NURS 465 TIU Stakeholders for The Yakima County Washington State Community Assessment

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COLLEGE OF NURSING WASHINGTON STATE UNIVERSITY N465: Application of Population Health Principles Guidelines for Presentation of Community Assessment Findings Purpose: This assignment meets course objectives 1, 2, and 3 by demonstrating: • Application of community and public health nursing concepts to communities and populations with identified health needs • Utilization of methods of community analysis as a basis for community planning and program development • Application of relevant research, theory, framework models, and concepts from the professional literature relevant to community/population nursing and public health • Ability to disseminate information to your professional peers Presentation (anticipated 3 hours of practice experience time): The presentation will be in the form of an infographic. An infographic is a visual representation of information, data, and knowledge intended to present complex information quickly and clearly for the intended audience. Key information for the infographic should come from your community assessment and plan of action to address the identified health issue. Your informatic should tell the story of your community/population. The Infographic must contain: ➢ Clear identification of your population/community ➢ Demographic information: 3-4 population characteristics (i.e. age, gender, SES, education, housing status, etc.) and compare to the same data at the local, state, and national levels. This helps identify how your population may be similar or different from the population at large. Use graphic format with legends on infographic at county/state/national levels. ➢ Health disparities identified – compare for similarities and differences of your community/population to those at the local, state, and national levels ➢ Determinants of health identified – at least 3 that impact the community/population ➢ Priority problem statement (etiology and supporting evidence) ➢ Data driven plan of action – based on Minnesota Model of Public Health Interventions and the Logic Model from chapter 5 in the Savage Text. ➢ Proposed interventions and outcomes ➢ Evaluation plan ➢ Submit separate Word document with references in APA format. Includes at least 3 current evidence-based journal articles and 3 additional demographic sources (including websites) and citation from the Savage text is expected. COLLEGE OF NURSING WASHINGTON STATE UNIVERSITY N465: Application of Population Health Principles • • Resources: (Please do not pay for software). Free software for the construction of an infographic is available at https://piktochart.com/ . Or https://www.canva.com/design/play?category=tACFahzNhT4&type=TABQqtO7tYQ Or – instructions for using PowerPoint: https://graphicmama.com/blog/how-to-make-aninfographic-in-powerpoint/ Port Gardner Community Assessment and Plan of Action for a North Everett Neighborhood By Amanda Klipp Population Characteristics 8,156 Total Population Port Gardner is one of 19 neighborhoods in Everett. Considered part of North Everett, Port Gardner includes some of the original areas from when Everett was first established as a city. This area also contains part of Downtown Everett, the Everett Transit Hub and Train Station, and part of the Port of Everett Median Income $73,775 75k $67,521 $66,023 50k $38,600 Percentage of Population that is White Port Gardner 25k 75.8% Everett 65% Area 0 Washington Port Gardner Everett National Income ($) 67.5% Nationally Washington 60.1% 0 25 50 75 100 Percentage Determinants of Health Percentage of Community Paired with Primary Care Provider Median Gross Rent 1500 1,515 1,337 1,316 1,096 1000 500 ng St at es to n ish m Snohomish County (77.6%) te d W as hi ho ni United States (77.2%) Washington (76%) Healthy People 2030 Goal (84%) U Sn o Ev er et t 0 Rent ($) Food Stamps Prevalance Port Gardner 30.1% 21.5% Everett Snohomish County 11.8% Washington United States 13.9% 13% Identified Health Disparities Mental Health Substance Abuse Polypharmacy Priority Issue The main health concern shared among interviewees was concern about mental health in the community. Mental Health and access to services in the community 2018 Rates of Depression among 10th Graders This included: access to care homelessness (which is exacerbated by mental illness) recovering from the change of life from the Covid-19 pandemic 47.9% 38.2% 28.1 Female (41.94%) Homeless per 10,000 (2021) Male (24.61%) Combined Rate (33.45%) 30.1 30 Mentally Unhealthy Days 20 Snohomish County Average 4 . 1 Washington State Average 13.8 10 0 4 . 