Running head GLOBAL EVENTS1[Type text][Type text][Type text.docx

Running head: GLOBAL EVENTS 1
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GLOBAL EVENTS 2
Global Events
Samantha M. Tallarine
Capella University
BSN-FP4014
Global Perspectives of Community and Public Service
July, 2019
DISASTER REPORT AND ROLE OF NURSES
Global event regarding disaster, taking many lives:
· In discussing the global event regarding the disaster and
prevailing scenarios which have occurred throughout the human
history, creating hindrance and allowing us to rehabilitate
ourselves from the stains of previous global events which have
taken a lot of lives along with it.
· The basic structure to control a disaster is to improvise the

true skills of a professional controlling and providing the exact
information about the working weather machines and other
things required in the community and tell others to remain
updated from the emerging outcomes and symptoms most
relevant in our neighborhood.
· Manhood from the beginning has evolved many techniques and
rules to evaluate the power and business for him with proper
facilities and benefits. Nuclear plants and demonstrating plants
like these for the building up of power and electricity has
eventually a great role in this modern society. With cheap and
fascinating production of the electricity with little effort just in
order to control the reaction and turbines occurring in the field.
· The reactors for the production of electricity has termed to be
used uranium as a fuel to burn the water turn it into steam and
that steam runs the turbine. This might look like a simple
process, but the network of complications with it is uncountable
and every single person is truly responsible for the outcome of
the good or bad result.
· The windmills, dams, and solar plants are considered the
safest and convenient way to yield cheap electricity as it does
not have a risk of explosion, but when the wind is high enough
to carry windmills out of the ground may have a little chance to
assist a disaster.
Chernobyl incident in Ukrainian SSR near Pripyat:
The incident happened near Pripyat in 1986, on April 26, it was
an RBMK reactor that has built in flaws regarding to its
structure and design, then it was tested for working on low
power to release the power and allow the generators to operate
the rest of the reaction. The gap between the starting of the
generators was 1 minute.
Since 1982, 3 tests were conducted with the result of a failure,
this was the fourth attempt. The chief engineer, Dyatlov, was
leading the reaction that time with the night shift, and this shift
had not been properly informed about the test and how to run it.
Procedures were not carried out with proper management and
follow up of the manual. This carelessness brought catastrophe,

resulting in the overheating of the core where the fission
reaction was carried out in the building # 4. The core exploded
with an immense amount of energy leading towards the open
environment dispersing the radioactive fuel in the sky and open
air.
Radioactive content moved rapidly out of the core and dispersed
into the environment leading towards the developing disaster,
which cost many lives.
Lies and carelessness brings fuel to fire:
The chief engineer told the owner of the reactor that the
situation was under control to protect his job and told them the
tank of water exploded, adding fuel to the fire, and didn’t tell
them that he saw graphite on the ground, which was supposed to
be inside the core. Graphite controlled the efflux of the atoms
inside the core. As the atoms split due to the collision with each
other, a tremendous amount of energy lead to the boiling of
water and converting it into steam which in turn causes the
turbine to run electricity.
Basic manual follow up:
The manual for running the test was not followed regularly and
properly. The night shift was not aware of the test which was
supposed to be run after the time lapse of 10 hours.
The design of the RBMK reactor had many flaws depicting that
it might not work with an alternate pathway which bring more
economic power to the Ukrainian community enhancing the
power development and escaping the power crisis of the city.
This would help people to work with cheap electricity, but that
night of August they were playing with a ticking time bomb in
their hands.
Dispersion of the radiation and radioactive atoms in the
environment causing cancer:
The radiations after the explosion spread out into the
environment, and contaminated each and every single thing. A
meeting was held after the explosion, and the mayor was told
that the reactor engineers had informed them that the situation
was under control. Professor Legasov, the researcher of the

nuclear and atomic energy, told them that its not under control
and they are all lying to each other for the sake of not wanting
to create panic. He advised them to evacuate the city and cover
the core with sand as soon as possible. Commander Sheberni
was appointed with Legasov as an assistant to educate him
about the current situation and find the solution to put out the
burning fire and decease the spread of radiation of the reactor.
Firemen and role of Healthcare professionals:
Parallel to this all, fire fighters were called that night to put out
the fire and were directly exposed to the core, causing them to
vomit instantly and eventually burning off their skin.
Individuals exposed to such type of radiation can develop
thyroid cancer like symptoms and live for shorter life span.
When they were rescued and brought to the local hospital, they
were transferred to the hospital in Moscow far away from the
radiation. Their clothes were ripped off of them, as they were
contaminated. Most nurses and staff were not aware about the
symptoms of a radioactive exposed person. They dropped all
their clothes into a room where no one can go. Proper
medications were given to them with the iodine isotopes to
accommodate the body not to absorb the external iodine
eliminate from the fission of the radioactive atoms.
Social attitudes and related behavior of high authorities:
· The researchers when they get to know about this catastrophic
disaster, many Civil and Army Crops developed strategies and
they were informed that to evacuate the city as soon as possible
surrounding the vicinity of 30 km radius. Hospital staff and
other army doctors and agencies showed manipulated
mechanisms to help out the stranded victims.
· Most of the people were not in the proposal of evacuating, but
the devastating situation had led them to move from that
contaminated place.
· If the core remained exposed then it would require 24000
years to be feasible and suitable for humans to live, but the
whole continent would be dead at that time. Costing millions of
lives and contaminating everything, including ground water,

food, animals, trees, air, buildings etc.
· Rescue teams formed in the area of the incident and the needs
of that time at that scenario was to be united and think
positively to cast out the solution from the catastrophic disaster.
Many agencies from the other cities helped and provided aid to
the refugees and medications with proper treatment.
· Majorly the area was cured and the other 1, 2 and 3rd reactors
were closed properly to dispose of and to prevent the harm and
alarming situation again. USSR military troops and men helped
the citizens to evacuate safely without creating panic attach to
anyone which may bring more complications in the handling of
the situation.
Prevention from the meltdown by corporation another terrible
risk:
Press conferences were held and it was being conducted to the
world that after great struggle, the emerging fumes from the
reactor were now down and cooled off. The use of iodine for
humans, and boron mixing with sand were thrown thousands of
tons over the reactor to cool it down. The melt down was
prevented by the action and paying depth of their lives by three
men who work at the Chernobyl nuclear power plant and know
how to prevent the melt down. These men were rewarded with
1200 rubles every year and promotions in their field. From the
whole crowd, only 3 men stood to go in there and open the
valves by hand manually. They were suited completely and
tightly to prevent as much radiations as they can from
penetrating their bodies.
Thus, with unity and the corporation of the people and co-
workers took out the Chernobyl from the ditch, which is getting
deeper and deeper for the living beings.
Effective role of nurses and medical staff eliminating racism:
· The incident of Chernobyl is the unforgettable incident in the
life of Russia; it has created a great impact on the surrounding
citizens, as well as the people who survived it at that time. The
entire emergency policies developed strategies to control such a
huge amount of population to be accommodated in hospitals in

nearby cities, and allowed them to reside in their habitat and
provided every single need and assistance to them.
· Yet it cost many lives, and it was said, “what is the cost of
lies? If we have heard enough lies, then we no longer recognize
the truth.” Some intellectual minds and skill based body and
analysis surely helps a lot to protrude out of the disaster.
· Earthquakes and tsunamis occurred every year without any
dominate appearance causing the loss of many lives.
· Not on the basis of being the nationalist of that area, rather to
cure every single being at the time of the incident was the scope
and motive of the entire nurse and rescue teams. They were
passionate and willing to help people, even in such devastating
condition.
· The main goal is to make those atoms from the spread or it
will create panic and causes deaths in the whole continent.
Russia was answerable that time and those who did it were also.
They were sentenced to be imprisoned for more than 10 years,
but the trade and cost of death should be and must be death, no
other way will pay the depth and only the sufferings can be felt
by those who have seen it with their own eyes.
Animal control and health department:
The animals of the Chernobyl and nearby area were killed,
including mostly dogs in it. They were shot by guns and
bludgeoned with hammers so they may not contaminate other
creatures on earth and which will spread the contamination and
radioactive substances just like fire in the jungle.

Resources
Devell, L., Tovedal, H., Bergstrom, U., Appelgren, A.,
Chyssler, J., & Andersson, L. (1986). Initial observations of
fallout from the reactor accident at Chernobyl. Nature,
321(6067), 192-193. doi: 10.1038/321192a0
Drottz-Sjoberh, B., & Sjoberg, L. (1990). Risk perception and
worries after the chernobyl accident. Journal of Environmental
Psychology, 10(2), 135-149. doi:10.1016/s0272-4944(05)80124-
0
Perko, T. (2011). Importance of risk communication during and
after a nuclear accident. Integrated Environmental Assessment
and Management, 7(3), 388-392. doi:10.1002/ieam.230
Poortinga, W., & Pidgeon, N.F. (2004). Trust, the Asymmetry
Principle, and the Role of Prior Beliefs. Risk Analysis, 24(6),
1475-1486. doi:10.1111/j.0272-4332.2004.00543.x
Tornado Disaster in Joplin, Missouri and in Birmingham,
Alabama
Samantha Tallarine
Capella University
BSN-FP4014
July, 2019
EFFECTS ON COMMUNITY HEALTH
.
The occurrence of crises such as hurricanes and volcanic
eruptions leave the affected communities without access to
healthcare (Delgado, Gonzalez, & Swathi, 2017).

