nutrition, decrease physical activity, increase sexual behavior, violence, suicide, that will put them at a risk for health problems (Nies & McEwan, 2015) In 2013, the population of Chesapeake, Virginia is 230,571 (United Stated Census Bureau) Chesapeake Public School Nurses in 2011-2012 treated 681,526 students in their clinic; treated 117,058 ill students; treated 98,041 students that needed first aid and injured themselves; performed 62, 089 nursing procedures; counseled 175, 158 students and parents; and administered 128, 869 medications (Chesapeake Public Schools, 2012). WOW, that is a lot of patients!

This week’s lessons discusses the evolving role of the school nurse not only attending the students’ needs but involvement in “policy-making activities at both the local and state levels (CCN, 2015) The question proposed in this week’s lesson regarding some of the roles for the community health nurses is also applicable to the school nurse. The school nurse is the clinician, case manager, advocate, educator, researcher, administrator, change agent, case finder, coordinator and consultant in order to meet the complex needs of students. According to Nies & McEwen, many of today’s health challenges are different from those of the past and include behaviors and risks linked to the leading causes of death such as heart disease, injuries, and cancer. In the suburb that I live in there has been no violence reported by students in the school system that my daughter is a fifth grade teacher. I think the locale of the school system can increase potential risk for violence.

In the school system that my daughter is a teacher she says that they deal more with behavior problems and lack of parental involvement in the child’s progress. There are more students that are being treated with mental illness at such an early age. She had one child that was diagnoses as a bipolar. There have been several cases of child abuse that she has had to report. She feels a challenge to education system is holding children more accountable to meet requirements verses appeasing parents. Many parents are the first to say, no it’s not my child when in fact their child is the leader of the disruptive group.

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Since President Bush initiated “no child left behind” program, I think this has caused challenges for the teacher to develop more creative styles of teaching without the support of administration and parents. I did not realize that the school nurse role included seven elements that they need to focus on that was listed in this week’s discussion. I thought their primary role was clinical services that included first aid and screening. After reviewing the elements, I can see this as an interdisciplinary team approach that should include teachers, lunch room staff, parents and students to ensure that students receive a top notch school health program that will provide them the tools to have a healthy lifestyle.


United States Census Bureau. Retrieved from:

Chesapeake Public Schools, (July, 2012). School Health Advisory Board. Retrieved from: Nies, M. A., & McEwen, M. (2015). Community/Public health nursing: Promoting the health of populations (6th ed.). St. Louis, MO: Saunders/Elsevier. Chamberlain College of Nursing. (2015). NR443 Week 4: Community Health Roles, Settings, and Interventions.[online lesson]. Downers Grove, IL: DeVry Education Group

Community school nurses have a very difficult job. School age children have such a variety of health concerns that can be congenital, environmental, behavioral, and socioeconomic. (Nies & McEwen, 2015) Where does a CHN start? Promoting wellness, health education, and identifying deficiencies within the schools, and creating programs to improve services is a great beginning. I do believe that most problems that we see in children and adolescents are universal. Inactivity, obesity, poor nutrition, and substance abuse are a few examples, but these problems can escalate even more when as a child’s socioeconomic condition worsens. When researching statistics I was shocked to find out that that 8.3% of teenagers in Broward County had engaged in sex before the age of 13, that is higher than the national average of 6.2%. ( To make things worse, Broward County also has the second highest rate of Infectious Syphilis in the state.

HIV and Chlamydia are also on the rise compared to the rest of the United States. Sexually transmitted diseases in this demographic are increasing but teen pregnancy is on the decline. This I believe is a real problem, sex education must start in our homes with parents and transcend into our schools. According to our reading, sex education in our schools remains controversial. However, it seems like a necessity for our youth to have a nonjudgemental forum in which they can receive accurate information

Wow, I was amazed at the statisctis for STD’s in Broward County and wanted to see how Chesapeake Virginia rated. Per 100,000 there was 588.3 per people diagnosed with Chlamydia and that is higher than the state of Virginina and nationally. Gonorrhea was 108.9 compared to national level of 107.5.

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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.

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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.