0 Everett/ Snohomish County Washington Plan of Action Priority Intervention: Reintroduce Mental First Aid Classes Mental or Psychological First Aid is: “humane, supportive, and practical help to support fellow human beings suffering serious crisis events”.5 It is an evidenceinformed approach with the goal of promoting an environment with five essential elements – (1) safety (2) self- and community-efficacy (3) calming (4) connectedness (5) hope – all of which have received empirical support as restoring social and behavioral functioning". (From The World Health Organization (WHO)’s 2011 Guide for Field Workers, quoted by Gispen & Wu, 2018) Benefits of Mental First Aid Classes Improved knowledge of mental illness Improved ability to identify individuals with mental illness Improve ability to attribute behaviors to mental illness Reduce stigma around mental health Promote positive beliefs around treatment Increase utilization of care Implementing Mental First Aid #1 Select evidence based curriculum #2 Identify local partners #3 Select public sites (ideally from partners) to promote services: Everett Public Library, shelters, and local healthcare provider offices #4 Select sites to provide classes: Everett Public Library and local shelters #5 Collect data on participants before starting classes, immediately after completing classes, and 6 months after completing classes. #6 Evaluate effectiveness of classes Goals Certify 500 Port Gardner/ North Everett Residents in Mental Health First Aid 50 of 500 Individuals involved with shelters Evaluation Reduction in reported mentally unhealthy days following implementation of Mental First Aid courses in community Increase in reported self-efficacy in accessing mental health care and supporting others with mental illness Thank you for Reading! :D 1 Community Assessment Practice Experience Journal 1 Ebrima Darboe Washington State University NURS465: Population Health Principles Professor Joan M. Caley, MS, RN, ARNP, PHCNS-BC February 21, 2022 2 Practice hours and overview As of now, I have completed 24 hours of work on the community assessment project. As I recall, the community assessment was supposed to be conducted in this order, yet I always made sure that I conducted the assessment before looking at the statistics and demographics pertaining to Yakima County. Being aware of the environment and surroundings is what helped me to become more aware of my surroundings. After conducting the assessment and observing the neighborhood deeply, I was amazed by the findings. Seven neighboring counties surround Yakima County in south central Washington state. To the west, the Yakima is densely forested with mountainous terrain, while to the east, it is mostly arid with rolling foothills and fertile valleys. Agriculture has been Yakima's main economic activity for decades. My drive through Yakima began with a part that I am unfamiliar with. In my observation of this part of the community, I observed that children lack safe places to play, nearby grocery stores and a nearby elementary or middle school. Two strangers of Hispanic descent questioned me when I was walking through the evening. Once the questioning had reached confrontational levels, I produced my military identification and explained my work. Suddenly, I saw a change in their attitude towards me. Ultimately, these two men ended up being pivotal to my project's success. It was mainly Hispanic communities I worked with. In addition to talking with community leaders, I was able to attend community events. As the day progressed, I noticed many homeless people in nearby homeless settlements. I researched Yakima County statistics after conducting the assessment. According to my research, the three greatest community needs are: 1) behavioral health challenges and access to care, 2) lack of access to healthcare services, 3) homelessness, and 4) child obesity epidemic (Faubion et al., 2012). The more information I gathered, the more clearly I saw that all the community needs I mentioned are the major concerns. I was more confident about the assessment when I was able to connect what I identified to the actual need. 3 Reflection It was my first time in Yakima County, so I drove around an area I was unfamiliar with. Conducting a community assessment and identifying what the community needs was difficult when researching my own community. This bias makes me blind to the needs of my community since I must have a bias towards my community. The needs in my area of the city aren't as apparent as those in the area I live in. I was amazed to see the differences between the lifestyles of the community members after interviewing them. According to one individual I interviewed, there were no health disparities in their lives, as they always had access to good insurance and doctors at their disposal. This person has never experienced financial hardships, so they have always had easy access to healthy foods. Meanwhile, I interviewed a number of people who were opposite in every way. Their kids had no safe place to play because they lived in an unsafe neighborhood. A number of services were offered in that neighborhood that attracted homeless people. The fact that I interviewed six different people with completely different lifestyles in different parts of Yakima is quite remarkable. The differences occur because of factors such as lifestyle, income, education, and other determinants of health. Goals for community assessment program In the next phase of the assessment, I plan on gathering pertinent information and identifying the top 3 factor that affect health disparities in the community. In order to identify a priority health issue that I might be able to target for my community, I would like to review the interview answers in more detail and compare them one to another. In order to reduce health disparities in the community, a plan must be developed. 