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E Folio Community Nursing 1

E-Folio Community NursingFrostburg State University

Drew Chapman

12/2/2013


E Folio Community Nursing

According to the AACN Baccalaureate Essentials for professional nursing practice these

are some of objectives achieved in the Community Nursing course written in essentials VII

clinical prevention and population health. Health promotion, disease, and injury prevention

across the lifespan are essential (American 2008). Studies have helped identify major

determinates in population health such as lifestyle, environmental and genetic factors (American

2008).

.

Exemplar

I decided to choose the community health assessment as the exemplar. This assignment

focuses many of the objectives mentioned in the AACN Baccalaureate Essentials for

professional nursing practice. Some of the topics that this assignment and the essentials had in

common were treating the population of people to help the most rather than addressing each

individual’s problems. Health promotion and prevention when it comes to community nursing is

always a priority.


Reflection

The health assessment assignment demonstrates many common positive denominators in

comparison with the Professional nursing practice essentials VII. Some of the common topics

discussed in both were the importance of primary prevention in population focused nursing. This

includes screenings, educating the public, and immunizations. They both also touch on the idea

of looking and analyzing an entire area or group of people. Then taking in all the information

about the specific population and address the most occurring health concerns in that community.

In addition, it is necessary to think about other factors that could impede a community from

achieving or not achieving health goals and objectives. Then after analyzing every aspect of the

population such as age, education, average salaries, geographic location, access to health

facilities, access to supplies, schools, and environmental factor this can help us correct problems

in the community to help them improve community health.


ReferencesAmerican Association of Colleges of Nursing (2008).The Essentials of Baccalaureate Education for Professional Nursing Practice. AACN Board of Directors. Washington D.C 20036 https://blackboard.frostburg.edu/bbcswebdav/pid-1097665-dt-content-rid-2090759_1/courses/2138NURS402_705_COMB/BaccEssentials08%282%29.pdf

https://blackboard.frostburg.edu/bbcswebdav/pid-1097665-dt-content-rid-2090759_1/courses/2138NURS402_705_COMB/BaccEssentials08(2).pdf

https://blackboard.frostburg.edu/bbcswebdav/pid-1097665-dt-content-rid-2090759_1/courses/2138NURS402_705_COMB/BaccEssentials08(2).pdf


Community Health Assessment on the Scott Key Center

Frostburg State University

Drew Chapman

11/27/13

AbstractThis community health assessment will most likely be one of the more unique health

assessment than others because we will be looking at the Scott Key Center population as our

community and we will also look at the surrounding communities in Frederick County.


The Scott Key center is a non-profit organization that provides support to individuals

with intellectual disabilities to work towards maximum independence and community

integration. The Scott Key Center offers creative and meaningful employment within the

Frederick community. Basically the Scott Key Center functions as an employer for people with

learning disabilities. I will be referring to the Scott Key Center as SKC for further reference.

Clients at the SKC have a wide range of level of functioning which can determine what

jobs are best suited for each individual. Clients provide janitorial services, green house, mailing,

assembly and production, document shredding, toner cartridge remanufacturing, and some work

in the community at local restaurants and other businesses.

We will be looking at the SKC clients as our community population for the health

assessment. I will discuss specifics regarding the SKC clients and their community such as age,

Ethnicity, Race, Mortality, Population, Gender, Amenities in the community, Health services,

Social systems, and air quality to name a few. We will look at anything and everything that could

impact the lives and health of the clients at the Scott Key Center in the community setting. Lastly

we will examine the top three health risks of the clients at the SKC.

Community Health Assessment

LocationThe Scott Key Center is located in Frederick Maryland northwest of downtown, take 15

north to Rosemont Avenue to Rocky Springs road. Appendix C and appendix D show Frederick


County on the map and also the urgent care centers and hospitals in the region. Frederick County

has been a fast growing county over the last decade now having more than 240,000 residents in

the 2012 census (City Data). The SKC only provides its services to Frederick County residence

only. The SKC is just a few miles away from Frederick city and about a 50 minute drive to major

metropolitan areas like Baltimore and Washington D.C; where your more sophisticated hospitals

and health services are located. Frederick Memorial hospital is the hospital in the Frederick

region located pretty much in city quarters and just a few minute drive from the SKC.

