Community Health: Obesity Prevention University Essay Example

Target Population: Children from low-income African American and Hispanic families living in Miami-Dade County aged between three and seventeen

The Size of Population: according to the last census, 2,712,945 people live in the county (“Miami-Dade County profiles: American,” 2017).

Geographical Location and Climate

The community is located in the state of Florida’s most southeastern part. The data obtained from the 2017 census indicates that the county is the most populous one in the state and also the seventh-most populous in the country. Miami-Dade County covers the area of 1,946 square mile, which makes the location third-largest county in the state of Florida. The county is second-largest in population density, having 1,423 people per square mile (“Miami-Dade County, Florida,” n.d.). Miami-Dade follows only one county, Broward, the density of which is 1,566 people per square mile.

The largest and most important city in the county, Miami, is located near the islands of Key Biscayne and is bordered by Biscayne Bay on the east (“Miami: Geography and climate,” n.d). The climate in the area is semi-tropical, and there are no temperature extremes in Miami-Dade. Summers are warm and long, and winters are dry and mild. The county has a very high humidity level, which ranges from 86 to 89 percent (“Miami: Geography and climate,” n.d). Overall, the location and climate are rather pleasant for people living there, as well as for many tourists.

Demographics

The total population of Miami-Dade County was estimated at 2,712,945 in 2016 (“Miami-Dade County profiles: American,” 2017). Thus, there was an increase by 0.7% compared to a year earlier and an increase by 13.6% compared to 2007. The growth of the population younger than fifteen constituted 3% (13,300 people) between 2007 and 2016. Within the same period, the number of citizens older than sixty-five increased by 23% (80,900 people) (“Miami-Dade County profiles: American,” 2017). The so-called “young working-age population,” individuals between fifteen and forty-four, increased by 10.3% (102,000 people) (“Miami-Dade County profiles: American,” 2017, p. 15).

Meanwhile, the older working-age population, citizens between forty-five and sixty-four, grew by 21.7% (129,600 people). The ratio of working individuals per people over sixty-five dropped from 4.5 in 2007 to 3.8 in 2016. The number of working people per dependent individuals (children under fifteen and elderly people over sixty-five) did not change between 2007 and 2016, and it constituted 2.0 (“Miami-Dade County profiles: American,” 2017).

The number of Hispanic population in Miami-Dade County increased from 62.0% in 2007 to 67.7% in 2016. Currently, the total Hispanic population is estimated at 1.84 million. The number of Black non-Hispanic citizens increased by 1.9% (448,900 people) from 2007 to 2016. At the same time, the total population share of this group decreased from 18.0% to 16.1% within the period 2007-2016 (“Miami-Dade County profiles: American,” 2017). The White non-Hispanic population dropped to 381,200 people (by 12.7%). The share of the cohort fell from 17.7% in 2006 to 13.6% in 2016 (“Miami-Dade County profiles: American,” 2017).

As of 2016, there were 2,222,826 working-age citizens in Miami-Dade, 1,372,153 of whom were in the labor force. Out of those, 1,370, 947 were in the civilian labor force (1,290,097 employed and 80,850 unemployed). 1,206 were in armed forces, and 850, 673 were not in the labor force (“Miami-Dade County profiles: American,” 2017). In the civilian labor force, the unemployment rate was 5.9%. The number of women sixteen years and older constituted 1,155,800 in 2016.

Out of them, 640,949 were in labor force, 640, 730 were in the civilian labor force, and 600,380 were employed. 181,609 people had children younger than six, and 345,226 citizens had children between six and seventeen (“Miami-Dade County profiles: American,” 2017). By classes, workers were divided into private salary and wage workers (1,057,880), government employees (120,686), self-employed individuals (108,942), and unpaid family workers (2,589).

Out of the employed population over sixteen (1,290,097), the following occupation division was recorded in 2016:

  • 252,384: health care, social services, and education;
  • 160,672: administrative, management, scientific, and professional services;
  • 158,752: retail trade;
  • 149,588: recreation, entertainment, arts, and food services;
  • 106,084: warehousing and transportation;
  • 103,636: construction;
  • 97,194: real estate, insurance, and finance;
  • 79,895: services other than public administration;
  • 57,130: manufacturing;
  • 46,086: wholesale trade;
  • 44,806: public administration services;
  • 23,941: information;
  • 9,929: forestry, fishing and hunting agriculture, and mining (“Miami-Dade County profiles: American,” 2017).