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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 Air Quality. (2012). Indiana County of Dubois Government Website. Retrieved from City Data: Dubois County, Indiana. (Onboard Informatics, 2013). Retrieved April 22, 2014 from Dubois County. (n.d.). In Wikipedia. Retrieved April 22, 2014 from,Indiana Dubois County Health Department (2012). Indiana County of Dubois Government Website. Retrieved from Dubois County Indiana Profile (Kelly School of Business, 2014). Retrieved from Flood Insurance Study: Dubois County, Indiana and Incorporated Areas (Federal Emergency Management Agency, 2014). Retrieved from Healthy Dubois County (Healthy Dubois County, 2014). Retrieved from Invasive Animal Species Information (Dubois County Soil and Water Conservation District, 2014). Retrieved from State & County Quick Facts: Dubois County, Indiana (United States Census Bureau, 2014). Retrieved from U.S. Department of Health and Human Services. (2012). About Healthy People. Retrieved from U.S. Department of Health and Human Services. (2013). Nutrition and Weight Status. Retrieved from U.S. Department of Health and Human Services. (2013). Heart Disease and Stroke. Retrieved from

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Community Health Nursing Essay

The implementation of a program which makes health care accessible is a goal of any society. In line with this goal, the establishment of community health nursing was formed. This provided better opportunities for people to acquire the right health care assistance for each of their concerns. There were some factors that may be attributed in the formation of a health nursing. These influenced the creation of the program which intended to provide resolutions for problems that have long been encountered. The first source of influence may be justified even before the 19th century Europe.

In the past, family members who were sick were just attended by female members of the family and were not able to access full health care from a professional or a specialist (Allender, 2004). One of the great problems which were encountered by societies was the minimal opportunity for ordinary people to go to a medical specialist. Almost always the case, only those who have the economic capability were able to avail these types of services. Add to that the seemingly underdeveloped infrastructures back then.

This paved the way for an idea to bring at least satellite health care units in small communities to service the general public. One more attribute which lead to the development of community health care can be pointed out to religious charities. The monks in Florence, Italy had committed a historical health care service for those who encountered accidents. They even provided first aid solutions for people who needed their help even on a 24 hour basis. As a matter of fact, these religious figures even provided the necessary health care for various pilgrims to some of the considered holy lands based on religious beliefs.

During the medieval times, there have also been great developments in community based health services. There was a time when a law catering to the poor of England was passed in 1601. This rule designated the instructions for health specialists to render their services to the poor who did not have any means of availing health care. Since the governing sector is centralized in the royal institution, it was really easy to disseminate the services to identifiable poor communities in the country.

Another historic event took place in France when the Friendly Visitor Volunteers was formed. In 17th century France, there was a great deal in re-establishing the economy. This prompted the organization to render public health services by sending the service directly to the homes of the poor and disabled. The main funding process of the organization was initiated by wealthy women individuals of the society who cared for the welfare of the general public. The community health nursing was definitely a very good approach in caring for the needy and unfortunate.

However, by the time the Industrial Revolution hit Europe and America, the group of these community based health units were greatly reduced. This paved the way for what the present health care structure societies have today. Hospitals and health centers were established even in bigger units and concentrated near urban areas. This was in direct contrast to the former approach of delegating specific health units among communities. Even though the extent of community health nursing is already reduced, newer counterparts in modern society today still has the same principle.

Home nursing can be availed today via appointments with doctors and nurses. There are also some programs among today’s hospitals which can provide an extended health care service at home based on agreements. Moreover, the establishment of home care nursing centers provides at least a refuge for patients outside of hospitals. The modern day health professionals are partnering directly with individuals who want to improve their communities in promoting optimum health care (Richmond Health, 2001).Community description and data analysis Orange County is located in the United States of America in the Southern region in the state of California. In addition with Los Angeles to the north, San Diego County to the south and Riverside and San Bernardino counties to the east. There are 84 cites within the county and several unincorporated areas. The County has a total area of 789 square miles of land and 158.6 square miles or 16.6% of water. The average temperature is about 68 degrees Fahrenheit (“Orange County, California”). There are also several beaches that are along the coastland that cover more than 40 miles. In addition to its popularity of being home to Disneyland, this county is well known for being a tourist attraction. Orange County was established after the severe drought in the 1860’s.

