Community Health Nursing Assessment
Western Governors University

Community Health Nursing Assessment

A1. Community Description
Hernando County is located in west central Florida. The county was officially established on February 27, 1843. It was created from portions of Alachua, Hillsborough and Orange Counties and centered between Citrus County to the north and Pasco County to the south. Its county seat is Brooksville and its largest community is unincorporated Spring Hill. According to “Hernando County History” 2010, the county has a total area of 589.08 square miles, of which 478.31 square miles is land and 110.77 square miles is water. Hernando County is a relative small community but is known for its wild life and national parks. Chassahowitzka National Wildlife Refuge is a National protected area of Hernando, and Weeki Wachee Springs (home of the mermaids) along with Withlacoochee State Forest are State protected areas. The county is known best for its nature preserves and is called the Nature Coast of Florida. This community has a census of 173,000 people, 93,425 households, and 79,575 families residing in this community (U.S. Census Bureau, August 16, 2009). The racial makeup of the community is 92.85% white, 4.07% black or African American, 0.30% Native American, 0.64% Asian, 0.02% Pacific Islander, and 0.98% from other races. It is also estimated that out of the 55,425 households 21.80% had children under the age of 18 living with them, 60.40% were married couples living together. 23.30% of all households were made up of individuals and 14.70% hand someone living alone who was 65 years of age or older. The average household size is around 2.70. The median income for a household in the community is around $32,572, and the median income for a family is estimated at $37,509. Hernando county commissioners oversee operations pertaining to emergency management; water usage; land usage; zoning; parks & recreation; growth & development; homelessness; and health issues. The county’s commerce is dependent on agriculture, private and government business, growth and development, and tourism (“Hernando County History”, 2010). Statistical information obtained for this community will provide valuable information that will help ascertain the impact of care and how that care will be delivered.

A2. Data

Demographic and Socioeconomic Demographic and Socio-economic characteristics are often strong predictors for assessing healthcare outcomes and access to healthcare. In Hernando County the population exceeds 173,000, and during the next twenty five years, the county’s population is expected to increase by 49.3 percent compared to 44.9 percent for the state of Florida. Thirty-one percent of Hernando’s population is older than age sixty-five compared to eighteen percent for Florida as a whole. The county is “older” than most counties in Florida. According to the Well Florida Council (2006), Hernando County has a significantly higher percentage (91.6) of white residents compared to only (4.6) of black residents. In contrast, 6.6 percent of Hernando County residents comprise Hispanics and other nationalities. The median incomes of residents living in the county are substantially lower than those of all Florida residents. Hernando households have incomes less than $25,000 per year compared to the state as a whole however, unincorporated Spring Hill residents has an average income of $ 50,000 per year. Only 10.3 percent of persons in Hernando County fall below the federal poverty level compared to 12.5 percent for the state however, the county has a smaller percentage of its children in poverty than the state of Florida. According to Well Florida (2006), nearly twenty-two percent of Hernando County residents (age 25 and older) have no high school diploma, whereas 40 percent with high school diplomas, eighteen percent have acquired a college degree, and the drop-out rates were higher compared to other counties.

Access to Healthcare According to (Florida CHARTS: Community Health Assessment Resource Tools Set, n.d.). In 2009, there were nearly eighteen thousand non-elderly uninsured residents, and 18,200 were Medicaid eligible. Prescribed drugs comprised nearly twenty-one percent of Medicaid expenditures, there were 247.2 HMO enrollees per 100,000 of the population, and avoidable hospitalizations in the county were twenty-two percent of the population. Residents of Hernando have access to healthcare through various medical personnel and facilities. The County has 206.5 licensed medical doctors, 22 dentists, and 2,565 licensed nurses. There are 210 licensed healthcare facilities which includes four hospitals, seventeen assisted living facilities, five skilled nursing facilities, twenty-one adult family care homes, and one crisis stabilization unit. In conducting this access to healthcare it was discovered that many families of low-income and no-income suffered from one are more core-morbidities such as heart disease, diabetes, renal disease, alcohol abuse, perinatal conditions, suicide and liver disease. Also, dental services are a key concern that was identified in this community. It is important to note that Hernando County has been designated as a medically underserved population by the federal government. Due to the poverty statistics of Hernando County, much work needs to be done in order to provide and improve affordable quality healthcare to its residents (“Well Florida Council”, 2006).

