COMMUNITY HEALTH FIELD PROJECT
The community fieldwork was carried out in Fairfax country, part of the state of the Commonwealth of Virginia. The country is considered to be the second richest county across the United States in view of the median household income. The total area of the county is estimated at 1,050 square kilometers (406 square miles) (Economic, Demographis and Statistical Research, 2015). Out of this total area, 391 square miles are made of dry land, while 15 square miles are made of water. The total population of Fairfax county is 1,094,774 persons, with 287,451 households and 417,147 households. 62.68 percent of this population are Caucasian, while African-Americans, Native Americans, and Asians make up 9.15 percent, 0.51 percent, and 17.98 percent respectively. A majority of the population, 36.9 percent, are between ages 25 and 44, while 27.8 percent are below eighteen years (Suburban Stats, 2016). On the other hand, those with ages between 18 and 24 make up 7.09 percent of the population, while 25.8 percent and 7.97 percent include those with ages between 45 and 65, and those above 65 years respectively. Being among the richest counties, Fairfax County has well developed infrastructure in terms of roads and other social amenities. It has various recreational resources including parks, biking trails, pools, and playgrounds. It also has well connected streets and roads, which efficiently accommodate traffic (Economic, Demographis and Statistical Research, 2015). A majority of the residents use personal vehicles for transportation. Nevertheless, there is a rich network of cabs, which is complemented by the metro transit that connects the metropolitan regions. The county also has some of the best hospitals in the US, including Fair Oaks and INOVA Fairfax, which provide care services to its residents. The education system of the county is also well established, with top ranked public schools and catholic schools, and various institutions including the University of Fairfax providing tertiary education (Economic, Demographis and Statistical Research, 2015).
Health Concern Studied
During the fieldwork, I explored the problem of stroke in Fairfax County. a stroke is a condition that leads to the death of cells in the brain as a result of deprived supply of oxygen in a certain part of the brain. According to Healthy People 2020, heart conditions form the main cause of death in the US, with stroke being ranked third among the leading causes of death across the US. Combined with heart disease, stroke is highly prevalent and costly to the US. In 2010, the Nation incurred $500 billion as a result of stroke and heart disease related health care (Healthy People 2020, 2016). Stroke is an equally issue of great concern in Fairfax county, standing among chronic lower respiratory disease and cardiovascular disease as the leading causes of death in the county. Important is the fact that most of the risk factors that are associated with stroke are modifiable. The factors include: high levels of cholesterol; diabetes; high blood pressure; overweight and obesity; cigarette smoking; and lack of physical activity and poor diet (Healthy People 2020, 2016; Seshadri & Debette, 2016). These conditions have a long-term impact on the blood vessels, including increasing their rigidity and reducing their elasticity, which increases the chances of developing heart attacks, strokes, and heart failure.
The stroke related death rate in Fairfax is 30.4 per 100,000 persons. This is lower than the Healthy People 2020 target of 34.8 per 100,000 persons and the US median of 46.0 per 100,000 persons. The older adults are at more risk of developing stroke in Fairfax County with a death rate of 209.2 per 100,000 persons (CDC, 2016). This could be attributed to the prevalence of other chronic conditions such as diabetes, hypertension, overweight, and obesity among this population. Individuals between ages 45 and 64 and those between 18 and 44 have a death rate of 8.7 per 100,000 persons and 1.6 per 100,000 persons respectively (Virginia Department of Health, 2015). There is no enough data to show the prevalence of stroke among individuals under the age of 18 years in Fairfax. There is unequal distribution of resources in the county, which affect the access to health. Such resources include employment, health, health resources, insurance coverage, and socioeconomic resources. The wages received by the workers in the county are defined by their level of education, hence low levels of education lead to lower wages (Lowrey, 2014). The Caucasian population in Fairfax has more opportunities for insurance coverage, quality education, and job accomplishment as compared to the other ethnicities and racial groups (Stephens, 2015). As such, the minority groups in Fairfax are more exposed to social and environmental factors that increase their risk of developing stroke or being exposed to stroke risk factors. Some of these disparities include inadequate access to treatment, increased exposure to risk factors, poor care leading to poor treatment outcomes, inadequate access to timely and appropriate care, and the high rate of mortality. This could explain the high death rate of 36.5 per 100,000 persons among Asians and 33.7 per 100,000 persons among African Americans in Fairfax county as compared to 28.9 per 100,000 persons among whites (CDC, 2016).
