Assigment .Apa seven . All instructions attached.

John’s Journey

Caring for Vulnerable Populations in the Community

Goals of this Case Study Assess a community to determine how social

determinants of health impact the health,

healthcare, and needs of a community.

Analyze data such as demographics, morbidity

and mortality rates to determine the prevalence of health risks and assets

within a population.

Interpret findings to determine the priority

problem within a community.

Write a community health nursing

diagnosis.

Develop intervention goals for a population

based on the community health nursing diagnosis.

Analyze the possible risks and benefits of

healthcare options for a client.

State the client’s priority health needs.

List the appropriate community resources

that are available to the client and his family.

Develop a care plan for the client and his

family.

Discuss appropriate health promotion

interventions for the client.

Discuss the client’s health education

needs.

Demonstrate communication principles

and interprofessional healthcare team

collaboration for continuity of care.

Synopsis of the Case Study

Figure 1. Finger Pressing Button. Adapted from “Optizen Labs”, retrieved from http://optizenlabs.com/pl/tag/case-study/

John’s Journey • As you work through Mr. John Miller’s case study, you will find

links to data sources regarding the community. • Analyze the data presented to help you consider the questions

found throughout the case study. As you will see, often there is more than one correct answer to a question or more than one way to meet the needs of the community and its residents.

• As you read through Mr. Miller’s story, consider the factors in his community which impact his health and his family. Many communities often lack many services that contribute to community health such as grocery stores, transportation, affordable and available health care, and affordable childcare.

• After you read through the case study, there will be questions for you to answer. Interventions must be tailored to address problems specific to a community.

• 35-year-old combat veteran

• Amputee • Divorced • Unemployed • Caretaker for his

daughter with Autism • Has post traumatic stress

disorder • Has a substance abuse

disorder

John Miller

Figure 2. Early military photo of Army. Printed with permission from S. Justin.

• John’s 5-year-old daughter

• Has a diagnosis of autism with a moderate speech delay

• Receives speech, occupational, and behavioral therapy services

Sophie Miller

Figure 3. Alexander. (2020, January 16) Sophie going to school.

John’s Military Life • John joined the military after

graduating from high school. He was a tank driver in the Army' 1st Armored Division.

• His first duty station was Fort Bliss, Texas and after two months of service, he was deployed to New Orleans during Hurricane Katrina.

• John completed two tours in Iraq and served a total of six years in the military.

• He received an Other Than Honorable Discharge after being involved an off- base fight with a fellow platoon member.

• He has a service-connected disability of PTSD from combat in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF).

Figure 4. Military tank. Adapted from “Sputnik News”, retrieved from https://sputniknews.com/military/201609111045187046- russia-tank-division-formation/

Becoming a Civilian

Veterans Court Life After Other Than Honorable Discharge

PTSD Camp Hope

• How does PTSD make integrating into civilian life more difficult for veterans?

• What are some factors in John’s military history which contributed to his PTSD?

• What are the limitations associated with a less than honorable discharge?

Veteran Demographics

Figure 5. Soldier suffering from PTSD. Adapted from “KLSA News”, retrieved from https://www.ksla.com/story/22110456/ptsd- treating-the-silent-enemy-with-hearts-4-heroes/

Figure 6. Camp Hope building sign. Adapted from “Watchtower Security”, retrieved from https://watchtower-security.com/camp-hope- providing-new-hope-to-veterans-and-their-families/

Figure 7. Defendant standing before a judge. Adapted from “Judge Marc Carter”, retrieved from https://judgemarccarter.com/ Figure 8. Military discharge notice. Adapted from “Military Benefits”, retrieved from

http://militarybenefitspangeshi.blogspot.com/2017/06/military-benefits-dishonorable-discharge.html

Military Separation Codes

John and Sophie • John worked as an electrician’s apprentice in

Baytown earning $15/hr. • He worked 40 hours a week and sought overtime

when his daughter’s schedule allowed. • This job did not provide him with health

insurance, but Sophie qualified for Medicaid due to her father’s low income and her disability.

• John began classes at a technical school to become an electrician but was unable to complete this program due to Sophie’s therapy schedule and his PTSD symptoms.

Figure 9. Electrician Cartoon. Adapted from “The Balance Careers”, retrieved from https://www.thebalancecareers.com/electrician-526009

Autism Autism Treatment

• What therapy and treatment will Sophie require?

• Are these resources available in Baytown?

• Many people living in poverty experience food insecurity.

• John and Sophie survive mostly on cold cereal and peanut butter sandwiches. Fruit and vegetables are rare luxuries for them. They also get food from a local food pantry to fill in the gaps between checks.

Food Costs in Baytown Hungry in America

Going Hungry

• What is food insecurity? What are the three components of food insecurity?

• How does food insecurity impact Americans?

• Housing is the biggest expense in one’s budget.

Housing Costs in Baytown Cost of Living Calculator

• What is the cost of living in Baytown?

• How much would a two- bedroom apartment cost in Baytown?

• What expenses must be factored into determining the cost of living?

