Outcome 6
Outcome six involves us being able to manage the direct and indirect care of individuals, families, groups, communities, and populations to promote, maintain, and restore health. I feel that the Community Health Nursing course helped me to best achieve this outcome. As part of this course, we were required to complete several hours with a community health nurse. I had the opportunity to work with a school nurse. Before doing this clinical, I assumed that school nurses sat in their offices most of the day and attended to children that came in with cuts or minor illnesses. I was blown away by the amount work that these nurses complete on a daily basis. There are only nine nurses for the entire Washington county school district. Each nurse is in charge of several schools. A care plan must be filled out for each child that has any form of illness. The nurse that I had the opportunity to follow involved the family in the plan of care for these children by talking with them in person and educating everyone directly involved with caring for these children. One child had a feeding tube and the nurse encouraged the parents to come in and assist with educating the staff on how to care for this child. I feel that the nurse was able to collaborate and manage appropriate care for these children. Although I do not have any documentation about this experience to add to my portfolio, she was a great example to me and helped me to achieve this outcome.
In the Community Health Nursing course, I also had the opportunity to research one of the most prevalent diseases in my community, which is heart disease, and create a plan of action as to how we can educate the community by explaining what it is as well as appropriate prevention measures. This has helped me become more aware of health issues specific to my community. I learned the importance of sharing my knowledge about preventable diseases to everyone that I come in to contact with. I feel that I am better able to promote, maintain, and restore health among individuals, families, groups, and communities after taking this course.
Lastly, the Gerontological Nursing course helped me to achieve this outcome by allowing me to assess and create a plan of care for an elder in the community. This also helped me to realize the importance of sharing my nursing knowledge with others. I feel that I was able to better the quality of life for the elder that I worked with. I plan to take all of the experiences and knowledge that I learned through these courses and use them not only in my future nursing practice, but in my daily life by educating those that I may come in to contact with.
Community Health Project
Community Assessment and Analysis
St. George, Utah is a city located in southern Utah. It contains flat layers of red rock, mesas, and narrow canyons. It lies in a desert and sits on a lower elevation than most of the rest of the state. Because of this, it is the hottest part of the state and averages only 8.25 percent of precipitation annually (St. George, Utah). As of 2010, the census for St. George was 72,897 people; the census for the entire state of Utah was 2,763,885. The median household income is slightly greater in St. George at a median of $48,501 compared to the state median of $45,300 (United States, 2012); however, unemployment levels are greater in St. George at 7.1% versus 5.8% for the whole state.
There is similar access to education in St. George compared to the state of Utah; there are several elementary, middle, intermediate, and high schools in the city. Dixie State College is the main college in St. George. There are no universities in the area, compared to four major universities with graduate programs throughout the rest of the state (Education, 2012). St. George city is comparable to the state of Utah containing several public parks, a county library, local police station and fire department, the local IHC hospital, Dixie Regional Medical Center, and emergency services. The dominant religion is The Church of Jesus Christ of Ladder Day Saints, which is the same as the rest of the state. The main freeway in Utah runs through the city of St. George. There are local bus transportation as well as taxi services. There is also an airport, which is smaller than the main one in Salt Lake City. Like the state of Utah, St. George’s dominant political party is Republican (Utah-political, 2012).
The leading cause of death for the state of Utah is disease of the heart. This is the second leading cause of death in St. George, with malignant neoplasm’s being number one (Utah Department, 2011). Crime rates for St. George in 2010 were 93 per 100,000 inhabitants, robbery was 13.7 per 100,000 inhabitants and property crime which was the highest at 2,211.1 per 100,000 inhabitants was still lower than the national average of 2,941.9 (St. George crime, 2010).
The ratio of physicians per citizens is slightly higher in St. George at 21.2 physicians per 10,000 people than that state average of 20.8 physicians per 10,000 people (Utah Department, 2012). St. George is comparable to the state of Utah by containing offices where people can apply for WIC, insurance, food stamps, or other assistance as well as several home health and hospice agencies, nursing homes, senior citizen centers, a hospital, and a health department (Hospitals, 2012).
Target Population
The target population is those with coronary artery disease (CAD) living in the city of St. George, Utah. Reuben Evans, nurse manager of Dixie Regional Medical Center’s cardiovascular unit, says that the illnesses most seen on the unit are a “combination of CAD and congestive heart failure”. He believes that most of the people that he meets do not see themselves as actively ill, rather they learn through the process of the illness that seeing to their cardiovascular health ensures better health overall (personal communication, October 2, 2012).
