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running head community assessment 1 community assessment african american adults with diabetes francesco scarpelli empire state college

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community assessment table of contents introduction 4 epidemiology 5 type 1 diabetes 6 type 2 diabetes 6 complications 6 treatment and prevention 7 healthy people 2010 objectives 8 community overview 8 neighborhood health center 9 niagara county and diabetes 11 cultural influences 12 socioeconomic influences 13 environmental influences 14 windshield survey 15 boundaries 16 houses/decay and pollution 16 economics 18 open spaces parks 18 shopping areas and businesses 19 transportation 19 health and social service agencies 19 protective services 20 2

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community assessment religion 21 schools 21 general 21 evaluation 22 key informant interviews 23 community diagnosis 28 developmental stage 28 community health nursing model 29 nursing theory 30 ideal community health nursing role 31 primary prevention 31 secondary prevention 33 tertiary prevention 34 political issues 34 service learning project 35 high risk population focus assessment 35 community agency program assessment 38 intervention 38 conclusion 39 references 41 appendix a census tract 202 43 appendix b diabetes mellitus tutorial 44 3

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community assessment community assessment african american adults with diabetes 4 the primary objective of public health nursing is to the do the greatest good for the focus population and for the greatest amount of people in this regard it is only fitting that a primary focus would be to determine strategies in order to create a healthy environment for those specific populations in the greatest need american nurses association 2007 in contemplating my community assessment focus i found myself attempting to discover a community which included those who are most in need i wanted to find a population at high risk for certain illness and also those with limited knowledge of health care promotion and prevention as low socioeconomic status has shown to adversely affect health clark 2008 i chose a low income area of niagara falls known to have a high percentage of the population below the poverty level between 9th and 17th streets in the highland avenue district i chose this neighborhood because included in this community is the mt st mary s neighborhood health center a clinic where the uninsured and also the underinsured can go to receive quality health care in addition this community has a high incidence of certain illnesses which will be described further in this paper in regard to my chosen population focus i will be assessing african american adults given the high rate of diabetes in the african american population i will further concentrate on the community health nurse s role in meeting the specific health needs of african american adults with diabetes and health teaching in this area of health promotion and prevention furthermore the majority of the population in my chosen community is uneducated and the level of unemployment is high a high percentage of this community depends on government financial assistance in addition many who are employed do not receive health insurance benefits research has shown a link between many acute and chronic illness and living in poverty studies

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community assessment have also shown that the health of individuals with moderate income that live in low-income neighborhoods is also negatively affected clark 2008 in this paper an overview of the epidemiology of diabetes will be covered in addition the data gathered will be provided in the form of a community assessment in regard to african 5 american adults with diabetes the demographics of the local highland avenue community vital population statistics of the community and the population served by the neighborhood health center furthermore additional data will be generated and provided in the form of a windshield survey a personal community observation from my standpoint and key informant interviews finally the data will be interpreted to pinpoint the described health problem in this community its need for action the strengths of the community and the community health nurse s role in health promotion and prevention epidemiology diabetes mellitus is a group of chronic illnesses which affects millions of americans each year it is characterized by high levels of blood glucose as the body is made of millions of cells each cell requires energy to function the body uses glucose to create this energy for the glucose to enter the cells two things must occur the cells must have enough receptors to accept the glucose and the hormone insulin must be present to unlock these receptors the patient education institute 1995-2009 when one or both of these processes are disturbed hyperglycemia occurs this hyperglycemia is caused by a decrease in the secretion of insulin by the pancreas or a decrease in the activity of the insulin produced lewis heitkemper dirksen 2000 although there is no cure for diabetes there are many treatment options used to control the disease.

