community health nursing
- Discuss aspects of a health concern not being addressed despite the efforts of services and partnerships involved and describe the ultimate outcome(s) or goal(s) from Healthy People 2020 relating to that specific health concern.
Answer the following questions to assist in data interpretation:
- What similarities are apparent between the data that were gathered and the data that were generated?
- What differences are apparent between the data that were gathered and the data that were generated?
- What are the weakness and strengths of this community?
- In what areas is improvement needed in this community?
The assignment should be written in an APA-formatted essay. The essay should be between 1500 and 2000 words in length and include at least two scholarly sources other than provided materials.
NEIGHBORHOODASSESSMENT 1
Neighborhood Assessment
1
Neighborhood Assessment
Victoria Oladele
Aspen University
Community Health Nursing
Alicia Hinton FNP-BC, ADM-BC
(October 26, 2020)
Neighborhood Assessment
Defining the Community
The community under study in this paper is Queens. Queens is classified as one of the five boroughs of the New York City. It is part of the larger New York City indicating that it is urban based. It is coextensive with a respective county of New York State thus considered a county too. It was consolidated in the New York City in 1898. Its neighbors Brooklyn at the Western end of Long Island, and Nassau County to the East. Around 47% of its population is foreign born and it serves as one of the most ethnically diverse counties in US. It is also highly diverse in linguistics. The county has an estimated 2.28 million people with the Asians (Non-Hispanic) having the largest population
The county has a total area of 178 square miles, 109 square miles being on land and 70 square miles being in the sea. On the West, it is bordered by Brooklyn, and the Newton Creek. Northwest it is bordered by Newton Creek, and far west by Manhattan. To the North, it is bordered by Bronx. Flushing Bay and Flushing River are also North of Queens. To the South, it is Rockaway Peninsula. Jamaica Bay is also located in this area too.
The County comprises of several neighborhoods. Many residents of Queens identify themselves with these neighborhoods rather with the county or New York City at large. The major neighborhoods in the city include Flushing, Whitestone, Middle Village, Ozone Park, Astoria, Rockaway Beach, Richmond Hill, Jamaica, Bellerose, Corona Heights, Rego Park among others.
On literacy levels, around 81.5% of the population are high school graduates or have a higher level of education compared to the country percentage at 88.8% (US Census Bureau, 2018). Around 31.5% have tertiary level education that is a bachelor’s degree or like national percentage. 10.1% of the population under 65 years in the county lack health insurance services compared to national’s 9.5%. The birth rate for the past 12 months stands at 4% and the infant mortality rate is 3.9 per 1000 live births (TownCharts, 2020)
This community health assessment is being conducted to determine the current health status and needs in Queens County. In future, the data collected may help in designing a health improvement plan for the County and inform how best resources should be allocated to satisfy the existing needs. Harboring a large number of foreign-born citizens and non-citizens too, they assessment will also be used to research on their access to healthcare especially the undocumented immigrants. The assessments will also help increase knowledge about public health and how different activities are interconnected in relation to health.
This information to be used in the community assessment has been collected through online data gathering from accredited and reliable sources. Onsite data was also generated by visiting different neighborhoods in the county. The data was generated through participant observation, windshield survey, engaging in focus groups, and a KAP survey. All ethical procedures and also protocols offered in curbing the COVID19 pandemic where be adhered to in the process.
Assessment
Diversity of Population
Queens is distinct from other communities in the country due to its highly diverse population. It has people from different races. The interesting concept is that most of this racial groups are highly clustered in specific locations in the neighborhood (TownCharts, 2018). The population of the County is estimated to be around 2,278,906 as per the Statistics released by the United States Census Bureau in 2018. It was estimated to have 865,578 housing units with a total of 777, 904 households (US Census Bureau, 2018). There was an estimate of 2.97 persons per household. The median value in each household was estimated at$481,300. The owner occupancy is rated at 44.5. The age based demographics are as follows; 6.2% are under the age of 5, 13.9% are between the ages of 6-18, 64.2% are between the ages of 19-64, and 15.7% are over the ages of 65 (US Census Bureau, 2018). Females had the highest percentage of the population at 51.5%. 47.5% of the residents are foreign-born. The Median household is estimated at $62, 006 and per capita income at $28,814 (US Census Bureau, 2018). Around 12.2% of the residents live below the poverty line in the country.