Maryanne Covington, cardiovascular health education specialist, reports that there have been several changes recently made in the community in regards to heart health. Implementation by Dixie Regional Medical Center (DRMC) to meet with skilled nursing facility nurses to educate them on heart failure symptoms and interventions to help prevent exacerbation in their patients, 12 lead EKGs have been installed in emergency service vehicles including reading education to emergency responders to significantly reduce the time required from entrance to the emergency room to being ballooned in surgery, conducting vascular support groups, speaking at community health fairs and active aging presentations, and hosting a Heart Health series where local physicians speak about heart health issues and heart disease. She also mentioned that DRMC was just named one of the top fifty cardiovascular hospitals 2013 in the United States for the fifth year according to Modern Health Magazine. She notes that the 2012 year to date statistics of patient being admitted to DRMC with a primary diagnosis of CAD was 1,201 patients. Those being admitted with a secondary diagnosis of CAD were 5,897 patients (personal communication, October 2, 2012).
Community Analysis
Heart disease is the leading cause of death for the state of Utah and is the second leading cause of death in St. George. The total number of those being admitted to DRMC primarily for or who have a secondary diagnosis of CAD for the 2012 year to date is over 7,000 people in St. George, this is roughly ten percent of the entire population. DRMC has an exceptional cardiovascular unit with knowledgeable physicians that have been able to lower the mortality rate for those with heart failure, CABG, and acute myocardial infarctions. Although there has been a significant effort put in place in St. George to treat patients with cardiovascular diseases, more needs to be done on education regarding prevention and maintenance of this disease to the community. If the community can focus on prevention, rather than on fixing the issues after they have risen, the incidence of CAD and other cardiovascular diseases will reduce significantly.
References
Education in Utah. (2012). Retrieved September 27, 2012 from http://www.utahlifescience.com/career/destination_education.htm
Hospitals in Utah. (2012). Retrieved September 27, 2012 from https://health.utah.gov/myhealthcare/facility.htm
St. George, Utah. (n.d.). Retrieved September 27, 2012 from http://en.wikipedia.org/wiki/St._George,_Utah#Climate
St. George crime data. (2010). Retrieved September 27, 2012 from http://www.homefacts.com/crime/Utah/Washington-County/St.-George.html
United States Census Bureau. (2012). State & county quickfacts. Retrieved September 27, 2012 from http://quickfacts.census.gov/qfd/states/49/4965330.html
Utah Department of Health. (2011). Utah’s vital statistics births and deaths 2010. Retrieved September 27, 2012 from http://health.utah.gov/vitalrecords/pub_vs/ia10/10bx_10122011.pdf
Utah Department of Health. (2012). 2011 Utah state health profile. Retrieved September 27, 2012 from http://health.utah.gov/opha/publications/2011StateHealthProfile_FINAL.pdf
Utah-political parties. (2010). Retrieved September 27, 2012 from http://www.city-data.com/states/Utah-Political-parties.html
Community Problem Identification, Nursing Diagnosis, and Project Plan
To review, diseases of the heart are the number two leading cause of death in the St. George, Utah area. According to the Utah State Health Profile for 2011, heart disease is the number one cause of death for Americans (Utah Department of Health, 2012). Diseases of the heart include problems with heart valves, coronary arteries, the heart muscle, and can also affect the heart rate and rhythm.
In part two of the community assessment series on those with coronary artery disease (CAD) living in the city of St. George, Utah an analysis of the data compiled was conducted with the end result being two different community nursing diagnosis. The first nursing diagnosis is insufficient community understanding of coronary artery disease. The second nursing diagnosis is deficient community awareness of modifiable risk factors. For the purpose of this last section of the series, only one community nursing diagnosis has been chosen in presenting an intervention plan, which is deficient community awareness of modifiable risk factors.
Goal of Intervention Plan
In the state of Utah, cardiovascular disease affects 2,828 people (Utah Vital Statistics, 2011). The goal of the community intervention plan to be discussed is to reduce the incidence of cardiovascular disease in the St. George, Utah community through education and the reduction of risk factors, as well as to increase the understanding of modifiable risk factors to prevent heart disease. As quoted by Nies & McEwen, “rates of CVD can decline further when individuals become more aware of risk factors and accept responsibility for managing their own health and well-being” (2011, p. 315). There are many modifiable risk factors to prevent or help control heart disease: lowering cholesterol, quitting smoking, lowering blood pressure, and decreasing obesity. The level of prevention relevant to the plan is primary prevention. An appropriate Healthy People 2020 objective to be met is to reduce coronary heart disease deaths (Healthy People 2020, 2012).
Objectives
Outcome Objective
By December 31, 2015, death related to cardiac disease will decrease by 10% as recorded by vital statistics for the community for people over the age of 65, residing in St. George, Utah. This decrease will result from the plan of action involving increased education throughout the community, seminars for heart disease, as well as increasing education about the modifiable risk factors.
