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Capstone Paper Project

Maureen D. Amilca
University of South Florida













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Introduction
Surrounded by the Everglades, Okeechobee Lake and the Atlantic Ocean, Palm
Beach County is the biggest county in land mass area in the state of Florida. Measuring at
2,386 sq. miles, this county is compromised of an estimated of 1,300,000 residents (State
of Florida, 2011). According to the Department of Health (2010), this region is
considered an urban area because of its fast pace, high population density and city life.
Three major employers for the county are the school boards, government and health care
(Florida Tax Watch, 2012). The health care system of this area is dedicated in providing
access to those who are uninsured. The Coordinated Care Program developed by the
Health Care District makes sure that they offer resources such as preventive care,
inpatient hospital, prescription drugs and other beneficial aid to the residents (HCDPBC,
2013). Palm Beach was ranked number 14 out of all the 67

counties in the state of Florida
for overall health outcomes (County Health Ranking, 2013).
Compared to the whole state of Florida, Palm Beach socioeconomic factors such
as families living below poverty is below average (8.6 for the county and 9.9 for state of
Florida) and population over the age of 25 without high school diploma is below average.
According to Florida Charts, Palm Beach is at 13.2 and the whole state is averaging at
14.7. However these socioeconomic factors can improve since its in the second quartile.
In addition, the population above the age of 5 that does not speak English is higher than
the state. This region was ranked in the 4
th
quartile, averaging at 13.0 compared to the
whole state, which stands at 11.8 (Florida Charts, 2011).
Strengths and Improvements
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Based on the research conducted in the County Health Profile, three strengths that
Palm Beach County posses is having access to health care, low death rate to chronic
diseases and low unintentional injuries. Under health status and access to health care, this
county was ranked number one. This was demonstrated by adults who received a flu shot
in the past year, which was at 42 percent; adults who rate their health status as poor,
which was at 16 percent; Adults with any type of health care insurance coverage, which
was at an 89.7 percent. Also Palm Beach has a low death rate to chronic disease such as
cardiovascular disease, cancers and respiratory disease. Age-adjusted death rate to
coronary heart disease is at 92.2 rate; stroke is at 28.6, and heart failure is at 5.8.
Moreover, lung cancer death rate is at 38.1 and colorectal death rate is at 12.0. Also
chronic lower respiratory diseases age-adjusted death rate is at a 26. 3 rates compared to
Florida, which was at a 38.6 rate. The third strength of this county was low unintentional
injuries, which include motor vehicle crashes. This rate for this indicator was at an 11.0
compared to the state, which came in at 12.9 (Florida Charts, 2011).
On the other hand, three indicators that Palm Beach County needs to improve on
is low birth weight births (births <2,500 grams); adults who are overweight; and the high
rate of infectious diseases. According to Florida Charts (2011), babies being born at low
birth rate are at a 9.1 percent, compared to Florida, which stands at an 8.7 percent. This
health indicator trend is also getting worse. In addition, adults who are overweight are
41.8 percent compared to the whole state, which is at a 37.8 percent. Lastly, Palm Beach
has a high increase of infectious disease such as syphilis and HIV. Syphilis case reported
is at a 4.0 rate and Florida is 6.2. Even though the rate is lower than the state, its in the
4
th
quartile, which shows that it needs improvement. The death rate for HIV/AIDS is at a
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4.7 and the state of Florida is at a 4.3 (Florida Chart, 2011). To be clear, Florida Charts
rank these indicators from the 1 to 4. IF an indicator is ranked lower such as the number 1
it means it is favorable situation. That is what the county is aiming towards. However if a
health indicator is at a high number such as 4, it is least favorable (Florida Charts, 2011).
Adults who are overweight in Palm Beach County are an important health
indicator to focus on. This should be priority because being overweight can lead to other
chronic health issues and being overweight can be preventable. According to Healthy
People 2020, individuals at healthy weight are less likely to develop high blood pressure,
dyslipidemia, type 2 diabetes, osteoarthritis, cancers, heart disease, and complications
during pregnancy (Healthy People, 2013).
Community Health Models
Determinants-of Health Model is factors that contribute to the health of
population. Factors such as biology, environment or even lifestyle can have impact on a
person well being. The model helps nurse by narrowing problems to focus on and
choosing an appropriate intervention for a specific population. In other words, health
determinants give nurses explanation on why some people are healthier than others
(WHO, n.d.).
Some factors that contribute to the adults being overweight are human biology,
health system, environment and lifestyle. Some of these factors do overlap with one
another. According to the National Institute of Health (2012), genes can affect the
amount of fat stored in the body. Also if both parents are overweight, there is a high
chance of children being overweigh because children tend to adapt the same eating habits
as their parents. Alongside the gene factor is the environment that individuals reside in.
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From the increase of fast food restaurants, food advertising, lack of health, and oversized
food portions, the environment has a strong impact on ones weight. Fast food is cheaper
and quicker, so it is easier for those to eat out. Plus, when the portion size is larger and
fulfilling, there are more pros than cons to eating out (NIH, 2012). Also, individual
lifestyle can have an affect on their weight. Lack of physical exercise can cause weight
gain that leads to people taking in energy rather than burning energy. The reason for this
can be due to lack of time because Americans are either busy working (Everett, 2013), or
taking care of the family. Furthermore, the depletion of sleep can cause weight gain.
There are two hormones that play a role in lack of sleep and weight gain, called ghrelin
and leptin. When the body is hungry, ghrelin is release, which informs the body to eat,
and when one is lacking sleep, the body produces more ghrelin. However with the
hormone leptin, it is vice versa. It tells the body to stop eating and there is less of it
flowing through the body when a person is sleep-deprived (Mann, n.d.).
Population Diagnosis
Adults in Palm Beach County, at risk of imbalanced nutrition: more than body
requires related to food intake, socioeconomic status evidenced by the county rate of 41.8
percent compared to the state of Florida that is at 37.8 percent. (Florida Charts 2011;
Unbound Medicine, 2013).
Adults in Palm Beach County, at risk of sedentary lifestyle may be related to lack
of interest, resources, lack of training or knowledge of specific exercise needs evidenced
by the county rate of 41.8 percent compared to the state of Florida that is at 37.8 percent
(Florida Charts 2011; Unbound Medicine, 2013).

