Community Nursing assignment
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NUR_335_SP18_CommunityAssessmentPowerPointExample.pptxGloucester County
Community Assessment
Pictured above is the Gloucester County seal. According to research performed by the Gloucester Historical Committee, the beehive represents “the unity of a community working together” (Gloucester County Virginia Gen Web County History, 2009). The beehive impression was found on documents that date back to 1832, but it was not confirmed the official seal of Gloucester County until 1974 (Gloucester County Virginia Gen Web County History, 2009, para. 5).
Gloucester county seal [digital image]. (2011). Retrieved from http://www.medievalfantasiesco.com/Gloucester
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History of Gloucester County, Virginia
Gloucester County was formed in 1651
Named after Gloucester County, England
Location of the Powhatan Indian settlement, Werowocomoco
Lands were heavily used for tobacco production
Home to Dr. Walter Reed and Thomas Walker Calhoun
Played an important role during the American Revolution
“Daffodil Capital of the World”
Gloucester County has a rich history. It was established as a county in 1651 but was occupied by the Virginia Algonquians (also known as the Powhatan Indians) even before the English first settled in Jamestown in 1607. Their settlement was known as Werowocomoco. They were ruled by Chief Powhatan, father to Princess Pocahontas (Gloucester County Virginia Gen Web County History, 2009). There are two historical markers citing the history of Werowocomoco and one statue of the Indian Princess Pocahontas located within Gloucester County.
From the 1600-1700’s Gloucester lands were used for tobacco production. This gave rise to many plantations and estates. Several of them still remain today including Warner Hall, a 600-acre plantation that was home to George Washington’s grandparents. The ruins of Rosewell Mansion still exist. Rosewell was the largest, most lavish estate in all of Gloucester (Gloucester Visitors Center, 2010).
Gloucester was also home to Dr. Walter Reed and Thomas Calhoun Walker. Dr. Walter Reed, 1851-1902, was a U.S. Army pathologist and bacteriologist. He was best know for discovering that yellow fever was transmitted by mosquitoes and not by contact. This lead to the eradication of yellow fever. Gloucester’s local community hospital is named after Dr. Walter Reed. Thomas Calhoun Walker, born 1862 and died in 1953, was the first African American to practice law in Gloucester County. He served for two terms on the Gloucester Board of Supervisors and was “a vigorous civil rights spokesman that advocated for the education and land ownership of all blacks” (Gloucester County Virginia Gen Web County History, 2009). Gloucester was also home to many confederate soldiers.
Gloucester also played an important role during the American Revolution. At the southern tip of the county, where Gloucester extends into the York River, is a place that was known as Tyndall’s Point. The name was later changed to Gloucester Point. During the American Revolution, a fortification was built here to protect the waterways. It is also the location of the Second Surrender by General Cornwallis to George Washington at Yorktown (Gloucester County Virginia Gen Web County History, 2009).
Last to mention, but definitely not least, Gloucester is well known for it’s golden yellow fields of Daffodils. These flowers have been around since the founding of Gloucester in 1651. Historians claim when English settlers arrived in Gloucester they brought daffodils along to remind them of their home in England. The flowers quickly spread and began to grow wild in unattended fields. At some point, people began to realize they could profit from the sales of these flowers. Tourists began to travel to Gloucester during the daffodil’s peak flowering season to witness the golden yellow fields. This earned Gloucester the name “Daffodil Capital of the World” (Warner Hall History, n.d.). Many people still flock to Gloucester in early spring for their annual Daffodil Festival.
Pictured above, top right: Gloucester county marker Z-10. (n.d.). [digital image]. Retrieved from http://www.markerhistory.com/gloucester-county-marker-z-10/
Pictured above, bottom right: Andrews, K. (n.d.). Historic icons of Gloucester county [Virginia map print]. Retrieved from http://nebula.wsimg.com
On the right side of the Historic Icons of Gloucester County map, from top to bottom, it depicts: Warner Hall Plantation; Ware Episcopal Church, known to be an encampment area for confederate soldiers; Dr. Walter Reed’s birth place; and the Colonial Courthouse, one of the oldest courthouse buildings still in use (Gloucester Visitors Center, 2010). On the left side of the map, top to bottom: Abingdon Episcopal Church, the first church of Gloucester and one of the original 8 churches of colonial Virginia still remaining; Thomas Calhoun Walker’s residence; the iconic Gloucester Daffodils; Long Bridge Ordinary, the “first established shopping place for travelers going along the old Indian Road” (Gloucester Visitors Center, 2010); the Botetourt building, a pre-revolutionary tavern named for Lord Botetourt Norborne Berkeley, Baron of Botetourt, and sent from Gloucester, England to be Governor of Virginia (Gloucester Visitors Center, 2010).
