TASK 1:
APPLICATION OF COMMUNITY HEALTH & POPULATION­FOCUSED
NURSING

A. Identification of Community
The community that I have choose is Harrison County, Indiana. Harrison County is located far down in the southern part of the state of Indiana its border is followed and made up of the Ohio River on the east side. The Blue River runs along the county's western border. Six counties are adjacent to Harrison County. The county has a total area of 486.52 square miles, of which 484.52 square miles is land and 2.00 square miles is water (Harrison County, Indiana (IN), 2015) .
The county was officially established in 1808. According to a census in 2010 the county’s population went from 39,364, and made increase of 6.6% back in 2000. There was 12 thousand births from 2000 to 2006, 8.9 thousand deaths from 2007 to 2013, and infant deaths per 1000 live births from 2000 to 2006 was 5.1. The population is made up of 96.5% White Non­Hispanic Alone, 1.5% Hispanic or Latino, and 0.9% Two or more races. The median resident age is 40.0 years of age. When comparing males to females, males make up 43.4% of the population and females make up 56.6% (Harrison County,
Indiana (IN), 2015) .
The administrative center of the county is Corydon , which was the former capital of Indiana. Harrison County has become a diverse economy with no portion employing more than 13% of the local workforce. The largest employer in the area is Horseshoe
Southern Indiana , followed behind by Tyson Foods and the Harrison County Hospital.
There is 3,701 companies counted according to the 2007 Survey of Business Owners
( American FactFinder ­ Community Facts ).

B. Summary of Tools, Description of Selected Community, & Interpretation of Collected
Data
● Population Economic Status Assessment
○ The population size is 39, 364 according to 2010 Demographic Profile. The average household income is 53,483 which was determined by 2010­2014
American Community Survey 5­Year Estimate. 12.4% of households are at or below poverty level. When looking at racial/ethnic group percentage of percentage of poor, 11.9% whites are below poverty level, African Americans
1.3%, Asian 19.4%, and Hispanic 28.3%. When looking at age under 18 years of age is at 15.5%, 18 to 64 years of age is 12.2%, and 65 and older is 8.5%.
Population 16 and older unemployed is 8.6% ( American FactFinder ­ Community
Facts) .
○ Persons enrolled in hospital insurance and/or supplemental medical insurance such as Medicare in July 1, 2003 was 5,159. Population without health insurance coverage is 14% , and children under 18 without health insurance coverage in
2000 was 7% (Harrison County, Indiana (IN), 2015) .
● Disaster Assessment and Planning
○ Harrison County historical area­adjusted tornado activity is significantly below
Indiana state average. It is 4383529.8 times below overall U.S. average.
Tornadoes in this county have caused 2 fatalities and 16 injuries recorded between
1950 and 2004. On 6/2/1990, a category 2 (max. wind speeds 113­157 mph) tornado injured 9 people and caused between $50,000 and $500,000 in damages.

Harrison County­area historical earthquake activity is slightly above Indiana state average. It is 77% smaller than the overall U.S. average. The number of natural disasters in Harrison County is 15 which is greater than the US average of 12.
There has been 12 major disasters (Presidential) declared and 3 Emergencies
Declared (Harrison County, Indiana (IN), 2015) .
○ The Harrison Co health department describes many ways to prepare and assess for disasters. One including the the H5N1 strain of avian flu, influenza virus, its milder cousins, SARS, Hepatitis and many others are just some of the illnesses that could affect the community. The Harrison County Health Department is developing plans to immunize or provide anti­viral medication to the population in the event of an epidemic that affects the health of the citizens of this community. They known the devastation of natural disaster and how the community is commonly affected by tornadoes, floods, winter storms, and extreme heat. The New Madrid and Wabash Valley faults are not too far away causing concern for earthquakes as well. Flooding from the Ohio river in the past has caused many blockages in road slowing down or preventing transportation and closing down local companies. Responses to bioterrorism, HAZMAT incidents and natural disasters are coordinated with the Harrison County
Emergency Management Agency, Harrison County Hospital EMS, local Fire
Departments and the Harrison County Sheriff's Office ( Harrison County, Indiana,
Health Department, 2015) . Hoosier Hills Pact is an emergency shelter for the county ( Emergency Shelter List By County, 2008) .