Primary Community Resources and Partners
There are various resources in Fairfax County that have been put in place to prevent and manage the high rate of strokes. One of the resources is the availability of 911 emergency services which allow individuals at the risk of stroke to be quickly transported to a health care facility for early intervention (Fairfax County Government, 2016; Fairfax County Government, 2016). The county also has four stroke centers that serve both men and women, which help to diagnose, manage, and rehabilitate persons at the risk of stroke. In addition, the county is home to Health South Rehab Hospital, which is nationally ranked as seventh among centers for stroke treatment and management considering its 71.5% community safe return rate. On the other hand, individuals who want to be treated from home receive such services from home health agencies in the county. the county also has 24 rehab nursing homes that care for stroke patients. The State government has also established an agency for secondary and primary prevention referred to as the Fairfax Community Health Care Networks (CHCN) which provides the residents with services such as education, teaching, and early diagnosis of stroke under the sponsorship of Medicare and Medicaid (Fairfax County Government, 2013). The Fair County Public Schools have also organized free camps throughout the county that allow individuals to learn more about stroke and the various measures that they can put in place to prevent the health condition.
The fieldwork interviews provided information related to the causative factors of stroke. It was clear from the interviews that most of the factors that led to the stroke among the residents of Fairfax was lack of physical activities and poor diets which later lead to the development of diabetes, overweight, and obesity. One of the respondents in the interviews mentioned that despite the availability of biking trails, he was not able to go biking because of lack of time. He also mentioned that he owned a car and thus drove to work and back home, or to many place that he wanted to visit. It is clear that the level of physical activity in Fairfax is low with most people using personal vehicles to ferry them around, hence limited walking. In addition, most people were working and hence reported to lack time to cook and hence highly depended on fast foods from convenient food stores, most of which are high in calories, an aspect that highly contributes to weight gain and an increased intake of cholesterol, thus exposing them to increased risks of stroke.
Aspects of the population health concern not being addressed
As much as most of the efforts put in place by the partners are directed towards creating awareness of the problem of stroke and testing for the risk factors, it is clear that the social factors such as unemployment among the minority groups, who form the majority of those affected by stroke, remain unaddressed. Unemployment reduces the capacity of these populations to access healthy foods as they cannot afford them and instead end up consuming junk cheap foods that are high in cholesterol and calories, thus effecting their health and predisposing them to stroke.
C. Outcomes Identification
One of the desired outcomes in the case of Fairfax is to prevent the occurrence of stroke related modifiable risk factors such as diet related diabetes, obesity and overweight, high blood pressure, poor diet, and high cholesterol intake. Another desired outcome is equality in terms of accessibility to health services across the county among members from diverse racial, ethnic, and socioeconomic groups to allow for early detection and management of strokes or stroke related risk factors. Lastly, another goal for intervention is increased awareness among members of the public of the various issues that surround stroke including the modifiable risk factors and how behavioral change can affect such factors, and the signs of stroke that can allow them to seek clinical help.
Nursing Action Plan
Considering that most of the risk factors that lead to the development of stroke are modifiable, one of the steps that should be taken towards reducing the prevalence of stroke in Fairfax is educating the public on behavioral consideration that they ought to make to prevent this condition. Creating awareness through community forums and discussions would allow the community members across the county to understand the relationship between their behavior, such as dietary behavior and physical activity, and their health outcomes. Such education should involve the health care professionals from the stroke centers across the county. On the other hand, strict policies should be put in place to reduce the prevalence of convenient food stores across the county as this would encourage individuals to prepare healthy food at home. Lastly, it is important for the state government to consider promoting equality in terms of employment by developing policies that would encourage workplace diversity as this would increase employment opportunities and hence income for individuals from the minority races, thus allowing them to afford both insurance coverage, quality health care, and healthy diets.
Population-focused specific objectives
- Increased efforts should be directed at reducing the stroke related death rate among individuals above 65 years of age by 30 percent by the end of the year 2016 through nutritional education and promotion of physical activities.
- Increasing free camps by 50% across the county by 2016 to allow for increased accessibility of health care services among individuals with low socioeconomic status at a low cost.