The Clients at the SKC (Community)The demographic at the SKC is well diversified with young and old and variety of levels

of functioning. Most of the clients at the SKC attended Rock Creek School or the Success

program which is a school that educates students with learning disabilities. Most of the clients

have a high school certificate and a couple clients who are higher level of functioning have a

high school diploma. All clients at the SKC have a diagnosis of some type of learning disability

such as Autism, Down syndrome, or learning disabled and this is a requirement in order to enter

into the program because this is how a client is able to get funding through the DDA

(Developmental disabilities administration). Ages at the SKC range from 18 to 70 years of age.

From my random sample of the total 120 clients that work at SKC I choose 31 clients and the

average age came out to be 47.7 years of age, see appendix H. Ethnic backgrounds at the SKC is

of the total 120 clients is 14 African American, 103 Caucasian, and one Indian, see appendix G.

The gender ratio is 57 females and 63 males for the 120 total clients. Employment and income at

the SKC varies from client to client. As I said before the SKC is an employer for the clients.

Depending on the individual the money they can earn varies. Some clients at the SKC only have

the capability to do piece work where they are paid by the piece i.e.: every piece of paper


shredded or every eight tea bags placed in a box they will receive compensation. Some clients

are able to work and make minimum wage or more working on janitorial crews or working at

local businesses in the community such as retailers or restaurants. The SKC helps the client find

and keep these jobs out in the community. Mortality at the SKC is statistics since 2006 and has

had one death from seizure disorder, two related to cardiac event (congenital heart defect), one

from cranial aneurysm, one from CVA, one related to Alzheimer’s, and one from colon cancer.

Social SystemLiving arrangements vary from client to client. Seventy two clients out of the one

hundred and twenty live at home with family. Other clients live in group homes. The clients at

the SKC have a few group homes that most of them utilize. A couple of the clients live

independently with minimal assistance. The population in Frederick city by the census in 2012

was about 66,000 and has been a 25% increase in the number of residents in Frederick’s urban

area (City data 2012). As stated earlier the income of the clients at the SKC varies. The median

household income in 2011 was 61,000 and in year 2000 it was about 48,000 dollars (City Data

2012). The estimated median house or condo value in 2011 was about 236,000 and in year 2000

it was 134,000 (City Data 2012). The median rent in Frederick was 1,250 dollars in 2011 (City

Data 2012). Only one client at the SKC has their driver’s license and commutes to work every

day on their own. Most of the clients utilize the SKC fleet of vans and bus service to get to and

from the center and work. There are 102 clients out of the total 120 that utilize the vans and

buses for transportation. Some of the clients have family drive them to the center as well.

The SKC has many healthcare facilities in its vicinity easily available for the clients and

nearby neighborhoods. Frederick Memorial hospital is the main hospital in Frederick County.


Other options for hospitals for Frederick county residents would be Carroll Hospital Center in

Westminster (35 miles), Shady grove Hospital (25 miles), Johns Hopkins in Baltimore (40

miles). The more invasive and highly specific medical treatment a person needs they will need to

go to hospitals in Washington D.C and Baltimore. There are five urgent care centers within the

region. Four of them are within a 5 to 10 minute drive and one that is about a 20 minute drive.

Most of these urgent care centers are run through the same entity as Frederick memorial hospital.

There is one on Buckystown pike, one on Frederick Crossing lane, one on south main street in

Mount Airy, one on Oak Street in Frederick, and Worthington Boulevard in Frederick. All

clients at the SKC are required to have a primary care physician and other subspecialties such as

neurologist to be able to enter into the program. The SKC is required to monitor the client’s

health and maintain documentation records of anything medical regarding the client. Clients

have an option of receiving their medications while at SKC. Due to being a government entity

the SKC is supervised strictly and needs to abide by rules and regulations set by government

agencies that provide the funding needed to continue the program.

