Clinical Plan Of Care For Underserved Population In Glendale, California

Background Information

In tis clinical plan of care, the aim of the service will be a diverse group of population having lowest household incomes and higher rates of chronic diseases and disease management in the United States of America. The city of Glendale is situated in the County of the Los Angeles, California with an estimated population of about 200,167. The per capita income is about $ 29,264. The median household income is below the state average. Due to less physical activities and source of healthcare facilities the vulnerable group of population in this location are prone to chronic healthcare disease such as cardiac diseases, diabetes, bronchitis and cancer. Further the few people were insured with any Medicare facility are very less, that increases the risk related to chronic disease in the population.

While discussing the social history it should be mentioned that chronic disease is one of the biggest reason due to which people lose their life in USA. Chronic diseases included diabetes, cardiovascular diseases and more. Diet, nutrition, lifestyle and environment are few of the reasons due to which development of such disease can be seen (Riegel, Jaarsma&Strömberg, 2012). In a report, the people in Glendale mentioned that 40% of them had a fruit once in a week, whereas only 18% mentioned that they used to eat green vegetables once in a day. The rate of cigarette smokers were higher in this state and more than 47% adults were regular smokers (Duggleby et al., 2012).

In this place, it is very difficult for people to take care of their health in a holistic manner as with low income and low resources, they had less or no health literacy that was the primary reason for their health concerns. While observing the concerns of this community, resources, time and income was emerged as primary needs. Further, they also had the need of sanitizers, potable water and healthy food, as due to the less availability of proper food they are not been able to fulfill their nutritional requirements. Therefore, the basic fundamental needs such as food, shelter, health are the needs of the community.

The problem for such rates of chronic diseases are the health risk behavior of the community. The four prime reasons include, lack of exercise or physical activity, alcohol consumption rate, high tobacco use and poor nutrition level of the population. It should be mentioned that as per the data of CDC more than 80,000 people died each year in this community, hence binge drinking is another risky health condition, within which most of them belonged to the lower income families. . Hence, lifestyle and less income is the main reasons for chronic health outcomes(“Los Angeles County Department of Health Services-Services-Emergency“, 2018).

Social History and Health Concerns

The service will be provided to the town hall of Glendale, California and this project will be for the lower income group population of Glendale, having low income and higher rates of acquiring chronic disease (Thom et al., 2013). Upon a patient’s visit, their vital signs, height, weight will be recorded. Further the health history will be assessed and then all the cost of the medication will be assessed.After providing care to the patient, follow up will be taken and then referral will be provided to them so that so that in excessive severity they can attain quality healthcare in another healthcare facility.

USCR	Men/unmet rationale
Sufficient intake of water food and air	Partially met as the environment was fresher than other US cities, as well as the water available was potable, however, healthy food was limited to some population.
Care for eliminations (urinating, perspiration, menstruating)	Partially met as due to less availability of resources, they were not been able to take care of their sanitation and excretion related health.
Activity and rest related balance	Unmet, the older adults and women were not active in their lifestyle and therefore the balance was not maintained.
Social interaction and solitude related balance	This was met as the relationship between people in the community was sting and social interaction was healthy.
Prevention of hazards	Unmet, along with health, mental stability, and economic condition was suffering and therefore, children, older adults and pregnant womenlived in hazardous condition.
Normal function and development	Partially met as they were able to go to the healthcare center to make their condition better.

DSCR	Men/unmet rationale
Maturational : changes in needs with development	Partially met, as those belonging to the lower income group were not using healthcare service.
Situational : deleterious functions of different life events	Partially met, as the older adults were unaware of their chronic situation and was also unable to understand the effect of this on their health

HDSCR	Men/unmet rationale
Determining appropriate medical health	Met as, maximum of the people, especially the children and the older adults visited the healthcare center for their plan of care
Awareness and taking care of pathological condition	This is partially met as a section of people were sincere about their health and trusted the healthcare system for that.
They carried out their therapeutic and diagnostic measures properly	This was also partially met as they had financial constraints
They knew the side effects of medicines	Partially met, as most of the patientswere unaware of the medicinal side effects of their health and were consuming medicines for their general ailments without the healthcare prescription.
They were keen to modify their self-concept	Partially met as a section of adults were trying to change their sedentary lifestyle so that their health can be changed.