Natural disasters destroy the necessary infrastructure like roads
and power supply
The outbreak of diseases like Ebola affects health care delivery
because of the exposure to the virus.
In the long-run, the crisis’s effect on the social susceptibility of
the populace can have a ripple impact, which further burdens
health care delivery care in the community.
Shifts in victim demographics creates significant workload for
weakened health systems
2
RESPONSE TO 2011, TORNADO IN JOPLIN
The Missouri Department of Health and Senior Services (DHSS)
activated the PHEP-financed State Emergency Operations
Center and Emergency(CDC, 2011).
It integrated public health into the emergency response and, in
partnership with its associates, lead and coordinated the health
care and public health sectors.
Local health units took advantage of existing collaborations
with health units in others states to offer mutual aid utilities
like administering tetanus vaccinations.
The private sector-inclusive of churches, Joplin residents, the
business community, and volunteers offered relief to the
victims.
3
RESPONSE IN BIRMINGHAM, ALABAMA
The state through FEMA activated its National Response
Coordination Staff to Level II
Level II activates its emergency support operations inclusive of

search and rescue, public health, mass care, and transportation
(FEMA, 2011).
FEMA coordinated the emergency response teams ensuring that
the exercise went on smoothly.
The private sector also provided aid, with the Salvation Army
offering free meals to the affected victims.
In comparison to the Joplin tornado the Birmingham response
was well coordinated.
4
Key Lessons Learned in the Joplin Disaster
Hospitals should test all emergency plans to pinpoint and
correct weaknesses(Smith & Sutter, 2013).
It is important to draft emergency plans to provide medical staff
with critical thinking capabilities to manage disaster responses.
Tactical and strategic communication is vital to coordinating
response teams, media and the public.
5
Key Lessons Learnt in Birmingham, Alabama
It is important to update disaster training and have the
necessary equipment for future disasters
inclusive of items to assist hospitals in evacuating and kits to
convert busies for patient transport.
The disaster also showed the need for counties and cities to
have debris contracts in place before a disaster.
6

CURRENT PRACTICES JOPLIN
A majority of hospitals in Missouri have their emergency
operations plans and their command centers active.
In case of a community crisis there is enough notice and time to
prepare and communication systems are uninterrupted.
The hospitals are able to dispatch teams based on the
information they have on the extent of injuries and fatalities in
the area community.
7
CURRENT PRACTICES IN BIRMINGHAM
The current practice in Birmingham involves educating the
medical staff of the proper vehicle extraction-methods
In case of a crisis the seriously injured people can find their
way to hospital easily.
The disaster plan in Birmingham also involves an alternative
supply of medicines such as tetanus toxoid to the medical
emergency teams in the field in case of an emergency.
Physicians in the area educate residents on how to respond to
tornadoes and other community crises.
8
KEY AREAS FOR IMPROVEMENT
The key areas for improvement are the supply of water,
medication, and power.

Since natural disasters destroy the existing infrastructure it is
important to have a backup plan on how to supply water and
medicines.
Sometimes the nearest hospitals where the residents would go in
case of a crisis may be destroyed or over-burden by the surge of
victims thus, it is important to have a plan to counter the effect
like provision of additional staff.
During natural disasters power outages are witnessed
It is important to have an alternative radio communication to
ensure communication is not interrupted.
9
RECOMMENDATION
Nurses require more education and preparation in reacting to
crises
Nurses get minimal crisis-focused instruction as part of their
formal training.
The federal financing is inconsistent, whereas local and state
cutbacks endanger the public health workforce (Brand, 2016).
More training and resources will enhance the nurses’ capacity to
safeguard the country’s health during extraordinary
occurrences like tornadoes(Brand, 2016).
10
REFERENCES
Brand, R. (2016, May 1). When Disaster Strikes. Retrieved from
Robert Wood Johnson Foundation:
https://www.rwjf.org/en/library/research/2016/05/when-
disaster-strikes.html
CDC. (2011). Tornado in Joplin, Missouri. Retrieved from
Center for Disease Control and Prevention:

https://www.cdc.gov/cpr/readiness/stories/mo.htm
FEMA. (2011). Response and Support Efforts for Southern U.S.
Tornadoes and Severe Storms. Retrieved from FEMA:
https://www.fema.gov/blog/2011-04-29/recap-response-and-
support-efforts-southern-us-tornadoes-and-severe-storms
Smith, D., & Sutter, D. (2013). Response and Recovery after the
Joplin Tornado: Lessons Applied and Lessons Learned. The
Independent Review , 18(2): 165-188.
Swathi, J., Gonzalez, P., & Delgado, R. (2017). Disaster
management and primary health care: implications for medical
education. International Journal on Medical Education, 8: 414-
415.
The End!
Running head: GLOBAL HEALTH 1
GLOBAL HEALTH 2

Global Health
Capella University
BSN-FP4014
June, 2019
Global Health
Heart disease is one of the non-communicable conditions that
affect many people globally. According to the statistical report
from the World Health Organization, heart disease has been
ranked as the leading cause of death. In the year 2016, this
disease claimed a total of 17.9 million lives, which amounts to
31% of all deaths globally. It is also established that the disease
is more prevalent in low and middle-income countries as the
mortality statistics revealed (Barquera et al, 2015). The most
common type of illness is the Coronary Heart Disease, which
affects people primarily due to lifestyle practices and behaviors
such as poor nutrition, consumption of alcohol and lack of
exercise. The poor outcomes of this disease have been
associated with a deficiency or delayed access to health care
intervention due to lack of resources or absence of health
facilities that provide quality healthcare as far the
cardiovascular disease is concerned (Mozaffarian et al., 2016).
Several factors have been identified to influence health
and the delivery of healthcare associated with cardiovascular
disease. These factors are categorized into different levels.
There are individual factors such as sedentary lifestyles, feeding
on fast foods rich in carbohydrates and fats, lack of exercise
and consumption of alcohol and smoking of tobacco products
(Barquera et al, 2015). Presence of these factors in a person's
life increases the incidences of the disease.

Socioeconomic and biological factors are the second type of
factors contributing to the presence of heart disease. Many
individuals in middle-income and low-income countries lack
funds to seek immediate care interventions whenever there are
signs of heart disease. This is coupled with a low level of
education that negatively influences health-seeking behaviors
(Mozaffarian et al., 2016). Biological factors such as genetic
make-up of individuals in different parts of the world influence
the incidence and prevalence of some forms of heart disease.
People with African descent have been found to have a higher
susceptibility to cardiac diseases as compared to other races.
Individual factors are the organization or the state-based factors
to the incidence and prevalence of heart disease. Many
countries globally have poor infrastructure that fails to provide
primary and specialized cardiac care to patients with heart
disease. Low-income and middle-income countries globally
have poor roads connecting the people with healthcare facilities
(Mozaffarian et al., 2016). As a result, delivering care to
patients who develop heart condition at their home is impaired
by lack of adequate transport, resulting in delayed care, which
is the leading cause of complications, including death, among
patients with heart diseases. In addition to poor infrastructure,
there is also the poor distribution of healthcare institutions in
many countries where facilities and healthcare professionals are
concentrated in urban centers (Mendis, Davis & Norrving,
2015). This results in the unequal distribution of care services
where people in rural areas lack the essentials.
Human resources is another factor that influences heart disease
and the treatment of these conditions. Management of this
disease involves primary prevention, secondary and tertiary
prevention. Globally there is a significant shortage of healthcare
personnel to provide health education to act as fundamental
prevention strategies (Mendis, Davis & Norrving, 2015). Also,
identified cases have not been effectively managed due to lack
of adequate qualified healthcare professionals. This shortage
has been associated with a lack of sufficient resources for

training healthcare professionals in many countries.
Role of Altruistic Organizations
The healthcare sector is one of the largest and complex
departments globally due to the effects of many human and
environmental activities on health. Heart disease is one of the
conditions that even though has no outbreak still requires
emergency services. Several organizations have been
established to provide emergency services to victims of heart
disease. Altruistic organizations were created to play the same
roles as these other organizations. The purpose is to promote
timely interventions to heart disease, hence reducing the risks
of complications associated with these diseases (Stewart,
Manmathan & Wilkinson, 2017). The charitable organization
provides emergency care through transporting patients from
their residence to the point of emergency care. Also, these
organizations have medical personnel who provide immediate
care services to patients before transferring them to a
specialized institution for further consideration (Carrera et al.,
2018). Through these practices, these organizations have
improved health outcomes in patients with heart disease in
different parts of the world.
Interventions to Address the problem of Heart Disease
Being one of the leading causes of morbidity and mortality at
the global stage, heart disease has been managed in different
countries to reduce its incidences and prevalence. The
interventions have been aimed to prevent new people from
being affected; early identification of the disease, treatment
through comprehensive care, and provision of rehabilitative
services to the victims of heart disease. One of the steps taken
by countries is the increment in the number of personnel to
provide care to people (Stewart, Manmathan & Wilkinson,
2017). This has been achieved through the establishment of
medical training institution to provide quality education to
healthcare professionals hence reducing the gap between
demand-supply of healthcare services (Mendis, Davis &
Norrving, 2015).

