Windshield Survey with Reflection Sarah Kinnard NUR/405 Healthy Communities: Theory and Practice November 7, 2011 Beth Edwards, MSN, FNP- BC ? Windshield Survey The first step required for providing community health nursing services involves a comprehensive assessment of the community. This can be accomplished by a windshield survey, conducted by making visual observations from a car while driving through the neighborhood. Valuable information and data collection during a windshield survey can be used to identify the health-related needs of the community and evaluate the need for additional community health services.

Delaware is divided into three counties; Kent is centrally located between New Castle and Sussex County. Kent County is home to the state capital, Dover. I have chosen Kent County Delaware, where I reside, as the focus for my windshield survey. Community Health Defined According to Stanhope and Lancaster, (2008, p. 192) “A community is defined as a social network of interacting individuals, usually concentrated in a defined territory. ” Members within a community interact with each other in local businesses, schools, hospitals, and churches; this interaction creates a sense of belonging and purpose within the community.

Community health recognizes the specific health needs of the community, offering resources and health education to improve community health outcomes. Community health is defined as “the meeting of collective needs by identifying problems and managing behaviors within the community itself and the between the community and larger society” (Stanhope & Lancaster, 2008, p. 347). Community health is not limited to improving outcomes of an individual suffering from a particular disease or illness, but concentrates on the improvement of the community as a whole. In public health nursing, the community rather than an individual becomes the client.

Although individuals make up the community and nurses may assist individuals, priorities remain focused on the health care needs and outcomes of the community as a whole. Determining the effectiveness of interventions and evaluation of outcomes relies on data collected from members within the community. Aspect of Community Health Specific characteristics and health concerns have been identified, affecting the health of current Kent County residents, such as limited access to healthy foods, shortage of primary care physicians, and limited availability to recreational facilities promoting fitness.

While there are a few local farmers within the county, residents have extremely limited access to healthy food outlets such as organic foods and produce from grocery stores, produce stands, and farmer’s markets. According to County Health Ranking (2011) 47% of Kent County residents have access to healthy foods, falling drastically behind the national benchmark of 92%. Produce departments with local grocery stores have limited variety and quantity and offer minimal organic produce.

Grocery stores in my local areas typically advertise sales on red meat high in fat content, convenient calorie dense frozen meals, processed or canned foods with large amounts of sodium, and unhealthy, concentrated sugar containing snacks. When grocery stores offer sale prices on these items, they are promoting the consumption of unhealthy foods and poor food choices. Kent County has limited number of primary care physicians available to provide health services, including screening for potential health risks and preventive care.

Statistics show a ratio of one primary care physician per 1,555 residents of Kent County, nearly twice the number or residents compared to national standards (County Health Rankings, 2011). Limited city and county funds prevent the establishment of additional community recreational facilities available to local residents. Healthy People 2020 Health Indicators Many of the health indicators addressed by Healthy People 2020 are major health concerns within Kent County Delaware. However, I have chosen to focus on obesity.

As a medical-surgical nurse in a community hospital, I frequently care for patients seeking medical treatment for both chronic and acute illness associated with obesity. The U. S. Preventive Services Task Force encourages rigorous behavioral dietary counseling interventions for adults with hyperlipidemia and other known cardiovascular and diet-related chronic disease such as diabetes (Healthy People. gov, 2011). Creating nutritional and physical activity worksite programs assist in the Healthy People 2020 objective to reduce the incidence of obesity.

Another strategy to decrease the occurrence of obesity is to educate families on the importance of reducing the amount of time spent watching TV, movies, playing video games, or searching the Internet. To support families, alternative physical activities should be recommended and available for families. In an effort to fight obesity, Kent county needs increased public awareness of healthier food choices, availability of local fresh fruit and vegetables, and engaging in regular cardiovascular or strengthening exercise.

This can be accomplished by a health fair sponsored by Bayhealth Medical Center, partnering with local farms, such as Fifer Farms, local fitness centers, and the YMCA. Community Nursing Diagnoses Community nursing diagnoses that support the endeavor of reducing the incidence of obesity include: 1. Altered nutrition, more than the body requirements related to consumption of excess calories as evidence by the prevalence of overweight and obese adults. 2. Knowledge deficit related to lack of nutritional education as evidenced by the consistent unhealthy food choices. 3.

Ineffective community therapeutic regimen management related to a limited number of primary physicians to monitor and screen for overweight and obese adults as evidenced by the percentage of adults with a BMI greater than 30. Interventions for the first two diagnoses are as follows: 1. Provide nutrition education, discussing healthier food options and alternative to fast-fast. Increase awareness of local market at Fifer Farms offering fresh fruits and vegetables. 2. Partner with local markets to increase the availability of healthier food choices and greater variety and quantity of fresh produce.

Interventions for third diagnosis include: 1. Partner with Bayhealth Medical Center to increase awareness of obesity within Kent County and the health risk associated with obesity 2. Establish health screenings that include nutritional information and BMI measurements throughout the community at least once a month. Cultural Diversity When addressing community health issues, we cannot ignore the impact cultural diversity plays. Communities within America are becoming increasingly culturally diverse, Kent County is no exception.