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Physical Environment of Gloucester County
Located on the Middle Peninsula in the Coastal Plains region of Virginia
288 square miles
Land area: 217 square miles
Water area: 71.4 square miles
Population: 37,143
Rural
Mostly Flat
Surrounded by many bodies of water
Moderate climate
Gloucester County is located on the Middle Peninsula (MP) in the coastal plains region of Virginia. The MP is made up of 6 counties including Essex, King and Queen, King William, Middlesex, Mathews, and Gloucester (Patterson, 2013). Gloucester County is located at the southwest end of the MP and is mostly flat. It is a rural area, with a total population of 37, 143 (United States Census Bureau, 2015). If you enter Gloucester from the north, you will see many farms. As you continue south, you will enter Gloucester Courthouse. This area is located mid-county. Here you will you find many new housing developments and businesses. At the most southern end of the county is an area known as Gloucester Point. This area of Gloucester is famous for it’s beach, fishing pier, and boat launch. It’s also an the area where the York River empties into the Chesapeake Bay. On any given day, standing on the Gloucester Point beach, you can see United States service vessels, fishing boats, or recreational boats out on these waters.
Pictured above, top left: Gloucester County, highlighted in yellow, in the map of VA.
Map of Gloucester County. (n.d.). [digital image] Retrieved from http://www.virginiaplaces.org/vacount/graphics/gloucester.gif
Pictured above, bottom left: Gloucester county surrounded by the other 5 counties of the Middle Peninsula.
Gloucester County Virginia genealogy resources. (n.d.). [digital image] Retrieved from https://s3.amazonaws.com/ps-services-us-east-1-914248642252/s3/research-wiki-elasticsearch-prod-
s3bucket/images/thumb/e/ec/Vagloucester.jpg/400px-Vagloucester.jpg
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Physical Environment of Gloucester County (cont.)
Boundaries
North: Farmlands
West: York River
East: Ware River, North River, & the Mobjack Bay
South: Gloucester Point Beach
York River/Chesapeake Bay
Coleman Bridge
Virginia Department of Transportation. (2011). The George P. Coleman Memorial Bridge [digital image]. Retrieved from https://www.flickr.com/photos/vadot/7449300370
Pictured above: The George P. Coleman Memorial Bridge. This is a double swing bridge that crosses over the York River, connecting Gloucester Point and Yorktown via route 17 (Virginia Department of Transportation, 2011). The land mass on the right side of the photo is Gloucester Point. You can see the white sands of Gloucester Point Beach. On the left side of the photo is Yorktown Landing. A toll is required when headed northbound, crossing from Yorktown into Gloucester County, but is not is not required when heading in the southbound direction.
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Demographics
Gloucester County Population Percentages:
Gloucester County, Virginia has a total population of 37,143 people. The state of Virginia has a total population of 8,382,993 people. This means that Gloucester makes up only 4.4% of Virginia’s total population. Females slightly outnumber males living in this county by 1.6%. The largest percent of the population, based on age, are people between the ages of eighteen to sixty-four years old (United States Census Bureau, 2015).
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by Gender
Percent of Gloucester Population by Gender Male Female 49.2 50.8
by Age
Gloucester Population by Age Under 5 Under 18 18-64 65 + 5.2 20.399999999999999 56.5 17.899999999999999
Race/Ethnicity
The graph above shows that Gloucester County is homogeneous, not integrated. White people make up 87.7% of the total population. This is apparent as you visit places throughout the county. Many of the workers you encounter at local businesses are predominately white. African Americans make up the second highest percent of Gloucester’s population, followed by the Hispanic/Latino population. This trend follows the same pattern as the state of Virginia, but differs from United States ethnicity percentages. When looking at ethnicity percentages throughout the entire United States, the Hispanic/Latino population outnumber African Americans (United States Census Bureau, 2015).
Gloucester is home to several ethnic restaurants. They have three Chinese restaurants, one Japanese restaurant, one Thai restaurant, and 2 Mexican restaurant. The Thai restaurant, Bangkok Noi, is a local favorite. There is no evidence of signs or menus in languages other than English, except at the county buildings or offices of health provider. Even at these location they are limited and are only offered in Spanish.
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Values and Beliefs
29 Churches in Gloucester
County
Predominantly Baptist &
Methodist
No Temples or Mosques
Gloucester has 29 churches located within the county. The denominations include Baptist, Methodist, Non-Denominational, Episcopal, Lutheran, Presbyterian, Catholic, Church of God, Pentecostal, and Church of the Nazarene. Ten of these churches are Baptist, which correlates with statistical data that Baptist is the most practiced religion in Gloucester. According to Sterling’s Best Places, 41.6% of Gloucester residents affiliate with a religion and 18.38% affiliate with the Baptist (Sterling’s Best Places, 2016). This is the highest religious affiliation out of all denominations. Methodist is the second (Sterling’s Best Places, 2016).
