Focused Nursing Field Experiences: Application of Community Health and Population

Focused Nursing Field Experiences
Focused Nursing Field Experiences

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Focused Nursing Field Experiences: Application of Community Health and Population

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Task 1: Social Media Campaign

Part of cultural competency is advocating for sensitive patient populations with regard to health issues or needed improvements in the community. A big part of advocacy is creating effective stories from your community and understanding how to broadcast your message. In our society today, social media is a powerful leveraging tool to get a story out, build support, and demonstrate advocacy.

Focused Nursing Field Experiences


A. Submit a completed “Community Health Clinical Time Log” form.

B. Write a problem description, including all of the following information about the community where you performed your field work:
● the primary prevention topic
● target population (i.e., those affected by the health concern)
● population size
● demographics
● geographical area (e.g., county, city, town)
● area size
● physical and social environment

C. Explain how the health concern is linked to a health inequity or health disparity within the target population.
1. Identify specific data to support the health inequity or disparity conclusion.
2. Discuss the primary community and prevention resources currently in place to address the health concern.
3. Discuss the underlying causes of the health concern.

D. Discuss the evidence-based practice associated with the selected primary prevention topic.
1. Identify data about the selected primary prevention topic from the local (county), state, and/or national level.

E. Develop a community health nursing social media campaign strategy that will convey your health message and address the primary prevention topic by doing the following:
1. Describe your social media campaign objective.
2. Recommend two population-focused social marketing interventions to improve the health message related to your chosen primary prevention topic.
a. Discuss the rationale for your recommendations.
3. Identify the appropriate social media platforms you will use to communicate with the target population.
a. Discuss the benefits of each chosen social media platform in supporting preventative healthcare.

F. Discuss how the target population will benefit from your health message.

G. Describe best practices for implementing social media tools for health marketing.

H. Create a social media campaign implementation plan by doing the following:
1. Identify stakeholder roles and responsibilities in implementing the plan.
2. Discuss potential public and private partnerships that could be formed to aid in the implementation of your campaign.
3. Create a specific timeline for implementing your campaign.
4. Explain how you will evaluate the effectiveness of the campaign.
a. Identify the measurable tools necessary to evaluate the campaign.
5. Discuss the costs of implementing your campaign.

I. Reflect on how social media marketing supports the community health nurse’s efforts to promote healthier populations.
1. Reflect on how your social media campaign could apply to your future nursing practice.

J. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.

K. Demonstrate Professional communication in the content and presentation of your submission.

Focused Nursing Field Experiences

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Spiritual or religious values and traditions

Spiritual or religious values and traditions
Spiritual or religious values and traditions

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Spiritual or religious values and traditions


What spiritual or religious values and traditions underscore concern for environmental health? Discuss the role of spiritual or faith-based institutions in environmental stewardship. How have these spiritual or ministerial efforts supported local public health initiatives? What collaborative efforts have been made in environmental health, both locally and globally, with regard to spiritual or faith-based collaboration?

Well-functioning healthcare systems are fundamental for maintaining healthy populations. Good health is essential for a country’s economic productivity and social development.

Community public health initiatives focus on identifying specific geographic areas with high levels of need and helping those communities overcome barriers to living healthier lives. Community members’ average lifespans can differ by 20 to 30 years based on inequities that restrict access to healthy food, affordable health care, and mental health support, according to the American Public Health Association.

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Tackling smoking during pregnancy in England

smoking during pregnancy
smoking during pregnancy

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An analysis of policy to Prevent Smoking during Pregnancy in England

Executive summary

The incidence rates of smoking during pregnancy, and complications associated with it are still rampant in England. This is attributable to issues such as lack of strong leadership in policy implementation and inadequate infrastructures to raise awareness and training on how to prevent increase of smoking incidences during pregnancy. The proposed projects aims at evaluating the government strategies of tackling direct smoking during pregnancy on unborn child in England, with the aim of evaluating their effectiveness or establish if there is need for review.

