Jack Mendez
Community Assessment
RN 402-Community Health Nursing
March 10, 2010

One of the most significant assessment findings within North Minneapolis is the prevalence of crime. When asked, many people around the metro will say that North Minneapolis is a “bad area” or that it is “unsafe”; this usually comes with a non-verbal look of concern from the person giving their input. How much worse is North Minneapolis than other metro areas? To find the answer to this question statistics and data from North Minneapolis will be analyzed. Assessment data will look at physical-environment, psychological, biophysical, sociological and behavioral aspects of Minneapolis as well as more specific areas within Minneapolis.
Physical Environmental Community Assessment
Minneapolis consists of 5 precincts or geographical areas that are controlled by different policing bodies. North Minneapolis falls primarily under the 4th precinct. “Its service area is bounded by Interstate 94 W on the East, Interstate 394 on the South and the city limits on the West and North” (City of Minneapolis, 2010). The fourth precinct consists of 16 zones which comprise the farthest north and northwest areas of Minneapolis.
The nursing assessment will also focus in on the residents living within the Victory zone, one of the many zones within the city of North Minneapolis. Victory runs along Victory Memorial Parkway to Xerxes on the west, down to Dowling Avenue, and east to Newton Avenue. Victory is an attractive area to live because of its walking trails on the parkway and easy access to many major highways including 100, and 94. Other major highways such as 394 and 694 are only minutes away.
The White population is the largest group in Minneapolis at 365,924 people (Minneapolis: Population Profile). The Black population is the second largest in the City of Minneapolis with 68,818 people (Minneapolis: Population Profile). The Asian, Hispanic, Pacific Islander, and American Indian racial groups all have significantly lower populations than that of the Black and White population within Minneapolis (Minneapolis: Population Profile).
The population for Victory in the year 2000 was 4,975 compared to 4,815 in 1980 (Victory). The ethnic distribution in Victory from 1980 to 2000 changed significantly. The Black, American Indian, Asian, and Hispanic population was almost non-existent in 1980. In the year 2000 the White population went down almost 1,000 people and the Black population went up almost 1,000 people. Asians and the “Others” group also grew to nearly 300 people each by the year 2000. The Hispanic population was the second to last smallest population in 2000, coming right ahead of American Indians. See Appendix I for exact numbers on ethnic distribution.
In the year 2000, the population in Minneapolis was 382,618 (Minneapolis: Population Profile). This number rose from 1980 at which time the population was 370,951 (Minneapolis: Population Profile). The largest population falls within the age group of 25 to 34 years old at 78,978 people in the year 2000 (Minneapolis: Population Profile). The smallest population by age in Victory is 85 years and over; the largest is 25-44 years (Victory). From the year 1990 to 2000 the population of ages 5 to 64 increased, but after 64 started decreasing (Victory). Appendix I shows specific numbers for age distribution within Victory. The population of Hennepin County, which will also be discussed in the assessment, is currently estimated to be 1,239,837 people (Falkowski, 2010).
Biophysical Community Assessment
Shown in Appendix M, as of 1999, overall poverty levels for Minneapolis were 17% (City of Minneapolis). Families in Minneapolis had a poverty rate at 19% in 1999 (City of Minneapolis). This means one fifth of families in Minneapolis were living in poverty at the turn of the century. According to Census data for 2000, families with a female householder and no husband present that had children less than 5 years old had the highest poverty level at 44.2% in the City of Minneapolis (Minneapolis, Minnesota, Economic Statistics). The poverty rate for all races in Minnesota in 2007 was 12.6% (Poverty Rate by Race/Ethnicity – Minnesota), lower than the City of Minneapolis. The Black population had the highest poverty rate for 2007 in Minnesota at 37.1% (Poverty Rate by Race/Ethnicity – Minnesota). Due to the fact that Minneapolis has a large Black population, and the Black population in Minnesota has the highest poverty rate, poverty rates for the Black population in the City of Minneapolis must be high as well. In Appendix D, Minneapolis Vital Statistics shows Percentage of Births to Unmarried Mothers. There are many communities or “zones” within North Minneapolis that have high percentages in this category. Camden and Near North have two of the highest percentages and both fall within North Minneapolis. In 1994 women under 17 that gave birth unmarried was at 96% (Minneapolis Vital Statistics). In years following, that percentage went down slightly, but as of 2007, the percentage is back to where it was in 1994 (Minneapolis Vital Statistics). There was no significant difference in 2007 between US born women and Foreign born women giving birth unmarried. American Indians had the highest percentage of births to unmarried mothers which stayed consistently around 85% from 1994 to 2007 (Minneapolis Vital Statistics). Black and Latino races came in second, both with around 60-70% of births to unmarried mothers (Minneapolis Vital Statistics). White and Asian races had the lowest percentage of births to unmarried mothers. In conclusion, births to unmarried mothers falls primarily within the ages of 17 and younger especially in the American Indian, Black, and Latino populations in many zones within North Minneapolis.