4 ANA Standard of Practice for Public Health Nursing My nursing practice was based on the American Nurses Association's Standard 1 for community health nursing, which is "The public health nurse gathers comprehensive data on the health status of the community" (American Nurses Association (ANA), 2007. p. 1). The act of assessing patients is something I do consistently at work; however, assessing a population or community felt very different. Earlier, I mentioned that I carefully assessed the situation visually before gathering relevant data. It was a relief to me to find out that the windshield survey had identified a need in the community, and this made me feel that I was on the right track. My experience in my community has led me to think I might be performing the assessment more often now. My continuous assessment will help me identify more community needs, which will allow me to develop possible programs. Scholarly peer reviewed article This evidence-based article examines factors that play into neighborhoods' health status in Chitewere et al. (2017). Several factors are taken into account such as political, economic, and social factors and the effects they have on individuals. As I interviewed people about their neighborhoods, I found this article relevant to how they felt it was affecting their family's health. It was great to read this article since it took into consideration more than just safety, parks, and sidewalks, etc. This paper explores how neighborhood disadvantages and health disparities persist and identifies social inequality. There are many interpretations of any given concept presented by the author, but definitions are also explained to clear up any confusion. According to the author, the topic he explores does not take a conventional approach because it examines the neglected and underexamined ways neighborhoods are formed, which sheds light on several forgotten aspects of the connection between neighborhoods and health. In 5 his article, he discusses the importance of social factors and promoting equality. My mind goes to "why must this neighborhood persist?" After reading this article, I ask myself, "why should this neighborhood persist?" According to the people I interviewed, the neighborhood has been steadily deteriorating. Their children are unsafe and she doesn't always have access to health care. The article examined neighborhood safety among other things. The researchers found that negative perceptions of neighborhoods decreased people's willingness to improve their neighborhoods. This article has given me a new perspective and ideas/methods to reduce modifiable social and political factors in relation to this population. This was due to decreased collective efficacy. 6 References American Nurses Association (2007). Scope and Standards of Public Health Nursing Practice American Nurses Association. chromeextension://efaidnbmnnnibpcajpcglclefindmkaj/viewer.html?pdfurl=https%3A%2F%2Far chive.dialogue4health.org%2Fphip%2FCHPHLI%2FPDFs12_13_10%2FStandards_of_P HN_Practice_2007.pdf&clen=22377&chunk=true Chitewere, T., Shim, J. K., Barker, J. C., & Yen, I. H. (2017). How neighborhoods influence H=health: Lessons to be learned from the application of political ecology. Health & place, 45, 117–123. https://doi.org/10.1016/j.healthplace.2017.03.009 Faubion, R. J., Brown, J., Bindler, R. C., & Miller, K. (2012). Creating a community coalition to prevent childhood obesity in Yakima County, Washington: Rev it up! 2008. Preventing Chronic Disease. https://doi.org/10.5888/pcd9.110243 https://worldpopulationreview.com/us-cities/yakima-wa-population 1 Community Assessment Practice Experience Journal 2 Ebrima Darboe Washington State University NURS465: Population Health Principles Professor Joan M. Caley, MS, RN, ARNP, PHCNS-BC March 6, 2022 2 Community Assessment Practice Experience Journal I am now 40 hours into my practice hours for community assessment. I have accumulated a lot of hours during which I composed emails and interviewed some key informants throughout the community. Through literature reviews and research for my paper and journal, I have also collected evidence to support my topic. Reading course materials and completing discussion posts accounted for the remainder of my hours. As part of my outreach efforts, I sent emails to several key stakeholders within my community, including the chairperson of the planning commission, the city administrator, and several healthcare providers from the Yakima County health district. The emails I sent have yet to receive a single response; I also sent a copy of the questionnaire but have yet to receive a reply. However, despite my disappointment, there is not enough time between writing this journal and my correspondence. While I am investigating alternative stakeholders with whom to speak with, I am trying to identify those who might be more willing to participate. I was unable to connect with pertinent members of the city council during my short time on this project. However, it has been an extremely valuable learning experience for me since it demonstrates the challenges that everyday people face when attempting to contact their city officials regarding issues within our communities