Infrastructural development is another intervention associated
with management of heart disease. Most countries have diverted
most of their funds to the development of infrastructure to
promote quality and accessible healthcare for citizens (Mendis,
Davis & Norrving, 2015). Primary healthcare has strengthened
to provide comprehensive care, including cardiac services to
patients (Cappuccio & Miller, 2016). To reduce complications
and death due to delayed care as a result of poor roads, roads
have been constructed to connect rural areas and urban centres
to ease transportation of patients.
The cost of healthcare is one of the factors that negatively
influence the outcomes of heart disease globally. Many people
in low-income and middle-income societies have failed to
access medical services due to lack of enough funds to transport
and pay for medical bills. As a result, there has been the
establishment of ambulance services and emergency contacts to
facilitate prompt transportation of patients to healthcare
facilities. Policies have been introduced by many countries to
make healthcare services accessible to even people with low
income (Mendis, Davis & Norrving, 2015). This has been
achieved the provision of health insurance to most vulnerable
groups such as the elderly and people with little income. With
this, cardiac services, which are usually very expensive, have
been covered, enabling the majority to access quality care hence
improving outcomes.
Effects of Health Decision at Local Level
One of the factors determining health practice and outcomes are
the decisions made concerning the disease. Heart disease is
most prevalent in populations with low income, elderly and
without a higher level of education. The common cause of heart
illness among these populations is due to poor health decisions
made due to lack of essential resources. Individuals in urban
areas are aware of the disease and its impact without necessarily
being educated. People in urban areas and have better income
will have the resources to practice good nutritional practices,
which are essential in the incidences and prevalence of heart

disease (Threapleton et al., 2013). These individuals also attend
cardiac clinics for the screening of heart disease, which has
promoted timely interventions, hence improving outcomes.
During these visits to healthcare clinics, individuals in urban
areas have been able to acquire health education about the best
practice and behaviors that would promote better cardiac, and
overall health (Stewart, Manmathan & Wilkinson, 2017).
Some instances have seen individuals make poor decisions that
have resulted in poor health outcomes due to the presence of
heart disease. These decisions usually are made without
consideration of the implications they have on health. Majority
of individuals in low-income society feed mostly on fast foods
and lack enough time to have physical exercise. As a result, the
accumulation of fats and sugars in the body increases the risk of
development of heart disease (Misra et al., 2017). Some
individuals are chronic consumers of alcohol and smokers of
tobacco products. These two have been identified to contain
substances that increase the risks of heart problems. Most of
these decisions have been made due to lack of education to
improve or to counsel on the impacts of such to cardiac and
overall body health.
Evidence-based Interventions
There are interventions which have been proven to be effective
in the management of heart disease. These interventions are
grouped into three categories, primary, secondary and tertiary
management of the cardiovascular disease. Primary
interventions to prevent incidences of heart disease include
health education on proper nutritional practices, avoidance of
sedentary lifestyle and cessation of smoking and alcohol
consumptions (Stewart, Manmathan & Wilkinson, 2017). Other
preventive measures include routine screening of persons for
heart disease. Education of patient on the early signs and
symptoms of any form of heart disease is also part of the
preventive interventions (Threapleton et al., 2013).
The second type of interventions that have been implemented is
the availability of treatment options and supplies for the

identified cases of heart disease. Countries have set up primary
care facilities with the capacity of providing emergency
services to patients with different forms and acuity of
cardiovascular disease (Misra et al., 2017). This has been
achieved by strengthening the role of the community health
department and professionals. Provision of primary healthcare
facilities has also promoted the prompt intervention that as not
available due to the distance between the patient and the point
of care which were mostly located in urban centres (Wallace,
Smith, Fahey & Roland, 2016).
Thirdly, management of the cardiovascular disease has been
provided through setting up of special department in healthcare
facilities to offer expert care to a patient with critical heart
diseases. This includes the surgical management of heart
disease by specialized healthcare professionals (Wallace, Smith,
Fahey & Roland, 2016). In cardiology departments, supportive
interventions such as cardiac rehabilitation have been provided
in most countries to assist patients in recovering from heart
disease through monitored cardiac exercise (Cappuccio &
Miller, 2016). The overall outcome of these interventions
improved health outcomes among patients with heart diseases
hence a reduction in mortality and morbidity rates.
Resources
Barquera, S., Pedroza-Tobías, A., Medina, C., Hernández-
Barrera, L., Bibbins-Domingo, K., Lozano, R., & Moran, A. E.
(2015). Global overview of the epidemiology of atherosclerotic
cardiovascular disease. Archives of medical research, 46(5),
328-338.
Cappuccio, F. P., & Miller, M. A. (2016). Cardiovascular
disease and hypertension in sub-Saharan Africa: burden, risk
and interventions. Internal and emergency medicine, 11(3), 299-
305.

Carrera, J. S., Brown, P., Brody, J. G., & Morello-Frosch, R.
(2018). Research altruism as motivation for participation in
community-centered environmental health research. Social
Science & Medicine, 196, 175-181.
Chow, C. K., Redfern, J., Hillis, G. S., Thakkar, J., Santo, K.,
Hackett, M. L., ... & Bompoint, S. (2015). Effect of lifestyle-
focused text messaging on risk factor modification in patients
with coronary heart disease: a randomized clinical
trial. Jama, 314(12), 1255-1263.
Mendis, S., Davis, S., & Norrving, B. (2015). Organizational
update: the world health organization global status report on
noncommunicable diseases 2014; one more landmark step in the
combat against stroke and vascular disease. Stroke, 46(5), e121-
e122.
Misra, A., Tandon, N., Ebrahim, S., Sattar, N., Alam, D.,
Shrivastava, U., ... & Jafar, T. H. (2017). Diabetes,
cardiovascular disease, and chronic kidney disease in South
Asia: current status and future directions. bmj, 357, j1420.
Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K.,
Blaha, M. J., Cushman, M., ... & Howard, V. J. (2016). Heart
disease and stroke statistics-2016 update a report from the
American Heart Association. Circulation, 133(4), e38-e48.
Stewart, J., Manmathan, G., & Wilkinson, P. (2017). Primary
prevention of cardiovascular disease: A review of contemporary
guidance and literature. JRSM cardiovascular disease, 6,
2048004016687211.
Threapleton, D. E., Greenwood, D. C., Evans, C. E., Cleghorn,
C. L., Nykjaer, C., Woodhead, C., ... & Burley, V. J. (2013).
Dietary fibre intake and risk of cardiovascular disease:
systematic review and meta-analysis. Bmj, 347, f6879.
Wallace, E., Smith, S. M., Fahey, T., & Roland, M. (2016).
Reducing emergency admissions through community-based
interventions. BMJ, 352, h6817.
Running Head: COMMUNITY HEALTH
1

COMMUNITY HEALTH
2
Community Health – Diabetes
Capella University
BSN-FP4014
June, 2019
Community Health – Diabetes
Diabetes is a disease that affects a large portion of the
population, especially the elderly. This is a disease described by
high levels of glucose or blood sugar. The glucose in the body
comes from the food that we eat every day. Insulin is a hormone
that makes it possible for glucose to get into the body cells and
give them the energy that enables an individual to perform
different duties. Type 1 Diabetes indicates that the body is
physically unable to make insulin. On the other hand, in an
individual with Type 2 Diabetes, which is the most common
type, the body is not able to utilize the insulin secreted from the
pancreas.
Without enough insulin in the body, glucose stays in the blood.
Too much glucose in the blood system can cause some severe
health issues such as vision problems, kidney failure, and nerve

damage. There are many people who are not able to discover
their diabetic conditions until it is in its final stages. In this
paper, we are going to discuss the occurrence of diabetes in
California, the burden that comes with it and how the
government and the healthcare department are working around
the clock to reduce the rate of diabetes.
Diabetes in California
Type 2 Diabetes can be developed at any stage in life. However,
most people who have it range from middle age to the older
adult. Risk factors include age over 45, a familial history of
diabetes, and when one is obese or overweight. In the United
States, black adults are more likely to have type 2 Diabetes in
comparison with their white counterparts. Almost half of the
adult population in California is diabetic. This includes every
one person out of three young people who live there are either
pre-diabetic or already have type 2 diabetes and not yet
diagnosed. According to the study conducted, there is an
alarming insight into California’s future when it comes to the
rate of diabetes. The study was done by the UCLA Center for
Health Policy Research and came out with results and they are
as follows; it was discovered that an estimate of 13 million
adults in California are diabetic. 46% of them are undiagnosed
or have prediabetes. 2.5 million Which is equivalent to 9
percent of the adult population are already diagnosed. When the
two groups are combined they represent 15.5 million people,
which is an estimate of 55 percent of the state’s population.
Because diabetes is found in older people, the study was able to
indicate that 33% of young adults who are aged between 18 and
39 have prediabetes which means that they are not aware of
their diabetic condition (Hawley & McGarvey, 2015).
According to the study above, it is a clear, that to date, diabetes
is an epidemic and is affecting most people in many countries
daily. There is limited accessibility to healthy foods in low-
income communities, most people can only access soda and junk
food in the markets and other neighboring urban centers, thus
most people are prone to be obese and overweight, which is a