Housing Costs Food Costs Autism Treatment

• How would John’s PTSD prevent him from being able to pursue education and employment?

Unemployment

Co ns

id er

at io

ns :

What are the most dangerous jobs?

What are the most common on-the-job injuries?

Why are men more at risk of fatal or serious work-related injuries.

Workplace Injuries

After three and a half years of working as a civilian, John’s left arm was amputated in a work-related accident.

Injury Statistics On-the-Job Injuries

Figure 10. Workplace Injury Prevention Signs. Adapted from “Hive Health Media”, retrieved from https://www.hivehealthmedia.com/workplace-injury-prevention/

Unemployment and Disability • After losing his job, John applied to the Veteran’s Administration for healthcare benefits and was granted some

benefits related to his PTSD. • He also received worker’s compensation to pay for his injury-related expenses and receives worker’s

compensation lifetime income benefits. If John’s weekly gross income from his job was $600, how much is his income from worker’s compensation?

• He sought employment elsewhere but was unsuccessful. • John’s only source of income is worker’s compensation. He also receives $355 per month in food stamps or SNAP

benefits. Sophie receives Medicaid because of her disability and low income. Sophie is not eligible to receive monthly payments from SSI as the family income is too high to qualify. John and Sophie do not qualify for Temporary Aid to Needy Families (TANF) as their income is too high.

What is worker’s compensation insurance? Worker's Compensation How much does worker’s compensation pay and how long can one receive these benefits? Benefits How does one qualify for SSI? SSI for children What are the criteria for receiving TANF? TANF What is the average amount of food stamps that a family can receive per month? SNAP

What are the social determinants of health?

SDOH may result in differences in health and health care across populations.

Environmental and social conditions may lead to inequities in access to health care and availability of health care, leading to

health disparities.

The social determinants of health are essential to community health. The SDOH often explain why some

people and communities thrive while others struggle.

Social determinants of health (SDOH) are the conditions in the environments where

people are born, live, learn, work, play, worship, and age that affect a wide range of

health, functioning, and quality-of-life outcomes and risks.(Healthy People, 2030).

The social determinants of health include: • economic stability

• education access and quality • social and community context • health care access and quality

• neighborhood/built environment (Healthy People, 2030)

Why are Social Determinants of Health important to communities?

• The social determinants of health are essential to community health.

• The determinants help us understand, apply, and evaluate health policies and programs that affect the health of people, families, and their communities.

• In collaboration with federal, state, and local community partners, relationships and common goals can be explored and relationships can be established to promote the health within communities. (HP2030, 2021)

Nurses Role: Social Determinants of Health

• As you go through the case study, look for social determinants of health for John. These will be summarized at the end.

• Nurses must be able to recognize and address SDOH and population health needs.

• Nurses often encounter at- risk populations and individuals and have an opportunity to improve the individual’s well-being and the overall health of the community.

• Communities may lack many resources that contribute to community health such as grocery stores, transportation, affordable housing, and affordable childcare (examples of social determinants of health).

• What is the definition of homeless?

• How many families are homeless in the US?

Defining Homelessness Homelessness Statistics

FOUR MONTHS AFTER JOHN’S INJURY AND LOSS OF JOB, HE WAS EVICTED DUE TO NON-PAYMENT OF RENT.

HE LIVED WITH HIS DAUGHTER SOPHIE AT STAR OF HOPE, A SHELTER FOR HOMELESS FAMILIES.

WHILE AT STAR OF HOPE, HE STARTED REHABILITATION AT THE SOBERING CENTER BUT MISSED MANY APPOINTMENTS.

Homelessness

Sobering Center Star of Hope

Figure 11. Sobering Center website homepage. Adapted from “Sobering Center”, retrieved from https://houstonrecoverycenter.org/sobering-center/ Figure 12. Star of Hope website homepage. Adapted from “Star of Hope”, retrieved from https://www.sohmission.org/

• How many children are homeless in the US?

• What are some of the factors leading to homelessness?

Homeless Children

AFTER THREE MONTHS, JOHN WAS REMOVED FROM THE SHELTER FOR REPEATED ALCOHOL AND OPIOID USE.

STAR OF HOPE, AS A MANDATORY REPORTER, MADE CONTACT WITH CHILD PROTECTIVE SERVICES AS JOHN’S DRUG USE AND HIS DAUGHTER’S DISABILITY WERE AREAS OF CONCERN.

HE AND SOPHIE LIVED IN HIS VEHICLE FOR TWO WEEKS UNTIL HIS AUNT CLARA CONTACTED HIM AND OFFERED TO TAKE THEM IN UNTIL HE CAN “GET BACK ON HIS FEET”.

Homelessness

Mrs. Clara Miller • John’s 70-year-old widowed aunt

who lives alone in her small home in Baytown, has pension from teaching and owns her home

• She encourages John, who is estranged from the rest of his family, to return to the VA for treatment of his substance abuse

• Aunt Clara becomes Sophie’s caretaker and enjoys having Sophie in her home

• But she is finding it difficult to care for an active young child due to her health conditions

• What are leading causes of death for which Aunt Clara is at risk for considering her age, gender, and race?