Regardless of denomination, it is important to remember the large role these faith communities play in providing services to Gloucester county residents, especially to minorities and vulnerable groups (Anderson & McFarland, 2015). For example, in 1997 the Abingdon Episcopal Church Outreach Committee initiated a drive to build a clinic to serve people without health insurance living in the Gloucester and Mathews counties. There was so much excitement over this project that other churches and members of the community wanted to assist in helping the cause. In August of 1998 the Gloucester Mathews Free Clinic opened, offering quality healthcare to the uninsured, adult population of Gloucester(Gloucester Mathews Care Clinic, 2016).
Top Left: Bethel Baptist Church Sign stating, “PRAYER IS THE ORIGINAL WIRELESS COMMUNICATION. NOTE: GOD ANSWERS!”
Bethel Baptist Church. (n.d.). [digital image]. Retrieved from http://www.bethelbaptistgloucester.org
Bottom left: Photo of Abingdon Episcopal Church during peak daffodil season.
Abingdon Episcopal Church, Gloucester, VA. (n.d.). [digital image]. Retrieved from http://www.bostonchurchinfo.com/build/upload/abingdon_daffod1.jpg
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Health & Social Services
What Gloucester offers their community:
Mental Health/Addiction Services
Laurel Shelter
G.U.E.S.T. Program
Gloucester Mathews Care Clinic
Obstetric Services
Pediatric Services
Gloucester VA Department of Health
1 Hospital
3 Urgent Care Facilities
Gloucester offers many health and social services to help the Gloucester community achieve optimum health and wellness.. There are several mental health/addiction inpatient and outpatient counseling centers in Gloucester County: Horizon Health Corporation, Therapy Associates of Hayes, Community Service Board, and Gloucester Counseling Center. Many of the local churches hold Alcoholics Anonymous (AA) & Narcotics Anonymous (NA) meetings
There is evidence of alcohol use in Gloucester. Out of 30,370 licensed drivers in Gloucester County, there was a total of 436 MVAs that resulted in 5 fatalities and 285 injuries. Out of these 436 MVAs, 50 were alcohol related (Department of Motor Vehicle, 2015).
Laurel Shelter of Gloucester is and emergency shelter for domestic violence & sexual assault victims and/or their children.
Gloucester also has the G.U.E.S.T. program. G.U.E.S.T. (Gloucester United Emergency Shelter Team) is a coalition of local churches that work together to provide emergency shelter for the homeless in our area during the winter months. Participating churches provide overnight lodging and meals to those who have no home of their own.
The Gloucester Mathews Care Clinic provides quality health care for the uninsured population, ages 18 and older, in Gloucester and Mathews county. Approximately 21% of Gloucester adult residents are uninsured according to the 2007 census (Gloucester Mathews Care Clinic, 2016) .
There is one community hospital, two urgent care centers, two pediatric practices; Sentara Pediatrics and Courthouse Pediatrics, one physical therapy group, numerous independent practitioners, and counseling services as listed above.
There is one hospital, Walter Reed Hospital, located at the north end of Gloucester county, two urgent care centers located mid-county; MD Express Urgent Care and Sentara Urgent Care, and the Gloucester Mathews Care Clinic, also located mid-county. All are easily accessible, located along the major artery route 17. Almost all community members are located only a few minutes away, with the longest travel time being approximately 15-20 minutes.
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Transportation
Major Artery: Route 17
Private Transportation: 83.3%
Public Transportation: Available
Closest Airport: Newport News/
Williamsburg
In Gloucester, 83.3 % of people get around by private transportation, 11.2% by Rideshare, and 2.6% by public transportation. Private transportation includes personal vehicles and Community Ride Share with park and ride lots. Public transportation includes Bay Transit, public school transportation, and two taxi services, Southern Bell & Metro Taxi.
Bay Transit is a community, non-profit transportation service. It has two circulator buses, the Courthouse Circulator and the Hive Express. There is a low fee of $0.50 to ride. Each bus has specific pick-up/drop off locations, one in the Courthouse area and one that travels to the south end of the county. They operate daily from 6 am to 2 pm. You must call ahead to reserve a seat. They also offer pick-up service 7 days a week from 6am to 6pm, but there are additional fees for this service. Bay Transit has the ability to transport people with disabilities and bicycles.
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Safety
Sheriff’s Office
VA State Police
Jail
6 Fire and Rescue Stations
Gloucester has a local Sheriff’s department, a jail, and Virginia State Police headquarters. It’s home to 6 Fire and Rescue Stations including: Station 1 GC, Station 2 Mark Pine, Station 3 Rescue Squad on Hayes Rd., Station 4 Harcum Rd., Station 5 Providence Rd., and Station 6 Sassafras Rd. These public servants do more than provide protection and safety for our community. They also offer programs like CPR certification and Shop with a Cop, a program the raises money for children in the county facing economic disparity.
