Nurse-Care Analysis of Sheepshead Bay the Area

¶ … Nurse-Care Analysis of Sheepshead Bay

The area is 4,074 square miles. Its population is 123,178. The people density of people who live in Sheepshead Bay compared to general inhabitants of Brooklyn of people per square mile is 30,233 to 34,917 (City-data.com; web).

On my visits there, I was astounded by the mass of people rubbing shoulders one with the other. The streets seemed dense and crowded with a great number of apartment buildings, more than those in the more laid back areas such as Flatbush and Queens, and also more than those in the vicinity of Coney Island. There were also a lot of immigrant offices and lawyers specializing in immigration services that was telling of the area.

In fact, involvement with immigrants who had been seeking service with bureaucracy involved with obtaining a Green card revealed that many of them, although living in other parts of Brooklyn (sometimes far from Sheepshead Bay) had been recommended to travel to Sheepshead Bay for service.

Whether correctly or not, Sheepshead Bay has a reputation for attracting Russian emigres particularly those who are 'fresh off the boat from Russia'. Either way, there are certainly a lot of Russian-culture-oriented stores in the area, and Slavic faces and Russian language was a phenomenon that I encountered frequently and consistently as well as the selling of vodka, and it seemed to me, from the newspapers on display and advertisements and bulletins that I saw in passing that Marxism, in some form or other, is still a dominant political perspective. That is paradoxical since capitalism is huge here with many small and shabby stores (mainly corner markets) frenetically competing with one another.

My assumption that the majority of the population are elderly and retired, was supported by data on City-data.com (http://www.city-data.com/neighborhood/Sheepshead-Bay-Brooklyn-NY.html) that showed most of the population to be in the 45 age range +. Whilst there is a drop in the ages between 30 and 35, there seem to be more individuals in the ages between 20 and 30, otherwise the number of adolescents that live here are still lower, and still lower still are the amount of children between 0 and 10 years of age (City-data.com; web). Statistical data corroborates my impressions: that a mainly elderly population inhabits the area and that those of a more fertile age and capacity move to other localities.

There are also seemed to me to be relatively few schools in the region due perhaps to the depletion of younger parents there, possibly, although not necessarily, to the shabbiness of the place, and possibly due to the notoriety of the place attributable to crime (the so-called 'Russian mafia') and concerns of safety.

The overwhelming segment of races (85%) is Caucasian. Approximately 10% is Asian, 5% Hispanic, 3% Black, and 2% other races (City-data.com; web).

The median household income in 2009 was $44,279 compared to the general median household income in Brooklyn of the same year, which was $40, 478.

The median rent in 2009 was $856 compared to the median rent paid in Brooklyn of that same year which was $812 (ibid.). It seems to me that it is the proximity of Sheepshead Bay to Coney Island that raises the rent here that makes it an otherwise desirable neighborhood to live in despite its squalor and incidence of crime in certain parts of the region. Proximity to Coney Island also affords opportunities to up-and-coming businessmen and hustlers.

Interestingly enough, there are more females than males living in Sheepshead Bay (64,304 to 58,875). The median age of the males is 37.2 compared to the median age of the males in the city in general, which is 33.1. The median age of the females, on the other hand who live in Sheepshead Bay are 42.0 compared to the median age of the whole city, which is 34.8 (City-data.com; web). It seems as though a largely middle-aged female population is attracted to Sheepshead Bay, and this is intriguing.

There are, too, I noticed a lot of prostitute services and strip-tease industries in the area. My assumption is that it may be these that attract a lot of the women ('women of the night') to this specific region.

The average household size is small: 2.6 individuals compared to the average household size of Brooklyn as a whole, 2.8 individuals. The average family size of Sheepshead Bay is 3.2 members compared to that of Brooklyn in general that has 3.4 members (ibid.). This, again, cohered with my general impression of mainly middle-aged older population with few children.

On the other hand - and this was a piece of data that flummoxed me - City-data.com told me that approximately 51.0% of the population constituted married couples, and this number was even more surprising compared to the 38.6% in the general Brooklyn neighborhood. I was also surprised to discover that 22.4% of these couples had children compared to the 19.1% in Brooklyn as a whole (ibid.). It may be that other areas external to this specific region have more children and possibly more schools than I noted in my migrations. Or, simply perhaps that children traveled to schools outside the locality and that my observations were incorrect.

There are also a small percentage of single mother households (5.9%), but a significant number of never married males, 15 years and older (14.1%) and a slightly lesser, but still significant number, of never married families (11.9%); the proportion, in each case, to Brooklyn as a whole is 18.2% and 19.1% (City-data.com; web).