Potential public and private partnerships
To facilitate nutritional education of the older adults in order to promote proper dietary behavior and increased physical activities, it is important for health care providers including physicians and nurses to partner with nutritionists, dieticians, and physical education professionals in providing older adults with their age specific information while keeping ibn mind their general physiological changes and the social support that they receive. Home health agencies should also be involved in monitoring the dietary practices of their elderly patients to ensure compliance with the guidelines. On the other hand, health care providers from the stroke centers, Fairfax Community Health Center, and the Fair County Public Schools should be involved in a partnership that would allow them to create additional free camps that would allow them to educate members of the community on the best health care practices that would avert stroke related risk factors, and to provide them with free services including screening for stroke related risk factors and providing individuals with the necessary treatment to prevent stroke. Such free services would allow the unemployed and those with low income to access quality health care.
|Permit Obtaining from local authorities|
|Printing pamphlets and brochures on stroke risk factors|
|Training participants (health care professionals, nutritionists, dieticians, and physical fitness instructors)|
|Hiring of Venues|
|Educating older adults on diet and physical activities through forums, during hospital visits, during home care, and during public rallies|
|Educating and treating of Community members through free camps|
To evaluate the success of the intervention actions, the rate of deaths due to stroke will be reviewed. A decrease in stroke related deaths is a clear indication that individuals were able to learn on how they can avoid the risk factors that contribute to the development of stroke. On the other hand, a reduction in the rate of people who eat away from home, especially those who eat in convenient food stores would also indicate positive dietary behavior. Lastly, a review of the rate of employment and enforcement of policies that promote diversity at the workplace would be used to assess the efforts put in place by the government to ensure that equality in employment is promoted across all races.
fieldwork has allowed to clearly understand the social, political, and
environmental factors that underlie the health of the community, which in most cases
are not properly address by the national, state, or county officials. By
depriving individuals, especially those from minority populations, an opportunity
to access proper education, employment, and insurance, such individuals are
denied the opportunity to access proper health care. As such, there is need for
authorities to consider creating a level ground for each individual to access
the same quality of education and employment, amidst improving the health care
sector, in order to promote equality in terms of household income and hence
affordability of health care.
CDC. (2016). Stroke deaths: Fairfax County, VA. Retrieved from Centers for Disease Control and Prevention: http://wwwn.cdc.gov/CommunityHealth/profile/currentprofile/VA/Fairfax/881
Economic, Demographis and Statistical Research. (2015). Demographic Reports 2015: County of Fairfax, Virginia. Retrieved from Fairfax County Government: http://www.fairfaxcounty.gov/demogrph/demrpts/report/fullrpt.pdf
Fairfax County Government. (2013). Community Health Care Network (CHCN). Retrieved from Fairfax County Government: http://www.fairfaxcounty.gov/hd/pcs/hdchcn.htm
Fairfax County Government. (2016). Contact / Directions. Retrieved from Fairfax County Government: http://www.fairfaxcounty.gov/police/contact/
Fairfax County Government. (2016). Text-to-911 Service is now live in Fairfax CountyOUNTY!!!! . Retrieved from Fairfax County Government: http://www.fairfaxcounty.gov/911/text-to-911/
Healthy People 2020. (2016, July 9). Heart Disease and Stroke. Retrieved from Healthy People 2020: https://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke
Lowrey, A. (2014, March 15). Income Gap, Meet the Longevity Gap. Retrieved from New York Times: http://www.nytimes.com/2014/03/16/business/income-gap-meet-the-longevity-gap.html?_r=0
Seshadri, S., & Debette, S. (2016). Risk Factors for Cerebrovascular Disease and Stroke. New York: Oxford University Press.
Stephens, A. (2015, June 25). Fairfax County Faces Stark Stats on Income Inequality. Retrieved from Next City: https://nextcity.org/daily/entry/fairfax-county-jobs-income-inequality
Suburban Stats. (2016). Population Demographics for Fairfax County, Virginia in 2016 and 2015. Retrieved from Suburban Stats: https://suburbanstats.org/population/virginia/how-many-people-live-in-fairfax-county
Virginia Department of Health. (2015). Virginia Health Indicators. Retrieved from Virginia Department of Health: http://www.vdh.virginia.gov/healthpolicy/healthequity/minorityhealth/documents/va_healthindicators/Tour%20of%20VA_Alexandria_Arlington_Fairfax.pdf