The water supply to the SKC is city water as well as the local large communities in the

area. Mostly the older built homes in more rural areas are not connected to city water, they

would be more likely on well water. Frederick County in the past year in January of 2013 they

started a Renewable Waste-to-Energy Facility located on Metropolitan Court in Frederick

Maryland. It’s an eleven acre site and it takes solid waste, bio-solid’s, and tires; they collect from

Frederick and Carroll County. You can find the link in appendix L. There are several local parks

in the Frederick area. Frederick city has a recreation area and park right in the middle of the city

called Baker Park. Other parks within a 10 mile radius of SKC are Memorial Park, Gambrill

Park, Rosehill Manor Park, Pinecliff Park and Ballenger Creek Park. Air quality in Frederick is


monitored and sent out reports by the Frederick County Health Department. You can look at

appendix E for the Air quality chart which is from the Frederick County Website. Frederick’s air

quality is almost always in the green level which is the highest quality of air one could breathe.

Windshield SurveyMy windshield survey is based on two local communities. We will look at Whittier and

the downtown Frederick area. There are two pictures of both areas located in appendix F.

Whittier is a larger community which is just a five minute drive from SKC. Whittier also has

many amenities located inside the community. It has an Elementary school Whittier elementary

school. It also has strip malls full of local businesses. The community has single families,

townhomes, and condos all of which have well-kept roads with street lighting and sidewalks. The

community also has a nice little lake with fountains. The community also offers its residents a

community pool during the summer months.

Downtown Frederick has historical buildings, retail stores, businesses, restaurants,

churches and schools. Some of the churches date back to the early 1900’s. There are about eight

churches located in Frederick’s downtown area and has mixture of about 9 elementary, middle,

and high schools within a 15 mile radius of SKC. Some of these schools include Crestwood

Middle, Thomas Johnson Middle, Monocacy Middle, West Frederick Middle, Frederick High,

Thomas Johnson High, Tuscarora High, Parkway elementary, and Maryland School for the Deaf.

The downtown area has more issues than the suburban areas like Whittier. There are some areas

within the city where there are people hanging around on the front steps of their row houses

smoking. Some of the homes are in need of repair, needs painting, or other upkeep needs. Some

areas in downtown have uneven sidewalks which make exercise more difficult; but it also offers


a park in the middle of the city where it has a stream running through it and offers picnic area

and community pool. It is very common to see people playing tennis on the courts, people

playing soccer or throwing Frisbee in the open fields. There are some parts of downtown

Frederick that have nice single family homes in good condition. These homes are older Victorian

type that were built many years ago and their range in sale price is significantly higher than the

norm. There are several playgrounds and fields throughout the downtown area as well as fitness

centers. There is a new Sport and Health up at Market Square just a 5 minute drive from the

downtown area and one on Buckystown pike. There is a YMCA located 5 miles away from

downtown and SKC. There is an indoor recreation facility very close to Baker park which is the

park located in the downtown area. The downtown area also has Frederick memorial hospital and

two urgent care centers within a five minute drive. There is a large nursing home that just was

built right next to SKC called Citizens nursing home. There are several nursing homes available

within the area such as Homewood, Country Meadows, and North Hampton Manor. There are

large strips of legal and medical offices within 15 minutes of SKC on Thomas Johnson Dr. On

this street there are physical therapy offices, primary care, orthopedic, Ear, nose and throat

doctors, x-ray and MRI centers.

