Health Promotion and Disease Prevention Plan

Flushing and Whitestone Disease Prevention Plan
New York is a city that comprises of several different neighborhoods. What makes this city to be distinct are how diverse these areas are, their vast historical account and also the people. However, protracted and gradually increasing income inequality, coupled with a past of racial seclusion of residents, has given rise to startling health discriminations between neighborhoods. There is a tendency of deteriorating health results gathering in areas that individuals of color consider to be their homes and where several people reside in poverty. The purpose of this paper is to lay emphasis on the disease prevention plan for the neighborhoods of Flushing and Whitestone.
Community Setting and Role
Within this expanse, the most prevalent cause of premature death is cancer with a likelihood of 24 percent followed by heart disease, which has a likelihood of 21 percent. Other causes constitute 42 percent, and this consists of aspects such as accidental incidents, which comprise of 5 percent, demises associated to HIV, which comprise of 3 percent, murder and suicide, which are 3 percent and 2 percent respectively. It is imperative to note that these illnesses that result in premature death have an effect on both men and women, for the most part those between 45 and 64 years. Imperatively, for individuals at the age pf 65 years and beyond, the topmost reasons for their demise are cancer and heart disease (New York City Department, 2002). With respect to men, prostate, lung, and colorectal cancers are the main causes of death whereas amongst women, the main causes of death comprise of lung, breast, and colorectal cancers. Lastly, other causes of premature death amongst individuals of 65 years and beyond includes wounds emanating from falling (Ashpole et al., 2013).
In this case, the preceptor is a high ranking clinical staff within the Flushing Hospital Medical Centre. Taking into consideration the demographical features of its key service region, Flushing Hospital has ascertained fundamental concerns within the locality it renders services to and is dedicated to diminishing inequalities in healthcare accessibility in order to improve the health status of all populaces. In this regard, the rates of demise together with data delineating a characteristic from each of the ten most significant regions determined by New York City’s Take Care New York (TCNY) 2016 are outlined for Flushing Hospital’s regions and comparisons made against other neighborhoods like Queens and NYC.
Target Population
The populace of the region spans over 255,000, which comprises of 52% of individuals from the Asian descent, 28% being white, 17% being of the Hispanic descent, 2% being African American, and 2% being other. Approximately, 57 percent of the people within the region are born from a foreign land and 47 percent of them are not properly proficient in English. In addition, in accordance to the data profile, roughly 70 percent of the inhabitants within the region termed their individual health as being either excellent, very good, or good based on ranking with a life expectancy of 83.6 years (NYC Health, 2015).
Other concerns precluding members of the target community from maximizing the healthcare system include cultural aspects, especially those associated to religious beliefs. In the same manner, an obstacle to proper healthcare is the absence of health literateness and acquaintance of the prevailing system of healthcare. There is a significant need for religious leaders and the community in its entirety to work in tandem to enhance the maintenance of healthcare, and augment knowledge associated to the prevalent causes of death or illnesses within the community. For instance, one of the approaches of accomplishing this is taking into account the necessity for sustaining a healthy heart and the appraisal and treatment of the different kinds of cancer by detecting it early. In the same manner, two of the most causative factors of heart diseases amongst the community residents include high levels of cholesterol together with high blood pressure, and it is imperative to conduct the screening amongst residents and also establishing maintenance programs (Ashpole et al., 2013).
The level of education of the residents in the target community is assorted. Majority of the members of the community have either attained a high school diploma or attained some kind of college education, statistics being 28 percent and 42 percent respectively. In addition, 23 percent of the inhabitants with 25 years or higher have attained a college degree. The reports also indicate that approximately a quarter of the area residents lacked healthcare insurance and cover. In general, 20 percent of adults in the populace lack a primary care provider which approximately satisfied the TCNY target, demonstrating that the inhabitants of the region have better accessibility to healthcare, which gives rise to lower occurrences of visitation to the emergency department (Ashpole et al., 2013).
Priority Issue
The issue of significance and priority is linked to the health status of minority groups within the target population. Adults and children from the minority group with a low-income status experience an uneven burden of chronic illness, utilize hospital emergency room services more frequently for healthcare, have inferior health status, and greater premature demise. In addition, according to FHMC (2012), there is a greater likelihood of lower-income minority populations lacking accessibility to healthcare and eventually developing mental health problems such as drug abuse linked to high psychosomatic stressors like loss of job opportunities and financial stress.
Within the area of Queens, there is a perceptible inequity in the ratios of premature births in the sense that Black non-Hispanics experience a greater rate of premature births in comparison to White non-Hispanics. This inequity is perceptible when making a comparison of premature birth rates for Hispanic and White non-Hispanic mothers between NYS and Queens, with the latter being greater (FHMC, 2012). Furthermore, the neighborhoods mirror high rates of risk factors for low birth weight and preterm births, together with births to Medicaid recipients, African-American and Latino women, and low-income women.