contributing factor to diabetes (Berkowitz et al., 2014).
Prevention of Diabetes is Possible
Diabetes is a condition that can be put under control and be
prevented. Most people are victims of prediabetes, which is a
condition where glucose levels are higher than normal but their
hemoglobin A1C is not elevated enough to be in a state where
they can be diagnosed as diabetic. Within a period of 5 years,
30% of people with prediabetes are more likely to advance to
being type 2 diabetic and 70% among them are at a high risk of
developing diabetes in their lifetime (Sudore et al., 2012).
In the United States, diabetes is considered a chronic disease,
which is very costly for the citizens and the government. In
California, the rate of diabetes has increased by 35% since the
year 2001. In a year, the amount of money spent on medication
for people with diabetes is twice as high as that of the people
who do not have diabetes. For example, an individual who has
been diagnosed with diabetes around the age of 42 years, the
money spent on medication can be approximately $124,600
compared to someone who has not been diagnosed with it
(Sudore et al., 2012). There is a need for prediabetic people to
participate in National Diabetes Prevention programs to prevent
more cases of diabetes. There is also a need for the government
to come up with policies and other necessary changes that will
make it possible to increase the rate of screening and preventive
measures and go ahead into encouraging people to adopt healthy
living and active lifestyles in their daily dealings. Providing
alternative ways of acquiring healthy foods at a subsidized price
is important for low-income communities.
Actions Taken Towards Prevention of Diabetes in California
Studies have indicated that losing weight can control Type 2
Diabetes. This means that one has to engage in physical
exercises in all its forms and change the foods that they eat.
Choosing a healthy lifestyle has been shown to reduce the rate
of diabetes by 58 percent among the people who are at a higher
risk of contracting it (Sepah et al., 2014). The legislature can be
involved in passing measures that will focus on reducing the

rate of sweeteners added in beverages, which are a contributing
factor to increase in calories among children. The target is not
only on sodas, but also on other sugary drinks that are assumed
to be healthy such as juices, sports drinks, and enriched water.
These drinks are specifically targeted at children, so there needs
to be education sessions for children and their parents on how to
have a balanced and healthy diet.
Contribution of Nurses on Diabetes
The main task of a nurse in any healthcare unit is to make sure
that the patient receives the required medical attention and
optimal care. They are able to detect and make sure the
necessary precautions are taken to prevent diabetes before it
gets out of control. There are specific practitioners that have
basic knowledge of oral therapy and insulin and due to this,
they are able to advise the patient on when to take treatment and
which type of treatment is suitable for them. This makes it
possible for the patient to receive quality services that make it
possible for them to manage their illnesses and thus avoid
chronic conditions that may lead them to be admitted in the
hospital down the road. An increase in diabetes patients leads to
a strain in the resources and services available to deal with the
disease (Tuso, 2014).
There is a need for leaders and other non-governmental
organizations to join hands and make sure that they are able to
deal with diabetes, which has become a national epidemic. The
individual effort toward living a healthy life is an important
thing. Families should make it a personal goal to live a healthy
life. There is a need for beverage manufacturing industries to
make sure that they have been able to provide beverages with
low sugar content for people to incorporate healthy food choices
into their daily dealings. Education and other important services
should be provided to individuals to make it possible for them
to know the ways that can be used to prevent and put under
control diabetes and its effects.

Resources
Berkowitz, S. A., Karter, A. J., Lyles, C. R., Liu, J. Y.,
Schillinger, D., Adler, N. E., ... & Sarkar, U. (2014). Low
socioeconomic status is associated with increased risk for
hypoglycemia in diabetes patients: the Diabetes Study of
Northern California (DISTANCE). Journal of health care for the
poor and underserved, 25(2), 478.
Hawley, N. L., & McGarvey, S. T. (2015). Obesity and diabetes
in Pacific Islanders: the current burden and the need for urgent
action. Current diabetes reports, 15(5), 29.
http://newsroom.ucla.edu/releases/majority-of-california-adults-
have-prediabetes-or-diabetes
Sepah, S. C., Jiang, L., & Peters, A. L. (2014). Translating the
diabetes prevention program into an online social network:
validation against CDC standards. The Diabetes educator, 40(4),
435-443.
Sudore, R. L., Karter, A. J., Huang, E. S., Moffet, H. H.,
Laiteerapong, N., Schenker, Y., ... & John, P. M. (2012).
Symptom burden of adults with type 2 diabetes across the
disease course: Diabetes & Aging Study. Journal of general
internal medicine, 27(12), 1674-1681.
Tuso, P. (2014). Prediabetes and lifestyle modification: time to
prevent a preventable disease. The Permanente Journal, 18(3),
88.
Running head: WELLNESS EDUCATION PROPOSAL 1
WELLNESS EDUCATION PROPOSAL 2

Wellness Education Program Proposal
Capella University
Organizational and Systems Management for Quality Outcomes
Wellness Education Program Proposal
October, 2018
References
Blake, H., & Gartshore, E. (2016). Workplace wellness using
online learning tools in a healthcare setting. Nurse Education in
Practice, 20, 70-75.
doi:http://dx.doi.org.library.capella.edu/10.1016/j.nepr.2016.07.
001
Upchurch, D. M., & Bethany, W. R. (2015). The importance of
wellness among users of complementary and alternative
medicine: Findings from the 2007 national health interview

survey. BMC Complementary and Alternative
Medicine, 15Retrieved from
http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.p
roquest.com%2Fdocview%2F1779790673%3Faccountid%3D279
65
Professional Development
Samantha Tallarine
Capella University
Health Promotion and Disease Prevention in Vulnerable and
Diverse Populations
September, 2018
CAM and Spirituality for Health Care Workers
Organizational education plan:
What is CAM?
Nurses role in providing spiritual care
Who can benefit from CAM?
CAM = Complementary and alternative medicine
“CAM is defined as various practices and products that are not
considered part of conventional medicine. Complementary
medicine refers to practices and products that are used together
with conventional medicine, while alternative medicine refers
those that are used in place of it.” (Topuz, Uysal & Yilmaz,
2015) Complementary medicine can be used in conjunction with
traditional medical practices, maybe in order to alleviate side
effects. Alternative medicine can be used when a patient maybe
feels their medication is not effective, or if they would rather
not take part in polypharmacy.
Nurses can specifically play a major role in integrating CAM

into normal practice. If they make their patients feel confident
and comfortable to consider CAM, it opens up the door for
questions and potential use. Nurses need to be educated on
different CAM practices in order to give their patients correct
information, and help integrate it into their plans of care.
Who can benefit?
Cancer patients (specifically patient’s on chemotherapy and
radiation)
Patient’s with allergy medications
Palliative care patients
2
Ethical and Legal Principles of CAM
Ethical Principles
Autonomy
Beneficence
Non-maleficence
Legal Principles
Independent self-regulation.(Complementary and Alternative
Medicine for Doctors [CAMDOC] Alliance, n.d.)
Ethical Principles:
Autonomy
Patient’s have the right to make their own decisions when it
comes to their healthcare. In providing patient’s with the option
of partaking in either traditional medicine, alternative medicine,
or a blend of the two (complementary), it ensures they are
making a well informed choice in their plan of care. In order to
educate patients on their options, healthcare workers need to be
educated on all forms of care, and be willing to comply with a
patient’s autonomy.
Beneficence
This ethical principle is to help a patient advance his/her own
good. By providing patients with well rounded information on

all forms of healthcare at their disposal you give them the tools
to choose their plan of care the way they see fit.
Non-maleficence
Do no harm. Having healthcare professionals take an oath to
make sure their patients receive the best care possible, and with
no harm done to them allows patients to feel safe in their care.
With doctors and nurses armed with the knowledge of CAM, it
will ensure patients receive high quality care that will not cause
further harm to them.
Legal Principles:
Independent Self-Regulation
In order to be government-approved a CAM professional must
be registered to provide the necessary self-regulation within the
CAM practices.
3
Economic Principles of CAM
Evaluations of cost
Evaluation of effectiveness
Patient perspective
Data availability
CAM treatment needs to be evaluated in order to determine if it
can be covered by health insurance, and what the overall impact
will be for the patient. Most forms of treatment are not covered
under insurance, therefore patients need to weigh the pros vs.
cons when it comes to choosing their plan of care. The use of
CAM needs to be brought into the light, and be readily available
for patient’s to understand. Data also needs to be collected
about which therapies are being used, and how effective they
really are. In compiling data about the effectiveness, as well as
the cost of treatment, patient’s will be empowered to make a
well-rounded decision. The more data that becomes available,
the more educated health care practitioner's can become on

