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Summary

A community is a group of individuals with a shared characteristic or interest living together within a larger society. Per Saarloos, D., Kim, J., & Timmermans, over the course of twenty years, the field of health promotion has revealed increased attention for the likely impact of the environment on health. It has become the standard approach to categorizing the various environmental influences on individual health behavior (2009. para. 3). In a community, there are eight subsystems; they are physical, health and social, safety and transportation, education, recreation, politics and government, communication, and economics. In Sentinel City, there are four communities. In this paper, I will continue my window survey and discuss four of the eight subsystems with exploring the different communities.

please read the paper below to find some information to complete the assignment. you can also find more information on the internet.

Physical Environment 

The Physical Environment features of communities have been linked to disability, mortality, general health status, chronic conditions, birth outcomes, health behaviors and other risk factors for chronic disease. Along with mental health, injuries, violence, and other important health indicators (Cubbin, Pedregon, Egerter, & Braveman. 2008). 

Sentinel City’s first community, Nightingale Square the sidewalks and streets have hardly any rubbish on them and are not in bad shape, buildings are mostly big and bright, there may be some graffiti but it is not much, and it is not that obvious. The trees are nicely trimmed, and beautiful cars line the road. Nightingale Square has tennis courts, a basketball court, and parks, large condominiums, beautiful storefronts for clothing, jewelry, and various other shops. There are a grocery store and a gas station located at the end of the community, where it seems to be not as clean, and a small amount of garbage is outside a few buildings. Buildings are not quite as attractive but are still nice, and there is more graffiti on the buildings. There is a large pharmacy, a dentist office and barber shop in the vicinity. Residents are walking, running biking, and walking dogs. Nightingale Square is a community that has “everything” there is a sense of friendliness and openness to other people towards grocer, but in the other areas, there seems to be a feeling of superiorness to the remainder of the community. At and across from the grocer seems to be a place that people like families, couples and others will stop by and watch the entertainment or come to meet people to “hang-out.” 

The second community is Acer Tech Center the sidewalks and streets are mostly clean, buildings are in good shape, there is more garbage outside buildings, sidewalks are nice, and there is a bit more graffiti than Nightingale Square but not too bad. A few loose dogs and cats are running around, the trees are neatly trimmed, and the cars are in good shape. A large hospital, Sentinel City Healthcare Center is one of the first things to see and then there is Acer Center Business Center next to it. In between the hospital and the business center, there is a large fruit stand and courtyard where people are “hanging -out.” There is a small grocer, but the large one is not too far away clothing shops, a barber shop, and trade shops. City Hall is in Acer Tech Center where there is a bunch of protesters (middle-class?) protesting about taxes. There is a Historic Hotel in Acer which is more than likely a tourist attraction or something like that. People are walking, riding bikes and running. There is another “hang-out” area in a courtyard across from the Affordable Housing Project, where there are a small fruit and vegetable stand with people sitting on benches, standing, or walking around. Acer Tech seems to be friendly, and a more pleasant area to welcome strangers because there is a large mixture of people throughout the community in various classes, races, and ages. The third community Casper Park is unlike the first two communities, the streets are dirty, there is, even more, garbage outside buildings, there is more noticeable graffiti, and the buildings need repair, some of them have windows boarded up and some vacant. Low-Income Housing is available, there are fewer cars, and the are not in top working order. The park is in appalling shape with garbage, and crates all around, homeless people, dogs, cats, and rats running around. The trees and grass are overgrown and need some attention. There is a small fruit and vegetable stand and courtyard across from Low-income Housing; people are sitting on benches and walking around. There is a small grocer, a check cashing store, clothing store, pawn shops, and a barber shop. Casper Park at first seems to be welcoming and friendly but going deeper into the community you get a sense of territoriality. 