Impact Objective
By December 31, 2013, DRMC readmission rates will decrease by 3% for patients with heart disease that are over the age of 65, residing in the St. George, Utah area. This will be measured by the DRMC readmission records for 2013 and compared to the readmission records of 2012.
Resources
As with the community intervention plan, it is important to evaluate the availability of resources in the area. Maryanne Covington, cardiovascular health education specialist, reports that DRMC hosts a Heart Health Series annually, allowing local physicians to speak about heart health issues and heart disease. They also have started meeting with nurses working in skilled nursing facilities in the St. George area to educate them on heart failure symptoms as well as interventions to help prevent exacerbation in their patients. Patient education is completed at DRMC prior to discharge. Follow up calls are then done on every patient that leaves the cardiovascular unit with a diagnosis of heart failure within 48-72 hours of discharge, then again every seven days for four weeks to ensure that the patient has the education that they need to help prevent re admittance. Other resources include cardiologists at Dixie Regional Medical Center, Vascular Support Groups, and speaking at community health fairs, active aging presentations (Covington, 2012), local Senior citizen programs, Cardiac Rehabilitation services, and the American Heart Association.
Constraints
Problem areas include but are not limited to language barriers, the lack of knowledge about heart disease by the general public, a lack of knowledge by the general public of the risk factors for heart disease, and a lack of knowledge of available resources and programs in the St. George, Utah area.
Plan of Action
There are several ways of implementing community interventions. One of the best ways of doing this is through education. There are numerous resources already available to the community; they just need to be better advertised to make people aware of them. Ways to inform and educate the community on cardiovascular disease include mass communication activities, educational activities, and connecting with people for support.
An example of a successful mass communication activity includes a weekly radio show that is aired every Wednesday and hosted by Dr. Chander, a local cardiologist, who discusses various issues in health care, and who could provide detailed, factual information about heart disease and the modifiable risk factors to prevent or help control CVD. Another intervention is to make information posters that include signs and symptoms of cardiovascular disease, and the modifiable risk factors that can help control it or prevent it from occurring. It should also include resources and support groups available in the community. Fact sheets can be printed and placed in doctor’s office waiting areas, and other public places around town.
Successful educational activities include the Heart Health Series, sponsored by Dixie Regional Medical Center allowing local physicians to speak about heart health issues and heart disease. Another intervention is the continuation of DRMC reaching out to other local health care businesses and not only educating their healthcare staffing on signs and symptoms of heart failure, but also on cardiovascular disease, ways to promote heart health, and how to provide education to their patients on modifiable risk factors. Lastly, educational activities will include the continuation of DRMC to provide discharge teaching to those leaving the cardiovascular unit with an emphasis on detailed information about heart disease and its modifiable risk factors, as well as continuing to provide follow up phone calls to those that have been recently discharged to home from the cardiovascular unit.
Vascular Support Groups are available in the St. George community, and provide a great way for members of the community to connect with other people for support. Another example of support is the local Senior Citizen programs that are available for older adults, heart health screenings and classes can be stressed, and will allow seniors to connect with other older adults in the community. The Cardiac Rehabilitation services offered at Dixie Regional Medical Center promote heart health and physical activity and provide a great means of support, especially in those who have experienced any form of heart disease or have had heart surgery. The American Heart Association is also an excellent resource available that contains information about heart disease, ways to get health, and provides information on support groups available. Its mission is to “build healthier lives, free of cardiovascular diseases and stroke” (American Heart Association, 2012). Increased awareness of these support groups and resources can be done by providing information posters as discussed previously in this paper, having these resources announced on the weekly radio show, and having doctors and health care team members promoting these resources to the community.
In conclusion, there are several strategies and interventions that can be employed to reduce the incidence of cardiovascular disease in the St. George, Utah community. There are several great resources that currently exist within the community that are established and ready to help. This is a good start; however, there are still some areas that can be addressed, mainly printed materials available in public locations, the utilization of the weekly radio talk show and Vascular Support Groups already in place. By increasing the awareness of the many resources currently available, as well as implementing new interventions and resources, the community will be better informed about cardiovascular disease and ways to prevent or maintain it.
References
American Heart Association. (2012). Our mission. Retrieved from: http://www.heart.org/HEARTORG/General/About-Us---American-Heart-
Association_UCM_305422_SubHomePage.jsp
Covington, M. (2012, October 02). Interview by R C [Personal Interview]. Cardiovascular hospitalizations., St. George, Utah.
Healthy People 2020. (2012).