• What health promotion teaching could a nurse provide to Aunt Clara to help her improve her health?

• How many grandparents and other older adults are raising young children?

• What unique challenges do these family members face in child- rearing?

• No history of tobacco use • Drinks occasional glass of red wine • Diagnosed with hypertension and

takes “one pill every morning” • Has not been back for a follow-up

appointment since starting this medication

AUNT CLARA’S Health History

• Aunt Clara’s Health Risks

• Health Promotion

• Raising Grandchildren

• Texas Statistics on Grandparents

Raising Children

Figure 13. Alexander. (2019, November 24). Aunt Clara posing outside of her home.

Declining Health • One evening, John is found in his car unresponsive. He is

transported to the Texas Medical Center where it is confirmed that he has had a CVA as a result of untreated hypertension and past drug use.

• Although John has health benefits through the VA for his mental health disorder and worker’s compensation for issues related to his arm amputation, he does not have general health insurance. He is transported to the county hospital for treatment.

• He is admitted to the county hospital for treatment of the CVA which results in left-sided hemiparesis. The county hospital has a neuropsychiatric center and inpatient and outpatient rehabilitation services. John is depressed and frustrated by the added disability from the CVA and is also experiencing opioid withdrawal symptoms.

• He is also worried about Sophie and Aunt Clara who are fifty minutes away from the county hospital and have not been able to visit him.

Healthcare Funding Terminology

How are county or other public hospitals funded?

What terminology is important for one to understand regarding funding?

Communication • After an assessment of John’s needs

and income, the county hospital arranged for John to receive home health and rehabilitation services at Aunt Clara’s home.

• The home health nurse is often the bridge between inpatient and outpatient care for vulnerable clients such as John.

• These clients often have multiple health problems that require treatment from multiple health care providers.

• Effective communication, such as the SBAR technique, is essential to assure continuity of care.

Situation Who is the person and what is happening with

them?

Background What is their clinical and

social history?

Assessment What is the problem?

Recommendation/Request What would you do to correct the situation?

• Here is an example of SBAR communication for the handoff of John’s care from a discharge nurse to the home health agency.

• What would a SBAR from the discharge nurse to mental health services include?

”I’m calling about John

Miller, a patient on our stroke

unit.”

How would the SDOH

impact John’s

recovery?

”Mr. Miller is a 35- year-old male with

a left arm amputation. Mr. Miller was unable

to afford medication for

Hypertension and had a stroke

resulting in left- sided hemiparesis 2 weeks ago. He requires physical

therapy, and medication

management. He is on Soboxone

for opioid addiction.

He is unemployed.”

“Mr. Miller will be home bound

requiring follow-up home

health care. Mr. Miller lives with his Aunt. He will need assistance accessing

resources to cover the

expenses of rehabilitation.”

“Mr. Miller requires

home health

nursing. Can you do an intake interview with him today?”SBAR and Other

Communication Techniques

Recovering Health • Based on the care plan for John, the home health agency provides

weekly nurse visits to monitor John’s hypertension and recovery. He was discharged on Suboxone and was referred to a 12-step program.

• The home health agency also provides an orderly or aide to bathe John and help with light housekeeping such as laundry and changing John’s bed linens.

• John receives these services free of charge due to his low income.

• John also receives telehealth services regarding management of his hypertension and stroke recovery through the county, and the VA has free psychiatric telehealth for his PTSD.

• John is applying for SSI based on the disability from his amputation and the effects of the CVA. Due to his disabilities, John is unable to leave home without great difficulty and the use of medical transport and therefore is considered home-bound.

• What are the criteria to receive home health care?

• How does home health care benefit the health of the community?

Home Health

Windshield Survey

In the windshield survey that follows,

identify how the community impacts John, his family and

others.

Baytown City Website Baytown Economics Poverty and Health

Figure 16. From Community as Partner: Theory and Practice in Nursing (8th ed, Figure 11.3 The community assessment wheel, the assessment of segments of the community-as-partner model. p.179), by E. T. Anderson & J. McFarlane, 2019, Wolters Kluwer. Reprinted with permission.

So how do we define a “Community”?

Let’s look at the World Health Organization (WHO) and how they define ”community”… • "Communities" are groups of people that

may or may not be spatially connected, but who share common interests, concerns or identities. (WHO, 2020).

• The windshield survey helps answer the question, ”How do the communities we live within affect our lives and healthy wellbeing?”

Figure 14. Children running in a low-income neighborhood. Adapted from ”PCI Announces Neighborhood Approach to Transform Urban Slums at the Clinton Global Initiative (CGI) Annual Meeting”, retrieved from https://www.pciglobal.org/pci-announces-neighborhood- approach-to-transform-urban-slums-around-the-world-at-the-clinton-global-initiative-cgi-annual-meeting/

Figure 15. Ariel view of a neighborhood community. Adapted from ”The Villages Florida”, retrieved from https://www.352area.com/florida/the-villages/

Baytown Texas

Figure 17. Fred Hartman bridge leading into Baytown, Texas. Adapted from “City of Baytown Website”, retrieved from https://www.baytown.org/discover-us/about

Windshield Survey

Using the Assessment

Wheel as your guide, conduct a

digital community

assessment of Baytown. Health by

Zip Code

Baytown City Website Baytown Economics Poverty and Health County Overview

• What is Baytown’s population?

