Running head: HEALTHY COMMUNITY 1

Creating a Healthier Community: The Community Nurses Role

in Promoting a Healthy Community
Marlee Griggs
University of South Florida









HEALTHY COMMUNITY 2
Creating a Healthier Community: The Community Nurses Role in Promoting a Healthy Community
This paper will introduce a Florida county, analyze the strengths and needs of that
county, and then use the needs to guide the selection of a priority health issue. The priority health
issue will be explored through the development of primary, secondary, and tertiary interventions,
while looking at the role of the community health nurse and other stakeholders. This paper will
focus on Hillsborough County, which is a large urban area of 1,277,746 residents. The three
major employers are the School District of Hillsborough County, MacDill Airforce Base, and
Hillsborough County Government (Suncoast Employers, 2011). The three largest healthcare
systems include BayCare Health System, Florida Hospital, and Tampa General Hospital. Some
key facts about the population and socioeconomic status of residents include the following: the
number of families living below the poverty level is 15% for the county compared to 14.7% for
the state; 66% of the county population is older than the age of 25 with a high school diploma
compared to the states 65.7%; 1.6% of the county is older than age 5 and does not speak English
compared to the states 11.9% (Florida Department of Health [DOH], 2013). An analysis of
Hillsborough County reveals a priority health issue that a community health nurse is uniquely
trained to help resolve through the development of evidence-based community interventions.
Through the use of the DOHs information, three strengths of Hillsborough County
became apparent and they include: injury and violence, social and mental health, and maternal
and child health. One way to measure injury and violence is through violent crimes, like forcible
sex offenses, which speaks to the safety of a community. Hillsborough County has seen a
significant reduction in this type of violent crime, and the countys three year rate is 39.4
compared to the states three year rate of 52.7. A component of social and mental health is the
rate for domestic violence; Hillsborough Countys rate has consistently decreased over the years,
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and from 2010-2012 had a rate of 583.0 compared to the states rate of 586.5. This is an
important area to assess because it helps depict the mental health of the community. A childs
school readiness at kindergarten entry is an element of maternal and child health. Children in
Hillsborough County have a rate of school readiness at 96.2, compared to the state rate of 91.1.
Women and children are often the most affected by poverty, but this rate demonstrates one
strength of the community. (DOH, 2013)
Three needs were found under the following health indicators: communicable diseases,
chronic diseases, and health resources availability. Communicable and infectious diseases can be
measured by looking at the rate of vaccine preventable diseases. From 2010-2012, Hillsborough
County ranked poorly in this area in comparison to the state with a rate of 1.7 compared to the
states rate of 1.2. This information represents a threat to the health of the county as residents are
contracting diseases that can be prevented with a vaccine, which affects the morbidity and
mortality of residents. One of the chronic diseases that can be measured to gauge the health
status of the community is diabetes. The percentage of adults with diagnosed diabetes in
Hillsborough County is 11.7% compared to the states 10.4%. Looking at chronic diseases is
relevant because it shows an area where further education is needed. Health resources
availability is important because it determines what health-related resources residents have
access to. The number of full-time Hillsborough County Health Department employees can be
used to measure this indicator, and the county has significantly less in comparison to the state of
Florida, with a rate of 36.3 compared to the states rate of 62.3. (DOH, 2013)
The health indicator that this paper will focus on as the priority health issue is
communicable and infectious diseases, specifically focusing on the rates of vaccine preventable
diseases for vaccine-targeted age groups. It has become increasingly popular for parents to not
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provide immunizations for their children and it not only affects their child, but the population as
a whole, which is depicted by the data from the DOH. Vaccinations have had a huge impact on
the health and wellness of communities and have drastically decreased the mortality rate, and it
is important to decrease the vaccine preventable disease rate for vaccine-targeted age groups
occurring in Hillsborough County. (DOH, 2013)
Community health models can be utilized as a framework to assess community health
issues. The Determinants-of-Health model was developed as part of the Healthy People2020
initiative, and it explores the questions of what makes one healthy vs. unhealthy and what can be
done to create a society where everyone has a chance to live long, healthy lives. There are
several categories that encompass the model and a community health nurse can utilize these
different categories to assess a health issue and implement interventions that influence these
factors to improve the health of a population. (U.S. Department of Health and Human Services
[HHS], 2014).
