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This assignment requires students to undertake a community assessment of the made-up City of Horizon. Students will identify and discuss the implications of a health issue for the Horizon community and consider the roles of the Registered Nurse or Health Care Worker in advocating, mediating and enabling health promotion.
The assignment is to be presented as a report using the template provided on the moodle site

The City of Horizon Public Health and Wellbeing Plan is a five (5) year plan aimed at improving the health and wellbeing of the region’s residents. The City of Horizon Public Health and Wellbeing Plan aligns with the State Public Health Plan, South Australia: ‘A Better Place to Live’, and hence follows the same four key priority areas identified:

  1. Stronger and Healthier Communities and Neighbourhoods for All Generations
  2. Increasing Opportunities for Healthy Living, Healthy Eating and Being Active
  3. Preparing for Climate Change
  4. Sustaining and Improving Public and Environmental Health Protection.

Health priorities have been identified using statistical research and local knowledge of the population profile, burden of disease and social determinants of health in our community. These priority issues allow Council to focus its public health contribution and partnerships toward improving these areas over the duration of this five year plan.

The specific actions the City of Horizon Public Health Plan address include:

  • Poor Nutrition and Diet;
  • Physical Inactivity;
  • Healthy lifestyle;
  • Obesity;
  • Mental Health;
  • Suicide prevention;
  • Domestic Violence;
  • Drug and alcohol misuse;
  • Delayed Early Childhood Development (inc immunisations, learning, socialising);
  • Community transport considerations; and
  • Planning for the impacts of potential long term changes in the region’s climate.

Health priorities for City of Horizon

The community health report provides the opportunity for the exact health conditions of the different levels of the community all the while discovering the different external and internal factors acting on the changes in the health status (Feinman et al. 2015, pp. 1-13). This assignment attempts to discuss the community health status of city of horizon with respect to the present community assessment of the city of the horizons including the demographic profile, psychosocial profile, community infrastructure, goods and services, health services and resources, potential health issue of the people of the city of horizons, role of the registered nurse in health promotion of the community, and a summarizing conclusion. The primary purpose of the community health assessment is to understand the impact of social capital, infrastructure, demographic and psychosocial factors on the health status of the community and discover one particular health issue (Clark 2015). Along with that, this report will also attempt to discuss the role of a registered nurse in promoting the health on a community wide scale which is a crucial requirement of professional practice of a nurse.

  1. Demographic Profile

Demographic details can be mentioned as the statistical data that provides information regarding particular geography of the region and the associated information that has the significant impact on the community health statistics of the community. Considering the demographic details of the city of Horizon, it is located at the Limestone Coast region of South Australia, having Adelaide to south and Melbourne to the North-west, Southern Ocean to East, and is surrounded by Yonder district council (City of Horizons 2018). The land mass of this city consists of 4248 square kilometres, the city has access to underground water and the climate of the city is Mediterranean type. Considering the population profile of the city, it has to be mentioned that the census population of the city as calculated in the year of 2016 is 28351 that are inhabiting 12273 dwellings and the average household size of the city is 2.3. Exploring these details further, it has to be mentioned that there are 13693 males and 14657 females living in the city. Among the population, there are 652 aboriginals and 1446 people speaking a language other than English. Considering the age group of the dwellers of the city of Horizon, 12.2% of the total population are children and 4.9% are adolescent or youngsters without a job. The service age group constitutes 10.3% of the total population encompassing the age group of 18 to 24. However, 34.3% of the population of the city is middle aged and aging. Hence, it can be considered that the city will have predominant health issues that pertain to an aging population (Marmot & Allen 2014). As per the demographic statistics, 29% of the total population of the city, only 29% have dominant households with two person inhabiting them, it indicates that the families are smaller during the early marriages and then the families increase in size with the advent of children. The aboriginal population is 652 and they are inhabiting mostly the coastal regions of the city (City of Horizons 2018)

