Community Assessment Paper
This paper is a community assessment of the city of Wesley chapel, Florida. It will describe the demographic data of the city as well as focus on the population, neighborhoods, and economic status of the community. Community assessments are an essential way for the nurse to become more accustomed to the community that they will be working in.
Structure
Wesley Chapel, Florida is a suburban community with a population of 51,229. Located approximately 20 miles north east of Tampa, Florida. It’s is bounded by 1-75 to the west, Morris bridge road to the east, State Road 56 to the south, and neighborhoods just north of state road 54. There are approximately 12 fire and rescue stations within five miles of the community. Policing is performed by the Pasco County Sheriff’s department and there is one sub-station in Wesley Chapel but there are always an adequate number of sheriff deputies on patrol in the community. Additionally, Interstate 75 forms the western boarder of Wesley Chapel so there is also a Florida State Trooper presence usually nearby.
Wesley Chapel is substantially more affluent than the communities that surround it. As of 2016, the largest share of households has a property value in the $200k-$250k range ("Wesley Chapel, FL", 2016). The majority of homes are private and are a part of individual communities with their own schools and shopping areas within. There are also a significant number of rental apartments. These range from luxury rentals to low income housing however, the low-income housing is substantially less prominent than in many areas around Florida and across the United States.
Although there is some public transportation provided by Pasco County Public Transport, the routes and number of routes are limited to only the largest thoroughfares and service is not as consistent as in an average city. It’s important to note that that the bus route that goes through Wesley Chapel stops at The Medical Center at Trinity (approximately 15 miles to the west) and also goes directly to Florida Hospital of Wesley Chapel. As is the case with most major hospitals, Florida Hospital of Wesley Chapel and The Medical Center at Trinity have many health care facilities, health care professional’s offices and health care clinics nearby that are accessible by the bus routes ("Routes & Schedules").
There are several churches, but no synagogues and mosques within five miles of the community. These churches were found while looking at google maps: New Tampa First Baptist Church, Grace Empire, Tampa Bay Presbyterian Church, Harvest Church of Tampa, Atonement Lutheran Church of Wesley Chapel Elca, Life Church, Faith Baptist Church, Grow Life Church, Carmel Friendship Baptist Church, Grace Baptist Church, and LifeSpring Adventist Church.
These religious institutions are often valuable resources for residents pertaining to their health care needs. At the very least, they are a great place to seek assistance with transportation or even companionship services for patients in the community.
Population
Age Distribution
According to the ("Census profile: Wesley Chapel, FL", 2016) as of 2016, Wesley Chapel Age Distribution is 0-9 is 15%, 10-19 is 16%, 20-29 is 20%, 30-39 is 15%, 40-49 is 16%, 50-59 is 12%, 60-69 is 8%, 70-79 is 4%, 80-89 is 3%, and lastly the median age of Wesley Chapel is 35.9 years.
Gender Distribution
According to the ("Census profile: Wesley Chapel, FL", 2016) as of 2016, the Gender Distribution in Wesley Chapel is 26,554 (52.8%) Women and 24,645 (48.2%) Male.
Population Density
The population density of Wesley Chapel, Florida is 1,166.1 people per square mile and is expected to keep increasing due to the increasing growth of the community (Wesley Chapel, FL Demographics, 2016).
Education Level
According to the ("Census profile: Wesley Chapel, FL", 2016) as of 2016, Wesley chapel’s educational level was 6% is uneducated, 22% have a high school diploma, 32% have some college education, 25% have a bachelor’s degree, and 15% are post-graduates.
Ethnic Diversity
The ethnic diversity in Wesley Chapel is primarily White with 60%, 10% is African American, 1% is Native American, 6% is Asian, and lastly 21% is Hispanic ("Census profile: Wesley Chapel, FL", 2016).
Religious Diversity
As of 2016, the religious diversity in Wesley Chapel is not as prominent then in other areas that are within a five-mile radius of my community. The following were found on (“Religion in Wesley Chapel, Florida”,2016):
3.4% are Baptist, 0.2% are Episcopalian, 9.4% are Catholic, 0.6% are Lutheran, 1.9% are Methodist, 2.7% are Pentecostal, 0.5% are Presbyterian, 0.5% are LDS, 2.9% are another Christian faith, 0.0% are Jewish, 0.1% are an eastern faith, and 0.1% affiliates with Islam
Economic Status
According ("Wesley Chapel, FL", 2016) the economic status in Households in Wesley Chapel have a median annual income of $73,981. Most of the population travels to work with an average commute time of 28.4 minutes. The largest industries in Wesley Chapel, FL are Healthcare & Social Assistance (3,537), Retail trade (3,247), and Educational Services (2,758), and the highest paying industries are Finance & Insurance ($62,525), Utilities ($61,094), and Professional, Scientific, Tech Services ($55,852). 6.95% of the population for whom poverty status is determined in Wesley Chapel, FL (3,544 out of 50,988 people) live below the poverty line, a number that is lower than the national average of 14%. The largest demographic living in poverty is Female 25-34, followed by Female 55-64 and then Female 35-44.