complementary and alternative medical practices. With doctors
and nurses as advocates for a multi-faceted treatment plan,
patients will become more comfortable disclosing their
alternative therapies; this will allow for open and honest
communication between patients and their doctors and nurses.
4
Global Impact of Ethical, Legal, and Economic Principles of
CAM
Global acceptance is causing a greater demand for
complementary and alternative treatment methods
Patients thrive off taking their treatments into their own hands
Complementary medicine allows for some pharmaceutical and
medicinal interventions as well as alternative methods
Global Acceptance:
“Although the use of CAM therapies has been increasing in
recent years, the debate about the clinical efficacy of these
therapies has been controversial amongst many medical
professionals.” (Walker, Armson, Hodgetts, Jacques, Chin,
Kow, Lee, Wong & Wright, 2017) This is because most medical
professionals are not traditionally trained in complementary and
alternative medical practices. In order to increase the use of
CAM, medical and nursing schools need to integrate CAM
practices into their curriculum. When CAM practices become a
normal occurrence in patient’s plans of care, it will allow them
to be open and honest when requesting help, and will ensure a
better delivery of care.
Patient Autonomy:
Patient’s have the opportunity to partake in many modes of care
when CAM is offered to them. Instead of just having one option
from their healthcare provider, they are able to pick and choose
which pharmaceutical interventions or alternative options they
will include in their plan of care. This ensures patient’s are

remaining autonomous, and will increase satisfaction.
5
Affects of Traditional Medicine, CAM, Spiritual, and Holistic
Care on Individual Action Plans
Pros/Cons of traditional medicine (TM) and complementary and
alternative medicine (CAM)
Pros/Cons of spiritual and holistic care
Traditional Medicine (TM) and Complementary and Alternative
Medicine (CAM):
Pros:
Evidence based practice is readily available, and there are many
research studies done each year to back up new findings
Side effects and adverse effects are thoroughly explored, and
weighed out when developing treatment plans
Doctors and other health care providers are most knowledgeable
when it comes to traditional medicine and certain CAM
practices, therefore will be most supportive of this plan of care
Insurance covers traditional medicine, and most CAM
modalities
Cons:
Pharmaceutical companies drive the entire medical field, and
doctors get incentive to prescribe certain drugs
Pharmacological interventions are the foremost part of a
patient’s treatment plan, especially in hospitals
CAM is not always widely accepted, so patient’s may not be
forthcoming with their doctors that they are using the different
practices
Spiritual and Holistic Care:
Pros:
Treatment is completely in the patient’s hands

Spiritual beliefs can help to raise patient’s hopes and beliefs,
and give them positive outlooks
Embracing spirituality can lead to joining different
organizations, and having a big supportive community
Cons:
Research is scarce on how holistic care effects the use of
pharmaceutical products, can be potentially dangerous or fatal
for patients
Ingredients aren’t always clear, and patient’s can be putting
themselves in harm way or allergic reactions
Not recognized by insurance companies, and can lead to
exponentially high medical bills
6
Affects of Traditional Medicine, CAM, Spiritual, and Holistic
Care on The Asian Population
39.9% Asian CAM users
Higher usage in women
Use of dietary and herbal supplements
Vegetarian and plant-based diets
Asian American women are more likely to use CAM practices
than their male counterparts. Associated factors linked to CAM
usage are gender, educational level, acculturation, and tobacco
use. It was found that women with a ”high school education or
below, no health insurance, lack of English proficiency, and
those who did not use tobacco reported a higher use of CAM.”
(Balagopal, Klatt & Geraghty, 2010) CAM use also was found
to correlate with those who considered themselves spiritual
beings. The number of Asian CAM and holistic care users is
growing within the United States because there has been an
great influx of Asian immigrants. This means that the need for
doctors and nurses to increase their knowledge on these specific
practices has exponentially grown as well. With the ever
changing population needs, healthcare providers need to endure

continuing education to keep up and care for their patients
safely.
7
Resources for Educational Plan
HealthCare Chaplaincy Network
Professional Continuing Education (PCE)
Clinical Pastoral Education (CPE)
The National Center for Complementary and Alternative
Medicine (NCCAM)
Conclusion
Although CAM practices are slowly being brought into the light
within the medical community, it has been shown that
healthcare providers still lack some of the most basic
knowledge. Curriculums within medical and nursing schools
need to be altered to include CAM practices. This will allow
healthcare providers the insight to offer their patients multiple
ways to care for them, and ensure patient autonomy. On top of
that, if patients feel comfortable to disclose they are using CAM
or holistic practices, it will decrease many medication errors
that are seen when patients are not forthcoming with their home
treatments.
References
Complementary and Alternative Medicine Alliance. (n.d.). The
regulatory status of complementary and alternative
medicine for medical doctors in Europe. Retrieved from
http://camdoc.eu/Pdf/CAMDOCRegulatoryStatus8_10.pdf
Complementary and alternative medicine in the united states.
(2005). Retrieved from https://ebookcentral-proquest-
com.library.capella.edu
Klafke, N., Mahler, C., von Hagens, C., Blaser, G., Bentner, M.,

& Joos,S. (2016). Developing and implementing a complex
complementary and alternative (CAM) nursing intervention
for breast and gynecologic cancer patients undergoing
chemotherapy--report from the CONGO (complementary
nursing in gynecologic oncology) study. Supportive Care in
Cancer, 24(5), 2341-2350. doi:http://
dx.doi.org.library.capella.edu/10.1007/s00520-015-3038-5
References
Misra, R., Balagopal, P., Klatt, M., & Geraghty, M.
(2010). Complementary and alternative medicine use
among Asian Indians in the United States: A national
study. Journal of Alternative and Complementary Medicine,
16(8), 843–852.
Topuz, S., Uysal, G., & Yilmaz, A. A. (2015). Knowledge and
opinions of nursing students regarding complementary and
alternative medicine for cancer patients. International
Journal of Caring Sciences, 8(3), 656-664. Retrieved from
http://library.capella.edu/login?qurl=https%3A%2
%2Fsearch.proquest.com%2Fdocview%2F1732805856%3F
accounti d%3D27965
References
Walker, B. F., Armson, A., Hodgetts, C., Jacques, A., Chin, F.
E., Kow, G., Wright, A. (2017). Knowledge, attitude,
influences and use of complementary and alternative
medicine (CAM) among chiropractic and nursing
students. Chiropractic & Manual
Therapies, 25doi:http://dx.doi.org.library.capella.edu/10.1
186/ s12998-017-0160-0
Zupančič, V., & Krope, K. (2017). Pilot study on the
responsiveness of nurses to the Patient’s request for
complementary medicine. Journal of Health Sciences, 7(2),
115-123. doi:http://

dx.doi.org.library.capella.edu/10.17532/jhsci.2017.386
Running head: OBESITY IN HISPANICS 1
OBESITY IN HISPANICS 7
Obesity Within the Hispanic Population
Capella University
Diverse Populations
Evidence-Based Practice
August, 2018

Obesity Within the Hispanic Population
The term “Hispanic” is used to describe a number of
different ethnicities; Mexican, Puerto Rican, Salvadoran,
Cuban, Dominican, Guatemalan, and many others. The obesity
epidemic does not discriminate based on age, 42.5% of Hispanic
adults are considered obese, and they “also have the highest
prevalence of obesity among ethnic groups of able-bodied U.S.
children and adolescents” (McDonald, Huang, Proudfoot, Le,
Chiang & Bush, 2016, p. 1957). There are numerous amounts of
risk factors that come with obesity, and mixing these risks with
issues in accessing healthcare is a potentially fatal problem.
Obesity “is a common denominator in the development of
metabolic syndrome, non-alcoholic fatty liver disease (NAFLD),
diabetes, and cardiovascular disease (CVD)” (Velasco-
Mondragon, Jimenez, Palladino-Davis, Davis & Escamilla-
Cejudo, 2016, p. 10). These co-morbidities make the need for
preventative medicine and easy access to healthcare even more
important within the Hispanic population.
Childhood Obesity Within the Hispanic Population and Parental
Involvement
Childhood obesity is an epidemic throughout the nation, but
particularly higher within the Hispanic population. Being one of
the fastest growing minority groups in the United States, we
need to focus on first of all preventing children from becoming
obese, but for the ones who are sadly already facing obesity,
there needs to be proper protocols put into place. According to
the CDC, they consider “a child between the ages of two and 18
years to be overweight if between the 85-95th percentile, and
obese if above 95th percentile” (McDonald, Huang, Proudfoot,
Le, Chiang & Bush, 2016, p. 1962). BMI was the main focal
point of the study by McDonald, Huang, Proudfoot, Le, Chiang

