Running head: Population and Community Health 1

Population and Community Health Promotion Project

Crystal. E. Parks RN

Delaware Technical and Community College

Population and Community Health 2

Abstract

Population community nursing is challenging but most rewarding. The nurse has an important

role in community population nursing as they are trusted, depended on, and mostly peoples only

advocate for help with health concerns, economic, education, and societal help. As Westside

Wilmington through the perspective of Saint Francis Healthcare Community and Charity we

identified several health needs limiting it to three most important areas, access to health care,

violence, and substance use. Over 80% of the tract 22 population live under poverty, with health

insurance and within violent areas that are deteriorating quickly we will identify goals, resources,

and help for this community to continue to improve and thrive.

Population and Community Health 3

Population and Community Health Promotion Project

The opportunity population and community health provides for all members involved is

eye opening and breath taking. My area of population is Wilmington City, New Castle County

Delaware. I was fortunate to be accepted by Saint Francis Hospital for my facility of practicum.

Within the hospital I worked with Community and Charity Care, Patient Experience, Trauma,

Education, and Chief Nursing Officer. In each area of care the population and community were

addressed from different aspects of care and preventative measures. A wide range of income,

ethnicity, education, and age was experienced through- out my practicum experience.

Site Location Data

The Wilmington, New Castle County area of Delaware has a wide range of population

and community. The area directly served by Saint Francis is broken down by tracts and areas of

the inner city. Westside Wilmington consist of 4 main census tracts, tract 14, tract 15, tract 22,

and tract 23. We mainly focused on tract 22. African Americans, Indians, Asians, Puerto Ricans,

Spanish, and Caucasians all reside within Westside Wilmington (tract 22 will be referred as

Westside Wilmington in the duration of this paper.) Complete Data is seen in table 1 in the table

section of the paper.

Windshield Survey

As I drove around the area of all 4 tracts and mainly tract 22 numerous sight evaluations

are obvious. Row homes are the main source of home styles offered. Frequent random areas

throughout Westside Wilmington had boarded up ply wood windows and doors on row homes

that are abandoned. Multiple young children ages approximately 6 through 13 traveled in groups

playing on uneven, broken up paved sidewalks close to majorly traveled 4 lane highways and

side streets unattended. There are several small playground parks but the equipment is missing,
Population and Community Health 4

broken, or occupied by loiters, homeless, or occupied with groups of young to middle age adults

"hanging out". Many areas had porches connected to the front of the homes where middle age to

older adults were observed sitting on steps, playing cards, or sitting on lawn chairs having

conversation or listening to music. Trash on the curb sides, on the streets, and around the outer

perimeter of the homes laid old and decomposing. Small personal owned quick market stores on

random corners, large laundry mat, and corner take out restaurants along with multiple churches

of different denominations, ethnicity, and languages are scattered in this location. Right in the

middle of all 4 tracts sits Saint Francis Hospital. See Image 1 for locations of tracts within

Westside Wilmington.

Healthcare Policies

Westside Wilmington is located in an extremely low poverty area of the city which has a

majority of young children and elderly (age 65 year old or older) that populate the communities.

The first healthcare policy that is heavily warranted in this area is the 1960's developed Medicare

and Medicaid to aid the older adults and the poor and disabled. The second most important

policy is the Patient Protection and Affordable Care Act of 2010 which improves access to

affordable health coverage for everyone, including most vulnerable, to provide ways improve

quality of care and outcomes. (Savage, Savage, Kub, & Groves, 2015, p. 535)

Data and Statistics

As seen previously in Table 1 the demographics categorizes tract 22 with multiple health

concerns. The community vital signs and social determinants clearly indicate and represent

what is observed in the windshield survey. Refer to Table 2. Community Vital Signs and Social

Determinants of Tract 22 Westside Wilmington in the table section of the paper. Much of the

population lives under poverty levels, with drug related overdoses, highly sexually transmitted
Population and Community Health 5

diseases, high infant mortality rates, diabetes, obesity, and asthma. Majority of our elderly

population lives under poverty, alone, and with disabilities. A surprising number of the

community in tract 22 have serious dental health concerns and again our elderly lives toothless.

