Delaware Technical Community College

NUR 330 Population and Community Health

Population/Community Health Promotion Project

STUDENT NAME: Miranda Jennings DATE: November 19, 2017

SETTING: Lombardy Elementary School

ASSESSMENT

Answer the following questions:

1) Gather data on your specific site location:

a) Population/community

i) The population for this site are elementary school children at Lombardy Elementary

School in Wilmington, Delaware.

b) Cultures/Ethnicities Served

i) I have worked with children from many ethnicities. I feel the populations of the

school accurately represents the ethnicities seen in Wilmington. These include, but

are not limited to: Caucasian, African American, Hispanic, Middle Eastern, Asian,

etc.

c) Languages

i) The languages I have heard the children speaking include English and Spanish.

However, I have spoken to several children who speak other languages at home.

d) Age Range

i) The children are aged 5 11 years.

2) Use the Windshield survey on p. 87 & 88 of your textbook to identify community resources

and barriers to healthcare for this population/community.

a) The Lombardy Elementary School is right off of route 202 and I95. The school is close to

downtown Wilmington. Many of the children who attend the school live in Wilmington

and North Wilmington. The area surrounding the school is suburban with a nearby

childrens hospital Nemours, library, shopping, restaurants, public transportation,

churches, and parks. The children who live in downtown Wilmington live near public

transportation, several hospitals, I95, churches, and parks. Some barriers to these

resources the children at Lombardy experience would be poverty. The school nurse

carries a clothing bank in a variety of sizes that is meant for children who have

incontinence episodes or soil their clothing playing. However, with the weather getting

colder, we have been having to give out the clothing to children who were sent to school

without a coat. Similarly, there are several children who have been sent to the nurse for

hygiene issues when they were sent to school with dirty clothing having not showered.

These children who are unable to properly bathe or wear appropriate clothing would not

have access to all of the necessary community resources.

3) What healthcare policies apply to your population/community?

a) The healthcare policy I have chosen to address with this population is immunizations.

The state of Delaware required that all students entering into public school be

immunized. The immunizations required by the state of Delaware are as follows:

i) Five or more doses of DTaP or DTP Td vaccine.

ii) Four doses of IPV or OPV.

iii) Three doses of Hepatitis B vaccine.

 iv) Two doses of Measles, Mumps, and Rubella vaccine.

v) Two doses of Varicella vaccine (School Health Services Program, n.d.).

b) The exemptions to the vaccinations include both religious and medical exemptions

(National Conference of State Legislature, 2016). Medical exemptions for the Varicella

vaccine would be children who had a history of chicken pox prior to school age. These

children are required to provide copies of lab work proving that they have the titer in their

system (School Health Services Program, n.d.). Another form of medical exemption from

vaccines would be children who are allergic to part of the components of the vaccine. In

these cases, the families need to have the childs physician provide record that the child is

allergic (School Health Services Program, n.d.). The last case of medical exemption

would be for children who have previous health conditions that would be worsened by

the administration of the vaccine. An example of this is children with previously

compromised immunity such as leukemia or HIV (School Health Services Program, n.d.).

The second type of vaccine exemption allowed in the state of Delaware are religious

exemptions. For children to be approved for religious exemptions, the parents need to fill

out the exemption form and have it notarized (School Health Services Program, n.d.).

4) Identify data and statistics and any historical perspective related to this

population/community or problem.

a) A major barrier this population encounters is poverty. Children living in poverty have a

variety of issues including food insecurity, housing issues, and affordability of care. The

US Census Bureau of 2016 found the following percentages of families with children that

are living at or below the poverty line base on zip code: 19801 46.6 percent, 19802

39.3 percent, 19805 32.2 percent (Christiana Care Hospital, 2016). The zip code for
 Lombardy is 19803 where no data was collected, but children who attend the school

come from all of the above listed zip codes. Research conducted in 2016 showed that 50

percent of children in public schools in New Castle County are enrolled in the free lunch

program (Christiana Care Hospital, 2016).

5) What is the role of the nurse at this site?

a) The nurse at my site has many roles. She manages medication administration for many of

the students. The medications she gives most often are inhalers for asthmatic children

prior to recess or gym class, ADHD medications to children, insulin pens to the diabetic

children, and additional medications that children need to take such as antibiotics or pain

medications when they are ill or injured. She also cares for children that come to her

office throughout the day for their different ailments. The common ailments we have seen

are children with sore throats, headaches, upset stomachs, vomiting, and recess injuries.

She is also responsible for keeping clothing available to children who have incontinent

episodes or fall and soil their clothes at recess. The nurse also provides annual screenings

on the children including vision, hearing, and scoliosis screening. If children were to fall

seriously ill or injured at school, she carries emergency medications and has a jump bag

to respond to ill children in other areas of the school.