Appendix E shows “Percentage of Births for Which Prenatal Care was Adequate or Better”. The white population had the best birth rates in which prenatal care was adequate; the percentage for this group grew from 1994 at 77% to 86% in 2007 (Minneapolis Vital Statistics). American Indians only have a 39% adequacy rate for prenatal care (Minneapolis Vital Statistics). The Asian, Latino, and black populations all have about 50% adequacy rates for prenatal care (Minneapolis Vital Statistics). There was a near 20% difference between US born citizens and Foreign born citizens in which foreign born citizens received less adequate prenatal care than US born citizens (Minneapolis Vital Statistics). Among ages 19 and under, 50% of citizens did not receive adequate prenatal care (Minneapolis Vital Statistics). Overall, all groups 19 years of age and younger and foreign born people need increased prenatal care.
Appendix F shows statistics for women that actually received prenatal care in the first trimester. Women that fall into the American Indian race have the lowest percentage overall for receiving prenatal care in the first trimester; the White race came in first with the highest percentage for receiving prenatal care in the first trimester (Minneapolis Vital Statistics). This also gives statistics for the Black, Asian, and Latino races; Black coming in right under the White population. For races shown besides White, all were around 50% in 1994, but went up to between 60 and 70% by 2007 (Minneapolis Vital Statistics). It is alarming that throughout the first trimester there is still 30 to 40% of ethnic minorities not receiving prenatal care; a lot of pertinent information and education is presented to women and the families at this time. “Infant Death Rates among Minneapolis residents during the period 1994 – 2007” (Minneapolis Vital Statistics), shown in Appendix G, gives results for births, infant deaths, and infant mortality. The White population in Minneapolis had the highest birth rate at 2,626 babies and the second highest infant death rate at 17 in 2007 (Minneapolis Vital Statistics). The Black population in Minneapolis had the second highest birth rate at 1,798 babies and the highest death rate at 29 in 2007; this was almost double the infant death rate of what the White population had (Minneapolis Vital Statistics). The Latino population grew from 222 births in 1994 to 1,105 births in 2007 (Minneapolis Vital Statistics), thus, having the largest population increase of all ethnic groups in this time period. The Asian birth rate is the smallest among minority groups in Minneapolis at 429 in 2007 (Minneapolis Vital Statistics). Latino, American Indian, and Asian infant death rates were very small in 2007 with only 1 to 2 deaths per group (Minneapolis Vital Statistics). Infant mortality rates were highest among American Indians at 13.2 during 2003 to 2005 (Minneapolis Vital Statistics). The Black population came in second for infant mortality rates at 9.9, Latino came in third at 5.2 (which has significantly decreased since 1996), the White population came in fourth at 3.7, and the Asian population had the lowest infant mortality rate at 2.3 (Minneapolis Vital Statistics). Camden, a zone located within North Minneapolis, had the second highest infant death and infant mortality rate when compared to all other zones in Minneapolis (Minneapolis Vital Statistics).
The Victory zone of North Minneapolis had an increase in overall income from 1990 to 2000 (City of Minneapolis, 2010). This could be explained by the increase in the white population from 1999 to 2000 and the decrease in African Americans during that same time period. Also, during that same time period the poverty level was not only lower for Victory when compared to the rest of Minneapolis, but had decreased from 1990 to 2000.
According to the Minnesota Department of Health, Hennepin County had the highest number of Food borne and Waterborne Outbreaks in Minnesota for 2008 (this is the most current data). Hennepin county also had the highest blood lead levels in 2008 (Environmental Health: Section F, 2008).
Sociological/Behavioral Community Assessment
Crime totals in different precincts of Minneapolis for various years. | 2008 | 2007 | 2006 | 1st Precinct | 11605 | 11920 | 11794 | 2nd Precinct | 7262 | 8805 | 9143 | 3rd Precinct | 16956 | 18143 | 18627 | 4th Precinct | 14638 | 16041 | 17693 | 5th Precinct | 10567 | 11795 | 12565 | Citywide Crime Report | 61029 | 66711 | 69827 |
Table 1
(Information included within the table is courtesy of the Minneapolis Police Department, crime and arrest statistics.)
