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Capstone Project PaperFion KungUniversity of South FloridaNUR 4636, semester 3Dr. JohnsonJune 18, 2013Capstone Project PaperIntroduction of Orange County and Geographic LocationAccording to the United States Census Bureau (2013), Orange County contains many metropolitan areas such as Orlando, Kissimmee. All of the cities cover area of a total of 903.43 square miles. It is located in the center of Florida. In 2011, the Florida Department of Health reported a population of 1,160,468 persons currently living in Orange County. The population is divided with 70% white, 21.7% black, and 8.3% others. Orange County has areas that is considering both urban and rural. Orange County is considered one of the largest counties of the State of Florida. (United States Census Bureau, 2013). Many people work for Orange County. According to the Florida TaxWatch Briefing (2012), three of the major employers are Orange County Public Schools, The Greater Orlando Aviation Authority, and The Orange County Government. According to Orlando Health (2012), Orlando Health is a not-for-profit healthcare networks. It has locations throughout Central Florida. There are many hospitals associated with it such as Orlando Regional Medical Center, Arnold Palmer Hospital for Children, Winnie Palmer Hospital for Women & Babies, MD Anderson Cancer Center Orlando, Dr. P. Phillips Hospital, South Seminole Hospital, South Lake Hospital, and Health Central Hospital. In addition, based on (2013), starting in January 2014, individuals who are under ages of 65 with income below 133% of the federal poverty level is eligible for Medicaid which help to cover the health care cost. During the years 2006-2012, the Florida Department of Health reported that an average of 10% of Orange County’s families fell below the poverty level. The poverty level of Orange County is almost the same as the state of Florida. During the same period, 9.9% of families in Florida were below the poverty level. In addition, 86.9% of population, specifically those older than 25 years old, had a high school diploma. The percentage of the Orange County is below the state average of 14.7%. Orange County has a low high school graduation rate due to the fact that 12.8% of the population, age 5 and older, cannot speak English well compared to the state percentage. Florida only has 11.8% of the population, age 5 and older, cannot speak English well. In addition, 27.5% of Orange County population is Hispanic compared to the state which was 22.8% (Census Bureau, 2013). Strengths of Orange CountyAccording to the Florida Department of Health (2012), Orange County has three major health indicators that demonstrate strengths, compared to the state health indicators, during the years of 2009 to 2011. The three health indicators are the causes of death from motor vehicle crashes, cirrhosis, and AIDS/HIV. The major causes of death in Orange County such as cancer, heart disease, and stroke are comparable with the state of Florida. On the other hand, the causes of death by motor vehicle crashes, cirrhosis, and AIDS/HIV are lower in Orange County. The deaths from motor vehicle crashes were reported at 10.5% compared to the state percentage at 12.9%. These percentages indicate that the population of Orange County follows the traffic laws better than the rest of the state population. There were fewer deaths caused by cirrhosis in Orange County compared to the state: 7.0% v.s 10.5%. This shows that Orange County residents drink less alcohol than the state population. The AIDS/HIV death rates in Orange County were also lower compared to the state average. The statistics prove that the programs of Orange County implemented to prevent this sexually transmitted disease from spreading are working. People can get condoms from anywhere from school to the doctor's office for free or purchase them in any stores around the county.Weakness of Orange CountyOrange County has some areas that need to be improved on, such as death from diabetes, pneumonia/influenza, and chronic lower respiratory disease. Diabetes is one of the major concerns for Orange County, which has 22.3% deaths caused by diabetes, compared to the state average of 19.5%. It is also a concern for the whole nation. Due to the complication of the disease and higher rate of patients, it costs the Orange County health care system a lot more, compared to the state average. The second weakness is the high rate of pneumonia/influenza in Orange County. The state average is 9.0% while Orange County is 11.5%. If influenza left it untreated, it can turn into pneumonia. Pneumonia is a serious infection that can cause to death. The last weakness is chronic lower respiratory disease, which is a serious disease that mostly affects the lung. The state average is 38.6% while Orange County is 40.7% (Florida Department of Health, 2013). There are two types of the most deadly, known as emphysema and chronic bronchitis (, 2011). Both of these diseases can be caused by cigarette smoking. One of the symptom of these diseases is shortness of breath that cause by airway obstruction which is irreversible. Primary health concernOut of all the weaknesses of Orange County, diabetes is the major health issue. There are two types of diabetes. Type 1 diabetes is when the insulin-making cells are eliminated by the body’s immune system. It is genetic so there is no way to prevent it. On the other hand, type 2 diabetes is when the body uses insulin inefficiently, which leads to glucose buildup in the bloodstream. The cells will not receive as much glucose as they need and will be damaged over time. Ultimately, it will lead to other problems, such as erectile dysfunction, vision loss, and kidney disease so it is very important to address this issue. Determinants of Health Models and population diagnosisAccording to the World Health Organization, the determinant of health model is a method of using all the factors, such as circumstances, environment, genetics, income, education level, and relationship with friends and family to determine the impact to individual health (health model, 2013). By using this model, a community health nurse will be able to understand the general factors and able to adjust the interventions to a particular health issue that affect a specific population. There are several factors that contribute to the priority health issue, such as human biology, lifestyle, and health system determinant. According to the determinant of health model for diabetes, there are two groups of people that will develop diabetes. The first group is pre-diabetes who have the disease through genetics. It is less common than the other type. Unfortunately, there is currently no cure for type 1 diabetes. On the other hand, type 2 diabetes is more common nowadays. People usually have this disease for a while without knowing until they feel the damage (, 2011). According to the Centers for Disease Control and Prevention (2012), this group includes people making poor lifestyle decisions, such as smoking, Risk factors also include hypertension, and high blood cholesterol. Based on the PRC Community Health Survey (2009), the statistics show 29.8% of the population in Orange County are