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Industrial Heights Community Assessment Sentinel City has a population of 663,862 consisting of four communities: Acer Tech, Nightingale Square, Casper Park and Industrial Heights (Sentinel City, 2020). The focus was primarily made on Industrial Heights community with comparing the other communities to identify underlying causes that needed attention in healthcare. The disparities are alarming and stand out in Industrial Heights were most help is needed. After weeks of observation, Industrial Heights is the most vulnerable population and is in need of an assessment, analysis, nursing diagnosis, plan and evaluation to improve the health and well being of the community. Assessment A healthy community consist of eight subsystems: education, politics and government, recreation, communication, transportation, economics, physical environment, and health and social services. The living conditions in Industrial Heights stems from many factors in the community that correlate with the subsystems mentioned above. Unfortunately, for Industrial heights the observations as a community nurse are based on the living conditions, the people, and statistical data compiled from Sentinel City. Physical Environment The buildings structures are stable and have an outdated look to them. Some buildings are dirty and have graffiti. The streets are fairly clean. There are some edges of streets that have potholes. The street signs are maintained. There is very minimal grass and a few trees with no park. The amount of trees and parks are very limited. There are no parks or tree plants or grass in the community. In Markevych et al. (2017), people who walked in the park showed a decline in systolic blood pressure measured with an ambulatory device as well as improved performance in a task requiring directing attention. The sidewalks are narrow and fairly in decent shape. The

biggest concerns is the garbage, lack of benches, lights, and broken phone booths cause many issues and raise many health concerns. In Suarez-Balcarez et al. (2020), studies indicate people are less likely to walk on poorly kept and visually unappealing sidewalks. Walking is correlated with both improved physical and emotional health. The roads look semi-maintained with the exception of cracks/potholes around the edges of sidewalks along the streets. Parking is limited and there aren’t enough working street lights. Billboards in Industrial Heights are promoting cigarettes use by. “All the Buzz, none of the smoke” compared to advertising how to promote health and staying safe. An example is “Get vaccinated, stay healthy!” or “Fighting addiction. We’re in your corner.” Graffiti and board-ups in buildings is more prominent. Some are frightening (skull graffiti). According to Elrod & Fortenberry (2017), billboard advertising appears to be well suited to make a positive difference when deployed by institutions seeking to elevate health status of the disadvantaged. Stray dogs and rodents roaming around is a concern and no bicycle paths. Community feels unsafe to walk and live in. In Penakalapati et al. (2017), poorly managed feces impact increased risks of diseases. Education The observations related to the educational system is very concerning in Sentinel City. Sentinel City has one visible school district located in Industrial Heights. There are no other alternatives for children to go to such as: magnet, Montessori private, religious, or special education schools. The Montessori method of education provides, supportive environment for children of all abilities and learning styles. Learning styles for children with special needs, physical disabilities, learning differences in reading, writing, spelling and/or math; ADHD; and mild-to-moderate autism spectrum disorders (American Montessori Society, 2020). The only school is in Industrial Heights and the only way for the children to get to school is by a school

bus, local bus or train ride. Walking would not be ideal as for most it is miles away. The parents are more than likely not to take the children to school as it is too far away and if they do it would be for safety reasons due to the streets not being safe. The observation of no library in Sentinel City. The lack of after school programs that can offer tutoring or after-school activities in the community where the children can be physically fit. In Flaherty (2016), public libraries can serve as community incubators for understanding ways to enhance individual well being and overall community health. Politics and Government Indications of political involvement observed were the protest outside city hall for taxes for the rich. Garbage on the streets and sidewalks causing a public-health threat, that can serve as a prime habitat for rodents and mosquitos that can spread malaria, dengue fever, and other health conditions. Mayor would like to bring additional revenue into the city by increasing tourism. Radio Buzz keeps the citizens in Sentinel City updated with new policies and public service announcements. Economics Industrial Heights community has a feeling of “surviving” more than anything considering the alarming number of homeless people, vandalism, graffiti, signs of criminal activity, dirtiness in the streets and buildings, garbage and rodents on the streets, and stray dogs. According to Tobacco Use and Dependence Guideline Panel (2008), tobacco dependence is a chronic disease that often requires repeated intervention and multiple counseling. Eliminating the use of tobacco early on in life can minimize the chronic health conditions tobacco causes. Chronic health conditions that require multiple trips to clinicians, specialist and treatments. The chronic disease of COPD and lung cancer were selected because of the sickening advertisement

of tobacco products sending the wrong message of choosing E-cigarettes over cigarettes gives a “buzz” feeling. Neither is good for ones health and can lead to death if not prevented. Smoking is choice and the children should know this important information early on in life so that it can be prevented. The lack of highways Health & Social Services In Sentinel City the health and social services are very limited to communities who are financial stable. There is only one main hospital located in Acer Tech. The hospital provides medical care advocates, senior transportation, service animals, meals on wheels, and elder abuse prevention. Resources was observed in Industrial Heights at the Interfaith Church Soup Kitchen. It provides nutritional food for those in need such as elderly, children, and homeless population. In Hunger And Health (2020), an estimated 5.5 million people age 60 years of age and older experience food insecurity and faced with choosing between paying for groceries and buying medicine- a difficult choice with potentially severe health implications. Communication In industrial Heights community there are two forms of communication formal and informal. Formal communication are observed in neighborhoods by the use of billboards and signs. Billboards in most communities are positive and promote healthy advertising. In Apollonio & Malone (2008), public health advertisements may be inadvertently packaged with product advertisements that undercut their message. The negative billboards that advertise alcohol or beer can be minimized by local government by a special committee that will approve signs before they are plastered in the community. The government can have more predominant signage enforcing: No trespassing, No vandalism, No loitering, or Towing after hours and so forth to minimize the negative influence throughout Sentinel City. Informal communication

