Running head: Community assessment 1 Community assessment 14 Community assessment Institution: Student’s name: Date: General Community Characteristics New York City has five predominantly recognized boroughs demographically. Manhattan is amongst the most densely populated city whereby it is a recognized district with historical origin, culturally identified, economically stable and equipped with different health care centres. The many different heath care centres have influenced the manner in which nursing services in the community are offered. Most institutions ensure that they deliver high quality nursing services with a view of attracting more patients and building their brand. Manhattan being a coextensive district in NYC, it receives over 30 million visitors per year, though most of the tourists hardly see away from the “22.6 square miles (58.5 square km)” of Manhattan Island, the smallest urban district. Manhattan is easily recognized by residents and visitors since it is divided alluring 220 east-west streets and 12 north-south avenues. It is overloaded with places of enduring interests, cultural institutions and one of the world largest skyscraper. Sachs (2016) states that other neighbouring cities recognizes Manhattan as the primary borough hub for business, centre for administrative services, and a financial centre for metropolis and their origin of their renown. Inside this considerable historic disparity. Geographically, Manhattan is found in New York and this greatly influences the delivery of nursing services. For instance, NYC Health + Hospital corporation manages all the public hospitals located in New York. The corporation has developed practices to be observed in the hospitals with an aim of improving healthcare in the city. The practices greatly influence the manner in which nursing services are provided. Manhattan is mainly made out of neighbourhoods that give tranquil sanctuaries to satisfied occupants. No region of NY exhibits dynamism and transformation as ultimately as Manhattan. Crowds enter it day by day to look for their prosperities, and extra millions come to wonder about their endeavours. It is Manhattan that they name an "incredible place, yet I wouldn't have any desire to live there." Demographic and Socioeconomic Characteristics Manhattan is one of the highly densely populated district in NYC, though smallest geographically. In the United States, NYC is the leading county with highest population and the leading densely populated region globally (Stanhope & Lancaster, 2018). The facts are supported by the 2010 census report that the district has the highest population compared to other boroughs because it holds a populace of “1,585,873 living in a land area of 22.96 square miles (59.5 km2), or 69,464 residents per square mile (26,924/km²)” (U.S. Census Bureau Quick Facts). It is the wealthiest county that stabilize U.S economy with a 2005 per capita income above $100,000. Manhattan is the smalles ...

1. Running head: Community assessment 1
Community assessment 14
Community assessment
Institution:
Student’s name:
Date:
General Community Characteristics
New York City has five predominantly recognized boroughs
demographically. Manhattan is amongst the most densely
populated city whereby it is a recognized district with historical
origin, culturally identified, economically stable and equipped
with different health care centres. The many different heath care
centres have influenced the manner in which nursing services in
the community are offered. Most institutions ensure that they
deliver high quality nursing services with a view of attracting
more patients and building their brand. Manhattan being a
coextensive district in NYC, it receives over 30 million visitors
per year, though most of the tourists hardly see away from the
“22.6 square miles (58.5 square km)” of Manhattan Island, the
smallest urban district. Manhattan is easily recognized by
residents and visitors since it is divided alluring 220 east-west
streets and 12 north-south avenues. It is overloaded with places
of enduring interests, cultural institutions and one of the world
largest skyscraper. Sachs (2016) states that other neighbouring