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Disaster Preparedness
“The Department of Emergency Management protects communities by coordinating and integrating all activities necessary to build, sustain, and improve the capability to mitigate against, prepare for, respond to, and recover from threatened or actual natural disasters, acts of terrorism, or other man-made disasters. ”
Gloucester County has a Emergency Preparedness Plan that is easy to access via the http://gloucesterva.info website. They provide a 16-page Disaster Preparedness Guide that covers all 4 stages of community disaster response: 1) preparedness, 2) response, 3) recovery, and 4) mitigation. The plan was last updated in 2016.
Preparedness: reviews potential threats in the county and where to get important emergency information during and after a disaster. It also encourages appropriate insurance coverage, indoor and outdoor property review of potential hazards, a disaster plan for home, businesses, and family. They encourage residents to include special needs and pets, listings of community shelters, having an evacuation plan, community evacuation routes, and what to include in emergency disaster supply kits in their disaster plan.
Response: There is a listing of all Local Emergency Response Teams with their roles during a disaster (Gloucester Sheriff’s Office, Va State Police, Gloucester Fire & Rescue, Abingdon Fire & Rescue), as well as other agencies like the U.S. Coast Guard, F.B.I., Virginia Department of Emergency Management, Red Cross, Va Department of Transportation, and FEMA. All contact information for these agencies/teams are listed in the plan. They also encourage members of the community to become part of the Community Emergency Response Team (CERT) and participate in emergency preparedness trainings.
Recovery: Gloucester’s Recovery Plan includes 8 Steps to Recovery following a disaster. It emphasizes focusing on the job ahead, finding assistance following a disaster, assists community members with registering for assistance, and prepares them for returning home. They also include a Disaster Distress Hotline to aid community members in dealing with the emotional effects of trauma following a disaster
Mitigation: Gloucester County has a 550 page All Hazards Mitigation Plan. It is accessible via http://gloucesterva.info under the mitigation tab. It focuses on breaking the cycle of disaster damage, reconstruction, and repeated damage. Although they have mitigation plans for all hazards, their primary concern is flooding since the community is low lying and surrounded by water.
Gloucester Emergency Management [digital image]. (n.d.) Retrieved from http://gloucesterva.info/EmergencyManagement/tabid/676/Default.aspx#sthash.nIMzEtpX.dpuf
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Recreation
7 Parks
Abingdon Park
Ark Park
Beaverdam Park
Brown Park
Woodville Park
Tyndall’s Point Park
Gloucester Point Beach Park
The Gloucester Community has 7 parks. Abingdon Park has baseball, soccer, and Lacrosse fields. Ark Park has baseball and soccer fields, basketball courts, and a children’s playground. Beaverdam Park offers hiking, boating , fishing, horseback riding, and picnicking. Brown Park has a skateboarding ramp, disc golf, and a dog park. Woodville Park is home to several community soccer fields, including one sand soccer field. They hold and annual Surf & Turf sand soccer tournament there every June. Tyndall’s Point Park is a historic park. Gloucester Point Beach Park is located at the south end of Gloucester County, along the York River. There is a fishing pier, boat launch, children’s playground equipment, and a snack bar. Gloucester County’s Parks and Recreation Department holds many sporting events at some of these parks throughout the year and also offers outdoor summer camps.
The one draw back is that transportation is needed to get to any of these parks. The lack of sidewalks and trails throughout Gloucester county hinders some people from being able to access these beautiful recreation area.
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Community Nursing Diagnosis #1
1) Potential for health problems in mothers and infants of Gloucester associated with not breastfeeding (BF) related to lack of knowledge regarding the short and long-term health care benefits of BF, inadequate resources at Gloucester Health Department’s Women Infant & Children (WIC) office to meet BF education and support needs, and lack of lactation consultants (LC’) employed by obstetric and pediatric practices within the community as manifested by 23% of infants seen in Gloucester’s WIC office in 2015 were BF and 77.2% were formula-fed, no BF education classes or support services offered at the Gloucester’s WIC office, and only one LC employed by an obstetric or pediatric provider within the county.
Communities, especially health care providers within those communities, have a responsibility to do everything they can to promote the health and well-being of mothers and their children. Educating expectant mothers and their families on the short and long-term health benefits of breastfeeding (BF), and offering resources for BF support, can help accomplish this goal. According to the U.S. Surgeon General, “One of the most highly effective preventative measures a mother can take to protect the health of her infant and herself is to breastfeed” (U.S. Department of Health and Human Services, 2011, para. 1).
In 2007, the Evidence-Based Practice Center (EPC) in Boston, MA, part of the Agency for Health Care Research and Quality (AHRQ), published a report that summarized the outcomes of BF on maternal and infant health. EPC reviewed over 9,000 scholarly articles and studies that focused on BF and it’s impact on maternal and infant health. Studies that were of poor quality were discarded. The findings suggested that if infants were exclusively breastfeed for the first 6 months of life they experienced fewer episodes of ear infections, vomiting, or diarrhea. Finding also suggested fewer cases of pneumonia, severe lower respiratory tract infections, and sudden infant death syndrome (SIDS) in breastfed infants (Meyers, 2009). The difference in the percentages of common infant illnesses, among exclusively breastfed infants, are staggering. “Among formula-fed infants the incidence of vomiting and diarrhea is nearly 100% in the first year of life, as compared with such illness in fewer than half of breastfed children” (Meyers, 2009, p. 13).