● Neighborhood/Community Safety Inventory
○ Air pollution­particulate matter is 13.7%. There has been 0% drinking water violations. There are drowning hazards with the ohio river and blue river on the borders of the county. Though all pools whether a public facility or residential have laws to abide by that include surrounding the pool entirely with a fence.
There has been 0% drinking water violations ( Health Rankings, 2015) .
○ 11% of housing units pose a safety haz ard meaning they lack in a kitchen facility or plumbing facility, are overcrowded or severely cost overburdened. There is 50 deaths related to driving, and 11 of them involving alcohol in the years
2009­2013. Violent crimes were reported 86 times in 2010­2012 ( Health
Rankings, 2015) . There are programs such as neighborhood watch, and ERT
(Emergency Response Team) program, and Crisis Negotiation Teams
( Emergency Preparedness and Response, 2015). T here is over 30 Safe Place Sites in the county that those may go to receive help whether it be a family issue, domestic violence, and other issues these places are provided with resources tools to help someone at vulnerable time ( Harrison County Indiana Sheriff's
Department) .
● Cultural Assessment Tool
○ The hispanic population makes up 1.5% of harrison county with a total of 581 people. 24.8% hispanics in the community are considered under poverty level
( Health Rankings, 2015) . When speaking to the members of the hispanic population in Harrison County, they described members of their race to be an

adult once they were able to financially care for themselves or at the age 18. The girls when coming of age were common to have a quinceanera at the age of 15. It was described that the elderly had great say in the care of those who were sick in the family. The use of spiritual healing or Curanderismo was common with those had fallen ill. Mental illnesses were to be described more as a physiological symptom like a headache, and hallucinations or delusions were seen to be as spirits or ghosts. These kinds of illness were handled more discreetly and kept within the family as much as possible. Males play a dominant role over women as far making the ultimate decision making. The two leading causes of death are heart disease and cancer among Hispani cs ( Escarce, 2006). Common jobs positions acquired by this group of people were related to agriculture, construction, domestic and food services, and other low­wage occupations, and found to be less in management, professional, technical, sales, or administrative support positions. Having a lower income and educational attainments are obstacles, because it will be less likely they will be able to obtain health insurance coverage or be able to navigate through health care delivery system, or communicate with providers.
● Windshield Survey
○ While driving through the community I observed the Harrison County is a rural area with large scale farming throughout the county, mostly corn and soybeans .
The majority of the shopping areas and services were located in Corydon. There was three noticeable medical facilities that were passed including Harrison

County Hospital, and two Kindred Healthcare. There were also multiple private owned medical practices as well. All of these medical facilities were with a five minute drive or less.There is a very large tourism attraction in the area being the
Horseshoe Riverboat Casino and Hotel, as well as two cave sites. The means of transportation seem to mostly be cars and people walking. Most of the people that
I saw walking seemed to be within the closely knitted shopping sites and restaurants in the Corydon area. Shopping ranged from farmers markets, retail stores, antiques, glass art, and other locally owned shops. Multiple gas stations and fast food chains were present. The neighborhoods depending in what area you were in went from small and run down to well kept and nice yards. The farther you got from Corydon the more space between housing units there was. The denominations of churches were mostly Methodist and Catholic. Most if not all of the media including signs and billboards were all presented in English. I did not recognize any political banners or signs in yards posted out within the community. Though I have seen them at other times when it’s closer to local elections time frames. There is an expressway, I­62, that is easily is accessed on and off of right next to the majority of businesses and the hospital.
● Scavenger Hunt
○ The Health Department target population is the community as a whole and its visitors. They advertise in the local medical facilities, YMCA, senior centers, and multiple shelter. They use brochures, emails, and have pamphlets for different situations that person may have and contacts to reach them for help. There are