& Bush because it was found that people of Hispanic ethnicity
have a higher average BMI.
One of the biggest barriers to helping children and
adolescents deal with obesity is dealing with the parents. In the
study conducted by Gauthier and Gance-Cleveland, the way
Hispanic parents perceived their preschool aged child was
examined, and if it effected the child’s weight development. It
was found that “the majority of parents did not have an accurate
perception of their child’s actual weight status, and most
frequently underestimated their child’s actual weight category
... when asked which children looked the healthiest, the
majority of parents selected photos of overweight or obese
children” (Gauthier & Gance-Cleveland, 2015, p. 551). Most
parents in the study equated their children with being healthy to
them being happy, not considering the actual health part of it. If
their child shows signs of intelligence, and are excelling in
school, if they’re happy, and feel good, parents seem to be okay
with them being overweight or obese. As the study progressed,
it was found that the parents weren’t lacking knowledge, as they
correctly identified the causes of obesity, but were lacking in
implementing strategies for not only the actual weight loss, but
putting preventative measures in place for other children.
The Hispanic culture is known to equate food with family
gatherings, and love, as well as family members using food as
both a reward and punishment. Residence within the United
States seems to have had a major impact on the obesity levels of
Hispanic people. Many Hispanic people are living below the
poverty line and this leads to “changes in parenting practices
related to increasing work hours, lack of time with family, and
less time to cook … parents acknowledged increased
accessibility of ‘junk food,’ change in choices of food available
(e.g., high-fat foods), and increased food costs as being
significant factors” (Gauthier & Gance-Cleveland, 2015, p.
557). These families need to be educated on making healthy and
flavorful modifications to their traditional foods, as well as
resources within their community to gain access to fresh foods

and low-cost exercise programs. In order to appeal specifically
to the Hispanic culture, the family needs to be treated as a unit,
and healthy eating and exercise needs to become a lifestyle
among all members. Knowledge is power, and the more we
teach people on how to prevent diseases, the less chronic illness
we will see in the future. We need to ensure that vulnerable
populations get access to the same top-notch healthcare that the
majority receives.
Familism and Its Effect on Obesity in Hispanic Older Adults
Traditional Hispanic values place the utmost importance
on putting the family as a unit before one’s self, and this is
referred to as familism, or familismo. Older adults have been
observed to place great emphasis on this value, and pass it down
to the future generations as they grow up. This value can be
both a positive and a negative when talking about obesity
among Hispanic older adults. Savage, Foli, Edwards, and
Abrahamson found that compared to white older adults,
Hispanics are more likely to be obese, especially women.
“46.6% of Hispanic women ages 65 to 74 are obese compared to
38.9% of White, non-Hispanic women in the same range”
(Savage, Foli, Edwards & Abrahamson, 2015, p. 2).
Although Hispanics have a longer life expectancy, they are
known to not use preventive care, and seek long-term care less
than other populations. Some of this is in part due to lack of
healthcare access, but it also is because they have a skewed
view of familial roles from their beliefs in familism. Loyalty,
solidarity, and reciprocity are their driving forces, and it is
believed within the Hispanic culture that the younger generation
has a duty to care for the elderly. Caring for family members is
nothing to be frowned upon, but when an older adult is facing
numerous co-morbidities they need to be cared for by trained
individuals.
Gender roles are regarded very heavily in the Hispanic
culture, and this places both men and women in extreme danger
of becoming fatally ill. “Men may refrain from spending money
or taking time off from work instead of visiting clinicians for

preventive care or acute visits in an attempt to save money for
their families … Hispanic women are more likely to stop cancer
treatment if they perceive they have duties to fulfill within their
families. Some Hispanic women will not pursue care, fearing it
may interfere with their roles within the family” (Savage, Foli,
Edwards & Abrahamson, 2015, p. 3). In ensuring that the
Hispanic population receives access to affordable healthcare,
we can make preventive screening a normal occurrence, and
decrease the chance of chronic illness.
One potential barrier that I observed through my research
is that there are a limited number of Hispanic healthcare
professionals. Only 5% of physicians, and 1.7% of licensed
registered nurses are Hispanic, which may add to the reason as
to why older adults in the Hispanic population do not seek help
with their health. They may fear going to the doctor and not
being able to effectively communicate with them due to
language barriers, or a fear of being ethnically misunderstood.
As stated earlier, Hispanics hold their culture and their families
in the highest regard, and if that value is threatened they will
most likely remove themselves from that situation. In increasing
the outreach to younger generations, and providing
opportunities for more Hispanic healthcare workers, we can
make the workforce more diverse, and inclusive, especially
within the Hispanic population.
Implemented Health Care Initiatives
NYU Langone Hospital – Brooklyn is in the heart of
Sunset Park, Brooklyn, NY, and they have implemented
numerous programs in order to combat some of the diseases
plaguing the community that they serve. They are striving to
provide affordable and sometimes free healthcare to populations
who are in need, specifically targeting the Hispanic population.
Their hospital has piloted a program called Healthy Habits
Program/Programa de Habitos Saludables to help combat
childhood obesity, and it consists of a “12-session multi-
disciplinary program for 10- to 11-year old obese Hispanic
children and their parent(s)” (Kaplan & Hopkins, 2018). The

program focuses on teaching children and their parent’s about
the 5-2-1-0 health model which promotes 5 or more fruits &
vegetables per day, 2 hours or less of recreation screen time, 1
hour or more of physical activity, and 0 sugary drinks (more
water and low fat milk). The goal is to stabilize BMI, and to
help families make better overall choices when shopping and
preparing meals.
Epidemiology of Obesity Within the Hispanic Population
Epidemiology is defined as the study of the distribution
and determinants of health-related states or events, and the
application of this study to the control of diseases and other
health problems. In conducting my research, I used four
different studies as reference points. All of the studies shared a
common interest in digging deeper to understand why the
Hispanic population is so vulnerable to obesity, how we can
prevent it, and how can we treat it. The two different factors I
wanted to explore were obesity in children, and obesity in the
older adult. The studies I chose highlighted both age groups,
and it was found that in both instances family roles play a major
part in the prevalence of obesity. Immigration into the United
States has further added to the risk to become obese due to the
convenience of high fat, low nutrient foods. Hispanics in urban
settings face immense risk because the rising price of living,
and the large percentage of people living below the poverty
line. Obesity is a major problem looming on the Hispanic
population throughout the nation on a daily basis, and we need
to increase education on healthy living, increase access to fresh
foods, and implement affordable screening techniques for the
co-morbidities that can result from obesity.
Conclusion
The largest ethnic minority in the United States are
Hispanics, with 21.9% of children (ages 2-19), and 42.5% of
adults being overweight or obese. “The most recent reports
show that the leading causes of disease among Hispanics are
heart disease, cancer, and high blood pressure, while the leading
causes of death are cancer, heart disease, and unintentional

injuries” (Velasco-Mondragon, Jimenez, Palladino-Davis, Davis
& Escamilla-Cejudo, 2016, p. 2). With the exception of
unintentional injuries and certain cancers, obesity may precede
all of the above diseases. In order to decrease the occurrence of
obesity in all age groups, healthcare access needs to be
improved upon, and patients need to be educated on
implementing a healthy lifestyle in their homes. Parents must
play a greater role in recognizing if their child is gaining too
much weight, and they need to be working hand in hand with
their pediatrician to keep their children healthy.
Healthcare facilities also need to make sure that they are
adequately representing their surrounding community, and
implementing strategies to deal with each health concern that
plagues the different populations within it. NYU Langone
Hospital – Brooklyn’s pilot program is a prime example of how
facilities can take a greater interest in the diverse population
surrounding them, and help to treat and prevent the diseases that
they are vulnerable to. If all healthcare facilities would
implement affordable or free programs to target diseases that
plague the demographics within their communities, we can help
to reduce the incidence of chronic illness that precedes a
preventable disease.
References
Gauthier, K. I., & Gance-Cleveland, B. (2015). Hispanic
parental perceptions of child weight in preschool-aged children:
An integrated review. Childhood Obesity, 11(5), 549-559.
doi:http://dx.doi.org.library.capella.edu/10.1089/chi.2014.0152
Kaplan, S. A., & Hopkins, K. (2018, April). NYU hospitals
center progress report. Retrieved from
https://nyulangone.org/files/april-2018-csp-progress-report.pdf
McDonald, M. L., Huang, A., B.A., Proudfoot, J. A., M.Sc, Le,
J. T., Chiang, G. J., & Bush, Ruth A, (2016). Association of

obesity, BMI, and hispanic ethnicity on ambulatory status in
children with spinal dysraphism followed near the california-
mexico border. Journal of Health Care for the Poor and
Underserved, 27(4), 1956-1969. Retrieved from
http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.p
roquest.com%2Fdocview%2F1844319689%3Faccountid%3D279
65
Savage, B., Foli, K. J., Edwards, N. E., & Abrahamson, K.
(2015). Familism and health care provision to hispanic older
adults. Journal of Gerontological Nursing, , 1-9.
doi:http://dx.doi.org.library.capella.edu/10.3928/00989134-
20151124-03
Velasco-Mondragon, E., Jimenez, A., Palladino-Davis, A.,
Davis, D., & Escamilla-Cejudo, J. (2016). Hispanic health in the
USA: A scoping review of the literature. Public Health
Reviews, 37doi:http://dx.doi.org.library.capella.edu/10.1186/s4
0985-016-0043-2
Running head: ORGANIZATIONAL EVAL. 1
ORGANIZATIONAL EVAL. 8

Organizational Evaluation of NYU Langone Hospital –
Brooklyn
Capella University
Diverse Populations
Organizational Evaluation
July, 2018
Organizational Evaluation of NYU Langone Hospital –
Brooklyn
Both U.S. born and immigrants from Latin America account for
a little over 40% of the population of Sunset Park, Brooklyn.
Spanish is prevalent in most homes, with 45% of children living
in households where English is not spoken. With language
barriers still prevalent, it makes communicating with both the
children and their parents difficult, and places them at risk for
health issues. “An estimated 19% of Sunset Park residents
between the ages of 5 and 14 are obese, increasing their risk for
diabetes, heart disease, high blood pressure, cancer and asthma.
Sunset Park also has a high concentration of children living in
poverty and a large Hispanic population (42%), who are
particularly vulnerable to obesity.” (Kaplan & Hopkins, 2018)
Obesity is even more prevalent when a family is living below
the poverty line, because buying healthy groceries may not be
an option. “Twenty-nine percent of residents live below the

