Essexs countys economic wealth is not distributed uniformly across all residents, with large urban areas that include a large number of poor and minority populations with 11.7% county families had income below the poverty level. As of 2011, 10.8% residents were unemployed. Essex County is the first county in United States to create county wide park system. As of now 5,745 acres of green space which includes vast reservations developed parks 21 one of them. The community has big golf courses and tennis courts In addition to this, there are seasonal community fairs and other community events that provide an occasion for community interaction. And there is provision for bike lanes. Fire department and police department renders excellent service. The waste disposal and pest control department maintains healthy and hygienic environment. There are community parks, swimming pools, sports clubs, and many other establishments providing amenities to support the physical and leisure activities of the residents. The community has a big golf clubs. In addition to this, there are seasonal community fairs and other community events that provide an occasion for community interaction.
Interview with the Community health Nurse Melissa Garfield RN, BSN (telephone Interview) Conducted on 10/23/2014. Melissa works for Barnabas Health System at present she is a clinical supervisor who in charge of approximately 100 employees which includes registered nurses, respiratory therapist, occupational and physical therapist. They work very closely with the state and they are Medicare certified. What is your role in disease prevention, surveillance and health Promotion? What steps are you taking to alert the community to educate them? The role of community health has changed greatly over the years. We play a very important role in the community for prevention of disease and promotion of health. They help in preventing disease by community teaching and help early detection of a problem. The greatest challenges we face has nothing to do with the season of the year, it is with hospitals discharging patients more quickly to shorten the length of stay and the acuity of the patients in the community are much higher which necessitates the clinicians that are more skilled than ever. As of now they have to take care of patients with tracheostomy, peg tube feeding, long term chest tubes, nephrostomy tubes and ventilators and administer antibiotics.
The job of the community health nurse is educate the family members how to take care of their loved one at home, and what to do when there is emergency there is always redundancy what to do when there is emergency. She gave the example of Hurricane sandy when they had to go visiting homes of patients who were oxygen dependent, ventilator patients and patients with special electronic beds and make sure they had electricity and if not they had to be moved to acute care center. For me that was the most challenging thing I faced in the community. This transcends any season. At the moment it is season change and we have to make sure our homebound citizens and senior citizens for getting flu vaccines and get them ready for winter making sure they have access to heat and hot water. Now we are also educating the community about Ebola. What ethnic groups do you deal with?
Essex County is made up of very diverse race and culture. There is no single dominant culture or race. We have African- American, White-Americans, Hispanic, and Asians. They visit all communities in the county; they have escorts who are from the community who helps her when she goes home visiting. The only home they are not allowed to go is if they see anyone actively doing drugs, or drinking for safety reasons.
What spiritual resources are available?
The community health nurse has to respect every religion, culture and their way of life and traditions as long it doesnt cause any harm to the individual. Essex County has churches of every denomination, temples, synagogues and mosques which are easily accessible. What are the five biggest health issues pertaining to Essex County? What is being done to educate the community for its prevention? Heart Disease including congestive heart disease.
There are non-health related issues like homicide, violent crimes deaths injuries and mortality rates related to this are high in the community. The community health nurses organize community teaching in churches, senior citizen homes and in adult day care center and churches where they teach about diet, exercise, compliance with medication and follow up with the physicians. They also check blood pressure and sugars during this time. Making sure people in the community follow healthy diet is challenge as this county has very high rate of fast food joints. Are you adequately funded? What would you like to see more funding for? We are insurance and Medicare dependent and if the patient doesnt have insurance then it is charity care. They organize fund raisers for cancer prevention. Every program is important to the community but more funding is needed for preventive care which in turn will promote health. What are some of the preventive programs organized Barnabas health community services?
The role of community health nurse involves educating the community in prevention of disease which in turn promotes health. Tobacco free living
Preventing drug abuse and excessive alcohol use
Injury and violence free living
Reproductive and sexual health
Mental and emotional well-being.
They also have program called whats in your bag where they collaborate with the pharmacist in the community check the prescription medications the patients are taking and make sure there is no duplications for example Norvasc and Amlodipine. They update the list of the medication they are taking which helps when they go to the doctors or hospital. They also assist in the community in proper disposable of unused and expired medicine. The nurse also teaches how to store medications especially narcotics. They also help in the immunizations of seniors especially flu and pneumonia and preschool children. The school nurse is in charge of making sure the school age kids are up-to-date with immunization. Are the health resources adequate in Essex County?