The number of high risk health concerns are too numerous to mention but after reviewing the

data it is clear that tract 22 has major social, economic, and health concerns that are alarming

compared to the nation benchmarks.

Role of the Nurse

The community nurse/nurses have a significant role in the Westside Wilmington area.

Most of the population/communities have come to trust and depend on the nurse and Saint Clare

Van for treatment, guidance, support, fresh food, and medications. The most important role that

I identified is education and delivery of resources. As most areas are unsafe to travel after dusk

resources area key contributor for proper health concerns for many. The advocacy the nurse,

nurse practitioner, driver, and resident is overwhelmingly emotional when you see it in "live

action". Passionate, caring, understanding, nonjudgmental deliverance of health care delivered

to this community is unspeakable. The community of Westside Wilmington in particular would

not thrive as well as they do without the advocacy and dependability of the nurse to show up.

Disease management and preventative measures

Health needs of the community specifically identified and implemented by Saint Francis

Hospital's Community and Charity Care are access to care, obesity, substance use, and violence.

They do the very best to address access to care by providing affordable/free clinical care through

their Saint Clare Van Mobile Outreach , expanding patient services to larger groups of

community members in need underinsured, non-insured, or insured. Obesity is difficult due to

the conditions that the multitude of the population live in with violence and no safe area to
Population and Community Health 6

exercise in. They focus on education and resources for obesity including nutrition classes, access

to fresh foods, and food pantries. The community nurses focus on tobacco use, snuff, e-

cigarettes, and vaping, along with opioid, cocaine, heroin, and PCP use. Educational material,

counseling referrals, inpatient rehabilitations are offered, and medications that can help people

kick the bad habits. Support systems are reviewed and at times counselors will travel on the

mobile van outreach. Violence is the most difficult to address. Gun violence, drug crimes, theft,

and overall attitudes make it hard for many people to want to leave their homes to seek medical

attention, health care prevention, food, or exercise. Education, support groups, pantry deliveries,

and youth group activities are all offered. Many of the churches offer evening and night hang

out hours, activities non church related, and movie nights to keep young children, teenagers, and

even young adults off the streets from violence.

Health Insurance Status and Priority of Care

Health insurance is not the route cause or major factor of health needs and concerns as

the majority of people are covered. The national benchmark is 100 while Wilmington is at 97.3.

(Schieffert, 2019, p.11) More of the fact is the priority of care that factors into the health

concerns. The number one priority is access to health care. In the city transportation, office

hours, people working late or shift hours, and physician's office hours. The second most

important priority which also factors into access of care in the violence. Many at certain times

refuse to travel the streets in Westside Wilmington due to the violence that is around them and as

you may guess the substance use is third. A lot of the violence is directly tied into the opioid,

heroin, cocaine abuse that is seen in tract 22. These three most important areas must be and are

being addressed to help decreased the health concerns and statistics seen in Table 2.
Population and Community Health 7

Analysis

After review of all data, the three major needs of the Westside Wilmington Delaware tract 22

area is access to health care, violence, and substance use. As the majority of the population lives

in under poverty spending 30%+ of their income on rent alone, limited transportation, and hours

worked leaves access to health care difficult. The violence of crime due to the poverty levels

include theft, drug sales, drug use, and killings. The lack of guidance and education contributes

to these behaviors along with the use of substance use. Tabaco, vaping, PCP, heroin, and the

highest abused drugs opioids cause people to react, not think clearly, and become desperate to

have after dependency is established. Goals to help improve all three concerns are challenging.

Access to care goals are to increase the number of residents who have access to primary care by

10%, increase utilization of free and low cost health care services, and build partnerships with

other organizations. Implementation of this can be done by utilizing the Saint Clare Van more

often, in high violence areas, and on off hours. Evaluation is in reporting number of patients

seen, new patients seen, and referrals to Family Practice from the van. Resources are Catholic

Charities Behavioral Health from the van including housing assistance, food, and clothing.