Heart Disease and Stroke. Retrieved from: http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=21
Nies, M.A. & McEwen, M. (2011). Community/public health nursing: Promoting the health of populations (5th ed.). St. Louis, MO: Elsevier Saunders.
Utah Vital Statistics. (2011). Births and Deaths 2010. Retrieved from:http://health.utah.gov/vitalrecords/pub_vs/ia10/10bx_10122011.pdf
Utah Department of Health. (2012). 2011 Utah State Health Profile. Retrieved from: http://health.utah.gov/opha/publications/2011StateHealthProfile_FINAL.pdf.
Community Elder Project
Assignment 1
My community elder, Joan, is a seventy-eight year old female that is a fairly healthy and able to live independently at this time. She did not have any errors noted from the Short Portable Mental Status Questionnaire (SPMSQ), which suggests that she does not show any signs of intellectual impairment. She also scored a total of two points on the Geriatric Depression Scale, which suggests that she does not have depression. The plan that I have developed to help my community elder remain cognitive function includes educating and encouraging her to stay active mentally, physically and socially. I will do this by providing her with information about the senior citizens center and the various activities and screenings that they offer and encourage her to attend a few activities that she is interested in. My elder goes on a walk every morning with her friend; I will encourage her to continue doing this so that she is being physically active and socializing with other older adults on a daily basis. She also volunteers at the local hospital, which will help her to remain socially active. I will encourage my community elder to exercise her mind by doing puzzles and memory games and educate her on the importance of getting the proper amount of nutrition and sleep. Although Joan does not show current signs of depression, I feel that it is important to educate her about this mental illness and to provide her with information on how to get help if depression occurs in the future.
Assignment 2
My community elder, Joan appears to have excellent social resources noted from the OARS scale. Based on her scores from the Barthel Index of Activities of Daily Living and the IADL, Joan is very independent. She scored a moderate risk on the DNT scale and has minimal sleeping difficulties. Joan was aware of advance directives, but did not have a finalized plan as to living arrangements that may need to be made in the future.
The plan that I have developed for Joan to help her remain as independent as possible includes educating her on the importance of nutrition and encouraging her to continue staying physically and mentally active, as reviewed in the plan for assignment 1. I also plan to educate her on programs available to her such as meals on wheels, and home health if she begins to see a decline in her physical abilities and will inform her to seek help through her physician as well. Joan stated that she eats one meal in the afternoon each day and just “picks at things the rest of the day”. She does eat nutritious foods; I just plan to encourage her to increase her daily food intake. Joan does have two daughters that live within fifteen minutes of her and two other daughters that live in Idaho and Wyoming. I will encourage her to speak with her daughters and formulate a plan in case Joan eventually needs to make other living arrangements in the future. I plan to educate her on other living arrangement options such as assisted living and long term care facilities to help her and her daughters make the best decision for her. Finally, I will encourage Joan to continue being active during the day, and avoiding frequent naps to continue helping her sleep well through the night.
Assignment 3
My Community Elder, Joan is a fairly healthy seventy-eight year old female. The Tinetti gait and balance assessment shows that Joan had good balancing and functioning ability, and is considered a low falls risk. She denies any pain at this time, and does not take any analgesics for pain relief. As far as her past medical history, Joan gets seasonal hay fever, has had a hysterectomy, and has macular degeneration. She is able to see well and read for small periods at a time. She is retired, but volunteers two to three times weekly at the hospital and walks every morning with her friend. She lives alone and is able to care for herself independently; she still drives around town but not on the freeway.
The plan that I have outlined for Joan is to encourage her to continue exercising daily as well as stress the importance of eating nutritiously. I will also encourage her to continue taking her oral ocuvite to help with her eye sight and to continue following up regularly with her ophthalmologist and primary care physician. Lastly I will educate her on chronic diseases and how to help continue preventing them, I will also inform her of signs and symptoms of chronic diseases and to contact her physician if the occur. I will inform her not to rearrange her furniture very often, to avoid having rugs, and to have adequate lighting in the house to help avoid falls.
Assignment 4
My community elder, Joan, is in pretty good health for her age. The plan that I have developed for Joan is designed to help her prevent the onset of new illnesses. I will encourage her to continue balancing sleep and activity by walking every morning with her friend as well as volunteering at the local hospital one day per week and being active in her church. I will educate her on geriatric syndromes such as falls, syncope, dizziness, and urinary incontinence. To prevent falls I will encourage her to keep her rooms free of clutter and well lit, and to wear appropriate footwear. For syncope and dizziness I will encourage her to change positions slowly, increase the amount of salt in her diet if approved by her physician, and to wear TED hose if tolerated. Toileting at least every two hours can help to minimize urinary incontinence. Keeping hydrated and proper peri-care can help to prevent urinary tract infections from occurring.