  1. Psychosocial Profile

Specific actions addressed in the plan

The socio-economic profile of a city has a significant impact on the health status and living condition of the people of the community. Considering the socio-economic stratification prevalent in society (Stanhope & Lancaster 2015). It has to be mentioned that there is a well-established link predominantly observed between the socio-economic disadvantage and the poor health outcomes. The index of relative disadvantage or IRSD score of the town is 927. 40% of the population had a pensioner concession card which is the highest proportion in the lime coast region and it further strengthens the fact that the population of the city of Horizon is aging. Employment rate of the nation is considerably low with 6.7% of the eligible population aged between 16-24 years of age having unemployment benefits which indicates at lack of employment opportunities in the town which will also have a significant impact on the health status of the community.  The educational status indicates that almost 20% of the 16 year old population of the city is not partaking in the full time secondary education which is alarming and is also slightly higher as compared to the rest of the non- metropolitan areas all over the globe (Reusch & Manson 2017, pp. 1015-1016). Along with that, 12.2% attained a year 12 qualification and were enrolled for university education which is also only two thirds when compared to the non-metropolitan average as well. The occupational sector of the city is mostly dominated by health and social care, retail trade, accommodation, agriculture, forestry and fishing. Considering income statistics, it has to be mentioned that 4% of the total population earned $1500 on a per week basis, although most of the population has much lesser income. 5.4% of the population has no income and predominant income groups are $200-$299, $300-$399 and $400-$599, which hints at much lower socio-economic status. Considering the transportation system, the most of the population commutes by cars either as drivers themselves (14852) or as passengers (1285). Other most common types of transportation includes motorbike, bicycle, or just walking; very few people (45 each) travel to work by bus or taxy. The level of community networking in the town is high as reported by the population at 90.2% confirming getting support at crisis. Hence, it can be mentioned that the level of social support is also a considerable facilitator of good health and living condition of city (City of Horizons 2018).

  1. Community Infrastructure, Goods and Services

Community infrastructure and the delivery or accessibility of the goods and services has a huge impact on the living condition and the socio-economic burden on the population of the town, hence while detailing the community profile report for a city, it is very important to include the infrastructure and availability of the services as well (Tay et al. 2015, pp 780-790). It has to be mentioned that City of horizon has a very convenient location and it has become one of the main service centres for South-Eastern Australia. It is a well-established regional centre and is a very popular tourist attraction along with being a nice retirement destination. It has many exceptional facilities provided to the population a range of accommodation, shopping malls and entertainment theatres and multiplex. A few notable includes City include the Horizon Cultural Centre, Romero Vineyard and Wine Complex, Visitor Information Centre and Horizon Backpackers Hostel, Yonder Museum and Library, Horizon Aquatic Centre, Horizon Recreation Centre, Limestone Lake Adventure Park and Playground, Horizon Mall, the Horizon Hotel Limestone Coast Caves, Limestone Coast Maritime Village, Cape Arch Penguin Viewing Platform. Hence, it can be considered that the town has good infrastructure and opportunities for the dwellers to engage in entertaining leisure activities as well modern urban living (City of horizons 2018).

  1. Health Services and Resources

Demographic profile of City of Horizon

Health service and resources are a very integral need for a healthy and functional community. Horizon has a tertiary level hospital and full complement of healthcare facilities such as Physiotherapy, Radiology, Podiatry, Pharmacy, Pathology and Medical science services, Nutrition and Dietetics, and a GP Plus clinic. The health care facility present in the town has considerable infrastructure and also offers a variety of specialized health services to the population yet the health status of the community is not as up to the mark. There are various health issues prevalent in the population of the town such as obesity, diabetes mellitus, cardiac complications and renal disorders. As all of these health adversities are non-communicable, it can be considered that the impact of the socio-economic determinates of health and the lifestyle behaviours of the population are the most important contributing factor to the predominance of these health conditions. However, with enough interventions being taken in order to facilitate lifestyle modification and changes in dietary habits can help in reducing the burden of these diseases (Smolowitz et al. 2015, pp. 130-136).