Chapter 1: Introduction

 Cigarette smoking carries a threat both to the expecting mother and her newborn. Approximately, 20% of the women smoke through their pregnancy in the UK (Department of Health, 2012). This trend is associated with numerous adverse effects such as premature births, miscarriages and prenatal mortality. Direct smoking during pregnancy is associated with number of respiratory disorders and pregnancy complications (Free et al. 2011). It is also associated with financial crisis. It is estimated that treating mothers and their children on healthcare complications associated with direct smoking during pregnancy is about £20-£87.5 per annum (Bauld,  Hackshaw, and Ferguson, et al 2012).

Given these damages associated with the tobacco used on the unborn child. This paper conducts an analysis of policy to Prevent Smoking during Pregnancy in England.  Although it is the government responsibility to ensure that child has the best start of life, the government policies have done very little in protecting the children from the dangers of tobacco use pre and post-birth (Chen et al. 2012).

Background/Study rationale

It is estimated that approximately 10 million adults in the UK are smokers. In England, 17% females and 22% males are smokers. Research indicates that the prevalence rates ate highest among the young population between the ages 25 and 34 years and lowest among the elderly population (McEwen et al., 2012). Smoking At Time of Delivery (SATOD) indicates that there is high rates of prenatal smoking in England. Although comparative studies indicates some decline in prenatal smoking proportion (from 15.1% to 12.7% in 2006/7 and 2012/13 respectively), the declining rate is very low (Chen et al. 2012).

 Approximately, 12.7% of the women practice prenatal smoking. The national average highlights big disparities on prenatal smoking across the nation. For instance, in Blackpool, one in four  (27.4%) expectant mothers smoke during pregnancy as compared to 1 in every 100 expectant mothers who smoke during pregnancy (0.5%) in Westminster. The tobacco control plan for England has established national ambition to reduce smoking during pregnancy by 11% by end of 2016 (Department of Health 2011).

Smoking has generally been banned in all public places and even in workplaces since July 1, 2007. The implementation of this rule had followed earlier implementation of similar legislation in Scotland, Northern Ireland, and Wales.  Healthy Lives, healthy people tobacco plan, which was published in March 2011. It aimed at stopping promotion of tobacco use through the regulation of tobacco products.

The English government takes these responsibilities very seriously. The NHS England is expected to collect adequate data about smoking throughout pregnancy using the Carbon monoxide (CO) screening strategies. This is not compulsory requirements, indicating that current data on smoking pregnant women may not be the true picture, and may not be the most effective strategy to evaluate the extent of smoking during pregnancy (Department of Health 2011).

To start with, the government has improved its actions to stop the promotion of tobacco. This has been done through the implementation of tobacco displays and regulation of images and portrayals in the entertainment industry. Other measures include the policy of increasing taxes, introduction of initiatives to help quit and increased regulation of the tobacco products. However, the incidence rates of smoking during pregnancy, and complications associated with it are still rampant in England.

This is attributable to issues such as lack of strong leadership in policy implementation, reduced mass media campaigns, poor role models and champions that people can emulate to discredit smoking as well as enlightening the populations about dangers associated with smoking, and inadequate infrastructures to raise awareness and training on how to prevent increase of smoking incidences during pregnancy (Godfrey et al. 2010). Therefore, what are the government’s effective strategies of tackling prenatal smoking in England?

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Aims and objectives


 To critique government policy to prevent Smoking during pregnancy in England

Specific Objectives

  1. To examine the increase in prevalence rate of smoking during pregnancy
  2. To examine government plan to reduce incidence rates of smoking during pregnancy
  3. To examine the effectiveness of the government policy i.e. is there need for review?

 Literature search strategy

The key questions that were used during literature search were structured from the study objectives. This included;

  1. Why is there an increase in prevalence rate of smoking during pregnancy?
  2.  What is government plan or initiatives to reduce incidence rates of smoking during pregnancy?
  3.  Are the established government plans effective? 

The main focus of the literature review was  articles that gave definitive information from the controlled trials, randomized experiments, systematic reviews and any other article that had additional information on research topics.  The inclusion criteria included papers published not more than six years ago, written in English and peer reviewed articles.  Articles written in other languages, Newsletters and articles published more than six years ago were excluded.

The aim of this research was to investigate the impact of government policy on smoking during pregnancy. This aimed at evaluating the government plan to reduce incidence rates of smoking during pregnancy, and to establish if these interventions are effectiveness or there is need for review.

