Community is a large group of people with a common concern. The concept of community holds that there are many dimensions, which bring people together in order to interact with one another. Communities are groups of people living in particular places, with locality being central to their definition as communities. Hitchcock, Schubert, & Thomas (2003) also indicate that definition of a community as a population of particular geographic area is the one that has been generally used by health planners in their assessment and planning work.
This study focuses on Hispanic community in Los Angeles, California. Most Hispanics have very different origins. Zaninetti (2010) says that some Hispanic communities in Los Angeles are the fruit of America’s colonial heritage. Hispanic community in California has become the epicenter of Mexican immigration as well as a leading Hispanic state in the country (Zaninetti, 2010). With just 1 million that is 14% of metropolitan population, Los Angeles is the city most marked by the presence of Hispanics.
Between 1970 and 2000 Hispanic community in Los Angeles continued to grow rapidly because of both massive immigration and high fertility rates. Los Angeles is the largest county in the United States occupying 4,752 square miles. Los Angeles has 88 cities, largest by far being the city of Los Angeles. The city is a home to approximately 5 million people, and more than 10 million people inhabit Los Angeles county.
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Hispanic community in Los Angeles is particularly affected by poverty. Zaninetti (2010) says that average income per capita in Hispanic community in Los Angeles was only 1.5% of national average in the last 10 years. It is important to note that 22% of the population lives below the poverty threshold. Moreover, the issue of language in healthcare, which affects Hispanic community in Los Angeles contributes to the debate on issues of integration in the country.
Description and Characteristics of a Community
Hispanic community makes up 51.5 % of the total population of the United States. Kukanyika & Smart (1992) noted that Hispanic community in Los Angeles is a community of long-term residents rather than recent immigrants. 71 % of Hispanic population in Los Angeles is native born. According to the analysis conducted by the Hispanic Health and Nutrition Examination Survey only 4.2 % of Mexican Americans between the ages of 18 to 74 years reported consulting a folk medicine practitioner in the year prior to the survey. In addition, the risk of low birth weight for Hispanic newborns is 1.73 times higher in the second generation compared to the first. Analysis shows that increased use of English language by Hispanic youth was associated with higher rates of education.
Death rate is lower for Hispanics than for non-Hispanics between the ages of 45 and 64 and the ages of 25 and 44. Kukanyika & Smart (1992) claim that given the impact of chronic disease such as diabetes in Hispanic communities in Los Angeles, there is a need to focus on morbidity data. Hispanics have a high life expectancy, but given the types of health problems, which are most common in this community, it is likely that they are living unhealthy lives. Kukanyika & Smart (1992) claim that for Hispanic people family is an all encompassing concept, and distinction between immediate and extended family is virtually nonexistent. Within the family network Hispanics frequently put maintenance of the family and their role in it before their own needs.
There are several types of services available for Hispanic communities in Los Angeles. These services include health department, service of private medical physician, dentist services, hospital clinics, pharmacies, health promotion services, mental health services, and school and occupational health services. These support systems for Hispanic families include programs that provide direct family assistance as well as employment training, health education, and parenting classes. Other services provided for Hispanic communities in Los Angeles include official and voluntary services, self help groups, and support groups. Policy development activities include community education and information efforts related to health, literacy, economic development, and citizenship.
Lin & Harris (2008) note that expenditures on social service programs that are designed to reduce barriers to employment and obstacles to personal wellbeing are at least as large as total expenditures for more commonly identified cash assistance programs provided to Hispanic community in Los Angeles. Hispanic community is provided with a safety net and antipoverty assistance. The aim of this service is to ensure that the poor have adequate access to social service programs and providers. Lin & Harris (2008) also indicate that job training programs and adult education, which are provided to Hispanic community in Los Angeles, help increase low quality of public school education and reduce barriers to self-sufficiency and economic advancement. Other services provided include access to mental health services. They provide assistance to rehabilitate victims of drug abuse.
Statistics indicate that 50 % of Latino women between the ages of 15 and 17 years are sexually active. Aguirre-Molina, Molina, & Zambrana (2007) note that adolescent pregnancy is related to increased sexual activity at an earlier age. 35.2 % of Hispanic women, including teens, are less likely to receive formal health education on birth control methods, STDs, or on how to say 'no' to sex. Leading causes of death among Hispanic community include HIV/AIDS, cancer, injuries, TB, and heart diseases. Aguirre-Molina, Molina, & Zambrana (2007) indicate that infection with human papillomavirus (HPV) and sexually transmitted disease (STD) may well explain high incidence of cervical cancer and mortality due to it among Hispanic women in the community. HIV/AIDS emerged as the third leading cause of death for Latino women between the ages of 25-44 years. In Hispanic community in Los Angeles, the number of children born to mothers aged 15 or younger is nearly two times (1.75) bigger than the number of children born to mothers aged 20-21. This indicates high rates of child abuse and neglect. Children born to mothers aged 16-17 are 1.41 times as likely to become victims of child abuse or neglect.