2. cities recognizes Manhattan as the primary borough hub for
business, centre for administrative services, and a financial
centre for metropolis and their origin of their renown. Inside
this considerable historic disparity. Geographically, Manhattan
is found in New York and this greatly influences the delivery of
nursing services. For instance, NYC Health + Hospital
corporation manages all the public hospitals located in New
York. The corporation has developed practices to be observed in
the hospitals with an aim of improving healthcare in the city.
The practices greatly influence the manner in which nursing
services are provided. Manhattan is mainly made out of
neighbourhoods that give tranquil sanctuaries to satisfied
occupants. No region of NY exhibits dynamism and
transformation as ultimately as Manhattan. Crowds enter it day
by day to look for their prosperities, and extra millions come to
wonder about their endeavours. It is Manhattan that they name
an "incredible place, yet I wouldn't have any desire to live
there."
Demographic and Socioeconomic Characteristics
Manhattan is one of the highly densely populated district in
NYC, though smallest geographically. In the United States,
NYC is the leading county with highest population and the
leading densely populated region globally (Stanhope &
Lancaster, 2018). The facts are supported by the 2010 census
report that the district has the highest population compared to
other boroughs because it holds a populace of “1,585,873 living
in a land area of 22.96 square miles (59.5 km2), or 69,464
residents per square mile (26,924/km²)” (U.S. Census Bureau
Quick Facts). It is the wealthiest county that stabilize U.S
economy with a 2005 per capita income above $100,000.
Manhattan is the smallest in land area but the third –largest
populated borough in NYC.
United States has referred Manhattan as the centre that does
well economically and culturally develop. NYC serves as the
monetary capital centre for both NASDAQ as well as the New
York Stock Exchange, with an estimated GDP of over $1.2

3. trillion. Universities, museums, tourist’s attractions sites are
amongst the famous landmarks that distinguish Manhattan
community from other boroughs. United Nations Headquarters
are as well located in this borough. The city is described as a
metropolitan centre where most of the government business are
conducted, businesses, simulation activities as well as where
national banks can be accessed.
Key Community Groups and Health Concerns
In Manhattan city, some people are more vulnerable than others.
Specifically, elderly and children are mostly affected since
according to U.S. Census Bureau Quick Facts 16.1% and 9% of
elderly and children respectively live in abject poverty. That is
why, in Mary Manning Walsh Nursing Home, they strive to
identify this portion to understand their level of vulnerability so
as to provide appropriate interventions. According to Stanhope
& Lancaster (2018), limited and uneven distribution of
resources in the community is the leading causes of subjecting
these populations to vulnerability. Aging population need
prompt intervention to alleviate life-threating effects like
developing depression which leads to pressure ulcers. The
hospital contends that, to increase resilience, the situation can
be reversed when accessible resources are allocated properly.
Poverty maybe as result of low income amongst the elderly,
which later contribute to their poor health like developing
pressure ulcers due to stress and also lack of accessing quality
healthcare system. As indicated from the county health
statistics, elderly population without insurance coverage in
Manhattan city is estimated as 10% which is higher than
Hampshire city which has an average of 10%. This is why;
Sachs (2016) argues that, Individuals at the two closures of the
age difference are frequently less ready to adjust to stressors
physiologically". Kids in poverty are likewise an extraordinary
concern of society. An investigation of Stanhope & Lancaster
(2018) expressed that the "rate of kid destitution is an
expanding function of the level of salary imbalance". Likewise,
"the higher is the pay disparity, the more prominent is the rate

4. of kid poverty.
Children are another vulnerable group predisposed to
malnourishment, underweight and poor health. Vulnerability
contributes to loss of lifespan work opportunities and shortfall
of quality education (Stanhope & Lancaster, 2018). Report from
county ranks states that compared to other neighbouring
borough; Manhattan carries a 36% of children in who are
eligible to get reduced-price lunch. Also, 3% consist of
uninsured children and 40% is the mortality. Generally, medical
attendants play significant roles in coordinating and connecting
vulnerable population with the accessible resources in the
community and different organizations. They can work with
others as well as offering health education in the public to
establish a wellbeing program. Most importantly, medical
attendants can impact enactment and health policies that
influence the susceptible populace.
Community Health Assessment
Manhattan Borough, New York City
With a promise to give the most astounding quality medical care
service to each individual in all the five boroughs in New York
City, the NYC Health + Hospitals public healthcare sector is the
biggest of its sort in the US (Efraim, 2010). Citizens of
Manhattan district get public medical care service from clinics
run by NYC. Pressure ulcers (PU) prevalence presents a
substantial weight on medical care facilities. Improved
therapeutic care and better living conditions have expanded the
future of the old populace. Many aging victims experience the
ill effects of severe and ceaseless infections, dietary
inadequacies, and susceptibility (Issel & Wells, 2017). A major
predisposing factor for PU is comorbidities notwithstanding the
aging process bringing about idleness. The number of PU
victims over the age of 80 years has been increasing due to
prolonged life expectancy, leading to higher risk of disability
and immobility. Higher mortality rate reported in Manhattan is
a result of PU conditions (Barnidge et al., 2013). Another study

