Sentinel City’s Community Nursing

Demographics Assessment

The total population of Sentinel City is 663,862. Broken down by age, persons under 5 years of age consist of 7.4% of the population, under 18 is 21.7%, and persons 65 and older comprise 10.5%. Racial distribution includes 80.6%, 31.5% Hispanic, 10.4% black, 3.7% Asian, 2% American Indian or Alaskan Native, and 3.1% mixed race. The median household income in the city is $246,300, but 18.9% of residents continue to live below the poverty level.

Sentinel City is broken down into four distinct neighborhoods, each being economically distinct. The affluent Nightingale Square neighborhood has a population of 103,974, but a median income of $269,550, with only 0.7% uninsured. The Acer Tech Center neighborhood has a population of 168,390 and a median income of $166,300 with an uninsured rate of 1.5%. Casper Park District is middle-class, with a median income of $80,134 and the highest population in the city of 352,643, and an uninsured rate of 22.7%. Finally, the Industrial Heights community can be considered a low-income area with median earnings of $24,672 and an uninsured rate of 37.5% with a population of 38,855 people.

Neighborhood/Community Safety Assessment

Sentinel City has a number of safety and population affecting concerns that were identified in the assessment. Areas such as industrial heights have an extensive garbage overflow problem as well as some evidence of buildings in disrepair. Another safety hazard that was present was smog and pollution coming from the factory in Casper Heights. Substance abuse is a relevant community safety issue as many complaints and arrests have been made due to drug use and excessive intoxication. The alcohol abuse and recovery programs run by Parks and Recreation indicated common use, particularly among some age groups, males, and racial groups. EMS response times in the city range at approximately seven minutes per city hall data, which is on par with the national average for urban areas.

Crime is a significant safety issue for Sentinel City, like gang violence and multiple related crimes are present such as homicide, assault, and robbery. The level of crime is decreasing per police department reports but remains relevant. Violent crimes such as aggravated assault, rape, and murder are prevalent comprising 3,606 cases per 100,000. The most common arrest charges in the city include trespassing, public intoxication, and substance possession.

Windshield Survey

Neighborhoods in Sentinel City are evidently split based on socio-economic class and industry. Nightingale Square and Acer Tech Center are the more affluent communities, driven by the business and technology industry. These areas are well maintained with cleaner streets and modern buildings. Public amenities are more prominent in these areas with parks, tennis, and basketball courts. There are also various businesses in the vicinity including grocery stores, cafes doctor’s offices, and even government offices. The Acer Tech Center has the Historical Hotel and businesses as well. While there are some less clean buildings and the presence of stray dogs, the public activity on the streets is clearly present.

The Casper Park neighborhood is middle class but has extensive issues with garbage and building maintenance. Rodents and stray dogs are present which is a public health problem. The Senior Living Center and some health offices are located in the area. However, businesses and restaurants are still thriving in the area. The Industrial Heights district is the most impoverished and has high levels of crime. The Soup Kitchen is located in this community with other support services for low-income families such as Section 8 housing. This community is evidently rundown and facing economic struggles that are reflected in infrastructure.

Scavenger Hunt

Sentinel City offers a wide range of health programs and community resources which address various population needs and demographics. The City Hall Social Services offers government-mandated programs such as Medicaid and Medicare, SNAP programs for the impoverished, WIC services, as well as child and adult protective services. The city also manages departments include parks and recreation, water and sanitation, and others that affect the population and urban functionality. Parks and recreation manage outdoor parks and indoor community centers that offer opportunities for physical activity, social interaction, and educational programs for both kids and adults, stimulating active lifestyles and a place that community members can obtain support. There is also a range of private and non-profit types of resources such as elderly services that provide senior living facilities, a Better Health Clinic focusing on reproductive health, and a soup kitchen that feeds the homeless and offers food assistance. The city also offers an Affordable Housing Project for low-income populations.

Data Analysis

Sentinel City as any urban area has a wide variety of neighborhoods that differ based on socio-economic development and upkeep. While affluent neighborhoods have a greater range of infrastructure, upkeep and maintenance, public amenities, and general public well-being, lower-income communities suffer from extensive degradation and lower availability of facilities. In turn, this affects public health and safety, as populations feel greater safety in better-off communities. The poor cleanliness of some neighborhoods due to garbage, rodents, and abandoned buildings presents public health threats such as disease. Some communities and populations are also affected by lack of access to proper public resources as well as the availability of jobs. Homeless populations are supported by merely a few government programs and non-profits such as the Soup Kitchen. The overall health profile of the population is not available, however glaring aspects such as preventable disease transmission present among the population and high levels of substance abuse are present. Public health programs and community support resources are scarce, particularly for vulnerable populations. It is necessary to engage the city’s resources to address key infrastructure and public health issues that are underlying potential health problems.

Identification of City Problems

The community health assessment identified several egregious issues in Sentinel City that must be addressed based on Healthy People 2020 objectives and recommendations. The first issue is a high level of crime, characterized by multiple crimes such as homicide, aggravated assault, and robbery, including gang-related activities. Although crime levels are gradually decreasing, it remains a significant issue for the population. Crime and violence are a topic under the neighborhood and built environment domain of the social determinants of health objective. Violence and crime can lead to premature death or injury as well as creating suffering, mental distress, and reduced quality of life in communities. Repeated exposure can result in negative health outcomes among the population, ranging from poorer physical and mental health to increased obesity levels as people fear engaging in physical activity. This particularly impacts children and adolescents who can be at risk for long-term effects. Relevant Healthy People 2020 objectives for this issue are to reduce the perpetration of crimes by minors and young adults, as well as decrease homicides and physical assault in the neighborhood (Healthy People 2020, 2019a).

The second identified issue is an environmental health, stemming from the pollution from the factory in Casper Heights. As part of the Healthy People 2020 Environmental Health topic, it is an objective to “reduce air toxic emission to decrease the risk of adverse health effects” (Healthy People 2020, 2019b). The constant interaction of the population with the environment affects their health and aspects such as quality of life, years lived, and health disparities. Outdoor air quality is a critical indicator of environmental health and exposure to hazardous substances such as pollution can be detrimental to population health. Furthermore, poor environmental health has a tremendous impact on at-risk populations whose health status is compromised as well as affecting societal factors.

The third issue that is significant for the city is substance abuse. Drug and alcohol abuse and information regarding rehabilitation program usage indicate that the problem is relevant for Sentinel City. Certain age groups such as 21 to 50 and males are affected along with a significant proportion of racial minorities. The substance abuse objectives of Healthy People 2020 focus significantly on reducing adolescent use and the general population engaging in abuse or binge drinking as well as substance-related deaths. Substance abuse is potentially the biggest and most direct threat to population health, having a significant impact on individuals’ families, and whole communities. Additionally, substance abuse health effects are cumulative and are interrelated with a wide range of other physical, social, mental, and public health problems such as STDs, violence and abuse, crime, suicide, and motor vehicle accidents (Health People 2020, 2019c). Substance abuse is such a deep-rooted and complex issue in communities, requiring significant and vital efforts to address underlying causes.

Discussion of Community Resources

Sentinel City offers a level of support through its community resources to address the pertinent issues of substance abuse. Substance abuse commonly stems from a range of factors, some of which include a lack of a support system, lack of awareness and education about its dangers, and pressure from one’s peers or surroundings. First, the city offers social services through its government programs, these provide protective services, affordable housing, and a variety of programs to enhance social stability for families and individuals. This includes improved access to healthcare through Medicaid as well as non-governmental organizations such as the Better Health Clinic that can offer testing and education regarding substance abuse. To enhance community support and directly vulnerable groups such as youth away from illicit drugs and substance abuse, the Parks and Recreation department runs a community center that offers sporting and educational programs. Through common participation and widespread community projects, the city can involve the population in healthy lifestyles and provide awareness about the dangers of substance abuse. Facilities and programs such as these along with government agencies are efforts that impact population well-being and effectively begin to address health disparities by focusing on some social determinants of health such as access to food, shelter, education, and basic healthcare.

Primary Prevention Topic

The primary prevention topic based on the severity of the issue and one that can be addressed through targeted interventions is substance abuse. This issue poses the most direct and imminent threat to the population health, and as mentioned, impacts a wide range of health-related and social aspects of the community. Substance abuse can easily become an epidemic as evident by the opioid epidemic throughout the United States and the far-reaching consequences of excessive drinking that have been observed in public health. Therefore, Sentinel City should focus its public health strategies on the prevention of substance abuse.

A combination of efforts utilizing primary, secondary, and tertiary prevention strategies have been effective in intervening to reduce morbidity and mortality associated with substance abuse, particularly with the misuse of illegal drugs and opioids. Primary prevention includes the focus on reducing the incidence of substance abuse by preventing new cases from arising through education of the population and reducing access to these substances. Those who are already experiencing substance abuse at any level must be treated by providing access to rehabilitation and therapeutic measures before serious complications arise and ensure long-term sobriety (Kolodny et al., 2015). These aspects can be implemented as part of a city-wide public health intervention with appropriate services and access offered to the affected populations.

Reflection

The simulation provides an opportunity for practice on how to conduct a comprehensive assessment of a city, identifying key factors, indicators, and influences. Through a combination of collected data, health policy analysis, and understanding of resources that a community offers, public health professionals are able to determine the general social well-being and health risk factors for a given geographical area. In a manner, such simulations are vital to obtaining initial experience as real-world assessments are tremendously more complex. The assignment has driven personal interest in my local area of residence and hometown as I have become more aware of the myriad of public health issues that may be influencing population well-being and stability.

As an individual working in the healthcare sector, particularly nursing, there are actions that can be taken to create meaningful change. Nurses can work with patients on an individual basis, educating them about potential risks and providing guidance on maintaining a healthy lifestyle and accessing community health resources. Furthermore, nurses are encouraged to engage in advocacy on behalf of patients and the population regarding public health initiatives or risks with governments and influential organizations. I believe that while individual action matters, a greater impact can be made collectively. Therefore, engaging with the community, public health organizations, and even fellow medical professionals, can make a difference in addressing identified issues in the real world and increasing the availability of community resources.

References

Healthy People 2020. (2019a). Crime and violence. Web.

Healthy People 2020. (2019b). Environmental health. Web.

Healthy People 2020. (2019c). Substance abuse. Web.

Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., & Alexander, G. C. (2015). The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Annual Review of Public Health, 36(1), 559-574. Web.

Thornton, R. L. J., Glover, C. M., Cené, C. W., Glik, D. C., Henderson, J. A., & Williams, D. R. (2016). Evaluating strategies for reducing health disparities by addressing the social determinants of health. Health Affairs, 35(8), 1416-1423. Web.