The last community is Industrial Height, the first thing in the community is the school which is nice with a large playground attached. There is a church with a soup kitchen, the streets dirty but not too bad. However, the deeper into the community, the more garbage there is that lines the streets. Graffiti is all over,  from the church with signs of tagging in various buildings like the Better Health Clinic and the building next to it, which seems to be a gang’s hang out due to the massive skull sign out front. There are cars broke down, one on fire, garbage can on fire, buildings have large gang related murals painted on the some of the sides. The Department of Transportation is located here, down the street there is a rundown grocery with not much to choose from, there are boarded up store fronts and one store with busted out windows. Construction for re-development housing with burst sewage pipes with more dogs, cats, and rats running free. There are few cars on the road, an occasional motorcycle every so often and some people walking. This community is not welcoming; it has a feeling of being very unsafe, it is very closed-up and territorial areas. 

Health and Social Services

“Access to comprehensive, quality health care services is essential for promoting and maintaining health, preventing, and managing the disease, reducing unnecessary disability and premature death, and achieving health equity for all Americans. This topic area focuses on three components of access to care: insurance coverage, health services, and timeliness of attention. When considering access to health care, it is important also to include oral health care and obtaining necessary prescription drugs” (Access to Health Services. n.d.).

Sentinel City Healthcare System has various healthcare and social service facilities in all the diverse communities. There is the main hospital with the Emergency, Inpatient, and ambulatory care. Spread throughout the city are nine primary care clinics with Eighty-two physicians and eight specialty clinics with thirty-three doctors. The dental care there are three orthodontist clinics, one endodontist clinic, three dental hygiene clinics and two pediatric oral surgery clinics which are also spread throughout the city. Mental Health services are also available throughout the city the Mental facilities range from case management service to the State Mental Hospital to have a total of five options. The vision clinics and vision therapy centers are also spread throughout. Depending on the community is the deciding factor to what is available, unfortunately, the communities needing the most healthcare, the poor and impoverished communities have the least available or needs to travel the furthest. Eldercare social services that are available are medical assistance advocates, service animals, Government Entitlement Assistance, Senior Community Centers, Meals on Wheels, and Elder Abuse Prevention Advocates. There are 3472 senior living units, twenty-four Swing bed, thirty-six Long Term Care, and sixty-four Skilled Nursing facilities. More facilities are two hundred forty-eight Assisted Living, 2874 Nursing Home units, and 1048 independent senior living apartments, these are all spread through the city. 

Healthy food choices are also of importance there is Jo’s Grocery in Nightingale Square that sells organic food for most their sales, there are three fruit and vegetable carts in two of the communities Acer Tech, and Casper Park placed at the courtyards in the community. The fourth community has a Soup Kitchen at the church that feeds the homeless and hungry healthy meals. Besides the large grocery store, there are many small groceries and one that is moderately sized in Industrial Heights. There are numerous fast food restaurants, Italian, donut shops, Sushi, Pizza shops, to name a few. There are a few of restaurants that are sit down dinners with healthy choices available.  

Safety and Transportation

Per the website, County Health Rankings, Community Safety considers not only intentional acts in neighborhoods and homes but also injuries caused accidentally. Many injuries are predictable and preventable. Living in unsafe neighborhoods can accelerate aging and harm health because of the chronic stress associated with it. Neighborhoods that are unsafe causes anxiety, depression, and stress, keeping people indoors, away from neighbors, exercise, and healthy foods due to the fear of violence. Jobs are harder to find because companies may be less willing to invest in unsafe neighborhoods (2017).  

Sentinel City, has a high rate of violence, depending on the community is greater the risk of being a crime victim, There are Police patrolling in police cars in all communities. The police seem to have the city covered a good as possible, they are at the Grocery Store in Nightingale Square, directing traffic at the hospital in Acer Tech, and the School in Industrial Heights. Other that having an increased amount at City Hall for obvious the obvious reason of the protest there are also increased in Industrial Park for the broken storefront windows and patrolling on foot in Casper Park. Even tough there seems to be somewhat adequate police presence; I feel that it is highly possible for crime to be committed, especially in Industrial Heights and Casper park. Due to gang involvement, low-income and poverty, this makes it a greater chance for there to be crimes and aggravated assault being the top crime.

