Nursing Care Plan Based on Epidemiological Model - Case Study Example

Health Need Assessment Nursing care plan: Based on Epidemiological Model Introduction In this assignment the community and public health of Crawleyin West Sussex will be assessed in order to develop a community nursing care plan with the expectation that it would promote and protect the health of the populations of this community. It will be accomplished using knowledge from nursing, social, and public health sciences. It will be population-based, community-oriented care plan based on this community's problems. The goal of such care is prevention of disease and disability for all people through interventions designed for that specific population. Identification of the Area This health needs assessment will be done surrounding Crawley in West Sussex. This author has been placed in this area for clinical experience. This author had a session of academic learning on health needs assessment, and using this knowledge, the health needs assessment of this particular geographic area can be undertaken. West Sussex is geographically located in the South England. The county of Sussex is divided into the East and West for geopolitical reasons. It is a county with diverse features, and very popularly known to be the county hosting stately homes and castles. Government has protected these areas as countryside, which offers its residents walking and cycling tracks. Crawley and Worthing are the largest settlements, both of which are located along the south coast. Crawley has a population of 99,744. Crawley is the economic powerhouse of West Sussex, and it is the biggest settlement in West Sussex, and it is a new town as per New Towns Act of 1946. Crawley is in expansion ever since it was a New Town that started with expansion which has been ever increasing, leading to a change from peaceful countryside to a busy staging post on the London to Brighton Road. Now there are 13 neighbourhoods of Crawley. Much of the town's employment is derived from the demands of the Gatwick airport and the related travel industry. The town has plenty of open space including among others Tilgate Park, where there is a nature centre including woodlands. It can now be termed as a bustling commercial centre at a hugging connection on the A23 busy London-Brighton Road. Grade I listed buildings are regarded as public spaces in Crawley which are interspersed among the walking paths and cycling tracks. These buildings include the parish church of St Margaret, the parish church of St Nicholas, and Friends Meeting House in Langley Lane. These are linked by a famous cycle path, the Crawley Millennium Greenway. It is a pleasant place to live, since other than other facilities necessary for healthy living, it is considered as a major regional shopping centre. It has good sports and leisure facilities including nightclubs, the Hawth Theatre, and the K2 Sports Centre (Crawley Borough Council. 2007). The Crawley education system belongs to the comprehensive education system. In the whole of West Sussex, there are 36 county maintained secondary schools, one academy, and over 20 independent senior schools. Generally, primary education is provided through a mix of infant, junior, primary, first, and middle schools. The students come from 13 residential neighbourhoods based around the old market town. These areas are separated by main roads and railway lines. These neighbourhoods each have a variety of housing types, terraced, semi-detached, and detached houses. Apart from these, there are numbers of low-rise flats and bungalows. The authorities do not allow residential tower blocks. Almost all houses have their own gardens and are set back from roads. Each neighborhood has been constructed around a shopping area, community centre, and church. There is provision for recreational open space, and each neighbourhood has a dedicated school. Unfortunately despite this, the level of higher education is Crawley population is lower than the national average. The percentage of people having up to class IV education is 20% (Crawley Borough Council. 2007). From the epidemiologic point of view, Crawley has 99,744 population, which accounts for 13.2% of the population of the county of West Sussex. This has a younger population, and it comprises of an ethnically diverse population. About 64.5% of the population is aged below 45, and about 15.5% of the people are from a non-white British ethnic background. In this borough, the percentages of people from Indian and Pakistani origins are 4.5% and 3% respectively. Each acre of its area holds 54 persons, and it is one of the most densely populated districts in West Sussex. The socioeconomic condition of Crawley is sound, since there is a boom in the economy in this region due to its vicinity of the second largest airport in England, and consequently many industries have developed, raising the economy of this area. Consequently the employment rate is high, leading to an improvement in household economy (Crawley Borough Council. 