There are two major factors that contribute to the priority health issue and include health
system and lifestyle. The health systems involvement is demonstrated in a study by Benin and
colleagues where both vaccinators and nonvaccinators expressed a fear of mistakes being made
and had experienced instances where their previous children had received the wrong vaccination;
these mistakes led to the mothers questioning whether the pediatrician could be trusted
(Benin,Wisler-Scher, Colson, Shapiro, & Holmboe, 2006). Another reason given by those that
choose to not vaccinate is the feeling that they are alienated in the health care system and they do
not have the support they desire. These feelings lead to distrust of the pediatrician, and in turn,
the development of a trusting relationship with someone that practices naturopath or homeopath
and supports not vaccinating (Benin et al., 2006). It is becoming a popular lifestyle choice among
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individuals and families to not vaccinate their children. Benin and colleagues looked at how a
mother decided whether or not to vaccinate and focused on three main areas related to making
decisions about vaccinations (2006). A mothers key sources of information was the first domain
and the mothers that chose not to vaccinate used trusted sources such as homeopath or
naturopath, books, the Internet, and Mothering magazine; whereas those that chose to vaccinate
most often viewed the pediatrician as their trusted source of information (Benin et al., 2006). A
negative nursing diagnosis was developed to address the priority health issue and it states: A risk
of contracting vaccine preventable diseases among children in Hillsborough County related to
parental concerns about vaccine safety as evidenced by an increase in the rate of vaccine
preventable diseases in the county compared to the state.
Using this nursing diagnosis as a framework, the community health nurse can then
develop interventions to help resolve the priority health issue facing Hillsborough County. An
intervention that focuses on the primary level of prevention is essential in ensuring that parents
will choose to vaccinate their children. One research article discussed that one inhibitor to
mothers deciding whether to immunize their children or not was their experience with the
medical community (Benin et al., 2006). This intervention would focus on a group of
individuals, in particular, pregnant mothers and their partners. The objective of this intervention
is to promote health through building trusting medical relationships with the parents before the
child is born, to increase the likelihood of parents choosing vaccination. The stakeholders
involved in this intervention include community members and health care providers. The
intervention will include several community based educational meetings that will discuss
important immunization information. The community health nurse can be involved in several
facets of this intervention, such as meeting with local OB/GYNs and pediatricians to recruit their
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assistance. It is also within the community nurses scope to lead the planned meetings and
provide the educational information on immunizations. Benin and colleagues found that the
mothers who fell in the nonvaccinators group, wanted to build a trusting relationship with
traditional pediatricians, but were unable to because they could not find the support they were
searching for (2006).
The intervention for the secondary level of prevention focuses on a system-wide
approach. Research completed by Fielding et al. shows that the use of an Immunizations
Information Systems (IISs) increases the immunization rates and decreases the number of
vaccine preventable diseases (2014). The IISs is a confidential computer database used to record
all immunizations given by participating providers in a prescribed area. Implementing an
intervention like IISs in Hillsborough County would allow for the surveillance of the
immunization status of residents and would help gather data to tailor further interventions to
those who are not vaccinating their children. The involved stakeholders include community
members, legislators, and healthcare providers. The IISs is beneficial to community members
because it helps increase compliance with the developed immunization schedule, which leads to
a healthier community. It also would allow for healthcare providers to use the system to send
reminders to clients and receive feedback and assessment from clients which can help improve
services (Fielding et al., 2014). One could take this intervention a step further by contacting
legislators and seeking their participation in creating policies or laws that mandate all providers
to be a part of the IISs. A community health nurse is pivotal in the process as an advocate for
participating in the IISs, inputting the data, and delegating tasks to appropriate personnel. The
nurse could also be involved in meeting with local legislators to discuss the IISs to better the
health of the community.
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The intervention to address the tertiary prevention level will focus on individuals in the
population and the involved stakeholders include community members and health care providers.