The standard search strategies were applied, which involved querying of the main data bases namely, London Metropolitan University Library MetCat, British Medical Journals, Library Catalogue, Wiley online library, Science Direct, Worldcat.Org, Sage journals online, NHS.Gov, NICE guideline, Parliament UK,  and Local Government Website-Census.   The querying was done using the key words below,

Key Words

 ‘stop smoking’ OR ‘Tobacco control’ OR  AND‘government policy’ OR ‘Pregnant women’ OR
‘Smoking education’  OR ‘Quit smoking’AND  ‘Government strategies’ OR ‘Policy review’

The potentially relevant articles in identified in these databases were those written in English, published less than six years ago and strictly are peer reviewed journals. However, some articles published earlier were included into the study, to build up on the study history to current trends. (Chen et al. 2012).

From the analysis, 218 articles relating to smoking during pregnancy met the inclusion criteria. Three quarters of them were highlighting on the negative health consequences associated with prenatal smoking, only 10% of the articles tackled the issue of English policy on tobacco use. Out of these 21 articles, eight articles were analysed as indicated in Table 1.1

 Ethics and anti-oppressive practice consideration

This paper will deal with ethical concerns that affect indirectly and directly the well-being of the human beings. The issue of maternal autonomy is very important. Irrespective of child’s interest, pregnant women have the right to make their own decision. This is because forcing decisions to pregnant women are ineffective strategies, and are both unconstitutional and unethical in deontological perspectives. If other members of the society have the freedom to   smoke and to drink alcohol; the rights must not disappear with pregnancy (Free et al. 2011).

According to the utilitarian theory, moral imperative must take precedence over the freedom of choice. This is because the pregnant women are carrying another life, whose rights must remain reserved. Despite the increased foes in the newspaper, researchers are obliged under international laws to conduct research in a way that protects and promotes human health, including prenatal and maternal health. All ethical regulations that protect and uphold individuality, the aspects of autonomy and protection of human rights as proposed by the government and other institutions that promote ethics will be observed (Fleming et al. 2012).

Project outline

The proposed proposal consists of four chapters. These chapters help critiquing the England policy on prenatal smoking. Chapter 2 is the literature review, which consist of thematic headings including the overview of prenatal smoking in the UK, the prevalence rates of prenatal smoking in the UK, factors associated with prenatal smoking, impact of smoking to the mother and unborn child and the socio-physiological impact of prenatal smoking. This helps in understanding the general attitudes to smoking during pregnancy, and the identification of the key legislations that help reduce and prevent smoking during pregnancy.

 Chapter 3 explores the theory and practice. This reflects on the government policy initiative- Smoke free legislation: The Health Act 2006. A critical analysis of the policy impact was done. To understand the policy impact better, the agency link identified is Action on Smoking and Health (ASH).  This agency link is chosen because it is mainly concerned with the impact of prenatal smoking on children health, their parents and relatives. 

The programme intervention identified was Framework Convention on Tobacco Control. This programme changes, strengths and weaknesses are analysed (Mackenbach, 2011). The ethical tensions and dilemmas associated with the programme are also described. Chapter 4 is the last chapter and generally consists of study conclusions, reflections, and study recommendations.


Bauld, L., Hackshaw,,L., and Ferguson, J. et al (2012). Implementation of routine biochemical validation and an ‘opt out’ referral pathway for smoking cessation in pregnancy, 2012, Addiction, 107 Supplement 2: 53-60

Chen, y.-F., et al., (2012). Effectiveness and cost-effectiveness of computer and other electronic aids for smoking cessation: a systematic review and network meta-analysis. Health technology Assessment, 16(38).50.

Department of Health (2011). Healthy lives, healthy people: a tobacco control plan for England, London, Department of Health, 2011.

Free, C., et al., (2011). Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single blind, randomized trial, Lancet, 378(9785): 49-55

Godfrey C. et al. (2010). Estimating the costs to the NHS of smoking in pregnancy for pregnant women and infants, 2010. York: Department of Health Sciences, The University of York. Cited in NICE, Guidance aims to protect thousands of unborn babies and small children from tobacco harm’. Available from:

Mackenbach, J. (2011). What would happen to health inequalities if smoking were eliminated?. BMJ, 342(jun28 1), pp.d3460-d3460.

