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Community assessment

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General Community Characteristics

New York City has five predominantly recognized boroughs demographically. Manhattan is amongst the most densely populated city whereby it is a recognized district with historical origin, culturally identified, economically stable and equipped with different health care centres. The many different heath care centres have influenced the manner in which nursing services in the community are offered. Most institutions ensure that they deliver high quality nursing services with a view of attracting more patients and building their brand. Manhattan being a coextensive district in NYC, it receives over 30 million visitors per year, though most of the tourists hardly see away from the “22.6 square miles (58.5 square km)” of Manhattan Island, the smallest urban district. Manhattan is easily recognized by residents and visitors since it is divided alluring 220 east-west streets and 12 north-south avenues. It is overloaded with places of enduring interests, cultural institutions and one of the world largest skyscraper. Sachs (2016) states that other neighbouring cities recognizes Manhattan as the primary borough hub for business, centre for administrative services, and a financial centre for metropolis and their origin of their renown. Inside this considerable historic disparity. Geographically, Manhattan is found in New York and this greatly influences the delivery of nursing services. For instance, NYC Health + Hospital corporation manages all the public hospitals located in New York. The corporation has developed practices to be observed in the hospitals with an aim of improving healthcare in the city. The practices greatly influence the manner in which nursing services are provided. Manhattan is mainly made out of neighbourhoods that give tranquil sanctuaries to satisfied occupants. No region of NY exhibits dynamism and transformation as ultimately as Manhattan. Crowds enter it day by day to look for their prosperities, and extra millions come to wonder about their endeavours. It is Manhattan that they name an "incredible place, yet I wouldn't have any desire to live there."

Demographic and Socioeconomic Characteristics

Manhattan is one of the highly densely populated district in NYC, though smallest geographically. In the United States, NYC is the leading county with highest population and the leading densely populated region globally (Stanhope & Lancaster, 2018). The facts are supported by the 2010 census report that the district has the highest population compared to other boroughs because it holds a populace of “1,585,873 living in a land area of 22.96 square miles (59.5 km2), or 69,464 residents per square mile (26,924/km²)” (U.S. Census Bureau Quick Facts). It is the wealthiest county that stabilize U.S economy with a 2005 per capita income above $100,000. Manhattan is the smallest in land area but the third –largest populated borough in NYC.

United States has referred Manhattan as the centre that does well economically and culturally develop. NYC serves as the monetary capital centre for both NASDAQ as well as the New York Stock Exchange, with an estimated GDP of over $1.2 trillion. Universities, museums, tourist’s attractions sites are amongst the famous landmarks that distinguish Manhattan community from other boroughs. United Nations Headquarters are as well located in this borough. The city is described as a metropolitan centre where most of the government business are conducted, businesses, simulation activities as well as where national banks can be accessed.

Key Community Groups and Health Concerns

In Manhattan city, some people are more vulnerable than others. Specifically, elderly and children are mostly affected since according to U.S. Census Bureau Quick Facts 16.1% and 9% of elderly and children respectively live in abject poverty. That is why, in Mary Manning Walsh Nursing Home, they strive to identify this portion to understand their level of vulnerability so as to provide appropriate interventions. According to Stanhope & Lancaster (2018), limited and uneven distribution of resources in the community is the leading causes of subjecting these populations to vulnerability. Aging population need prompt intervention to alleviate life-threating effects like developing depression which leads to pressure ulcers. The hospital contends that, to increase resilience, the situation can be reversed when accessible resources are allocated properly. Poverty maybe as result of low income amongst the elderly, which later contribute to their poor health like developing pressure ulcers due to stress and also lack of accessing quality healthcare system. As indicated from the county health statistics, elderly population without insurance coverage in Manhattan city is estimated as 10% which is higher than Hampshire city which has an average of 10%. This is why; Sachs (2016) argues that, Individuals at the two closures of the age difference are frequently less ready to adjust to stressors physiologically". Kids in poverty are likewise an extraordinary concern of society. An investigation of Stanhope & Lancaster (2018) expressed that the "rate of kid destitution is an expanding function of the level of salary imbalance". Likewise, "the higher is the pay disparity, the more prominent is the rate of kid poverty.