observed in Industrial Heights is the graffiti and negative billboards promoting tobacco use. As mentioned in Healthy People 2020 (2017), “communication inequalities may act as a significant deterrents to obtaining and processing information, in using the information to make prevention, treatment and survivor-related decisions, and in establishing relationships with providers.” Recreation In Sentinel City, there is a lack of recreational families and parks. Recreation reduces symptoms of depression and fosters improvement in mood and feelings of well-being (CDCP, 2020). It is without a doubt that opening more facilities will improve health issues that can be decreased or stopped by exercising. “Physical activity, exercise, and sport have well-known positive effects on physical and psychological health” (Davis et al., 2015). Safety and Transportation The safety concern in Industrial heights begins with the presence of police offices talking in a huddle amongst themselves in a corner, instead of spreading out and being more visible to the community. According to the Centers for Disease Control and Prevention (2018), violence has a very strong impact on lifelong health, opportunity and well-being. “Individuals exposed to violence are often at higher risk of developing physical and mental health conditions, experiencing other forms of violence, and experiencing educational and job challenges” (Centers for Disease and Prevention, 2018). Analysis Industrial Heights consists of a population of 38,8555 with more than half of its population being a minority. It has 46.8% Hispanic or Latino primary ethnicity and 13.1% African American secondary ethnicity. The community has over twenty percent of its population under the age of eighteen, over eleven percent under five years old, and a less than one percent of

persons over the age of sixty-five. The median household income in Industrial Heights is $24,672. Thirty-seven and a half percent of Industrial Heights population are without health insurance (Sentinel City, 2020). One of the many concerns of the communities overall health concerns are the 3,917 homeless people that are at a higher risk of health conditions due to improper nutrition, risk to infections, and mental health. According to Poverty and Health (2020), poverty and low-income status are associated with a variety of adverse health outcomes, including shorter life expectancy, higher life expectancy, higher rates of infant mortality, and higher death rates for the leading causes of deaths. The strengths the community has is the soup kitchen that provide food for the homeless, low-income families and the elderly. The challenges and weakness in Industrial Heights lies in the lack of resources in the community. According to Krueger & Higgins (2002), poor housing conditions are associated with a wide range of health conditions, including respiratory infections, asthma, lead poisoning, injuries, and mental health. Nursing Diagnosis Industrial Heights as a vulnerable population has many health concerns that can be addressed. One of the most concerning that can be an umbrella to many other health concerns will have to begin with the ineffective health maintenance related to the lack of medical insurance as evidence based by insufficient financial resources. The intervention is: having system guidance for health insurance and learning facilitation. The expected outcome will be an increase of enrolled individuals in Industrial Heights seeking care more frequently. Plan In Industrial Heights community the plan is to have the community be more involved with the other communities and the city’s Mayor. The plan involves gathering the funds and

resources needed for the community to succeed. It is important to develop policies for the challenges, weakness, and strengths the community has in order to rebuild and increase the health of all. The vision to empower the community to improve the underlying causes such as violence, crime, sanitation, transportation, parks and recreational facilities, environmental hazards, and other social determinants

and most importantly community involvement will

promote a healthier atmosphere for everyone. The plan will involve having the Mayor and his staff, the local business owners in the community, all local church leaders, the police, the school officials, the hospital and local clinics representatives and local community members that are leaders meet together monthly in town-hall meetings to go over major concerns and issues in their neighborhoods. Having a monthly meeting will allow the community to know through a local newsletter of the issues that are a priority and can be resolved before the next town-hall meeting. In Healthy People (2020), it is recommended to improve the conditions of daily life by: encouraging communities to be accessible so all can live in, move through, and interact with their environment; encouraging community living; and removing barriers in the environment using both physical universal design concepts and operational policy shifts. Implementing an open house and having a minimum of fifty health insurance enrollments a day will help Industrial Heights community to have access to medical care and resources. Insurances will be able to set-up care managers to individuals that have increased health risks. It will be imperative to hold the town leaders accounted for the results that is needed. Evaluation The implementation of the plan to improve and increase the number of individuals enrolled in healthcare medical insurance and have access to resources has been successful in Industrial City and all the other community. Industrial Heights has more individuals, families

and the elderly enrolled in medical insurance. The resources have improved the healthcare and well-being of many people who are no longer homeless and have a new beginning. Industrial Heights has a decrease of vandalism, graffiti has been cleaned up, and there are garbage containers in each block to minimize the litter in the streets. People have a sense of being happy and this is all owed to the communities engagement in improving the life quality of a vulnerable population in need. Conclusion After weeks of observations of assessing Industrial Heights and its neighboring communities, it is beyond a doubt the importance the role of a community nurse has in a vulnerable population. Sentinel City’s Mayor has much ground work to do to improve the healthcare and well being of all communities and not leave out anyone in the process. Providing resources that can improve the livelihood of a child, individual in need, the elderly and the homeless will go along way in Industrial heights. The main health concern of having health insurance available and accessible will improve the future of Sentinel City....