Community health nursing refers to application of nursing practice and public health or community health practice with an aim of promoting and preserving the health of populations. The practice involves general and comprehensive services. It does not have limits to particular groups or diagnosis and maintains continuous service delivery (American Nurses Association, 1980). Currently, many changes in the delivery of healthcare services have occurred including healthcare financing, health policies, healthcare focus and methods of delivering health services. This aims at maintaining healthier communities through prevention of health problems. Community health nurses need to assess the community to identify health needs and come up with appropriate community diagnosis which guides interventions. The discussions below involve the assessment and formulation of community diagnoses for Fairfax community.
Description of Community (Community Assessment)
The community is found in Fairfax County at the state of Virginia. It has a population of about 1.01 million people. This community owns a lot of assets, which makes it rich. It consists of several races and ethnic groups. The people have a good education. The community has high per capita income and abundant community resources such as social, intellectual and cultural ones. However, there is uneven distribution of resources among the residents of the community. Some segments of the community have low socioeconomic status, poor health status, lack of insurance coverage, unemployment and differences in life expectancy.
The Fairfax community has the highest population in the state of Virginia. Its population has increased by about eleven percent, and it is expected to grow steadily over the next few decades. Most of the people in the community are growing old. The total population is increasing, and growth occurs across all the age groups. The community comprises of diverse racial and ethnic groups. Fairfax County forms the major employment market in the state. It has low employment rates as compared to the rates for the whole state. It has high educational attainment with more than half of the population having graduate degrees. Approximately 58,000 people in the county live in poverty, and 3.5 % of families live in poverty. The percentage of residents having health insurance cover is slightly higher than for the nation. Although the county has a lot of wealth, more than one out of ten residents lacks health insurance cover. The residents of the county have higher quality of live. The county records low crime rates. It also has high quality and well-distributed recreational, cultural and educational facilities.
The county has well-distributed safety net resources, technologically advanced hospitals and ambulatory care centers. Despite this, it has few primary healthcare services and faces a growing demand of the same. The hospitals recorded decreased percentages in terms of discharges, and hospital stays attributed to advanced technology and even distribution. The residents of the community can access health services provided by both private and public institutions at no or reduced cost. The local government funds three health centers to provide primary health services together with ten charity organizations. The community has long-term care facilities that provide services to the retired people and other adults. The healthcare workforce in the county is reducing due to aging and retirement of the staff. The new workforce entering the primary healthcare is inadequate to replace those retiring. The number of nurses in the state is projected to be reduced by 2015.
The quality of air in the Fairfax County is rated as the poorest in the Virginia state. The water quality is low as most of the marine and freshwater for recreation does not meet the water quality regulations and guidelines. Risk of lead exposure to children is low with less than one percent of children under the age of three months were found to have elevated blood lead levels. Lyme disease cases have increased by 13% in the last decade. The incidence is highest during early summer months. In the year 2000, 19 cases were reported, and in 2009, 260 cases were reported.
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Maternal, Child and Adolescent Health
The percentage of children born with low birth weight, that is weight below 2500 grams, was 24.6 % of the total live births. Infant death rates were 21.4 per 1000 live births. Neonatal death rate was 24.4 per 1000 live births. Teenage pregnancy was 33 per 1000 females.
Behavioral Health and Disabilities
Fairfax has many individuals with mental problems as compared to other counties in Virginia. The youths aged 10-24 years and the elderly aged above 65 years are at a greater risk of committing suicide. In 2009, the 32.8 % of students in public schools reported instances of depression, with 37.6% reporting symptoms of attempting suicide. Substance abuse among the youth in the community is low. Individuals with disabilities in this community aged over sixteen years and above access employment opportunities to a lesser extent than those without disabilities. The community has 67,000 individuals with disabilities representing 6.6% of the total population. The most prevalent disabilities among adults include ambulatory, independent living and hearing disabilities. The community has more than 24,000 students with disabilities receiving special education.
Weight, Nutrition and Physical Activity
Fairfax has 58.1% of adults who are overweight and obese. The rate of obesity among children has also risen. Most of the residents eat the required servings of food in a day. More than half of the community population is physically inactive. The youth engage in sedentary activities such as computer games, other electronic games and other non-academic activities which reduce their physical activity.
Interpretation of Data
The infant mortality rate in the community was 21.4 per 1000 live births, and neonatal death rate was 24.4 percent. This can be attributed to low birth weight of the children, which puts them at a high risk of infections. The total population growth rate of the county is 11%. This growth is high and can be a result of the improved healthcare services; this raises the life expectancy of the population. The percentage of poverty is 5%, which can aggravated by unemployment and disabilities. The incidence of Lyme disease increased from 19 cases in the year 2000 to 260 cases in the year 2009. The increase may have occurred due to environmental changes in terms of climate change. The prevalence of overweight and obesity among the adults is 58.1%, which occurs due to a sedentary lifestyle and reduced physical activity.
The presence of disabled people makes them lack employment, which then increases poverty levels. People become overweight and obese due to the lack of physical exercises and activity. Low birth weight leads to higher risks of neonatal and infant deaths. During the climate changes, especially when it approaches summer, the cases of Lyme disease increase.
Appropriate community diagnosis can be made based on the identified health needs such as low birth weight, environmental problems, poverty and lack of physical activity. They include inadequate maternal health services to provide prenatal care to pregnant women, inadequate services to provide primary prevention with respect to teenage pregnancies, inappropriate environmental care to maintain quality air, and knowledge deficit of the community with respect to the importance of physical activity to avoid obesity.
Community health nursing forms an important field in the provision of primary healthcare services. It prevents the occurrence of illnesses in the community. The activities aim at encouraging the population to maintain good health status through promotion of healthy lifestyles. Community nursing contributes to success of primary healthcare services.
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