Children are another vulnerable group predisposed to malnourishment, underweight and poor health. Vulnerability contributes to loss of lifespan work opportunities and shortfall of quality education (Stanhope & Lancaster, 2018). Report from county ranks states that compared to other neighbouring borough; Manhattan carries a 36% of children in who are eligible to get reduced-price lunch. Also, 3% consist of uninsured children and 40% is the mortality. Generally, medical attendants play significant roles in coordinating and connecting vulnerable population with the accessible resources in the community and different organizations. They can work with others as well as offering health education in the public to establish a wellbeing program. Most importantly, medical attendants can impact enactment and health policies that influence the susceptible populace.

Community Health Assessment

Manhattan Borough, New York City

With a promise to give the most astounding quality medical care service to each individual in all the five boroughs in New York City, the NYC Health + Hospitals public healthcare sector is the biggest of its sort in the US (Efraim, 2010). Citizens of Manhattan district get public medical care service from clinics run by NYC. Pressure ulcers (PU) prevalence presents a substantial weight on medical care facilities. Improved therapeutic care and better living conditions have expanded the future of the old populace. Many aging victims experience the ill effects of severe and ceaseless infections, dietary inadequacies, and susceptibility (Issel & Wells, 2017). A major predisposing factor for PU is comorbidities notwithstanding the aging process bringing about idleness. The number of PU victims over the age of 80 years has been increasing due to prolonged life expectancy, leading to higher risk of disability and immobility. Higher mortality rate reported in Manhattan is a result of PU conditions (Barnidge et al., 2013). Another study shows, an average elderly person with stage IV hospital-acquired PU spends an average of $129,248 (Jaul & Menzel, 2014). A review done on repetitive admissions, an average of $124,327 is spent on community-procured PU. The higher appearance of complications and the extended time taken for patients in the facility to heal increases the health cost as the ulcer grade continues to develop. Intricacies, for example, contaminations or osteomyelitis, increase related financial expense altogether.

Existing Resources

Some of the available national, regional and local resources found in Manhattan borough to help in battling elderly pressure ulcer are:

Educational institutions

Some of the institutions include NYU College of Global Public Health and Mandi School, The College of Allied Health. Students at these institutions should educated about pressure ulcers and its prevalence in older individuals. In this resource, education is the social determinant of health that is met.

Local & regional hospitals

Local and regional hospitals should learn from one another, identify areas that need adjustments and collaboratively develop strategies to address pressure ulcers in the community. The hospitals can also collaboratively work to determine healthy behaviours necessary for the prevention and management of pressure ulcers. In this resource, healthy behaviour is the social determinant that is met.

Granite State Independent Living

The main aim of the institution is to improve the quality of life of individuals with disabilities and championing for the needs of the elderly through advocacy, support and information. Social support and educations are the social determinants met under this resource.

Strengths and weaknesses

A notable shortcoming that may be a hindrance with executing a public wellbeing program on pressure ulcers is the absence of familiarity as well as knowledge with the etiology of the pressure ulcer development, particularly at the community setting. Non-proficient care providers and the primary group have a significant responsibility in prevention. Immobile patients receiving care at home are checked and followed up by nurses and GP to check the underlying signs of the skin to effectively plan proper interventions and medications needed (Issel & Wells, 2017). Occasional training and continuous coherence of training are significant for the primary group, caregiver, and the family. Another shortcoming around community contribution is absent. Implementing a community health strategy requires collaborative efforts from other stakeholders and the community. Without the community the strategy becomes less effective. The strength in the community is improved care delivery on teaching and by avoiding outside pressure, shearing forces, and enhancing the dietary condition of the older just as regard for care and avoiding dampness of the skin. Education is very crucial in the implementation of a community health strategy because will ensure individuals in the community are aware of the health concern, its prevalence in elderly people and the role of the community in addressing it.

Opportunities

There is a prospect for community-based associations to make an establishment essential for improving quality medicinal services. The obligation is set on the local setting, such, officials, and public members, to help with building up a productive plan. The possibility to diminish the wellbeing inconsistencies identified with stress-related illnesses is realistic with a focused on project and crafted by the public as a whole. A few vacant structures in the district offer space that could be used to make a counselling therapy unit. The chance to build up an active community wellbeing plan is conceivable. The community wellbeing plan will be able to address the needs of elderly individuals particularly when it comes to prevention and treatments of pressure ulcers. Extensive studies indicate that a community wellbeing plan is very crucial in addressing health concerns within a community because it assesses the concerns based on the risk factors (Knapp, 2018).