Congruent to my perception that Sheepshead Bay is an emigre locality is the statistical observation that a striking 16.0% of people in this neighborhood either speak little English or are totally unfamiliar with the language compared to the 12.3% of immigrants in Brooklyn as a whole. Indeed the percentage of foreign-born residents is a high 48.6% compared to the 37.8% of foreign residents in Brooklyn itself.

This factor of immigration coupled with the fact that such a high number have had a minimal high school education if at all (21.2% compared to the 28.5% of Brooklyn in general) can pose critical problems to the general health of the locality in that immigrants have peculiar health challenges. This is compounded by the fact, that there seem to be more non-college graduates here (i.e. people who have ceased education with high school) than in any other part of Brooklyn (28% compared to 27.8%) (ibid.).

This area also seems to have an inordinate amount of vehicles (1.1% of houses compared to the 1.0% in Brooklyn itself; and 0.6% of apartments compared to the 0.4% of general Brooklyn). This could be more an indicator of Russian values (the perceived value of possession of a car) than of general wealth. A large percentage of units, too, have a mortgage (61.3% compared to the general Brooklyn 67.1%). Housing prices range higher than the median price range of Brooklyn ($616,988 to $589,809); again it could be the proximity to Coney Island and the industrial advantage that hikes the prices. The average housing value (and this supported my impressions of the housing being largely shabby and uncared for) is lower than of Brooklyn in general ($275,942 compared to $284,435 for 2-unit structures). Indeed, most constructions in the zone were built in 1939 or earlier (City-data.com; web).

A huge percentage of the population is below poverty level (17.2% compared to the 25.1% of Brooklyn in general), many of the families have both members working strenuously to make ends meet (ibid.).

What I also noticed was the fact that a conspicuous number of the population are involved in industry or service jobs and this coheres with much of the research done on illiterate immigrants, generally, accepting lower-level, more dangerous jobs in the economic sector.

In this regards, 11.8% of males in Sheepshead Bay are absorbed in the service sector compared to the 17.3% of the borough as a whole. A large 12.4% are involved in construction, extraction, and maintenance occupations as compared to the 13.6% of the surrounding borough, and 9.2% are involved in transportation and material moving occupations (City-data.com; web).

Reports of American immigrants show that they invariably turn to the lowest paying and most dangerous jobs usually because of language difficulties, sometimes, it is thought due to prejudice (Ramakrishnan, 2006).

Part II. Nursing diagnoses

Based on the above information, the top five nursing diagnoses for the community nurse caring for the neighborhood would be the following: 1. Depression, 2. Suicide, 3. Alcoholism and substance abuse, 4. Reluctance to use services, 5. Work-related dangers.

1. Depression:

Numerous studies have documented disparities in depression between younger immigrants and older immigrants particularly those with language problems. Depression seems to be more rampant in the latter group. Some studies have noted that non-literate immigrants are more likely to receive sub-standard care and to experience poorer outcomes from anti-depressant treatment, with fewer follow-up visits and earlier discontinuation (Miranda et al., 2003). Some immigrants also seem to prefer psychology to pharmacotherapy. Higher rates of depression among the more illiterate group may also be referred to language differences, particularly incomprehension of language nuances relating to health factors, and a consequent fear of dealing with any situation that involves the language on a level that is incomprehensible to them thus causing them to avoid help when they most need it. Differences in cultural idioms used to express comfort or discomfort also play a part as well as somatic presentation.

Sandy and Elliott's (1996) review of the literature found that previous studies have been inconsistent in their adjustment and decision of causality of these factors. It was undecided whether it was language (i.e. insufficient proficiency in English) or culture of origin, or the acculturation scale itself that was used that determined results and/or interpretation of result, but their own case study and survey revealed that language skills had an undeniable effect on seeking and receipt of health care. Depression, therefore, often seems to be linked to deficiency in language skills. Depression is particularly prominent amongst females who also have a tough time straddling work, looking after family, and making ends meet.

Intervention: In all these case, it would be important to have Russian speaking health care workers, preferably Russian in origin themselves and who understand the culture. The workers must be sensitive to the immigrants particularly those who come from a lower educational background. It is also recommended that more social workers be involved in the scenario to attract and persuade immigrants to use health-care facilities so that they receive treatment for their depression. Guideline-concordant treatment for depression seems to be the most effective intervention for impoverished immigrants. Sometimes (depending on the level of depression) this is bolstered by medication. And psychotherapy. Miranda et al. (2003) recommend intensive outreach, childcare and transportation to care when needed, and encouragement to comply with evidence-based medication or psychotherapy treatment.