Frederick County Community Annual Report

This is Frederick County’s Health Department Annual report of 2012. This report touches

on many aspects of the Frederick County’s Health department has done for the community to

help the residents of Frederick. They have made progress in improving the mental health services

for residents in Frederick. This report shows they have created new substance abuse treatment


programs and prevention which is run by mental health therapists and other clinicians. They have

also taken strides in helping people with gambling addictions. They have also been able to

provide additional outpatient clinics for mental health services. The report touches on helping the

problem of lack of dental services to our children. They have shown that they have improved the

access to oral hygiene for children. The report talks about community health services provided

such as the Cancer prevention and education screening program. Other topics discussed in the

report is School Health, Developmental center, Environmental health, Public health

preparedness, and the Scott Key Center. You can find the link to the Frederick County annual

report in Appendix A.

The Top Community Health needs at the SKC

The top three health priorities for the clients of Scott Key Center are Obesity,

Hypertension, and Seizures. These three problems are the most important health diagnosis and

the most common community health concern at the SKC. The number one community health

diagnosis at the SKC is obesity. There are a lot of clients who are overweight or obese according

to BMI (body mass index). Refer to appendix I for the pie graph on average BMI of clients at the

SKC. The data is shown representing 31 clients. From the sample of 31, 20% of clients BMI was

under 25, 42% had a BMI between 25 and 30, 19% had a BMI between 30 and 35, and another

19% of the clients had a BMI over 35. The data shows that 80% of the clients have a BMI over

25; a BMI over 25 is considered overweight. BMI over 35 is considered morbidly obese which

accounts for 19% of the sample. BMI information is from National heart, Lung, and Blood

Institute. BMI is not always an accurate method of measuring or evaluating a person’s ideal body

weight. There are a variety of factors that are not included in a BMI calculation. It does not


consider the person’s body girth and muscle that can weigh more than fat. Some people who

have good physical health with more developed muscles and wider frames than the average

person would not be an individual would use BMI as an accurate method to deciding ideal body

weight. I believe the clients at the SKC show high BMI’s because they of a few reasons. One is

the access to healthy foods. Almost all of the clients in one way or another is dependent on

someone to do the grocery shopping and to supply them with food to eat. And the one who live a

more independent life are more likely to have limited money resources and may find it difficult

to buy healthy food choices with the money they have every month. Another aspect we need to

think about is each individual’s ability to think for themselves and have the knowledge to make

the right food choices. One of my educational activities played on this idea. I gathered pictures of

a variety of foods good and bad and I asked the client, “Please choose four food items you think

are healthy for you that won’t make you fat.” After that I asked them 50/50 questions, “Which

food is better for your health?” This ice cream or this bowel of vegetables? After a complete

evaluation of my results it has shown that about 51% of the clients were able to identify the

correct healthy foods most of the time. But identifying and actually choosing and eating the right

foods is a different thing. The things we need to do to resolve this problem is by teaching the

clients as much as we can and to lead by example. Families and the staff need to lead as

examples and eat the right foods. Finding support people to help the clients who can’t make the

right food choices is also another intervention. Addressing the issue of obesity would also lower

the mortality of the SKC population according to the top reasons for death. Since 2006 two

clients died from heart disease, one from CVA, one colon cancer, and one cranial aneurysm. All

of these medical diagnosis can be prevented or significantly lower the risk if the clients lost

weight.


The second community diagnosis is Hypertension. According to appendix J, hypertension

is the leading medical condition. There was 13 clients out of 31 that has hypertension (41.9%).

That means the patient’s blood pressure is over 140/90 most of the time (Medicine plus). I also

considered clients hypertensive if they were on a hypertensive medication. I was not very

surprised about my top community diagnosis. The client’s blood pressure is most likely

influenced by the client’s body weight. There is a higher incidence of people with hypertension

or are overweight in addition to many other medical conditions like diabetes. I choose to address

hypertension in my health assessment because of its prevalence at the SKC and the high costs it

will have on their health in the future. It is important to address hypertension because this will

prevent organ and artery damage which increases the client’s risk of atherosclerosis and heart

disease. As we saw earlier in the mortality rates if we can prevent heart disease and

atherosclerosis we can eliminate 50% of the total mortalities in the last eight years.