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community assessment type 1 diabetes in type 1 or insulin dependent diabetes the body s immune system destroys the critically important insulin producing beta cells of the pancreas as the insulin production is affected the type one patient requires insulin injections to control blood glucose levels risk factors may be autoimmune environmental or genetic the signs and symptoms of type 1 diabetes are extreme thirst and urination hunger weight loss blurred vision and fatigue niddk 2007a type 2 diabetes in type 2 diabetes the body does not make enough insulin and also cannot use it correctly generally the body begins as resistant to insulin and over time the pancreas loses its ability to produce the crucial hormone of those diagnosed with diabetes 90-95 are type 2 risk factors may be modifiable or non-modifiable modifiable risk factors include obesity and physical inactivity non-modifiable risk factors include age ethnicity and family history african americans native americans native hawaiians asians/pacific islanders and latino americans are at higher risk for developing type 2 diabetes signs and symptoms include drowsiness extreme thirst frequent urination slow healing wounds and frequent infections type 2 diabetes is treated with oral antidiabetic agents or insulin niddk 2007a complications 6 the many complications of diabetes prove that this disease is as deadly as it gets as it affects every body system imaginable these complications include heart disease and stroke hypertension microvascular disorders such as blindness peripheral vascular disease which could lead to amputations renal disease and nervous system disorders such as neuropathy decreased healing and frequent infections lewis heitkemper dirksen 2000 the enormous effect of

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community assessment diabetes on the health of the american people and also on the economy cannot be ignored diabetes is the seventh leading cause of death on all u.s death certificates 23.6 million americans 7.3 of the population have diabetes 1.6 million more americans over 20 years of 7 age are diagnosed every year 5.7 million of these individuals are undiagnosed furthermore 57 million more americans have prediabetes over 200,000 americans die each year from diabetes related complications in addition the risk of death doubles when diabetes is present fiscally the u.s spends 174 billion dollars annually on diabetes niddk 2007b treatment and prevention prevention of the modifiable risk factors is a way of decreasing chances of a diabetes diagnosis this can be accomplished by maintaining a healthy diet exercising regularly and maintaining a healthy weight maintaining healthy lipid and blood pressure levels and making regular visits to your doctor for routine physicals as it has been shown that diabetes can lead to serious and potentially life threatening complications it is imperative to remain compliant with prescribed medications and/or treatment and take initiative to control the disease by effectively maintaining healthy blood glucose levels with type two diabetes this can be accomplished many times by exercise and losing weight and maintaining a healthy diet many also have to take oral antidiabetic agents in addition still other type two diabetics may also need insulin to effectively control blood glucose levels type one diabetics always require insulin to control their blood glucose levels in the u.s 2-14 of diabetics take insulin only 13 take oral agents and insulin 57 take only oral agents and 16 take neither oral agents nor insulin niddk 2008

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community assessment healthy people 2010 objectives the main goal of the healthy people 2010 objectives is to increase the health and quality 8 of life for all people to do this it is imperative that we identify important health issues that may act as barriers to achieving this goal of health and wellness in regard to population health main objectives include prevent diabetes 5-2 reduce the diabetes death rate 5-5 and reduce kidney failure due to diabetes 4-7 clark 2008 of the leading healthy people 2010 health indicators the ones relevant to the topic of diabetes are physical activity overweight and obesity and access to health care community overview table 1 the highland avenue community demographics 1 ny state 48.5 51.5 77.4 73.4 17.3 16.7 n/a 79.1 27.4 13.7 1 us 49.3 50.7 87.2 79.8 12.8 15.4 n/a 80.4 24.4 13.2 2 population demographics male female age18 years and older 38.7 61.3 56.8 0.3 98.5 0.9 17.6 35.1 3 53.5 2population $13,778 ethnicity white black or african american hispanic or latino of any race education less than 9th grade education high school graduate bachelor s degree or higher poverty level individuals below poverty level 1ny income home median household income $55,980 1us $52,029

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community assessment ownership/value home ownership rate median household value 53 $148,700 66.2 $119,600 19.9 $60,600 9 u.s census bureau 2010 u.s census bureau 2000 neighborhood health center resource my chosen agency is called the mt st mary s neighborhood health center it is located at 3009 9th street in the highland avenue district of downtown niagara falls the agency is a rented building attached to an alternative school for troubled children in addition the niagara falls housing authority is also attached to this building the clinic is surrounded by low-income public housing units including centre court jordan gardens and unity park this area is the community of niagara falls which contains the most poverty the median income is the lowest in the city and the percentage of african americans is the highest in the city which demonstrates a higher risk for certain illnesses on monday february 9th 2010 i paid a visit to my chosen community agency and interviewed a registered nurse and also the agency director this visit had confirmed my suspicions that i had indeed chosen the right community on which to complete this community assessment i stayed at the agency for one hour and assessed the agency its mission the role of the registered nurse what population the agency serves and why this particular population is high risk i learned how the work of this agency contributes to the overall health of the community finally i assessed the impact of cultural environmental economic and social influences on the health of the community after this session i took a half hour and began my windshield survey i drove around the community and assessed the surrounding area.