6) What disease management and preventative measures are being used?

a) The first disease prevention strategy used at Lombardy is that children are required to be

immunized prior to beginning school, unless they fit into an exemption category.

Similarly, the school keeps track of the childrens primary care doctors and requires

health screening to be performed prior to the beginning of school. The school nurse

performs health screening on the children including vision screening on kindergarten and
 second grade students, hearing screening on second grade students, and scoliosis

screening on fifth grade students. The nurse keeps a jump bag that has emergency

medications such as epinephrine, inhalers, oxygen, and other necessary equipment

necessary for ill children. The nurse also has a supply of epi pens or Benadryl for

children with known allergies they may come into contact with while at school. The last

disease prevention strategy the nurse employs is teaching proper hand hygiene to children

in kindergarten. She also encourages all students who come to her will illnesses or who

cough or blow their nose to wash their hands.

b) Disease management strategies being used at Lombardy include medication management

by the school nurse. The nurse keeps a second inhaler for asthmatic students that can be

administered prior to gym class or recess as well as rescue inhalers that can be used as

needed. The nurse also administers afternoon doses of ADHD medications that several

students require. Lombardy has two diabetic children. The nurse has the students check

their blood sugars prior to lunch and administers sliding scale insulin coverage for the

students based on the results. The nurse also has the students return after lunch where

they calculate the carbs in the food they ate and administers additional insulin if

necessary. These two students also have their blood sugar rechecked at 3pm just prior to

going back home. Students who have injuries such as broken bones, infections, or other

illnesses are monitored by the nurse and she administers PRN pain medication as directed

by the childrens doctors or afternoon doses of antibiotics.

7) What is the predominate health insurance status of this population/community?

a) The vast majority of the children at Lombardy have health insurance. The insurances they

carry include Delaware Medicaid and commercial insurances. A study conducted by

 Christiana Care Hospital found that 94.5 percent of children in New Castle County are

insured (Christiana Care Hospital, 2016).

8) Identify your priorities of care for this population/community.

a) The priorities of care for children coming into the nurses office would be the normal

Airway, Breathing, and Circulation. Of the shifts I have worked so far, we have not come

across any students with serious alterations to these priorities. I did speak to the nurse and

she told me about cases she has had where there were students with serious ailments and

how she managed the cases. She keeps doses of epinephrine IM that can be administered

to children with airway issues caused from allergic reactions. She also has oxygen,

inhalers, and duoneb medications that can be administered to children with breathing

difficulty. The nurse has bandage supplies she can use for students with circulation

problems related to playground injuries. When students have ailments that are out of her

scope of practice, she is to call the parents and either have them take the student to the

hospital or call 911 at the parents discretion.

ANALYSIS

Respond to the following:

Review Data:

Review all of the data collected from your population, looking for needs/problems, including

background, population/community information and epidemiologic concerns. Identify at least

three problems/needs.

Problem/Need 1: Hand washing and disease prevention.

Problem/Need 2: Access to healthcare.

Problem/Need 3: Parental involvement in child disease processes.

Identify Disparities and/or Barriers:

What disparities and/or barriers have you identified within the population/community? Develop

specific recommendations to address these disparities and/or barriers.

A major disparity that has been identified in this population would be the high poverty

level. In the surrounding zip codes to the school, as many as 46.6 percent of the households with

children as living at or below the poverty level (Christiana Care Hospital, 2016). Poverty

presents many issues for the children including lack of food, shelter, clothing, and access to

healthcare. To combat the issue of access to food, the public schooling system in Delaware offers

the free lunch program. This program provides breakfasts and lunches to children that qualify

free of cost. In New Castle County, 50 percent of public school students are enrolled in this

program (Christiana Care Hospital, 2016). To combat the issue of clothing, the school nurse

keeps a supply of school uniforms that are available for students who need a change of clothing.

These clothes are donated by families or purchased by the school. For access to healthcare, many

families living in poverty in Delaware turn to the emergency department for healthcare. The

emergency departments in the direct vicinity of Lombardy are Alfred I DuPont Hospital for

Children, Wilmington Hospital, Saint Francis Hospital, and Christiana Hospital. The facilities

that offer primary care services to patient with all types of insurances or no insurance at low cost

in New Castle County are Nemours, which has locations throughout the county, Claymont

Family Health Services, Henrietta Johnson Medical Center, Saint Francis Family Practice, the

Saint Clare Outreach Program, Westside Family Healthcare, and Wilmington Hospital Health

Center (Delaware Health and Social Services (DHSS), n.d.).

Develop SMART Goals: (SMART = Specific, Measurable, Achievable, Realistic & Timely)

What are the optimal SMART goals to address each of these needs/problems? Develop

appropriate goals for your population/community. Your goals should be reflective of the

resources available to the population/community.

