The reason these chronic disease indicators were selected is because my clinical site was a home care agency and therefore I was highly exposed to the chronic diseases that most affect the health of Hillsborough County adult population. The rate of death related to melanoma in Hillsborough County was 2.3 per 100,000 between 2007 and 2009 (Florida Department of Health [FDOH], 2010). The state rate in the same years was 2.9. Healthy people 2020 target rate is 2.4 deaths per 100,000 populations (U.S. Department of Health and Human Services [USDHHS], 2010). Therefore Hillsborough County ranks favorably in regards to this indicator. Hillsborough County also meets the Healthy People 2020 target rate in regards to the prostate cancer death rate of 21.2 deaths per 100,000 males (USDHHS, 2010). The rate of the County between the year of 2007 and 2009 was also 21.2 deaths per 100,000 males (FDOH, 2010). Hillsborough County age-adjusted death rate related to diabetes was 26 per 100,000 between 2007 and 2009. Healthy People 2020 target for this indicator is 65.8 deaths per 100,000 (USDHHS, 2010). Therefore the county also ranks favorably in regards to this chronic disease indicator. Despite the improvements described Hillsborough County still has health indicators that need improvement. In regards to chronic diseases Hillsborough County’s rate of adults who had their cholesterol checked in the past five years was 72.9% in 2007 in comparison with the state rate of 73.3 % in the same year (FDOH, 2010). Healthy people 2020 target for this indicator is 82.1 %. Coronary heart disease age-adjusted hospitalization rate for Hillsborough County is ranked higher than the state level at 454.5 per 100,000 (FDOH, 2010). The state rate for the same indicator is 440.4 per 100,000 (FDOH, 2010). In regards to health status 16.6% of the Florida adult population rate their health status as “fair” or “poor” (FDOH, 2010). Hillsborough County adult population rate is 18.6% for the same indicator (FDOH, 2010). The above data not only points to areas that needs improvement but also indicates that the population of this county is at risk for cardiovascular disease.
Human biology, health system, environment and lifestyle are the four general determinants of health that contributes to disease. Age is a factor of human biology that contributes to cardiovascular disease. According to the American Heart Association 2010 update cardiovascular disease is very prevalent in individuals 65 or older and multiple risk factors increase with age (Lloyd-Jones et al. 2010). Access and quality of health care system can significantly interfere with diagnosis and treatment of cardiovascular diseases. In Hillsborough County the percentage of adults who could not see a doctor at least once in the past year due to cost in the year of 2007 was 18% between the ages of 45 and 64 in comparison to the state level of 15.8% (FDOH, 2010). According to Lloyd-Jones et al. (2010) patients who are uninsured or self-paying have lower probability than insured persons of having cardiac tests ordered. The environment can have factors that increase the risk for the development of cardiovascular diseases. Second hand smoking, for example, can cause damage to blood vessels and decrease blood flow in the coronaries increasing the risk for cardiovascular disease (Lloyd-Jones et al. 2010). Lifestyle has a significant importance in preventing cardiovascular disease and death. According to the American Heart Association report a 2.3% decline in physical inactivity between 1980 and 2000 prevented 17.445 deaths due to cardiovascular disease in the United States (Lloyd-Jones et al. 2010).
Cardiovascular disease primary prevention can be accomplished at the individual or community level through health education (Farnkvist, Olofsson, & Weinehall, 2008). Health education at the individual or community levelwould focus on teaching how to identify and eliminate individual risk factors that can potentially cause cardiovascular disease.
Health education in terms of health promotion is a process in which the individual learns about the disease and makes informed decisions about health (Clark, 2008). The role of the community health nurse at the individual level is to identify the risks of the individual and to provide education on how to prevent the development of the disease. At the individual level the community health nurse will be developing teaching materials that provide information about health promotion and risk factor modification. The nurse can also encourage the individual to seek self-care by providing credible internet sources as educational material.
Health education about cardiovascular disease may focus on modifying risk factors such as sedentary lifestyle, smoking, obesity and high cholesterol levels in both the individual and community level. Lin, O’Connor, Whitlock and Beil, (2010) suggest that health education and individual counseling can increase physical activity and promote engagement in healthier diets and positively affect the prevention of cardiovascular disease in adults.
Community Based Intervention
Strengths Priority Health Issues• Low rate of death related to • Low rate of adults who had melanoma their cholesterol checked in• Low rate of death related to the past five years prostate cancer • High rate of Coronary• Low death rate related to disease hospitalization diabetes • High percentage of adult population rating their health status as “fair” or “poor”
In Hillsborough County the adult population is at risk for cardiovascular diseaserelated to a combination of risk factors as evidenced by: (a) The lack of moderate physical activity by 66.3% compared to 65.4% for the state level (b) 39.4% rate of overweight adults in comparison to the state rate of 38% (c) 22.1% of adults are current smokers in comparison to the state level of 19.3% (d) 10.7% of adults had a heart attack, angina, or coronary heart disease between the age of 45 and 64 compared to 9.1% for the state of Florida (e) 72.9% of the adult population had their cholesterol checked in the past five years in comparison to 73.3% of the state level (FDOH, 2010)
Health system Human biology Access and quality of Age health care Environment LifestyleSecond hand smoking Physical activity
HealthIntervention EducationStakeholders Community Members
Health educationLevel of recipient of the intervention Individual Community
Health education in terms of health promotion to prevent cardiovascular disease: • The community health nurse will educate the individual or community about the Individual disease and about his/her individual and predispositions to develop the disease. community • The community health nurse will teach how to achieve a healthy lifestyle through physical activity and a healthy diet.
Risk factor modification to prevent cardiovascular disease: • At the individual level the community health Individual nurse will teach about the negative effects of a sedentary lifestyle, smoking, obesity and high cholesterol levels as they contribute to cardiovascular disease. • At the community level the community Community health nurse will advocate for community resources that will facilitate risk factors modification.
ReferencesClark, M.J. (2008). Community Health Nursing: Advocacy for Population Health (5th edition) Upper Saddle River, NJ: Pearson Education, Inc.Farnkvist, L., Olofsson, N., & Weinehall, L. (2008). Did a health dialogue matter? Self- reported cardiovascular disease and diabetes 11 years after health screening. Scandinavian Journal of Primary Health Care, 26, 135-139. doi:10.1080/02813430802113029Florida Department of Health. (2010). Florida Charts: Community Health Assessment Resources Tool Set. Retrieved from http://www.floridacharts.com/charts/chart.aspx
ReferencesLin, J. S., OConnor, E., Whitlock, E. P., & Beil, T. L. (2010). Behavioral counseling to promote physical activity and a healthful diet to prevent cardiovascular disease in adults: A systematic review for the U.S. preventive services task force. Annals of Internal Medicine, 153, 736-750. doi:10.1059/0003-4819-153-11-201012070-00007Lloyd-Jones, D., Adams, R. J., Brown, T. M., Carnethon, M., Dai, S., De Simone, G., . . . Wylie-Rosett, J. (2010). Heart disease and stroke statistics 2010 update: A report from the American heart association. Circulation Journal of the American Heart Association, 121, e46-e215. doi:10.1161/CIRCULATIONAHA.109.192667U.S. Department of Health and Human Services (2010). Healthy people 2020. Retrieved from http://www.health.gov/healthypeople/url