The benefits of breastfeeding do not stop in infancy but continues into childhood and adulthood. BF is associated with decreased rates of obesity, diabetes, and childhood leukemia. Research has suggested that breastfeeding mothers have a lower rate of breast cancer, ovarian cancer, and type 2 diabetes, and if they breastfed for 12 month or more, they had lower rates of high blood pressure, hypercholesterolemia, diabetes, and cardiovascular disease compared to women that did not breastfeed (American Academy of Pediatrics, 2012).
Some of the economic benefits of breastfeeding include a decrease in U.S. spending on health care cost and keeping formula containers out of landfills. “A detailed pediatric cost analysis based on the AHRQ report concluded that if 905 of US mothers would comply with the recommendation to breastfeed exclusively for 6 months, there would be a savings of $13 billion per year” (American Academy of Pediatrics, 2012, p. 832). These savings did not include time parents missed from work due to their infant or child’s illness or adult deaths from diseases acquired in childhood.
Evidence-based research has proven the resounding health and economic benefits of breastfeeding. This is why U.S. government and private agencies that are concerned about the overall health of Americans strongly endorse “breastfeeding and human milk as the normative standard for infant feedings and nutrition” (American Academy of Pediatric, 2012, p. 827).
Based on all the information provided above, and the fact that the Gloucester community is severely lacking BF education and support, I chose this as my number one, priority diagnosis. I feel that my ethical decision making was based on the fact that, overall, this issue will have positive health and economic benefits for the greatest number of people. This type of ethical decision making is referred to a teleology. It’s also considered a primary prevention program because the goal is to “improve the health and well being of the community, making it less vulnerable to stressors” (Anderson & McFarlane, 2015, p. 257). This includes all ages, genders, ethnicities, and economic status.
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Expected Breastfeeding Outcomes
Increase community knowledge on the short and long-term health benefits of BF by offering 2 free, community, BF classes per month for the remainder 2017, encouraging spouses, significant others, grandparents, or any support persons to also attend.
Increase the percentage of WIC mothers choosing to breastfeed their infants to 33% by December 15, 2017.
Increasing community knowledge on the health benefits of breastfeeding is the first step towards increasing the number of infants that are breastfed. According to the U.S. Surgeon General lack of knowledge is one of the key barriers to breastfeeding and even though there is a great deal of evidence-based research on breastfeeding, there are still huge knowledge gaps (U.S. Department of Health and Human Services, 2011).
Out of 10 surrounding counties, Gloucester’s WIC program has the second lowest percentage of women choosing to breastfeed their infants, ranking in at 33% (Virginia Department of Health, Three Rivers Health, 2016). The target goal at the national level, set by Healthy People 2020, is to increase the proportion of infants who are breastfed to 81.9% by 2020. In 2011, in the state of Virginia, 79.2% of infants where breastfed and that same year, at the national level, 80.5% of infants were breastfed (Health People 2020, 2012). You can see how Gloucester’s WIC population falls extremely short in meeting this target goal.
Interventions/strategies :
Collaborate with local obstetricians, pediatricians, and the Gloucester VA Health Department, WIC office to determine if there are any health care providers willing to provide this service to expectant mothers, and their support systems. REVISED PLAN: If health care and social service providers are unable to offer classes, encourage the importance of educating the expectant mother, in the office, about the shot and long-term benefits of breastfeeding.
2) Encourage obstetricians, pediatricians, and the Gloucester VA Health Department to educate all staff members on the importance BF plays on the overall health outcomes for mothers and infants and inquire/offer staff the opportunity to become Certified Lactation Counselor (CLC). This will increase the number of professional available to educate and support the BF needs in Gloucester county and, in-turn, help mothers initiate and continue breastfeeding. According to the National Center for Chronic Disease Prevention, in 2013 there were 3.8 CLCs per 1000 live birth in the U.S., but in the state of Virginia there was less than 3 per 1000 live births (National Center for Chronic Disease Prevention, 2014).
Although hospitals in other counties offer free BF education classes, the closest one is at least 30 minutes outside of Gloucester. This will not help community members with limited transportation resources. REVISED PLAN: If there are no health care or social service providers willing or able to offer BF education classes, attempt to collaborate with CLC’s in other counties. See if they would volunteer their services to teach BF classes twice a month.
The classes should be offered at least twice a month at alternating times. An example would be, the firth and third Thursday of the month. One the first Thursday of the month the class could be held in the morning and on the third Thursday of the month it could be held in the evening. This would ensure accessibility for working individuals.