2007). Since the inception of the New Town, there had been expansions in its communication and transport. There has been major road upgrades including development of a motorway link. The airport and its connectivity has been mentioned earlier, and added to this there has been a guided bus transit system that caters to transport of the people of this borough. The London-Brighton highway runs through Crawley, and the Station Road and the High Street are parts of it. Regular train services are available from Crawley to London Victoria and London Bridge stations and Gatwick airport. This easiness of the transport system has further been augmented by regular bus services from Southdown Motor Services and London Transport. Now Crawley's main bus transport operator is Metrobus. This provides local services between the different neighbourhoods and town centre along with other long distance services (Crawley Borough Council. 2007). This is a pleasant place to live in since the rural county nature of England mixes in judicious proportions with the industrial environment of Crawley. Its connectivity, transport, economy all lead to a facilitated living. While the authority takes good care of the education of its population, the other amenities for a pleasant life are not to be overlooked. Sports and leisure are important activities that are promoted in this area. The borough council owns the Broadfield stadium. Football and Rugby are the regular games. There is a golf course located in the Tilgate Park. The Sussex county football league is very famous. On the campus of Thomas Bennett Community College near the Broadfield stadium, the K2 leisure centre is located. It is the training site for 2012 Olympics in London and it harbours an Olympic-sized swimming pool. For other recreations there are quite a few cinema halls, the most prominent of which is Cineworld cinema in the Crawley Leisure Park, which has other than this, a ten-pin bowling centre, various restaurants, bars, and fitness centres. Apart from these centralized games and recreation facilities, each neighbourhood has self-contained recreational areas, and the town has other larger parks. The examples are Queen's square, Goff's park, and Tilgate Park and nature centre. Apart from children play areas, art centres; they house lawns, lakes, boating ponds, large areas of woodlands with footpaths and bridleways. The Tilgate Park has a golfing area and a collection of animals and birds (Crawley Borough Council. 2007). Crawley has a heritage of shopping centres. The Queen's square must be mentioned, since it was the first organized pedestrianized shopping plaza apart from shopping areas in the High Street and the north of the Railway Line. Other retail providers such as Tesco, Sainsbury, and Marks and Spencer have their stores and current plans are underway to expand these shopping facilities to meet the growing demand of the population. These are augmented by the growth of the public services which includes policing by Sussex Police. Statutory emergency fire and rescue services by the West Sussex Fire and Rescue Service which operate a fire station in the town centre. There is an active and efficient ambulance and paramedic service in this area that is run by the South East Coast Ambulance Services. The Town centre health clinic and ambulance station are operative, and the health needs of the community is catered by Crawley Hospital in West Green. This is operated by West Sussex Primary Care Trust, and some supplementary services are provided by the Surrey and Sussex Healthcare NHS trust. A 24-hour urgent treatment centre is operative in the area, and this is dedicated to the services for injuries that are semi life-threatening in nature. However, despite these amenities, the health services are deemed inadequate. Given this situation, the West Sussex County Council provides support to the learning service through School Improvement Support Programme, which includes support for learning in the early years and primary sections. This programme also extends to support for learning in the secondary stage which can culminate into school and professional development services. The programme actively promotes learning in the community that includes programmes like adult education, outdoor education, and school library services (Crawley Borough Council. 2007). Health Services in Crawley are provided by trust regardless of age on the basis of clinical care needs. These cares may be provided through specialist staff as and when indicated. The health services staff is dedicated to provide a comprehensive care to the population. The primary care trust takes care of the health care needs at the point of first contact. It may entail a visit to the doctor or dentist. The primary care service is also extended through NHS walk-in centres and through NHS direct. All these services in Crawley are managed by the West Sussex Primary Care Trust. Bodies like strategic health authorities are responsible for developing plans for improving health services in the local area, and they make sure local health services maintain high-quality services in extended areas of services. This authority also ensures integration of national priorities into local health service plans. The population enjoys a good standard of health and has relatively long life expectancies. However, there are areas where the population is below the current county averages, and the health indices of these people and the community can be done better. The current need is to promote better transport