Birth Rates Birth outcome indicators are critical measures of a community’s health status. Birth rates in Hernando County were substantially lower than the state of Florida as a whole. This was partially due to Hernando’s large population of senior citizens who are beyond childbearing age. Birth rates of black and Hispanic residents double those of white residents by 16.5 percent, and fifteen percent of births were from the teen population. Infant mortality in Hernando was 7.6 per 1,000 births in 2006-2009. Infant mortality rates for white residents are slightly higher than for white residents of Florida as a whole. However, mortality rates for blacks and Hispanics is more than three times higher than whites in the county (“Well Florida Council”, 2006).

Mortality/Leading Causes of Death Mortality rates are an indicator of major causes of death in Hernando County. These rates can assist healthcare providers and community leaders in healthcare delivery and policy in determining the medical service, prevention and education that is needed for the community. Life expectancy in the county is estimated for males 75 years and females 78 years. Heart disease is the leading cause of death in the nation and the state of Florida. Hernando County has an average of 604 heart disease deaths per year from 2000 to 2009. Brooksville has the highest mortality rate related to heart disease, and Spring Hill with the lowest. Because of the small number of black and Hispanic residents that reside in the county, white residents have a higher percentage of cardiac deaths overall. For black and Hispanic residents in the county, diabetes is the third leading cause of death. In addition, perinatal conditions, and HIV are in the top ten causes of death for blacks and Hispanics while influenza and pneumonia, suicide, and liver disease, and drug-related deaths are not (U.S. Department of Health and Human Services.n.d.).

Education Hernando County is a small community with limited educational resources for people who wish to seek higher degrees however; there are many opportunities for elementary, middle, and high school students. The county has ten elementary schools, four middle schools, three high schools, one college, two private schools, and three technical schools. Advanced degrees can be obtained in another county or on line through in-state or out-of-state universities. Students enrolled in grades 1-8 make up 11.1 percent of the population, 8.2 percent for grades 9-12, and 5.9 percent for college or higher. According to City-data, 2010, the average number of people 25 years or older with a high school diploma or higher is around 78.5 percent, and for the same age with a bachelor’s degree or higher is at 12.5 percent (“Hernando County Public Schools”, 2009).

Community Safety The Sheriff’s office of Hernando County provides law enforcement services to a population of 173,000 residents, this is an increase of nearly 330 percent since 1980, and the county continues to be regarded as one of the fastest growing counties in the state of Florida. The county has two sheriff’s offices and four sheriff’s sub-stations throughout the county. The Sheriff’s Department provides the community with professional and efficient law enforcement through well-trained employees, technologies, crime prevention, and a proactive approach to public safety. Crime statistics in the county as of 2009 include 4 murders, 66 rapes, 52 robberies, 523 assaults, 1154 burglaries, 2917 thefts, and 301 auto thefts, data has shown as the population grows so does the crime rates. The Hernando County Sheriff Department utilizes law enforcement support from surrounding counties when necessary. Within the community there are neighborhood crime watch groups that assist law enforcement with information leading to a crime or perpetrators of a crime. Hernando County has fifteen fire and rescue departments that are strategically situated throughout the communities of the county. The Hernando County Fire and Rescue Departments provide its residents with proficient and cost-effective fire prevention, fire suppression, pre-hospital emergency medical basic life support, non-transport and transport advance life support services, and hazardous materials response within a 419 square mile area of the county. The Fire Department conduct classes for its residents on fire safety and basic cardiac life support measures (“Hernando County Florida” 2010).

Environmental Assessment Hernando County residents rely on its Emergency Management Department, local news stations, and the emergency broadcast system to keep abreast of any impending whether alerts. Florida is known for its hurricanes, tropical storms, coastal flooding and lightning strikes whereas Hernando County is also known for these disasters the county is also known for its sinkhole activity. Many homes in Hernando County are damaged or destroyed by sinkhole activity. Information regarding these hazards is given to the county’s residents, schools and hospitals in a timely manner. Hurricane preparedness workshops are offered throughout the year to the county’s residents. When and if a disaster is due to strike, the county communicates to its resident’s information regarding evacuation zones, local shelters, transportation that will be available for the handicap and elderly and pet shelters. The county has been very successful in keeping its residents safe and informed with current systems in place. Air quality plays an important role in the health of its residents. Pollen, smoke from wild fires and industrial plants is a major air pollutant in Hernando County. The state as a whole conducts air quality controls in able to meet the standards for national air quality safety. With Hernando’s vast Forrest areas, the county is susceptible to wild fires especially during the dry season (“Hernando County Florida”, 2010).