Stress the importance of inviting fathers, grandmothers and other family members to attend the class. When talking to the expectant mother about attending the BF class, have them write down the name and address of any family member or support person they wish to accompany them to the class. Send an invitation to the expectant mother and their family member with the date, time and place the class will be held. Including family members and social support can help facilitate the expectant mother’s decision on how the baby will be fed and improve breastfeeding support after the baby is born (National Center for Chronic Disease Prevention, 2014).
Collaborate with the Gloucester WIC office to ensure all of their expectant mothers are invited to attend the class. Make an attempt to assist with finding resources for transportation, if needed.
Provide instruction for group teaching. Suggest using the Understanding Breastfeeding PowerPoint Class and providing written literature for patient to take home and review.
Check potential resources (government funding/charitable donations/redirected funds) available to fund BF education/support or coordinate a community fundraiser to support the cause.
Evaluation Strategies:
1) Shortly after initiating the BF education classes, I will use the formative process to evaluate if we are meeting our program goals (Anderson & McFarlane, 2015). Using a survey I will answer questions about BF classes. Did we offer the class twice a month, provide a comfortable facility that provided enough space for all participants attending the class, offer the classes at the times scheduled, make family members feel welcome, provide literature that reviews education material covered in class, have enough supplies for all participants?
I will also hand out a participant survey at the end of class to determine the effectiveness of the BF education classes. Some of the questions will be formative: Were you satisfied with the class? Was the environment conducive to learning? Other questions will be summative: What do you feel were the strengths of the class? Are there any areas for improvement? Are there any additional topics you would like to learn about? Can you tell me one thing you learned today that may have changed your attitude about BF? Summative questions like these can help determine short term outcomes of the BF education classes, like whether perceptions or attitudes about BF have changed (Anderson & McFarlane, 2015).
My second evaluation strategy will need to measure the outcome, or long term effect of this program. Did providing BF education classes increase the number/percentage of WIC mothers choosing to BF their infants in 2017? For this evaluation process I will use the pretest-posttest design and apply it to the BF classes offered WIC mothers. I will use the initial data from above and compare it to new data obtained after December 15, 2017.
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Expected Breastfeeding Interventions
Collaborate with local obstetricians, pediatricians, and the Gloucester VA Health Department, WIC office
Encourage obstetricians, pediatricians, and the Gloucester VA Health Department to educate all staff members on the importance BF
The classes should be offered at least twice a month at alternating times
Stress the importance of inviting fathers, grandmothers, and other family members to attend the class
Others as listed below
Interventions/strategies :
Collaborate with local obstetricians, pediatricians, and the Gloucester VA Health Department, WIC office to determine if there are any health care providers willing to provide this service to expectant mothers, and their support systems. REVISED PLAN: If health care and social service providers are unable to offer classes, encourage the importance of educating the expectant mother, in the office, about the shot and long-term benefits of breastfeeding.
2) Encourage obstetricians, pediatricians, and the Gloucester VA Health Department to educate all staff members on the importance BF plays on the overall health outcomes for mothers and infants and inquire/offer staff the opportunity to become Certified Lactation Counselor (CLC). This will increase the number of professional available to educate and support the BF needs in Gloucester county and, in-turn, help mothers initiate and continue breastfeeding. According to the National Center for Chronic Disease Prevention, in 2013 there were 3.8 CLCs per 1000 live birth in the U.S., but in the state of Virginia there was less than 3 per 1000 live births (National Center for Chronic Disease Prevention, 2014).
Although hospitals in other counties offer free BF education classes, the closest one is at least 30 minutes outside of Gloucester. This will not help community members with limited transportation resources. REVISED PLAN: If there are no health care or social service providers willing or able to offer BF education classes, attempt to collaborate with CLC’s in other counties. See if they would volunteer their services to teach BF classes twice a month.
The classes should be offered at least twice a month at alternating times. An example would be, the firth and third Thursday of the month. One the first Thursday of the month the class could be held in the morning and on the third Thursday of the month it could be held in the evening. This would ensure accessibility for working individuals.
Stress the importance of inviting fathers, grandmothers, and other family members to attend the class. When talking to the expectant mother about attending the BF class, have them write down the name and address of any family member or support person they wish to accompany them to the class. Send an invitation to the expectant mother and their family member with the date, time and place the class will be held. Including family members and social support can help facilitate the expectant mother’s decision on how the baby will be fed and improve breastfeeding support after the baby is born (National Center for Chronic Disease Prevention, 2014).
Collaborate with the Gloucester WIC office to ensure all of their expectant mothers are invited to attend the class. Make an attempt to assist with finding resources for transportation, if needed.
Provide instruction for group teaching. Suggest using the Understanding Breastfeeding PowerPoint Class and providing written literature for patient to take home and review.
Check potential resources (government funding/charitable donations/redirected funds) available to fund BF education/support or coordinate a community fundraiser to support the cause.