For any community, there will be a variety of different health issues and diseases affecting different age groups of the population, however, there are certain diseases that represent far higher burden of diseases affecting a considerable chunk of population and have a considerably high incidence and prevalence rate, recurring time and time again (Roden et al. 2015, pp. 704-714). For city of Horizons as well, there are number of different potential health issues pertinent in the population such as the obesity, diabetes and cardiac complications. However, focussing on the statistical data shared, the highest burden of diseases can be attributed to the Diabetes mellitus. Exploring the issue further it has to be mentioned that diabetes, both type 1 and type 2 contributes to 92.9% of the total burden of diseases in the city. Researchers are of the opinion that diabetes is undoubtedly one of the greatest public health priorities all over the world and considering the Australia as a nation, Diabetes is the epidemic of the 21st Century and also has developed into one of the biggest challenges that is confronting the Australia’s health system (Diabetesaustralia.com.au. 2018). In support, Walker et al. (2014), have mentioned Diabetes is one of the most reported health issues that the Australian citizens suffer from; according to the statistical data, 280 Australians develop diabetes every day and there are approximately 1.7 million citizens of Australia that are living with diabetes.  Hence, Diabetes is an alarming public health priority overall for Australia and city or horizon is also depicting a similar picture.

Type 2 diabetes is more prevalent in this community which indicates that the predominance of this diseases in the community is facilitated by the modifiable socio-economic determinants. It has to be mentioned that Diabetes is one of the co-morbidities which are intricately linked with three interconnected factors, weight management, obesity and physical inactivity (Braveman & Gottlieb, 2014, pp. 19-31). The socio-economic factors which has a significant role in facilitating this disease is poor nutrition and dietary habits, physical inactivity and sedentary lifestyle, and most importantly lack of proper obesity management along with tobacco and alcohol abuse. Exploring further the issue, it has to be mentioned that for the population of the city of horizon, the educational status and employment statistics is low as compared to the percentage of population belonging to the service age group. The income status of the majority of the population is very low as well which will evidently have a significant impact on the dietary habits and nutritional status (Roden et al. 2015, pp. 704-714). The dietary habits are also related with the educational status and low health literacy also has been reported to be evident contributing to lack of proper dietary habits contributing to obesity and in turn diabetes as well. Furthermore, lack of proper health literacy and education is also contributing to lack of obesity control and physical activity statistics of most of the population as well. Almost half of the population commutes by cars and only a small fraction of the population commutes to work by walking (Harkness & DeMarco 2016). Hence, the evident lack of physical activity among the dwellers are a considerable factor leading to the prevalence of diabetes. Diabetes is a very delimiting health condition which, if not adequately managed in a timely manner, can pave way for many related co-morbidities such as coronary arterial diseases, renal complications, retinopathy, foot ulcers and eventually organ failure as well due to severe glucose starvation. Hence, it is very important for the health care system of the town to prioritize diabetes and develop strategies to target the modifiable risk factors and control diabetes (de Andrade et al. 2015, pp. 1343-1351).

Socio-economic profile of City of Horizon

The registered nurse has a number of different responsibilities to fulfil while working in a community, the responsibilities of a registered nurse is not limited to the just providing care, but it also extends to enhancing health literacy, reducing disease burden, and improving lifestyle and health behaviour of the population as well (Anmac.org.au 2018). One of these roles and responsibilities of the registered nurses is the health promotion and there are various professional guidelines that direct the registered nurses to fulfil these responsibilities effectively (Ek & Svedlund 2015, pp. 1122-1131). NMBA registered nurse practice standards can be considered one such credible framework that directs the registered nurses. The Australian nursing and midwifery council or ANMC also has a set competency standards which can be of equal assistance to the registered nurses. For instance, the standard 7 states registered nurses to provide comprehensive, safe and evidence based interventions to achieve individual as well as group health outcomes, health promotion is an integral example. However, for engaging in health promotion, the Ottawa health charter can provide best assistance (Nursingmidwiferyboard.gov.au 2018). The Ottawa charter provides the aid of 5 action areas which the registered nurses can utilize in order to develop strategies to reduce the incidence of diabetes and help the diabetics better manage the disease. However, the basic strategies for the nurse to go through the action areas include enabling, advocating and mediating. According to the NMBA registered nurse practice standards as well, enablement is one of the core components of maintaining capability for practice; which can be facilitated by educating and empowering the community to take their own health decisions. Similarly, as per the second standard, advocating the health needs of the target population is extremely important for the registered nurses which not only helps in facilitating a therapeutic connection but also address all the areas of need as well (Who.int 2018).