5. shows, an average elderly person with stage IV hospital-
acquired PU spends an average of $129,248 (Jaul & Menzel,
2014). A review done on repetitive admissions, an average of
$124,327 is spent on community-procured PU. The higher
appearance of complications and the extended time taken for
patients in the facility to heal increases the health cost as the
ulcer grade continues to develop. Intricacies, for example,
contaminations or osteomyelitis, increase related financial
expense altogether.
Existing Resources
Some of the available national, regional and local resources
found in Manhattan borough to help in battling elderly pressure
ulcer are:
Educational institutions
Some of the institutions include NYU College of Global Public
Health and Mandi School, The College of Allied Health.
Students at these institutions should educated about pressure
ulcers and its prevalence in older individuals. In this resource,
education is the social determinant of health that is met.
Local & regional hospitals
Local and regional hospitals should learn from one another,
identify areas that need adjustments and collaboratively develop
strategies to address pressure ulcers in the community. The
hospitals can also collaboratively work to determine healthy
behaviours necessary for the prevention and management of
pressure ulcers. In this resource, healthy behaviour is the social
determinant that is met.
Granite State Independent Living
The main aim of the institution is to improve the quality of life
of individuals with disabilities and championing for the needs
of the elderly through advocacy, support and information.
Social support and educations are the social determinants met
under this resource.
Strengths and weaknesses
A notable shortcoming that may be a hindrance with executing a
public wellbeing program on pressure ulcers is the absence of

6. familiarity as well as knowledge with the etiology of the
pressure ulcer development, particularly at the community
setting. Non-proficient care providers and the primary group
have a significant responsibility in prevention. Immobile
patients receiving care at home are checked and followed up by
nurses and GP to check the underlying signs of the skin to
effectively plan proper interventions and medications needed
(Issel & Wells, 2017). Occasional training and continuous
coherence of training are significant for the primary group,
caregiver, and the family. Another shortcoming around
community contribution is absent. Implementing a community
health strategy requires collaborative efforts from other
stakeholders and the community. Without the community the
strategy becomes less effective. The strength in the community
is improved care delivery on teaching and by avoiding outside
pressure, shearing forces, and enhancing the dietary condition
of the older just as regard for care and avoiding dampness of the
skin. Education is very crucial in the implementation of a
community health strategy because will ensure individuals in
the community are aware of the health concern, its prevalence
in elderly people and the role of the community in addressing it.
Opportunities
There is a prospect for community-based associations to make
an establishment essential for improving quality medicinal
services. The obligation is set on the local setting, such,
officials, and public members, to help with building up a
productive plan. The possibility to diminish the wellbeing
inconsistencies identified with stress-related illnesses is
realistic with a focused on project and crafted by the public as a
whole. A few vacant structures in the district offer space that
could be used to make a counselling therapy unit. The chance to
build up an active community wellbeing plan is conceivable.
The community wellbeing plan will be able to address the needs
of elderly individuals particularly when it comes to prevention
and treatments of pressure ulcers. Extensive studies indicate
that a community wellbeing plan is very crucial in addressing

