Running head: CAPSTONE PAPER

Noor Tamari November 1, 2013 Capstone Project Formative

CAPSTONE PAPER Hillsborough County is an area known for its natural treasures, warm climates, and universities. It has an approximate population of 1,293,525, with Tampa as its largest city (Florida Department of Health). It is vital for a public health nurse to have knowledge of Hillsboroughs population, with a specific understanding about the health and wellness of its inhabitants. This paper will provide a brief overview of Hillsborough County and explore the leading areas of strength and weaknesses. Priority leading health indicators will also be addressed and a population diagnosis with three levels of prevention will be discussed followed by a healthy policy proposal. Hillsborough County is famous for its warm sunny climate, its many beaches located

minutes away, and tourist attractions, such as Bush Gardens and the Pier. It is located on the west coast of Florida, with Tampa as its largest city. It is mostly residential with a large population in Temple Terrace due to students attending the University of South Florida. The three leading Hillsborough County employers are Baycare, Publix, and USF. There are also many health care centers nearby. Moffitt Cancer Center, Florida Hospital, Baycare, VA hospital and urgent cares are all minutes away. Household income data from the U.S. Census Bureau 2008 indicates that 13.9% of individuals fall below the Federal Poverty Level. This is slightly higher than the percentage for Florida state overall which is 13.3% (Community Health Profile, 2011). Approximately 27% of the county population who are 25 years and older have a high school diploma, compared to 30% in Florida overall (Community Health Profile, 2011). Some strengths for Hillsborough County include access to healthcare, clinical preventative services, and ongoing research. Under the Florida Breast and Cervical Cancer Early Detection program, women between the ages of 50-64 and are in financial need can receive free mammograms, pap tests, pelvic exams, and clinical breast exams. This is run through the Hillsborough County Health

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Department. Also USF College of Public Health offers free flu vaccines to the public every year. This is a great benefit to Hillsborough County as it helps decrease illness and increase health promotion. With that being said, the high number of adults and children overweight/obese would be an important health indicator of Hillsborough County. Poor nutrition and low amount of physical activity are two other important health indicators. Poor nutrition could be due to lack of time to cook healthy meals and cost of vegetables and fruits. Decreased physical activity may be due to lack of time as well, an increase in the number of video games available, and fatigue from work. I would consider the increase in obesity a priority health indicator in Hillsborough County. 34.7% of Hillsborough County Residents are obese in 2009 which is a significant increase from 24.9% in 2007 (Community Health Profile, 2011). This is especially important because of the health consequences obesity has on the population. Heart disease, stroke, and type-two diabetes are among the leading causes of death (U.S. Department of Health and Human Services, 2012). Obesity also puts a strain on medical costs in America. Making good diet choices and increasing physical activity are simple ways to help maintain a healthy body weight, decrease obesity, and improve health overall. The range of personal, social, economic, and environmental factors that influence health status are known as determinants of health (U.S. Department of Health and Human Services, 2012). This model can assist the community nurse in developing interventions that are most likely to be effective by targeting multiple determinants of health such as education and transportation. A major factor that contributes to obesity is lifestyle. An increase in the use of video games and computers and a decrease in physical activity play a major role in the rise in obesity. Physical activity and dietary patterns are known to be major determinants of obesity. A

CAPSTONE PAPER nursing diagnosis would be, ineffective health maintenance related to lack of exercise and improper diet consumption as evidenced by an elevated BMI. Potential reasons that explain the relationship between childhood obesity and watching television include poor food preferences due to food advertisements, overconsumption of food from distraction, and removal of physical activity. (Santaliestra-Pasas, Rey-Lpez-Pasas & Moreno Aznar , 2013). All age groups and ethnicities are affected by obesity; however there is a higher percentage of Black women who are obese 36% (Florida charts, 2013). There is also a recent trend that shows an increasing obesity rate among the youth. The population risk situation is the rise in obesity and obesity-related health diseases in Hillsborough County. In Hillsborough County, 34% of the population is overweight and 24% is obese (Florida charts, 2013). Poor eating habits and a lack of exercise are all characteristics related to this risk factor. A primary level of prevention is a method done to prevent the disease from occurring. Policies that encourage walking and cycling to school and work instead of using a car or using the stairs instead of the elevator would be a great examples of primary preventions for obesity. The nurse could assist in implementing a primary level of intervention by giving advice to populations at risk for gaining weight such as adolescents or patients taking steroid therapy (Chambers & Wakley, 2007). An example of a primary level of prevention is a nurse at a hospital wellness center. The nurse measures patients weight, height, cholesterol, BMI, blood pressure, and blood glucose. The nurse can then educate people on nutrition and lifestyle choices. With an increasing number of children and adolescents overweight or obese, schools can also be an important and effective place to address obesity concerns. Another example of primary level of prevention is school nurses addressing issues of overweight/obesity and reinforcing evidence-based nutrition and physical activity behaviors.