A 2014 report containing recent data on the county demonstrates that in 2012, there were 838,772 households in Miami-Dade (“Miami-Dade County economic,” n.d.). Out of them, 96,871 had an income of less than $10,000. 168,889 households had an income between $10,000 and $24,999; 214,750 earned $25,000-$49,999; 214,726 had between $50,000 and 99,999; 79,868 earned $100,000-$149,999; and 26,759 had an income of $150,000-$199,999. Finally, there were 37,091 households with the income of $200,000 or higher (“Miami-Dade County economic,” n.d.). The median household income in 2012 was $41,400, and the mean income was $63,863. The sources of household income in 2012 were the following:

  • wage or salary (77%);
  • social security income (7%);
  • self-employment (6%);
  • interest, net rental, or dividends (5%);
  • retirement income (3%);
  • other kinds (1%);
  • supplemental security income (1%);
  • public assistance income (less than 1%) (“Miami-Dade County economic,” n.d.).

As of 2016, racial demographics were as follows:

  • 2,052,266 – white;
  • 500, 126 – Black or African American;
  • 53,012 – Asian;
  • 10,175 – American Indian and Alaska Native;
  • 3,557 – Native Hawaiian or other Pacific Islander;
  • 139,716 – some other race (“Miami-Dade County profiles: American,” 2017).

Physical and Social Environment

Through the windshield survey, such Miami-Dade communities as Palmetto Bay, Cutler Bay, Pinecrest, and West Perrine were evaluated. As of 2014, the population of Palmetto Bay constituted 24,513 people (“Palmetto Bay, Florida,” n.d.). Out of them, 52.3% were female, and 47.7% were male, the median resident age being 42.4. The estimated median household income constituted $45,935 in 2016. The estimated median house price in 2016 was $265,200.

During the windshield survey, it was possible to observe many recreational zones and sports facilities. The parks belonging to the “Village of Parks” attract attention due to a variety of recreational options. There are also many healthcare institutions in the area, such as Jackson South Community Hospital, South Miami Hospital, Larkin General Hospital, Miami Children’s Hospital Early Intervention Program, and others. A good variety of grocery stores allows citizens to buy healthy and fresh food. The most convenient ones seem to be Aldi, Publix, the Fresh Market, and Farm Stores Palmetto Bay. Although there are many fast food restaurants, there are also places where one can eat healthy food. There are several churches belonging to different confessions.

The population of Cutler Bay in 2014 constituted 44,321 people. 50.1% were males, and 49.9% were females, with the median age of 36.7 (“Cutler Bay, Florida,” n.d.). The estimated median household income recorded in 2016 was $45,935. The estimated house price was $265,200 (“Cutler Bay, Florida,” n.d.). The windshield survey allowed analyzing the recreational and healthcare facilities in the community.

A big recreational park offers such options for developing sports habits as soccer fields, running tracks, baseball and volleyball fields, jogging paths, and bike trails. There is a variety of grocery stores the majority of which are located in convenient places, such as Kelcy’s Grocery, President Supermarket, Aldi, and others. Most street food options are narrowed by fast food, which decreases the population’s access to healthy food. There is a community health center within two miles from the residential area. Also, there are several gyms both near homes within a driving distance. Healthcare facilities include hospitals and dental clinics, such as Jackson South Medical Center and Wound Care Center.

Pinecrest is another community in Miami-Dade that was observed during the survey. The population of the area was 19,521 in 2014 (“Pinecrest, Florida,” n.d.). There were 51.3% of females and 48.7% of males, the median age being 42.5.

The estimated median household income constituted $135,964 in 2016. The estimated house value in 2016 was $1,000,000, which was the highest of all the observed communities. Mansions in Pinecrest are very large, and they are surrounded by big lawns. The community being luxurious, there are beautiful spacious parks offering recreation for citizens. There even is a clear distinction between parks for relaxation and exercising.

