Brockton, Massachusetts: Use of the Adaptation Model, Nursing Process and Guidelines for a Comprehensive Community Assessment This work in writing will utilize the Adaptation Model, nursing process and guidelines to complete a community assessment, analyze gathered data for implications for health care, formulate a nursing diagnosis for the community, and incorporate findings into the nursing process and formulate a care plan for a specific community problem.

According to the Public Health Nursing: Leadership Guide and Resource Manual" published by the Massachusetts Association of Public Health Nurses (2005) nurses employed in public health nursing are constantly conducting assessments of the community's needs and resources both those available to the individual and groups. Public health nurses are focused on organization and working with a diverse network in promoting ensuring and strengthening the well-being and health in the community with goals for high standards of health care for the population. Public health is the systematic approach in the preservation, protection and improvement of the entire population's health enabled by "prevention and control of communicable disease, injury and prevention of disability" while promoting health status excellence for everyone in the community. This is inclusive of the prevention of epidemics and disease spread while protecting against hazards that are environmental in nature as well as response to disaster and community recovery inclusive of health care services access combined with promotion of healthy lifestyles.

Adaptation Model

The Adaptation model is a conceptual framework with a focus on the patient as "an adaptive system, one in which nursing intervention is required when a deficit develops in the patient's ability to cope with the internal and external demands of the environment." (Mosby's Medical Dictionary, 8th edition, 2009) These demands have been divided into four categories including those of:

(1) physiologic needs;

(2) the need for a positive self-concept,

(3) the need to perform social roles and (4) the need to balance dependence and independence." (Mosby's Medical Dictionary, 8th edition, 2009)

The maladaptive response of the patient is assessed by the nurse and utilizes this response to identify the type of demand creating the conflict. Nursing care is then planned around promotion of adaptive responses for successful coping with the effect that present stress places on the well-being of the patient. This is a model that was proposed by Sister Callista Roy.

A changing environment requires that the patient respond successfully and it was proposed by Sister Callista Roy that the environment must be considered in terms of the internal and external stimuli that affect the group or individual. Environmental stimuli is reported to be inclusive of "the conditions, circumstances, and influences that surround and affect the development and behavior of an individual or group.' (Mosby's Medical Dictionary, 8th edition, 2009)

Health is described as "a state being and a process of becoming an integrated and whole person. " (Mosby's Medical Dictionary, 8th edition, 2009)

Adaptive behavior takes place in four modes:

(1) physiological;

(2) self-concept;

(3) role function; and (4) interdependence. (Mosby's Medical Dictionary, 8th edition, 2009)

All of these four modes are collectively termed as 'wellness'. (Mosby's Medical Dictionary, 8th Edition, 2009)

The adaptation model is conceptualized as shown in the following illustration.

Figure 1

Adaptation Model

Illness is reported to be "ineffective adaptation in one or more of these modes. Nursing is a theoretical system of knowledge that prescribes a systematic process related to the care of the ill or potentially ill person." (Mosby's Medical Dictionary, 8th edition, 2009) Stated as the goal of nursing is the promotion of all four adaptive modes during wellness and illness." (Mosby's Medical Dictionary, 8th edition, 2009)

Six Steps in Nursing Process of Adaptation Model

There are six steps in the nursing process of the adaptation model including the following:

(1) assessment of behaviors, data regarding the client's physiological, self-concept, role function, and interdependence behaviors are collected. Once the data have been collected, the nurse must judge whether the behaviors are adaptive or ineffective. Thus the primary question is: To what extent is the person adapting to environmental stimuli?

(2) assessment of influencing factors, priorities are set for further assessment and identification of the environmental stimuli that influence the client's behavior and so contribute to the adaptive or ineffective responses.

(3) nursing diagnosis, involves a behavioral description of the client's adaptive or ineffective responses and identification of the most relevant influencing factors, as well as establishment...