fees for services required, services ranged from animal vaccination coupons, child and adult vaccinations, outreach programs for those with HIV, mammograms, and vital records.They did have a website with many resources linked on it. A barrier I believe would be a lack of translation for communication with those that are limited with use of english. There is minimal diversity in the people that work there but the staff was welcoming and answered questions asked.
○ The YMCA described sharing commitment to nurturing the potential of kids, promoting healthy living and fostering a sense of social responsibility. They offer many programs including child care before and after school, camps while kids are on breaks from schools. It is a safe place where anyone can physical workout and play in the community. They offer classes for keeping up with one’s physical health, for certification in things like CPR and lifeguarding, and they have a Big
Brother program. There is a membership to participate and to use the facilities and its programs. Though assistance can be obtained based on income. They do have a website that is used to display information and events. The staff was well dressed and was more diverse than most of the visited facilities I had gone to ( Our YMCA
­ Harrison County, Indiana, 2015) .
○ Harrison County Community Services, Inc help the community by providing a safety net for families by reducing the effects of poverty in our community through the Food Pantry, Crisis Assistance, and Low Income Home Energy
Assistance Program (LIHEAP). They have a food pantry available, they help families with low income with rent, prescriptions, and utility bills. They also help

with obtaining and handing out school supplies to kids in need around the start of school. This program can help others but only once every six months per family.
They have a website that they use and they do seem to be partnered up with many local business and organizations who donate to help the community and its people's needs.
● 1 . It appears that the community has many issues that are visible and accounted for but nothing that is overly extravagant as far as statistics go. The population is mostly populated by the caucasian race, with little minorities present in the county. There is obvious violence and injury especially with driving accidents, some of which are involving alcohol. Living circumstances are poor on the outskirts of the busy part of the community and it was prevalent that this was a popular area of housing that the minorities in the community lived, like the hispanic population. There seems to be little assistance provided throughout the community for those that are not english speaking or have difficulty with understanding the english language, even in healthcare facilities.
Though the community is small there is many opportunities for physical exercise in a safe area such as local pools, the YMCA, schools, and parks and reservations. With that keeping the communities ability to control obesity as well as helping to lower cardiac disease and or diabetes II risk factors. High risks involving environmental or geographical issues in this community would be the occurrence of floods due to being surrounded by multiple rivers, as well as winter storms and high heat temperatures in the summer months.

● C.1 . The three areas of needed improvement that I have selected are the lack of educational and community based programs, increased access to healthcare by low income individuals, and the violence and injury rate in Harrison County.
○ Educational and community based programs is an objective of Healthy People
2020 that I believe will enhance the quality of life in Harrison County.
Educational and community­based programs according to Healthy People 2020 are “most likely to succeed in improving health and wellness when they address influences at all levels and in a variety of environments/settings” ( 2020 Topics and Objectives – Objectives A–Z, 2014) . The website also describes the use of multiple settings such as “school, worksites, healthcare facilities, and the community” as places that can be used for these educational programs. The community of Harrison County would benefit from such a resource. These programs teach about topics such as injury and “violence prevention, chronic diseases, physical activity,” and others which in relation to the communities’ needs is necessary ( 2020 Topics and Objectives – Objectives A–Z, 2014) . Topics such as the hazards of drinking while intoxicated, or the importance of preventive care for people who have high risk factor for cardiac complications and cancer are a prime example that could be involved in these programs. It could also be used to help inform those who are pregnant or planning to be safe practices while pregnant and that could in return help with lowering the infant mortality rate.
Having these programs located in multiple setting will help cover all parts of the population in the county. Those who are unable to make it to one area will be

most likely to be able to attend another, therefore increasing the chance for attendance. According to Healthy People 2020 the use of “nontraditional settings can help encourage informal information sharing within communities through peer social interaction” ( 2020 Topics and Objectives – Objectives A–Z, 2014) .
○ Access to healthcare for all individuals is a necessity, though not everyone obviously has it. Having a low income like described in my cultural assessment may make it hard for individuals to afford insurance or even pay out of pocket expenses if they do have it. Disparities in access to health services affect individuals and the society as a whole. Healthy People 2020 objective Access to
Health Services states that “limited access to health care impacts people's ability to reach their full potential, negatively affecting their quality of life. Barriers to services include: lack of availability, high cost, and lack of insurance coverage”
( 2020 Topics and Objectives – Objectives A–Z, 2014). Not having access to vital care and eliminating barriers to accessing can lead to unmet health needs, delays in receiving appropriate care, inability to receive preventive services, and hospitalizations that could have been prevented. Not having insurance makes it hard to get care when it’s needed and when they do receive insurance, it then becomes an even bigger issue to have to pay the medical bills that go along with getting care. Another benefit that would come from improving access to healthcare is having a primary care physician as one’s chief outlet when seeking medical aid. These physicians can develop meaningful and trusting relationships with patients and “provide integrated services while practicing in the context of

