Care of population

Community health nurses are known to focus on a specific population, advocate, educate, and collaborate with members from a community to promote better health. According to Nies, A. M. & McEwen, M.(2011), “The major goal of community health nursing is to preserve the health of the community and surrounding populations by focusing on health promotion and health maintenance of individuals, families, and groups within the community. Lucanus Developmental Center is a non-profit organization, located in Hollywood, Florida, for individuals with intellectual disabilities, Dementia, and Down Syndrome. The center includes a library, movie theatre room, nail and hair salon, and exercise equipment. These amenities are free to the participants of this center. Transportation is also provided if necessary. Lucanus is located in a lower-middle class neighborhood containing retail stores such as supermarkets, national pharmacy chains, gas stations, national fast food restaurants, and small private restaurants, food stores, and public schools.

There are banks, medical professional offices, a hospital within a few miles and a few residential areas as well. According to the U.S. Census Bureau (2014, Mar27), Hollywood is a city of about 145,000 people in South Florida. Accessibility to healthcare is not a challenge due to the fact that there are many readily available resources to the consumer and public transportation if needed. On the other hand affordability is a challenge for the reason that this geographic location is of the lower economic status and has an increased unemployment status. The sources of most jobs are fast food restaurants, retail stores, and grocery stores which provide minimum-wage positions. Many people of Hollywood live in small homes which indicate low-income families. The most common ethnicity in this town is White followed by Hispanic.

One health risk that was observed is the vast amount of fast food restaurants around which puts the community at risk for obesity. Another threat to the community is the sun exposure and degrees of heat around spring and summer which puts them at risk for skin cancer. On a weekly basis, students and professors from Chamberlain College of Nursing work as a team with participants of the day program by demonstrating and performing resistance, flexibility, strength and balance exercises to evaluate if the clients progress or decline. Also, dancing to Zumba is incorporated daily to promote physical activity and well-being. Moreover, health fairs are sponsored at Lucanus which provide free health screenings for those who encounter issues with the affordability of healthcare. By developing a SMART goal related to physical activity the nurses that volunteer at Lucanus can assess, diagnose, plan, implement, and evaluate every individual as a community and modify if necessary. Targeted Population

The majority of the participants at the Lucanus day program are dependently elders over 65 years of age. The targeted population attending this developmental center has intellectual disabilities such as conditions known as Down Syndrome and Dementia. According to the National Down Syndrome Society (2012), “A few of the common physical traits of Down Syndrome are low muscle tone, small stature, an upward slant to the eyes, and a single deep crease across the center of the palm.” As a community health nurse, one should implement interventions that will promote the quality of life and improve on some daily living activities that they require assistance with. Unfortunately, most adults with Down Syndrome ages 65 and older have a higher prevalence of Alzheimer’s or some form of dementia.

As stated by Alz.org (2014), “Early symptoms of Alzheimer’s may include reduced interest in being sociable, conversing, or expressing thoughts, decreased enthusiasm for usual activities, decline in ability to pay attention, sadness, fearful, or anxiety, irritability, uncooperativeness, or aggression, restlessness, seizures that begin in adulthood, changes in coordination and walking, and memory loss may also occur.” Our goal as community health nurses is to identify the issue within this targeted population, providing health screening and promotion, educating them on the importance of exercise, and collaborating with families and staff of the Lucanus Developmental Center to support these individuals with intellectual disabilities. Key Informants

The consumers at Lucanus Developmental Center have a variety of diagnoses that affects their mental status. Alzheimer’s, dementia and Down syndrome to name a few are the most common diagnosis among their population. This makes it difficult to rely on the information that the individual would express. We as nursing students, get our information about the consumers directly from the nurses and staff members that have already been working on a daily basis with them. On the other hand, Lucanus staff gets their information from legal guardians, family members and other medical personnel that have known the patient for a long time. Nursing Diagnoses

#1 Impaired verbal communication among Lucanus participant’s in day program related to intellectual changes as demonstrated in classroom setting conversations with participants.

#2 Imbalanced nutrition more than body requirements among Lucanus participant’s in day program related to sedentary activity level and lifestyle as demonstrated in BMI that is above 25 in all 18 consumers observed.

#3 Impaired physical mobility among Lucanus partcipatnt’s in day program related to decreased strength and endurance as demonstrated in impaired ability to move and coordination during daily exercises. Wellness Diagnosis

# 1 There is a potential for a healthy life style among Lucanus day program participant’s related to their readiness to participate in exercising activities as evidenced by their participation in the balance, strength, balance exercised as well as any Zumba or dancing activities. Health Priority with Justification

At Lucanus Developmental Center they make physical activities and nutrition a priority. The staff has a daily schedule of physical activities that consists of strength, balance, flexibility and resistance. Their goal is to keep the consumers active and avoid further deterioration that might affect their activities of daily living. They also make sure that the consumers have a well balance diet. They tend to incorporate fruits and supplemental nutrition such as Ensure. The staff makes sure to avoid any type of soda or high sugar drinks or any type of junk food. Social activities are a priority as well, since they try to entertain the consumers and make them feel better by doing different types of activities such as painting their nails, watching a movie, dancing and drawing. They play music for them which is very therapeutic. SMART Goal