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Expected Breastfeeding Evaluation
Implement a survey regarding BF classes
Program goals
Participant satisfaction
Participant learning
Participant attitude
Outcome measurement
Increased number/percentage of WIC mothers who BF
Evaluation Strategies:
1) Shortly after initiating the BF education classes, I will use the formative process to evaluate if we are meeting our program goals (Anderson & McFarlane, 2015). Using a survey I will answer questions about BF classes. Did we offer the class twice a month, provide a comfortable facility that provided enough space for all participants attending the class, offer the classes at the times scheduled, make family members feel welcome, provide literature that reviews education material covered in class, have enough supplies for all participants?
I will also hand out a participant survey at the end of class to determine the effectiveness of the BF education classes. Some of the questions will be formative: Were you satisfied with the class? Was the environment conducive to learning? Other questions will be summative: What do you feel were the strengths of the class? Are there any areas for improvement? Are there any additional topics you would like to learn about? Can you tell me one thing you learned today that may have changed your attitude about BF? Summative questions like these can help determine short term outcomes of the BF education classes, like whether perceptions or attitudes about BF have changed (Anderson & McFarlane, 2015).
My second evaluation strategy will need to measure the outcome, or long term effect of this program. Did providing BF education classes increase the number/percentage of WIC mothers choosing to BF their infants in 2017? For this evaluation process I will use the pretest-posttest design and apply it to the BF classes offered WIC mothers. I will use the initial data from above and compare it to new data obtained after December 15, 2017.
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2) High prevalence of obesity among adults living in Gloucester County related to lack of physical activity, lack of street designs that encourage physical activity, and easy access to unhealthy food choices as manifested by 33% of Gloucester adults with a Body Mass Index (BMI) greater than or equal to 30, 25% of Gloucester adults report no physical activity, a shortage of sidewalks and bike trails within the county, 26 fast food restaurants but only 5 farmer’s markets.
Community Nursing Diagnosis #2
As listed above, obesity effects 1/3 of the adult population in Gloucester county (County Health Ranking Road Map, 2015). According the World Health Organization (WHO) obesity is one of the risk factors that contributes to the burden of disease (WHO, 2012). Between 1999-2014 the 2nd and 3rd underlying causes of death in Gloucester county were acute myocardial infarction (MI) and atherosclerotic heart disease (County Health Ranking Road Map, 2015). Obesity is a strong contributing factor to both these diseases.
The high prevalence of obesity in Gloucester county, along with it’s risks, lead to increased morbidity and mortality, made me prioritize this as my 2nd highest nursing diagnosis.
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Expected Obesity Outcomes
By December 2018, decrease the percentage of obese adults, ages 18 and older, living in Gloucester County by 5%.
By December 2018, increase the percentage of adults, ages 18 and older, engaging in at least 30 minutes of moderate intensity aerobic activity 5 days/week by 5%.
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Expected Obesity Interventions
Focus on education
Collaborate with other health care providers within the community to see if they would be willing to assist with education programs
Encourage local employers to offer healthy meal and snack choices, develop partnerships with local wellness programs
Attend a Gloucester County transportation planning meeting
Interventions/Strategies:
Prevention always starts with education so my first intervention will focus on education. Educate the community on the importance of diet and exercise to maintain a healthy weight. Use the American Heart Association’s recommendation for physical activity, “at least 30 minutes of moderate-intensity aerobic exercise 5 days per week or at least 25 minutes of vigorous aerobic activity at least 3 days per week” (American Heart Association, 2014). Set up an education stand at local community fairs or festivals showing health food choices. Make sure display are bight and easy to read. Talk about ways to adjust diet to reduce calories, like limiting sugar containing beverages to one drink per day. Have suggestion for low cost or free exercise programs in the community. Remind people that when they engage in health preventative behaviors, they are modeling positive behavior for their children and grandchildren.
2) Collaborate with other health care providers within the community to see if they would be willing to assist with education programs.
3) Encourage local employers to offer healthy meal and snack choices, develop partnerships with local wellness programs, offer benefits/incentives to employees that participate in wellness programs or obesity prevention, and comply with labor laws to SUPPORT BREASTFEEDING AT WORK!
Attend a Gloucester County transportation planning meeting. See if there is a plan of action or money in the budget to address modifying Gloucester’s street designs to include additional sidewalk, crosswalks, and biking/pedestrians trails as a way to promote safe, physical exercise within the adult population. “The simplest, positive change you can make to effectively improve your heart health is to start walking (American Heart Association, 2014, para. 4).
Evaluation:
I will use a pretest-posttest one-group design strategy to evaluate if there was a decrease in obese adults living in Gloucester and also to verify if there was an increase in the number of adults engaging in physical activity. In each of these situation I would collect data on two separate occasions and compare the data to determine if there was a decrease of obese adults or an increase in physical activity (Anderson & McFarlane, 2015).
Another evaluation tool I could use is a case study. I would use data obtained from participants that enrolled in wellness programs, tracking involvement in program activity and reports prepared by wellness programs. This would help me determine if wellness program participants engaging in the required amount of physical activity, 30 minutes of moderate intensity aerobic activity 5 days/week, had any impact on weight loss/obesity rates.