family and community” ( 2020 Topics and Objectives – Objectives A–Z, 2014) .
Which will increase the chance that these individuals will receive the necessary care required to treat and prevent further illnesses.
○

The last topic objective of Healthy People 2020 I’ve chosen is violent and injury prevention . My community displays a violent crime rate of 86 crimes in the years
2010­2012. Ther e was 50 deaths related to driving accidents, and 11 of them involving alcohol in the years 2009­2013. Most injuries are preventable, and proper care should be put into action, because though these injuries may not have an immediate impact they do affect a person’s well being with time. Examples of this are “disability, poor mental health, high medical costs, premature death, and a lost of productivity” ( 2020 Topics and Objectives – Objectives A–Z, 2014) .
Policies should be made to help prevent the escalation of behaviors that will lead to crime, people of the community should be given and taught problem solving skills to help them control their behaviors and lessen the chances of violence.
Community members should also be the taught the importance of car safety like seat belts, proper use of a car seat according to age and weight, and defensive car driving skills. These topics are ones that could be covered in the educational and community programs mentioned earlier. Another issue that is covered under this objective that affects my community is the physical environment, especially when talking about housing conditions. There is 11% of housing units that are not safe, and this could ultimately lead to falls, fires, or burns, due to improper repairs, unfinished living areas, over crowded living conditions.

● C.2. I’m choosing to continue with the topic of having access to healthcare. Some of the resources that are available after researching online in my community are the health department of harrison county, who will give access to vaccinations, TB screening, flu shots, mammograms, and tetanus shots. They have a maternal health and child clinic to help with pre­, ante­, and post­ pregnancy medical issues, and they offer birth control options. There is senior screenings hosted throughout the county that will check blood pressures. The YMCA of Southern Indiana partners with insurance companies and employers who encourage their customers' health through fitness incentive programs, examples of these are Blue Cross Blue Shield Bluepay, Humana Vitality, and Silver
Sneakers. They make requirements like work out the required amount of times and they will add money to your blue cross account.
● C.3. My primary prevention topic is going to be, prompting health care access that are preventative care measures for community members both with a low income and without insurance that will prevent or identify illnesses before a higher care level is required to help the community member.

● D. References
American FactFinder ­ Community Facts. (n.d.). Retrieved December 14, 2015, from http://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml Emergency Preparedness and Response. (2015, October 7). Retrieved December 14,
2015, from http://www.harrisoncountyhealth.com/preparedness.htm

 Emergency Shelter List By County. (2008, December 1). Retrieved December 14, 2015, from http://www.in.gov/ihcda/files/Emergency_Shelter_List(1).pdf Escarce, J. (2006). Retrieved December 14, 2015, from http://www.ncbi.nlm.nih.gov/books/NBK 1989 9/
Harrison County, Indiana (IN). (2015). Retrieved December 14, 2015, from http://www.city­data.com/county/Harrison_County­IN.html#ixzz3u9sbafFY Harrison County, Indiana, Health Department. (2015, October 7). Retrieved December q14, 2015, from http://www.harrisoncountyhealth.com/Main_page.htm
Harrison County Indiana Sheriff's Department. (n.d.). Retrieved December 14, 2015, from http://www.hcsdin.net/
Health Rankings. (2015). Retrieved December 14, 2015, from http://www.countyhealthran kings.org/app/indiana/2015/rankings/harrison/county/outcomes/overall/snapshot 2020 Topics and Objectives – Objectives A–Z. (2014). Retrieved December 15, 2015, from http://www.healthypeople.gov/2020/topics­objectives
Our YMCA ­ Harrison County, Indiana. (2015). Retrieved December 14, 2015, from http://ymcaharrison.org/our­y/