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Capstone Paper Summative VersionCaitlin M. DarbyUniversity of South Florida Capstone Paper Formative VersionAlachua County, located in the state of Florida, is home to nearly 251, 417 residents (Census bureau, 2013). The county covers 875.02 square miles of land and there are approximately 282. 7 persons per square mile (Census bureau, 2013). Alachua houses both urban and rural areas within the county. Nearly 75.4% of Alachua County is considered urban while the remaining 24.6% is classified as rural (Florida health department, 2013). The city of Gainesville is considered a metropolitan area and is the only metro area within Alachua County (Census bureau, 2013). The county of Alachua has a wide variety of businesses and employment opportunities. The University of Florida (UF) is currently the leader among the major employers in Alachua County (Gainesville chamber, 2013). In 2012 the University of Florida, an education industry, employed 14,723 individuals (Gainesville chamber, 2013). Following closely behind UF, Shands Hospital recorded 12, 588 employees on their payroll (Gainesville chamber, 2013). The Veteran’s Affairs Medical Center (VA) ranked third for the major employers in Alachua County. The VA paid 4,317 employees in 2012 (Gainesville chamber, 2013). Shands Hospital and the Veterans Affairs Medical Center are both listed as health care industries in Alachua County (Gainesville chamber, 2013). Alachua County has a large selection of health care providers and services for individuals to choose from. The provider directory for the county of Alachua includes, primary care, dental care, urgent care, vision care, radiology services, physical therapy, podiatry, chiropractic care, neurology care and orthotics care (Alachua county, 2010). Other health care facilities and services include, adult day care centers, assisted living facilities, ambulatory surgery centers, crisis stabilization units, hospices, hospitals, intermediate care facilities and skilled nursing facilities (Alachua county, 2010). Alachua County’s current population as mentioned earlier is around 251, 417 (Census bureau, 2013). The dominant group residing in Alachua is Non-Hispanics accounting for 91.1% of the population (Census bureau, 2013). The leading ethnicities in Alachua County are Caucasian, African-American and Hispanic (Census bureau, 2013). Approximately 71.3% of the county’s population is Caucasian (Census bureau, 2013). The African-American ethnicity compromises 20.3% of the total population (Census bureau, 2013). The Hispanic population accounts for only 8.9% (Census bureau, 2013). Alachua County is very diverse and has a wide range of ethnicities not mentioned above. Alachua is faced with a poverty percentage higher than the state of Florida. Alachua’s poverty percentage between 2007-2011 was 23.6% while Florida’s was only 14.7 % (Census bureau, 2013). From the percentages is it obvious that many Alachua County individuals are struggling to make ends meet. Although Alachua County residents are struggling financially majority over age 25 obtained a high school diploma (Census bureau, 2013). Alachua achieved an average above the state in regards to individuals over the age of 25 with a high school diploma between 2007-2011. Alachua County’s percentage was 90.3% while the state of Florida’s was 85.5% (Census bureau, 2013). The county seems to be promoting education and high school graduation since they are keeping their rate above the state. Between 2007-2011 there were approximately 13.8% Alachua County residents, age five and older, whose primary language was not English (Census bureau, 2013). The states average for non-English speaking individuals between 2007-2011 was 27% (Census bureau, 2013). Alachua County’s percentages for non- English speaking individuals, older than age five, were significantly lower than the state average. Analyze, Interpret and Prioritize DataResearching Alachua County’s health indicators on Florida Charts (2013) and comparing my findings to information published on Healthy People 2020 allowed me to identify the major strengths of the county. Alachua County’s first strength is access to healthcare. Alachua County has a wide variety of health care providers, which means access to health services is readily available to consumers. The rate of total licensed physicians between 2007-2011 in this county was approximately 678.7 compared to the state of Florida’s average of 326.7 (Florida department of health, 2013). According to Healthy People 2020 (2013), an individual’s overall sense of well-being and health status is impacted by their access to health care services. Regular and reliable access to health services can: prevent disease and disability, detect and treat illnesses or other health conditions, increase quality of life, reduce likelihood of premature (early) death, and increase life expectancy (Healthy people, 2013). The second strength of Alachua County is the low motor vehicle crash rate, which is classified as a health indicator under injury and violence. Alachua County’s motor vehicle accident rate for 2007-2011 was estimated around 9.7 while Florida’s average rate remained around 12.4 (Florida department of health, 2013). Motor vehicle accidents contribute to a large percentage of injuries sustained by individuals across all life stages. For example, motor vehicle accidents are the leading cause of death for children/adolescents and more than 2.3 million adult drivers nationwide were injured as a