services which will lead to less congestion and less pollution, which can serve to protect the environment and also prevent respiratory diseases. The mental health problem is another issue, and there is a current need to increase these services. This also includes coverage of people who are suffering from the effects of substance abuse, specially drugs and alcohol. Promotion of healthy life style is another area where attention is necessary. Sensing this need, there is a program called Crawley Wellbeing which is intended to help people take their first steps to get well, stay well, and feel well. Local doctors and healthcare professionals can help these programmes. To that end, there is a need to convert the existing health services to become the hub for healthy lifestyle information (West Sussex County Council, 2009). Community Health Problems A population based survey was designed to do a systematic health assessment to identify the most important public health issues of this community. Epidemiology is the study of the distribution and determinants of health-related states or events in human populations and the application of this study to the control of health problems. The core of epidemiology is the use of quantitative methods to study disease and risk factors in human populations. These epidemiologic tools are conventionally great tools in assessing the prevalence and risk factors of any health problems in the community. These procedures analyze the demographic data to discover the causative association between a health problem and the population. Therefore, these would be acceptable tools to design a community nursing intervention to prevent the health problem. The two most important local community problems identified were deficits in healthy lifestyles related to sedentary lifestyle and poor dietary choices and drug and alcohol abuse and addiction (West Sussex County Council, 2009). Community Epidemiologic Data and Population Based Surveillance Although detailed statistic would be necessary and they may be presented following the surveillance Local Community Problems 1. Need to promote healthy lifestyles 2. Promotion of drug and alcohol abuse Nursing Care Plan and Interventions Since these problems are associated with unawareness of the population, this indicates self-care deficit according to Orem's self-care deficit model, and an educative supportive intervention according to Orem can influence the health-related behaviour from Johnson's behavioral systems model. Once educated, people will automatically tend to protect themselves from harmful influences of unhealthy health habits according to Neuman's system model, where they would themselves feel the need for protection from the problem which can be remedied through nursing interventions. For both these identified problems, these theoretical frameworks are applicable. This is the case of a community of people who need to pay attention to healthy lifestyle. The population has no history of any illness, and from the familial point of view, there is no significant history of any illness either. Most are in a stressful job in the inner city involving considerable movement. However, currently, the population leads mostly a sedentary life. The blood pressure recorded shows a higher trend in the population, which is definitely in the hypertensive range. Thus, the population demonstrates indication for future hypertensive heart disease (Jensen et al., 2000, 898-903). This is a matter of concern, and this assignment explores the possibility of this risk modification through lifestyle measures such as exercise (Grandi, 2004, 617-625). Currently, the population is not involved in any planned exercise. However, analyzing their lifestyles, few interesting facts emanate that can be utilized to plan the exercise that is needed for their health. The population is a closed community, like group activities. Therefore, they do not prefer exercising alone, and if offered, they would prefer exercising in a group. This cannot be a regular daily activity for them since they hardly have spare time during the day since they work long hours, sometimes until 8 pm. They get an hour for lunch, and after works, they would be too exhausted to do anything. In the weekends, they are free. They have community centres with gym; and they can afford joining there, and they can drive himself to go there. Many are smokers, and this also aggravates his risk. If the population is considered a client, the pathway of assessment and planning may be tabulated below Current Status Desired Status (Goals) Action Prescribed Adherence Factors Body Composition: BMI 24.2 Client has normal BMI, but given his sedentary lifestyle and hypertension, exercise is indicated without any diet modification Increased activity in the form of exercise. No diet modification necessary. Abstinence from smoking. Client has no spare time. Only weekends are free. Does not like to exercise alone. Likes group activities. Currently sedentary. No current exercise programme. Drives. Although mentioned, given the nature of the drivers, perhaps would not walk and drive everywhere. At least 3 to 5 days of exercise every week including weekends. To start with moderate then going into regular exercise pattern of vigorous activities. To plan