Table 1, which depicts crime totals for different areas of Minneapolis, includes crimes such as homicide, rape, robbery, aggravated assault, burglary, larceny, auto theft, and arson. The 4th precinct, in which Victory is located, came in second when compared to the other four precincts for having the most crime.
“It is mentally exhausting to go through a burglary”, says Raul, a resident living in the 4th precinct. “It is expensive, time consuming, and people forget about the time I takes to clean up the house following a burglary”, says Raul. A survey taken of residents living in the block of 39th Street and Washburn Avenue North (see Appendix A for a list of residents) shows some shocking statistics. Three households currently living there have experienced burglaries, robberies, and/or assaults. This is for one block’s worth of residents and does not take into account previous residents that have recently moved out. After conducting less formal conversations with many of the residents it was found that at least 5 households have moved in within the last year; therefore, does not take into account the experiences of people living there before them. Burglaries, such as the one Raul went through caused much un-needed stress. When discussing burglaries with other residents in the area, many people complained about how little the insurance company covered.
According to Janet Mengelkoch, Community Preparedness Specialist, it is important to make sure that the emergency services provided for residents within the Minneapolis community are well run. It is her job to make sure that governmental organization services such as food shelves, food banks, shelters, social service programs, and services for at risk populations have plans in place to protect their facilities as well as making sure they have proper information to give their consumers about their services. Janet discussed the importance of the nurse’s role within the sector of public health she works for. For example, it is her job to make sure that the nurse has correct information when giving vaccinations at a flu clinic, or when working for a public school working through H1N1 flu outbreaks amongst the students.
Appendix K gives data related to STD incidence and prevalence rates for 2008. Table 2b shows the highest number of cases for Gonorrhea occurring in Minneapolis (591 people) and amongst the Black (839 people) population for males and females (STD Surveillance Reports 2008 - Minnesota Dept. of Health). Table 3 shows the highest rates of Chlamydia (5,002 cases) and Gonorrhea (1,448 cases) occurring in Minnesota are happening in Hennepin County, also where North Minneapolis is located (STD Surveillance Reports 2008 - Minnesota Dept. of Health). Appendix L, figure 1, which exhibits the incidence of Chlamydia in 2007, shows that the Black population in Minnesota had the highest incidence in which 1,850 people were reported to have this disease (Chlamydia and Gonorrhea Among Blacks in Minnesota, 2007 - Minnesota Dept. of Health). The second highest racial group came nowhere near close to the incidence that the Black population exhibits (Chlamydia and Gonorrhea Among Blacks in Minnesota, 2007 - Minnesota Dept. of Health). Figure 3 shows the incidence of Gonorrhea in 2007. Once again the incidence of Gonorrhea in the Black (850 people) population was much higher than any other race (Chlamydia and Gonorrhea Among Blacks in Minnesota, 2007 - Minnesota Dept. of Health). The Hispanic race was the second highest, but only had 100 people reported to have the disease (Chlamydia and Gonorrhea Among Blacks in Minnesota, 2007 - Minnesota Dept. of Health).
Representative Jeff Hayden is the State Representative for District 61B that serves the City of Minneapolis (Jeff Hayden (DFL) 61B - Minnesota House of Representatives ). Jeff works out of the State Office building in St. Paul (Jeff Hayden (DFL) 61B - Minnesota House of Representatives ). He is the “go to” person for any issues a community has that is in need of change. Health care has been a priority for Jeff; therefore, it is important for the City of Minneapolis and health care workers working with citizens of the city to know where and how to get in contact. Jeff’s Legislative Assistant is Tim Remer who can be reached at the phone number 651-297-5723 (Jeff Hayden (DFL) 61B - Minnesota House of Representatives ). Jeff can be reached directly at rep.jeff.hayden@house .mn (Jeff Hayden (DFL) 61B - Minnesota House of Representatives ). R. T. Rybak is the current Mayor for the City of Minneapolis. Mayor Rybak is currently working to “revitalize north Minneapolis, attack juvenile crime, make Minneapolis a wireless city, end homelessness in ten years, and significantly reduce the City’s energy consumption to combat global climate change.” (About the Mayor) Mayor Rybak works at the Minneapolis City Hall on South 5th Street, and can be reached at 612-673-2100 (About the Mayor). Mayor Rybak is another contact person for resolving health issues in the City of Minneapolis.
