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By Tosin Ola, RN
Demographics
 Age                       Educational level
    Median Age is 39.5     Race
    Largest sector is
                                 % of population
     between ages 25-44.
 Gender ratio
    Men are 43.38%                           White
    Women are 51.66%                         Black
                                              Asian
    Women rule!
                                              Hispanic
 Socioeconomic status                        Other
Health Care Status Indicators
 Mortality rate            Causes of death
 Infant mortality rates       Cancer
 Age specific deaths          Stroke

 Vaccine preventable          Suicide

    Flu/pneumonia          Unintentional causes
 Tobacco smoking              Drug induced deaths
                               Suicide
                               Falls
Environmental Assessment
 Housing
 Zoning
 Parks
 Recreational areas
 Industrial
 Agricultural areas
 Businesses
 Hospitals and clinics
 Public transportation
Environmental Assessment cont.
 Public assistance
 Police and fire
 Courts and legal system
 Schools
 Churches
Comparison of Populations
Residents of MLK                    Residents of Broadway
   Lower socioeconomic level        More affluent
   Predominantly Black              Predominantly White
   Often dressed haphazardly        Immaculately groomed
   Take public transport or walk    Ride bicycle or take cars
   Stores with more variety and     Stores with high end
    cheaper prices                    items, vegan, green, health
   Smoke and drink                   conscious
   No health insurance              Smoke and drink
   Unhealthy lifestyle practices    Have health insurance
   More active in church            More active in community
                                      forums
Assessment using Watson’s
 Community involvement
 Meet me at the Lloyd
  Center
 Disseminating
  information
 Neighborhood watch
 Maintaining law and
  order
Nursing Diagnosis
 Health promotion deficit
 related to tobacco
 smoking as evidenced by
 high mortality rates in
 Multnomah county
 related to cancer and
 tobacco related
 conditions.
Nursing Outcomes
 Knowledge - Cancer Threat Reduction: Extent of
  understanding conveyed about
  causes, prevention, and early detection of cancer by
  third visit to clinic
 Risk Control - Tobacco Use: Personal actions to
  prevent tobacco use will be stated and demonstrated
  by community members by next community meeting
 Health Orientation: Personal commitment to health
  behaviors as lifestyle priorities within 1 month
Nursing Interventions
 Community Health Development: Assisting members
  of a community to identify a community’s health
  concerns, mobilize resources, and implement
  solutions
 Case Management: Coordinating care and advocating
  for specified individuals and patient populations
  across settings to reduce cost, reduce resource
  use, improve quality of health care, and achieve
  desired outcomes
 Behavior Modification: Promotion of a behavior
  change within one month
Evaluation
 Personal observation
 Members’ verbal statements and stories of quitting
 Increase in amount of Nicorette sales and
  prescriptions
 Members will ask for referral to local hyno-therapist
 Members will answer smoking questionnaire at the
  end of the session and get a score no lower than 70%
  on cancer reduction, healthy lifestyle and tobacco use.
References
 Multnomah County Health Department (2006). Top 10 Causes of
    Death in Multnomah County. Retrieved January 19, 2009, from
    http://www.co.multnomah.or.us/health/hra/reports/DeathLeading
    Causes2006.pdf
   Multnomah County Health Department (2007). The Health of
    Multnomah County. Retrieved January 18, 2008, from
    http://www.co.multnomah.or.us/health/hra/health_mc.shtml
   Sperling, B. (n.d.). Multnomah County [Data file]. Available from
    Sperling’s Best Places: http://www.bestplaces.net/
   Tobacco Prevention and Education Program. Multnomah County
    Tobacco Fact Sheet 2009.
   Portland, Oregon: Oregon Department of Human Services, Oregon
    Public Health Division, 2008
   U.S. Census Bureau (July 25, 2008). Multnomah County QuickFacts.