McEwen. A. et al (2012). Evaluation of a programme to increase referrals to stop-smoking services using Children’s Centres and smoke-free families schemes,. Addiction, 2012, 107: 8–17.

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OBESITY: Community Health and Population focused Nursing


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OBESITY: Community Health and Population focused Nursing

Identify a community for which there is data available that will support the diagnosis

  The county is located in Pennsyltucky-in the northern region of the State. The region is mountainous and is characterized by stone mining industry. The region experiences warm and humid summer and heavy instant snow falls during winter. The region lies in York County. The region has diverse ethnic community owing to the large immigration of people from Gotham city.  The community assessed was my county state which was among was one of the hardest hit by the 1919 influenza pandemic.  Since then, the State has established adequate measures to ensure that such incidences do not occur again.

 The main non-communicable health problem identified in this region is obesity.  Obesity has serious consequences on the residents of this county’s health as well as the economy. This is because obesity is associated with a number of chronic health complications such as stroke, diabetes, cancer, and coronary heart disease. In the USA, obesity accounts for 147 billion dollars of the total health cost. Most people in this county are have adopted unhealthy lifestyles such as poor diet and physical inactiveness (CDC, 2016).

B. Health needs assessments

Population Economic Status

 The demographic data released by the Census Bureau in, York County has a population of 438,052.  The county reports 0.7% of the population change.  The population density is estimated to be 484 per square meter. The median age is reported to be 40.6. Approximately, 70% of the populations are in the family. The unemployed in this region is about 4.7%. The employment growth rate is less than 1%.  The income per capita in this community is estimated to be $ 27,996 (York County PA, 2016). 

Disaster Assessment and Planning

 The County is prepared for management of disasters. The York County office of Emergency Management (EOM) is responsible for the Emergency management program. The mission of the office is to protect the community by integrating necessary activities that sustain and improve their ability to mitigate, prepare and respond to the threatened natural disasters they ensure that the community are notified of emergency situation (York County PA, 2016). 

Neighborhood/Community Safety Inventory

 The main risk of concern of the County is caves and sinkholes and the severe winters which make it not favorable for the outdoor activities (York County PA, 2016). 

Cultural Assessment

 The culture and history of this county is unmatched in the country. The area is neighbored by super historic sites with an impressive ethnic population.  The big cities in the county comprises of Italian, Irish, Chines among other immigrant communities. This is complemented by the rural lifestyles where most of the people in the mix of Amish which adds wild austerity to the culture (York County PA, 2016). 

Windshield Survey

 The homes are mainly detached and well maintained. The in-town homes yards are smaller as compared to township hopes. The roads are generally is in good condition to serve the business in the region.  The main health concerns are that some roads are busier which an issue for physical activities such as cycling and walking along the path. This is due to the inadequate maintenance of the pedestrian paths, which can be used by the community to walk or cycle to their work places.

There are also high reports of injuries associated with car accidents.  The parks are poorly maintained and I noticed several sink holes that have not been covered. This is makes it difficult for the residents to engage in outdoor activities.  In addition, there are fewer green grocery shops. Therefore, most of the residents rely on fast foods because they are cheap and easily available. There is a big contrast of York County, Pa when compared with the neighboring counties as they have a nice climate and environment place to work and live.


 The following six facilities were explored, Health department, YMCA,  Fire department,  American Red Cross, National Alliance on Mental illness, and community Center.  The public health departments include Health department. This organizations target the residents of York County Community. The facilities advertise themselves through public facilities such as health centers and educational facilities. The main barriers observed are inadequate medical cover and Language barriers.

There is no service fee as these services are funded by the Local government. The staffs in these facilities are welcoming and very respectful. They are always ready to help. The main issue I observed is language barrier. Only few of the staff could speak other languages fluently, which makes it difficult for them to communicate with Non- English speaking residents. The organizations operate in both referrals and self-referrals process. The organization has details in internet and any person can access information from any location (Health York County, 2015).