Violence goals are to partner with community supports to address the violence issues, and to

partner with programs which will expose youth and young adults to the healthcare perspective of

gun violence and trauma. Evaluation plans are to follow up with the programs for the youth and

young adults monthly with numbers of people attending, track the number of people seen for

behavioral health needs through the van. Resources March for Peace and other community

organizations. Trauma resources, education, and school teachings. Substance use goals ae to

partner with the American Lung Association and American Cancer Society for tobacco use, e-
Population and Community Health 8

cigarettes, and vaping. Provide education to physicians about the prescribing of opioids, along

with more timely referrals and identification for inpatient rehabilitation for substance use/abuse.

Resources are Delaware 1800 Quit Line, quite smoking education pamphlets, and primary care

physician's referrals to rehab.

Conclusion

Westside Wilmington, New Castle County Delaware tract 22 has several major health

concerns including access to health care, violence, substance use, obesity, diabetes, poverty,

education, and much more. As the local, state, and national government agencies are heavily

involved in this area much more dedication, resources, health workers, volunteers, and local

officials need to step in to help this deteriorating population and community. The difficulties

faced in tract 22 with different ethnicities, poverty, language barriers, and limited resources the

community is crying for help.

Population and Community Health 9

References

American Lung Association in Delaware. (n.d.). Retrieved from

https://www.lung.org/about-us/local-associations/delaware.html

Delaware. (n.d.). Retrieved from https://www.cancer.org/about-us/local/delaware.html

Detailed Listing 2019. (n.d.). Retrieved from

http://www.peaceweekdelaware.org/detailed-listing-2019/

Mental Health. (2015, August 26). Retrieved from

https://www.catholiccharitiestrenton.org/services/mental-health/

Saint Francis healthcare community health needs assessment implementation strategy.

(2019). Retrieved from https://www.stfrancishealthcare.org/documents/CHIP.pdf

Savage, C. L., Savage, C., Kub, J., Kub, J. E., & Groves, S. L. (2015). Public health

policy and finance. In Public Health Science and Nursing Practice: Caring for

Populations (p. 535). Philadelphia, PA: F A Davis Company.

Schieffert, L. (2019). 2020 Community Health Needs Assessment. DE.

The State of Delaware. (n.d.). Smoking Quitline - Delaware Health and Social Services -

State of Delaware. Retrieved from https://dhss.delaware.gov/dph/dpc/quitline.html

Population and Community Health 10

Tables

Table 1

Community Profile Data

Total Population 3,271

African American 51 %
Hispanic/Latino 45%
White 25%
w/Disability 16 %
Age 5+ w/ language other than English 48%
spoken at home
Per Capita Income 12,677
Living Below Poverty 42.7%
(Schieffert, 2019, p.9)
Population and Community Health 11

Tables

Table 2 Community Vital Signs and Social Determinates of Health

Tract 22 Westside Wilmington 2020.

Indicator National Wilmington Tract 22

Benchmark

Adults w/ Health Insurance 100 97.3 --

Children w/ Health Insurance 100 97.3 --

Adults who visited Dentist 63.2 52.7 36.7

Adults 65+ w/ total tooth loss 14.3 21.6 33.8

Homicide 5.5 235.0

HIV/AIDS 3.3 20.8

Drug Overdose 11.3 38.1

Infant Mortality(per 1,000 live 6.0 14.3

Births)
Opioid Overdose 14.9 28.4

Children Asthma Hospitalizations 18.3 92.9

Under 18 per 10,000
13.5 35.2 36.6
High Cholesterol
2.9 4.3 5
Adults who experience Stroke
5.6 7
Adults with CAD
9.8 16.9
Adults with Diabetes
119 135.5
Breast Cancer
109 136.2
Prostate Cancer
12 23.8 29.5
Adults Who Smoke
30.5 36.4 39.3
Adult Obesity
152.8 571.4
Chlamydia Incidence Rate 113 151.5
Gonorrhea Incidence Rate
Population and Community Health 12

People Living Below Poverty 12.1 27 42.7

People 65+ Living Below Poverty 7.2 21.2 39.2

People w/ Disability Living in Poverty 27.1 35.6 37.4

High School Graduation Rate 87 70

Spending 30%+ of Income on Rent 49.3 56.8 70.4

Trinity Health Mid-Atlantic

Saint Francis Healthcare
2020 Community Health
Needs Assessment
(Schieffert, 2019, p.9-21)
Population and Community Health 13

Figures

Figure 1. Tracts of Westside Wilmington