Patient Problem (stated as NANDA diagnosis)	Expected outcomes	3 identified nursing interventions	Evaluation
The patient is having high risk of chronic illness including diabetes, cardiac arrest, further less activity can also cause obesity.	1. By the end of the care session, the patient will be able to understand the effectiveness of activity for healthy lifestyle and will seek medical healthcare interventions, if any chronicity occurs.	Firstly the clients ability to learn and understand the healthcare importance of the physical activity and for that their mental stability and previous knowledge will be assessed. Rationale: depending on the learning ability of the patient the healthcare professional will inform him or her about the importance of physical activities.	1. This outcome was met as I was able to observe the change in the health literacy in people belonging to the low income group and they were now more interested in self managing their life style.
Such education will be provided to the women and the elderly people with low economic background in the community so that early intervention can be applied. Rationale: early interventions are effective in developing healthy community (Pandit et a., 2014)
Different problem solving teaching strategies will be applied so that self-efficacy of the people can be enhanced. Rationale: after providing advice, patients should be influenced so that these can be implemented (Brook et al., 2013).
2. The patient will demonstrate important physical activities such as exercises, walking, jogging at the end of the care session and will be able to take care of their medicines.	The activities of the patient will be monitored, so that chronic conditions and infections can be managed. Rationale: low health literacy can lead to transmission of the infectious diseases. (Gillespie et al., 2012).	2. This was partially met as the physical activities they were performing required more practice and dedication and cannot be addressed due to lack of time as most of the people have to work overtime due low income status.the proper implementation of exercise and other healthcare interventions will be ensured
Rationale: it is important because it will prevent infections and will determine the patient’s safety and security while receiving healthcare interventions(Kankeu et al., 2013)
The patient will be provided with continuous and coordinated care so that in expert observation, the habit of activity can be imposed. Rationale: it is important as it makes the patient alert and active while performing physical activities (Valentijn et al., 2013).

Comparison of underserved and more affluent community:

Similarities

Dissimilarities

· Both of the community suffers from serious health issue due to lack of proper diet and physical activity.

· Both of the community is susceptible to communicable diseases, but the difference is the rate of transmission is less in case of affluent community.

· Both of the community suffers due to excessive substance abuse such as alcohol, drugs and other solvent abuse.

· The people from underserved community lacks access to nutritious food thus suffers from poor nutritional health issue, whereas in the affluent community, nutritious food is available and affordable to keep the people healthy.

· The affluent community could easily avail the costly treatment process in order to cure severe diseases and prevent them in an effective manner, in contrast, the people with low-income lacks access to the improved technology related to treatment process.

· Disparity in the distribution of health resources is another issue. The resources are accessible for the affluent community to an extent, whereas, the underserved community suffers due to lack of access to such resources (Pickett & Wilkinson, 2015).

Thus, it is important to implement effective plan of care in order to reduce the health inequality between these communities and improve the health condition of the underserved population for providing them a better standard of living.

References

Duggleby, W., Hicks, D., Nekolaichuk, C., Holtslander, L., Williams, A., Chambers, T., &Eby, J. (2012). Hope, older adults, and chronic illness: a metasynthesis of qualitative research. Journal of advanced nursing, 68(6), 1211-1223.

Edwards, M., Wood, F., Davies, M., & Edwards, A. (2012). The development of health literacy in patients with a long-term health condition: the health literacy pathway model. BMC public health, 12(1), 130.

Goldman, M. L., Ghorob, A., Eyre, S. L., &Bodenheimer, T. (2013). How do peer coaches improve diabetes care for low-income patients? A qualitative analysis. The Diabetes Educator, 39(6), 800-810.

Kankeu, H. T., Saksena, P., Xu, K., & Evans, D. B. (2013). The financial burden from non-communicable diseases in low-and middle-income countries: a literature review. Health Research Policy and Systems, 11(1), 31.

Los Angeles County Department of Health Services-Services-Emergency. (2018). Retrieved from https://dhs.lacounty.gov/wps/portal/dhs/services/emergency/

Pandit, A. U., Bailey, S. C., Curtis, L. M., Seligman, H. K., Davis, T. C., Parker, R. M., … & Wolf, M. S. (2014). Disease-related distress, self-care and clinical outcomes among low-income patients with diabetes. J Epidemiol Community Health, jech-2013.

Pickett, K. E., & Wilkinson, R. G. (2015). Income inequality and health: a causal review. Social science & medicine, 128, 316-326.

Riegel, B., Jaarsma, T., &Strömberg, A. (2012). A middle-range theory of self-care of chronic illness. Advances in Nursing Science, 35(3), 194-204.

Thom, D. H., Ghorob, A., Hessler, D., De Vore, D., Chen, E., &Bodenheimer, T. A. (2013). Impact of peer health coaching on glycemic control in low-income patients with diabetes: a randomized controlled trial. The Annals of Family Medicine, 11(2), 137-144.

Valentijn, P. P., Schepman, S. M., Opheij, W., &Bruijnzeels, M. A. (2013). Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. International journal of integrated care, 13.

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