There is a greater likelihood of low birth weight and premature births giving rise to medical issues, both as newborns, issues such as brain bleeding, patent ductus arteriosus, and heart problems further on in life. The Neighborhoods have shown comparatively inferior percentages of preterm births and low birth weight occurrences. The low birth weight rate is 6.51 percent in comparison to the Healthy People 2020 main target of 7.8 percent. Roughly 11.1 percent of the births that took place in the area zip codes were premature, which satisfies the Healthy People 2020 objective of diminishing the percentage of premature birth occurrences to 100 percent or lower (FHMC, 2012).
With respect to the undesirable and worrying number of hospitalizations taking place owing to falls, lack of coverage, minimal rates of immunizations, and lack of HIV screening are all aspects that necessitate enhancement. Statistics indicate that roughly 15% of inhabitants live below the established federal poverty level. This is associated to the fact that 9 percent of the residents are unemployed and over 50 percent spend more than a third of their monthly gross income on rent. However, the occurrence of non-attendance amongst children in elementary is low, with solely 8 percent of the student missing 20 school days or more. Roughly a quarter of the adults lack health cover, 9 percent lived devoid of required medical care, and 9 percent has late prenatal care or failed to experience such care at all (NYC Health, 2015).
Plan of Care
The prevention measures of the target population are for the primary, secondary, and tertiary levels. On one hand, primary prevention measures comprise of health education provided by nurses together with immunizations. Secondly, secondary prevention measure encompasses early diagnosis, proper illness screening, obtaining similar cases, and immediate treatment. Finally, tertiary prevention measures largely lay emphasis on the falls experienced by the elderly in the sense that they are offered substitute options for housing and are provided with physical therapy and Direct Observed Therapy (Rector, 2018).
There is a great need for a huge effort to be engaged in the plan of care. In an endeavor to interact with the community, a health nurse can communicate with the president, members of the council, and community leaders of the region through conferences, assemblies and presentations, which will enable community learning as well as generate awareness regarding key community aspects. The necessity for increased available health insurance and free STD and HIV screening clinics, in addition to augmented health teaching needs to be executed. In the same way, the significance of frequent doctor’s appointments and health screenings ought to be accentuated through community health initiatives.
The ageing population might require health services such as assisted living, home health assistants, or tele-health innovation. Taking full advantage of community resources in addition to health initiatives would make it possible for the communicated to gain significant education as well participate in disease management, which will generate constructive transformations. Whereas there are several apprehensions amongst the community that can be addressed and tackled by the public health nurse, the fact that the region experiences a significant pervasiveness of falls, is largely troublesome. As a result, the medical diagnosis that we select to take into consideration and address comprise of risk for falls health issues, hazardous use of medications, and unsafe environment (Ashpole et. al, 2013).
There is a tendency of patient screening, case findings and education by nurses to lay emphasis on prevailing health risks that worry the community. For instance, the occurrences of older adults being hospitalized due to falls were highest in the region, with this statistic being 25 percent greater within the neighborhood than Queens in its entirety. Moreover, 30 percent of all these cases of hospitalization were caused by hip fractures. In addition, there is a lower likelihood of adults having HIV screening undertaken as indicated by the fact that solely 15 percent of them went for testing in the preceding year. Another noticeable aspect is that 57 percent of the people who indicated of having multiple sexual partners stated that they do not use condoms, a figure that is 17 percent greater compared to the mean rate of Queens and 19 percent greater than that of NYC (Ashpole et al., 2013).
A significant aspect of the prevention of HIV is to hearten each and every individual to obtain frequent HIV testing and become aware of their HIV status. The frequency of HIV testing is lower in general within the area as compared to NYC. The pertinent HIV testing targets set out by Healthy People 2020 are to augment the percentage of individuals living with HIV who are aware of their serostatus from 80.6% to 90% and to improve the percentage of teens and adults who have gone through HIV testing in the past years from approximately 17 percent to 19 percent (FHMC, 2012; Healthy People 2020).
Another area to be taken into consideration is the preventing and treating cancer, which is prevalent in the area. Between the period of 2010 and 2011, the rates of patients going through colonoscopy were constant and steady across the regions of Queens and NYC, in addition to West Queens. However, these rates were relatively superior in Whitestone and Flushing by 2011. In delineation, a colonoscopy is a medical procedure that encompasses inserting a colonscope within the colon as well as rectum in order to conduct an examination and get rid of, if acceptable, any anomalous tissue to check for cancer. It is imperative for the target community to lay emphasis on enhancing the frequency of colonoscopy procedures, comprising of the endeavors to increase awareness of colon cancer and also raining the number of suitable medical appointments to the gastrointestinal clinic for screenings (FHMC, 2012). In addition, accentuation ought to be on attaining financing for the Cancer Services program through the New York State Department Of Health to augment the rate of disease screening amongst individual that lack insurance coverage or lack full coverage for breast, cervical, colorectal and prostate cancer (FHMC, 2012).
Taking into consideration the primary, secondary, and tertiary prevention measures, the fundamental objective for the prevention plan is the endorsement of health for women, children and infants. A fitting instance is the development of a Women, Infants and Children (WIC) program financed by the New York State Department of Health, which offers food coupons and teaching to low-income expectant women and children up until the ages of 5 years old and is on the lookout for Baby Friendly Designation by encouraging exclusive breastfeeding (FHMC, 2012).
Project Plan Map
No.
Objective
Activity
Responsible persons
Due date
Evaluation