7. health concerns within a community because it assesses the
concerns based on the risk factors (Knapp, 2018).
Barriers
Numerous obstructions can meddle with the fruitful execution
of a community wellbeing plan. Perhaps the most significant
obstacle for the vulnerable populace in this borough is the
geological area. Treatment for pressure ulcers incorporates
routine caregiver visits related to regular doses of medicine.
Inaccessibility of care means the patient will not receive
effective therapy. Availability to treatment centres is frequently
restricted; this is highlighted in rural regions. The four other
boroughs in NY have numerous therapy hospitals, yet
Manhattan has rare treatment offices accessible without
traveling.
The local problems are only one boundary. Financial difficulties
are likewise a boundary to the effective operation of a public
wellbeing program. Empowering nearby organizations,
communal associates, as well as regional and local
administration cooperates to make a plan that is useful to the
public will encourage the accomplishment of the program.
Accomplices can improve the accessibility of assets and can
bolster and perform central assignments (Efraim, 2010). The
lower payment level in rural areas than urban centres
contributes to a higher experienced poverty rate that directly
affects healthcare service delivery. Another barrier is the
language barrier that makes it difficult for healthcare providers
to communicate with elderly patients. New York has a great
history of immigrations and it is estimated that more than 140
different languages are spoken in the city. In addition, New
Yorkers are approximately from 200 different nations (Ancker,
2016). Therefore, some of the elderly patients are unable to
express themselves while communicating with health care
providers which leads to poor health outcomes.
COMMUNITY HEALTH STRATEGY
Problems

8. The first problem is the poverty levels in Manhattan especially
with the elderly. The poverty numbers and absence of quality
health care have been noted to be a challenge for Manhattan just
as the elderly community experiencing pressure ulcers. Older
individuals with pressure ulcers face critical difficulties
meeting all requirements for housing, which increases rates of
taking patients to the crisis rooms and emergency services
(Eldredge et al., 2016). The high levels of lack of proper care
and joblessness have been accounted for to add to "stress and
anxiety" having negatives impacts on person's wellbeing as
ecological components and systemic factors as it influences
depression and trauma and bigotry (Knapp et al., 2018).
As indicated by Knapp et al (2018), medical care access
contributes to incredible differences on socioeconomically
level, influencing wellbeing in the Manhattan neighborhoods.
Research shows that inhabitants experience extraordinary stress
identified with salary and poverty, way of life practices and
death rates (Eldredge et al., 2016). This populace is regularly
noted as having a lower health status as they are viewed as less
associated with taking part in health-promoting exercises, which
may bring about higher death rates from disease (Knapp et al.,
2018).
Another community problem that the elderly population faces
are abuse and maltreatment. According to the biology of aging,
it is expected that, with time, the aging population becomes
weak. This fragility renders them to be dependent for care and
support – in some cases calling for help on essential needs like
toileting and feeding support and housing provision. In contrast
to a kid who fully depends on the parents, an elderly person is
full of experience, emotions, and information – and fully
developed. This makes the caregiving situation increasingly
mind-boggling. A study in Manhattan found that 59 percent of
caregivers detailed verbal hostility as a style of compromise.
Paid caregivers in nursing homes were at great danger of getting
to be abusive on the off chance that they had low occupation
fulfillment, treated the older like youngsters, or felt burnt out