Public health nurses are responsible for assessing and recognizing health risks for cultures within the community. The Office of Minority Health is committed to persistently assessing the impact of policies and programs on racial and ethnic health. The Office of Minority Health was created in response to poor health outcomes for minority groups such as African Americans, Hispanics, Asian Americans, and Native Americans (U. S. Department of Health & Human Services, 2010). This agency holds a tremendous amount of responsibility, assisting minority groups with overcoming barriers and improving access to health care.

African Americans make up more than 24% of the Kent County population. The leading causes of death among African Americans include: heart disease, cancer, diabetes, and HIV. According to the Centers for Disease (2010) African Americans suffer a disportionally high prevalence of the following conditions and risk factors: hypertension, infant mortality, and tuberculosis. Housing and zoning: •55 + retirement communities available •Rural homes lack city sewer and water services •Newer single family homes Victorian & Colonial homes built over 100 years ago with health concerns of lead based paint and asbestos. •Apartments available within city limits only •Nursing homes & Assisted Living Transportation: Means: •Limited service available with DART bus system •A small number of taxi service companies •Amtrak station with bus service •Rental car companies •Ambulances Roads in town have street lights, signs, lighting, and sidewalks. However, most of Kent County is rural. The roads in rural areas do not have sidewalks, even in residential areas and offer no lighting at night.

Rural country roads can be dangerous due to unexpected animals crossing the road at night. Race and ethnicity: •Majority Caucasian •African American •Small populations of Hispanic, Asian American, Haitians, and Guatemalans. Open space: •Rural areas provide a large amount of open space •Single family homes typically average less than 2200 square feet but generally sit on larger lots of ? acre or larger. •Many of the farms have greater than 20 acres •One large park located in Dover provides an area for walking, playground, and baseball fields. Service centers: Planned Parenthood Center •Independent Women’s Counseling available for family planning •Many Pharmacies •City Police, Fire Department & Library •Delaware State Government Offices •State funded social services center A relatively small number of: •Physicians •Urgent Care •Dentist •Outpatient Lab •Rehab & Physical Therapy Religion and politics: •Many small community churches from Jehovah’s Witnesses, Southern Baptist, and Catholic Religions •Members of local churches are often seen walking throughout local neighborhood talking to residents about their faith and church. Many state offices are located in Kent County, politics are often discussed and decisions made regarding policies and programs. Boundaries: •Eastern side of the county is bordered by the Atlantic Ocean •Western side of Kent county is bordered by Maryland and ironically Kent County, Maryland •New Castle County is located north and Sussex County is located to the south •Signs are located along Route 1 marking Kent County boundaries. Stores and street people Grocery stores include Safeway, Acme, Super Fresh, and locally owned independent grocery stores •Discount Stores are visited frequently such as Dollar General, Dollar Tree, Ollie’s, and Big Lots •Several Pawn Shops and Advanced Payroll Loan or Check Cashing business •Liquor Stores •Many fast-food restaurants including McDonald’s, Burger King, Sonic, Arby’s, Wendy’s, Hardee’s, Taco Bell, KFC, Chick-fil-a, and Boardwalk Burgers & Fries. •One local family owned & operated farm with store selling fresh seasonal fruits & veggies. Most people travel by car, limiting the number of street people. However, students are often observed outside Delaware State University walking to and from nearby shopping centers and fast-food restaurants. Health and morbidity: •One of the three hospitals located in Delaware is centrally located in Kent County •Multiple small graveyards are randomly located throughout the city limits •Handicap parking spaces are often utilized by those displaying a handicap sticker •During Nascar Racing Events public intoxication and alcohol consumption is a major concern for the resident of Dover. Commons” •Downtown Dover offers a welcoming area with historical colonial landmarks and museums •Many of staff at local business and restaurants greet patrons •Retired males gather at local Dunkin Donuts in the morning to discuss the weather and condition of crops over coffee and donuts Signs of decay: •Unfortunately, recent declines in the economy caused the closure of several businesses such as Value City, Circuit City, Golden Coral, and Blockbuster, leaving vacant buildings. Playtex industrial plant remains empty and run down due to closure •Abandoned homes and farms can be found in outlying areas •Majority of homes are occupied however there has been an increase in the number of vacant homes due to foreclosure. Media: •The Dover Post is a local weekly newspaper highlighting local news, events, and churches •Local news broadcast is available from WBOC •Numerous locally broadcasted radio stations provide additional information on current and upcoming events ? References County Health Ratings. (2011). Kent, Delaware. Retrieved from http://www. countyhealthrankings. rg/delaware/kent Centers of Disease Control and Prevention. (2010). Black or African American population. Retrieved from http://www. cdc. gov/omhd/populations/BAA/BAA. htm Healthy People. gov. (2011). Nutrition and weight status: interventions and resources. Retrieved from http://healthypeople. gov/2020/topicsobjectives2020/ebr. aspx? topicId=29 Stanhope, M. , & Lancaster, J. (2008). Population-centered health care in the community (7th ed. ). St. Louis, MO: Mosby Elsevier U. S. Department of Health & Human Services (2010). The Office of Minority Health. Retrieved from http://minorityhealth. hhs. gov