Lastly the third priority for the community health assessment is seizures. A common

medical condition that the clients have at the Scott Key Center. There seems to be a higher

incidence in seizure disorders in individuals with learning disabilities. Appendix K shows a

visualization of the distribution of medical diagnosis. The graph shows that 35 out of 120 clients

have a seizure disorder (29.1%). The SKC already has measures in place to help address this

issue. The SKC keeps records of all clients who have a history of seizures and documents every

seizure a client has while at the center. Many of the clients are also on anti-seizure medication

and see a neurologist. Some also follow special diets to decrease the chances of seizures.

Seizures was chosen in my health assessment because 30% prevalence is too high to ignore.

Although in most circumstances there is little we can do to prevent a seizure other than

medication and diets. But we can educate staff and care givers what to do in case a client starts


having a seizure. We first need to think of the clients safety first when the seizure starts.

Remove furniture or items away from the client that could harm the client. If the client is having

a seizure in a chair it may be safer to lower the client to the floor to prevent a fall. We can also

educate staff and caregivers to take notes on the movements and duration on the seizure as well

as any other specific’s. Take notes on which body parts move or twitch, note level of

consciousness of the client, and note the eye movements and pupil size. All this information can

be very valuable to a neurologist. There is medical literature that has been recorded that can

pinpoint the locations of brain that are causing the seizure by the physical representation of

certain body movements.

The Healthy People 2020 ranked heart disease and stroke as priority 21 and nutrition and

weight status as number 29. Hypertension was not on the list. Access to health services,

adolescent health and Chronic back conditions/ arthritis were the top three health priorities in the

2020 initiative. I do not think it is justifiable to list the top health priorities at the SKC in

accordance to the healthy people 2020 because the clients at the SKC are a unique demographic

unlike any other group. This is written by the U.S Department of Health and Human Services.

The healthy people 2020 uses leading health indicators as the framework for their goals and

objectives for the United States. They select and organize the leading health indicators by using

health determinates and health outcomes for the basis of this report. They look at factors such as

social and physical environments, multi-sector policies, individual behaviors, and health services

available to the public. They also keep in mind all the stages of life and each of their

perspectives.

Goals and Objectives for the Scott Key Center clients


Goal #1

Clients at the Scott Key Center will be active participants their own health maintenance and promotion or

have support persons to help them make smart healthy choices.

Clients at the SKC have a variety of level of functioning. Some clients at the center have the capacity to

make smart decisions health wise and others do not. I performed an educational activity on healthy food

choices and about 50% of the clients were able to correctly identify healthy food choices and poor healthy

food choices; I.E “Which is better for your health a brownie sundae or a chicken salad?” Some clients

would choose a brownie sundae. We will try to teach the clients as much as we can about maintaining a

healthy lifestyle such as food choices and exercise. This is the number one goal because this can help in

resolving the first health concern at the SKC which is obesity. The majority of the population at SKC is

overweight or obese and this is a problem. If we can get the clients at a healthy weight we can further

reduce the chances of other morbidities that come with being overweight such as developing diabetes and

hypertension. We can hit two birds with one stone in this case.

Objectives for goal #1

Clients will identify one or more ways to promote a healthy lifestyle.

Clients will identify healthy food choices or have support people to help them make

healthy food choices.

Clients will put into practice the identified ways to promote a healthy lifestyle.

Goal#2


Staff and caregivers will learn about the relationships between poor diet and lack of exercise by

learning about chronic diseases such as hypertension, diabetes, obesity, and heart disease to help

themselves as well as the clients at Scott Key Center. As well as teach about seizures; what to do,

medications, and what to note when a client is having a seizure. In this goal we are able to cover the

last two top community health needs- hypertension and seizure disorders.

Objectives for goal #2

Clients or their support persons will identify one or more ways to lower blood

pressure.

Clients will monitor their blood pressure or have a support person manage their blood

pressure.

Clients or support persons will learn about seizure control to prevent seizures and

document seizure events.