There are many modes of transportation in the City of Minneapolis. The city has an overabundance of taxis. The metro-transit bus system makes thousands of stops throughout Minneapolis in which destinations can be outside of the City. Minneapolis is currently working on extending the light-rail system to be accessible to areas outside of Downtown Minneapolis, but is a great way to get around in the area it currently serves. Minneapolis is fully of biking trails, many of which have two or three lanes so that people can walk and rollerblade all on different paths. Major highways surrounding Minneapolis have special car pool lanes for people driving with more than one person in the car. This is a great way to avoid traffic. Some car pool lanes do require a fee for use. Fees depend on how often the car pool lanes are used and can range anywhere from a few quarters to hundreds of dollars for use throughout a year.
The City of Minneapolis website gives many suggestions for recreational activities. Bicycling, ice skating (indoor and outdoor), golfing, and visiting regional parks are all activities citizens can participate in that also provides a source of exercise. The public health nurse should encourage activities such as these to keep the community active and free of disease and illness.
Psychological Community Assessment
“Today, the MPD (Minneapolis Police Department) has approximately 800 sworn officers and 300 civilian employees” (Inside the Minneapolis Police Department). The goal of the MPD is to make the city of Minneapolis “the safest place to live, work and visit” (Inside the Minneapolis Police Department). The goal of the police department is to help citizens within the community find peace of mind and decreased stressed. The Minneapolis fire department has 28 fire stations in Minneapolis. This allows the fire fighters to make it anywhere in the city in record time, especially since there are 414 firefighters on staff. The Minneapolis fire department’s “goal is for the first company to arrive on scene within 5 minutes 90% of the time. Our current average response time is 3 minutes 52 seconds” (Fighting Fires).
The City of Minneapolis has a solid emergency preparedness plan. According to the city, the emergency plan was originally developed for natural and man-made disasters then strengthened to include terrorist acts (What has the City of Minneapolis done to prepare for an emergency). The Emergency Preparedness Director works directly with the Mayor to coordinate plans when disasters happen. Responders are trained to use protective equipment and are required to participate in simulations and city-specific courses that go through the emergency plans.
There are many jobs within the City of Minneapolis. “The City offers employment in over 600 position titles from entry-level to management” (Frequently Asked Questions about a Job with the City of Minneapolis). Jobs with the city offer vacation, sick time off, as well as many other benefits. This is a good resource and place to start looking for unemployed citizens off Minneapolis. Currently, Mayor Rybak is “proposing to more than double the funding for our adult job training, placement and retention programs from $511,000 to $1.2 million in 2010” (2010 City of Minneapolis Budget, 2010). This will help decrease the unemployment rate and aid in job placement for many people within the City of Minneapolis.
It is a good idea to have many different cultures living amongst each other as long as it is understood that everyone is seen as equals and everyone should be treated that way. After discussing the ethnicity of the area with many residents it could be concluded that everyone is aware of the racial differences within the community as well as stereotyping taking place. Some of the comments made by residents were so vulgar and distasteful that they will not be quoted in this assessment. According to Representative Jeff Hayden, people should “take care of each other regardless of their differences”.
Health system factors
Unfortunately, many people within Victory are unsatisfied with health services provided in the area. “The economy is poor, and money is tight” describes a citizen of Victory. “We drive all the way to Bloomington for our healthcare. This is where our insurance is taken, the little bit that they help us with.” While talking to people in the area it was concluded that many did not know about the clinics providing services for little (or no) cost right in the city of occupance. Many people in the community also did not know that with many health facilities there is always an option to have flexible payment plans when paying full amounts are not possible.
Becky Macintosh, who works for the Department of Health, recommended Northpoint Health and Wellness and Freemont Community Health Services for citizens within North Minneapolis who are in need of health services. These clinics are not free but serve uninsured; therefore, are willing to work with patients on payment plans and budget planning. Freemont Community Health Services is located on Freemont Avenue and is only open on Monday through Friday from 8 a.m. to 5 p.m. (Freemont Community Health Services, 2005). Health care needs should to be taken care of during the week in order to access this facility. The clinic’s hours of operation may make it difficult for people to seek health care that work normal daytime hours.
Another facility located in Minneapolis is Red Door Service which provides STD testing, health education, and pregnancy services (Red Door Services). The clinic runs on the basis that patients are seen regardless of ability to pay (Red Door Services). Patients can come on a walk-in basis, but only a set number of patients can be seen per day (Red Door Services). For this reason it is important that patients come early in the day to assure they are seen. Appointments are needed for pregnancy services (Red Door Services). The clinic is only open Monday through Friday during daytime business hours (Red Door Services).