• What is the average age of the population in Baytown?

• How does the poverty rate correlate with a community’s health?Figure 18. From Community as Partner: Theory and Practice in Nursing (8th ed,

Figure 11.3 The community assessment wheel, the assessment of segments of the community-as-partner model. p.179), by E. T. Anderson & J. McFarlane, 2019, Wolters Kluwer. Reprinted with permission.

Less Than Half of Baytown’s Population

is Married

• How does one’s marital status impact health?

• What are the reasons for the reported health difference between married and unmarried people?

Marital Status and Health

Figure 19. Graphical depiction of martial status in Baytown, Texas. Adapted from “City Data”, retrieved from https://www.city-data.com/

Baytown is diverse…

Figure 20. Baytown Cricket Club. Adapted from “The Baytown Sun”, retrieved from http://baytownsun.com/sports/article_3b7cf636-af3f-11e9-8bef-23e51e3c1675.html

Figure 21. Baytown Festival 2019 Flyer. Adapted from “Baytown Events”, retrieved from http://baytownevents.com/events/baytown-festival-taste-of-the-caribbean-celebration- 2019/

Figure 22. Residents of Baytown, Texas posing at the “Walk With a Doc” event. Adapted from “Walk With a Doc”, retrieved from https://walkwithadoc.org/join-a-walk/locations/houston-tx-2/

…with a lot to do. Figure 23. Pirate’s Bay Waterpark in Baytown, Texas. Adapted from “The Scene Magazine”, retrieved from https://www.thescenemagazine.com/2015/06/06/149444/baytown-s-pirates- bay-waterpark-fun-for-the-family

Figure 24. Children enjoying a water slide at Pirate’s Bay Waterpark in Baytown, Texas. Adapted from “Kids Visitor”, retrieved from https://kidsvisitor.com/en/baytown/place/7807-pirates-bay-waterpark/

Figure 25. Briarwood Park in Baytown, Texas. Adapted from “Baytown City Website”, retrieved from https://www.baytown.org/city-hall/departments/parks-recreation/parks

Figure 26 Kayakers at the Eddie V Gray Wetlands Education Center in Baytown, Texas. Adapted from “Baytown City Website”, retrieved from https://www.baytown.org/city-hall/departments/parks-recreation/eddie-v-gray-wetlands-education-center

Physical Environment

Baytown’s major employer and source of tax income are the many oil refineries that

are located there. Refinery Risks

• What does a refinery do and why are they vital to our nation?

• What are some health risks associated with living near refineries?

• What are some health risks of working at a refinery?

Figure 27. Houston Ship Channel. Adapted from “Texas State Historical Association”, retrieved from https://tshaonline.org/handbook/online/articles/hdb01

Physical Environment Baytown is on the Galveston bay with lovely

scenery and opportunities for recreation.

• Why is recreation essential to a community’s health?

• What populations may not be able to enjoy recreation in Baytown?

• How can barriers to recreation be addressed at the community level?

Benefits of Health and Recreation

Figure 28. Kayaking near the San Jacinto Monument. Adapted from “Visit Houston”, retrieved from https://www.visithoustontexas.com/houston-and-beyond/destinations/

• How can Baytown and its residents prepare for a weather emergency?

• Why do individuals need to be prepared to survive for at least 3 days in a disaster?

• What would a community disaster plan for Baytown include?

• How do disasters impact a community’s mental health?

Baytown is subject to hurricanes and

resulting flooding.

Physical Environment

Psychology of a Crisis Preparing for Disasters

Figure 29. A flooded street after Hurricane Harvey. Adapted from “Inspire Investing”, retrieved from https://www.inspireinvesting.com/2017/09/01/where-is-god-when-houston-happens/flooded-street-full-of-people-evacuating-their-homes-rescue-hurricane-harvey-900new/

.

• What does “shelter in place” mean?

• What health risks does an event like this one pose for Baytown residents?

• How are victims of a disaster triaged?

• Click on the link below to find out what chemicals petroleum plants can releasePhysical

Environment

Baytown is also at risk for refinery fires and/or explosion.

Baytown Explosion Seek Shelter Triage What Is In That Smoke?

How can Baytown and its residents prepare to shelter in place? What supplies would Baytown residents need to shelter in place for this type of emergency? What would a community disaster plan for Baytown include? How do disasters impact a community’s mental health?

Figure 30. Exxon Mobile Baytown Complex Fire. Adapted from “KHOU News”, retrieved from https://www.khou.com/article/news/investigations/exxonmobils-baytown-plant- has-history-of-environmental-violations/285-5c60a4b4-e83b-43ec-a41a-96ec8a70d17b

Housing in Baytown Housing in Baytown varies from apartments to mansions; however most neighborhoods are

middle-class with homes costing approximately $150,000.