S: Participant’s decrease in body weight by 1 to 2 BMI units. (approx. 10-15 lbs.) M: Several health benefits including lowering blood pressure, blood cholesterol and blood glucose levels. A: Nutrition teachings should be offered to participants and those preparing their meals. Physical activity promotion during day program and at home. R: Healthy eating, exercising and an appropriate body weight promote a longer happier life. T: Program should begin as soon as possible and continue for six months. Health Promotion Plan

Throughout the clinical term a health promotion plan was implemented at Lucanus developmental center. One of the goals of the health promotion plan throughout the term was to raise awareness of the benefits of physical activity and promote regular exercise on the targeted population. The intervention program falls into three categories that include health promotion, primary prevention, and secondary prevention. In primary prevention, the goal is to help those who have risk factors to prevent the development of the disease or delay the disease from occurring. In secondary prevention the goal varies because it is to help those individuals who already have the disease from getting worse and teaching them how to manage the disease effectively. The research consistently shows that persons with mental disabilities such as Down syndrome, Alzheimer’s disease and Mental retardation are less fit than their peers without a disability and that fitness levels are generally low. (Physical Activity of Adults With Mental Retardation: Review and Research Needs, 2006).

Most individuals with intellectual disabilities lack physical activity in their daily routines and by incorporating it into daily activities it can help improve the outcome of each participant. The objective of the health promotion plan was to perform exercises at least three times per week and teach participants and assist them in proper food selections, such as implementing a diet rich in fruits and vegetables. Some of the exercises included flexibility, strength, balance and resistance. Faculty members at Lucanus chose the participants based on their ability to perform these exercises. The nursing students and instructor from Chamberlain College of Nursing work one on one with each individual and demonstrate the proper way to perform the exercises. The data collected was used to compare on a weekly basis the progress of the participants and used to also measure if any improvement was achieved.

Based on a study performed they concluded that people with ID have a sedentary behavior which is evidenced by the poor health of the population. (Dixon, 2013). This study also shows that there is a lack of secondary prevention among this population and they emphasize that this must be addressed to the community in order to reduce secondary conditions and increase functioning and improve the quality of the life of those aging with intellectual disabilities. The expected outcome of the health promotion plan is to avoid the deterioration of the targeted population. Agency Partner

The Mission at YMCA is to promote health, well-being and fitness. They will help and support the community to achieve those goals. Their purpose is to provide as many communities as possible a place that they can learn about healthy living and social responsibilities. This is a nonprofit organization that depends on volunteers and contributors in order to operate. The community needs to get involve and each individual will teach others on how chose healthier way of living. This specific agency was selected because we wanted to point out the excellent job that the volunteers of this center do in order to help the community. The students are making sure that the selected population stays fit, healthy and taking care of.

They are making a difference in the community by pushing each of these consumers to be able to keep their mobility and independence. They take the consumers to the YMCA to perform multiple activities. The location we chose was YMCA that is located in Hollywood, Florida. Their office hours are Monday-Friday 5:00 AM – 9:30 PM. At this facility they offer programs in Health and Fitness, Aquatics, Camping, Family, childcare, community development, sports, and teens. Since this is a nonprofit organization, Chamberlain College of Nursing supplies nursing students to Lucanus Disability Center in order to help with quality patient education to their consumers. The nurses’ role is to assess the individuals, teach them about better choices for them to improve in certain areas. The nurse students would participate in community health fairs and performed blood pressure screening as well as nutrition and BMI. They will also take the consumers to the YMCA along with Lucanus’s staff and make sure that the target population gets some exercises at the center. Evaluation

Lucanus offers a safe and positive environment for its participants and promotes a longer healthier lifestyle. Every individual that attends this center are given effective and quality care. The elderly consumers who attend Lucanus are exposed to little or no exercise at home. Therefore, the work done by Lucanus’s staff, Chamberlain nursing students and other volunteers to keep them active is very important. Their progress is recorded from week to week and we were able to see improvement in all the participants as evidence by increased repetitions and compliance. We also saw a significant improvement in the individual’s endurance. Being able to identify the issues with this population and creating a plan to help them has been very rewarding.

References
Alzheimer’s Association. (2014). Down Syndrome and Alzheimer’s Disease. Retrieved from the Alzheimer’s Association website: http://www.alz.org/dementia/down-syndrome-alzheimers-symptoms.asp Dixon-Ibarra, A., Lee, M., & Dugala, A. (2013). Physical Activity and Sedentary Behavior in Older Adults With Intellectual Disabilities: A Comparative Study. Adapted Physical Activity Quarterly, 30(1), 1-19. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2009). Nursing care plans guidelines for individualizing patient care (8th ed.). Philadelphia: F.A. Davis. National Down Syndrome Society. (2012). Down Syndrome Facts. Retrieved from the National Down Syndrome Society website: http://www.ndss.org/Down-Syndrome/Down-Syndrome-Facts/ Nies, A. M. & McEwen M. (2011). Community/Public Health Nursing: Promoting the Health of Populations (5th ed.) St. Louis, MO: Elsevier Inc. Physical Activity of Adults With Mental Retardation: Review and Research Needs. (2006).American
Journal of Health Promotion, 21(1), 2-12. U.S. Census Bureau. (2014, Mar27). State and County Quick Facts. Retrieved from the United States Census Bureau website: