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Community Nursing Assessment

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Submitted By ompnurse
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The Community I chose is located in Marion County, Indianapolis, Indiana. The population of Indianapolis, Indiana in 2013 is listed as 843,393 (City­Data, n.d.). Indianapolis is the host of several major events every year which includes the Indianapolis 500 mile car race; the Brickyard which hosts the Allstate 400 Nascar race; the Indiana Black Expo Circle City Classic football games bring some of the best black college teams to our city every October; the Indiana Black Expo Summertime Celebration at the convention center downtown and the NCAA Mens Final Four Basketball Tournament which is one of the most popular college events that the city hosts every year. These are just a few of the events that Indianapolis host each year. The community I am observing is primarily composed of blacks and is in the 46202 zip code. It is located approximately six blocks east of a well “manicured” neighborhood known as the Old Northside and, approximately, a ten minute drive to downtown Indianapolis. Several of the neighborhood residents state that in the past 10­12 years, there has been a slow influx of whites moving into the Old Northside neighborhood due to the construction of new houses, condos and renovations of older homes which. At one time, blacks were moved out of those same houses because they were deemed unlivable and were condemned. Needless to say, a lot of those houses were never condemned but, were boarded up for
15­20 years until they were bought by contractors who renovated the houses and resold them. These homes are listed on the market anywhere from $175,000 to $300,000. WINDSHIELD SURVEY There are very few black owned businesses in the neighborhood. Within walking distance, there are two “soul” food restaurants with meals high in fat and calories. There is a McDonald’s, Wendy’s KFC, White Castle, Taco Bell and two coffee shops within a mile or two of this community. There are no health food stores within the area. There are two black owned beauty shop and a barbershop. There are four baptist churches, one catholic, protestant and apostolic church in the nearby area. There is one grocery store within walking distance and the nearest two drug stores are more than two miles away. There are two grade schools in the immediate area. The nearest middle school and high school is too far to walk to. There are four hospitals approximately 2 to 4 miles away. There are not any community centers or boys’ and girls’ club in the area. There is one swimming pool within walking distance, but it is not very safe for children to walk to so they have to wait until an adult can take them. There are several known drug houses in the immediate area where countless of people traffic in and out of the neighborhood. In less than 30 minutes, I noticed at least six cars pull up outside one of the “drug” houses and, a young man would come out to the car and, an exchange of some type would take place. The nearest gym or workout facility is downtown at least 5 miles away. I was told by a neighbor, that in this block that there is one hispanic family with nine people who reside in the same duplex unit, three white families and ten black families. There are eight school aged children in this neighborhood. Some of these people have lived here for over thirty years. The houses have either wood or some type of aluminum/wood­like siding. There are no homes in this community that are made of brick. The community consists mainly of two story homes, there are at least two or three duplex units in each block of the community. The front yards are small, but have larger side or back yards. Two of the homes have a driveway and, while most of the homes have detached garages. Population Economic Status Assessment The 46202 area is home to approximately 16,335 people. The median age of the population is thirty­two years old. The majority of the population is white totaling 8,749, the second highest population group is black consisting of 5,802 people (USZIP, n.d.). The median household income in 46202 is $33,000. The majority (60%) of the people are renters and 17% are homeowners. There are 1,319 people who receive food stamps/public assistance. There are approximately 29.8% households at or below the poverty level and 32% of children are living in poverty (County, 2014). The composition of low­income group by race: African American 28%, Asian 16%, Hispanic 27%, Native American 22.3%, White 13.6%, Other 41.8% (American, 2013). The unemployment rate for Indianapolis in 2015 is 6.8% it was previously 5.8% in 2014 (Homefacts, 2015). The percentage of the population receiving state assistance is 2.8%. The percentage of workers with employment based health benefits is 59%. Percentage of people not seeking health care due to financial constraints is 16.1% Those people without any insurance (19%) have access to Eskenazi Health (county hospital). The per capita income for 2013 was $38,622.00. The homeless in Indianapolis total 6,024 as recorded in 2013 and approximately 12% of those are veterans. Neighborhood/Community Safety Inventory The safety hazards in the 46202 area is a result of many of the homes being 50­75 years old. With homes that age, there is the potential of asbestos used in the exterior siding of the home, lead paint, old electrical wiring and rodents. One of the homes in the neighborhood suffered from a fire over a year ago resulting from old electrical wiring. The owner, Freda B., stated that she noticed every once in a while, the lights or one of the appliances would turn off and they just thought a fuse had blown. Little did they realize that there was a problem with the electrical wiring and the covering over the copper wires were worn and exposed. This house was built in 1910 and the electrical system had only been updated one time. After the fire, the entire home was rewired and brought up “code”. This is an issue with many of the homes in this area. Another home in that neighborhood had a plumbing issue that had gone unnoticed until the water pressure fell significantly and it was found that a pipe had cracked that led from the kitchen pipes and was leaking into the lower level causing mold and odor. The few homes that do have a “basement” are merely “dirt” basements and not functional. Mice and other rodents get in from cracks in the foundation and make themselves a “home” in the basement. This can become an issue for people with upper respiratory issues as they have to breath in the mold and dust from the “dirt basements”. Most of the homes do not have central air which can be a problem for the older occupants and people with asthma and COPD. Indiana’s coal­fire power plants have been named the dirtiest in the country being one of the top ten areas affected year round (WTHR, 2013). The mercury level in Indiana ranks 4th in the nation. There is a proposal to reduce mercury by 66% by the year 2018(Toxic, n.d.). Mercury is a neurotoxin which is harmful to pregnant women and children There also seems to be a problem with raccoons in this area. Mr. Frank said that some raccoons have climbed on to his roof by overhanging trees and have made holes in roof and getting in above his ceiling. Cultural Assessment The age composition in 46202: Age Male Female 0­5 yrs 4.48% 5.86% 6­11 yrs 3.45% 4.20% 12­17 yrs 3.68% 4.30% 18­24 yrs 17.04% 17.10% 25­34 yrs 24.17% 19.08% 35­44 yrs 17.20% 11.92% 45­54 yrs 14.36% 12.8% 55­64 yrs 8.07% 9.45% 65­74 yrs 4.25% 7.07% 74­84 yrs 2.42% 5.24% 85 & over 0.88% 3.17% As far as the cultural attitudes regarding age and the affect it plays in health care is the black population tends to believe that as one ages, health problems are just a part of getting “old”. Mrs. E. says if she has minor issues that don’t seem to bother her too much, she will not seek out medical help because she does not have money to waste. She tends to believe that the doctors don’t know what they are talking about and they are just out to make money. She has heart disease, hypertension and diabetes, she picks and chooses which medication she takes because they make her sick to her stomach and give her headaches. The black population in this neighborhood often wait until the illness or disease is so advance out of control until they require hospitalization. There’s a saying among older black people that if you “live right, you’ll live long”. Black women will seek medical help faster than black men. Black men tend to think it’s a sign of weakness if you seek out help. By the age 16, most black children are considered young adults and usually making adult decisions for themselves. Blacks have little patience for disobedient children and will often spank as a form of punishment for bad behavior. Some forms of punishment may be to take away privileges, entertainment activities and made to do extra chores. I asked some of the black women in this community how they deal with stress. Marie B. stated she and her friends will sit around the house on the weekend, drink, play cards and listen to music. She states it’s too expensive to go out for entertainment. Angel L. says she tries to take her kids to the children’s museum and the zoo once a year but, that it literally sets her behind on her bills when she does. She often does not have enough money to buy the things that she and her children need. Christmas time is hard for her because she is not always able to buy toys for her kids and she will often receive care packages from her church during the holidays. Disaster Assessment and Planning Guide Indiana has severe thunderstorms and tornadoes throughout the spring and summer seasons. When there is a tornado, it can have a devastating affect on the community as a whole. There are lives lost, severe injuries and devastating property damage. There are businesses and homes which may not have adequate insurance coverage and, therefore, may not be able to rebuild or get adequate compensation for the damage. Drinking water would be affected as well as the food supply. In a rural area this would pose danger to farm animals as well damage to crops, causing financial stress to farmers. The state performs “testing” of tornado sirens and warnings through television broadcastings throughout the spring/summer with the first one beginning in March. This is to alert residents what to do and where to seek shelter in case of an actual tornado. Population Health Scavenger Hunt The Gleaners Food Pantry is in a big brick warehouse building. It is very organized and clean. They will sometimes advertise on the radio, but mainly it’s through word of mouth and handouts that are seen in stores and businesses. The staff is polite and helpful. The only language spoken there is English. There are no fees, but they do take donations from the public and a lot of businesses hold a food drive at work and drop it off at the food pantry. There is a bus line that runs pass their front door. The Fire Department is located approximately a mile or more from the community I am assessing. I have taken my grandson before and they are very receptive and good at explaining about the dangers of fire to kids and will even demonstrate the stop, drop and roll process. The fire department pass out smoke alarms to homes in the inner city. They have a couple of hispanic firemen who speak spanish. The “house” is very clean and they were all wearing some type of polos or tee shirts that had the IFD emblem on it. Substance Abuse Facility The Salvation Harbor Life houses men and women. It is a detox facility and intense rehabilitation facility. The outside does not look very inviting and there were several residents standing around outdoors smoking. After you open up the first set of doors, you have to “buzz” in. The employees there were former addicts themselves, so they are able to communicate more effectively and understand the struggles that a drug addict has to go through to get recovered. The employees state that they enjoy giving back and helping people who have lost their way while giving them hope to turn their lives around. There is a fee of $50.00 to detox and then after that, if the person decides to stay on, it’s done by a sliding scale fee. They have church services every Sunday and NA meetings every day. There are buses that comes in front of the establishment. The Homeless Shelter is a newly built facility. The guy who was there when I stopped in was on television several months ago telling his story of being a heroin user in the past. He and the other staff members were very informative and helpful. They don’t charge any fees, but they will take donations. There have showers and two huge rooms where the men sleep on cots. It is located downtown so it’s accessible by foot and bus. The YMCA holds several different classes and group workout training. It has meetings for diabetic classes to teach healthy cooking and eating and also has classes to help loss weight. It has an indoor pool, basketball, racquetball courts and workout equipment. The staff were pleasant and laid back. The fees range anywhere from $50 for a single person and much more if you have a family. The do offer a sliding scale for single parents with children. They speak english and a little spanish. They advertise through the media and brochures. The Planned Parenthood has recently opened up a new facility near where I live which is about 20 minutes north of downtown. It very inviting and the staff was great. They are non­judgemental regardless of your reason for being there. The fees for the services are minimal, depending on your insurance or what you make. The staff appeared professional and knowledgeable about the services offered. With abortions, they give the female information to take home to read and to think for a couple of days before making a decision. They give out information about STDs and offer different types of birth control.
Summary of the Assessment of the Community My assessment of the 46202 area is that it is not culturally diverse. The poverty level is high and there is not enough money for preventive health care or everyday needs. People can’t afford to buy fresh fruits and vegetables because of the cost, so they buy more processed meats and canned goods. The area is not safe for walking and that deters people to get and exercise. There is only one park nearby and no community center or gym facilities to accommodate the lower income population. The two restaurants in the area serve meals high in fat and calories which can lead to heart disease and obesity issues. The older blacks in this area do not seek out medical attention until they really need it which leads to increase hospitalizations. Diabetes and obesity seem to be the major issues in this community. The homes are not well maintained and there are environmental issues as well as safety issues. The electrical in the homes are outdated and are a fire hazard. The old “dirt” basements and rodents that reside in the basement pose health problems for the occupants who have asthma and other upper respiratory illnesses. There is a high incidence of tornadoes in the city of Indianapolis. Knowing that the safest place in a tornado is the lowest level and, most of the homes in this neighborhood have dirt basements which are not sanitary or functional. In Marion County, there is an average of 3.6 days of poor physical health and 3.8 days of poor mental days. Smoking among adults average 24% while 14% in the nation smoke, 32% of adults are obese compared to 14% nationwide, there is 27% of physical inactivity, 16% of excessive drinking compared to 10% in the nation, 19% of the people are uninsured compared to 11% nationally. Screening for diabetes is at 84% and, 90% nationwide (County Health, 2014). There are 750,000 adults and children with Type I and II diabetes and over 1.9 million more are borderline diabetics (American, n.d.). Blacks are more prone to diabetes more than any other ethnic group. I identified three Type I diabetics and two type II diabetics and, two were family members. The top three leading causes of death include heart disease at 222.8 deaths out of 100,000 people compared to U.S. rate of 196.09, cancer deaths are 215.9 per 100,000 while the U.S. ranks 179.26 and, lung disease at 63.5 per 100,000 while the U.S. is 41.36 per 100,000 people (Indiana, 2014). The problem I would like to investigate is diabetes. Having diabetes lowers the expectancy of life by up to 15 years. The risk for Heart disease increases by up to 4 times. Diabetes also is the cause of amputations, kidney failure and blindness. The goals of the Healthy People 2020 are for people to achieve longer healthy lives while preventing premature death, disease and illnesses across all groups. Promote physical and social well being and increase the quality of life by developing healthy behaviors throughout the lifespan. To reduce the disease and the financial stress of diabetes, improve the quality of life for those who have or are at risk for diabetes (CDC, 2011). Measures to prevent diabetes include increasing the intake of healthy foods and drinks, such as fresh vegetables and fruits. Finding opportunities to increase physical activity on a regular basis in order to obtain and maintain a healthy weight. Eskenazi Health has a program called Healthy Me. This is a free program offered to all Eskenazi patients and families. The program teaches alternatives for healthy eating and exercise. They have a newsletter that gives you tips for healthy eating and highlights a “exercise of the month”. Indy in Motion offers free fitness classes at several community centers and parks throughout the city. The YMCAs hold classes for diabetics for weight loss and offers a reduced rate for memberships. Heart disease, diabetes and obesity seem to be the major issues in the community I assessed. Mrs. E., (mentioned earlier in this assessment) has heart disease, hypertension and is overweight. Mrs. V. has had open heart surgery and, has had two strokes in the last 12 years states she was overweight up until last year when she lost 50 lbs. due to hospitalization of an unknown illness. I noticed at least five people out in the neighborhood and they all appeared overweight. Some of the health concerns mentioned in the INDYSTAR newspaper and the Indianapolis Recorder newspaper are smoking rates among teens and adults, obesity, diabetes, asthma and mental health. Indiana has the highest rate of teens considering suicide and ranks second for those who have attempted suicide (IndyStar, 2015). The community seems to be concerned with obesity and heart disease. Rev. M., minister of a local church, states that he has several church members who have had heart attacks and strokes in the last year or two and, he had a “mild” heart attack three years ago. Rev. M. says he knows that he should eat better, but due to his schedule, it is often easier to pick up fast food. He states he tries to use his treadmill at least once a week but, he knows he needs to do more in order to lose weight. Freda B. states that she knows two people under the age of 50 that have had heart attacks. She believes it is because they were overweight, not eating the right foods and, lack of exercise. Freda also expresses her desire to join a gym, but can’t afford the monthly membership fee. She makes approximately $26,000/year and has a 12 year­old daughter and takes care of her bedridden mother. Her neighbor, Mr. Thomas, states that he just does not have the money to buy healthy food and, so he mainly eats lunch meat, sardines and peanut butter and jelly sandwiches. He says that his doctor has told him that he needs to lose 25­30 lbs, he is borderline diabetic and hypertensive. I work at Eskenazi Health in the operating room and I questioned Dr. G., a trauma doctor, about the type of emergent patients who come into the emergency room. Dr. G. stated that chest pain, gunshot injuries, abdominal pain, COPD, diabetes and exacerbation of asthma seemed to be some of the main reasons why people end up in the emergency room. Most are admitted because of other poor health issues and others are kept on a 23­hour observation period. I believe that there are number of factors affecting the quality of life in this neighborhood which include: Low income/poverty level, poor physical health days, lack of affordable gyms, physical inactivity, poor mental health days, alcohol use and depression.

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