The county has different ethnic groups and is very racially diverse which is attributed to the higher number of foreign-born populations. The three largest ethnic groups in the county are Asian (Non-Hispanic), White (Non-Hispanic), and African American. Around 49.5% of these were born in Latin America, 33.5% in Asia, 14.8% In Europe, 1.8% in Africa and 0.4% in North America. 44. % of the population speak English at home, 23.8% Spanish, and 16.8% Indo-European language among other languages. The three most foreign spoken languages are Spanish (505,010 speakers), Chinese (Incl Mandarin, Cantonese, 208,114 speakers), and Bengali (76,812 speakers) (US Census Bureau, 2018). As of 2018, there were 1.04 more Asian residents than any other race in the County. Chinese community comprise the highest percentage of the Asian community while Puerto Ricans comprise of the largest percentage of the Hispanic population.
With many of the foreign-born population already naturalized, there are many undocumented immigrants in Queens. According to a report by Migration Policy Institute, Queens County is home to around 246,000 of the 643,000 undocumented immigrants living in New York (Migration Policy Institute, 2018). Due to their status, many of them lack access to healthcare services. Due to the fear of being deported, many of them are not able to access tertiary level education and have to grapple with low paying menial jobs throughout their stay in the County (Hayduk et al., 2017). Many are not able to afford quality housing and live in illegal basements with poor conditions (Stewart et al., 2019). These areas have poor hygiene and sanitation which expose the occupants to infectious diseases. The basements structures have weak walls, poor wiring, poor lighting, and lack emergency outlets. In case of an emergency, the occupants have no alternative escape route except the entrance.
According to a field article by the New York Times (Stewart et al., 2019), many of them arrive at the country illegally and they migrate to Queens which is more a convenient settling place. Many already have relatives or friends from their local countries in the County and come in hope of earning to help back at home. Most of their earnings are sent to families back at home and many are left with so little for their own use (Wyrick et al., 2017). Many of them conduct menial jobs thus cannot afford a quality lifestyle. There is need to improve the lives of these immigrants through better access to health and other process that provide them with legality to be in the country. There should be programs to cater for the innocent children who arrive at the country while young or those born to undocumented immigrants.
Data Generation
Windshield Survey and Personal Observation
The survey was conducted in three days in different neighborhoods in the county checking out for various health indicators. The areas covered were Jamaica, Corona Heights, Richmond Hill, Flushing, Astoria, and Bellerose. In two of the days, the survey was done by driving around the County to cover many areas comprehensively and the last day through public transport to have obtain first-hand experience. This was combined with personal observation which involved parking the car at strategic places and assessing the population.
The community has diverse architectural designs in the houses present. This can be attributed to the diverse cultures residing in the County. Interestingly, many of these houses seem to have been built around 10-25 years ago especially in the estates. The houses are congested, and others are even attached. Some have backyards, or parking spaces. This can be attributed to the high population in such a small area.
Deep in the low end-suburbs the situation was different, there were many apartments. There were many posters advertising houses with cheap renting costs. The posters were in different languages with the majority being English Spanish, and Chinese. A visit was made to one of the houses to obtain a clearer picture of the situation at hand. It was poorly constructed and was divided into small rooms like a dormitory. The lighting and ventilation were poor, and all residents shared a bathroom and a toilet.
7 parks were identified in Queens during the survey. However, many of them were located a bit far from the residential places. Many of them were spacious and very green such as Flashing Meadows Corona Park, and Forest Park. The parks had fewer people which may be attributed to the current pandemic. A quick observation on the walking behavior of many residents in Jamaica’s public streets indicated urgency and precaution No criminal activity was noted, however, there was a sense of insecurity and fright which indicated gaps in the security.
Around 20 clinics were observed during the survey. 12 of them are in high end areas of the County. 14 community clinics were also observed. The community clinics seemed to have an influx of patients than the private ones. There are also several hospitals in the community. In Jamaica, 2 hospitals were identified, Jamaica Hospital Medical Centre and Queens Hospital Centre. Other hospitals identified were Flushing Hospital Medical Centre and New York Presbyterian in Flushing, Elmhurst Hospital Center in Elmhurst, Mount Sinai Queens in Astoria, and ST. Mary’s Children Hospital in Bayside. From the survey, the County has a good number of health facilities. However, quality of services offered was determined through feedback from a focus group.
Focus groups
Data from the community was also collected by organizing a focus group. The focus group had 10 members. Recruitment of members was done with the assistance of various contact people within the county (friends, colleagues, and relatives). The group members were diverse in terms of economic status, geographical location, ethnic background, gender, citizenship status, and age. All members were of the group were above 18 years. There was representation of different ages (0-5 years, 6-18 years, 19-64 years, and over 65 years). Ages 0-5 years, and 6-18 years were represented by parents with children at those levels. Each participated signed a consent form and a Non-Disclosure Agreement on everything shared within the group setting. The discussion took place in a park for a duration of 3 hours.