Less than a mile away from the Victory zone in North Minneapolis is North Memorial Hospital. The hospital is well known for its level 1 trauma center, in which people are airlifted to from all over the state. North Memorial offers many support groups and programs which include: domestic violence support programs, family birth programs, home health and hospice, grief and loss support, nutrition education, and diabetes education and support programs (to name a few).
According to Janet Mengelkoch there are 45 food shelves in the city of Minneapolis with many unaccounted for in her books. Minneapolis is very culturally diverse; therefore, many food shelves and shelters in Minneapolis cater to a wide variety of different cultures. For example, the Asian Women United of Minnesota/House of Peace, located in Minneapolis, “provides emergency shelter and support services for battered women, especially Asian women” (Emergency Shelters for Abused (or Battered) Women in Minneapolis). Upon calling the shelter to get information about the location, its whereabouts could not be disclosed. According to the central office at the shelter, “the only way I can give you our cross-streets is if you are coming to our facility to receive help and if you are on your way here; otherwise, we cannot give out our location to protect the women staying here.” This is a great way for the facility to protect the women staying there and to prevent further abuse.
Another facility that acts as a food shelf, mosque, school, banquet hall, and assists with community employment services and is specifically designed for the “Muslim-American” community is Masjid An-Nur (Outreach & Services). Monthly food shelf distribution occurs on the 3rd Saturday of each month from 8:00 am to 9:30 am, on a first-come, first-served basis (Outreach & Services). Upon distribution of food, consumers need to present a state issued photo ID, proof of residence, income, and complete an application showing the number of people in the household (Outreach & Services). Masjid An-Nur also provides free clinics outside the city of Minneapolis in Fridley (to the north) and Bloomington (to the south) if citizens of the Minneapolis Muslim community want to stay within their culture for health care, but cannot afford to pay.
There are also many shelters for adolescents in the community. One such shelter, Project Foundation North, is located in North Minneapolis and “provides emergency and transitional housing for teens and young people, ages 14 – 20 who are homeless” (Emergency Shelters for Abused (or Battered) Women in Minneapolis). The Harbor Light Center of Minneapolis Salvation Army “offers emergency shelter, meals, and support services for sober homeless adult men (age 18 and older)” (Emergency Shelters for Abused (or Battered) Women in Minneapolis). The positive exception to this facility is that it also “provides transitional housing for up to 6 months for single men who meet income guidelines” (Emergency Shelters for Abused (or Battered) Women in Minneapolis).
The Northpoint Health and Wellness Center is a food shelf for the residents of North Minneapolis which also offers advocacy programs and social services (Community Programs). The food shelf is only open Monday through Thursday with limited daytime hours (Community Programs); therefore, people within the community needing food may have a difficult time if they work daytime hours. Another great resource for residents of North Minneapolis to get food as well as support groups for all ages, male and female, is the Oasis of Love located on Emerson Avenue North in Minneapolis. This facility offers support groups for women of domestic abuse, children that have witnessed violence and men who have been violent and/or abusive (Oasis of Love, Inc.). A child development program is also available for families that need child care during odd hours of the day such as night, evening, or early morning. This service is available for “families transitioning from welfare to a work environment” (Oasis of Love, Inc.).
There is a “tipline” on the City of Minneapolis website that youth within the community can call anonymously to report weapons, assault, and violence within their school. The goal of the website is to encourage safe schools and to prevent injury. The number is, 1-866-SPEAK-UP (PAX-Real Solutions to Gun Violence). It can be scary to call the police because for most people it has been taught that you only call the police for serious matters; this will help kids and adolescents feel that they have someone to talk to other than the police if they feel threatened.
Community Assets that can Assist with Problem Resolution
Currently, the North Minneapolis police department offers crime fighting tips and links on their website for North Minneapolis residents which includes, “adopt a vacant home to promote safer neighborhoods” and “safeguard your home during vacations”. These are great resources for victims of robbery that are worried to leave their homes because of the fear that they will be burglarized again. There are also many different types of support groups that can help people who have been victimized by assaults or any other type of crime to join. For example, North Memorial offers groups for domestic violence and injury prevention programs (for kids). When one home is burglarized, the whole neighborhood feels the effects. People feel invincible, as if it will never happen to them; but it can.
Residents of Victory, specifically off of Washburn Avenue and 39th street, verbalized how important it is that they have a strong, close nit community; one that looks out for each other. “When something doesn’t look right, we call the police”, said Jerry, a resident in the area. The neighborhood currently displays signs in almost all the yards, front and back, reading “we watch, we call”. The purpose of these signs is to tell citizens that don’t belong in the area that the people residing in the area are watching them. If they don’t belong there they need to leave or risk being escorted out of the area by police.