ReferencesNational Heart, Lung and blood institute. BMI National institute of health. Retrieved from http :// www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm

Department of the Environment Frederick Maryland. State of Maryland government. Retrived from http :// mde.maryland.gov/programs/Land/SolidWaste/Pages/Programs/LandPrograms/ Solid_Waste/index.aspx

City-Data.com. Frederick MD area. Retrieved from http:// www.city-data.com/city/Frederick- Maryland.html


Medlineplus. High Blood Pressure. Retrieved from http:// www.nlm.nih.gov/medlineplus/ency/article/000468.htm

Healthy People 2020 (2012). Healthy people 2020 brochure in PDF. http://www.healthypeople.gov/2020/TopicsObjectives2020/pdfs/HP2020_brochure_with_LHI_508.pdf

Appendixes

Appendix A

Frederick County’s annual report

http://www.frederickcountymd.gov/documents/19/Annual%20Report%202012%20FINAL%20web%20version_201212031547089006.pdf

Appendix B

Transportation of clients

102; 85%

18; 15%

Transportation for SKC clients

Clients who use SKC buses or vans Clients who do not

Appendix C



http://www.healthypeople.gov/2020/TopicsObjectives2020/pdfs/HP2020_brochure_with_LHI_508.pdf



Frederick County

Appendix D

Urgent Care and hospitals in the Area


Appendix E

Air Quality in FrederickAir Quality Index

Levels of Health ConcernNumerical

Value Meaning

Good 0-50 Air quality is considered good, and air pollution poses little or no risk.

Moderate 51-100 Air quality may pose a moderate health risk,

especially for those who are unusually sensitive to air pollution.

Unhealthy for Sensitive Groups 101-150

Members of sensitive groups, children and adults with respiratory and heart ailments, may

experience health effects and should limit time spent outside. The general public is not likely to

be affected.

Unhealthy 151-200 Everyone may experience health effects and

should limit their outdoor activity; members of sensitive groups may experience more serious

health effects.

Very Unhealthy 201-300 Everyone may experience more serious health effects and should avoid outdoor activities,

especially individuals with heart and breathing


ailments, children, and older adults.

Appendix F

Two pictures of nearby communities of Scott Key Center: Whittier (left) and Downtown Frederick (right).

Appendix G

Ethnicity of the clients at the SKC

African American Caucasian Indian 0

20

40

60

80

100

120Ethnicity out of the total120 clients

Series 1 Column2 Column1

Appendix H


Age of Clients at the SKC

Under age 2525 to 35

35-4545-5555-6565-75

75 and older

0 1 2 3 4 5 6 7

Age of clients at the SKC

Series 3 Series 2 Series 1

Appendix I

BMI of SKC client’s

BMI under 25; 6; 19%

BMI between 25 and 30; 13; 42%

BMI between30 and 35; 6; 19%

BMI 35 and over; 6; 19%

BMI distribution

BMI under 25 BMI between 25 and 30BMI between30 and 35 BMI 35 and over

Appendix J

Top health concerns at SKC


Hyperte

nsion

Cerebral Palsy

Asthma

Hx of c

ancer

Epliepsy Pica

0

6

12

Diagnosis

Clients out of 31 Column2

Appendix K

Top health Concerns continued

Seizure disorder Diabetes Alzheimers/Dementia0

10

20

30

40

Clients out of 120

Clients out of 120

Appendix L

Waste-to-Energy Facility

• HTTP:// MDE.MARYLAND.GOV/PROGRAMS/LAND/ SOLIDWASTE/DOCUMENTS/WWW.MDE.STATE.MD.US/ASSETS/DOCUMENT/FRD%20CO%20WTE/SWP%20FRED%20WTE%20FACT%20SHEET.PDF


Appendix MHealthy People 2020 link in PDF. http://www.healthypeople.gov/2020/TopicsObjectives2020/pdfs/HP2020_brochure_with_LHI_508.pdf



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