obese, compared to the state percentage of 24.1%. The statistic also shows 26.6% of the population in Orange County lacks exercise, compared to the state percentage of 25.4%. The population diagnosis is the teenagers of Orange County at risk for developing diabetes related to poor lifestyle decisions such as unhealthy diet that lead to obese as evidenced by a 29.8% of people obese. Primary Level Of InterventionBased on the diagnosis, there is a model of intervention spanning from the Orange County level to community level to individual level. The primary intervention is targeting teenagers who are obese and under the age of 18 in Orange County. According to The Child Health and Healthcare Quality in Florida (2008), 33% of high school male students in Central Florida are above normal weight, while 23% of high school female students are above normal weight. In addition, the African-American and Hispanic population's rates of being overweight are higher than Americans. Physical activity is one of the main factors against obesity. Therefore, Orange County need to keep students active in school by providing more equipment for sports during gym class. Also, it is important for schools to educate the students to spend more time outside after school hours. Many children spend too much time indoors playing video games and watching TV. Furthermore, nutrition is a part of protection against obesity as well. The Orange County public schools need to encourage students to eat more fruits and vegetables, drink milk instead of soda, and cut down on snacks such as chips and candy. The interventions are geared toward students, teachers, and health care providers. The role of the community nurse in developing and carrying out the intervention are promoting positive lifestyle changes. (Health Department in Orange County, 2013). Secondary Level Of PreventionThe secondary prevention is community involvement in health screening, BMI screening, blood glucose screening, and blood pressure screening. According to Child Health and Healthcare Quality in Florida (2008), one of the barriers that keep people from preventing and treating obesity are inaccessibility to medical care. It is due to lack of insurance and resource of low income people in Central Florida. Also, physicians do not get compensated enough from Medicaid in order to treat and prevent diabetes. The community needs to seek more funding from the county in order to provide free screening, BMI screening, and blood glucose checks. The stakeholders for this intervention will be the health care providers and community members. As a community nurse, the roles in the secondary intervention are screening the population, and educating the patient and carrying out the treatment instructions for the patient. Tertiary Level Of PreventionLastly, the tertiary level of prevention is individual effort to prevent diabetes. According to the Florida Department of Health in Orange County, teenagers who think they are likely to be at risk of having diabetes can monitor their health closely with signs and symptoms, such as frequent urination, excessive thirst or extreme hunger, unusual weight loss, increased fatigue, irritability, blurry vision, poor circulation, and wounds that do not heal properly. In addition, they need to do the following to prevent further negative impact on their health, such as increase physical activity, eat plenty of fiber and vegetables, choose whole grains over white flour, limit intake of processed foods, reduce sugar intake, lose extra weight, and stop smoking. The Orange County schools always have certified nurses on site. Students can always come for a checkup and consultation. At this level, the role of the community nurse must be helping the physician in treating patients, such as providing all the necessary tests whenever the patient visit the office. The stakeholders will be the health care providers and community members.Health Policy ProposalIn conclusion, in order to fight against diabetes in Orange County for teenagers, there must be a new health policy that the county can use to protect the young generations from having diabetes. The new policy that I want to propose is called moderation life. This policy is aiming at the primary level of prevention. Moderation means choosing what is the best for health and not what is bad for health. I propose to add more nutrition, healthy food choices, and remove unhealthy food choices such as fast food, soda and snacks from the vending machines in the schools. Eating fast foods, snacks and drinking soda are one of the reasons that teenagers in the U.S are overweight and obese, compared to other countries. The stakeholders for this proposal will be health care providers, company and organizations that promoting healthy food such as Organic Valley. The supporters will be community members, students and health care providers. This policy is a message to promote a better healthy lifestyle and prevent obesity and diabetes. On the other hand, there might be some opposition from the private sectors, such as the fast food and beverage industry. This policy may have a negative effect on the sales and stock price of the fast food and beverage industry. In order to make this policy effective, the first steps I would to present my proposal to the president of the public schools. I would provide and show the m the statistics and researches of diabetes and obesity in Orange County. I also would explain the benefits of adding healthy food choices into schools. I would ask for the schools to promote the healthy food. This policy will impact the Orange County in a positive way by decrease the rate of obesity. Educating the teenagers of choosing healthy food over fast food can decrease chance of being obese and developing diabetes. Healthy food also can give a better nutrition than fast food. It will enhance the population's health in general by promoting a healthy diet and maintain healthy. . (2013). Eligibility. Retrieved June 26, 2013. from Health. (2012). About Us. Retrieved June 26, 2013. from Community Health Survey. (2009). Orange County. Retrieved June 26, 2013, from States Census Bureau. (2013). Orange County, Florida. Retrieved June 25, 2013, from TaxWatch Briefing. (2012). Florida's Top Ten Largest Public Employers By County. Retrieved June 25, 2013. from . (2011). Chronic Lower Respiratory Diseases. Retrieved June 26, 2013, from Department Of Health. (2012). Population Atlas. Retrieved June 26, 2013, from Department Of Health. (2012). Florida Mortality Atlas. Retrieved June 26, 2013, from Health Organization. (2013). The Determinants of Health. Retrieved June 26, 2013, from Centers for Disease Control and Prevention. (2012). Florida Surveillance Data. Retrieved June 26, 2013, from Department of Health. (2013). County and State Profile Report. Retrieved June 26, 2013, from Florida Department of Health in Orange County. (2011). Community health. Retrieved June 26, 2013, from generalhealth/communityhealth/chronicdisease/diabetes/index.aspChild Health and Healthcare Quality in Florida. (2008). Obesity. Retrieved June 26, 2013, from Health Florida Hospital. (2013). Diabetes. Retrieved June 26, 2013, from ................
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