CAPSTONE PAPER Secondary prevention targets those who are at risk for a problem and offers ways to reduce that risk (Chambers & Wakley, 2007). Secondary prevention with obesity includes seeking out individuals who are already obese and offering to help before complications occur (Chambers & Wakley, 2007). An example would be a nurse providing nutritional counseling to patients who suffer from obesity. Individualized nutritional counseling can give the patient vital

education on how different nutrients, such as proteins, carbohydrates, and fats, can have an effect on obesity. Nutritional counseling can also help reduce the risk for complications and improve patient well-being. Nurses should conduct a dietary assessment once a diagnosis of obesity has been made, and consider factors such as work schedule, food preferences, and amount of time devoted to food preparation. Tertiary prevention involves identifying individuals who already developed a medical problem as a result of their obesity, and managing them effectively to help decrease long term risks. (Chambers & Wakley, 2007). An example would be a patient who is obese and is showing signs of end-organ disease. This patient would probably be prescribed medications for management as well as recommended lifestyle changes. Complications of obesity include immobility, diabetes mellitus, hypertension, and death. Nursing interventions include educating patients about nutrition and diet planning, the complications that can arise from obesity, the importance of exercise for maintaining health, and recognizing different symptoms. Nursing care can also make a difference in the management of complications. An example is diabetes. A nurse can teach a patient blood glucose monitoring, insulin administration, signs and symptoms of hypoglycemia, and the importance of exercise and nutrition in diabetes management. A nurse also has an important role as a patient advocate. Some patients may lack insurance and/or have trouble paying for equipment and healthy food options. It is important to refer these patients to a

CAPSTONE PAPER social worker and offer free or low-cost resources such as diabetes education classes at a local hospital that are free to the public. Health care policies that are effective can have a positive impact on health care. Health policies are plans that can be taken to reach health care goals in the community. My health care

proposal would focus on the youth and their dietary needs. I would suggest offering more healthy and affordable options for breakfast and lunch in elementary, middle, and high schools. Students would make better choices if they were offered more healthy meal options. With that in mind, I would also recommend that they increase school lunch time. There is a pressure on schools to increase class time to improve school grades. They do this by taking time from lunch. However, many students are left with less than 10 minutes to actually eat their meals. In order to order to help decrease obesity, I would propose that schools allow students more time to eat their meals. I would also suggest offering after school group exercise classes such as Zumba and Pilates. This would be especially beneficial to students who could not afford the cost of a gym membership. I would also suggest that school nurses teach a class to help prevent obesity during health classes. It should include information on BMI, weight management, the importance of a healthy diet, and physical activity needs. These examples are all primary level interventions. The goal would be to prevent obesity from a young age. Stakeholders that would be affected by this would be businesses that make a profit from selling pizza, fries and unhealthy snacks to schools. As other food options become offered, more students will be less likely to choose other unhealthy food choices. Schools would also need more funding to supply these extra meal options and funding to pay for an instructor to teach a group fitness class. I believe community members would support this health care policy because it improves the health of the youth and helps prevent obesity. It also helps to decrease future health care costs

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related to obesity. I think the group that would oppose this policy would be legislators because of the need for an increase in funding. Without funding, this policy could not be taken into effect. My plan to present this health care proposal by comparing the medical costs of obesity and obesity-related complications to the cost of this health care plan. I would also present statistics of the increasing number of obesity among the youth in Florida. I will also suggest different meal plans to include daily during breakfast and lunch and compare calories and nutritional benefits to what is already being offered. If this policy were to be taken into effect, it would have a positive influence on the youth in Hillsborough County and their overall health. It will help to educate children on the different healthy food options available, decrease the incidence of obesity, increase physical activity, and therefore decrease the risk for future obesity-related complications. Hillsborough County is an area with many communities, cultures, and religions. It has many strengths such as access to healthcare, clinical preventative services, and ongoing research. It also has weakness such as obesity, nutrition, and physical activity. Obesity was a health indicator focused in this paper; primary, secondary, and tertiary prevention levels were discussed. A health care proposal was also suggested to help decrease obesity among the youth in Hillsborough County through education, improved diet, and increased physical activity. It is important for community nurses to help educate their patients on the importance of their lifestyle choices. As a nurse, I will do the same as I know the importance of preventing disease over its cure.

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References Chambers, R., & Wakley, G. (2007). Obesity and overweight matters in primary care. (1st ed.). RADCLIFFE MEDICAL PRESS LTD. Florida Department of Health, Hillsborough County Health Department. (2011). 2010/2011 community health profile. Retrieved from website:http://www.hillscountyhealth.org/pdf/HCHD_20102011_Community_Health_Profile_Report.pdf Florida Department of Health. (2013). Florida charts. Retrieved from http://www.floridacharts.com Santaliestra-Pasas, A., Rey-Lpez-Pasas, J., & Moreno Aznar , L. (2013). Obesity and sedentarism in children and adolescents: what should be bone?. AULA MEDICA, Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24010749 U.S. Department of Health and Human Services. (2012, December 17). About healthy people. Retrieved from http://www.healthypeople.gov/2020/about/default.aspx.