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community assessment the neighborhood health center is a free clinic in niagara falls designed to serve the poor and underinsured no one in this institution is turned away and everyone receives quality health care with total regard for human dignity the mission of the center is to provide quality health care and a compassionate environment to improve the health of the community with special needs to those who are poor or vulnerable the core values are wisdom creativity and 10 dedication service to the poor reverence and integrity the population served is high risk due to poverty lack of financial resources education and employment along with many cultural environmental and social issues to be further described in this paper the clinic is a 6 room office employing 2 part time r.n.s 1 full time and 2 part time lpns 1 full time and 2 part time nurse practitioners and also pediatricians obstetricians and general practitioners who are reimbursed by the hospital/clinic the clinic bills medicaid and managed hmos such as fidellis provided health care includes adult pediatric and ob/gyn for adults some of the services provided include physicals immunizations sick and well visits routine hiv and std testing and respiratory treatments pediatric services include school physicals immunizations and sick and well visits the clinic sees 1100-1200 patients a month the majority of the patients are african american they are mostly local and walk or ride bicycles from local public housing many clients also use public transportation as there is a bus stop directly across the street from the clinic i have come to learn that this clinic is the only major contributor to public health in the area as the vast majority of the population utilizes these services nursing responsibilities and roles in the clinic are many on a daily basis nurses complete patient assessments and documentation administer immunizations take vital signs and provide vital health teaching the employees at the clinic screen for and treat these illnesses in hope that the patients will remain compliant and follow through with medications and further clinic visits.

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community assessment finally a main role of the nurse within the clinic is to be politically active and to advocate for 11 patients to the insurance companies to take better care of the working poor in the community and to cover more medications and tests supplies as the working poor are productive members of society who deserve as much coverage as the medicaid recipients the clinic also provides much social support as there is a low rate of social capita the incidence of stds has shown to increase the clinic provides free std screening in addition many health teaching classes are offered for nutrition diabetes smoking cessation spirituality promoting fitness emotional and depression support a health literacy program presentation and many more for those with transportation difficulty there is a van go service for a nominal one-dollar fee which transports individuals to their appointments and classes i have learned that the population in the highland avenue community is dependent on these services and at times may become demanding as many believe these services are owed to them this is true in spite of the fact that many rely on public financial assistance are unemployed and uneducated this is where the true mission of the clinic and the catholic sisters of charity come into play everyone is treated equal and no one is turned away finally in regard to finances the clinic operates at a financial loss and requires a subsidy from the hospital of 500,000-600,000 dollars a year to stay open and to continue to serve the community medicaid facilitated enrollers are used to enroll as many individuals as possible to minimize financial loss finally if this clinic did not exist this community would have no readily available health care options niagara county and diabetes the majority of the highland avenue community utilizes the neighborhood health center on ninth street as their primary source of health care from personal observation health

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community assessment teaching experiences as a student diabetes educator at the clinic and from speaking to the nursing staff and medical providers i have discovered that a high percentage of the local 12 population that attends the clinic comes complete with a diagnosis of diabetes as shown in the previous table 98.5 of the population is of african american decent as african americans are more likely to have diabetes and as statistics have shown in the introduction of this paper an imperative and ideal role of the community health nurse at the mt st mary s neighborhood health center is to act as a diabetes educator it is crucial for these nurses to increase awareness of the signs and symptoms of diabetes to provide current information on a regular basis in regard to risk factors treatment and prevention and to develop low literacy education materials due to the low education level of the local community the rate of diabetes in niagara county is 7.7 this exceeds the new york state rate of 6.6 this being said there are many cultural environmental and socioeconomic influences in the highland avenue district of niagara county that have an enormous impact on the rate of diabetes in the area and also on the incidence and severity of complications cultural influences the staff at the neighborhood health center addresses the impact of cultural influences on the health of the community as previously stated 98.5 of the population in the highland avenue district is african american u.s census bureau 2000 african americans are more to prone to illnesses such as diabetes hypertension and anemia in this paper i have focused on diabetes in the african american population 3.7 million an astonishing 14.7 of all non hispanic african americans ages twenty and older have diabetes this includes those diagnosed and undiagnosed this statistic is higher than in any other race african americans are two to three more times likely to have diabetes than whites u.s department of health and human