    Retrieved January 17, 2008, from
    http://quickfacts.census.gov/qfd/states/41/41051.html

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Community assessment of Multnomah county, portland,

  • 2. Demographics  Age  Educational level  Median Age is 39.5  Race  Largest sector is % of population between ages 25-44.  Gender ratio  Men are 43.38% White  Women are 51.66% Black Asian  Women rule! Hispanic  Socioeconomic status Other
  • 3. Health Care Status Indicators  Mortality rate  Causes of death  Infant mortality rates  Cancer  Age specific deaths  Stroke  Vaccine preventable  Suicide  Flu/pneumonia  Unintentional causes  Tobacco smoking  Drug induced deaths  Suicide  Falls
  • 4. Environmental Assessment  Housing  Zoning  Parks  Recreational areas  Industrial  Agricultural areas  Businesses  Hospitals and clinics  Public transportation
  • 5. Environmental Assessment cont.  Public assistance  Police and fire  Courts and legal system  Schools  Churches
  • 6. Comparison of Populations Residents of MLK Residents of Broadway  Lower socioeconomic level  More affluent  Predominantly Black  Predominantly White  Often dressed haphazardly  Immaculately groomed  Take public transport or walk  Ride bicycle or take cars  Stores with more variety and  Stores with high end cheaper prices items, vegan, green, health  Smoke and drink conscious  No health insurance  Smoke and drink  Unhealthy lifestyle practices  Have health insurance  More active in church  More active in community forums
  • 7. Assessment using Watson’s  Community involvement  Meet me at the Lloyd Center  Disseminating information  Neighborhood watch  Maintaining law and order
  • 8. Nursing Diagnosis  Health promotion deficit related to tobacco smoking as evidenced by high mortality rates in Multnomah county related to cancer and tobacco related conditions.
  • 9. Nursing Outcomes  Knowledge - Cancer Threat Reduction: Extent of understanding conveyed about causes, prevention, and early detection of cancer by third visit to clinic  Risk Control - Tobacco Use: Personal actions to prevent tobacco use will be stated and demonstrated by community members by next community meeting  Health Orientation: Personal commitment to health behaviors as lifestyle priorities within 1 month
  • 10. Nursing Interventions  Community Health Development: Assisting members of a community to identify a community’s health concerns, mobilize resources, and implement solutions  Case Management: Coordinating care and advocating for specified individuals and patient populations across settings to reduce cost, reduce resource use, improve quality of health care, and achieve desired outcomes  Behavior Modification: Promotion of a behavior change within one month
  • 11. Evaluation  Personal observation  Members’ verbal statements and stories of quitting  Increase in amount of Nicorette sales and prescriptions  Members will ask for referral to local hyno-therapist  Members will answer smoking questionnaire at the end of the session and get a score no lower than 70% on cancer reduction, healthy lifestyle and tobacco use.
  • 12. References  Multnomah County Health Department (2006). Top 10 Causes of Death in Multnomah County. Retrieved January 19, 2009, from http://www.co.multnomah.or.us/health/hra/reports/DeathLeading Causes2006.pdf  Multnomah County Health Department (2007). The Health of Multnomah County. Retrieved January 18, 2008, from http://www.co.multnomah.or.us/health/hra/health_mc.shtml  Sperling, B. (n.d.). Multnomah County [Data file]. Available from Sperling’s Best Places: http://www.bestplaces.net/  Tobacco Prevention and Education Program. Multnomah County Tobacco Fact Sheet 2009.  Portland, Oregon: Oregon Department of Human Services, Oregon Public Health Division, 2008  U.S. Census Bureau (July 25, 2008). Multnomah County QuickFacts. Retrieved January 17, 2008, from http://quickfacts.census.gov/qfd/states/41/41051.html

Editor's Notes

  1. Multnomah county is one of the 36 counties in the state of Oregon, located with Portland as its county seat. Portland is the second largest city in Oregon and the most populous metropolitan area in the state (U.S. Census Bureau [USCB], 2008, p. 1). As of 2007, Multnomah County's population is 681,454 people (Sperling, 2008). For the purpose of this study, the community focus will be primarily on the sector of Multnomah County in the 97212 area code, which will be called the Rose Sector.Rose Sector population:The 2007 population is 23,159. There are 8,335 people per square mile (population density) (Sperling, 2008).