result of a crash in 2009 (Healthy people, 2013). Alachua County as well as its residents are doing something right to prevent crashes as demonstrated by the Alachua County rate of motor vehicle accidents ranking lower than the state of Florida’s average. Alachua’s third strength, preventing pre-term births, falls under maternal, infant and child health. The county rate for pre-term deliveries (prior to 37 weeks gestation) between 2007-2011 was 11.9 while Florida’s rate was 13.8 (Florida department of health, 2013). According to Healthy People 2020 (2013), 12% of babies nationwide are born pre-term each year resulting in permanent disabilities, complications and developmental delays. Pre-term delivery rates can improve in all counties if women have sufficient access to health services and understand factors that can negatively influence their pregnancy (Healthy people, 2013). Analyzing the data for Alachua County on Florida Charts and Healthy People 2020 allowed me to determine the health indicators that are worse than the state average or pose a serious threat to the population. There were numerous health indicators lower than the state average but the bacterial sexually transmitted disease (STD) rate for Alachua County was outrageous. Chlamydia and gonorrhea were the leaders between the various STD’s. There was a rate of 231.3 for gonorrhea in Alachua versus 104.6 for the state rate between 2010-2012 (Florida department of health, 2013). Chlamydia in Alachua County was rated at 712.2 while Florida had a rate of 402.4 (Florida department of health, 2013). According to Healthy People 2020 (2013), there are around 19 million new sexually transmitted disease cases diagnosed nationally each year usually among adolescents and young adults. If STD’s are left untreated serious long-term health complications can arise and some are irreversible (Healthy people, 2013). STD transmission and sexual health education need to be addressed in Alachua County to prevent rates from rising even higher. The second health indicator, higher than the Florida state average, was the amount of falls recorded in Alachua County between 2010-2012. Fall rates, listed under injury and violence, were high for Alachua County between 2010-2012. Alachua’s rate was 20.1 while the Florida rate remained at 8.6. Falls can occur anywhere and they can result in injuries that are physically and emotionally debilitating as well as impact an individual’s health status and quality of life (Healthy people, 2013). Modifications such as vision screenings and medication review can be made to reduce the risk of falls especially in the elderly population (Healthy people, 2013). The final heath indicator that was worse than the Florida state average was deaths from diabetes/chronic diseases. Alachua’s rate for 2010-2012 was 23.5 while Florida’s rate was 19.6. According to Healthy People 2020 (2013), clinical preventative services like routine disease screening are crucial to reducing death and disability and improving the health status of our nation. These services can add years back to an individual’s life after being diagnosed with a chronic disease like diabetes (Healthy people, 2013). Routine screenings need to be implemented in the Alachua County health services departments to decrease the death rate from diabetes and other chronic conditions. Sexually transmitted diseases (STD’s), such as gonorrhea and chlamydia, are the priority health concern for Alachua County. Sexually transmitted diseases and the lack of sexual health education pose the greatest risk to the residents of Alachua County when compared to other health indicators. The county rate of 231.3 for gonorrhea and 712.2 for chlamydia are much higher than the state rate of 104.6 for gonorrhea and 402.4 for chlamydia (Florida department of health, 2013). These numbers are not acceptable and should be much lower because sexually transmitted diseases and transmission are preventable with proper sexual health education (Healthy people, 2013). According to Healthy People 2020 (2013), if STD’s are left untreated they can lead to serious long-term health conditions that are untreatable or irreversible especially in adolescent girls and young women between ages 15-24. The health conditions include reproductive health problems and infertility, fetal and perinatal health problems, cancer and further transmission of STD’s (Healthy people, 2013). Other complications include pelvic inflammatory disease, ectopic pregnancies and pre-term deliveries (Centers for disease control, 2013). Sexual health education is essential to improve the well-being and health status for all individuals and required to prevent the spread of STDs. Reproductive and sexual health services can increase the detection and treatment of STD’s (Healthy people, 2013). Improving Alachua County’s sexual health knowledge is crucial to reducing the rate of sexually transmitted diseases in this community. Comprehend, Discuss and Apply Community Health ModelsThe health status of individuals and populations cannot be determined by a single variable. When assessing a patient, a community health nurse needs to be aware and consider the multiple factors that affect the health status of that individual (World health organization, 2013). The nurse must also extend their focus beyond traditional health care by incorporating the different determinants of health into their practice to better understand the patient and their situation (Healthy people, 2013). Income, social status, education, physical environment, social