Homeless Population The state's definition of "homeless" has been expanded to include individuals who are living with friends and family members due to loss of housing or economic hardship. According to” Hernando County Health and Human Services”, 2012 previous census counts, the number of homeless individuals has varied over the past few years, with only 450 getting tallied last year. It was estimated on any given night in Hernando; of the homeless 52 percent are males, 29 percent females, and 15 percent children. But with unemployment at nearly 15 percent and record foreclosures, those who provide services to the needy continue to believe the numbers are much higher. Homelessness in Hernando County is reaching a higher socioeconomic level due to the country’s current economic crisis. There are several homeless shelters and organizations within the county that provides up to 3 nights monthly of emergency shelter to the homeless men and women in the Hernando County area. They also offer a 36-week Rehabilitation Program that is designed to assist men and women in the recovery and healing of their lives, spiritually, emotionally, mentally and physically (“Homeless Coalition of Hernando County”, 2009).

A4. Interpretation
Health Indicators Health indicators for Hernando County include access to affordable healthcare services, prevention or reducing risk factors related to heart disease, obesity, HIV, liver disease, pneumonia, influenza, and renal disease through education, and life-style changes. The health and well-being of Hernando County citizens is vital to the community as a whole. Education is the key to any community that wish to obtain and sustain a healthy lifestyle. Education for this community should include but not limited to; Smoking cessation, decreased alcohol consumption, healthy diets, exercise programs, and safe sex. It is also important for this small community to educate and monitor its homeless and underprivileged residents, and provide them with the necessary support, education and resources that are available to them (i.e. prescription assistance, Medicaid assistance, shelters, housing, food banks, blood pressure, cholesterol, and blood glucose screenings). Hurricanes, floods, wildfires, and sinkholes are other indicators that not only have a financial impact on the community but a major health impact as well. Keeping the community prepared will prevent complacency when a disaster strikes.

A5. Community Diagnosis

The community diagnosis made regarding the county of Hernando is based on the data obtained in this report. It is important to note that the county is small and mostly rural compared to other counties in Florida. Access to healthcare is a major concern. With a high number of uninsured residents, low-income or no-income homes, homelessness, and affordability of health insurance, the county healthcare access is not readily assessable. The uninsured may neglect their health and seek medical attention only if there is a major health crisis which can lead to rising healthcare cost. Hernando County leaders will have to find collaborative ways to implement and provide access to healthcare for those that are in need, and educate its citizens on the importance of prevention. Even though the county is steadily growing, an emphasis must be placed on attracting more medical specialist to the community that can provide services for medical conditions that would otherwise have to be dealt with in a neighboring county.

References

Florida CHARTS: Community Health Assessment Resource Tools Set. (n.d.). Retrieved February 15, 2012 from http://www.floridacharts.com/charts
Hernando County Public Schools. (December 15, 2009). Title 1.Retrieved February 15, 2012 From http://www.sdhc.k12.fl.us/SSFPDiv/Title1.asp
Hernando County, Florida. (December 18, 2010). In Wikipedia, the free encyclopedia. Retrieved February 15, 2012 from http://en.wikipedia.org/wiki/Hernando_County_Florida
Hernando County History. (2010). Retrieved from http://webcoast.com/herndo.htm
Homeless Coalition of Hernando County. (August 2009). Homelessness and Our Community. Retrieved February 22, 2012, from http://homelessofhc,org/
U.S. Census Bureau. (August 16, 2010). http://quickfacts.census.gov/qfd/states/12/12057.htlm
U.S. Department of Health and Human Services. (n.d.). Healthy People 2020: 2020 Topics and Objectives. Retrieved February 27, 2012, from http://healthypeople.gov/ 2020/topicsobjectives2020/overview.aspx?topicid=1
Well Florida Council. (2011). Working Together for Healthy Communities Retrieved February 27, 2012, from http:// www.wellflorida.org/wf_1.php

A3. Genogram