Problem/Need 1: The kindergarten students at Lombardy Elementary will demonstrate proper

handwashing techniques one week after a handwashing lesson.

Problem/Need 2: The identified uninsured students guardians will verbalize understanding of

available community resources for obtaining medical insurance directly after being given

pamphlets outlining the programs that assist uninsured children and families to obtain insurance.

Problem/Need 3: The foster parents of the two diabetic children at the school will demonstrate

proper calculations of insulin coverage based on the childs blood sugar reading and lunch carb

counts directly after instruction by the nurse and verbalization of calculations one week after

instruction.

Identify Available Resources:

What resources are available that will assist the population/community with meeting these goals?

What agencies or individuals are available in the nearby community that can serve as a

referral/resource for the population? Examine what is available and accessible to the population

as a resource to help address the identified problem. Please provide the agency/ individual,

address, contact information, as well as a rationale supporting the use of this agency. How will

the patient benefit from this community referral, specifically?

Health Care Connection is a program offered through the DHSS that provides access to

primary care physicians and health promotion and disease prevention services to
 Delawareans who are uninsured. The program also helps with access to discounted

prescriptions and laboratory and radiology services. To access the resources or to learn

more, families can call 2-1-1 or email DHSS_DPH_Healthaccessde@state.de.us.

The Delaware Healthy Children Program is a low-cost health insurance program for

uninsured children in Delaware. To quality students must have no insurance, be under the

age of 19 and live in Delaware, be a U.S. citizen, and live in poverty. To apply, parents

can call 1-800-996-9969 or print a flyer and mail it to:

o Delaware Healthy Children Program

PO Box 950

New Castle, DE 19720

The Diabetes Self-Management Program (DSMP) is a program from DHSS that offers

classes throughout the state several times a week at different locations. The classes teach

patients and families how to manage their condition and have experts that can answer

questions. To register for a class, parents can call 302-744-1020 or visit the website at

https://www.healthydelaware.org/Individuals/Diabetes/Self-Management-Education-

Classes.

Develop Interventions:

With the goals in mind, develop population/community-specific interventions and rationale to

assist with goal achievement. Plan interventions (include population/community resources) for

each of your identified needs/problems. All references must be properly cited using APA

formatting.

Problem/Need 1: The school nurse can provide hand hygiene education to the kindergarten class.

This group was chosen because that age is impressionable and are excited to learn. They also go
to recess twice in the day and do a lot of interactive play during class, so they will highly benefit

from increased hand washing as a method for disease prevention. The goal was set to have the

children demonstrate proper handwashing technique one week later to give the children time to

practice the handwashing and it will provide enough time to see if they retained what they

learned. The following link has a variety or resources the nurse can use to aid in the lesson:

https://www.cdc.gov/handwashing/resources.html.

Problem/Need 2: The school nurse or school social worker can provide information to the

parents of uninsured children on programs in New Castle County that help uninsured children to

gain insurance. This goal was chosen because access to health insurance allows for the children

to receive health screening and disease prevention services. This makes it possible to the families

to seek medical care prior to becoming ill. The social worker could help the parents to fill out the

forms and make the necessary calls. The two programs I found were the Health Care Connection

and the Delaware Healthy Children Program.

Problem/Need 3: This goal was selected because Lombardy has two children with type I

diabetes. These children are in foster care and have had multiple instances where the older child

was hospitalized for diabetic ketoacidosis because her diabetes was poorly managed. Her

younger brother was recently diagnosed with diabetes and does not know how to recognize the

signs and symptoms of when he goes into hypoglycemia. There have been multiple times while I

was in the office that his sugars were below 50 and he did not know. The foster parents should

attend a diabetes education class with both children so that the whole family learns techniques to

manage the childrens conditions as well as provide an opportunity for them to ask questions.

Based on where they attend the class, the class can be fully covered by insurance. The website
with class information is https://www.healthydelaware.org/Individuals/Diabetes/Self-

Management-Education-Classes.

Develop Evaluation Plan

Identify a method or mechanism for future evaluation of proposed interventions.

A method for future evaluation of the proposed interventions would be to keep in contact

with the school nurse to find out how the students/families were able to implement the plan.
 References

Christiana Care Hospital. (2016). Christiana hospital community health needs assessment.

Retrieved from https://christianacare.org/about/whoweare/communitybenefit/community-

health-needs-assessment/

Delaware Health and Social Services. (n.d.). Community health centers. Retrieved from

http://www.dhss.delaware.gov/dph/chs/chsservicecenters.html

National Conference of State Legislature. (2016, August 23). States with religious and

philosophical exemptions from school immunization requirements. Retrieved from

http://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx

School Health Services Program. (n.d.). Delaware immunization regulation. Retrieved from

https://www.doe.k12.de.us/Page/2871