For addressing the issue of Diabetes, the registered nurse will need to focus on three core action areas, building healthy public policy, strengthening community action and developing personal skills. Elaborating further, change in the predominant lifestyle is a very time taking procedure which will also attract a lot of resistance. Hence, there is need for enablement, advocacy and mediation of the health promotion strategies implemented by the registered nurses to reduce the burden of diabetes on the community and also prepare the diabetic patients to be able to better manage their disease as well. For the health issue selected for city of horizon, the registered nurse will need to take the aid of three action areas of the Ottawa charter. Firstly, the nurse will need to implement enabling strategies to develop personal skills of the population by educating and empowering the target population so that they design their own lifestyle improvement and dietary change program with the registered nurse providing collaborative assistance (Walker et al. 2014 pp. 29-48). Secondly, the aid of mediation is also needed to be taken by the registered nurse to develop personal skills of the target population of checking their own blood glucose levels using automated devices all the while taking the assistance of digital and social media and social and economic government authorities to organization quarterly campaigns. Lastly, the nurse will also have to advocate the ne4eds of the community to the local and national government authorities to implement diabetes and obesity screening campaigns twice a year for target and at risk populations along with implementation of activity centres (Furber et al. 2017, pp. 321-327).

Community infrastructure and goods/services accessibility

Conclusion

On a concluding note, health care can be considered as one of the greatest requirements for sustaining healthy living, each and every individual of the community regardless of the socio-economic gradient has an equal right and access to adequate health care services. However, in most cases, a community is associated with a varied range of different health disparities which can contribute to unequal health status for the members of the community. This community health assessment successfully identified the predominant health issues of a fictional community with resected to the demographic and psychosocial profile of the community and develop health promotional strategies to address the prevalent health issues of the community taking the aid of Ottawa charter and the strategies of enablement, advocacy and mediation. And it can be hoped that this assignment will be an excellent help in the future to develop community wide health promotional and preventative strategies as per standard guidelines and protocols all the while addressing each and every care need of the community.

References:

Anmac.org.au 2018. National Competency Standards for the Registered Nurse, viewed 15 Sep. 2018, Available at: https://www.anmac.org.au/sites/default/files/documents/ANMC%20Accreditation%20standards%20-%20Registered%20Nurse%202009_0.pdf.

Braveman, P., & Gottlieb, L. 2014. ‘The social determinants of health: it's time to consider the causes of the causes’. Public health reports, vol 129, no. (1_suppl2), pp. 19-31. Doi: 10.1177/00333549141291S206

Clark, M.J., 2015. Community health nursing. Prentice Hall. < https://testbanktop.com/wp-content/uploads/2016/11/Downloadable-Test-Bank-for-Community-Health-Nursing-Advocacy-for-Population-Health-5th-Edition-Mary-Jo-Clarkfm_irm-1.pdf >

de Andrade, L. O. M., Pellegrini Filho, A., Solar, O., Rígoli, F., de Salazar, L. M., Serrate, P. C. F., ... & Atun, R. 2015. ‘Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries’. The Lancet, vol. 385, no. 9975, pp. 1343-1351. DOI: 10.1016/S0140-6736(14)61494-X

Diabetesaustralia.com.au. 2018. Diabetes in Australia, viewed 13 Sep. 2018,  Available at: https://www.diabetesaustralia.com.au/diabetes-in-australia [viewed 13 Sep. 2018].

Ek, B., & Svedlund, M. 2015. ‘Registered nurses' experiences of their decision?making at an Emergency Medical Dispatch Centre’. Journal of clinical nursing, vol. 24 no. 7-8, pp. 1122-1131. DOI: 10.1111/jocn.12701

Feinman, R. D., Pogozelski, W. K., Astrup, A., Bernstein, R. K., Fine, E. J., Westman, E. C., ... & Nielsen, J. V. 2015. ‘Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base’. Nutrition, vol. 31, no.1, pp. 1-13. DOI: 10.1016/j.nut.2014.06.011

