Student Name Western Governors University D224 Global and Population Health Prof. Name Date Local City and a Subpopulation at Risk What is the local city and subpopulation under consideration? The focus is on Union City, Georgia, emphasizing the African American community living below the poverty line. This subgroup is particularly vulnerable due to socioeconomic disadvantages and associated health challenges, which impact their overall well-being and access to resources. What is the size of the community and specific subpopulation? Union City has an estimated population of over 27,000 residents. African Americans make up the majority of the population, accounting for approximately 85.9%. This racial group also represents the largest portion of individuals living in poverty within the city. What are the gender demographics? The gender distribution in Union City is: Gender Percentage (%) Male 44.7 Female 55.3 What is the racial composition of Union City? Race Percentage (%) African American 85.9 White 3.9 Hispanic 3.8 Two or more races 3.1 What is the average income and educational attainment? The average annual income in Union City is approximately $28,110. Educationally, 88.7% of the population have attained at least a high school diploma, reflecting moderate educational achievement within the community. What percentage of the population lives in poverty? The overall poverty rate stands at 12.4%, with African Americans below the poverty line comprising 6.1% of the total population. What are the crime rates in Union City? Crime Type Percentage (%) Murders 13.5 Rapes 22.5 Robberies 35 Assaults 69 Burglaries 92 What are the common occupations in Union City? Employment in Union City primarily revolves around office-based roles, indicating a workforce engaged mostly in service and administrative positions. What is the access to healthcare, transportation, and food like? What are the health and nutrition statistics? Nearly half of the population (48.6%) faces challenges related to health and nutrition, reflecting widespread issues in maintaining adequate health and dietary standards. What environmental concerns affect the subpopulation? A pressing environmental concern for African Americans living under the poverty line in Union City is limited access to sanitation facilities. Poor sanitation contributes to higher incidences of hygiene-related diseases. Additionally, homelessness exacerbates these issues by restricting access to stable housing, clean water, and sanitary conditions. Compounding this, Georgia’s elevated cost of living further limits access to these essential services. How do the demographics of this subpopulation compare to the broader community, and what health concerns are supported by the data? African Americans in Union City not only form the majority population but also bear a disproportionate share of poverty. Females aged 55-64 represent the largest demographic living in poverty, followed by older females (75+) and those aged 35-44. Challenges such as homelessness, food insecurity, and poor access to necessities like clean water and shelter contribute to adverse physical and mental health outcomes. National data suggest that among homeless individuals, 20% suffer from mental illness, while 16% contend with conditions such as substance abuse, HIV/AIDS, diabetes, or heart disease (Hunger, Homelessness and Mental Health: HOPE Is Here, 2021). These social determinants heavily influence the health status of this population. What is one social determinant of health (SDOH) affecting this community? Low income stands out as a crucial social determinant that profoundly impacts health outcomes within this community. It significantly contributes to increased morbidity and premature mortality among African Americans in Union City. How does low income affect health outcomes? Economic hardship limits access to critical health resources, including nutritious food, stable housing, and healthcare services. It heightens the risk of mental health issues such as depression, which can escalate to substance abuse and increased vulnerability to chronic diseases like cardiovascular conditions. During the COVID-19 pandemic, African Americans in Georgia experienced elevated mortality rates, partly due to preexisting disparities in healthcare access and socioeconomic factors (Shannon et al., 2022). What are the primary community health concerns? Cardiovascular disease is the leading cause of both death and chronic illness in Georgia, with a disproportionate impact on low-income African Americans. Other challenges include a shortage of healthcare providers and insufficient insurance coverage, which restrict access to necessary medical care. What health issues drive emergency room visits and hospital admissions? Injuries are among the leading causes of emergency department visits and hospital admissions within this community (Weiss & Jiang, 2021). What factors are reducing the quality of life in the community? The lack of affordable housing, limited healthcare services, and inadequate insurance coverage contribute significantly to the decline in quality of life. These shortages perpetuate health disparities and social instability in Union City. What resources currently support the subpopulation in addressing social determinants of health? Resource Description SNAP Provides financial assistance to purchase groceries, enhancing food security. Medicaid and Medicare Offer affordable health insurance to eligible low-income individuals and those with comorbidities. What additional resources are needed to address social determinants of health? Despite existing support programs like Medicaid, SNAP, Peachtree for Kids, and food banks, further resources are essential: Investment in education and mental health infrastructure could substantially reduce poverty levels and improve health outcomes within the community. What evidence-based intervention can address the resource gap in healthcare? A pivotal intervention involves reducing the Black-white wealth gap that perpetuates health disparities. Historical structural barriers have limited African Americans’ opportunities for wealth accumulation, negatively affecting health outcomes. Research indicates that post-COVID-19, white households recovered economically faster than Black households, which experienced sustained financial hardship (Brookings, 2022). Addressing these disparities requires comprehensive public policy reforms and enhanced fiscal support, including stronger safety nets and targeted income supports. How will this intervention reduce the resource gap? Closing the wealth gap through policy reforms and financial assistance can improve African American communities’ access to healthcare, education, and housing. This would reduce economic stressors contributing to poor health, thereby enhancing resilience against future economic downturns and promoting equity in health outcomes. References Brookings. (2022, March 9). The Black-white wealth gap left Black households more vulnerable. https://www.brookings.edu/articles/the-black-white-wealth-gap-left-blackhouseholds-more-vulnerable/ Hunger, homelessness and mental health: HOPE is here. (2021, November 8). https://gahope.org/hunger-homelessness-and-mental-health-hope-is-here/ Shannon, J., Abraham, A. J., Adams, G. B., & Hauer, M. (2022).