9. (Knapp et al., 2018).
Interventions
The potential intervention that ought to be incorporated into the
wellbeing technique for the Manhattan community would be
identified with the old populace. As indicated by Stanhope &
Lancaster (2015), medical attendants assume a significant role
in impacting political and social policies, for example,
affordable housing. As an essential intervention, moderate
housing, housing benefits, work training, and multisystem
training can be sturdy. As primary prevention for pressure
ulcers, medical attendants can instruct adapting systems, stress
decrease, and teach populaces about a healthy way of life
issues. Auxiliary counteractive action would include early
diagnosis, prompt treatment, and confinements of inability for
those nearly getting to be destitute or recently destitute
(Eldredge et al., 2016). For auxiliary prevention in pressure,
ulcers lead screening to identify bedsores and other related
aging issues. On a tertiary prevention level for the destitute
would incorporate comprehensive case management, physical
and emotional well-being services, and emergency shelters. The
aim of comprehensive case management is to address the
individual needs of the elderly in order to prevent and manage
pressure ulcers. Comprehensive case management should be
conducted through conducting risk assessment then developing
preventive measures for the patients at risk. For case
management to be effectively conducted, caregivers should be
trained on how to identify pressure ulcers while they are still in
early stages. The Braden Scale can be utilized in determining
the pressure ulcer risk for elderly patients. Effective case
management is linked to effective staging of pressure ulcers
therefore the most appropriate treatment is administered.
Physical well-being services include skin care because elderly
patients stay in bed or in a single position for too long which is
a contributing factor to the development of pressure ulcers.
Health care professionals should often check the skin of elderly
patients especially if they report pain in a part of their body.

10. Skin care should not only be the responsibility of health care
professionals but also individual patients. They should be
educated on how to keep the skin clean and dry, the products to
avoid and utilizing availed devices such as protective mattresses
and limb protectors. The protective mattresses are very
important in relieving pressure points. The key stakeholders for
implementing this strategy include the government, patients,
physicians and nurses. The government is important in availing
the required resources such as the protective mattresses and
limb protectors. Nurses are important for educating the elderly
patients and taking of them. Physicians are crucial in
identifying the most appropriate treatment for the pressure
sores. For the community to be involved, various community
awareness programs should be developed with an aim of
educating the community about pressure sores and ensuring they
understand how the pressure sores are prevented, acquired and
treated.
Teaching and Learning Strategy
As proficient medical caretakers, we have trained to instruct the
populace we are working with the delivery of medicinal
services. The populace we educate would incorporate those
most vulnerable referenced in this primer. Along these lines, to
be a successful instructor, we should comprehend the topic and
learning. Instructing methodologies should require extensive
techniques to guarantee all community individuals are reached.
For training on the system of services and providers to the old
populace, handouts can be given out concentrating on projects
in the region accessible that will offer help on a government,
state, and nearby level. Additionally, giving a patient-focused
care survey to evaluate the level of awareness and explain their
comprehension and inquiries concerning poverty.
Development of Health Strategy
So as to start programs for the development of a community
health strategy, a community appraisal of needs should be
established. In the wake of recognizing the demands, the targets
and results for the community will be set. Moreover, settled

11. objectives would be settled upon inside the community
alongside identifying populaces of interest, achievements, and
outcome goals. Now in the development procedure, recognizing
strategies, exercises, process targets, and accessible assets that
will help add to the purpose (s) and result destinations
(Stanhope & Lancaster, 2015). Generally, developing a health
strategy to address the problem of pressure ulcers will entail
five key steps. The first is performing a situational assessment
that will be aimed at acquiring more knowledge about the
population of interest and patterns that may impact the
implementation of the program. The second step is developing
goals, outcomes and outcomes objectives. The results of the
situational assessment will be used to identify the goals and
objectives. The third step is identifying strategies and resources
that are useful in achieving the identified goals and outcomes
objectives. The situational assessment results will also be useful
in this step. The forth step is developing indicators which will
be useful in assessing to what extent the stipulated goals and
objectives have been met. The final step is reviewing the
program plan which will be aimed at identifying areas that need
adjustments and ensuring that enough resources are available
for the program.
How the community health strategy is aligned with health care
policies or programs
The community health strategy aligns with YMCA-Healthy
living programs which are aimed at improving health of older
adults by ensuring that health care providers and the community
are well aware of the needs of old individuals and how the can
be met. YMCA-Healthy living strongly supports community
integrated health in an attempt to improve the associations
between interventions that are based on the community and
traditional health care.
References
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Borough), New York. Retrieved from:
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