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Interventions
Acknowledging that Palm Beach County adults are in the 4
th
quartile of being
overweight, it is important as a community nurse to intervene. The purpose of an
intervention is to lower the risk or threats to a population health. Nurses can do this by
prevention. There are three categories of prevention: primary, secondary and tertiary
prevention. Primary prevention focuses on decreasing the number of new cases.
Secondary prevention is reducing the rate of established cases in the community; tertiary
prevention is stabilize the amount of disability associated with a disorder (IWH, n.d.).
Primary level of prevention
An example of primary prevention for obesity in the county would be educating
individuals. Health care providers who encounter those who are at healthy weight should
continue to inform patients on eating the proper nutrition and exercising on a regular
basis. Doctors can provide a food pyramid brochure to individuals, so that it can continue
to guide healthy adults eating habits. The food pyramid or healthy plates, demonstrates
the portion of carbohydrate, vegetables, fats, fruits and dairy is needed on daily basis
according to age, gender and height. It also adds, physical activity on the bottom of the
pyramid to show how important exercising is to maintain ones body weight. (Harvard,
n.d.) Also, if individuals cannot find or afford local gyms, there are community
organizations such as churches that have fitness classes for free. The role of the
community nurse in the primary level of prevention is to help educate and promote.
Secondary Level of prevention
On the contrary to primary prevention, secondary prevention goal is to help
reduce those who are already overweight. This includes special attention and weight
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management of individuals. Also creating health fair for the community. Focusing back
to special attention and weight management, it is essential that clients are informed what
a BMI and waist circumference measurements by their health care providers. BMI is
body mass index, which is calculated as weight in kilograms divided by height in meters
squared. According to the U.S. Preventive Services Task Force, they found that the BMI
is a reliable and valid source to determine adults at risk for mortality and morbidity. In
addition to secondary prevention is creating health fair. Health fair are free events hosted
by different programs to screen and to educate the community on their health issue
(Healthy Life, n.d.). The role of the community nurse is help participate such as
educating, taking blood pressure, and also making that transportation are available for
those who cant make it to the fair on their own. Also provide resources on how the
community can go to a local store, such as Publix, to monitor their blood pressure.
Tertiary Level of Prevention
Tertiary prevention purpose is identifies those who are overweight with
complications and treat it. With being overweight can lead to chronic illnesses such as
type 2 Diabetes and hypertension (CDC, n.d.) Health providers can give treatment such
as antihypertensive and insulin medications to their patients, to reduce severe
complications. As community nurse, their role is to continue to monitor to see if
treatment is effective and also continue to educate living with complications.
Health Policy Proposal
Health policy is a vital part of health care. Health policy provides structure,
regulations and decisions to achieve a goal. Also health policies increase research funds.
Since the percent of adults over the age of 20 who are overweight is 69 percent, it is best
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to use secondary prevention. My proposal would be to increase knowledge of how to
calculate BMI and increase the amount of health fair in that area. Desired outcome is for