How Does Housing Affect Health?

• What health risks do low-income residents face who live in substandard housing?

• As you read through the following slides consider: what health risks do low-income residents face from their community?

Figure 31. $6.5 million estate in Baytown, Texas. Adapted from “Homes of the Rich”, retrieved from https://homesoftherich.net/2016/05/6-5-million-estate-in-baytown-tx/

Figure 32. Low Income House in Baytown, Texas. Adapted from “Realtor.com”, retrieved from https://www.realtor.com/realestateandhomes-detail/58-County-Road-4006_Dayton_TX_77535_M74096- 95113?view=qv

Figure 33. Graphical depiction of unemployment in Baytown, Texas. Adapted from “City Data”, retrieved from https://www.city-data.com/

Housing values in Baytown

Figure 34. Graphical depiction of house values in Baytown, Texas. Adapted from “City Data”, retrieved from https://www.city-data.com/

Figure 35. Graphical depiction of median household income in Baytown, Texas. Adapted from “City Data”, retrieved from https://www.city-data.com/

Based on the data, does the average Baytown resident make enough to own their own home?

Figure 36. Graphical depiction of most common industries in Baytown, Texas. Adapted from “City Data”, retrieved from https://www.city-data.com/

Figure 37. Graphical depiction of most common occupations in Baytown, Texas. Adapted from “City Data”, retrieved from https://www.city-data.com/

There are many restaurants in Baytown

Figure 38. A restaurant in Baytown, Texas. Adapted from “Yellow Pages”, retrieved from https://www.yellowpages.com/baytown- tx/mip/supermercado-la-vaquita-520814507

Figure 39. A restaurant in Baytown, Texas. Adapted from “Trip Advisor”, retrieved from https://www.tripadvisor.com/Restaurant_Review- g55456-d12399472-Reviews-Whataburger-Baytown_Texas.html

Eating Out Over 61% of adults and 35% of school-age children

in Texas are obese. • How does eating out impact obesity? • How can restaurants help their patrons to

eat a more healthful diet? • How does serving size differ from portion

size? • How have portion sizes changed in the US

over time? • How can one control portion sizes at

home?

Fast Food Portion Pitfalls Portion Distortion

Grocery Stores

Food Desert

There are plenty of grocery stores in Baytown and a farmer’s market

• What is a food desert? • Why is the availability of

quality food essential to community health?

Figure 40. The produce section of a Food Town grocery store in Baytown, Texas. Adapted from “Four Square City Guide”, retrieved from https://foursquare.com/v/food-town/4c0c1b0ebbc676b05f974cd5

Figure 41. An HEB grocery store in Baytown, Texas. Adapted from “Houston Public Media”, retrieved from https://www.houstonpublicmedia.org/articles/news/2017/12/06/2549 46/houstons-grocery-market-growing-fast-but-not-equally-across-the- region/

Figure 42. A meat market in Baytown, Texas. Adapted from “La Michoacana Meat Market”, retrieved from https://www.lamichoacanameatmarket.com/en /4910-n-main-st-baytown-tx-77521/

Figure 43. Advertisement for a farmer’s market in Baytown, Texas. Adapted from “Local Harvest”, retrieved from https://www.localharvest.org/baytown-farmers-market-M74023

Education

Figure 44. Students pose at St. Joseph’s Catholic School in Baytown, Texas. Adapted from “St. Joseph’s Catholic School”, retrieved from http://stjosephbaytown.com/

Figure 45. Robert E. Lee High School in Baytown, Texas. Adapted from “Trinity Oaks Master Planned Community”, retrieved from https://trinityoaksmpc.com/schools-1

Figure 46. Alamo Elementary school in Baytown, Texas. Adapted from “School Construction News”, retrieved from http://schoolconstructionnews.com/2016/10/04/efficient-program-management-drives-267-million- goose-creek-cisd-makeover/

• Referencing the graph, what is the education level of most people in Baytown?

• How does one’s education level impact health? • What is health literacy and how does it differ from literacy? • How does a community’s education level impact health

interventions? • How can nurses design effective teaching tools and

experiences?

Baytown has: • Public schools (Pre-K to 12) located

close to most neighborhoods • Community colleges

Health and Education

Health Literacy

Early Childhood Intervention Services

Figure 48. Graphical depiction of school enrollment in Baytown, Texas. Adapted from “City Data”, retrieved from https://www.city-data.com/

Safety Figure 49. Baytown Police Officers. Adapted from “Baytown City Website”, retrieved from https://www.baytown.org/city- hall/departments/police

Figure 50. Baytown Fire Department Fire Engine. Adapted from “Fire Fighters Worldwide”, retrieved from http://www.firefightersworldwide.com/2016/02/virtual-tour/

Figure 51. Baytown Police SUV. Adapted from “Sutliff and Stout”, retrieved from https://www.sutliffstout.com/accident- reports/baytown-police-department-bpd-accident-reports/

Figure 52. Fire Department Vehicles. Adapted from “Highlands Fire Department”, retrieved from https://highlandsfire.com/

• How does the crime rate in Baytown compare to the national crime rate?