The neighborhood’s grocery stores differ greatly from those in other communities. In particular, there are many healthy food stores which are large and offer a variety of products. The most convenient of these are Trader Joe’s, the Fresh Market, and Whole Foods. Additionally, there is a fresh fruit market opened daily that is situated in the residential area. Unlike Palmetto Bay and Cutler Bay, Pinecrest does not have many fast food restaurants. Instead, exquisite restaurants offering organic and health-conscious food prevail here. Public transportation is not popular since almost all citizens own cars. There are several private and public schools in the area. For those taking care of their physical shape, there are gyms, bike trails, and jogging tracks. Several churches, which appear to be Catholic, can be seen in the community.

The last community under observation was West Perrine. This area has the smallest population: in 2010, there were 9,460 people living there (“West Perrine, Florida,” n.d.). There were 54.4% of females and 45.6% of males, the median residential age being 34.9. The estimated median household income constituted $38,951 in 2016. The estimated average house price was $180,758 in 2016 (“West Perrine, Florida,” n.d.).

This neighborhood is not as good-looking as the previously described three. Houses are small and old-fashioned, there are no lawns, and yards are not kept in good condition. It is difficult to identify the color of some houses because they have not been refurbished for many years. In the streets, there is much dust and litter, and there is a dump situated too close to the residential area. The community has many fast food restaurants, such as Burger King and McDonald’s.

In West Perrine, no jogging tracks or bike paths can be seen. Streets are largely empty, with a few people waiting for public transport. Almost near every house, there are several cars: three or even four. The community has some grocery shops and supermarkets, but they do not appear as neat as those in Pinecrest, Palmetto Bay, or Cutler Bay. There are a few churches and elementary schools, as well as a magnet school. There is also a big park that could be used for fitness and working out. However, it does not seem to be a safe place at present, and not many people can be seen there.

Health Disparities

Disparity is a term that can be employed in various aspects, such as ethnicity, age, gender, and others. Recently, there appeared the term health disparity which means the health difference associated with economic, social, or environmental conditions (“Disparities,” n.d.).

According to Healthy people 2020, health disparities can have a negative effect on those groups of people that experience economic or social barriers to health grounded in their ethnicity or race, gender, religion, socioeconomic status, physical or mental disability, geographical location, or sexual orientation (“Disparities,” n.d.). Generally speaking, a disparity is observed whenever a person is being treated with some kind of discrimination.

In Miami-Dade County, health disparities are the same as defined for the whole state of Florida. The minority populations most affected by health inequality are Hispanic Americans, Alaska Natives, African Americans, Asian Americans, Pacific Islanders, and Native Hawaiians (“Minority health and health equity,” n.d.). Compared to the state’s general population, individuals belonging to the mentioned groups have poorer access to health care.

Also, these populations have a much higher incidence of such serious diseases as obesity, diabetes, stroke, heart disease, asthma, HIV/AIDS, and some others (“Minority health and health equity,” n.d.). The Office of Minority Health and Health Equity, which was established in 2004, aims at reducing disparities and increasing the access and quality of health care for all groups of people.

Miami-Dade County: Health Disparities

Miami-Dade is a minority-majority area, meaning that most citizens belong to minority groups. However, despite 67.5% of population being Hispanic and 18% being black, there are considerable health disparities in the community (“Miami-Dade County, Florida,” n.d.). African Americans and Hispanics usually have a higher level of poverty than the general population. Compared to Whites, these minority groups tend to have lower levels of education. For instance, in 2012, 22.9% of Hispanics and 36.0% of African Americans had less than high school diploma whereas only 4.9% of White non-Hispanic citizens had that level of education (“Miami-Dade County, Florida,” n.d.).

At the same time, only 14.5% of African Americans and 23.7% of Hispanics had a bachelor’s degree while as many as 50.9% of non-Hispanic Whites had the same level. Thus, it is possible to conclude that disparities in health access start with differences in education. The poorer level of education one has got, the lower-income profession they can find. As a result, many people cannot afford to pay their medical bills and sustain from visiting a doctor.

Another problem is that individuals with low income do not have money to pay for healthy food or attend a gym. As a result, many Hispanics and African Americans are obese, and the disease runs in the family (Gibbs & Forste, 2014). From an early age, children cannot receive all the vital products or eat enough fruit and vegetables. The major goal of the Office of Minority Health and Health Equity is to find ways of reducing disparities and providing children from all population groups with relevant healthcare options.

References

Cutler Bay, Florida. (n.d.).

Disparities. (n.d.).