Transportation in Sentinel City appears to be mostly by taking the bus, the next would be by bicycle, and then by car. Traveling on foot seems to be another means used by the residents. The least costly is bicycling/walking, the riding the bus and last would be by car. Another form of transportation ing Sentinel City that would be to travel from city to city is the train systems; it passes above Pine Street behind City Hall in Acer Tech. There is a highway close by because of there is an overpass over Station Road in Nightingale Square. There are fire hydrants throughout Sentinel city, and there is a Fire Department that responds to the car and garbage can fire in Industrial Heights. 

Conclusion

Sentinel City is just like any other city; there are kinds of people with many different situations. These people are rich, poor, or somewhere in between. There are no clear natural boundaries in Sentinel City, but you can see the conditions of the different communities an indication of these limits. The various communities where the people live, work, play, and how they live to affect their health. “Poverty and poor health worldwide are inextricably linked. The causes of poor health for millions globally are rooted in political, social, and economic injustices. Poverty is both a cause and a consequence of poor health” (Key Facts Poverty and Poor Health. n.d.). 

References:

Access to Health Services. (n.d.). Retrieved June 05, 2017, from https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services

Community Safety. (n.d.). Retrieved June 06, 2017, from http://www.countyhealthrankings.org/our-approach/health-factors/community-safety

Cubbin, Pedregon, Egerter, & Braveman. (2008, September). Where We Live Matters for Our Health: Neighborhoods and Health. Retrieved June 5, 2017, from http://www.commissiononhealth.org/PDF/888f4a18-eb90-45be-a2f8-159e84a55a4c/Issue%20Brief%203%20Sept%2008%20-%20Neighborhoods%20and%20Health.pdf

Key Facts Poverty and Poor Health. (n.d.). Retrieved June 05, 2017, from https://www.healthpovertyaction.org/info-and-resources/the-cycle-of-poverty-and-poor-health/key-facts/

Saarloos, D., Kim, J., & Timmermans, H. (2009, June). The Built Environment and Health: Introducing Individual Space-Time Behavior. Retrieved June 05, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2705214/

through your Windshield Survey of Sentinel City to a target population of your choosing. You will complete your project by comparing data from Sentinel City with similar data from the city where your target population lives. Your final project will be a 14-20 slide PowerPoint presentation You must view the Final Project Rubric below in order to accurately complete this assignment. 

Your final presentation will include 10 parts, which are described in detail below.

I. Introduction

Provide a brief introduction that includes the mission statement, vision, and/or the goals of your practice learning site. Answer = Atlanta VA medical center. There mission statement on the internet.

II. Description of Your Target Population

Compose a detailed description of your chosen target population, which is a specific group served by your practice learning site. In this section you will describe the demographic characteristics of your chosen target population, including the population’s socioeconomic status, vital statistics, education level, religion, and occupations. Include a table, graph, and/or figure display that includes relevant demographic data for your target population. Answer Hispanic

III. Comparison of Sentinel City Demographic Data

Compare the demographic data of Sentinel City with the demographic data from the city where your practice learning site is located. You should present this information in a clear to understand table. You can use the Data Comparison Table provided in Module 2. Compare sentinel city to Gwinnett county Georgia

IV. Key Informants

Identify 3 key informants in the city where your practice learning site is located and 2-3 questions you would ask them. Examples of key informants include, but are not limited to: political leaders, health care providers, service providers such as mail carriers or shop owners, members of the fire or police departments and long term residents of the community. People who live and work in the community are a rich source of information and can often provide data not found in printed form. Your mentor from your Practice Experience will serve as the 4th key informant. Include specific quotes in response to the questions you asked your mentor that support and/or contradict information cited in the literature.

V.  Key Health Concerns or Issues

Present a list of the top 3 health concerns for your target population. Provide a brief description of these concerns and include data from you target population city that supports the rationale for selecting these health concerns. Select one of the three health concerns you identified and state why you decided to develop an intervention that addresses this particular health concern/issue. Include the Healthy People 2020 objective that relates to your identified health concerns. Answer: hypertension, diabetes, and Heart disease

VI. Community Health Nursing Diagnosis

Develop a community health nursing diagnosis based on your analysis of the demographic and health status data that you gathered, as well as your conversations with the key informants. You may consult with your practice learning site mentor to help you develop this diagnosis.