A.
Decrease falls resulting in hip fractures and hospitalizations in Flushing and Whitestone
at 1 year and 5 years from date of execution (Ashpole et. al, 2013)

Form education programs and resources for older adults to make necessary changes in
environment to advance home safety (i.e., eliminate throw rugs).
Rationale: These measures avert injury to patient.
Provide satisfactory supervision to avoid injury to the patient.

Nurses, Plan managers
In 5 years
The care plan and intervention is deemed effective if the community hospitalization rate as a result of falls declines at the 1 year and 5 year standards



Educate patient with an unstable gait how to utilize assistive devices correctly.
Rational: Inappropriate use of assistive devices can place the patient at greater risk of falling.







Teach patient and family regarding the utilization of safe lighting. Advice patients to wear
sunglasses to decrease glare.
Hearten patients to wear given eyeglasses, hearing aids and prosthetic devices.
Rational: Proper lighting is continuously well-thought-out as a preventive measure.







Teach patient to ask about medications that have been prescribed for him or her.
Overmedication in older adults is one of the major risk factors in falls.
Rational: Understanding on the part of the patient and family can reduce the incidence of falls in
the home
Enable social service/case manager to make a home visit to help improve the home environment for the patient’s safety.
Refer patient and family to community resources that may offer assistance to the patient when needed.