Barriers

Numerous obstructions can meddle with the fruitful execution of a community wellbeing plan. Perhaps the most significant obstacle for the vulnerable populace in this borough is the geological area. Treatment for pressure ulcers incorporates routine caregiver visits related to regular doses of medicine. Inaccessibility of care means the patient will not receive effective therapy. Availability to treatment centres is frequently restricted; this is highlighted in rural regions. The four other boroughs in NY have numerous therapy hospitals, yet Manhattan has rare treatment offices accessible without traveling.

The local problems are only one boundary. Financial difficulties are likewise a boundary to the effective operation of a public wellbeing program. Empowering nearby organizations, communal associates, as well as regional and local administration cooperates to make a plan that is useful to the public will encourage the accomplishment of the program. Accomplices can improve the accessibility of assets and can bolster and perform central assignments (Efraim, 2010). The lower payment level in rural areas than urban centres contributes to a higher experienced poverty rate that directly affects healthcare service delivery. Another barrier is the language barrier that makes it difficult for healthcare providers to communicate with elderly patients. New York has a great history of immigrations and it is estimated that more than 140 different languages are spoken in the city. In addition, New Yorkers are approximately from 200 different nations (Ancker, 2016). Therefore, some of the elderly patients are unable to express themselves while communicating with health care providers which leads to poor health outcomes.

COMMUNITY HEALTH STRATEGY

Problems

The first problem is the poverty levels in Manhattan especially with the elderly. The poverty numbers and absence of quality health care have been noted to be a challenge for Manhattan just as the elderly community experiencing pressure ulcers. Older individuals with pressure ulcers face critical difficulties meeting all requirements for housing, which increases rates of taking patients to the crisis rooms and emergency services (Eldredge et al., 2016). The high levels of lack of proper care and joblessness have been accounted for to add to "stress and anxiety" having negatives impacts on person's wellbeing as ecological components and systemic factors as it influences depression and trauma and bigotry (Knapp et al., 2018).

As indicated by Knapp et al (2018), medical care access contributes to incredible differences on socioeconomically level, influencing wellbeing in the Manhattan neighborhoods. Research shows that inhabitants experience extraordinary stress identified with salary and poverty, way of life practices and death rates (Eldredge et al., 2016). This populace is regularly noted as having a lower health status as they are viewed as less associated with taking part in health-promoting exercises, which may bring about higher death rates from disease (Knapp et al., 2018).

Another community problem that the elderly population faces are abuse and maltreatment. According to the biology of aging, it is expected that, with time, the aging population becomes weak. This fragility renders them to be dependent for care and support – in some cases calling for help on essential needs like toileting and feeding support and housing provision. In contrast to a kid who fully depends on the parents, an elderly person is full of experience, emotions, and information – and fully developed. This makes the caregiving situation increasingly mind-boggling. A study in Manhattan found that 59 percent of caregivers detailed verbal hostility as a style of compromise. Paid caregivers in nursing homes were at great danger of getting to be abusive on the off chance that they had low occupation fulfillment, treated the older like youngsters, or felt burnt out (Knapp et al., 2018).

Interventions

The potential intervention that ought to be incorporated into the wellbeing technique for the Manhattan community would be identified with the old populace. As indicated by Stanhope & Lancaster (2015), medical attendants assume a significant role in impacting political and social policies, for example, affordable housing. As an essential intervention, moderate housing, housing benefits, work training, and multisystem training can be sturdy. As primary prevention for pressure ulcers, medical attendants can instruct adapting systems, stress decrease, and teach populaces about a healthy way of life issues. Auxiliary counteractive action would include early diagnosis, prompt treatment, and confinements of inability for those nearly getting to be destitute or recently destitute (Eldredge et al., 2016). For auxiliary prevention in pressure, ulcers lead screening to identify bedsores and other related aging issues. On a tertiary prevention level for the destitute would incorporate comprehensive case management, physical and emotional well-being services, and emergency shelters. The aim of comprehensive case management is to address the individual needs of the elderly in order to prevent and manage pressure ulcers. Comprehensive case management should be conducted through conducting risk assessment then developing preventive measures for the patients at risk. For case management to be effectively conducted, caregivers should be trained on how to identify pressure ulcers while they are still in early stages. The Braden Scale can be utilized in determining the pressure ulcer risk for elderly patients. Effective case management is linked to effective staging of pressure ulcers therefore the most appropriate treatment is administered. Physical well-being services include skin care because elderly patients stay in bed or in a single position for too long which is a contributing factor to the development of pressure ulcers. Health care professionals should often check the skin of elderly patients especially if they report pain in a part of their body. Skin care should not only be the responsibility of health care professionals but also individual patients. They should be educated on how to keep the skin clean and dry, the products to avoid and utilizing availed devices such as protective mattresses and limb protectors. The protective mattresses are very important in relieving pressure points. The key stakeholders for implementing this strategy include the government, patients, physicians and nurses. The government is important in availing the required resources such as the protective mattresses and limb protectors. Nurses are important for educating the elderly patients and taking of them. Physicians are crucial in identifying the most appropriate treatment for the pressure sores. For the community to be involved, various community awareness programs should be developed with an aim of educating the community about pressure sores and ensuring they understand how the pressure sores are prevented, acquired and treated.