Federal Poverty level compared to 21% of families in New York
City as a whole. Poverty is particularly acute among families
with children – 33% of families with children under 18 live
below the poverty level.” (Kaplan & Hopkins, 2016)
Childhood Obesity in the Hispanic Community
The Hispanic population is at a greater risk for obesity,
and they make up about 42% of the Sunset Park community.
Obesity increases the risk for diabetes, heart disease, high blood
pressure, cancer, and asthma; not to mention, for adolescent’s,
increases the risk of being bullied or teased. As stated earlier,
19% of children aged 5-14 years old are considered obese in
Sunset Park. This can be the result of a numerous amount of
reasons; some of which are living in poverty, lack of physical
activity, and cultural dietary habits.
At 29%, the amount of people living below the poverty
line is alarming, and only seems to be growing. This impacts the
way a family is allowed to feed themselves and their children.
With fast food being so much cheaper than fresh fruits and
vegetables, the numerous fast food chain restaurants usually
trump trips to the supermarket. Even if families do attempt to
buy fresh produce, the quality is not the greatest in the
surrounding area. There are farmer’s markets that take place,
but mostly during working hours, which also is impossible with
parents having at least 1 full time job.
Implemented Initiatives to Fight Childhood Obesity in Sunset
Park
NYU Langone Hospital – Brooklyn is in the heart of the Sunset
Park, and has implemented numerous programs in order to
combat some of the diseases plaguing the community. One in
particular was piloted in 2015 to help fight childhood obesity,
specifically within the Hispanic population. Healthy Habits
Program/Programa de Habitos Saludables consists of a “12-
session multi-disciplinary program for 10- to 11-year old obese
Hispanic children and their parent(s).” (Kaplan & Hopkins,
2018) The hospital has been running different cycles, and
making changes each time to better serve the participants. As of

March 2017, the hospital had reached 25 families, and a plan
was put into place to extend the program into a school-based
setting. In expanding this to an in-school program it increases
the pool of potential participants because children spend the
majority of their days there.
The program focuses on teaching children and their parent’s
about the 5-2-1-0 health model which promotes 5 or more fruits
& vegetables per day, 2 hours or less of recreation screen time,
1 hour or more of physical activity, and 0 sugary drinks (more
water and low fat milk). The goal is to stabilize BMI, and to
help families make better overall choices when shopping and
preparing meals. Some adjustments that have been made
throughout the program have been “extending the age range to
include nine-year olds; implementing electronic pediatrician
referrals to the program; refining program elements to
encourage changes in screen time and beverage consumption;
and adding a nutritionist home-visit to reinforce and
individualize healthy shopping and cooking practices.” (Kaplan
& Hopkins, 2018) The program has shown an increase in
participants the more readily available it becomes; it is now
available in two elementary schools within the community, P.S.
503/506, and the Center for Family Life, and is being operated
by the Family Health Centers at NYU Langone.
Gaps within the Healthy Habits Program/Programa de Habitos
Saludables and the Hispanic Community in Sunset Park
One potential shortcoming of the program is a shortage of
school nurses to implement it within the schools. If the program
is going to grow and reach as many children as possible, the
school setting is going to play a major part. Children spend
majority of their time in school, and by implementing the
program in this setting, it allows for school nurses to give
presentations within the classroom and monitor the children
during lunch and recess. In having supportive staff while
children make their lunch choices it can help to make it become
a lifestyle instead of just during the duration of the program.
Another gap within the program is that parents are

supposed to be included as participants in order to make the
whole family educated about making healthy choices. This
could cause a potential issue seeing as there is a high
concentration of families living in poverty within the
community, meaning that most parents are working at least one,
if not two jobs. If parents are not available to attend sessions it
could mean the children may not be able attend either. This
could mean that the children won’t have full access to healthy
selections at home because parents may not have the time to
prepare a home cooked meal, or they may not have the resources
to even supply health food options in the home.
Strategies to Bridge Gaps Within the Healthy Habits
Program/Programa de Habitos Saludables and the Hispanic
Community in Sunset Park
In order to ensure there is enough staff to educate and
monitor all the children within the schools, nursing students can
be implemented. School nurses only have a limited amount of
time that they can be out of their offices, so if student nurses
were brought in they would be able to sit with the children at
lunch, as well as attend recess with them to make sure they are
getting their daily exercise. If making healthy choices is put
into a child’s daily routine from a young age, it is much easier
for it to become a lifestyle instead of just a passing fad.
Combating the problem with parental attendance, and
access to healthy foods is a whole other issue. There is no easy
fix to this, and although we can take steps to make life a little
easier for our participants and the surrounding community,
completely rectifying this issue will take time and resources
that may not be available. Parents in the Sunset Park community
are struggling to provide the basic necessities for their families.
A good portion of the population is living below the poverty
line which means more time spent at work, and less time at
home with family. This also means that their paychecks need to
be stretched as much as possible, and that means that fresh
fruits and vegetables are most likely not a viable option;
especially for families with more than one child, or that have

dependent older generation family members living in the
household as well.
The Family Health Center can work together with community
businesses to organize farmer markets, and maybe speak with
restaurant owners to try to offer healthier options. Also, having
flexible hours and multiple training sessions in the Family
Health Center will allow for working parents to attend the
sessions without missing any work. We need to work together
with the community to help them realize that fast food
restaurants and eating starchy, high fat foods too often is not
good, and will be detrimental to their health as well as their
children’s health. On 4th Avenue there is a different fast food
chain restaurant on every other block, spanning the whole
neighborhood. In teaching families to avoid them and buy fresh
food we are promoting parents living longer for their children,
and helping to prevent children avoid chronic illnesses that
obesity places them at risk for.
Barriers to Implementation of Strategies to Combat Childhood
Obesity
Sunset Park may be an up and coming neighborhood, but
the current residents are just going to continue to struggle. New
businesses moving in means that property value will go up,
which leads to increase in rent, and this is without an increase
in salary. Sunset Park residents are at risk for falling even
further below the poverty line, and with that comes an influx of
the possibility of developing chronic illnesses. Also, we are
talking about a suburb in Brooklyn where there is already
limited space; organizing farmer’s markets will prove to be very
difficult because of scheduling conflicts for the already
overcrowded public areas.
Conclusion
Childhood obesity needs to be fought, specifically within
the Hispanic population in Sunset Park, Brooklyn. Children are
becoming more at risk due to the prevalence of fast food chain
restaurants being easy accessible and affordable, as well as
having parents who are working full time jobs. The Hispanic

population is at a higher risk for obesity throughout all ages,
and implementing a program to help children make healthier
choices is the first step in trying to combat it. Educating
children on making healthy choices a lifestyle from a young age
will encourage future generations to do the same, and can
potentially cut childhood obesity rates in half. NYU Langone
Hospital – Brooklyn is working hard to serve their community
by piloting the Healthy Habits Program/Programa de Habitos
Saludables; targeting the Hispanic population specifically,
taking feedback, and making changes with each cycle of
participants. Although there are barriers in the way of fighting
this epidemic, in constantly improving upon the program, the
community will have every opportunity to increase their
knowledge, and make healthy choices.
References
Kaplan, S. A., & Hopkins, K. (2016, June). Community health
needs assessment and community service plan 2017-2019.

Retrieved from https://nyulangone.org/files/complete-chna-csp-
appendices.pdf
Kaplan, S. A., & Hopkins, K. (2018, April). NYU hospitals
center progress report. Retrieved from
https://nyulangone.org/files/april-2018-csp-progress-report.pdf
The New York Academy of Medicine. (2014, October 3).
Brooklyn community health needs assessment. Retrieved from
https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/
pps_applications/docs/maimonides_medical_center/3.8_maimon
ides_cna.pdf
Tucker, S., & Lanningham-Foster, L. (2015). Nurse-led school-
based child obesity prevention. The Journal of School
Nursing, 31(6), 450-466.
doi:http://dx.doi.org.library.capella.edu/10.1177/105984051557
4002
Running head: WINDSHIELD SURVEY 1
WINDSHIELD SURVEY 2