I will also encourage her to take her medications as prescribed and inform her to notify her physician if she has any problems taking them. I will educate her on why it is so important to take her medications as prescribed to prevent nonadherence. I will also educate her on the importance of eating a nutritious, well balanced diet. Joan does not currently complain of pain, but I will educate her on the importance of pain management, and different approaches that she can take to help manage pain. Lastly, I will encourage Joan to follow up with her physician and ophthalmologist regularly and to notify them immediately of any changes in health status.
In the Community Health Nursing course, I also had the opportunity to research one of the most prevalent diseases in my community, which is heart disease, and create a plan of action as to how we can educate the community by explaining what it is as well as appropriate prevention measures. This has helped me become more aware of health issues specific to my community. I learned the importance of sharing my knowledge about preventable diseases to everyone that I come in to contact with. I feel that I am better able to promote, maintain, and restore health among individuals, families, groups, and communities after taking this course.
Lastly, the Gerontological Nursing course helped me to achieve this outcome by allowing me to assess and create a plan of care for an elder in the community. This also helped me to realize the importance of sharing my nursing knowledge with others. I feel that I was able to better the quality of life for the elder that I worked with. I plan to take all of the experiences and knowledge that I learned through these courses and use them not only in my future nursing practice, but in my daily life by educating those that I may come in to contact with.
Community Health Project
Community Assessment and Analysis
St. George, Utah is a city located in southern Utah. It contains flat layers of red rock, mesas, and narrow canyons. It lies in a desert and sits on a lower elevation than most of the rest of the state. Because of this, it is the hottest part of the state and averages only 8.25 percent of precipitation annually (St. George, Utah). As of 2010, the census for St. George was 72,897 people; the census for the entire state of Utah was 2,763,885. The median household income is slightly greater in St. George at a median of $48,501 compared to the state median of $45,300 (United States, 2012); however, unemployment levels are greater in St. George at 7.1% versus 5.8% for the whole state.
There is similar access to education in St. George compared to the state of Utah; there are several elementary, middle, intermediate, and high schools in the city. Dixie State College is the main college in St. George. There are no universities in the area, compared to four major universities with graduate programs throughout the rest of the state (Education, 2012). St. George city is comparable to the state of Utah containing several public parks, a county library, local police station and fire department, the local IHC hospital, Dixie Regional Medical Center, and emergency services. The dominant religion is The Church of Jesus Christ of Ladder Day Saints, which is the same as the rest of the state. The main freeway in Utah runs through the city of St. George. There are local bus transportation as well as taxi services. There is also an airport, which is smaller than the main one in Salt Lake City. Like the state of Utah, St. George’s dominant political party is Republican (Utah-political, 2012).
The leading cause of death for the state of Utah is disease of the heart. This is the second leading cause of death in St. George, with malignant neoplasm’s being number one (Utah Department, 2011). Crime rates for St. George in 2010 were 93 per 100,000 inhabitants, robbery was 13.7 per 100,000 inhabitants and property crime which was the highest at 2,211.1 per 100,000 inhabitants was still lower than the national average of 2,941.9 (St. George crime, 2010).
The ratio of physicians per citizens is slightly higher in St. George at 21.2 physicians per 10,000 people than that state average of 20.8 physicians per 10,000 people (Utah Department, 2012). St. George is comparable to the state of Utah by containing offices where people can apply for WIC, insurance, food stamps, or other assistance as well as several home health and hospice agencies, nursing homes, senior citizen centers, a hospital, and a health department (Hospitals, 2012).
Target Population
The target population is those with coronary artery disease (CAD) living in the city of St. George, Utah. Reuben Evans, nurse manager of Dixie Regional Medical Center’s cardiovascular unit, says that the illnesses most seen on the unit are a “combination of CAD and congestive heart failure”. He believes that most of the people that he meets do not see themselves as actively ill, rather they learn through the process of the illness that seeing to their cardiovascular health ensures better health overall (personal communication, October 2, 2012).
Maryanne Covington, cardiovascular health education specialist, reports that there have been several changes recently made in the community in regards to heart health. Implementation by Dixie Regional Medical Center (DRMC) to meet with skilled nursing facility nurses to educate them on heart failure symptoms and interventions to help prevent exacerbation in their patients, 12 lead EKGs have been installed in emergency service vehicles including reading education to emergency responders to significantly reduce the time required from entrance to the emergency room to being ballooned in surgery, conducting vascular support groups, speaking at community health fairs and active aging presentations, and hosting a Heart Health series where local physicians speak about heart health issues and heart disease. She also mentioned that DRMC was just named one of the top fifty cardiovascular hospitals 2013 in the United States for the fifth year according to Modern Health Magazine. She notes that the 2012 year to date statistics of patient being admitted to DRMC with a primary diagnosis of CAD was 1,201 patients. Those being admitted with a secondary diagnosis of CAD were 5,897 patients (personal communication, October 2, 2012).