During this time cattle ranching collapsed leading the way towards the boom in silver mining. This huge growth in population lead California legislatures to divide Los Angles county and created Orange county as a separate political entity in March 11th, 1889 (“Orange County, California”). The State of California and Orange County are in a severe water shortage as the state has implemented laws to discourage unnecessary water usage. Population and Economic Status From an epidemiologic viewpoint the U.S census in 2012 estimated the population in Orange County to be around 3,090,132 with a population density of 3871 people per square mile. The average household size in Orange County is 2, in addition, the average gross adjusted income of non-migrant tax payers in this county in 2005 was $74,786. The median average contract for rent in 2009 for renting an apartment is approximately $1,367 per month, while the average house value approximated to be around $530,000.

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The percentage of residents living in poverty in the year 2009 was approximately 10.7% with 5.8% being white non-Hispanic, 13.0% of black residents, 17.3% for Hispanic or Latino, and 18.6% for other race residents. The median age of Orange County residents in 2010 was 36 years old with males having the median age of 34 years old and females 37. The birth rate for live births per 1000 population from the year 2000 to 2006 was 15.4. Death rates showed slightly lower rates per 1000 from the years 2000 to 2006 with 5.8%. Persons enrolled in hospital insurance and/or supplemental medical insurance (Medicare) in the year 2003 was 309,081 (281,334 aged, 27,747 were disabled) (“Orange County, California”).

In comparison to residents without health coverage in the year 2000 was estimated at 15%. Unemployment rate is estimated at 143,026, while the amount of employed is estimated at 1,445,477 in the 2010 census report (“State & County Quick Facts”). Cultural Assessment From the biophysical considerations, the aging baby boomers make up 25.4% of the population in Orange County with more families caring for the elderly at home especially among the Hispanic population. There are over 7,326 persons living in nursing homes in 2010. Coping with stress and adapting to change when the unemployment hit an all time low in 2010 with 10,000 jobs lost put residents in a crisis.

Current unemployment rate in Orange County is 5.0% with and estimated 3 million people homeless. There are 44.1% white non-Hispanic, 33.7% Hispanic or Latino, 17.7% Asian and 1.5% Black non- Hispanics living in Orange County. There are slightly more females with 53.0% and males at 47.0%. The Republican Party slightly out numbered the Democratic Party in 2012 by approximately 8,000 votes. In March of 2000 there is a recorded foreign-born entry population of 165,344 people. The current population of college students is 230,749 and people 25 years of age and older with a high school degree or higher is 79.5%. Religion statistics show the Catholic Church Adherents has the highest population of 61.2% with the Jewish ranking at 4.7% and the LDS Mormon Church 3.4%. The most common place of birth other than Orange County among foreign born residents is Mexico at 46% with Vietnam coming in second at 13%.

There are 56.6% of residents who speak English at home, compared with 25.3% residents who speak Spanish as their primary language. The government finances expenditure in 2006 for Orange County for assistance and subsidies was $210,973,000 with public welfare and cash assistance programs paying out approximately $6,483,000 (Orange County California). Neighborhood/ Community safety There are approximately 18% of children living in poverty and with 26% living in single-parent households. Social and economic factors showed violent crime rates ranking at 230 and 37 injuries to death. There are no drinking water violations in comparison to 28% claims of severe housing problems among renters.

There are a low percentage of people having limited access to food at 1% of the population with 15 homeless shelters found in and around Orange County that have access to food, clothing and shelter (Orange County Health Department). Potential weather events include the high incidence for earthquakes. Orange County area has a historical earthquake activity high above the California state average and 2458% overall above the U.S average (Orange County California). Government finances expenditure for police protection for 2006 estimated over $276,955,000 and cost for correctional institutions was over $178,413,000 (Orange County California).