Social system
Schools
As Wesley Chapel continues to grow each year, the community resources have to grow as well. With the majority of the population being somewhat younger than surrounding cities, there has to be an adequate amount of schools. There is a considerable amount of schools within a five-mile radius of my house. They range from pre-kindergarten, elementary school, middle school, high school, and state colleges. The following were found while using google maps: Seven Oaks elementary, The Goddard school, New L.E.A.P.S Academy, Veterans Elementary school, Wiregrass Elementary, Sand Pine Elementary, Dr. John Long middle school, Wiregrass Ranch high school and Pasco Hernando State College. Additionally, there are more schools in the vicinity that are not within the five-mile radius but still close by.
Libraries
There is only one library that is located within 5 miles from the community which is New Tampa regional library.
Government services
Most of the government services within the community are more than 5 miles way. There are only two located within the 5 miles radius which are the Mike Fasano Department of Motor Vehicles and the Wesley Chapel post office.
Jails/Prisons
There are no jails/prisons within five-miles of the community. The closest one is 10 miles away and it’s in Zephyrhills; the Zephyrhills Correctional Institution.
Communication
Access to public internet can be found be at the local mall or local restaurants that offer free Wi-Fi. Some examples are the Barnes & Noble located in Wiregrass Mall, Panera Bread, Starbucks, and the New Tampa Reginal Library. All of these locations are within five miles of the community. Newspapers are available in several locations in the community such as neighborhood vending machines, supermarkets and restaurants. Publications include the Tampa Bay Times, USA Today and a handful of local community papers.
Volunteer Programs
Volunteer programs within 5 miles are the following: American Cancer Society, and Florida Hospital Wesley Chapel volunteer program.
Heath Care Access
Within 5-miles of the community, there are a plethora of locations to access health care. A scan of Google Maps shows a range from Urgent cares, hospitals, family doctors, walk in clinics, home health care. There is also one Mental Health facility. The following are within five miles within the community: Florida Hospital Wesley Chapel, New Tampa Urgent Care, Wesley Chapel Centra Care, MedExpress Urgent Care, Wesley Chapel Internal Medicine & Pediatrics, Family Care of Cypress Creek, Minute Clinic at CVS, Bright Star Care East Pasco County, A Good Care Home Care Companion Service, Home Helper, and North Tampa Behavioral Health Hospital.
Additional considerations
Environmental hazards
There are no railroad hazards within 5 miles of the community. However, there is a major interstate highway, I-75, that runs along its western border. Although as is the case with all major highways, there is no pedestrian traffic allowed on it, there have been instances when people have been seen walking along the roadway. Of course, all roads in the community that cross the interstate are reasonably safe for pedestrians as each crossing has the interstate elevated by an overpass. That being said, the sidewalks and crosswalks at these crossing are almost always a high traffic area and should be avoided if possible.
Resources for daily needs
There are a variety of grocery stores, pharmacies, and entertainment nearby. There are two Publix supermarkets located close by, a Walmart, Target, Winn-Dixie, Sam’s club, and Nutrition Smart are also located in the community. Some pharmacies located within 5-miles are Sam’s Club Pharmacy, CVS Pharmacy, there are pharmacies located inside both of the Publix’. There’s a Winn-Dixie Pharmacy, and Walgreen’s Pharmacy in the neighborhood as well. Some of the entertainment available in Wesley Chapel includes Cobb Theatres, A-MAZE-ing escape Adventures, Buffalo Wild Wings, Wiregrass Mall, Prime Bar, seasonal fairs located within Wiregrass Mall, Tampa Premium Outlets, Florida Hospital Center Ice. There are more forms of entertainment, but they more than 5 miles away.