  2. Age:The median age is 39.5 (Sterling, 2008). The largest sector is the productive age group of 25-44 making up 36% of the population. Please see the following handout: Appendix A for a breakdown of the ages in Multnomah county according to estimates from the 2006 Census. Gender: As you can see from the percentages in the Rose sector, the female demographic is slightly higher in the population with a lead of 7%.Socioeconomic status: The income per capita is $35,757, which includes all adults and children (Sterling, 2008). The median household income is $63,737. This is significantly higher than the $25,500 estimate of the poverty IRS nationwide poverty line (USCB, 2008). Educational level: Please see Appendix B for the breakdown of the Rose sector education. 93% of the population has at least a high school diploma.
  3. Infant mortality rates: in 2005, there were 7.6 infant deaths per 1000 live births. Mostly related to pre-term births, low weight babies, lack of prenatal care and teenage pregnancies (Multnomah County Health Department [MCHD], 2007, p. 31).30,000 Oregonians die each year, and 22% of those deaths are related to tobacco smoking (MCHD, 2009)Leading causes of death in the Rose sector are cancer, stroke and suicide (MCHD, 2007), with all these levels significantly higher than the national average. Residents of Multnomah county also die from heart disease,diabetes-related, chronic lower respiratory disease, unintentional injury, Alzheimer’s, flu/pneumonia, suicide, and nephritis (inflammation of the kidney) (MCHD, 2006). The rate of HIV mortality has fallen since 1990 (MCHD, 2006).Unintentional causes of death are unintentional injury, drug-induced deaths, alcohol-induced deaths, suicide, falls, accidental poisoning, motor vehicle traffic accidents, firearm injury, and homicide (MCHD, 2006).Deaths from communicable diseases include the 12.2 per 100,000 from flu/pneumonia which is preventable by vaccination. The Multnomah County Health Department has been making a big push for all at-risk populations to get vaccinated this year (MCHD, 2007).
  4. Housing: Almost everyone in the Rose sector has a place of abode. The homeless stay in shelters that are liberally sprinkled throughout the community and supported by the county, various churches and community groups (Sperling). Zoning: The rose sector is zoned into almost a perfect rectangle with 4 main intersecting streets of Martin Luther King Street, Fremont street, 15th Street, and Broadway. Each main street has local businesses, main stores, grocery stores and restaurants. Parks: There are 350 parks in Multnomah county. Within a 2 mile radius of my address, there are 6 parks. There are daily activities in the parks regardless of the weather, and many Rose sector residents own dogs which they walk daily. Recreational areas: The Lloyd Center Mall is a huge multiplex with 215 stores. This is a meeting hub for social gatherings, shopping, entertainment and all round fun for all ages. The Lloyd Center boasts 2 movie complexes, a skating rink, grocery stores and numerous restaurants both in and around the area.Industrial: The Rose sector has very limited industrial trade. Most of the warehouses and industrial areas are located off Interstate street, which is roughly 1.4 miles from the Rose sector. Trailers do enter the Rose sector daily with food and supplies.Agricultural areas: There are several outdoor farmer’s markets, gardens and gardening stores in the area. However, most farming is down outside the Rose sector. Health services: The MCHD is located in the Rose sector between Fremont and MLK. There are several clinics, doctor’s offices, chiropractors, dentists and Planned Parenthood offices in the area. The only hospital in the Rose Sector is Legacy Emanuel Hospital, a level 3 trauma and burn center hospital. Most residents know where the hospital is located. Public transit: The transportation system is adequate. Each main street has 2 bus routes and there is a MARC train system. Riding MARC during rush hour is free for everyone to encourage less driving. Many people also ride bicycles, walk or carpool.
  5. Public assistance: During canvassing, I discovered that Rose center residents had several resources for those in dire straits. The SCHIPs program offers insurance to all un-insured children, the county has a welfare program with food stamps, free groceries and assistance for eligible families. The Salvation Army helps to pay off electric/gas bills for residents that have overdue bills that they cannot pay. There were several halfway houses for recovering addicts, prisoners, prostitutes and the disenfranchised. There is a volunteer program that the homeless can get their feet washed and hair trimmed every Friday night. Police and Fire: There are 2 fire stations in the Rose district, one close to the Lloyd center and one on the other side of MLK. There is ample police presence and a low crime rate in the area, although Multnomah county has a crime rate of theft and non-violent crimes of 7/10 (Sperling, 2008). National crime rate is at a 3. There are 4 grade/high schools in the area and 1 community collegeThere are several churches…almost one on every main block.