B
Exclusive breastfeeding for as many patients as clinically possible (FHMC, 2012).

Completely carry out
breast-feeding curriculum from evidence-based sources by trimester for all pregnant patients

Plan manager, Nurses, patients, pediatrics, counselors
In 5 years
Maintain total number
of babies accompanying
mother to postpartum
an
d bypassing nursery as
the norm




Establish and start execution of nursing curriculum to prepare inpatient and outpatient
Maternal-Child RNs to sit for the examination certification in Lactation Counseling.







Developed a 4 hour provider educational program accentuated on the benefits of breast feeding and the
provider approach to promote this health choice by all patients; mandatory for OB/GYN, Pediatrics,
Family Medicine and Medicine.





C
Prevention & Treatment of Cancer (FHMC, 2012)
Emphasis on enhancing colonoscopy rates, as well as endeavors to increase colon cancer awareness and increase the number of suitable recommendations to the gastrointestinal clinic for screenings
Area Hospitals, Community organizations
In 5 years
Have a Population Health committee covering members of senior management and senior
clinical staff to monitor progress and make recommendations

D
HIV Prevention
The necessity for increased available health insurance and free STD and HIV screening clinics, in addition to augmented health education needs to be executed. In the same way, the significance of consistent doctor’s appointments and health screenings ought to be accentuated through community health initiatives
Community health nurse, council members, community leaders
In 5 years
Measure against the Healthy People 2020 HIV testing targets



Conclusion
In summary, the comprehensive assessment of the community demonstrates that the neighborhoods of Whitestone and Flushing satisfy majority of the World Health Organization Initiative Healthy Cities Elements. The region has a physical setting of high quality together with a steady and sustainable bionetwork. In addition, the community bears strength, is non-exploitive, communally supportive, and satisfies the fundamental needs for food, water, shelter, together with secure work settings for the populaces. The assessment also indicates that the population participates in health initiatives, specified by deteriorating risk factor statistics, and a great deal of the community has accessibility to a wide range of healthcare services, with efficacious communication and constructive interrelations. The economical situation of the community bears diversity, innovation, significance, and self-containment. Moreover, the city is largely linked to its historical account, and the prevailing structure is consistent with and augments the aforementioned elements. The community has a good general health ranking, and despite the fact that it is not ideal, the whole population has accessibility to suitable public health and healthcare. Incessant enhancement and progressively rising involvement in health initiatives, enhanced cleanliness, increased income, community security, and sustained accessibility to healthcare are all longstanding components that ought to go on being taken into consideration (Ashpole et al., 2013).




















References
Ashpole, J., Castillo G., Golbert, G., Levy, S., Terrin, N., Joseph, N., & Wilmott, K. (2013). Windshield Survey Zip Code 11219 – Borough Park. Retrieved March 14, 2018 from http://www.saraelevy.yolasite.com/resources/N492%20Windshield%20Survey%20FINAL.pdf
Flushing Hospital Medical Centre, FHMC, (2012) Community Service Plan 2013-2017 Prevention Agenda
Healthy People 2020 (n.d.). 2020 Topics and Objectives. Retrieved March 27 2018 from https://www.healthypeople.gov/2020/topics-objectives
New York City Department of Health. (2002). New York City Neighborhood Health Profiles: Brooklyn, 2000 (Rep.). Retrieved March 27, 2018, from The City of New York website: http://www.nyc.gov/html/doh/downloads/pdf/data/2000nhp-brooklyn.pdf
NYC Health (2015). COMMUNITY HEALTH PROFILES 2015: FLUSHING AND WHITESTONE
Older Adult Falls Publications. (2013, October 29). Centers for Disease Control and Prevention. Retrieved March 27, 2018, from http://www.cdc.gov/HomeandRecreationalSafety/Falls/index.html
Rector, C. (2018). Community and public health nursing (9th ed.). Philadelphia: Wolters Kluwer.