Community block parties are also a regular occurrence in the area, not just for residents of Washburn and 39th, but for surrounding areas as well. The purpose of these gatherings is to get to know your neighbor. Nick, a resident from Washburn Avenue states, “close, trusting neighbors are essential in feeling protected in your surroundings”. Nick owns two homes on the block, one that he lives in and one that he bought two years ago as a “fixer-upper”.
Community Barriers that may Inhibit Problem Resolution
Stereotyping, especially in North Minneapolis, is a problem. Stereotyping in this area can be attributed to the wide variety of cultures living together in one community. While driving through the community of North Minneapolis it was observed that there was a high percentage of the African American race. This seems to be the predominant race here. A different day, while driving through Southeast Minneapolis, it was observed that a large Somali population was walking on the streets and in high rise governmental apartment housing buildings. By educating ones self and others about a culture, stereotyping can be prevented.
Why are crime rates so high in this area? Is it because of unemployment and welfare rates in the area? Current “unemployment rates in the city have decreased from 8.4 percent in July 2009 to their current 6.8 percent, but other indicators of economic health are not as strong.” (Nord, J., 2010, March 11). Representative Jeff Hayden from North Minneapolis talked about the stigmas associated with being on welfare. “Remove stigmas from poor that they don’t want to work; they just may not have the opportunity” (Hayden, 2010). Finding jobs for people on welfare can help decrease poverty and health care costs. Hayden also discussed his push to make violence a healthcare issue, especially since violence affects the mental well being and stress of a person and can contribute to rising health care costs.
Conclusions that can be drawn from the Data
It can be concluded from the data gathered about North Minneapolis that many interventions should be put into place to make the community a safer, healthier place. Crime is a big problem and will drive up healthcare costs by affecting the psychological health of people. This is proven by the alarming burglary and assault statistics for North Minneapolis. North Minneapolis seemed separated by stereotypes and the wide variety of culture and minority living there. Providing education to the community is the best way to stop stereotyping.
It can be concluded from the physical-environmental data that the City of Minneapolis has a large population with many diverse cultures living in it. The White population is dominant within the City, but the Black population is the largest Minority group living there. Biophysical assessment data shows that there is a high incidence of Infant mortality, specifically among the Black population. Minneapolis also had a high rate of births to unmarried mothers. Prenatal care was inadequate by 50% or less for all minority groups, especially in younger women. Poverty rates for the City of Minneapolis were higher than the state of Minnesota collectively. Food and water borne illness is also a problem for North Minneapolis as evidenced by high poverty rates and poor living conditions. Crime seemed to be a problem for North Minneapolis when looking at sociological and behavioral data. Crime causes stress and mental anguish, therefore, is considered a health problem that can be addressed with nursing intervention. STD rates, especially for Gonorrhea and Chlamydia were extremely high within the Black population in North Minneapolis. People that the community can go to for addressing health care concerns are Representative Jeff Hayden and Mayor R. T. Rybak. Getting around in Minneapolis is efficient because of all the modes of transportation the city has to offer that other cities do not have. When people within the City of North Minneapolis are not worrying about crime, they should feel safe because of the many police officers and fire fighters working for the city. The City also has an emergency preparedness plan in which quick action will be taken to resolve any problems occurring from natural disasters or terrorist attacks. There are many resources for job placement in Minneapolis as well as the government working to increase funding for job training and placement. The nurse can help members of the community locate resources to find a job or train for a job.
Three Priority Health Problems for the Population
1) Food and water borne illness is a problem specific to the area of North Minneapolis. During the windshield survey of this community it was concluded that the statistics related to high prevalence of food and water borne illness in Hennepin County are also a problem in North Minneapolis due to poor living conditions and poverty levels.
Statistics from the Minnesota Department of Health (2005) documented cases of food and water borne illness by county. Documentation included the setting in which the illnesses occurred, number of cases, and specifically what type of food the illness came from (MDH 2005 Gastroenteritis Outbreak Summary). The statistics also gave a response to how the illness started and how it was transmitted. Many of the cases documented by this site resided in Hennepin County. Out of 41 groups of outbreaks throughout 2005, 19 of those groups occurred in Hennepin County (MDH 2005 Gastroenteritis Outbreak Summary). Settings for which illnesses occurred in Hennepin County include: restaurants, potlucks, and work place cafeterias (MDH 2005 Gastroenteritis Outbreak Summary). Sources for how the illness was transmitted include: ill food workers, ill food preparers, contaminated products, elevated histamine levels in implicated fish, time/temperature abuse when cooking food, contaminated raw product, and unknown causes (MDH 2005 Gastroenteritis Outbreak Summary).