Community Analysis
Heart disease is the leading cause of death for the state of Utah and is the second leading cause of death in St. George. The total number of those being admitted to DRMC primarily for or who have a secondary diagnosis of CAD for the 2012 year to date is over 7,000 people in St. George, this is roughly ten percent of the entire population. DRMC has an exceptional cardiovascular unit with knowledgeable physicians that have been able to lower the mortality rate for those with heart failure, CABG, and acute myocardial infarctions. Although there has been a significant effort put in place in St. George to treat patients with cardiovascular diseases, more needs to be done on education regarding prevention and maintenance of this disease to the community. If the community can focus on prevention, rather than on fixing the issues after they have risen, the incidence of CAD and other cardiovascular diseases will reduce significantly.
References
Education in Utah. (2012). Retrieved September 27, 2012 from http://www.utahlifescience.com/career/destination_education.htm
Hospitals in Utah. (2012). Retrieved September 27, 2012 from https://health.utah.gov/myhealthcare/facility.htm
St. George, Utah. (n.d.). Retrieved September 27, 2012 from http://en.wikipedia.org/wiki/St._George,_Utah#Climate
St. George crime data. (2010). Retrieved September 27, 2012 from http://www.homefacts.com/crime/Utah/Washington-County/St.-George.html
United States Census Bureau. (2012). State & county quickfacts. Retrieved September 27, 2012 from http://quickfacts.census.gov/qfd/states/49/4965330.html
Utah Department of Health. (2011). Utah’s vital statistics births and deaths 2010. Retrieved September 27, 2012 from http://health.utah.gov/vitalrecords/pub_vs/ia10/10bx_10122011.pdf
Utah Department of Health. (2012). 2011 Utah state health profile. Retrieved September 27, 2012 from http://health.utah.gov/opha/publications/2011StateHealthProfile_FINAL.pdf
Utah-political parties. (2010). Retrieved September 27, 2012 from http://www.city-data.com/states/Utah-Political-parties.html
Community Problem Identification, Nursing Diagnosis, and Project Plan
To review, diseases of the heart are the number two leading cause of death in the St. George, Utah area. According to the Utah State Health Profile for 2011, heart disease is the number one cause of death for Americans (Utah Department of Health, 2012). Diseases of the heart include problems with heart valves, coronary arteries, the heart muscle, and can also affect the heart rate and rhythm.
In part two of the community assessment series on those with coronary artery disease (CAD) living in the city of St. George, Utah an analysis of the data compiled was conducted with the end result being two different community nursing diagnosis. The first nursing diagnosis is insufficient community understanding of coronary artery disease. The second nursing diagnosis is deficient community awareness of modifiable risk factors. For the purpose of this last section of the series, only one community nursing diagnosis has been chosen in presenting an intervention plan, which is deficient community awareness of modifiable risk factors.
Goal of Intervention Plan
In the state of Utah, cardiovascular disease affects 2,828 people (Utah Vital Statistics, 2011). The goal of the community intervention plan to be discussed is to reduce the incidence of cardiovascular disease in the St. George, Utah community through education and the reduction of risk factors, as well as to increase the understanding of modifiable risk factors to prevent heart disease. As quoted by Nies & McEwen, “rates of CVD can decline further when individuals become more aware of risk factors and accept responsibility for managing their own health and well-being” (2011, p. 315). There are many modifiable risk factors to prevent or help control heart disease: lowering cholesterol, quitting smoking, lowering blood pressure, and decreasing obesity. The level of prevention relevant to the plan is primary prevention. An appropriate Healthy People 2020 objective to be met is to reduce coronary heart disease deaths (Healthy People 2020, 2012).
Objectives
Outcome Objective
By December 31, 2015, death related to cardiac disease will decrease by 10% as recorded by vital statistics for the community for people over the age of 65, residing in St. George, Utah. This decrease will result from the plan of action involving increased education throughout the community, seminars for heart disease, as well as increasing education about the modifiable risk factors.
Impact Objective
By December 31, 2013, DRMC readmission rates will decrease by 3% for patients with heart disease that are over the age of 65, residing in the St. George, Utah area. This will be measured by the DRMC readmission records for 2013 and compared to the readmission records of 2012.