support networks, genetics, health services and gender are all determinants in the well-being of a person (World health organization, 2013). The determinants listed above all contribute to the overall status of the patient’s health. Neither patients nor health care providers have direct control over these factors (Determinants of Health, 2013). Modification of certain determinants may be necessary to have a positive impact on the individual’s health. If the community health nurse understands all the factors involved in the determinants of health model then a more adequate assessment, diagnosis and treatment regimen can be determined and implemented for each patient. Social determinants of health such as environment and lifestyle as well as biological factors play a major role in sexually transmitted disease transmission (Hogben & Leichliter, 2008). Access to healthcare is a very important piece in preventing STD’s. Social determinants such as ethnic background, lack of insurance, race and low socioeconomic status are factors that reduce one’s access to reliable healthcare (Healthy people, 2013). According to Hogben and Leichliter (2008), “A lack of resources and inequality of resource distribution has been found to lead to risky sexual behavior, lack of health care, and rising STD rates” (Socioeconomic Status section, para. 1). Racial and ethnic disparities also put certain groups of individuals such as African-Americans, Hispanics and Native Americans at an increased risk of acquiring and transmitting chlamydia and gonorrhea (Hogben & Leichliter, 2008). Other social determinants such as, incarceration, illicit drugs, substance abuse, sexuality and secrecy, sexual networks, low mean income, unemployment, migration, and a lack of education are correlated with higher rates of STD infections (Healthy people, 2013). Biological factors contributing to acquiring and transmitting STD’s include asymptomatic nature of the infections, gender disparities, age disparities and lag time between infection and complications (Healthy people, 2013). Sexually active adolescents and young adults generally contract STD’s at a higher rate than older adults and women suffer greater from complications associated with the bacterial infection (Healthy people, 2013). According to Hogben and Leichliter (2008), “Until disparities in underlying social determinants and biological factors are addressed, the reduction of STD disparities cannot be guaranteed” (Conclusion section, para. 3).Population DiagnosisThe population diagnosis for the priority health issue of sexually transmitted disease transmission of chlamydia and gonorrhea in Alachua County is: The Alachua County population, especially individuals between ages 15-24, is at increased risk for acquiring and transmitting bacterial sexually transmitted diseases (STD) related to a community knowledge deficit as evidence by the county’s STD rate rising significantly higher than the state average. Develop and Discuss Evidence Based Interventions According to Community Health ModelsA cure has not been found for many STD’s that exist so preventing individuals from acquiring the infection is of great importance (Crane & Katz, 2012). Gonorrhea and chlamydia are both bacterium that grow in the reproductive tract of men and women (Centers for disease control, 2013). These STDs can be transmitted by oral, vaginal or anal sex and can infect the mouth, throat, eyes, anus or rectum (Crane & Katz, 2012). Individuals acquire the bacterial infection by engaging in sexual intercourse with someone who is infected with the disease (Centers for disease control, 2013). Health care workers and sexually active individuals need to understand the routes of transmission and the risk factors that can be modified to prevent the transmission of these diseases. As clinicians we have the responsibility to teach people ways to protect themselves against sexually transmitted infections. Recent studies indicate that the use of barrier methods such as condoms, spermicides and diaphragms are effective safeguards during sexual contact (Crane & Katz, 2012). Health care workers should also encourage individuals to modify their selection of sexual partners by choosing individuals that are uninfected or remain abstinent as well as promote a healthy mutually monogamous relationship (Grimes, Magder, & Stone, 1986). Community health nurses and informed community members need to educate sexually active individuals as well as adolescents and young adults about the safe sex practices listed above to prevent the occurrence of contracting a sexually transmitted disease. Pamphlets and flyers at clinics and hospitals as well as community programs lead on a voluntary basis by clinicians would be effective ways to educate individuals about protecting themselves against STD’s. Early detection, intervention and treatment of bacterial sexually transmitted diseases are crucial factors in secondary prevention strategies to avoid complications that arise from leaving these diseases untreated (Hunt, 2013). Individuals may be unaware that they have been infected with an STD due to silent symptoms (Centers for disease control, 2013). Due to unrecognized symptoms, yearly screenings for all sexually active individuals, symptomatic people, and young adults between the ages of 18-28 is essential in detecting STD infections (Crane & Katz, 2012). Community health nurses should also incorporate STD questions into their routine medical histories to help detect transmission of these bacterial infections (Crane & Katz, 2012). These questionnaires will help identify individuals who were missed by the yearly STD screenings because they did not develop or were unaware of symptoms (Crane & Katz, 2012). Community health nurses and other health care providers should encourage individuals diagnosed with an STD from the screenings or questionnaires to inform their partner as well as urge them see to a physician to prevent the further spread of these infections (Crane & Katz, 2012). Sexually transmitted diseases are a health threat to individuals and community members therefore treatment, a form of secondary prevention, is recommended when available (Crane & Katz, 2012). A stigma is placed on individuals diagnosed with a sexually transmitted disease therefore many cases are not reported and left untreated (Crane & Katz, 2012). Healthcare professionals should break this stigma, address symptoms of different STD’s and encourage symptomatic individuals to get screened by a physician (Crane & Katz, 2012). Chlamydia and gonorrhea can be treated if discovered early. Antibiotics will be prescribed to any patient diagnosed with either of these STD’s (Centers for disease control, 2013). The medication will stop the infection as well as provide symptom relief but it will not reverse any damage that occurred prior to treatment (Centers for disease control, 2013). Community health nurses as well as other health care providers need to inform diagnosed cases to take all prescribed medication and to refrain from having sexual intercourse until symptoms subside and treatment is completed (Centers for disease control, 2013). Providers also need to encourage the individual to have their partner screened and treated to avoid becoming re-infected (Crane & Katz, 2012).On-going assistance needs to be provided to individuals and community members living with sexually transmitted diseases to improve their overall well-being (Hunt, 2013). Structured programs lead on a voluntary basis by clinicians such as interactive discussions, counseling, peer groups and video discussions have been effective tertiary methods to prevent the spread of sexually transmitted diseases to other individuals (Crane & Katz, 2012). Community health nurses should form STD community support groups and encourage participation by posting meeting times in newspapers, clinics, and on the internet. Discussion topics should be centered on informing partners, monthly rescreening, complications if left untreated, importance of follow up appointments, medication compliance and education about acquired disease (Crane & Katz, 2012). Health care providers should also offer counseling sessions or refer individuals to licensed professionals to help patients cope with and understand their disease process (Crane & Katz, 2012). These programs could be of great benefit to the individuals that partake in them. The support groups and counseling sessions have the potential to increase knowledge, improve the participant’s quality of life and prevent the spread of sexually transmitted diseases. Health Policy ProposalSexually transmitted diseases (STD’s) are affecting the health status and quality of life for individuals living in Alachua County. Data collected between 1993 thru 2012 shows that chlamydia and gonorrhea rates have been much higher than the state average (Florida department of health, 2012). The community has a knowledge deficit regarding the modes of transmission and preventative measures to protect themselves against contracting or spreading an STD as indicated by the county rate. The residents of Alachua are contracting and transmitting STD’s at high rates and strategies to prevent this occurrence have not been implemented or were not effective. If healthcare workers and other community members work together to develop a policy aimed at educating the population about techniques to prevent STD’s then less individuals will become infected. Healthcare costs will decrease because less people will be relying on screening, diagnosis, and treatment for sexually transmitted diseases. Sexually transmitted diseases are extremely prevalent among the adolescent and young adult population. Sexually transmitted diseases are a risk to adolescents' health and fertility. Nearly half of new STD infections are among young people ages 15 to 24 (Healthy people, 2013). In 2010 Florida reported 12, 672 cases of gonorrhea and 53, 015 cases of chlamydia in individuals ages 15-24 (Florida department of health, 2013). Alachua County is factored into those 65, 687 cases of bacterial STD infections. These numbers are unacceptable when education and resources are available to prevent the spread of sexually transmitted diseases. Formation and implementation of a health policy addressing the knowledge deficit regarding sexually transmitted diseases in Alachua County among adolescents and young adults is necessary to protect individuals and prevent the spread of infection. A mandatory STD awareness program lead by informed licensed healthcare providers needs to be implemented in all high schools in Alachua County. The program would be geared towards increasing high school student’s knowledge about sexually transmitted diseases as well as providing them with the tools necessary to protect themselves during sexual intercourse. Receiving proper education about the transmission of STD’s and how one can reduce their risk of contracting the infection has the potential to lower the Alachua County STD rate. Research shows that effective STD prevention programs that modify behaviors