Student Name Western Governors University D224 Global and Population Health Prof. Name Date Description of Field Activity During a 10-hour clinical shift, I shadowed a BSN-prepared nurse preceptor at an outpatient clinic. Throughout the day, the preceptor engaged in various patient care activities that highlighted essential nursing roles such as patient education, interprofessional collaboration, communication, referral facilitation, and resource allocation. These efforts collectively aimed at enhancing patient wellness and preventive care. The preceptor cared for over 20 patients by administering influenza vaccines, ensuring patient safety with a vaccination screening checklist. In addition to giving shots, the preceptor emphasized the importance of flu vaccination, explaining how it lowers the risk of illness, hospitalization, and mortality related to influenza. This educational approach led to a higher acceptance rate of vaccines among patients. The preceptor also conducted focused assessments, such as reviewing patients’ blood pressure records. For instance, two male patients, aged 52 and 56, presented blood pressure readings between 120/70 and 137/90 mmHg. After consulting with the physician, referrals were arranged for laboratory tests and electrocardiograms. Patients received education on hypertension risks, including retinal damage, stroke, and kidney failure, and were advised on lifestyle changes such as regular exercise, weight control, and sodium intake reduction. The preceptor managed medication prescriptions by contacting pharmacies and handled patient phone inquiries to provide guidance on health and medications. How Does the Nurse’s Role Promote the Sphere of Care? Nursing Activity Sphere of Care Rationale Flu vaccine administration Wellness and Disease Prevention Immunization prevents severe flu complications, reduces hospital admissions, and lowers mortality (CDC, 2023). Patient education on hypertension Wellness and Disease Prevention Lifestyle counseling aids blood pressure control, preventing cardiovascular diseases. Blood pressure monitoring & referrals Wellness and Disease Prevention Early detection and diagnostic testing help avert complications related to hypertension. Prescription management Wellness and Disease Prevention Timely medication access supports effective disease management and patient safety. Communication and patient support Wellness and Disease Prevention Clear communication enhances patient adherence and improves health outcomes. The nurse’s flu vaccine administration directly supports disease prevention by protecting individuals from potentially fatal infections. Managing hypertension through patient assessments, referrals, and education reduces cardiovascular risks. Furthermore, efficient communication and coordination with healthcare providers and pharmacies maintain continuity of care, illustrating the nurse’s pivotal role in promoting wellness and preventive health. Description of Field Activity on January 26, 2024 On this 10-hour shift, I observed the BSN preceptor begin the day by carefully reviewing patient charts and laboratory results. Working alongside the clinic physician, the preceptor addressed needed interventions and referrals. Many patients were stroke survivors aged between 37 and 70 years, most experiencing unilateral weakness. One notable case involved a 67-year-old male presenting with mild headaches and muscle spasms on his weakened side. Laboratory results revealed hyponatremia (sodium 131 mEq/L). The preceptor discussed this finding with the physician, who ordered discontinuation of Lasix and prescribed Robaxin for spasms. The preceptor educated the patient regarding medication changes and arranged follow-up care. Another patient, a 45-year-old male with iron deficiency anemia, had difficulty swallowing iron supplements. The preceptor advocated for switching to a liquid form, obtained a new prescription, contacted the pharmacy, and provided nutritional counseling. A referral to a dietitian was also arranged to support the patient’s dietary needs. Additionally, a 63-year-old traumatic brain injury patient required help with health insurance changes to maintain ongoing rehabilitation. The preceptor collaborated with a social worker to assist the patient with paperwork and ensure continuity of care. The preceptor also educated stroke patients and their caregivers about fall prevention, emphasizing the use of assistive devices, home safety modifications, and warning signs that require medical attention. Each patient was given a stroke guide pamphlet to reinforce this education. How Are These Nursing Activities Related to the Sphere of Care? Nursing Activity Sphere of Care Rationale Focused assessment and lab review Regenerative/Restorative Early identification and treatment support optimal recovery and prevent complications in stroke patients. Medication advocacy and education Regenerative/Restorative Ensuring medication compliance aids oxygen transport and prevents anemia-related issues. Insurance assistance