Resources
As with the community intervention plan, it is important to evaluate the availability of resources in the area. Maryanne Covington, cardiovascular health education specialist, reports that DRMC hosts a Heart Health Series annually, allowing local physicians to speak about heart health issues and heart disease. They also have started meeting with nurses working in skilled nursing facilities in the St. George area to educate them on heart failure symptoms as well as interventions to help prevent exacerbation in their patients. Patient education is completed at DRMC prior to discharge. Follow up calls are then done on every patient that leaves the cardiovascular unit with a diagnosis of heart failure within 48-72 hours of discharge, then again every seven days for four weeks to ensure that the patient has the education that they need to help prevent re admittance. Other resources include cardiologists at Dixie Regional Medical Center, Vascular Support Groups, and speaking at community health fairs, active aging presentations (Covington, 2012), local Senior citizen programs, Cardiac Rehabilitation services, and the American Heart Association.
Constraints
Problem areas include but are not limited to language barriers, the lack of knowledge about heart disease by the general public, a lack of knowledge by the general public of the risk factors for heart disease, and a lack of knowledge of available resources and programs in the St. George, Utah area.
Plan of Action
There are several ways of implementing community interventions. One of the best ways of doing this is through education. There are numerous resources already available to the community; they just need to be better advertised to make people aware of them. Ways to inform and educate the community on cardiovascular disease include mass communication activities, educational activities, and connecting with people for support.
An example of a successful mass communication activity includes a weekly radio show that is aired every Wednesday and hosted by Dr. Chander, a local cardiologist, who discusses various issues in health care, and who could provide detailed, factual information about heart disease and the modifiable risk factors to prevent or help control CVD. Another intervention is to make information posters that include signs and symptoms of cardiovascular disease, and the modifiable risk factors that can help control it or prevent it from occurring. It should also include resources and support groups available in the community. Fact sheets can be printed and placed in doctor’s office waiting areas, and other public places around town.
Successful educational activities include the Heart Health Series, sponsored by Dixie Regional Medical Center allowing local physicians to speak about heart health issues and heart disease. Another intervention is the continuation of DRMC reaching out to other local health care businesses and not only educating their healthcare staffing on signs and symptoms of heart failure, but also on cardiovascular disease, ways to promote heart health, and how to provide education to their patients on modifiable risk factors. Lastly, educational activities will include the continuation of DRMC to provide discharge teaching to those leaving the cardiovascular unit with an emphasis on detailed information about heart disease and its modifiable risk factors, as well as continuing to provide follow up phone calls to those that have been recently discharged to home from the cardiovascular unit.
Vascular Support Groups are available in the St. George community, and provide a great way for members of the community to connect with other people for support. Another example of support is the local Senior Citizen programs that are available for older adults, heart health screenings and classes can be stressed, and will allow seniors to connect with other older adults in the community. The Cardiac Rehabilitation services offered at Dixie Regional Medical Center promote heart health and physical activity and provide a great means of support, especially in those who have experienced any form of heart disease or have had heart surgery. The American Heart Association is also an excellent resource available that contains information about heart disease, ways to get health, and provides information on support groups available. Its mission is to “build healthier lives, free of cardiovascular diseases and stroke” (American Heart Association, 2012). Increased awareness of these support groups and resources can be done by providing information posters as discussed previously in this paper, having these resources announced on the weekly radio show, and having doctors and health care team members promoting these resources to the community.
In conclusion, there are several strategies and interventions that can be employed to reduce the incidence of cardiovascular disease in the St. George, Utah community. There are several great resources that currently exist within the community that are established and ready to help. This is a good start; however, there are still some areas that can be addressed, mainly printed materials available in public locations, the utilization of the weekly radio talk show and Vascular Support Groups already in place. By increasing the awareness of the many resources currently available, as well as implementing new interventions and resources, the community will be better informed about cardiovascular disease and ways to prevent or maintain it.
References
American Heart Association. (2012). Our mission. Retrieved from: http://www.heart.org/HEARTORG/General/About-Us---American-Heart-
Association_UCM_305422_SubHomePage.jsp
Covington, M. (2012, October 02). Interview by R C [Personal Interview]. Cardiovascular hospitalizations., St. George, Utah.
Healthy People 2020. (2012).
Heart Disease and Stroke. Retrieved from: http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=21
Nies, M.A. & McEwen, M. (2011). Community/public health nursing: Promoting the health of populations (5th ed.). St. Louis, MO: Elsevier Saunders.
Utah Vital Statistics. (2011). Births and Deaths 2010. Retrieved from:http://health.utah.gov/vitalrecords/pub_vs/ia10/10bx_10122011.pdf
Utah Department of Health. (2012). 2011 Utah State Health Profile. Retrieved from: http://health.utah.gov/opha/publications/2011StateHealthProfile_FINAL.pdf.