She believes there are enough health providers; there are many hospitals, emergent day care centers and nurse practitioners all are very easily accessible. The problem is not enough resources she believes people not making use of these resources. There are many individuals with no insurance but they are never denied care. Essex County also has discount prescription card which gives 20% on prescription medication. What is the role of a community health in regarding to mental health? She is not specialized in this field but they do have separate division who takes care of these individual this team consists of behavioral health nurses and therapist. They do assess the patients if they need these services and refer them accordingly. Essex County has a big psychiatry hospital whose mission is to provide evidence-based care to promote patient recovery and return to community. Diet and Exercise
Obesity rates have doubled among children and tripled in adolescents and adults. Also our community has very high rate of fast food restaurant. The main of community health nurse is educating the community on healthy diet and the importance of exercise. Our community has lots of parks and open spaces, sports center which are well equipped but under used. There also community swimming pools. The community health nurses do not organize any activities in regarding to exercise, but the county has many such program which begin in spring with cherry blossom festival, they conduct marathons, bike riding competitions and hikes and camp outs during summer of which Barnabas health is a big sponsor.
Are they any nutrition deficiency in the community? Does the community provide safe drinking water? Most common problem are Vitamin D deficiency. There are many communities which live below poverty and many are homeless. But there are many organizations which help them like soup kitchens, food stamps, meals on wheels for home bound citizens, churches and many communities. Schools provide subsidized rate or free in some cases breakfast and lunches to the children. Farmers markets and community garden where one can grow fresh vegetables and fruits in summer. Tap water is safe for drinking which checked periodically and report of which is sent to all residents. 11. What is the role of a Community health nurse in relation to environmental issues such as heat assistance, cooling stations, pest control, waste disposal, and common air contaminants? Essex County has an environmental nurse that follows the Human Health Hazard Ordinance.
This ordinance is for dealing with health hazards that are occurring on the outside of the home and could potentially affect other members of the community. They work closely with town and municipality workers. They inspect the homes for rats or any insects bed bugs. They also observe how the garbage is being disposed. Overall the nurses job is to see if the resident is safe in their home. She also checks if the patient is oxygen dependent there is nobody in the house smoking, from individual perspective she also checks if they have working fire alarms. They check to see if they have provision for heat in winter. There is very good waste management system in the county. They have garbage and recycle bins in all public spaces. The environments hazardous waste and electronic waste is being collected by the county once in three months from the community or it can be taken to the disposable center by the resident. The community nurse plays no role in this.
12. What kind of sexuality programs are available e.g. growth and development, STD and AIDS education, contraception options. Is there sufficient access to birth control, support groups for pregnant women and new parents? What are the statistics for birth rates, abortion and miscarriage? Essex County works with Planned Parenthood, the pregnancy crisis hot-line, the Family Resource Center and Early Head Start programs. There is disparity among child birth and teen pregnancy. Low and low birth weight among African-American babies born is higher than other racial/ ethnic group. Teen pregnancy is more in lower socio-economic groups.
The school nurses provide sex education to the kids from elementary. There are many programs for maternal and child health. They support them and get necessary help needed in caring the baby and themselves. 13. How do you assist in disaster management planning? Are there other agencies you work with? Essex County nurses work with police, fire and EMS from all the cities and towns in the county. The nurses participate in disaster management drill a few times a year. Our other role in disaster management is to keep a list of personnel that may be needed to help when a disaster occurs. The list is reviewed and updated yearly. This list includes: Long-term care facilities
Clinics and hospital
Home care agencies
Water and energy facilities such a Alliant Energy Power Station 14. What are the Cognitive/ perceptual level of the community? The Essex County is home to large ethnic/ racial group. The main language is English but there is large number of residents about 20% of who dont speak English. The community nurses use language line to communicate with the patient or somebody from the family who knows the language acts as the translator. Essex County is home to five public and five private colleges. There is a great push to change the education system and get the children back to school. The graduate rate is 64% for the county which is low comparing to other counties in the state. 15. What is the self-perception / self- concept in the community? Are the residents happy? I dont know how to answer that. You know we both live in the same county there is big disparities how the economic wealth is distributed. There are large urban areas with poor and minority population, and some below poverty level.
The county is doing a lot to make sure all residents have equal opportunities. Like in the library they have activities for senior citizens; they also have activities for school age and preschoolers. They play a big role ]in summer reading program. The county also has free coaching in summer for sports activities like tennis and football. Each community in summer organizes movie night. There are equal opportunities for all. In certain communities in the county the violent crime rate and homicide rate is high compared to other counties in the state. There is also big problem with substance abuse. Due to which emergency room visits for substance abuse are high in the county. The families living in these areas face dangers which causes stress. Role and relationship
The people of the community continue to maintain respectful and healthy relationships with neighbors. The children are cooperative with one another and maintain respect towards elders and higher authorities, such as teachers. Local residents aid the older residents, especially during snow storm. The local police and firefighters offer innumerable services for the community. We ended our interview by her saying there are many services available in the community which the residents are not aware of. They also need more skilled nursing staff as the acuity of patients in the community is high.
The county of Essex New jersey. www. Essex-county nj.org Essex county quick facts from U S census bureau. Retrieved from quickfacts.census.gov/qfd/states/¦/34013.