Part II: The Community as a Nurse Practice Setting
The roles of acute care and home health care workers are similar from a technical perspective however, the application of those roles differ due to the setting. In acute care, the health care professional is usually under more time pressure with more patients to care for, often simultaneously (Potter, Perry, Stockert, Hall, 2017, p.18-19). Acute care nurses need to make decisions that are within the hospital protocols and physician orders (Potter, Perry, Stockert, Hall, 2017, p.18-19). They advocate for individual patients within their system, but usually have limited contact with third-parties like insurance companies, social services or community groups (Flavin, 2015). They are also responsible in writing and organizing the structure of care or the plan of care the patient receives (Flavin, 2015). In home care, there’s often more time for the nurse to connect with the patient and also add important components to their treatment including helping the patient understand their role in their own care, dealing with any limitations they may be experiencing from their condition, whether temporary or permanent (Potter, Perry, Stockert, Hall, 2017, p.20). Home health nurses tend to work with the entire community in order to help the patient with going to places that are located within where they live (Flavin,2015). Having great interdisciplinary communication and coordination skills is something a home health nurse needs in order to be more involved in the nurse-to-patient relationship. It also applies in providing care for a patient since the nurse is working with limited information having critical thinking and critical judgment is impetrative when deciding care priorities (Flavin, 2015). The nurse also can often interact with family to help them understand their role and how they can assist the patient with recovery and outcomes. Therefore, it’s important for the nurse to understand family dynamics, cultural and spiritual practices and habits of the diverse people who are in their community (Potter, Perry, Stockert, Hall, 2017, p.20).
Vulnerable Populations
In a community setting nurses care for a variety of different kinds of patients that often represent many different cultures and backgrounds. For many in these groups, their options for health care can vary as well (Potter, Perry, Stockert, Hall, 2017, p.34-35). Because of many recent changes in the health care system it can often be difficult for these groups of individuals to find the help they need. These high-risk groups are called vulnerable populations. Examples of the vulnerable populations are those that are living in poverty or the homeless, who are abused, often have a mental illness, are older adults, or are part of the immigrant population (Potter, Perry, Stockert, Hall, 2017, p.34-35). A community care nurses’ main responsibility toward the vulnerable population is health promotion, screening, and early detection and disease prevention for the vulnerable population (Potter, Perry, Stockert, Hall, 2017, p.34-35). Many of these patient’s health care needs are unmet or are ignored. Due to the prevalence of severe disease within these communities, these individuals may require more care than can be obtained in an outpatient or hospital. To provide adequate care for vulnerable populations, it is necessary to accurately evaluate each person’s health care needs individually. An important part of these evaluations is taking into consideration cultural beliefs, values and practices to properly determine their needs and interventions that will be most successful in improving their state of health (Potter, Perry, Stockert, Hall, 2017, p.34-35). Communication and caring practices are critical in learning a patient’s perception of his or her problems. Planning health care strategies that take into account all of these factors is important to create a plan of care that is effective and successful (Potter, Perry, Stockert, Hall, 2017, p.34-35).
Complete assessments enable community-based nurses to design specific interventions that fit within the context of their communities.
Personal Considerations for the Community Home Health Care Nurse
There are many considerations to remember regarding home health care. Some things to always keep in mind are to make sure the home health care nurse knows where they’re going and to be aware of their surroundings when they are out in the community. Lastly you need to know general tactics in case of any emergency situation that may occur. For getting to where they need to be and back, its important for the Community Home Health Care Nurse to have accurate directions to the locations where the clients live. You should always have more than one person to ask in case you need further help with directions. Letting your employer know your location and when you expect to report back keeps your employer up to date to where the nurse is and when he/she should be done (Brooks, 2012). Knowing where the local police and fire stations are is important in case there is a safety issue the home health care nurse knows where to resort too. Making sure the car is in working condition, has enough gas, and to keep doors and windows sealed and locked (Brooks, 2012). Parking in a well-lit area, away from large trees or shrubs and avoiding areas with poor visibility, isolated buildings or alleys is important in order to decrease the chances of potential attacks (Brooks, 2012). Avoid leaving items visible on the car seats during visits, lock healthcare and personal items in the trunk of the car and prepare materials needed during the visit in advance then carry them with you inside (Brooks, 2012). If the home health care nurse feels uncomfortable before exiting the car it’s important to remember to stay in the car and call the manager. Also, it’s critical to never park in the patient’s driveway, park in the street. The home health nurse should also notify and confirm with the patient; that way they are expecting the arrival of the nurse (Brooks, 2012).
While in the field the Community Home Health Care Nurse should keep safety and knowing how to keep themselves out of danger in consideration. Being alert of any signals and signs of violence, such as substance abuse, threats, and knowing if there is any presence of weapons. Also having knowledge of the type of community the neighborhood is located in, knowing when to avoid an area when the time of violence is high (Brooks, 2012). Having a calm and caring demeanor and not giving orders in a situation of anger, and always acknowledging the other persons feelings helps defuse the situation quicker. Avoid any behaviors that may be interpreted as aggressive like for example getting close, speaking loudly, and moving quickly (Brooks, 2012). The community home health care nurse should always know the nearest bathroom and exit and should notice if the path is clear just in case an emergency situation were to happen. It is important for the nurse to always have their phone in their pocket and ensure that its turned on during visitation. A nurse should always report to their employer any instances of verbal abuse and if such a thing occurs, the nurse should not be afraid to cut the visit short (Brooks, 2012). One very important aspect the nurse needs to take into consideration is to always trust their gut feeling. If something doesn’t feel right, they should contact the facility and inform them. The nurse should never feel paranoid and should feel safe its very critical for the nurse to always trust their judgment.