that may be unnoticed. Reflection Working on this assignment has also given me the opportunity to realize that underinsurance affects the community in which I live. Among all counties on the West Coast of the United States, Yakima County has the highest COVID-19 infection rate with 519 cases per 3 100,000 residents as of early May 2020. Lack of medical insurance is one of the factors believed to be responsible. Additionally, Yakima County is more socioeconomically vulnerable than other Washington counties. According to the 2017 Census Bureau, Yakima County's inflation-adjusted per-capita income was approximately $41,331, compared to the state and national per-capita incomes of approximately $57,896 and $51,640 respectively. As of 2017, Yakima County has an 18% poverty rate. This is significantly higher than Washington State's 9%, where 18% of adults are uninsured, as compared to 9%. Uninsured adult and child rates in Yakima County are higher compared with rates in the state (11.8% and 3.8%) and federal (14.8% and 5.7%) (Firebaugh et al., 2020). Goals for Community Assessment Program In order to move this project forward, my main goal is to find key stakeholders who will be willing to participate in the project, especially public health personnel. I felt behind in completing my assessment of the community due to my inability to communicate with some stakeholders. Nevertheless, I won't let that stop me from seeing this project through. Through perseverance and determination, I aim to leave a positive mark on the health of my community and especially the future generation (the children). Scholarly Peer Reviewed Article Apart from literature reviews, by Chitewere et al. (2017), and another study performed by Lee, et al. (2017), I have chosen to review an analysis by Lee, et al. (2017) in which the authors explore the combined influence of racial and ethnic factors, income factors, and health status factors on health insurance coverage and healthcare access. As a population source, Lee, et al. 2021, based their analysis on the 2017 Medical Expenditure Panel Survey (MEPS). The study 4 excluded participants aged 65 and older from the sample due to the confounding effect of their Medicare participation. The vulnerability measurement and insurance coverage status of the sample population were compared by Lee, et al. (2021). Several predisposing and enabling characteristics were considered for calculating vulnerability measures, such as demographics, social structure, and cultural beliefs, and health status or pre-diagnosed illness (Lee, et al., 2021). According to Lee, et al., 2021, vulnerability groups were categorize and the coverage status was summarize as a percentage. According to this study, income status and insurance coverage are strongly correlated, with lower income households having a higher rate of uninsured or underinsured populations (Lee, et al., 2021). A study found that racial and ethnic minorities were more likely to lack and be underinsured based on their insurance status (Lee, et al., 2021). As a minority in my chosen community, I believe this study is relevant because of the risk of inadequate health insurance coverage and limited healthcare access. This study has limitations, including the design of the study itself, where Lee et al. (2021) write that because "the dataset is cross-sectional, a causal relationship can't be established between individual socioeconomic characteristics and insurance coverage" (p. 7, para. 3). A sample population with limited information on the risk factors and limited sample size was also mentioned by the researchers (Lee, et al., 2021). 5 References Chitewere, T., Shim, J. K., Barker, J. C., & Yen, I. H. (2017). How neighborhoods influence H=health: Lessons to be learned from the application of political ecology. Health & place, 45, 117–123. https://doi.org/10.1016/j.healthplace.2017.03.009 Firebaugh, C. M., Beeson, T., Wojtyna, A., Bravo, L., Everson, T., Johnson, J., & Saldana, A. (2020). A community case study on geographic, environmental, and social health disparities in covid-19 disease: Yakima, Washington. Open Journal of Preventive Medicine, 10(11), 288–297. https://doi.org/10.4236/ojpm.2020.1011021 Gaffney, A., Dickman, S., Cai, C., McCormick, D., Himmelstein, D. U., & Woolhandler, S. (2021). Medical uninsurance and underinsurance among US children: Findings from the national survey of children’s health, 2016-2019. JAMA Pediatrics, 175(12), 1280-1281. https://jamanetwork.com/journals/jamapediatrics/articleabstract/2783319?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_sourc e=articlePDF&utm_content=jamapediatrics.2021.2822. Lee, D., Liang, H., & Shi, L. (2021). The convergence of racial and income disparities in health insurance coverage in the united states. International Journal for Equity in Health, 20(96). https://doi.org/10.1186/s12939-021-01436-z.
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Community Assessment for Stakeholders for the Yakima County Washington State

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1) Behavioral health challenges and access to care
According to Firebaugh (2020), the Yakima Health District has invested in bringing the virtual
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