There are 26 police departments and 12 fire departments through out Orange County with first responder medics on duty. The numbers for homicides between the years 2000-2006 have a less than state average with 27.8 per 1,000,000. Suicides are also at a below state average between 2000-2006 with 79.3 per 1,000.000. (Orange County California). While Immigration is an ongoing debate in Orange County and California the state’s immigrant population only increased by 15% (1.3 million) in the year 2000s, compared to 37% (2.4 million) in the 1990s (Public Policy institute of California). Obesity and Alzheimer’s disease is on the rise in Orange County. There are 70% of adults who rate their health as either excellent or good compared with 30% who rate their health as fair or poor. The incidence for Alzheimer’s disease has increased 39% between 2005-2009. In 2009 there is a recorded 33.1% adults considered over weight by comparison to 17.3% being obese. In 2011 the California Department of Children and physical fitness test showed 37.8% of children tested as having an unhealthy body composition. This high incidence has been found to be contributed to sedentary lifestyles and being overweight. These statistics show evidence for the pertinent nursing diagnosis of ineffective health maintenance as evidenced by the unfavorable health disparities listed above. (Orange County Indicators).

Nursing actions for these disparities include more after school activity programs that include physical activities. Schools to be required to offer more fresh fruit and vegetables to be included in meals. Offering education for families and children about the potential risks for child obesity and ways to decrease the numbers by offering nutrition counseling at school. Educating the community of health risk and signs and symptoms of Alzheimer’s disease and where to seek medical attention specifically for this illness in their community. Provide resources from organizations specially designed to assistance families with special needs for people battling Alzheimer’s disease such as respite care and hospice.

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Disaster Assessment and Planning During a disaster such as a nuclear power plant emergency or earthquake, tsunamis, terrorism and acts of war the Sheriff – Coroner is designated as the director of emergency services. The counties emergency operations center (EOC) is located at Loma Ridge. In the event of a natural disaster such as a flood, storm, dam failure or coastal oil spill the County executive officer is the director of emergency services (DES). (Orange County Sheriff). The County of Orange also collaborates with the California of Public Health and also with other entities to safeguard a consistent disaster and preparedness plan through out this region and nation wide (Orange County, California Disaster and preparedness training). Most Orange County residents are unaware of the disaster planning in their community although there is an overall sense of safety as they put their full trust in community officials. Although there are several safety issues throughout Orange County such as unsafe side walks for the elderly and non- handicap accessible. The County has funded grants and bonds to improve the potential hazards.


Orange County, California. (n.d). Retrieved from

County of Health Rankings & Roadmaps. (n.d) Retrieved from

Community Health Survey Orange County. (n.d) Retrieved from

Public Policy Institute of California. (n.d). Retrieved from

Orange County Sheriff Department California (n.d). Retrieved from

Orange County California Disease and Preparedness training.(n.d) Retrieved from

State and County Quick Facts (n.d) Retrieved from

Orange County Health Department. (n.d) Retrieved from

Orange County Indicators (n.d). Retrieved from

Orange County, California State

Community Diagnosis The above assessed parameters gives a brief overview of the Health and Safety of Orange County in the State of California. The overall county has statistics showing a healthy community except for the increasing numbers of overweight children who are lacking in physical activity and the increase in Alzheimer’s disease. The plan is to implement more education on nutrition and resources to families for assistance who suffer from Alzheimer’s diseases. Also included will be to educate the community on emergency preparedness and disaster planning.

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Healthy People provide a 10-year national objective for improving the health of Americans. It has established benchmarks and monitored progress over time in order to encourage collaborations across the country, empowering individuals toward making knowledgeable health decisions, and measuring the impact of prevention activities. The vision is for a society in which all people live long and healthy lives. Objectives new to Healthy People 2020 are related to policies targeting young children through physical activity in childcare settings, television viewing and computer usage, recess and physical education in the Nation’s public and private elementary schools. Physical activity is important as it can improve health and quality of life for all, including those with disabilities. Increased physical activity in children and adolescents can improve bone health, cardiorespiratory and muscular fitness, decrease levels of body fat and reduce symptoms of depression.

There is an epidemic of obesity among our children today, this is linked to the over use of computer games and television. Healthy People 2020 have set an objective that sets limits to screen time. It was rather interesting to me that the pediatrician informed me that my infant, now a toddler should not be watching television at all as recommended by the Journal of Pediatrics. As mentioned in The Journal for Nurse Practitioners, there is a dangerous link found between childhood obesity and asthma (Rance, & O’Laughlen, 2011). A common assumption is that weight gain occurs because many asthmatic patients avoid exercise since physical activity can trigger their symptoms, though many contributing factors coexist (Rance, et. al., 2011). Interesting enough there has been a suggestion that overweight/obesity as a risk factor for developing asthma (Papoutsaakis, Priftis, Drakouli , Prifti, Konstantaki, Chondronikola, & Matziou, 2013).