Community Elder Project
Assignment 1
My community elder, Joan, is a seventy-eight year old female that is a fairly healthy and able to live independently at this time. She did not have any errors noted from the Short Portable Mental Status Questionnaire (SPMSQ), which suggests that she does not show any signs of intellectual impairment. She also scored a total of two points on the Geriatric Depression Scale, which suggests that she does not have depression. The plan that I have developed to help my community elder remain cognitive function includes educating and encouraging her to stay active mentally, physically and socially. I will do this by providing her with information about the senior citizens center and the various activities and screenings that they offer and encourage her to attend a few activities that she is interested in. My elder goes on a walk every morning with her friend; I will encourage her to continue doing this so that she is being physically active and socializing with other older adults on a daily basis. She also volunteers at the local hospital, which will help her to remain socially active. I will encourage my community elder to exercise her mind by doing puzzles and memory games and educate her on the importance of getting the proper amount of nutrition and sleep. Although Joan does not show current signs of depression, I feel that it is important to educate her about this mental illness and to provide her with information on how to get help if depression occurs in the future.
Assignment 2
My community elder, Joan appears to have excellent social resources noted from the OARS scale. Based on her scores from the Barthel Index of Activities of Daily Living and the IADL, Joan is very independent. She scored a moderate risk on the DNT scale and has minimal sleeping difficulties. Joan was aware of advance directives, but did not have a finalized plan as to living arrangements that may need to be made in the future.
The plan that I have developed for Joan to help her remain as independent as possible includes educating her on the importance of nutrition and encouraging her to continue staying physically and mentally active, as reviewed in the plan for assignment 1. I also plan to educate her on programs available to her such as meals on wheels, and home health if she begins to see a decline in her physical abilities and will inform her to seek help through her physician as well. Joan stated that she eats one meal in the afternoon each day and just “picks at things the rest of the day”. She does eat nutritious foods; I just plan to encourage her to increase her daily food intake. Joan does have two daughters that live within fifteen minutes of her and two other daughters that live in Idaho and Wyoming. I will encourage her to speak with her daughters and formulate a plan in case Joan eventually needs to make other living arrangements in the future. I plan to educate her on other living arrangement options such as assisted living and long term care facilities to help her and her daughters make the best decision for her. Finally, I will encourage Joan to continue being active during the day, and avoiding frequent naps to continue helping her sleep well through the night.
Assignment 3
My Community Elder, Joan is a fairly healthy seventy-eight year old female. The Tinetti gait and balance assessment shows that Joan had good balancing and functioning ability, and is considered a low falls risk. She denies any pain at this time, and does not take any analgesics for pain relief. As far as her past medical history, Joan gets seasonal hay fever, has had a hysterectomy, and has macular degeneration. She is able to see well and read for small periods at a time. She is retired, but volunteers two to three times weekly at the hospital and walks every morning with her friend. She lives alone and is able to care for herself independently; she still drives around town but not on the freeway.
The plan that I have outlined for Joan is to encourage her to continue exercising daily as well as stress the importance of eating nutritiously. I will also encourage her to continue taking her oral ocuvite to help with her eye sight and to continue following up regularly with her ophthalmologist and primary care physician. Lastly I will educate her on chronic diseases and how to help continue preventing them, I will also inform her of signs and symptoms of chronic diseases and to contact her physician if the occur. I will inform her not to rearrange her furniture very often, to avoid having rugs, and to have adequate lighting in the house to help avoid falls.
Assignment 4
My community elder, Joan, is in pretty good health for her age. The plan that I have developed for Joan is designed to help her prevent the onset of new illnesses. I will encourage her to continue balancing sleep and activity by walking every morning with her friend as well as volunteering at the local hospital one day per week and being active in her church. I will educate her on geriatric syndromes such as falls, syncope, dizziness, and urinary incontinence. To prevent falls I will encourage her to keep her rooms free of clutter and well lit, and to wear appropriate footwear. For syncope and dizziness I will encourage her to change positions slowly, increase the amount of salt in her diet if approved by her physician, and to wear TED hose if tolerated. Toileting at least every two hours can help to minimize urinary incontinence. Keeping hydrated and proper peri-care can help to prevent urinary tract infections from occurring.
I will also encourage her to take her medications as prescribed and inform her to notify her physician if she has any problems taking them. I will educate her on why it is so important to take her medications as prescribed to prevent nonadherence. I will also educate her on the importance of eating a nutritious, well balanced diet. Joan does not currently complain of pain, but I will educate her on the importance of pain management, and different approaches that she can take to help manage pain. Lastly, I will encourage Joan to follow up with her physician and ophthalmologist regularly and to notify them immediately of any changes in health status.