Gibbs, B. G., & Forste, R. (2014). Socioeconomic status, infant feeding practices and early childhood obesity. Pediatric Obesity, 9(2), 135-146.

MiamiDade County economic and demographic profile 2014. (n.d.). Web.

Miami-Dade County profiles: American community survey. (2017). Web.

Miami-Dade County, Florida demographics data. (n.d.).

Miami: Geography and climate. (n.d.).

Minority health and health equity. (n.d.).

Palmetto Bay, Florida. (n.d.).

Pinecrest, Florida. (n.d.).

West Perrine, Florida. (n.d.).

Hand Hygiene Promotion In Hospital-Acquired Infections

The incidence of hospital-acquired infections can be listed among the leading concerns of healthcare specialists all over the world since infectious diseases often nullify the results of effective treatment strategies. Without exaggeration, the development of strategies helping to reduce the incidence of nosocomial infections is among the tasks of national importance. The proposed study is going to research the potential of hand hygiene promotion in this regard.

Patients

The problem of infections acquired during hospital treatment can affect any group of patients since the major risk factors vary depending on the type of infection. Also, speaking about the role of different parties in the given issue, it is pivotal to mention that there are conditions that spread primarily due to the mistakes of healthcare providers (Hor et al., 2017). They can be related to the exploitation and maintenance of medical equipment, certain disinfection errors, the violations of protocols for patient room cleaning, and similar factors.

The proposed project is going to focus on a group of hospitalized patients considered as a high-risk population. As is clear from the literature review conducted by Rodríguez-Atlas, de Abreu Almeida, Engelman, and Cañon-Montañez (2017), some chronic health conditions such as diabetes are linked to the increased risks of nosocomial infections. Additionally, the size of risks is strictly interconnected with the experience of surgical interventions, and it can be meaningful to focus on a patient group that demonstrates two or more risk factors (Rodríguez-Acelas et al., 2017).

Taking into account the consequences of infections acquired during hospital stays, it is especially significant to study the effectiveness of prevention strategies in high-risk populations. Therefore, the proposed research project will focus on adult post-surgery patients of both sexes who have a diagnosis of diabetes.

Intervention

In modern healthcare practice, there are some popular interventions aimed at the prevention of infectious diseases in hospitalized patients. Numerous projects are aimed at promoting compliance with hygiene requirements among nurses and other workers who contact patients (Sun, Chow, Hanowski, & Henderson, 2016). As for the planned study, it is going to emphasize the role of patients’ responsible attitudes to their health and self-care practices. The neglect of personal hygiene also contributes to the risks of infections and severely affects treatment outcomes, and this is why studying interventions that deal with self-care promotion is important. Therefore, it is pivotal to use the experiences of other researchers to develop an intervention to be tested.

The intervention for the planned study is aimed at helping hospitalized high-risk patients to develop healthy habits related to handwashing and hand hygiene. In particular, it is proposed to implement patient education sessions that involve both theoretical and practical components. About the theory of hand hygiene, all patients in the experimental group are to engage in 30-minute conversations with nurses devoted to the principles of hand hygiene.

During the conversations, patients will be educated about the infection transmission routes, the timeliness of hand-washing procedures (before food intakes and touching the ENT organs and eyes, after using hospital toilets and contacting with high-touch surfaces, etc.). After that, nurses will provide education concerning the types of hand hygiene products (soap, sanitizing liquids, etc.) and demonstrate how to use each option properly (Knighton et al., 2017; Fox et al., 2015). In the end, the clients will receive standardized printed materials presenting this information in a well-organized way (Haverstick et al., 2017). The education sessions will not be repeated, but all patients from the experimental group will be allowed to contact their health providers to ask additional questions.

Comparison

Commonly used procedures for the promotion of hand hygiene may vary depending on the healthcare facility. In the planned study, patients from the comparison group will receive no in-depth education, handout materials, and personalized instruction concerning the use of various options for cleaning their hands. With that in mind, they will be free to choose the options to be used based on the general rules of hand hygiene and their knowledge.

Outcome

The study will test the outcomes of the discussed intervention about the frequency of cases of hospital-acquired infections. Therefore, to answer the research question, it will be necessary to measure and compare the incidence rates of nosocomial infections in the comparison and intervention groups. Considering that some patients admitted to hospitals can already have some “hidden” infections, all individuals to be included in the study will be thoroughly examined before the start of the experiment.