As an adolescent I was diagnosed with having chronic asthma, as I was extremely active and not an overweight child. Physical activity was a normal part of my daily afterschool routine, I ran track, was a member of the swim team and was on the cheerleading squad. So having asthma one should not exclude physical activity from their life as it helps to prevent obesity and other ailments. A study illustrated that children were more adept at identifying healthy foods and explaining their benefits than identifying activities that make their bodies healthy (Lanigan, 2011). This study also discovered that the media was the primary source of children’s health knowledge. Parents need to become more involved and lead by example as it pertains to the health and welfare of their children. This is why I often volunteer for the various optimist clubs in the community, sharing information on the importance of staying active, hydrated and eating a well balanced diet.

I keep my kids in extracurricular activities such as sports, promoting physical activity and a healthy lifestyle. Early-learning professionals and parents need to play a more prominent role in teaching children about the benefits of healthy eating and activity (Lanigan, 2011). There has been a correlation between paternal influences on children’s weight gain, as a review demonstrated fathers who were overweight viewed themselves and their offspring as normal weight (Fraser, Skouteris, McCabe, Ricciardelli, Milgrom, & Baur, 2011). The children in this study were more likely to eat fast food, eat at fast pace, eat when bored and were less likely to eat dinner together as a family (Fraser, et al., 2011). As it was hard to discern whether these behaviors are a result of children modeling behaviors displayed by their fathers’, although the heavier the fathers were the greater the number of hours their children spent in sedentary activities such as watching television and using the computer (Fraser, et al., 2011).

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One strategy not mentioned in Healthy People 2020 is mandating parent involvement and modeling, which I consider first line of defense for prevention of childhood obesity and related disease. The Affordable Care Act (ACA), builds on and strengthens the foundation for prevention and wellness established by Healthy People, the nation’s health promotion and disease prevention aspirations for a healthier nation (Fielding, Teutsch, & Koh, 2012). The Guide to Community Preventive Services recommends making physical activity the easy choice by creating in our communities accessible parks and recreation; encouraging the social norm of walking, bicycling, and climbing stairs where these activities can reasonably substitute for driving and riding elevators or escalators; and placing greater emphasis on mass transit and mixed residential and commercial development to encourage greater spatial integration of places where people live, work and shop (Fielding, et al., 2012).

In conclusion, community based childhood obesity prevention programs with a school component focusing on both diet and physical activity is more effective at preventing obesity and overweight (Bleich, Segal, Wu, Wilson, & Wang, 2013). As previously mentioned one strategy not mentioned in Healthy People 2020 is mandating parent involvement and modeling, which I consider first line of defense for prevention of childhood obesity and related disease.


Bleich, S. N., Segal, J., Wu, Y., Wilson, R., & Wang, Y. (2013). Systematic review of community-based childhood obesity prevention studies. Pediatrics, 132(1), e201-e210. doi:10.1542/peds.2013-0886 Fielding, J. E., Teutsch, S., & Koh, H. (2012). Health reform and healthy people initiative. American Journal of Public Health, 102(1), 30-33. doi:102105/AJPH.2011.300312 Fraser, J., Skouteris, H., McCabe, M., Ricciardelli, L. A., Milgrom, J., & Baur, L. A. (2011). Paternal influences on children’s weight gain: a system review. Fathering, 9(3), 252-267. doi:10.3149/fth.0903.252

Lanigan, J. D. (2011). The substance and sources of young children’s healthy eating and physical activity knowledge: implications for obesity prevention efforts. Child: Care, Health & Development, 37(3), 368-376. doi:10.1111/j.1365-2214.2010.01191.x Papoutsaakis, C., Priftis, K. N., Drakouli, M., Prifti, S., Konstantaki, E., Chondronikola, M., & Matziou, V. (2013). Childhood overweight/obesity and asthma: is there a link? a system review of recent epidemiologic evidence. Journal of The Academy of Nutrition and Dietetics, 113(1), 77-105. doi10.1016/j.jand.2012.08.025 Rance, K., O’Laughlen, M. (2011). Obesity and asthma: a dangerous link in children: an integrative review of the literature. Journal for Nurse Practitioners, 7(4), 287-292. doi:10.1016/j.nurpra.2010.06.011

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Community Health Nursing Essay

As a registered nurse of only three years, I am often referred to by my peers as a “baby” nurse. However, in those short three years of practice I have learned and continue to learn many things whether medical, personal, or humanitarian. My personal nursing experience has been in surgical care services. The vast majority of the patients I have cared for are those undergoing elective procedures. They have chosen to have joint arthroplasty or some other type of procedure.