80 percent of adults in Palm Beach County to learn how to calculate body mass index and
understand how it relates to ones health. Also to increase the amount of time health fairs
are provided in that area by having it every Saturday. Stakeholders that would be affected
by this proposed health policy are community members, health providers and funding
sources. With community members, we can have local churches and school to provide
small health fairs on Saturday mornings to residents. At the health fair, funding sources
will be available so that individuals who lack money are assisted with information of
where to receive inexpensive health care. Also health care providers can educate on body
mass index, places to monitor their blood pressure (screening), eating properly and
exercising on a regular. On the other hand, some health care providers may oppose to this
health policy because they wont get paid for it since it is at health fair. My game plan is
to co-partner with those who value public health. Explain the benefits and the impact it
will have on the county. I will get it started by promoting at local schools, and jobs. Hand
out brochure on health fitness, different tools to measure body mass and different places
that are having health fairs. It is best to approach community members and organizations
that are willing to help. It is best to start off locally and small, because as community
nurse, we can monitor the population.
Health policy will make sure that those who are underserved have the opportunity
to get help at an inexpensive cost. This policy will enhance population health in general
by increasing knowledge of healthy living and different methods on how maintain
healthy weight.
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Reference
American Institute for preventive Medicine (n.d.). Health Fair Information. Retrieved
from http://www.healthylife.com/template.asp?pageID=64
CDC. (2012) What Causes Overweight and Obesity. Retrieved from
http://www.cdc.gov/obesity/adult/causes/index.html
County Health Rankings. (2013). Palm Beach. Retrieved from
http://www.countyhealthrankings.org/app/florida/2013/palm-
beach/county/outcomes/overall/snapshot/by-rank
Everett, Jenny. (2013). Excuse-proof Your Workout. Retrieved from
http://www.cnn.com/2013/04/29/health/health-excuse-workout
Florida Charts. (2011.) Palm Beach County, Florida. Retrieved from
http://www.floridacharts.com/charts/DisplayHTML.aspx?ReportType=7200&Co
unty=50&year=2011&tn=25
Florida TaxWatch (2012) Briefing Floridas Top Ten Largest Public Employers By
County. Retrieved from
http://www.floridataxwatch.org/resources/pdf/jobsbriefing.pdf
Harvard. (n.d.). Healthy Eating Plate and Healthy Eating Pyramid. Retrieved from
http://www.hsph.harvard.edu/nutritionsource/pyramid/
HCDPBC. (2013). Coordinated Care Program. Retrieved from
http://www.hcdpbc.org/index.aspx?page=146
Healthy People. (2013).Nutrition and Weight Status. Retrieved from
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http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=29
Mann, Denise. (n.d.). Coping With Excessive Sleepiness. Retrieved from
http://www.webmd.com/sleep-disorders/excessive-sleepiness-10/lack-of-sleep-weight-
gain
NIH. (2012). What Causes Overweight and Obesity? Retrieved from
http://www.nhlbi.nih.gov/health/health-topics/topics/obe/causes.html
State of Florida. (2011). Facts About Florida. Retrieved from
http://www.stateofflorida.com/Portal/DesktopDefault.aspx?tabid=95
Unbound Medicine (2013). Nursing Central. Retrieved from
www.unboundmedicine.com.
USPSTF. (n.d.). Screening for Obesity in Adults. Retrieved from
http://www.uspreventiveservicestaskforce.org/3rduspstf/obesity/obesrr.htm
WHO. (n.d.). The Determinants of Health. Retrieved from
http://www.who.int/hia/evidence/doh/en/









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