Analysis and Diagnosis of Problems and Assets
Data collected from the interview during the assessing phase will be used to provide the physician with further guidelines for plans of care and will help him come up with a nursing care plan. Rice (2006) noted that it is important to distinguish between the plan of care and patient care plan. Before the analysis, it is also important to initiate a phone call. During this time the home care nurse receives feedback about patient’s situation and current health status. The interview guide is show in the appendix section of this paper (Appendix 1).
Analysis phase moves next to the initial formal assessment interview. The purpose of this interview is to collect data and obtain other information related to Hispanic patient’s health. Rice (2006) says that even though a printed form, checklist, or outline is usually followed, nurses should be receptive to all information offered by patients, families, or caregivers. Assessment interview collects subjective data from patient’s responses to questions. Nonverbal cues, however, should also be noted (Rice, 2006).
Information should be collected about all prescription and non-prescription medications. Rice (2006) noted that home care nurses should ask to see all patient’s medicines including over the counter medications. According to Rice, medication analysis provides nurses with the opportunity to verify the name, dosage, and frequency of administration. Analysis also allows to find out the purpose of medication, adverse reactions, allergies, side effects, therapeutic effects, and patient compliance with the medication regimen.
Nutritional assessment should be conducted. The nurse in this case will identify any patient who may be at risk of developing protein energy malnutrition or specific nutrient deficiencies and adverse health reactions related to eating habits of Hispanic community in Los Angeles (Rice, 2006). Physical assessment of the patient should be made. It entails an evaluation of patient’s health status through the use of nurse’s specially trained senses of sight, hearing, touch, and smell (Rice, 2006).
Once the analysis has been conducted, the nurse interprets data and makes nursing diagnoses (Rice, 2006). Nursing diagnosis is a clear concise statement about patient’s health status. The diagnosis reflects patient’s healthy and unhealthy responses and supporting factors for each response. Rice (2006) notes that nursing diagnoses used in this case include knowledge deficit, activity intolerance, and self care deficit. The health care plan used in Hispanic community should utilize nursing diagnosis to coordinate multidisciplinary care.
The diagnosis should reflect medical treatment plan, interventions, projected outcomes of care, and long-term goals. During the diagnosis it is important to maximize the quality of patient care, ensure appropriate utilization of resources, and evaluate delivery of services. It can provide documentation to validate reimbursement of services (Rice, 2006). Nursing diagnoses should be derived and outcomes of care should be mutually determined.
Planning, Implementation, and Evaluation
Trends in healthcarefor Hispanic community, such as care paths, are merging nursing care plans with multidisciplinary needs. Rice (2006) indicates that with increasing emphasis on patient participation in the plan of care, nursing care plans are now commonly referred to as patient care plans. Hispanic community patient care plan is established by home care nurse and by multidisciplinary team, which includes a physician (Rice, 2006). The first step in the planning phase is establishment of priorities. Rice (2006) indicates that the nurse, the multidisciplinary team, and the patient care giver should work together to identify immediate concerns of Hispanics. The next step in the planning phase is identification of goals and outcomes of care. Rice (2006) indicated that goals and outcomes of patient care should reflect the nursing diagnosis and overall plan of care.
Once long and short term goals have been identified, home care nurses and physicians in partnership with the patient and multidisciplinary team can identify specific interventions, actions, or therapies that will help patients achieve outcomes of care and goal resolution (Rice, 2006). During the implementation phase it should be noted that nursing interventions are important and they should involve a great variety of procedural skills such as dressing changes, medication administration, and intravenous therapy (Rice, 2006). Implementation phase should integrate the plan of care and patient care plan into patient’s environment. Patients and caregivers are then able to take on the responsibilities for self care management. These will involve learning, assessment, task achievement, evaluation, and personal decision making for improved health.
Evaluation will be used to measure the effectiveness of medical treatment and appropriate utilization of resources. Rice (2006) notes that evaluation will help to determine patient’s progress in meeting outcomes of care and achieving long term goals of providing healthcare to Hispanic community in Los Angeles. Once goals of care are achieved or it has been determined that the patient no longer requires physician's care, he or she can be discharged from the institution. When nurses use interventions to improve health of population groups, it is important to measure outcomes for groups as a whole. Outcomes of community based healthcare practice will be determined by health status, functional abilities, and quality of life of Hispanic community. Descriptive statistics, such as mean range and percentages, will be used during the evaluation process (Kelly, 2011).
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