Your community health nursing diagnosis should be written using the following format:

Increased risk of (disability, disease, etc.) among (community or population) related to (disability, disease, etc.) as demonstrated in or by (health status indicator, or etiological/causal statement).

Examples:

Increased risk of obesity among school age children related to lack of safe outdoor play areas for children as demonstrated by above average BMI rates. 

Increased risk of depression among persons with a physical disability related to the lack of handicap accessible facilities and social isolation as demonstrated by high suicide rate

VII A & B. Intervention to Address the Diagnosis

Describe your proposed intervention that will address the community health nursing diagnosis for your target population. You may choose to develop your own intervention, or modify one that was recommended by the Task Force on Community Preventive Services (TFCPS).

To view recommended interventions, visit the TFCPS website and select the topic you plan on addressing for your intervention. (Note: at the bottom of most topic pages on the TFCPS website there is a sample on how to cite the webpage. After reviewing the topics, click the “Resources” tab then click “Fact Sheets”. Here you may find fact sheets to share with your mentor at your practice learning site.)

Whether you modify an existing intervention or develop one of your own, you must discuss why this intervention will or why you needed to modify it because it would not work for your target population. Include advantages, population fit, and barriers in use of the intervention. You should include the long-term goals, two measurable objectives, and the required resources such as: time, equipment, finances, etc. [Note: you are not required to carry out your intervention but may present it to your practicum site mentor]

VIII. Evaluation Plan

Describe your method for evaluating the objectives of your intervention (for example, pre/post-test, survey, questionnaire, phone interview).  Include one long term goal and two short-term measurable objectives.

Example of goals and measurable objectives:

Goal – To increase my potential for promotion at my place of employment

Objective – Complete all undergraduate nursing courses with a B+ or higher

Objective – Complete the American Sentinel University BSN program before 2020

Goal – To learn about public health nursing

Objective – Describe community health levels of prevention

Objective – List the 8 subsystems of a community

IX. Summary of Sentinel City

Summarize the assets (strengths) in Sentinel City pertaining to the 8 community subsystems. In addition to the “people” (the core) of the community, there are eight subsystems that come together to form the assessment data for your windshield survey, which will contribute to your overall community assessment of Sentinel City. The eight subsystems within every community include: 1) physical environment, 2) safety and transportation, 3) health and social services, 4) education, 5) recreation, 6) politics and government, 7) communication, and 8) economics.

Include your recommendations for improving/strengthening specific subsystems in Sentinel City.  Discuss other recommended changes or additions needed to improve the health of the population living in Sentinel City. Answer: Find the information on the internet

X. Reference List

Include a minimum of 6 references in APA format. The reference list should include relevant websites from state or federal sources and from peer reviewed professional journals. Journal articles do not have to be limited to nursing journals. No more than 50% of references should be from websites.

For the purpose of this assignment cite the Sentinel City demographic data as follows:

U. S. Census Bureau. (2010). American FactFinder fact sheet:  Sentinel City, USA Retrieved January 31, 2014, from https://factfinder.census.gov/servlet/

through your Windshield Survey of Sentinel City to a target population of your choosing. You will complete your project by comparing data from Sentinel City with similar data from the city where your target population lives. Your final project will be a 14-20 slide PowerPoint presentation You must view the Final Project Rubric below in order to accurately complete this assignment. 

Your final presentation will include 10 parts, which are described in detail below.

I. Introduction

Provide a brief introduction that includes the mission statement, vision, and/or the goals of your practice learning site. Answer = Atlanta VA medical center. There mission statement on the internet.

II. Description of Your Target Population

Compose a detailed description of your chosen target population, which is a specific group served by your practice learning site. In this section you will describe the demographic characteristics of your chosen target population, including the population’s socioeconomic status, vital statistics, education level, religion, and occupations. Include a table, graph, and/or figure display that includes relevant demographic data for your target population. Answer Hispanic

III. Comparison of Sentinel City Demographic Data

Compare the demographic data of Sentinel City with the demographic data from the city where your practice learning site is located. You should present this information in a clear to understand table. You can use the Data Comparison Table provided in Module 2. Compare sentinel city to Gwinnett county Georgia

IV. Key Informants

Identify 3 key informants in the city where your practice learning site is located and 2-3 questions you would ask them. Examples of key informants include, but are not limited to: political leaders, health care providers, service providers such as mail carriers or shop owners, members of the fire or police departments and long term residents of the community. People who live and work in the community are a rich source of information and can often provide data not found in printed form. Your mentor from your Practice Experience will serve as the 4th key informant. Include specific quotes in response to the questions you asked your mentor that support and/or contradict information cited in the literature.