appropriate activities to lead to a target blood pressure of at least a diastolic blood pressure of below 90 mmHg. No time for activities on a normal work day. Does not like exercising alone. Free weekends may be utilized for exercising. A group exercise programme may be beneficial. The local gym may be the venue of his exercise with his affordability and driving being used for a regular exercise programme Smoking and alcohol Abstinence from smoking and alcohol To seek help from physicians who can help them quit. None known. Outdoor stressful life may make it difficult. High blood pressure Normal blood pressure with a diastolic below 90 mmHg Exercise and abstinence from smoking. Stress management. Stressful job till 8 pm in the night every day. Stress and meeting with people in the sales profession may be causative. Driving, group activities, and affordability may help an exercise programme. Analysis Hypertension is a well-known risk factor for CAD (Barrios et al., 2008, 400-404). Endothelial dysfunction occurs as a consequence of high blood pressure, probably mediated by reduction of NO, phenomenon that has been demonstrated in most forms of experimental hypertension models. High blood pressure (BP) is the most common risk factor for cardiovascular disease. A sedentary lifestyle is one of the risk factors for hypertension (Phillips et al., 2007, 229-230). Studies of the effect of physical activity on hypertension concluded that aerobic training does reduce BP. Physical fitness training has a graded influence on BP, from a small influence on normotensive people to a larger impact on those with hypertension (Chase et al., 2009). The respective decreases in systolic and diastolic pressures have been reported to be 3/3 mm Hg for normotensive people, 6/7 mm Hg for those with borderline hypertension, and 10/8 mm Hg for people with hypertension. Analyses of research data indicate that people who are physically active experience reduced cardiovascular and all-cause mortality rates (NHS Executive, 1997, 3807). Physical activity is known to have a variety of metabolic and other effects that may partially explain its beneficial effects on BP (Hernelahti, Kujala, and Kaprio, 2004, 303-309). Physical activity may be associated with weight loss. It is suggested that each person perform a moderate amount of activity daily, with the amount of activity emphasized rather than the intensity (Parker et al., 2007, 703-709). The idea is that this offers people more opportunities for activities that fit into their daily lives. It is suggested that people perform this moderate amount of activity for 30 minutes or more on most, and preferably all, days of the week. These activities can take the form of brisk walking, yardwork or other household chores, jogging, or a wide variety of recreational activities. All children and adults should set a long-term goal to accumulate at least 30 minutes or more of moderate-intensity physical activity on most days of the week. Repeated intermittent or shorter bouts of activity spanning less than 10 minutes, including occupational, nonoccupational, or tasks of daily living, have similar cardiovascular and health benefits if performed at a level of moderate intensity (Hu et al., 2004, 25-30). These activities include brisk walking, cycling, swimming, home repair, and yardwork with an accumulated duration of at least 30 minutes per day. People who already meet these standards receive additional benefits from increasing this to more vigorous activity (Stewart, 2002, 1622-1631). During the last few years, the philosophy on exercise recommendations as a means has changed significantly. It is now appreciated that substantial health benefits can be achieved through minimal amounts of regular exercise, regardless of whether exercise results in a measurable improvement in exercise capacity (Greenwood et al., 1995, 583-587). Epidemiologic studies have shown that death rates from cardiovascular causes are considerably lower even among people who engage in modest amounts of exercise, less than the threshold that was generally thought necessary to increase exercise capacity (Hagberg, Park, and Brown, 2000, 193-206). Interventions A. Sedentary lifestyle and poor dietary choices 1. To promote physical activity, people will be encouraged to use the Community Center. To generate awareness about this resource and about the need for physical activity educative health promotion activities will be undertaken. 2. More public education about the harmful effects of obesity and beneficial effects of healthy diet will be instituted. Topics of education may include appropriate foods and foods that contain high fat and cholesterol. 3. People will be encouraged to use community parks. 4. Health Department should be requested to disseminate more health promotion about obesity and appropriate food. 5. Motivating programs such as health and exercise competitions and creating social networks that promote healthy food habits and need to reduce weight through diet control and exercise (Hanlon et al., 1998, 343-346). B. Cardiovascular Diseases 1. Health education through involvement of the Health Department on importance of cardiovascular health and its risk factors such as high cholesterol, hypertension, diabetes, diet, smoking, exercise, obesity, and alcohol and need for lifestyle changes. 