Windshield Survey of Sunset Park
Capella University
Diverse Populations
Windshield Survey
July, 2018
Windshield Survey of Sunset Park
Sunset Park, Brooklyn is a misunderstood, and often
underrated portion of this borough of New York City. This
paper will help to explore the ever changing neighborhood, and
highlight the specific healthcare needs of its diverse population.
Every neighborhood has their own health risks and specific
needs that need to be met within its different communities. In
order to understand Sunset Park, a windshield survey was
completed and evaluated to bring optimal care to the people
who make up this section of Brooklyn. We will expand upon the
needs of high risk populations, and those who are most
vulnerable within the community, and will lay out a plan to
enhance their livelihood.
Sunset Park
The borough of Brooklyn has many different areas that are
all unique and diverse in its own way; one of these well know
areas is called Sunset Park. The area used to be primarily
known for being a major port in both the 19th and 20th century,
but today it is an up and coming residential, commercial, and

industrial area. The area designated as Sunset Park ranges from
36th Street to 65th Street and goes from the waterfront all the
way to 8th Avenue. It has become a very diverse community,
with Hispanics making up the majority (42%). “Asian residents
were the fastest-growing segment, increasing by 241 percent
between 1990 and 2014 to 51,730. By 2014 they accounted for
more than one-third of the population.” (DiNapoli & Bleiwas,
2016) The median age is 34.2 years old, and it is evenly
dispersed between genders. Average life expectancy is 81.6
years, but when asked to report on the condition of their own
health, only 68% of the residents considered themselves as
“excellent,” “very good” or “good.”
Windshield Surveillance of the Community
A windshield and walking survey of the Sunset Park
neighborhood was completed to see if I could get a better grasp
on the community. I went back three different times to get a
good feeling of what it was it like at all different times in the
day. The surveillance was completed during morning hours
(between 9-10:30 AM), afternoon (12:30-2 PM), and early
evening (5-6:30 PM). I felt that this helped me to get a well-
rounded view of what the community has to offer.
Housing
There are 48,750 housing units in Sunset Park, 75% of
these units are rented out, and 58% of them are experiencing
maintenance defects. This is defined as water leaks, cracks and
holes, inadequate heating, presence of mice or rats, toilet
breakdowns and peeling paint. The average for the whole
borough of Brooklyn is at 62%. The homes from the outside
seem to be in good condition, while others appear run down.
There are no real front yards, the whole neighborhood is mostly
fenced in concrete areas, but this is consistent with the rest of
the borough.
“Poorly maintained housing is associated with negative
health incomes, including asthma and other respiratory
illnesses, injuries, and poor mental health.” (NYCDOHMH,
2015) Sunset Park has a higher percentage than the rest of New

York City when it comes to residents living below the Federal
Poverty Level (29%), and residents living with “Rent Burden”
(55%). This puts extra stress on the residents of the area
because they are living in aging buildings, in crowded living
spaces, and just barely making ends meet. The price of rent
makes it difficult to buy fresh groceries and healthy food, so
residents settle for fast food. This makes obesity and diabetes,
especially in children, even more prevalent.
Buildings and Surroundings
This area is home to a place called Industry City, the
largest facility in Sunset Park. It houses a variety of different
stores, and corporations, and since renovations have been
underway, 2,000 new jobs have been created. The Brooklyn
Nets basketball team even has a training facility in the building
where they also host youth sporting clinics as well as events
within the community. Sunset Park’s local hospital also just
underwent a transformation, as they were taken over by NYU
Langone Hospitals. The Brooklyn Army Terminal (BAT), once a
military depot during World War I, has also been renovated and
is now home to over 100 assorted businesses. This has caused
an increase in jobs within the area, and is helping to build up
the reputation of Sunset Park.
Although an influx of jobs is good for the community, the
pollution that comes with an industrial section is not healthy. It
was found that Sunset Park has 9.2 micrograms per cubic meter
of PM2.5, the most harmful air pollutant. This is higher than
both the readings within the rest of the borough of Brooklyn
(8.7), and in New York City as a whole (8.6). This pollutant is
known to cause health problems, especially in people with
preexisting health conditions, as well as at risk populations
(young, elderly, etc.).
Parks, Playgrounds, and Public Spaces
The community adopted its name from Sunset Park, one of the
highest elevation points of Brooklyn. The park has views of the
Manhattan skyline, a public swimming pool, and it also offers
free basketball courts, children’s play areas with sprinklers, dog

friendly areas, handball courts, and food carts. It is known as a
little slice of heaven amongst the busy city streets. There are
also many active churches, including one of the most famous
and the largest churches in Brooklyn, the Basilica of Our Lady
of Perpetual Help. To round out the history within Sunset Park,
they are also home to a national historic landmark, Green-Wood
Cemetery. The cemetery spans 478 acres, and is the final resting
spot for many famous individuals. They offer year round tours
to help navigate the large campus.
Education
As of the 2014-2015 school year, 80% of elementary
schools and 20% of middle schools were overcrowded in Sunset
Park. Despite the overcrowding, the students of Sunset Park
tested higher in Math and English proficiency than Brooklyn,
and New York City overall. The area also houses one of the top
schools in the city, the Beacon School of Excellence (P.S. 172).
Although there have been new schools added recently, there is
still a problem with residents not completing their education.
42% of the adults in the community haven’t finished high
school while there are an equal amount of high school and
college graduates (29%).
Transportation
Public transportation is prevalent in Sunset Park. There is
access to both buses and trains, which is primarily how
residents get around. Sunset Park residents spend an average of
44.2 minutes traveling to work each day, 64% of which are
taking public transportation. It is reliable, and easily accessible,
and a one-way ride costs $2.75. Also, a ferry was just put into
place last year that has a stop in Sunset Park; this also costs
$2.75 per way, and can take you as far as Rockaway or the other
way into Manhattan.
Hispanic Culture within Sunset Park
Both U.S. born and immigrants from Latin America
account for a little over 40% of the population. Everywhere you
look on 4th Avenue, Hispanic culture is apparent; from the
sidewalk shops selling merchandise from different countries, to

old women selling empanadas outside of church, and the music
you hear playing from open apartment windows or passing cars.
You can hear the residents speaking Spanish to each other from
across the street, and most storefronts have both Spanish and
English signs. The culture is thriving, and doesn’t seem to have
any end in sight in this community.
Spanish is prevalent in most homes, with 45% of children
living in households where English is not spoken. This can
cause a great barrier once children enter the school system
because they may not be at the level of English speaking that
allows them to keep up with their classes. Although the
Department of Education does offer a program, English as a
Second Language (ESL), it’s not guaranteed that a child will
thrive in it. This also creates difficulty when trying to seek help
when they fall ill, or need check ups.
Asian Culture within Sunset Park
As stated earlier, the Asian population is growing
immensely on the outskirts of Sunset Park. The immigrants have
created their own thriving community within the borough, and it
doesn’t look like it will go away anytime soon. The streets of
8th Avenue are lined with Asian food and fish markets, along
with other Asian storefronts. You can see signs with Asian
characters for blocks, and can hear multiple dialects of Chinese
being spoken. Similar to the Hispanic community, the Asian
community also faces the risk of falling behind with education,
and having issues seeking help for illnesses due to language
barriers.
Health Risks
The top ten health risks for Sunset Park residents are heart
disease, cancer, flu/pneumonia, lower respiratory diseases,
stroke, diabetes mellitus, accidents, drug-related, hypertension,
and liver disease respectively. Flu/pneumonia, and liver disease
are more prevalent in the Sunset Park area than what was
recorded citywide. The state of living the residents experience
can be making them more susceptible to getting the flu and
pneumonia. Apartments are cramped and overcrowded, adding

to the chances of spreading illness. The language barrier also
can cause people to shy away from receiving the influenza
vaccine, so prevention precautions become low.
It was also found that Sunset Park residents have the
lowest reported rate of partaking in physical activity within the
last 30 days of the survey being taken. This adds to the obesity
and diabetes problem seen within the community. Although the
community has resources for outdoor activity, many residents
don’t take part in physical activity.
Some other issues residents seem to cope with are
substance abuse, HIV, asthma, and the potential for lead
poisoning and certain cancers. Alcohol-related hospitalizations
were up to 881 per 100,000 adults, and drug-related
hospitalizations ranked 529 per 100,000 adults. Limited
educational, housing, and employment opportunities combined
with the availability of drugs contribute to drug and alcohol
addiction (NYCDOHMH, 2015).
Conclusion
Although the community within Sunset Park seems to be
thriving and keeps growing, upon further research it is clear that
the residents are facing issues when it comes to healthcare.
They are experiencing large numbers of heightened risk factors
due to the influx of immigrants, and housing situations. The
surrounding area is booming, and new jobs and organizations
are popping up, but I fear that all this will do is to raise prices
for the already struggling occupants. In order to care effectively
for this diverse community, the nearby healthcare centers need
to advocate for their patients, and make sure they are
accommodating all cultures to provide exceptional healthcare.
Prevention and screening is key, and their needs to be
community outreach programs in place to target all age groups,
regardless of culture they identify with or languages they speak.
There needs to be access to top notch healthcare, and it needs to
be affordable to keep this community thriving and growing for
the future.
References

Census profile: NYC-Brooklyn Community District 7--Sunset
Park & Windsor Terrace PUMA, NY. (n.d.). Retrieved from
https://censusreporter.org/profiles/79500US3604012-
nycbrooklyn-community-district-7sunset-park--windsor-terrace-
puma-ny/
DiNapoli, T. P., & Bleiwas, K. B. (2016, September). An
Economic Snapshot of the Greater Sunset Park Area. Retrieved
from https://www.osc.state.ny.us/osdc/rpt5-2017.pdf
Kaplan, S. A. (2016). CHNA Executive Summary. Retrieved
from https://nyulangone.org/files/chna-executive-summary-10-
31-16.pdf
New York City Department of Health and Mental Hygiene.
(2015). Brooklyn Community District 7: Sunset Park. Retrieved
from
https://www1.nyc.gov/assets/doh/downloads/pdf/data/2015chp-
bk7.pdf
NYU Hospitals Center Progress Report. (2018, April). Retrieved
from https://nyulangone.org/files/april-2018-csp-progress-
report.pdf
U.S. Census Bureau QuickFacts: New York city, New York;
UNITED STATES. (n.d.). Retrieved from
https://www.census.gov/quickfacts/fact/table/newyorkcitynewyo
rk,US/PST045217

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