  American Red Cross this organizations target the residents of Central Pennsylvania. It serves 22 counties including the York County Community. The facilities advertise themselves through public facilities and the internet.   It offers relief during pandemic and also facilitates blood donation processes. There are no barriers I observed in this organization as it helps every person of the society.

This organization obtains its funds from the Federal government.  It is actively involved during natural disasters of disease pandemic. In fact, the organization responded to 520 disasters in the Central Pennsylvania region, where it helped 803 local families who had been affected by disaster.  There is no service fee required for one to obtain help from this organization as it is funded by government and international bodies.  Most of the staff I interacted with were respectful and had positive attitude.

In addition, the organization has five staff members who could speak other languages fluently, which makes it easy for them to communicate with Non- English speaking residents during disaster. The organizations operate in both referrals and self-referrals process. The organization has all contact details in internet (its website) and any person can access information from any location (Health York County, 2015).

NAMI York County branch offers support to people with mental illness in York County.  The group offers support connection group that meets weekly and monthly. They also offer peer to peer and family to family education program that focusses on wellness, recovery and mental health. The facilities advertise themselves through public facilities such as health centers and educational facilities. The main barriers observed low awareness of the program in the community.

According to the director, most people in this community will not bring their loved ones to the organization because they fear discrimination. There is no service fee as these services are funded by the Local government, yet only a small fraction of the community enjoys the services. The staffs in these facilities are understanding, respectful and are always willing to help. Only few of the staff could speak other languages fluently, which makes it difficult for them to communicate with Non- English speaking residents or the deaf and dump. The organizations operate in both referrals and self-referrals process (Health York County, 2015).

 The YMCA organizations target the residents of York County Community.  This program offers health and fitness knowledge. The organizations operate in both referrals and self-referrals process. The organization works with people of all interests, abilities and ages.  The organization tailors the programs content to suit the client needs. The facilities advertise themselves through its website.

The main barriers observed are that the organization charges $30-$49 for membership. This implies that large fractions of the population are locked out from experiencing these services. Language barriers are also an issue. Only few of the staff could speak other languages fluently, which makes it difficult for them to communicate with Non- English speaking residents. The staffs in these facilities are respectful, but tend to favor members from high income household.

Fire department provides professional, effective and courteous emergency response in order to protect the lives of York County residents as well as their visitors. The organization takes every effort to reduce the risk of the people residing in the community by preventing fire incidences through education and risk assessment of fire investigation. The department comprises of 56 personnel, one civilian employee and over 45 volunteers. There is no membership fee as it is funded by the federal government. The organization works mainly through referrals and self-referrals (Health York County, 2015).

 Community center main role is health promotion of the York county residents. They do so by promoting various activities that people learn more about physical activity and good nutrition. They organize school based tournament and cultural weeks from which the community actively participate. However, only few community centers are operational so far. For this reason, most people in the rural areas rely on alternative medicines, and pregnant mothers deliver with the assistance of the house wives (Health York County, 2015).

Provide a logical interpretation of the collected data using concepts of epidemiology

 York County is one of the most obese counties in the UDA. The current obesity rates in this county are approximately 31%. This indicates that approximately a quarter of the residents are obese. According to the distributed sources, the normal aggregate costs identified with the visits particularly to the obesity related outpatient and inpatient visits are estimated to be US$ 156 and US$ 1,512 respectively. Direct medicinal costs are estimated to be 45%-70% of the aggregate expenses linked to the obesity outpatient and inpatient visits.  There are minimal reports with regards to the mortality and morbidity rates among the population in relation to obesity and its associated health complication (Health York County, 2015).

Identify any problems based on the Healthy People 2020 goals for the selected community.

In view of Healthy individuals 2020, there are problems affecting the selected community. These problems include lack of physical and social environments that facilitates promotion of good health, lack of adequate frameworks that will promote the development of healthy behaviors which aims at improving the residents quality of life and there lacks strategies that adequately help achieve health equity in this community implying that no measures have been successful in eliminating health disparities (Health York County, 2015).