Time

The dynamics of post-surgery patients’ general condition and health risks should be taken into consideration to provide more accurate results. It is generally believed that the first few weeks after surgical interventions present a period associated with high risks of infections and complications (Rodríguez-Acelas et al., 2017). As for the time component of the PICOT question, it is planned to conduct the assessments of patients’ health status on the fourteenth day after surgical operations.

Conclusion

To sum it up, patient safety belongs to a number of the key priorities for care providers, but there is a wide range of factors that threaten it and affect treatment outcomes. The proposed study is going to focus on the role that proper hand hygiene practices in patients play in the prevention of hospital-acquired infections. The following PICOT question will be utilized: in adult post-surgery patients with diabetes (P), does the provision of two-step interventions for hand hygiene promotion (I) instead of general instructions (C) reduce the incidence of HAIs (O) two weeks after surgery (T)?

References

Fox, C., Wavra, T., Drake, D. A., Mulligan, D., Bennett, Y. P., Nelson, C.,…Bader, M. K. (2015). Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses’ hand washing. American Journal of Critical Care, 24(3), 216-224.

Haverstick, S., Goodrich, C., Freeman, R., James, S., Kullar, R., & Ahrens, M. (2017). Patients’ hand washing and reducing hospital-acquired infection. Critical Care Nurse, 37(3), e1-e8.

Hor, S. Y., Hooker, C., Ledema, R., Wyer, M., Gilbert, G. L., Jorm, C., & O’Sullivan, M. V. N. (2017). Beyond hand hygiene: A qualitative study of the everyday work of preventing cross-contamination on hospital wards. BMJ Quality and Safety, 26(7), 552-558.

Knighton, S. C., McDowell, C., Rai, H., Higgins, P., Burant, C., & Donskey, C. J. (2017). Feasibility: An important but neglected issue in patient hand hygiene. American Journal of Infection Control, 45(6), 626-629.

Rodríguez-Acelas, A. L., de Abreu Almeida, M., Engelman, B., & Cañon-Montañez, W. (2017). Risk factors for health care–associated infection in hospitalized adults: Systematic review and meta-analysis. American Journal of Infection Control, 45(12), e149-e156.

Sun, J., Chow, B., Hanowski, B., & Henderson, E. A. (2016). Correlation between hand hygiene compliance and methicillin-resistant Staphylococcus aureus incidence. Canadian Journal of Infection Control, 31(4), 215-220.

Beyond Hand Hygiene: Preventing Cross-Contamination On Hospital Wards

The article discussed in the paper is devoted to the topics of patient safety and specific measures implemented to prevent the spread of infections in intensive care and surgical units. The qualitative study by Hor et al. (2017) was published in the BMJ of Quality and Safety, a peer-reviewed journal with an impact factor exceeding 7. Using the themes from interviews with healthcare providers and videotaped observations, the authors demonstrate the contribution of logistics in healthcare settings to successful infection prevention efforts.

Background of Study

The clinical problem that encouraged the researchers to conduct this study is inextricably connected to the existing differences between the recommended hygiene practices for providers and their actual uses. In particular, explaining the clinical problem, Hor et al. (2017) state that the average hand hygiene compliance rates do not exceed 40%, which indicates that “perfect compliance” is not possible due to everyday practical issues (p. 552). In general, the theory of infectious disease prevention does not present a research gap. However, its practical applications and related barriers are not fully studied, and the researchers focus on this problem to improve the effectiveness of infection control practices.

The significance of the study is established with the help of statistical data concerning the outcomes of nosocomial infections. In particular, the authors emphasize the contribution of hospital-acquired infections that affect “hundreds of millions of patients” annually to adverse patient outcomes and related healthcare costs (Hor et al., 2017, p. 552). With that in mind, the purpose of this study is to encourage healthcare workers to analyze their efforts aimed at infection prevention and, therefore, learn more about practical problems and considerations that can impact infectious morbidity rates in patients.

The work answers the research questions related to infection control practices other than hand hygiene and the key nurse-perceived problems in transmission prevention. Therefore, both purpose and research questions apply to the studied research problem.