Furber, C., Pusey, H., Busby, A., & Stringer, E. 2017. ‘Integrating public health practice into the graduate's role through pre-registration education’. British Journal of Midwifery, vol. 25, no.5, pp. 321-327. DOI: 10.12968/bjom.2017.25.5.321

Harkness, G.A. & DeMarco, R.F., 2016. Community and public health nursing: Evidence for practice. Wolters Kluwer. < https://hsrc.himmelfarb.gwu.edu/books/80/>

Marmot, M., & Allen, J. J. 2014. Social determinants of health equity. DOI: 10.2105/AJPH.2014.302200

Nursingmidwiferyboard.gov.au. 2018. Nursing and Midwifery Board of Australia - Professional standards, viewed 13 Sep. 2018, Available at: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards.aspx.

Reusch, J. E., & Manson, J. E. 2017. ‘Management of type 2 diabetes in 2017: getting to goal’. Jama, vol. 317, no. 10, pp. 1015-1016. DOI: 10.1001/jama.2017.0241

Roden, J., Jarvis, L., Campbell-Crofts, S., & Whitehead, D. 2015. ‘Australian rural, remote and urban community nurses' health promotion role and function’. Health promotion international, vol. 31, no. 3, pp. 704-714. DOI: 10.1093/heapro/dav018

Smolowitz, J., Speakman, E., Wojnar, D., Whelan, E. M., Ulrich, S., Hayes, C., & Wood, L. 2015. ‘Role of the registered nurse in primary health care: meeting health care needs in the 21st century’. Nursing Outlook, vol. 63, no.2, pp. 130-136. DOI: 10.1016/j.outlook.2014.08.004

South Australian public health act 2011, 2016. City of Horizons, Viewed on 13th September, Available from file:///C:/Users/LAPTOP_PS0020/Downloads/2590589_305162834_CityofHorizonPublicHealthandWe%20(1).pdf .

Stanhope, M., & Lancaster, J. 2015. ‘Public health nursing-e-book: Population-centered health care in the community’. Elsevier Health Sciences. <https://books.google.co.in/books?hl=en&lr=&id=mvWQCgAAQBAJ&oi=fnd&pg=PP1&dq=Stanhope,+M.,+%26+Lancaster,+J.+2015.+%E2%80%98Public+health+nursing-e-book:+Population-centered+health+care+in+the+community%E2%80%99.+Elsevier+Health+Sciences&ots=SYhxzFpg4O&sig=ozXUyPOpN08n4J7uNH7Xxa81tdg#v=onepage&q=Stanhope%2C%20M.%2C%20%26%20Lancaster%2C%20J.%202015.%20%E2%80%98Public%20health%20nursing-e-book%3A%20Population-centered%20health%20care%20in%20the%20community%E2%80%99.%20Elsevier%20Health%20Sciences&f=false >

Tay, J., Luscombe-Marsh, N. D., Thompson, C. H., Noakes, M., Buckley, J. D., Wittert, G. A., ... & Brinkworth, G. D. 2015. ‘Comparison of low-and high-carbohydrate diets for type 2 diabetes management: a randomized trial’, 4. The American journal of clinical nutrition, vol. 102, no. 4, pp 780-790. Doi: 10.3945/ajcn.115.112581

Walker, R. J., Gebregziabher, M., Martin-Harris, B., & Egede, L. E. 2014. ‘Independent effects of socioeconomic and psychological social determinants of health on self-care and outcomes in Type 2 diabetes’. General hospital psychiatry, vol. 36, no. 6, pp. 662-668. DOI:10.1016/j.genhosppsych.2014.06.011

Walker, R. J., Smalls, B. L., Campbell, J. A., Williams, J. L. S., & Egede, L. E. 2014. ‘Impact of social determinants of health on outcomes for type 2 diabetes: a systematic review’. Endocrine, vol. 47, no. 1, pp. 29-48. DOI: 10.1007/s12020-014-0195-0

Who.int. 2018. WHO | World Health Organization, viewed 13 Sep. 2018, Available at: https://www.who.int/?ReturnUrl=http%3a%2f%2fwww.who.int%2fhealthpromotion%2fconferences%2fprevious%2fottawa%2fen%2f.

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