Assessment: Observations and surveys can be conducted before and after to see whether the rate of depression has been reduced. It is also recommended that general communal surveys be conducted to assess longevity and cross-sectional changes in intensity and prevalence of disease.

2.Suicide

Suicide reports amongst immigrants find that levels are far higher amongst immigrants than they are amongst the native-born generation, and that it seems to be those who are illiterate who demonstrate the higher level of suicides. Studies, too, demonstrate that the highest levels of suicide, generally, emerge from low socioeconomic backgrounds and lower levels of education, the two being possibly, although not always, affiliated. Sheepshead Bay has all of these elements and more.

In this manner, it may be quite likely that the combination of low-paying jobs, many of them risky, lower access to resources and to better paying opportunities, as well as far more dissatisfaction in life, with health problems not being sufficiently addressed, may lead many illiterate immigrants onto to this final most dramatic step of killing themselves. Their low, if indelible, level of language skills that disables them from articulating their problem compounds this.

Intervention: This may be beyond the capacity of nurses and may involve the assistance of a large degree of other people. Nurses should be trained in recognizing suicidal cases and in dealing with these when they arise. Recognizing involves the ability to assess for suicidal symptoms, to search out risk factors for suicide and become familiar with them, and to investigate patient's current abilities to cope with acute or chronic stress. There are also assessment tools that can be used. Nurses can also direct immigrants to relevant non-profit resources and refer them to prevention programs and associations such as Alcoholics Anonymous

Assessment: As with depression, observations and surveys can be conducted before and after to see whether the suicide rate has been reduced. This can be performed by surveying the relevant clinics and hospital emergency wards.

3. Alcoholism and substance abuse.

The majority of studies related to immigrants have found that in certain areas -- such as in substance abuse and alcoholism -- attempted acculturation seems to have a negative impact (National Institute on Alcohol Abuse and Alcoholism (NIAAA), 2004) in that immigrants take to drink as a way of overcoming their problems and trying to fit in. As indication of the hugeness of the problem in Sheepshead Bay, emergency meetings held in schools in the Sheepshead Bay area have addressed attempted child abductions and there have been implications in these complaints in the rise in substance abuse and alcoholism (see Berke (2009) where communal voices have mentioned concerns).

Intervention: Nurses can be trained in using evidence-based approaches based on multicultural perspectives that involve the whole family. Here, steps can be taken that are similar to those involved with depression and suicide, with families and the patient referred as follow-up to relevant associations such as Alcoholics Anonymous. Since many more factors, aside from alcoholism are involved here, it is recommended that social services be brought into the picture and that an intensive investigation be done of the situation. This may be, too, beyond the purview of the nurse, but immediate steps can be taken to control the alcoholism itself, and the nurse can direct patient and family to applicable resources.

Analysis: As with depression, observations and surveys can be conducted before and after to see whether the suicide rate has been reduced. This can be performed by surveying the relevant clinics and hospital emergency wards.

4. Intimidation to use nursing services related to cultural factors

The less acculturated immigrants have more barriers to mental health care. This is aggravated by their lack of language skills and lower level of education. They are intimidated by the foreignness of America, and not fully cognizant of the importance, for instance, of having regular check-ups. Chesney (2004), for instance, found that predisposition to using health care largely depended on the level of immigrant's acculturation, so predisposition is another factor that intervenes. In fact, those who are acculturated are twice as likely to use the mental health care facilities. The health care facilities, therefore, need to be made more attractive and less threatening to the immigrant in order to encourage them to use them.

Intervention: The nurse can help here by having Russian speaking, and preferably Russian born workers who will interact with the immigrants and by understanding their culture. Most important is the evidence of a friendly, nursing manner, emphatic to the individual by speaking on his or her level and carefully addressing the individual's needs. Intensive communal outreach can be undertaken, with leaflets in both English and Russian showing clear direction and necessity of using resources, as well as making them less threatening. Incentives, too, may be accorded in order to persuade immigrants to use the facilities. Immigrants may be visited after childbirth, either in their homes or in the hospital itself, and they may be visited, too, during hospitalization, regardless of the reason for the hospitalization, in order that they may be informed and encouraged to use the services.

Assessment: Evaluation of results may be conducted by surveys, focus groups, and follows up with clinics and various health-organizations in order to assess whether there is an increase in immigrants utilizing the services. Immigrants, too, can be questioned regarding their level of comfort with health institutions, and whether these have increased / decreased during the last few years. Variables can be explored for improving their situation and towards mitigating their discomfort and overcoming their reluctance to use the services.