Lastly, having knowledge of some general safety tactics is important for the community health care nurse. Dress to protect yourself. Wear shoes and clothes that make it easy for you to move quickly. Avoid wearing expensive jewelry or carrying a purse (Brooks, 2012). Avoid any accessory that could potentially be dangerous such as necklaces or scarves. If possible, it’s always a good idea to use a buddy system (Brooks, 2012). Nurses can consider working in pairs, either in high-crime areas or on night visits or request an escort from local law enforcement in some situations(Brooks, 2012). Other options are; carry a whistle, take a self-defense course and a very important precaution is to always be sure your cell phone is sufficiently charged and operating when entering into potentially hazardous areas (Brooks, 2012).
Part III: Patient Scenario Q & A
Client Safety recommendation
Because the patient is an older adult and is unable to take care of his basic health needs, it’s important to inform the patient about what is not safe to have in his home. Due to his decreased mobility, eye sight and hearing acuity, he has an increased risk of falling. It is imperative to give recommendations that could improve his chances to staying safe in his home when he is alone. Some client safety recommendation may include: adequate lighting in the halls and stair wells, no throw rugs which can represent a tripping hazard due to their height or an upturned corner, grab bars in the bathroom and a shower seat. Any clutter should be removed as it could be a potential tripping hazard. Lastly, the nurse should have the patient wear non-slip socks to improve stability.
Health indicators and rationale
Mental health
According to Healthy People 2020, “mental health is essential to a person’s well-being, healthy family and interpersonal relationships and the ability to live a full and productive life.” A primary concern for this patient’s mental wellness is the fact that he recently lost his wife putting him at risk for isolation or depression. Additionally, because of his age, this patient is at risk for the mental illness indicators that commonly affect seniors in his age range such as Alzheimer’s disease which is among the top 10 causes for death in the United States. For interventions the nurse should engage the client in conversation and have him use his brain more that way he could take his mind off the situation and feel like he has a propose in life.
Injury
According to Healthy People 2020, “Injuries can make it more difficult for older adults to live independently, and injuries increase older adults' risk of premature death.” With the patient having to walk with a cane due to decreased mobility and balance the patient is at risk for falls. In fact, all older people are at risk of serious injury due to fall. Attention should always be paid to potential tripping hazards in an older person’s environment. A main concern a nurse should always take into consideration are stairs, elevated section of the living quarters and especially throw rugs. For elevated areas there should be railings at the very lease and if possible, the need to use that part of the dwelling should be mitigated or eliminated altogether. And, it almost goes without saying that bathrooms and showers or tubs are particularly hazardous for the elderly and extra special care and attention should be paid to making these areas a safe as possible with the use of grab bars and other safety equipment. It’s worth repeating that a simple fall can lead to serious injury such as a broken bone which can lead to significant lack of mobility for a prolonged period of time. In addition to the care and time it takes to heal from a life altering injury like that, these types of scenarios can further exacerbate an elderly person’s mental wellbeing and lead to further complications for their independence or even a premature death.
Social determinants
According to Healthy People 2020, “the Availability of community-based resources and transportation options for older adults can positively affect health status.” For this particular patient, since he can no longer drive a car and he has many health conditions which require him to receive care from health care providers outside of his home, community based transportation resources are essential for his plan of care. Additionally, it’s helpful for patient like him to have the opportunity to interact socially with other people outside of his home.
Health Prescription
Primary prevention
In primary prevention focuses on preventing illness or injury before it occurs. These preventative measures can range from removing potential hazard from a patient’s living environment to addressing potential mental health symptoms ("Primary, secondary and tertiary prevention", 2015). It’s imperative to provide education about nutrition and good eating habits. Additionally, educating this patient about his options for utilizing community resources such as transportation to and from his health care providers can be crucial to his overall wellness. It’s important not to assume that the patient understands the importance of going to all of his health care provider appointments because as it becomes more difficult for him to travel, he may tend to want to skip these critical visits.
Secondary prevention
Secondary prevention is concerned with treating and reducing the impact of an illness or injury that has already occurred ("Primary, secondary and tertiary prevention", 2015). It’s very important to detect any existing disease or injury as quickly as possible to stop or at least slow its impact on the patient. A good way to accomplish this is regular health screenings and other diagnostic tools. Additionally, it is important to ensure the patient is following any medications or activities which have been prescribed to treat the condition.