  6. Let’s visit the comparison chart for the 2 populations in the Rose district with the most differences between them. The two areas do mix occasionally, but the residents of MLK tend to stay in their area. MLK has shops, restaurants and stores more densely cramped and populated than the Broadway area. You can find everything you need within one block of MLK. Both neighborhoods are very involved in the interaction and raising of their offspring. The schools are mixed with all races and children from all sectors. I did a walkthrough the Irvington school (close to Broadway) and asked a few kids where they lived. Several stated addresses or areas outside the Rose sector and a couple were from the MLK area. The energy in both areas is very different; Broadway is more urbane and sophisticated, yet laid back. MLK is more active with loud noises, frenetic energy and very boisterous. The Broadway residents can be very wary and non confrontational, often backing away from conflict. MLK residents are more passionate in the expression of their feelings, and do not mind mixing dirty language and anger in their interactions. I did not see any cases of physical altercations.
  7. Using Watson’s caritas of trust building, non-judgment, empathy and compassion, a canvassing and survey of the neighborhood was done on 3 separate occasions. Since according to Watson, illness is a disruption of the bodymindspirit connection, particular attention was noted to any factor affecting this connection. The Broadway residents are more active in social causes, issues, volunteering and community forums. The one community meeting I went to had majority Whites, and most were from the Broadway and Fremont area. The MLK residents are very active in church though, and a lot of their issues are dealt with there. The Church board and minister are very influential in the community. Information is disseminated to the public through postings of bills and advertisements. Telephone poles across both districts are full of holes and staples from previous postings, and fresh bills from new events and opportunities in the area. Most businesses have a container or tack-board where residents can place their adverts or business cards. The Lloyd Center and the parks are the greatest meeting point of the two populations. Once at this entertainment area, both areas explore and bond with each other in different social interactions without incident. The neighborhood watch includes everyone in the community, and the police officer I interviewed told me that most of the calls for break-ins or crimes were from the community itself. The police force maintains safety and order in both areas and the residents are quick to call the police for any altercation or incident. The wait with 911 can sometimes be long in Broadway because most calls are non-emergent yet people use the emergency line anyway (Portland police officer [PPO], personal communication). The courts and legal system is like any other system in America, but the charges for tickets are cheaper (PPO, personal communication).
  8. Research shows that tobacco use is directly linked with the incidence of cancer (MCHD, 2007). The rate of cancer in Multnomah county has gone up in recent years, and so has the rate and incidence of smoking (MCHD, 2006). Over 150,000 Multnomah county residents regularly smoke tobacco products (Oregon Public Health Department, [OPHD], 2008).The Multnomah county has launched a progressive campaign to reduce smoking since 2000, and great strides have been made. The most recent was the anti-smoking ban that was passed in the county to include all restaurants, bars, clubs and public places. It is illegal to smoke in an enclosed building, and citations will be issued to offenders as of January 1st, 2009 (OPHD, 2008)
  9. Knowledge: Knowledge of how to reduce the risk of cancer by quitting or not smoking will be stated by the community members at the next weekly meeting. Risk Control: Community members will outline personal and community techniques that they have used to avoid or reduce tobacco use by next weekly meeting.Health Orientation: Community members will make personal commitment to healthy and positive lifestyle choices for overall improved health. All members will sign NEWSTART commitment plan by the end of the meeting.
  10. Seminars will be held in public places, community workshops, churches and the Lloyd center to teach and give awareness to the dangers of smoking. Participants will be able to state cancer reduction steps by end of teaching session. Efforts will be made to stop youth and people who don’t smoke not to start with adverts, educational seminars and pamphlets. An Anti Smoking bracelet will be given to those that commit not to smoke or to quit. Teach those that do smoke about alternative ways to quit smoking like hypnosis, Nicorette gum or the patch. Residents of community will make a personal commitment to prioritizing their health by reducing tobacco smoke inhalation within 1 month. Residents will talk to neighbors, friends and family that smoke to encourage them to stop smoking.