I have also had the great fortune to care for those who have been diagnosed with terminal illnesses such as cancer and leukemia. Many times I see these patients in the infancy of their disease process, but I also see them on a continue basis during treatments such as blood or platelet transfusions. The difficulties faced by patient s such as these are varied and bring with each a different set of needs to be assessed and addressed. You become not just a nurse but a caregiver, advocate, therapist, and more often than not a friend.

It is when working with these patients that the dynamics of quality versus quantity of life become central to care. In many cases family concerns, whether well meaning or not, may overshadow the patient’s wishes. Our selfish need to keep loved ones with us can blur the line as to the patient’s own wants and needs. In dealing with this you must also assess your own beliefs as to end of life decisions.

My role as a nurse must be to advocate for my patient, to develop trust in the relationship, and to follow through with their wishes. All the while promoting compassion in our interactions, In this case scenario, there are three strategies in which I would implement to address Mrs. Thomas as a patient. After assessing the patient and her situation referrals should be made for therapy modalities both physical and occupational, home health, and psychological/mental health for both Mrs.

Thomas and her spouse/caregiver.

Physical and occupational therapy could evaluate Mrs. Thomas and initiate a plan of treatment to increase stamina and range of motion to keep the patient at an optimum level of functioning. Physical improvement even in small increments can have a positive effect on the patient’s outlook. Home health could evaluate Mrs. Thomas and her need for pain control as well as her fear of dependency. Education at this juncture is imperative to patient outlook as well as outcome of treatments. With pain management in place, physical therapy could progress, thus increasing the level of patient participation. Also a mental health/psychological referral could be invaluable to both Mr. and Mrs. Thomas. Mrs. Thomas could be assisted in working through and understanding the stages of her illness, as well as her depression and sadness concerning her family relationships.

It could also help Mr. Thomas with his depression and allow them both to connect with support groups or individuals within the community with whom they can share experiences. One of the best resources for breast cancer patients is the Susan B. Komen Foundation. As a certified breast cancer educator, I have had the pleasure of working with both survivors and their families. Education is very important to all concerned in a medical diagnosis of breast cancer. Understanding of the disease process and its effects are also essential to a healthy outlook. The Komen Foundation offers support to patients, survivors, caregivers, and family members. It would be an excellent resource in which both Mr. and Mrs. Thomas could receive individualized treatment and support.

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The team approach is also necessary for working with patients, families, and caregivers. As a nurse you must accept that an individual cannot meet all patient needs so you draw upon other health care professional s to accomplish the highest levels of care.

A wide variety of team members can be utilized in the care of the Thomas’. Physicians who offer direct clinical care and disease pathologies, social workers/clinical case managers who can assist in community resources as well as their knowledge of insurances, spiritual leaders to aide in dealing with final decisions and spiritual needs of the patient and family, pharmacists who assist with a wide array of pharmacological treatments for pain and symptom control, dieticians can be helpful in counseling with meals, nutrition, supplements, and hydration. Other team members may include physical and occupational therapy, psychologists, and perhaps even volunteers to assist in the home and with errands.

The needs of Mrs. Thomas and her family will continue to fluctuate as her disease progresses. It is important for the team to stay abreast of these needs and adjust plans of care accordingly. At some point hospice services may be called upon and continued through death. This can be provided at home or on an inpatient basis.

Initiating a plan of action can alleviate stress from both the Thomas’. Mr. Thomas may feel that some of the caregiver burden has been lifted and this could aid in the treatment of his depression. This in combination with medication could be the keys to initiating successful treatment. If a psychological evaluation is needed due to the possibility of suicidal ideations, then immediate intervention is warranted with a crisis facility. Especially if there is deemed eminent danger of self harm.

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