Based on the results I may need to make alterations in program objectives. I might discover that I need to incorporate nutritional data, like calorie intake, into the program plan to achieve the desired goal.
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Expected Obesity Evaluation
Use pretest-posttest design strategy to evaluate if there was a decrease in obese adults living in Gloucester and also to verify if there was an increase in the number of adults engaging in physical activity
Use a case study method
Evaluation:
I will use a pretest-posttest one-group design strategy to evaluate if there was a decrease in obese adults living in Gloucester and also to verify if there was an increase in the number of adults engaging in physical activity. In each of these situation I would collect data on two separate occasions and compare the data to determine if there was a decrease of obese adults or an increase in physical activity (Anderson & McFarlane, 2015).
Another evaluation tool I could use is a case study. I would use data obtained from participants that enrolled in wellness programs, tracking involvement in program activity and reports prepared by wellness programs. This would help me determine if wellness program participants engaging in the required amount of physical activity, 30 minutes of moderate intensity aerobic activity 5 days/week, had any impact on weight loss/obesity rates.
Based on the results I may need to make alterations in program objectives. I might discover that I need to incorporate nutritional data, like calorie intake, into the program plan to achieve the desired goal.
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Reflections
This course has helped me to:
Discover the wonderful programs and initiatives Gloucester County has in place to encourage a healthy community.
Understand how overlapping subsystems can effect the health of the community.
Have a better understanding of the community nurse’s role in achieving healthier communities.
Using the Community-as-Partner model to assess the eight subsystems, 1) physical environment, 2) education, 3) safety and transportation, 4) politics and government, 5) health and social services, 6) communication, 7) economics, and 8) recreation, opened my eyes to the many wonderful policies and initiatives Gloucester County already has in place to encourage a healthy community for its core.
It was very evident that these eight subsystems overlapped to affect one another and the health of the community. One example of this is Gloucester’s issue with street design. Gloucester’s lack of safe street designs is not only affecting the safety of community but their overall health as well. Policy and government is needed to initiate a change and restore the health of the community in this case. I saw many examples of lines of resistance. One great example of this was the opening of the Gloucester Mathews Care Clinic to provide quality health care to the uninsured people of Gloucester. I also was witness to stressors, such as the loss of funding for WIC BF education and support, in my community.
Being a community is a very dynamic role. It requires identifying risks within community, working with the community to develop a plan for change and a desire for a healthier community. This project provided a wonderful example of the community nurse’s role to help citizens improve their optimal level of wellness within the community.
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References
American Academy of Pediatrics. (2012, March). Policy statement: Breastfeeding and the use of human milk. Pediatrics, 129(3),
827-841. doi::10.1542/peds.2011-3552
American Heart Association. (2014). American Heart Association recommendations for physical activity in adults. Retrieved from
http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/American-Heart-Association-
Recommendations-for-Physical-Activity-in-Adults_UCM_307976_Article.jsp#.WK-_rX9wmUk
Anderson, E. T., & McFarlane, J. (2015). Community as partner: Theory and practice in nursing (7th ed.). Philadelphia, PA: Wolters Kluwer.
Centers for Disease Control and Prevention., National Center for Chronic Disease Prevention and Health Promotion , Division of Nutrition, Physical Activity, and Obesity. (2014). Breastfeeding report card . Retrieved from
https://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf.
Gloucester County Virginia Gen Web County History. (2009). Retrieved from http://vagenweb.org/gloucester/history.html
Gloucester Mathews Care Clinic. (2016). Caring through sharing. Retrieved from http://www.gmcareclinic.com/history-of-the-clinic/
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References
Gloucester Visitors Center. (2010). Gloucester’s historic courthouse building: A self-guided tour. Retrieved from
http://www.goucesterva.info/Portals/0/tourism/documents/courtcircleselfguidedtour1010.pdf
Meyer, D. (2009). Breastfeeding and health outcomes. Breastfeeding Medicine, 4(1), 13-15. doi:10.1089./bfm.2009.0066
Patterson, P. (2013). Virginia’s middle peninsula. Retrieved from http://middlepeninsula.com/
U.S. Department of Health and Human Services. (2011). Executive Summary: The Surgeon General’s Call to Action to support breastfeeding. Retrieved from https://www.surgeongeneral.gov/library/calls/breastfeeding/executivesummary.pdf
United States Census Bureau. (2015). Quick facts: Gloucester county, Va. Retrieved from https://www.census.gov/quickfacts/table/PST045215/51073
Virginia Department of Health, Three Rivers Health. (2016, February). Annual Report. Retrieved from http://www.vdh.virginia.gov/content/uploads/sites/22/2016/05/AnnualReportFY157516.pdf
Warner Hall History. (n.d.). Retrieved from http://www.warnerhall.com
World Health Organization. (2012). Prioritizing risk factors to identify intervention s for economic assessment. Retrieved from http://www.who.int
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