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Provide a logical discussion of the problems in relation to the Healthy People 2020 goals

Arguably, York County is one of the weak links of global preparedness with regards to the management of obesity and associated chronic health complication. To begin with, there is no transparency in acknowledging the burden of obesity in the community. In addition, the public healthcare system has failed to establish systems that will ensure elimination of health disparities in the region. York County is one of the Counties in which obesity rates among the low income household is continuing to rise. The behavioral risk indicator indicates that the residents in this community hardly exercise. Only a third of the populations eat three servings of vegetables each day.  The data also indicates that one in five people in the community are smoke (Healthy People 2020, n.d.).

Research findings indicate that two in every three people are obese. The rates of other chronic condition are such as cardiovascular disease, cancer, and diabetes also comparatively high. In addition, one in every five people in this community is diagnosed with depressive disorder and anxiety. Consequently, this has a negative impact on the Healthy People 2020 strategies whose main aim is to realize longer lives that are free from preventable diseases, elimination of health disparities, and creation of safe social and physical environments that promote good health and behavior of the healthy people (Healthy People 2020, n.d.).

Provide a logical discussion of community resources that are available to address the selected problem


         Community resources such as CDC ACHIEVE Program give valuable information effective strategies to manage obesity and its associated disorders.  As mentioned therein above, people who are at risk of being  obese infants, elderly, people suffering from chronic diseases, and pregnant women due to aggravating factors such as poverty and lack of physical activeness. This institution helps to increase awareness of the role of proper nutrition and physical activeness in eradicating obesity and its associated complication.  

The strategies include funding the local governments to give them support to improve amenities including Heritage Rail Trail County Park, walking paths and bike routes. This aims at giving the pedestrians access to activities that will improve their health. The program also works with the other stakeholders including schools facility which plays a critical role in school food based programs. Other stakeholders involved includes fitness based programs and organization such as YMCA and YWCA.  This helps the community to understand their perceived threats as well as the preventive measures that must be undertaken (Payne et al. 2013).

CDC ACHIEVE Program also helps the National Societies to play a leading role in managing the effects of the pandemic. This is facilitated through the close connection to communities and their auxiliary role to the governments through a measure commonly referred to as “Eat Play Breathe York”. This improves delivery of preventive services such as personal protective clothing during the outbreak, procurements and dispatchment of disinfectants, creating awareness sessions at school level (CDC, 2015).

Provide a logical primary prevention topic based on the problem identified in part C2.

            Effective treatment of obesity begins with change in a person’s lifestyle.  The obese person is expected to self-monitor the calorie intake and physical activities. This is achieved through effective goal setting and ensuring that they avoid factors that would lead to relapse of the old unhealthy habits.  Effective management requires highly motivated patient and committed healthcare professionals including dieticians, physical therapists, psychologists and other subspecialists (Payne et al. 2013).

            Behavior modification that targets diet and exercise must be included in all obesity management strategies for individuals whose BMI is above 25 kg/m2. Pharmacotherapy strategies are recommended for people whose BMI is above 27 kg/m2. Bariatric surgery is recommended for individuals who have BMI between 30 kg/m2 and 35 kg/m2. In dietary behavioral changes, people are advised to eat low calorie diets and practice portion control of the diets. Most of the diets underlie the weight programs guidelines such as those advocated by Jenny Craig and Weight watchers. The basic premise involves ensuring that the person obtain detailed dietary inventory which is normally used to estimate their caloric intake (CDC, 2015).

It has also been hypothesized that taking water before each meal facilitates weigh loss in obese middle aged people. This is associated to increase in resting energy due to water induced.

Physical activeness is recommended as it is effective for patients with cardiovascular disorder and respiratory health issues. Exercises are important because they help burn the excess body fat. For effective observation, people are encouraged to have moderate exercises continuously in order to achieve the effective weight loss. Research indicates that shorter bouts of physical activeness have better outcomes (Health York County, 2015).


CDC. (2015). Overweight and obesity trends. Retrieved from

Health York County (2015). Health York County Coalition-community Health Assessment. Retrieved from

Healthy People 2020 (n.d.). Goals and objectives. Retrieved from

Payne, W., Hahn, D., & Mauer, E. (2013). Understanding your health. New York, NY: McGraw-Hill.

York County PA (2016).  2016 York County and Surrounding Areas Resource Guide. Retrieved from

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