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community assessment services 2003 this definitely shows a population in need nutrition can also be considered a cultural issue as diets high in sodium cholesterol and saturated fats as well as fried foods are 13 prevalent in this community poor nutrition in the african american community leads to obesity which is a major contributing factor to diabetes watters sati 2009 socioeconomic influences the neighborhood health center is very proactive in assessing the socioeconomic issues of this community the social worker at the neighborhood health center in niagara falls is a nun who works at the clinic full time she is part of the spiritual care department at st mary s she is very involved with medicaid applications and assisting individuals to a managed care hmo to receive more services paid for by the insurance company sister also assists with getting families governmental financial assistance and calling billing agencies to advocate for patients who have a hard time paying bills in addition sister also assists with providing diapers formula clothes and other child services for families in need sister also calls individuals out on issues she feels are lacking in integrity in regard to finances this of course is not always in the best interest of the patient and their family clark 2008 says that individuals will also have their own ideas of what their resources should be used for for example if sister sees an individual come in financial hardship needing medicaid or other financial services yet they are wearing new brand name clothes or driving a brand new car she will call them out and attempt to fix the situation scarcity results from insufficient resources and scarcity definitely flourishes in the highland avenue district as resources are severely limited clark the median household income is 13,000-14,000 per year this is the lowest in the city of niagara falls the unemployment rate is 11.8 and 49.4 of the population over the age of 16 is not in the labor force u.s census bureau 2000 a large portion of the community is uninsured or on

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community assessment 14 medicaid and many are unemployed access to healthcare is an imperative healthy people 2010 indicator in regard to controlling diabetes in regard to diabetes many of the underinsured depend on governmental financial assistance these are the working poor who do not qualify for medicaid lancets glucometer strips and other diabetes supplies may not be covered the patient is then financially responsible for their own purchases and therefore many times do without the clinic medical providers must see many of these patients once a week to control diabetes with only medications that the patient can afford and also by attempting to control their diet in 2003 24.4 of african americans were poor compared to 8.2 of non-hispanic whites u.s department of health and human services 2003 in regard to the social environment the impact on community health is great clark 2008 social factors such as low income prevent access to health care this poor access may lead to potentially deadly complications that could be managed with adequate health care as adequate blood sugar control is imperative for the prevention of complications from diabetes this lack of health care access because of finances or otherwise has been shown to be detrimental to health clark environmental influences environmental factors can have a negative effect on the health of a community it is important for the nurse working in the community to be aware of and in tune with these influences environmental factors are responsible for one fourth of the preventable illness in the world clark 2008 in conjunction with the neighboring housing authority the clinic employees are aware of those environmental factors that may contribute to illness they must act as patient advocates in this regard to promote community health these factors may include housing conditions air and water quality pollution and microorganisms clark in addition,

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community assessment neighborhood environment influences affect physical activity and exercise diet availability of 15 grocery stores with healthy food and recreational and educational facilities these are all issues which increase the risk of diabetes boston university medical center 2010 as the highland avenue community does have some grassroots projects to improve health and wellness along with a very proactive clinic staff the population still falls short in regard to effectively managing environmental factors to control diabetes these influences are closely related to the healthy people 2010 health indicators physical activity and overweight and obesity these indicators are imperative to manage in order to effectively control diabetes to achieve health and wellness windshield survey highland avenue community niagara falls ny the city of niagara falls has long been recognized as a tourist destination and a city of flourishing industry between the years of 1960-1990 many large businesses had left niagara falls the population dropped by one third and left behind was many abandoned industrial sites with buried contaminated waste they are called brownfield areas or areas over former industrial land grant money has been given to revitalize the area thirteen of the thirty-five abandoned sites in niagara falls are in the highland avenue community this area of the city covering 560 acres contains mixed residential and industrial property and has become an area less than sought after to live in furthermore it has been steadily declining and is filled with deteriorating abandoned homes and high crime rates terrible road conditions and the lowest household income rate in the city in addition this community has the highest concentration of african americans who are more prone to diseases such as hypertension and diabetes the low level of socioeconomics has played a major role in this community s demise as low socioeconomic status has shown to affect health clark 2008 i chose this area of niagara falls known to have a high poverty level between 9th and 21th street in the highland avenue district on the upper west

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