V.  Key Health Concerns or Issues

Present a list of the top 3 health concerns for your target population. Provide a brief description of these concerns and include data from you target population city that supports the rationale for selecting these health concerns. Select one of the three health concerns you identified and state why you decided to develop an intervention that addresses this particular health concern/issue. Include the Healthy People 2020 objective that relates to your identified health concerns. Answer: hypertension, diabetes, and Heart disease

VI. Community Health Nursing Diagnosis

Develop a community health nursing diagnosis based on your analysis of the demographic and health status data that you gathered, as well as your conversations with the key informants. You may consult with your practice learning site mentor to help you develop this diagnosis.

Your community health nursing diagnosis should be written using the following format:

Increased risk of (disability, disease, etc.) among (community or population) related to (disability, disease, etc.) as demonstrated in or by (health status indicator, or etiological/causal statement).

Examples:

Increased risk of obesity among school age children related to lack of safe outdoor play areas for children as demonstrated by above average BMI rates. 

Increased risk of depression among persons with a physical disability related to the lack of handicap accessible facilities and social isolation as demonstrated by high suicide rate

VII A & B. Intervention to Address the Diagnosis

Describe your proposed intervention that will address the community health nursing diagnosis for your target population. You may choose to develop your own intervention, or modify one that was recommended by the Task Force on Community Preventive Services (TFCPS).

To view recommended interventions, visit the TFCPS website and select the topic you plan on addressing for your intervention. (Note: at the bottom of most topic pages on the TFCPS website there is a sample on how to cite the webpage. After reviewing the topics, click the “Resources” tab then click “Fact Sheets”. Here you may find fact sheets to share with your mentor at your practice learning site.)

Whether you modify an existing intervention or develop one of your own, you must discuss why this intervention will or why you needed to modify it because it would not work for your target population. Include advantages, population fit, and barriers in use of the intervention. You should include the long-term goals, two measurable objectives, and the required resources such as: time, equipment, finances, etc. [Note: you are not required to carry out your intervention but may present it to your practicum site mentor]

VIII. Evaluation Plan

Describe your method for evaluating the objectives of your intervention (for example, pre/post-test, survey, questionnaire, phone interview).  Include one long term goal and two short-term measurable objectives.

Example of goals and measurable objectives:

Goal – To increase my potential for promotion at my place of employment

Objective – Complete all undergraduate nursing courses with a B+ or higher

Objective – Complete the American Sentinel University BSN program before 2020

Goal – To learn about public health nursing

Objective – Describe community health levels of prevention

Objective – List the 8 subsystems of a community

IX. Summary of Sentinel City

Summarize the assets (strengths) in Sentinel City pertaining to the 8 community subsystems. In addition to the “people” (the core) of the community, there are eight subsystems that come together to form the assessment data for your windshield survey, which will contribute to your overall community assessment of Sentinel City. The eight subsystems within every community include: 1) physical environment, 2) safety and transportation, 3) health and social services, 4) education, 5) recreation, 6) politics and government, 7) communication, and 8) economics.

Include your recommendations for improving/strengthening specific subsystems in Sentinel City.  Discuss other recommended changes or additions needed to improve the health of the population living in Sentinel City. Answer: Find the information on the internet

X. Reference List

Include a minimum of 6 references in APA format. The reference list should include relevant websites from state or federal sources and from peer reviewed professional journals. Journal articles do not have to be limited to nursing journals. No more than 50% of references should be from websites.

For the purpose of this assignment cite the Sentinel City demographic data as follows:

U. S. Census Bureau. (2010). American FactFinder fact sheet:  Sentinel City, USA Retrieved January 31, 2014, from https://factfinder.census.gov/servlet/