Methods of Study

The experimentations decision to apply qualitative research methods is justified by the nature of the research problem and the great role of subjective experiences in it. Concerning the perspective from which the study was developed, the researchers emphasize the experiences of nurses since they present the majority of participants, but this methodological aspect is not thoroughly analyzed in the work. To support their discussion of the clinical problem and the state of the art, Hor et al. (2017) cite almost thirty peer-reviewed sources that utilize both qualitative and quantitative methods of research.

Some of them are presented by studies with high levels of evidence such as systematic reviews, and experimental studies can also be found among references. Other types of literature used to strengthen argumentation include official reports by international associations tasked with disease prevention and infection control guidelines offered by WHO and local organizations in Australia.

The used references are dissimilar in terms of the date of publication. Thus, the majority of quantitative studies from the reference list are recent (2012-2016), but some older studies are also present. At the same time, professional reports, guidelines, and qualitative sources tend to be less up-to-date, with the oldest one published in 1983 (Hor et al., 2017). Given that some studies are not recent, their findings can seem incomplete compared to more modern works. Despite that, the researchers do not criticize the used literature and discuss their weaknesses; instead, they indicate that some research methods found in earlier studies are used in their project with minor changes.

Importantly, the article does not have a section fully devoted to the review of literature, and the majority of sources are cited in the introduction. Even though the review is not structured conventionally, the authors manage to include enough information to present logical arguments and proceed from the problem of non-compliance in nurses to their approach to solving it.

For example, the review includes statements concerning the variability of compliance rates and the need to consider the human factor and situational issues when conducting safety audits (Hor et al., 2017). Despite the practical significance of their findings, the researchers do not develop a new framework for infectious disease prevention in acute care settings. However, one of their conclusions points at the potential of boundary work in bridging the gap between the theory and practice of nosocomial infection prevention.

Results of Study

The findings provide explicit and clear answers to the research questions and therefore, align with the purpose of the study. To begin with, having analyzed videotaped observations and interview transcripts, the researchers single out a range of themes in everyday infection control practices. Among them are the use of personal protective equipment, hand hygiene, task distribution in teams, aseptic techniques, and the so-called “from clean to dirty” principle of conducting examinations (Hor et al., 2017, p. 556).

Also, the authors define two practitioner-perceived problems in infection prevention. They are the multitude of “things other than hands” that are not cleaned regularly and the presence of ignored boundaries related to different body parts or wounds of the same patient (Hor et al., 2017, p. 555). Concerning the findings’ practical implications, they include the need to pay focused attention to the logistics of nursing care to create successful infection control strategies.

The findings linked to the existing practical problems contribute to nursing science in several ways. To begin with, they shed light on the causes of healthcare providers’ inability to eliminate the cases of nosocomial infections such as the lack of holistic analysis of everyday care manipulations and their safety. Apart from that, the results help attract modern researchers’ attention to some unobvious factors in pathogen transmission, for instance, doctors’ personal objects.

Due to their nature, the findings can impact both nursing practice and education. As for practice, the need to reconsider the logistics of medical and nursing manipulations may lead to the introduction of new rules regulating the use of personal items in patients’ rooms. Speaking about education, it is possible to use the research results to update educational materials for nurses devoted to infection control.

Ethical Considerations

Speaking about the problems of ethics, the researchers obtained ethical approvals from different institutions in Australia. Among them are the University of Tasmania and other hospital ethics committees (Hor et al., 2017). The privacy of all 177 participants and involved patients was protected, and both written and verbal consents were obtained from them before the use of interviews and videotapes. Considering the used methodology, ethical problems related to treatment or its absence were not relevant.

Conclusion

To sum it up, the reviewed study delves into the topic of hospital-acquired infections and adds to the existing knowledge about everyday applications of disease prevention guidelines. The findings refer to the degree of effectiveness of currently used practices and neglected problems, which explains their relevance to nursing practice and education. In general, when it comes to the knowledge learned, it is linked to the need to reconsider the role of logistics-related concerns in the prevention of nosocomial infections and risk assessment efforts.

Reference

Hor, S. Y., Hooker, C., Iedema, R., Wyer, M., Gilbert, G. L., Jorm, C., & O’Sullivan, M. V. N. (2017). Beyond hand hygiene: A qualitative study of the everyday work of preventing cross-contamination on hospital wards. BMJ of Quality and Safety, 26(7), 552-558. Web.

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