• How can a community increase safety? • How does the presence of the refineries impact

emergency services in Baytown?

Baytown is served by its own police department and fire

department. Feeling Safe Crime Statistics

Figure 53. Graphical depiction of crime in Baytown, Texas. Adapted from “City Data”, retrieved from https://www.city-data.com/

Health Care in Baytown

Four major hospitals

Most medical

specialties

Home health and

hospice available

35 miles from the

Texas Medical Center

Figure 54. Baytown Health Center. Adapted from “Harris Health System”, retrieved from https://www.harrishealth.org/locations-hh/Pages/baytown-health-center.aspx

Figure 55. A patient receiving care in their home. Adapted from “Vitalis Healthcare”, retrieved from https://www.vitalishealthcare.com/

Figure 56. Kindred Hospital in Baytown, Texas. Adapted from “Biz Journals”, retrieved from https://www.bizjournals.com/louisville/news/2020/01/24/louisville-based-kindred-healthcare- closes-six.html

Figure 57. Altus Hospital in Baytown, Texas. Adapted from “Altus Hospital”, retrieved from https://altushospital.org/emergency-room/

Health Care: Only Part of the Picture

What is the difference between accessibility and

availability?

How would greater insurance coverage impact the infant

mortality rate in Texas?

How does the rate of uninsured in Texas impact

the health of Texans?

How do deaths from overdose in Texas compare

to the national rate?

What is Medicaid and what is its role in health care?

What are the top causes of death in Texas? How does this

compare with the US?

How would greater health coverage impact the causes

of death in Texas?

What is the infant mortality rate in TX?

Texas Uninsured Rate Mortality in Texas COVID-19 Mortality Overview Texas Health Ranking

• 77% of the population of Baytown has health insurance with over half of those having coverage through their employer.

• Texas consistently ranks as the state with highest rate of uninsured.

Government • Baytown has a mayor/city council

government.

• Texas has a governor and a legislature that meets biannually.

• How can residents be involved in their government? • How can one tell whether the community is engaged in the

political process? • What community groups may be underrepresented in the

political process? • How can this be addressed? • How can nurses be represented in politics and government?

Participating in Government Texas Votes Voter Turnout

Figure 58. Baytown City Council. Adapted from “Baytown one vote away from no-kill resolution”, retrieved from https://www.adopttosave.org/pursuing-no- kill/2017/9/12/baytown-one-vote-away-from-no-kill-resolution

Figure 59. Baytown Mayor Brandon Capetillo. Adapted from “Message from Baytown mayor Brandon Capetillo”, retrieved from https://www.baytowncops.com/?p=14371

Transportation

Figure 60. Traffic Jam. Adapted from “The Value of Public Transit in Toronto”, retrieved from https://www.urbaneer.com/blog/Value_of_pubic_transit_in_toronto

Figure 61. Baytown police blocking a traffic accident scene. Adapted from “Accident in Baytown causes major traffic in interstate 10”, retrieved from https://fox4beaumont.com/news/local/gallery/accident-in-baytown-causes-major-traffic-on-interstate-10#photo-5

Figure 62. Metro System Bus. Adapted from “Metro Highlights”, retrieved from http://naboo.langranddev.com/pdfs/highlights.pdf

Transportation • Though Baytown Residents have access to public transportation, most still commute to work in their car.

• The trade-off for using their own car is high pollution levels and monumental traffic. • Houston traffic consistently ranks as one of the worst in the nation.

Stall and Crawl Motor Vehicle Accidents Effects of Commuting on

the Body

• What interventions could be implemented to decrease traffic deaths in Houston? Click on the Accidents link below and use the tool to determine what interventions could be used and what they would cost.

• What is the impact of a long commute on health?

• How can not having a car be a barrier to access to health care?

Figure 63. Graphical depiction of means of transportation to work in Baytown, Texas. Adapted from “City Data”, retrieved from https://www.city-data.com/

Figure 64. Graphical depiction of travel time in Baytown, Texas. Adapted from “City Data”, retrieved from https://www.city-data.com/

Spirituality

• What is the difference between spirituality and religiosity?

• How does spirituality fit into self-care?

• How can you assess the spiritual/religious component of a community?

• How can local congregations improve community health?

Self Care COVID-19 and the Black Church

Religion and Public Life AIDS and the Role of the Black ChurchFigure 65. Masjid AlRahmah Mosque in Baytown, Texas. Adapted from “Facebook”, retrieved from

https://www.facebook.com/AlRahmahbaytown/?ref=py_c

Figure 66. St. Mark’s United Methodist Church in Baytown, Texas. Adapted from “St. Mark’s United Methodist Church”, retrieved from https://stmarksbaytown.com/

Figure 67. Graphical depiction of religion in Baytown, Texas. Adapted from “City Data”, retrieved from https://www.city-data.com/

According the graph what can you gather about religiosity in Harris county?