This problem should be given priority over others because it is a cause for clinic and hospital visits. This presents a problem for people living in Minneapolis because poverty levels are higher here than in other areas of Minnesota; therefore, many citizens cannot afford to seek health care and treatment for food borne illness. This issue will also drive up healthcare costs and prevent people from going to work. This vicious circle results in loss of income and further incidence of poverty. Many residents living in poverty are supported by the government for healthcare needs. With high poverty rates and high incidence of food borne illness, clinic visits are sure to rise and drive the government into further debt. Not only will this health problem hurt individuals, but will close businesses for indefinite amounts of time while investigations for the cause for food borne illness are underway. The nurse should educate this area on how to properly prepare food, when to throw food out, staying home when sick, and proper hand hygiene; all causes of food borne illness. It is also important to discuss the importance of expiration dates, especially with fresh produce and meats.
2) Another health care problem that was found specifically within the City of Minneapolis was a high incidence of Chlamydia and Gonorrhea in the Black population. Statistics show that the Black population has an overwhelmingly high incidence of these two STD’s when compared to other ethnic groups. This problem should be given priority over other health care issues in Minneapolis because it affects the largest ethnic group in the City of Minneapolis. Statistics show that Minneapolis is a growing urban area, therefore, these STD’s will continue to increase in the Black population. This will result in even higher rates of Chlamydia and Gonorrhea in Minneapolis.
3) Infant mortality rates are another area of concern for Minneapolis. Camden and Near North, two communities within North Minneapolis, have the highest percentages of births to unmarried mothers. Being a single parent, especially in an area of poverty can be stressful; care of an infant may be inadequate or neglectful. Statistics also show that all minority groups have a 50% or less adequacy rate for prenatal care. The two largest populations in Minneapolis also had the two highest infant death rates (IDR). Infant death rate’s (IDR’s) reflect the number of infant deaths per year. Although the White and Black populations have the top two highest infant death rates, the Black population’s IDR is twice as high as the White population’s IDR. This problem needs to be addressed because the high incidence of inadequate prenatal care, poverty, and unmarried mothers all contribute to high IDR’s.
Diagnosis and Implementation of Primary Community Problem: Infant Death Rates
The data collection regarding infant death rates in Minneapolis, especially among the Black population, is in need of a nursing diagnosis and intervention. An appropriate nursing diagnosis for the population of North Minneapolis is:
Caregiver role strain related to high birth rates to unmarried mothers and care of infants by single parent families as evidenced by high infant mortality rates.
Some interventions will focus on primary prevention and some will focus on secondary prevention. If a citizen within the community of North Minneapolis has not yet felt caregiver role strain, interventions will focus on primary prevention. If caregiver role strain is already occurring for an individual, interventions will focus on secondary prevention.
Goals and objectives related to decreasing IDR’s and preventing caregiver role strain: * Decrease infant mortality of the White and Black populations by half within one year in North Minneapolis by decreasing caregiver role strain. This would mean that the White population would have an IDR of 8.5 or less by 2011 and the Black population would have an IDR of 14.5 or less by 2011. * Creating programs that prevent families from separating or bring parents together before the infant is born.
By decreasing caregiver role strain the goal is that the parent(s) will provide a more stable environment for the infant as well as learning how to cope with the new lifestyle an infant forces the parent to be placed in.
Interventions for this community need to be at little or no cost to the consumer, easily accessible, and targeted toward pregnant women or women that have just given birth. There are many interventions that can be implemented by the nurse with the goal of decreasing infant mortality by preventing caregiver role strain. One intervention is to create a care center for infants. The purpose of creating a facility for infants is so that single mothers can have a break from the day to day stress of caregiver role strain. Another intervention is to provide support groups for parents of unborn infants and infants that are under a year of age. The purpose of creating a support group is to provide single mothers and couples raising an infant with the experiences of others in the same situation. Learning from each other can be the best kind of education. Not only can families attending these support groups learn from each other, but can use each other as sources for child care and can participate in social activities together.