2. Utilization of local parks, community center, hospital clinics, local physicians, and other community workers to disseminate information and education in the community. 3. Smoking and alcohol reduction campaign utilizing the school students. 4. Community-based diabetes awareness program 5. Encouragement of personal responsibility to induce a lifestyle change as described in part A. Evaluation Following implementation of these interventions, the incidence of obesity, changes in food habits, and incidence of cardiovascular disease can be assessed again based on community surveillance studies, and the data can be compiled to assess the improvement or deterioration. While implementing these interventions, it is important to remember that many interventions are also designed on education of the healthcare professionals. The diet and weight may be assessed on direct interview with the family. As expected both weight, food habits, and other parameters of lifestyle-associated cardiovascular risk factors to ultimately culminate into reduction in heart disease and changes in food habits and exercise patterns. The disease prevalence may be assessed from hospital records. All the members of the community are vulnerable, and it is expected that these interventions would help reduce the incidence. Since this care plan is based on epidemiologic data after 6 months of time, implementation of these interventions would lead to positive results. This can be reflected in another population based survey in this community that would result in decreased prevalence of the conditions mentioned earlier (Hensher and Fulop, 1999, 90-95). Conclusion Thus to know the health needs of the community, it is important to consider several factors. Geographic and geopolitical factors such as locality, housing, transport, education, and schooling, all occupy important roles in the needs assessment. In this assignment some of these have been highlighted. But the problems have been chosen from two angles, one is the life style associated risk factors which may occur even of the people have access to healthcare, and the other is problem with accessibility of healthcare that are not available to the people due to deficiencies in the service. A needs assessment must consider all the angles to be able to point out to the problem and to find out a solution. Reference and Bibliography Chase, NL., Sui, X., Lee, D., and Blair, SN., (2009). The Association of Cardiorespiratory Fitness and Physical Activity With Incidence of Hypertension in Men. Am J Hypertens; 23 (1). 399 - 417. Crawley Borough Council, (2007). Crawley Borough Council website. Retrieved from http://www.crawley.gov.uk/stellent/idcplgIdcService=SS_GET_PAGE&ssDocName=PR2405&ssTargetNodeId=99&strCSS=PB1_SS_MAIN on February 22, 2009. Grandi, AM., (2004). Hypertensive heart disease: effects of lifestyle modifications and antihypertensive drug treatment. Expert Rev Cardiovasc Ther; 2(4): 617-25. Greenwood, DC., Muir, KR., Packham, CJ., and Madeley, RJ., (1995). Stress, social support, and stopping smoking after myocardial infarction in England. J Epidemiol Community Health; 49: 583 - 587. Hagberg, JM., Park, JJ., and Brown, MD., (2000). The role of exercise training in the treatment of hypertension: an update. Sports Med; 30(3): 193-206. Hanlon, P., Murie, J., Gregan, J., McEwen, J., Moir, D., and Russell, E., (1998). A study to determine how needs assessment is being used to improve health. Public Health; 112(5): 343-6. Hensher, M and Fulop, N., (1999). The influence of health needs assessment on health care decision-making in London health authorities. J Health Serv Res Policy; 4(2): 90-5. Hernelahti, M., Kujala, UM., and Kaprio, J., (2004). Stability and change of volume and intensity of physical activity as predictors of hypertension. Scand J Public Health; 32: 303 - 309. Hu, G., Barengo, NC., Tuomilehto, J., Lakka, TA., Nissinen, A., and Jousilahti, P., (2004). Relationship of Physical Activity and Body Mass Index to the Risk of Hypertension: A Prospective Study in Finland. Hypertension; 43: 25 - 30. Jensen, JS., Feldt-Rasmussen, B., Strandgaard, S., Schroll, M., and Borch-Johnsen, K., (2000). Arterial Hypertension, Microalbuminuria, and Risk of Ischemic Heart Disease. Hypertension; 35: 898 - 903. NHS Executive (1997). The new NHS. London: Stationery Office , 1997(Cm 3807.) Parker, ED., Schmitz, KH., Jacobs, Jr, DR., Dengel, DR., and Schreiner, PJ., (2007). Physical Activity in Young Adults and Incident Hypertension Over 15 Years of Follow-Up: The CARDIA Study. Am J Public Health; 97: 703 - 709. Phillips, SA., Somberg, LB., Perme, A., Das, EK., and Gutterman, DD., (2007). Abstract 1140: Chronic Exercise Protects against Macro- and Micro- vascular Endothelial Dysfunction Induced by Acute Hypertension during Exertion. Circulation; 116: II_229 - II_230. Stewart, KJ., (2002). Exercise Training and the Cardiovascular Consequences of Type 2 Diabetes and Hypertension: Plausible Mechanisms for Improving Cardiovascular Health. JAMA; 288: 1622 - 1631 West Sussex County Council, (2009). Getting the Right Health Care Retrieved from http://www.westsussex.gov.uk/ccm/content/social-care-and-health/health/getting-the-right-health-care.enpage=9 on Febryary 22, 2009 Read More