Communication Baytown has access to several

newspapers and local TV stations. They have access to the internet and service

for cell phones.

Social Media and Health Let's chat

• What would be the most effective way to communicate with a community such as Baytown?

• How can a community’s demographics impact how one would communicate to the community?

• What are ways that social media can be useful in communicating public health messages?

Figure 68. Facebook Logo. Retrieved from https://www.facebook.com Figure 69. KHOU News Logo. Retrieved from https://www.khou.com

Figure 70. The Baytown Sun Logo. Retrieved from https://www.baytownsun.com

Figure 71. Houston Chronical Logo. Retrieved from https://www.chron.com/

Figure 72. ABC 13 News Logo. Retrieved from https://www.abc13.com/

Look at each measurement

area (i.e., infant mortality, crime rates, drop out

rates)

Compare the measurement

areas to a standard

population A standard

population is one that contains the

population of interest

Texas has a large, diverse population making it a good

standard for comparison

This is the core of the community

nursing diagnosis

Inference/Interpretation (Synthesis) What does all this mean?

How do we determine if a problem exists in Baytown? What impacts John and his family?

Two Important Measures

Distribution

• Counts frequencies and patterns of health events within groups in a population

• Tries to answer "who", "what", "when” and "where"

• Referred to as “descriptive epidemiology"

Determinants

• Searches for causes or factors associated with increased risk or probability of disease

• Tries to answer "how" and "why"

• Referred to as "analytical epidemiology

Baytown’s Health • Baytown residents report eating

away from home 4 times per week

• The average Baytown resident last saw a dentist 2 years ago

• Many Baytown residents do not perform regular oral hygiene

• 18% report that they are embarrassed because of their teeth

• ¼ report having gum disease.

What do the numbers mean?

• 37% are obese. • Drug use is prevalent in

Baytown. • 63% used marijuana • 25% used hard drugs

• 10% have diabetes • 20% have hypertension • 30% report being depressed • 80% drink alcohol every month. • 80% sexually active with 16

years being the average age of sexual debut.

• The average number of lifetime sexual partners for males and females was 10.

Baytown’s Health

• Over half of Baytown residents reported smoking cigarettes.

• Approximately one third of Baytown residents report getting exercise.

• Over 20% of Baytown residents report some condition that either prevents them from working or limits the work that they can do.

• Click on the provided link below to compare the health data for Baytown with a standard population.

• What do the numbers mean?

Figure 73. Health and Wellness Graphic Art. Adapted from ”Health and Wellness Coaching”, retrieved from https://joinccba.org/health-wellness-coaching/

Baytown’s Health Services

• What services does John and his daughter and Aunt Clara need?

• VA and medication

• Substance abuse treatment

• VA and virtual therapy

• Autism treatment

• Childcare

• Respite care

Figure 74. Health and Wellness Graphic Art. Adapted from ”Health and Wellness Coaching”, retrieved from https://joinccba.org/health-wellness-coaching/

Rates

• Basic measures of disease or death occurrence in a defined population over a specified time period

• Rates allow comparison between populations

Number of events in a specific time period

Population at risk in the same time period

K *K is the base number (100, 1000)

Comparing Rates

As we are able to compare rates per 100,000, Baytown has a lower rate of robberies than Texas.

Texas Statistics

Baytown Statistics?

Put it Together: Now that you’ve collected some data on Baytown, answer these questions:

WHAT ARE THE 3 TOP HEALTH PROBLEMS IN BAYTOWN?

WHAT ARE THE TOP HEALTH ASSETS IN BAYTOWN?

WHICH PROBLEM WOULD YOU CHOOSE TO ADDRESS AND

WHY?

WHAT COMMUNITY ASSETS ARE AVAILABLE TO ADDRESS

THE PROBLEM?

WHY IS IT IMPORTANT TO USE RATES FOR

COMPARISON OF DATA RATHER THAN THE

NUMBER OF EVENTS?

Community Health Nursing

Diagnosis Increased risk of among related to as demonstrated by

Four parts of a community diagnosis

Health problem/risk

Affected aggregate or community

Identified cause

Evidence of health

problem

Another Look at Community Nursing Diagnosis

as demonstrated in

(health indicators, such as rates of vaccination, life expectancy)

related to (etiological statement, what causes the problem)

among (community or population)

Increased risk of (disability, disease, etc.)

Example of a Community Diagnosis

Risk of adult obesity/overweight status among residents of Baytown, TX

related to a high prevalence of fast- food restaurants and knowledge

deficit of portion control as evidenced by 66% of adults in Houston being

overweight/obese and 66% of Texas adults being overweight/obese.

What other community health nursing diagnosis can

you think of that is appropriate for Baytown?

How do we help Baytown become a healthier community?

Figure 75. From Community as Partner: Theory and Practice in Nursing (8th ed, Figure 11.1 Community-as-partner model. p.174), by E. T. Anderson & J. McFarlane, 2019, Wolters Kluwer. Reprinted with permission.

What type of interventions can we do to help Baytown become a healthier community?