achieve positive health impacts and lower STD rates (McKeon, 2006). The STD education program would be free to ninth-twelfth grade students enrolled in the Alachua County school system. Each grade would attend an hour session two times a school year. A different healthcare provider would be assigned to each grade and would be a volunteer reaching out to help their community. Community members, health care providers and public officials would be affected by the healthcare policy. Parents of the children enrolled in the Alachua County high schools would fall into the community member category. Health care providers would be affected since they are donating there time and services to educate students about STD’s. Public officials also play a role in implementing the health policy because the school board members have to approve the plan before schools can enforce it. Parents, healthcare providers and community members are most likely going to support the health policy if they are aware of the STD rate in Alachua County and the age group that is most vulnerable to contracting the disease. Public officials, such as the school board members, are going to need convincing. Trying to enforce a mandatory program in the school system is a challenge and unless there is a major benefit to doing so the school board members will try to make it a voluntary program like sex education. A presentation illuminating the Alachua County STD rate for individuals between ages 15-24 is what the school board members need to hear to approve the STD awareness health policy. Seeing that their counties rate was significantly higher than the state average is not going to please them. The county rate needs to decrease. The school board members first need to approve the proposal then a mandatory STD education program can be implemented in all Alachua County high schools. Increasing sexually transmitted disease knowledge among high school students from all walks of life will impact the overall health and well-being of these individuals. These students fall into the age group most vulnerable to acquiring a sexually transmitted disease and experiencing complications from the infection. If we can lower the STD rate among these individuals then the overall STD rate in Alachua County will decrease. A free mandatory STD education class beginning Freshman year of high school in all Alachua County schools until senior year will provide young adults with continual information, tools and resources necessary to protect themselves from contracting an STD. Upon graduation these individuals will be equipped with life-long knowledge regarding STD’s and will be able to educate community members on the matter. The health policy discussed above will work to improve Alachua County’s overall health and decrease the sexually transmitted disease rate. ConclusionAlachua County has several health indicators that are superior over the Florida state average but one major weakness is contracting and transmitting STD’s (Florida department of health, 2013). Sexually transmitted disease rates in Alachua County are undesirable and should not be tolerated when prevention is possible. The rates have trended higher than the Florida state average for over 10 years (Florida department of health, 2013). The lack of knowledge about STDs and available programs are contributing to these statistics and affecting the health status of individuals, especially young adults, living in Alachua County (Florida department of health, 2013). In order to decrease the STD rate in Alachua, sexual health educational programs lead by clinicians, informational flyers and a mandatory STD education class for all high school students needs to be implemented. Without the necessary education about STD’s, Alachua County will remain above the Florida state average and continue to affect the quality of life for individuals residing in this county. Sexual health and STD education is essential to improve the well-being and health status for all individuals and required to prevent the spread of STDs. Improving Alachua County’s sexual health awareness and STD knowledge is crucial to reducing the rate and preventing sexually transmitted diseases in this community.ReferencesAlachua County Florida. (2010). Community support services. Retrieved from: for Disease Control and Prevention. (2013). Sexually transmitted diseases. Retrieved from: , L., & Katz, M. (2012). Sexually transmitted diseases. Retrieved from: Department of Health. (2013). County health status summary. Retrieved from: Department of Health. (2012). Florida trends and statistics. Retrieved from: Area Chamber of Commerce. (2013). Major employers in alachua county. Retrieved from: wp-content/.../08/Major-Employers.xls?Healthy People 2020. (2013). Determinants of health. Retrieved from: People 2020. (2013). Leading health indicators. Retrieved from: People 2020. (2013). Sexually transmitted diseases. Retrieved from: , M. & Leichliter, J. (2008). Social determinants and sexually transmitted disease disparities. Journal of the American Sexually Transmitted Disease Association, 35(2), S13-S18. Retrieved from , R. (2013). Introduction to community-based nursing (5th ed). Philadelphia, PA: Lippincott Williams & Wilkins. McKeon, B. (2006). Effective sex education. Retrieved from: States Census Bureau. (2013). State and county quick facts. [Data file]. Retrieved from: World Health Organization. (2013). The determinants of health. Retrieved from: ................
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