Teaching and Learning Strategy

As proficient medical caretakers, we have trained to instruct the populace we are working with the delivery of medicinal services. The populace we educate would incorporate those most vulnerable referenced in this primer. Along these lines, to be a successful instructor, we should comprehend the topic and learning. Instructing methodologies should require extensive techniques to guarantee all community individuals are reached. For training on the system of services and providers to the old populace, handouts can be given out concentrating on projects in the region accessible that will offer help on a government, state, and nearby level. Additionally, giving a patient-focused care survey to evaluate the level of awareness and explain their comprehension and inquiries concerning poverty.

Development of Health Strategy

So as to start programs for the development of a community health strategy, a community appraisal of needs should be established. In the wake of recognizing the demands, the targets and results for the community will be set. Moreover, settled objectives would be settled upon inside the community alongside identifying populaces of interest, achievements, and outcome goals. Now in the development procedure, recognizing strategies, exercises, process targets, and accessible assets that will help add to the purpose (s) and result destinations (Stanhope & Lancaster, 2015). Generally, developing a health strategy to address the problem of pressure ulcers will entail five key steps. The first is performing a situational assessment that will be aimed at acquiring more knowledge about the population of interest and patterns that may impact the implementation of the program. The second step is developing goals, outcomes and outcomes objectives. The results of the situational assessment will be used to identify the goals and objectives. The third step is identifying strategies and resources that are useful in achieving the identified goals and outcomes objectives. The situational assessment results will also be useful in this step. The forth step is developing indicators which will be useful in assessing to what extent the stipulated goals and objectives have been met. The final step is reviewing the program plan which will be aimed at identifying areas that need adjustments and ensuring that enough resources are available for the program.

How the community health strategy is aligned with health care policies or programs

The community health strategy aligns with YMCA-Healthy living programs which are aimed at improving health of older adults by ensuring that health care providers and the community are well aware of the needs of old individuals and how the can be met. YMCA-Healthy living strongly supports community integrated health in an attempt to improve the associations between interventions that are based on the community and traditional health care.

References

Ancker, J. S., Mauer, E., Hauser, D., & Calman, N. (2016). Expanding access to high-quality plain-language patient education information through context-specific hyperlinks. In AMIA Annual Symposium Proceedings (Vol. 2016, p. 277). American Medical Informatics Association.

Barnidge, E. K., Radvanyi, C., Duggan, K., Motton, F., Wiggs, I., Baker, E. A., & Brownson, R. C. (2013). Understanding and addressing barriers to implementation of environmental and policy interventions to support physical activity and healthy eating in rural communities. The Journal of Rural Health, 29(1), 97-105.

Efraim, J. A. U. L. (2010). Assessment and management of pressure ulcers in the elderly. Drugs Aging, 27(4), 311-25.

Eldredge, L. K. B., Markham, C. M., Ruiter, R. A., Fernández, M. E., Kok, G., & Parcel, G. S. (2016). Planning health promotion programs: an intervention mapping approach. John Wiley & Sons.

Issel, L. M., & Wells, R. (2017). Health program planning and evaluation. Jones & Bartlett Learning.

Jaul, E., & Menzel, J. (2014). Pressure ulcers in the elderly, as a public health problem. Journal of General Practice.

Knapp, M., Cambridge, P., Thomason, C., Beecham, J., Allen, C., & Darton, R. O. B. I. N. (2018). Care in the community: Challenge and demonstration. Routledge.

public health nursing (5th edition). St. Louis, MO: Elsevier.

Sachs, J. D. (2016). High US child poverty: Explanations and solutions. Academic pediatrics, 16(3), S8-S12.

Stanhope, M., & Lancaster, J. (2015). Public health nursing-e-book: Population-centered health care in the community. Elsevier Health Sciences.

Stanhope, M., & Lancaster, J. (2018). Foundations for population health in Community/