Tertiary Prevention

Treatment and rehabilitation to prevent disability (example: medications, procedures, rehab)

Secondary Prevention

Early detection and treatment of disease or injury to prevent disability and death (example: screening)

Primary Prevention

Intervening to decrease the risk for onset of disease, injury, disability or death (example: immunizations)

Levels of Prevention

1˚=Stop the illness from occurring

2˚=Identify cases

3˚=Control Complications

S

I

C

Guiding Principles When Choosing Interventions • There are upstream, midstream, and downstream

ways to address population health issues • Our behaviors and environment greatly influence

our health and are often amenable to change • We must consider the social determinants of

health in order to fully understand and address the health issue

• Epidemiological data allows us to assess the magnitude of the problem and determine populations at risk

• The following slides show an example of a health problem, heart disease, and levels of intervention

• What are upstream interventions for Baytown’s high rate of dental disease?

• What are some downstream interventions?

• Is one approach better than the other?

Aunt Clara’s Risk: Preventing Heart Disease

and Stroke

Primary prevention involves teaching

about ways to prevent heart disease

and stroke through health promotion.

A DIET LOW IN SODIUM, RICH IN

FRUIT AND VEGETABLES, HIGH IN

FIBER

DAILY EXERCISE ADEQUATE SLEEP

STRESS REDUCTION TECHNIQUE SUCH AS

MEDITATION, PARTICIPATING IN A

HOBBY

SMOKING CESSATION

Aunt Clara’s Risk: Preventing death and disability from heart disease and stroke

Secondary prevention is aimed at finding the presence of a

disease or condition on the early stages before it can cause serious illness or

death.

OBESITY DIABETESHIGH CHOLESTEROL HYPERTENSION

Secondary Prevention: Screen high risk individuals for:

Mr. Miller: Recovering stroke

Tertiary prevention: aims to aid recovery

from the damage done by the disease

or condition.

MEDICATION DIET

PHYSICAL THERAPY

REHABILITATION

ADAPTIVE DEVICES

Social Determinants of Health: Why are

some people healthier than others?

What effects the health of all

“communities”?

Social Determinants of Health: The range of personal, social, economic, and environmental factors that influence health status (Healthy People, 2020).

What makes us healthy or unhealthy?

What makes us sick or what keeps us well?

Figure 76. Social Determinants of Health graphic. Adapted from ”Non-Medical Measures to Improve Public Health: What Works?”, retrieved from https://www.njspotlight.com/2019/02/19-02-20-new-guidance-on-non-medical-initiatives-to-improve-public-health/

Education Economic Stability

Social and Community Context

Health and Health Care

Neighborhood and Built Environment

A Breakdown of Social Determinants of Health

Figure 77. Social Determinants of Health Graphic Art. Adapted from ”Social Determinants of Health-What are Payers Doing?”, retrieved from https://www.healthedge.com/blog-social-determinants-health-what-are-payers-doing

Baytown’s 16% poverty rate

Employment John’s employment status

Limited Employment opportunities in Baytown

Food Security Good availability of

Nutritious food

John’s ability to access and afford nutritious food

Safety net: food pantries Food stamps

Johns’ family’s medical bills

John’s family’s income

Housing Availability of affordable, safe housing in Baytown

Safety/Violence in Baytown

Food deserts Walkability

Pollution/toxins in air, water, housing

Lead contamination Grocery stores within

walking distance Police/fire response time

Transportation Availability and

accessibility of public transport

Bike trails/ Sidewalks

Quality Childcare Early childhood education

Preschool programs for special needs children

such as Sophie

Education resources at all levels Kindergarten through 12th grade

Educational Attainment in Baytown

Graduation/drop out rates in Baytown

John’s educational attainment

Literacy level in Baytown John’s reading grade level

Discrimination Minority Employment

Rate Diverse staffing in

schools, Fire and Police departments

Mental Health Supports for individuals

and families impacted by mental illness/substance

abuse Criminal Justice System

Veterans’ court Jail diversion programs Social Support Systems

Peer group support Substance abuse

Deaths in Baytown related to substance

abuse Parenting skills

Child abuse

Quality of care in Baytown John’s ability to access care

Insurance coverage Medicaid Medicare

Travel time to medical facilities

Availability of care for all ages Behavioral/speech therapy

Availability of primary specialty care

The SDOH: The Impact on Mr. Miller and His Family

John’s New Normal • John no longer abuses alcohol or opioids. • He continues on Suboxone and is

attending a virtual 12-step program several times weekly.

• John and Sophie are living with Aunt Clara • Aunt Clara is receiving respite care from a

local faith-based organization and can better manage her health.

• Aunt Clara wants to continue to care for Sophie and help John. Figure 78. Photo of ‘John’ in new normal. Printed with

permission S. Justin May 7, 2016.

References

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John’s Journey: Caring for Vulnerable Populations in the Community

2020 © Barbara E. Hekel, Bridgette Pullis, Juane Alexander, Christina DesOrmeaux, and Allison Edwards

Authorized by AACN