through social work Regenerative/Restorative Helping with insurance continuity prevents care disruption, supporting rehabilitation and recovery. Fall prevention education and referrals Regenerative/Restorative Education on safety reduces injury risk and promotes patient independence during recovery. The preceptor’s focus was on restorative care, aiming to optimize patient recovery and prevent further health decline. Nursing roles included coordinating care, managing medications, and addressing social determinants of health such as insurance, all essential for regenerative care. Description of Field Activity on January 30, 2024 During a 9-hour clinical shift, I observed the BSN preceptor participate in an Interdisciplinary Team (IDT) meeting. The preceptor advocated for increasing therapy time to allow comprehensive patient education regarding medication management and lifestyle changes. Family members supported these proposed changes. Throughout the shift, the preceptor administered COVID-19 booster and flu vaccines, providing patients with safety pamphlets and education on vaccine benefits. A critical incident involved a patient exhibiting hypoglycemia (blood glucose 66 mg/dL) without a history of diabetes. The preceptor promptly followed hypoglycemia protocols, stabilized the patient, and arranged referrals for food assistance programs through the North Texas Food Bank and Temporary Assistance for Needy Families. The physician was notified, and laboratory tests, including HbA1c, were ordered. The preceptor also provided smoking cessation counseling, explaining risks such as lung cancer and emphysema. One patient accepted a prescription for nicotine patches to aid quitting. Colon cancer screenings were conducted on four patients aged over 60 using Cologuard kits. The preceptor explained the importance of early detection and collected stool samples for laboratory analysis. Connection of Nursing Activities to the Sphere of Care Nursing Activity Sphere of Care Rationale IDT meeting participation and advocacy Wellness Adjusting care plans ensures patients receive needed education, improving disease prevention and management. Vaccine administration and education Wellness and Disease Prevention Immunizations protect against viruses like influenza and COVID-19. Hypoglycemia management and referrals Wellness and Disease Prevention Early intervention and social support prevent complications and promote overall health. Smoking cessation education Wellness and Disease Prevention Counseling reduces chronic disease

Student Name Western Governors University D224 Global and Population Health Prof. Name Date Global and Population Health A. Description of Location and Subpopulation Community/Location: Petersburg, VA Petersburg, Virginia, is a city with an estimated population of about 33,394 residents, according to recent reports (City-Data, 2024; U.S. Census Bureau, 2023). This city exhibits a complex demographic makeup and socio-economic landscape that significantly influences its public health challenges. Understanding these demographic and socio-economic details is crucial for tailoring health interventions and policies effectively. What is the demographic breakdown of Petersburg, VA? Aspect Description / Data Source Population Size Approximately 33,394 residents City-Data, 2024; U.S. Census Bureau, 2023 Gender Males: 45.6% (15,228); Females: 54.4% (18,166) City-Data, 2024 Median Age 36.9 years City-Data, 2024 Race/Ethnicity Black/non-Hispanic: 77%; White/non-Hispanic: 15.9%; Hispanic/Latino: 6.0%; Two or more races: 5.0%; Asian: 1.2%; Hawaiian/Pacific Islander: 0.1%; American Indian/Alaska Native: 0.1% City-Data, 2024; U.S. Census Bureau, 2023 Median Income $50,741 City-Data, 2024 Education Level High school diploma or higher: 87.1%; Bachelor’s degree or higher: 25%; Graduate/professional degree: 8.3% City-Data, 2024 Poverty Rate Overall: 22.2%; White Non-Hispanic: 19.2%; Black: 22.7%; Hispanic/Latino: 21.2%; Two or more races: 33.8% U.S. Census Bureau, 2023 Crime Rates (2022) Murders: 21; Rapes: 17; Robberies: 45; Assaults: 190; Burglaries: 88; Thefts: 682; Auto thefts: 87; Property Crime Rate: 193/100,000; Violent Crime Rate: 526.1 City-Data, 2024 Occupations Healthcare: 13.4%; Educational services: 9.2%; Public administration: 8.6%; Accommodation & food services: 7.4%; Unemployment: 8.9% City-Data, 2024 Access to Healthcare Uninsured population: 9.7% City-Data, 2024 Transportation Car: 84.2%; Carpooled: 9.8%; Bus: 2.4%; Walked: 1.2% City-Data, 2024 Food Access Grocery stores: 13; Restaurants: 24; Convenience stores: 3.04; Population without access to large grocery stores: 3.95% City-Data, 2024 Health Statistics Cancer incidence: 5.5%; Heart disease prevalence: 6.0%; Hypertension: 45.3%; Preventable hospital admissions (Medicare): 60%; Leading cause of death: Heart disease/strokes (22%) City-Data, 2024 Nutrition Obesity rate: 34.4%; Diabetes prevalence: 14.9% City-Data, 2024 Note: Data are approximated and reflect city-wide figures. What is the specific subpopulation of