For Community Health Nurses to knowledgeably plan services for a specific community, it is essential to know the community, identify health-related resources that may be helpful to members, and learn about gaps in services. One of the ways this can be done is by conducting a windshield survey ( head –to-toe assessment) of the community itself. This involves the generation of data that helps to define the community, the trends, stability, and changes that all serve to define the health of the community (Stanhope & Lancaster, 2011).
This windshield survey was conducted from a car and by walking and provided a visual overview of the community of Randallstown, MD. Some areas observed were: housing, race/ethnicity, religion, transportation, service centers, parks and recreational areas, commercial activities, entertainment, information about the population, health care problems, quality of life, and the perception of the community members. In this paper, this community will be examined in great detail.
Identification of needs in the community and health problems of the community will be discussed. Conditions and trends in the community that could affect the health of the population will also be discussed. Randallstown is an unincorporated community and census-designated place in Baltimore County, Maryland, United States. It is named after Christopher and Thomas Randall, two 18th-century tavern-keepers. At that time, Randallstown was a tollgate crossroads on the Liberty Turnpike, a major east-west thoroughfare (city-data. com).
Today it is a suburb of Baltimore, with a population of 32,430 as of the 2010 census. The area is bounded by roads and a railroad. In the 1990s, Randallstown transitioned to a majority African American community, and is currently notable for its broad ethnic diversity (U. S. Census Bureau). The population is composed of African Americans, White- Non Hispanics, Hispanics, Asians, American Indians, Africans, and Russians. The homes in Randallstown go as far back as sixty years old. Most of the homes appear to be in good or fair condition.
Some are single family homes and others are townhomes. According to city data. com, about 7,014 homes are detached and 2,067 homes are attached. There are also many apartment complexes occupied along with some mobile homes also present in the area. Nearly every home or apartment appears to have some form of air conditioning, heating (mostly central) and modern plumbing. There are barely any open spaces in Randalltown. The spaces seen are parking lots or recreational parks. During the survey, there was no animals seen on the streets.
The survey revealed some abandoned and broken down houses and cars. Some areas are well kept and the others had trash on the streets. The mean forms of transportation are public and private transportation. The public transport includes trains, buses, taxicabs and mobility vans for the disabled. Very few people walk to their place of work. The percent of the population that uses public transportation is 7% with 88% driving alone or carpooling (americantowns . com). The area also includes many service organizations.
Service groups include a community health center (the largest in Baltimore County), Arc of Baltimore, Chimes, and progress Unlimited, which caters to people with disabilities, nursing homes, assisted living, fire stations, police department, rehabilitation centers for trouble youths, drug/alcohol programs facilities, resource center (Liberty Resource Center), recreational parks, fitness center, doctor offices, dentists, pharmacies, and public library. Religion is also important to many people and those who are religious look for an organization that “fits” their unique beliefs.
The religious affiliations range from Judaism to Catholicism. Other services in the community are: dry cleaning, auto services, restaurants, sport bars, numerous fast food centers on every corner, liquor stores, gas stations, grocery stores (where people usually shop). They are all within one to two miles of the community. People hang out at the bars, fast food centers, the library, street corners, and the Seven-Eleven mostly in the evening and at night. They were seen smoking cigarettes, drinking soft drinks and some form of alcohol. People in this area read newspapers, listen to radio but most watch television .
The businesses that exist are mostly retails. There are no evidence of military installation, and the nearest industry (Solo factory) is outside Randallstown. Most people work within the area. The major employers are Walmart and Northwest hospital. Very few people work outside the area. It was noted that there is one community health center (Liberty Resource Center) serving the entire community and no social service office located within the community. The nearest one is about six to eight miles outside the area. Northwest Hospital is the largest healthcare facility the area, and is located in the middle of Randallstown.
It serves the whole community of Randallstown and its surrounding areas. It was also noted on assessment that large number of teenagers smoke. America is experiencing an alarming increase in drug and alcohol addiction. Drug and alcohol addiction in Randallstown have been an increasing problem since 2009. Of the 32, 430 people living in the community, about 6,846 consume alcohol that could classify them as heavy drinkers, and about 2,653 individuals use illicit drug of some type (usdrugtrends. com). Total crime risk in this Randallstown is 123 with murder risk of 7.
Crime risks are provided as a comparison to the national average (100) (americantowns. com). From the data gathered, the quality of life in Randallstown is fair. According to city-data. com, the percentage of adults living with diabetes is 9. 1% with the state average of 9. 1%. The obesity rate is 26. 4% with state at 26. 7%. While interviewing a resident of the community, needs identified consist of more police protection, more recreational facilities, cleaner environment, demolition of condemned houses, speed bumps to ensure pedestrian safety, and encouraging the use of community health fairs and screenings.
Another resident spoke about the poorly attended free flu shot clinic open to the public by Northwest Hospital. The health problems identified are related to smoking, drug and alcohol use, unhealthy eating habits and lack of health education. One nursing diagnosis is knowledge deficit related to lack of inadequate use of community health programs and facility. Education is of most importance for this diagnosis. Before any education can be done, one has to determine the peoples’ ability and willingness to learn.
The CHN (Community Health Nurse) can teach the population about the importance of these fairs, screenings, and facilities. The CHN can also intervene by talking one-on-one with individuals, posting fliers in the community about health fairs and screening, going door to door, and collaborating with responsible parties to ensure transportation are made available for the elderly and those without transportation. Ensuring that the people of Randallstown are aware of the location of these programs and referring them to community agencies may be incorporated into the care plan.
Another nursing diagnosis is ineffective health maintenance related to the presence of adverse personal habits (smoking, drug/alcohol abuse, poor diet selection, and lack of exercise). The CHN can assess the community’s knowledge of health maintenance behaviors. People may know that certain unhealthy behaviors can result in poor health outcomes but continue the behavior despite this knowledge. The CHN needs to ensure that people have all of the right information needed to make good lifestyle choices, and to have programs that determine rationale for failure.
People may be experiencing obstacles in compliance that can be resolved. The CHN may provide means for people to contact healthcare providers, and have access to health services and/or programs. CHNs may also provide a rationale for the importance of behaviors such as: a balanced diet low in cholesterol to prevent vascular disease; smoking cessation that has been directly linked to cancer and heart disease; cessation of alcohol and drug abuse which has physical addictions and social consequences; and regular exercise which promotes weight loss.
For these interventions to be effective, the CHN may also use the mass media and health policy in creating change among the population. Stanhope and Lancaster mentioned that the mass media such as the internet, newspapers, television, and radio are useful in providing information quickly to a large number of people. Health policy can also play a critical part in the adoption of healthful population-centered change and can help encourage interventions that promote community health (2011).
The CHN may lobby for public policy that will encourage or allow health- generating choices, work with communities or specific population groups within the community to develop public policy that target health promotion and disease prevention activities. The nurse needs to participate in assessing and evaluating health care services to ensure that people are informed of programs and services availability and are assisted in the utilization of these available services.