The main areas of discussion were accessibility, affordability, and quality of healthcare services offered among the different groups. Safety within the community, insurance coverage, transportation issues in the community, and levels of hygiene and sanitation. Other concerns harbored by the members were also discussed.
From the discussion, there was a wide disparity in terms of accessibility to care. Formally employed members (4) and those in the high-income cluster reported accessing quality health services in the local hospitals. All of them had working insurance packages. Among the others, health care services for young children (below 5) and those aged above 65 years were more available. This was cited to be because of special government programs in place. Members from Jamaica (2) were satisfied with services at Queens Hospital Center but indicated that they were sometimes impoverished due to the high number of patients (Stewart et la., 2019). 3 members in the group lacked insurance packages.
One of the members who lives in Rockaway, an undocumented immigrant, expressed his fears about visiting healthcare facilities and concerns on high healthcare cost due to lack of an insurance scheme. He expressed his guilt and disappointment for not being able to offer his children the best healthcare or accompanying them to the facilities on many occasions. Many of his neighbors who happen to be immigrants had the same challenges too with many opting for cheap private clinics which lacked comprehensive services. Language, and various cultural setting were contributing factors for others too. He also expressed concern over the high cases of mental health conditions i.e. acute stress, and depression among the immigrants.
There were various concerns on security especially with members residing in Jamaica, Flushing, and Walkaway. Most of them attributed the security cases to a high number of undocumented immigrants, high level of unemployment, and poverty. Housing was also reported to be a problem especially for those living in low-end suburbs. Congestion, and poor housing structures were cited as the main challenges.
On transportation, 6 of the 10 members reported owning cars but 3 of them used them to work. Interestingly, the 3 were from South East Queens and highlighted lack of effective public transportation systems in their locality as the main reason for using private transportation. All the others used public transportation to their workplaces and movements across the city. Subway system was the most frequently used, followed by commuter rail and buses. 8 of the members complained of increased transit time on roads due to traffic jams, and congestion in the subways. This could be a hotspot for infectious diseases. However, all this were reported to be temporarily reduced due to the current pandemic. Other concerns raised were on the COVID-19 pandemic. The members collectively voiced that the government needs to implement policies put in place to cushion the residents on the challenges brought about by the pandemic. There was also concern about an influx of the cases in Queens and laxity of residents on measures offered.
Survey
A short Knowledge, Attitudes, and Practices (KAP) survey was randomly shared among 50 participants. The response rate was 74% (37 responded to the survey). Though random, different factors such as economic status, ethnicity, age, and neighborhood were considered on sample selection. It was designed in multiple-choice format for convenience of the participants and analysis.
Some of the interesting concepts picked from the survey was the increased consumption of fast foods because of busy schedules (27.02% engage in multiple jobs). Only 20% engaged in exercises to boost their heath with majority citing lack of time, and resources. 64.865 engage in blue-collar jobs, 27.02% in white-collar jobs (professionally trained) and the rest (5.40%) are unemployed. Majority (81.08%) only visited health facilities when sick and did not engage in periodical screening services to determine their health status. 67.56 had support systems in terms of social capital. Many of this were aligned to friends of similar ethnic origin or first nationality. 64.86% expressed satisfaction on the safety levels in their homes. Lastly, 89.18% indicated spending time out with their families/close friends as their resting time.
In conclusion, neighborhood assessment provides institution broad knowledge about the neighborhood’s immediate health condition, what they lack and the problems. This knowledge can help to create neighborhood health advancement plan by defending how revenues should be used to provide for the need of the community.
References
Hayduk, R., Hackett, K., & Tamashiro Folla, D. (2017). Immigrant engagement in participatory budgeting in New York City. New Political Science, 39(1), 76-94.
Migration Policy Institute (2016). Retrieved from:
https://www.migrationpolicy.org/data/unauthorized-immigrant-population/state/NY
Stewart, N., Jones, R. C., Peçanha, S., Furticella, J., & Williams, J. (2019). Underground Lives: The Sunless World of Immigrants in Queens. The New York Times. Retrieved from:
https://www.nytimes.com/interactive/2019/10/23/nyregion/basements-queens-immigrants.html
TownCharts (2018). USA/New York/Queens County. Retrieved from:
https://www.towncharts.com/New-York/Demographics/Queens-County-NY-Demographics-data.html
US. Census Bureau (2018). Queens County (Queens Borough), New York; United States. Retrieved from:
https://www.census.gov/quickfacts/fact/table/queenscountyqueensboroughnewyork,US/PST045219
Wyrick, J. M., Kalosza, B. A., Coritsidis, G. N., Tse, R., & Agriantonis, G. (2017). Trauma care in a multiethnic population: effects of being undocumented. Journal of surgical research, 214, 145-153.