concern within Petersburg? Within Petersburg, minority populations—particularly Black residents and those identifying as two or more races—along with younger individuals, are especially vulnerable. The poverty rate among those identifying as two or more races is significantly higher (33.8%) compared to White non-Hispanic residents (19.2%). Additionally, nearly one-quarter (24.7%) of the population is under the age of 18, with many children disproportionately affected by poverty, creating urgent needs for focused social and health interventions (U.S. Census Bureau, 2023; City-Data, 2024). A1. Description of Environmental Concerns What are the key environmental health issues affecting Petersburg, VA? Petersburg faces serious environmental health challenges, notably poor air and water quality. The presence of the Petersburg compressor station results in emissions of nitrogen dioxide and sulfur dioxide, which degrade air quality and contribute to ecological damage in the Chesapeake Bay watershed. Industrial pollutants from local factories further worsen air pollution. These environmental burdens disproportionately affect low-income residents, who often lack resources to mitigate exposure, such as air purifiers. The Virginia Department of Health highlights that Petersburg has the state’s highest asthma hospitalization rate and the lowest life expectancy, directly linked to poor air quality. Respiratory conditions are exacerbated, limiting residents’ health and quality of life. Water safety is another concern, particularly regarding Lake Chesdin, part of the Appomattox River system. This water source faces contamination risks that could impact the city’s drinking water supply, posing additional health threats (Virginia Department of Health, 2023). A2. Comparison Discussion: Subpopulation vs. Larger Community How does poverty impact different racial groups and age groups in Petersburg? Poverty affects Petersburg’s population unevenly across racial and age groups, with minority groups and youth facing higher rates of economic hardship: Group Poverty Rate (%) White Non-Hispanic 19.2 Black 22.7 Hispanic/Latino 21.2 Two or more races 33.8 Population under 18 24.7 Population 18-64 20.9 Population 65 and over 10 These figures reveal that minority racial groups, particularly those of mixed heritage, and children experience higher poverty rates compared to older adults. Additionally, nearly 10% of the city’s population lacks health insurance, limiting access to essential healthcare services. Financial barriers and transportation challenges often prevent uninsured individuals from obtaining preventive care, further entrenching health disparities (City-Data, 2024; U.S. Census Bureau, 2023). B. Social Determinants of Health (SDOH) What is one major social determinant of health affecting Petersburg? Poverty and unemployment are significant social determinants influencing Petersburg’s health outcomes. High poverty levels contribute to limited access to quality healthcare, educational setbacks, food insecurity, transportation difficulties, and heightened crime rates. Collectively, these conditions exert a strong negative effect on community health. How do these social determinants specifically impact the subpopulation? The city ranks low compared to state and national health metrics, influenced by systemic issues such as poverty, homelessness, mental health struggles, financial illiteracy, racism, public safety concerns, and educational deficiencies (Virginia Department of Health, 2023). Approximately 9.7% of residents remain uninsured, often due to complex enrollment processes and limited awareness. Cancer is the leading cause of premature mortality in residents under 75, accounting for 37% of such deaths, followed by heart disease (CDC, 2023). Chronic diseases such as hypertension, diabetes, and obesity are widespread, especially in low-income neighborhoods where access to healthy food is restricted. Fast food outlets and liquor stores dominate these areas, worsening nutritional health risks (CDC, 2023). B1. Resources Available to the Subpopulation Resource Description Health Insurance Enrollment Assistance Local partnerships assist residents in navigating health insurance enrollment to reduce uninsured rates. Rebuilding Together Petersburg Provides free home repairs and safety upgrades for elderly, disabled, veterans, and low-income families to improve living conditions. C. Needed Resources What additional resources does Petersburg require to improve community health? To improve health outcomes, Petersburg needs expanded access to low-income health insurance programs that would increase affordability and coverage. Additionally, the city lacks adequate homeless shelter facilities, despite a rising number of homeless individuals. Currently, 361 people have been assisted by local coalitions, but no permanent shelter exists, highlighting a critical gap in housing support. D1. Explanation of Resource Importance Access to health insurance is essential for empowering individuals to obtain regular