These goals are stated as behaviors expected as the outcome of nursing intervention.
(5) intervention, involves management of environmental stimuli, which takes the form of an increase, decrease, modification, maintenance, or removal of internal or external stimuli. The intervention with the highest probability of reaching the desired goal is selected.

(6) evaluation, the effectiveness of the nursing intervention is judged. The criterion for effectiveness is whether the desired behavioral goal was attained. The outcome of this step is updating of the nursing care plan. (Mosby's Medical Dictionary, 8th edition, 2009)

Brockton - Demographics

Brockton is a mid-sized southeastern Massachusetts city and racially and ethnically diverse. Brockton was once alive with manufacturing and was known well for the shoe industry however, presently the service sector is the primary employment for residents in the Brockton area. The population of Brockton is approximately 60% white, 18% Black, 8% Hispanic, 1% Asian and 19% other race. Nearly 12% of the current population is Sub-Saharan African with many being Cape Verdean.

Reports stated that the per capita income in Brockton is "$17,163, with 15% of the population living below 100% of poverty level, 33% living below 200% of poverty level and almost 20% of children living below the poverty line.

Nearly 16% of the population are Medicaid recipients and almost 7% are unemployed. Income levels in Brockton are lower than Massachusetts' averages and rates of people living in poverty are approximately one and a half times the state averages. " (AHEC, 2009)

Health Status

Reports state that mortality rates in Brockton "with age-adjusted rates per 100,000 persons shows that "a number of significant differences from state rates emerge as follows:

(1) First, both White men and women have high mortality rates for HIV / AIDS as compared to White men and women in other parts of Massachusetts, twice and eight times the rates respectively.

(2) White women also have almost twice the mortality rate of respiratory disease as White women in the rest of the state.

(3) Black men in Brockton have high cancer mortality rates. They have more than two and a half times the rate of colorectal cancer and more than twice the rate of prostate cancer as Black men in the state as a whole. Interestingly though, their rate for lung cancer is significantly lower than the rate for Black men in the rest of the state (one-sixth the rate).

(4) Black men also have three times the mortality rate of diabetes as the Massachusetts average for Black men.

(5) Black women in Brockton have more than one and a half times the mortality rate of diabetes as the Massachusetts average for Black women.

(6) Hispanic men also fare worse than their counterparts in the state as a whole. They are more than three times as likely to die of lung cancer, almost four times as likely to die of diabetes and more than one and a half times as likely to die of respiratory diseases. However, they are only one-fourth as likely to die of circulatory disease as Hispanic men in other parts of Needs Assessment .

(7) Hispanic women in Brockton are almost three times as likely to die from breast cancer as Hispanic women in the state as a whole.

(8) Morbidity rates in Brockton show that White men and women have almost twice the rates of hospitalization for alcohol and other drugs as Whites in the rest of the state.

(9) White men and women in Brockton also have roughly four times the rate of hospitalization for HIV / AIDS related health issues compared to their rates in the rest of the state (3.6 and 4.4 times respectively).

(10) White men also have almost twice the rates of hospitalization related to obesity as White men in the rest of the state.

(11) Black women in Brockton also have almost twice the rate of hospitalization for HIV / AIDS related health issues compared to Black women in the rest of the state.

(12) Hispanic men in Brockton are more than one and a half times more likely to have alcohol and other drug related hospitalizations, almost twice as likely to be hospitalized related to circulatory disease and more than twice as likely to be hospitalized for diabetes related complications as Hispanic men in the rest of the state.

(13) Hispanic women in Brockton are almost three times as likely to be hospitalized for system circulatory diseases, more than twice as likely to be hospitalized for diabetes related complications and more than twice as likely to be hospitalized for respiratory disease as Hispanic women in the rest of the state.

(14) Asian/PI men in Brockton are more than twice as likely to be hospitalized for respiratory disease as Asian/PI men in the rest of the state and Asian/PI women are almost four…