The most cost effective way to get a lot of information to a lot of people is to advertise a crisis line for pregnant women and new mothers. The formal name for this program will be the “Pregnancy and Infant Care Crisis Line of Minneapolis”. Having a phone line to call prevents citizens from having to find modes of transportation in order to participate in the intervention. The ability to call a crisis line rather than leaving the house will also save time. It can be hard for parents to take newborns out of the house; there is a lot work involved with getting an infant ready. The service is completely anonymous unless the caller tells the volunteer in any way that someone will be harmed.
The crisis line will be run by nurses, preferably nurses with an obstetric background or education at or beyond a bachelor’s degree. This would include nurse midwives, nurse practitioners, and any other nurse that has assisted with births in a clinical setting or educated women on how to care for an infant. The nurse running the crisis line and taking calls will also need to have contacts such as lactation consultants, physicians, dieticians, therapists or counselors, and anyone that can provide sources of food, clothing, or shelter for the mom and infant. Therapists and counselors are needed for couples that are at high risk of splitting up, making one or the other a single parent.
The goal of the crisis line is to educate and help women that are struggling with pregnancy or caring for an infant. Women can call the crisis line to talk about options for the baby (if still pregnant), to get help organizing prenatal care, to discuss and plan immunizations and clinic visits for the infant, and to assist with problem resolution such as pain or discomfort during pregnancy. By assisting parents of the infant with getting the best care possible, the likelihood of an infant dying from unknown complications is much lower.
When people call the crisis line the nurse will always educate on how to care for the infant. The nurse will go over things such as laying an infant supine instead of prone and removing pillows and heavy blankets from the crib to prevent suffocation. The nurse will also discuss appropriate foods to feed the infant throughout different months during the first year. The nurse can go over basic facts about infants such as how much they tend to sleep and approximately how much milk they should have in one day. Signs in which an infant should be taken to a clinic should also be included while educating the mother and father about care of the infant; these include: changes in appetite, changes in mood, tender navel or penis, fever, diarrhea, vomiting, dehydration, constipation, colds, ear trouble, rash, and eye discharge (Mayo Clinic, When to seek medical attention, 2009). The volunteer nurse will always ask callers if they have used the crisis line before as well as remind callers that there is no limit for use of the program.
The crisis line will be advertised on flyers with the crisis line number and purpose included. Flyers will be posted in North Minneapolis where poverty rates are higher. The service is run by volunteers; therefore, no costs are incurred by having to pay someone to talk to members of the community. Each nurse will have the crisis line phone a set period of time, then will hand it off to another nurse to be on call with the crisis line. The benefit to having a crisis line is that the only cost incurred is by cell phone usage of the crisis line phone.
Low poverty levels in North Minneapolis may prevent citizens from having a phone line. This is one barrier to implementation that can be foreseen with this health program. To minimize the effects of this barrier, the flyer will include suggestions for how to get a hold of a phone to call the crisis line. In smaller print, the bottom of the flyer will say: “Don’t have a phone? Know anyone that does? If not, the Pregnancy and Infant Care Crisis Line of Minneapolis can also be reached by mail at xxx 4th Street North, Minneapolis, MN 55412 (for example). Please send us any comments, questions, or concerns you have regarding your pregnancy or infant as well as an address or phone number we can reach you at.”
Evaluation
Evaluation of the intervention will be assessed directly by how much citizens within the community use the crisis line. If the crisis line is not used very often, further measures will be taken to inform the community about the crisis line. This will include flyers being put at the front doors of homes in the community.
There will be documentation forms in which volunteers taking calls will fill out. Documentation needs to include the purpose of the call, information that was given to the caller, the name of the volunteer taking the call, any referrals to other health care workers, and if the caller is pregnant, already had the infant, or if it is the mother’s partner. The volunteer nurse will ask the caller if it is okay to save the phone number from which they called so that evaluation surveys can be conducted at a later time. Call back surveys will occur a month after the call took place, if it is okay by the caller. The surveyor will be the same person who took the call from the person that called in. The purpose of having the same person that took the call complete the survey is to conduct an evaluation not only on how the volunteer did with helping the caller, but to see how the caller is doing based on the education the volunteer nurse provided. The follow-up evaluation phone call should be documented. The caller’s satisfaction and quality of life related care of the infant will be included in the final documentation evaluation.
Infant mortality rates should decrease with the implementation of the intervention. The documentation sheets should be given to the City of Minneapolis so that more specific data collection related to infant mortality, prenatal care, and births to unmarried mothers can be completed.
By decreasing caregiver role strain, infant mortality rates will decrease. The Pregnancy and Infant Care Crisis Line of Minneapolis will help mothers as well as anyone else involved in the infant’s life provide safer care.

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