One potential complication of deciding not to vaccinate is that parents put their child and others
children at risk for contracting a vaccine preventable disease. If a child has contracted a disease,
it will be important for the health care provider to be involved and ensure that the child receives
necessary treatment. The provider will help the family deal with the consequences of the disease
by providing necessary treatments and following up with the patient to complete preventative
exams and ensure there are not long term effects or other health issues occurring. The healthcare
provider can also ensure that there is not a further impact on health by working with the parents
to have the child receive other needed vaccinations. Education will also be necessary to help
prevent the spread of the disease to other family members or residents of the community. An
important role for the community health nurse in this level is providing education to the families.
The Centers for Disease Control and Prevention (CDC) published a book for parents as a guide
to immunizations which can be used by the nurse to discuss any questions or concerns with the
family (2012).
The proposed interventions can be used to develop health policies that influence the
delivery of health care and ultimately the health of the community. A policy is a blueprint that is
used to guide the decisions made in the present and the future (Merriam-Webster, 2014). Health
policy and health care are directly related in that policies are established to guide the delivery of
health care across all different levels-organizational, local, state, national, and international. The
health policy proposal will focus on the primary level of prevention and will provide
immunization education to pregnant mothers and their partners. The goal is to promote the health
of the community by building trusting relationships between parents and the medical community,
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so parents will be more likely to immunize their children. Community members and health care
providers are the stakeholders affected by the proposed health policy. Those that would support
the health policy include health care providers, public officials, legislators, and funding sources.
These supporters have the ability to be a strong influence because they are in positions of power
within the community. Their influence and support can be a driving force behind accepting the
policy of improving vaccination rates among children in Hillsborough County. Potential
opposing forces would include community members, and while their influence may not be as
powerful as the supporters, it is not negligible. Community members have the power of personal
influence as they can share their opinion with those they know personally and can potentially
have a greater effect on peoples beliefs. Getting the intervention started will take coordination
and communication to secure the involvement of key stakeholders. The community health nurse
will need to approach local pediatricians to inform them of the proposal and determine if they are
willing to participate. The nurse will also need to meet with local OB/GYNs to garner their
support as they will be responsible for recruiting participants. Also, the nurse could contact the
CDC to obtain educational materials to provide to the involved participants. Providing
opportunities for community members to build a trusting relationship outside of office visits can
have long-term effects on the health of a community as it promotes health seeking behavior.
Implementing the proposed intervention in Hillsborough County could lead to a reduction in the
rate of vaccine preventable diseases, which leads to a healthier community. Also, because this
intervention will occur in the community, the effect is far reaching and will allow for more
individuals to participate and build relationships with those in the medical community.


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References
Benin, A. L., Wisler-Scher, D. J., Colson, E., Shapiro, E. D., & Holmboe, E. S. (2006).
Qualitative analysis of mothers decision-making about vaccines for infants: The
importance of trust. Pediatrics, 117(5), 1532-1541. doi: 10.1542/peds.2005-1728
Centers for Disease Control and Prevention (CDC) (2012). Parents guide to childhood
immunizations. Retrieved from http://www.cdc.gov/vaccines/pubs/parents-
guide/default.htm
Fielding, J. E., Rimer, B. K., Calonge, B. N., Chin, M. H., Clymer, J. M., Glanz, K.,
Remington, P. L. (2014). Recommendation for use of immunization information systems
to increase vaccination rates. Journal of Public Health Management and Practice,
00(00), 1-4. doi: 10.1097/PHH.0000000000000092
Florida Department of Health (DOH) (2013). Florida charts. Retrieved from
http://www.floridacharts.com/charts/
Policy (2014). In Merriam-Webster online. Retrieved from http://www.merriam-
webster.com/dictionary/policy
Suncoast Employers (2011). Largest employers by county on the Florida suncoast. Retrieved
from http://suncoastemployers.com/#hillsborough
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U.S. Department of Health and Human Services (2014). Determinants of health. Retrieved from
http://www.healthypeople.gov/2020/about/DOHAbout.aspx