Developing a Care Plan

Running head: PHASE 5 1

PHASE 5 13

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Phase 5: Developing a Care Plan

Jessica Wagnon

South University Online

Holistic Professional Nursing | NSG4075 S02

Week 6 Assignment 2

Grecia Ibarra

January 1, 2017


Developing a Care Plan for an Aggregate


A great amount of research has been conducted on the impact of disasters on mental health. However, little has been done concerning the impact disasters have on minor and marginalized people groups. Research suggests that the minority groups, specifically Latinos and African Americans, are at a higher risk of being exposed to disasters and consequently suffer more effects past the disaster. This is due to lower levels of disaster preparedness and education, the likelihood of living in poorly constructed homes, lower risk sensitivity and lower chances of clearing from scenes during disasters (Hill, 2007). They are also at a higher chance of experiencing physical challenges and suffering during disasters, and other effects such as property damage, personal loss, delay in restoration of utility services such as water and electricity (Becker, 2004).

They also experience a greater chance to suffer from post-disaster mental outcomes such as panic attacks, posttraumatic stress, and depression. Socio-cultural factors sometimes heighten the exposure and vulnerability to the disasters. They include concern for family and other social networks and adherence to cultural values Centers for Disease Control and Prevention (2005). An example is Familismo among the Latinos that influences the reliance on family to prepare for disaster and the reluctance to burden family by seeking help from the family, in case of disasters.

Close to 50 million Americans today are of African American nature. In 2010, half of this ethnic racial group lived I the south of America, 18 percent to the Midwest, 10 percent to the west, 18 percent mid-west and 17 percent northeast (Black City Info, 2016). Adversity like slavery which is historically based, race based exclusion from health, sharecropping and other numerous factors have translated to socioeconomic disparities that are being experienced by African Americans. The status in terms of socio economic is linked to mental health. Impoverished persons engaging in substance abuse, homeless and incarcerated are at very high risks of mental health. In Gadsden, the rejection of Africans Americans continues with considerable and even measurable problems in mental health.

There is minimal research available on the post disaster mental health especially on minority groups due to several reasons. They include lack of a sample size enough to provide adequate statistic power to test the differences across the minority groups. Purposeful sampling is also a common practice in carrying out research in post disaster mental health hence eliminating the chance for generalizing the results found (Hill, 2007). However, studies indicate that minority groups suffer a lot from disasters as compared to the majority groups.

Social determinants and non-social determinants have a strong correlation and influence on several health endpoints. This is especially very true for environmental health as studies have noted that exposures related to environmental risks are also unequally distributed. The unequal distribution is very much related to social and non-social characteristics such as ethnicity, income, gender and age. The risk and exposure to health depends on the group in question and the factors involved (Kramerow, 1999). In Gadsden, research has shown clearly that the African American group is more vulnerable than any other group to such factors that are endpoints in healthcare determination.

Studies done in trying to bridge such inequalities and improve health in the marginalized groups have adopted methodologies that incorporate realization of social patterns in risk exposure. In most cases health risks depending on the social and non-social factors have a considerable potential to act as confounders of the parameters of interest, this implies the connection between health and the respective risk factor. To get results with a clear view of the contribution to the risks I health, standardization techniques are applied to dis-factor the contribution of independent social economic. The above methodology and approach has made significant achievements in the assessment of several environmental risks and is being utilized widely in environmental epidemiology. It also reflects that social economic factors are a strong factor in environmental exposure.

Nonetheless, a complete understanding of how the environment risk factors fully operate for minority groups like in Gadsden in the reality of a social environment has not yet been reached. The understanding however if attained would be very informative to assist in the designing of policy that is affirmative action in nature and tries to bridge this disparity in health groups of minority African American (Hill, 2007). A framework of understanding around this issue does however point us to a number of major pathways: there is sufficient evidence that social determinants do affect health, what is unclear however is the relative importance of the socially determined exposure to environmental factors; social determinants may affect environmental conditions of a group of people and this contributes to the fact that certain specific groups or peoples are more exposed to harmful environments resulting to poor health disparity; on a level of given exposure that is the same, a marginalized group will show more severe health effects influencing the exposure response reaction; and social determinants themselves directly affect exposure as indicated in point number three and even beyond Centers for Disease Control and Prevention (2005).

The last two points are exposure differentials that cause variation of exposure. A good framework model can be used to identify the institutional landscape with respective services and actions that can tackle the inequalities. Several actors are moderated to reduce and mitigate the occurrence of inequalities in the environment whether they are socially caused or not. At the very first place, responsibility is with actors on the environment, occupational settings of a group and other factors like housing. The health sector also has a special and key role to play that is not reduced to the provision of health Centers for Disease Control and Prevention (2005). The health sector should additionally participate in preventive action and including other health stakeholders to address the increasing problem in health disparity and inequalities and therefore shape a common health in all policy approach (Becker, 2004). As demonstrated national health and welfare systems have a responsibility in joining forces and addressing the increasing problem being caused because of health inequalities. Environment6al inequalities have been seen in Gadsden to be a cause of health inequalities and there is need to join forces and solve the problem.

Disasters and especially natural disasters are indiscriminate in nature; however, research in a growing body of inquiry of health and disparities in marginalized communities and ethnic groups has demonstrated that poor and medically underserved persons that reside in rural areas do bear an unequal burden. African American ethnic group in Gadsden live in conditions that may not well be said to be rural but are underserved in terms of infrastructure which is a risk in times of disaster. The studies done in relation to rural areas can be replicated for this group with closer or almost similar confounding factors as a community that was based in a rural area with an underpinning of the baseline of being underserved in several ways that include health infrastructure.

Communities such as African Americans in Gadsden nationwide do suffer in a disproportionate manner for being underserved in health infrastructure. When disasters strike chances of a discontinuity in health arising is very high, this causes a fragmented infrastructure and channels for healthcare delivery in primary and secondary care. If an area has been previously underserved with provision of healthcare infrastructure, the area becomes even more distressing for the marginalized ethnic community (Becker, 2004). Areas like Gadsden that persistently struggle with healthcare disparities present challenges in attending to victims of such disasters. In the wake of such disasters it is likely that the disaster itself becomes an exacerbating factor of the existing environmental, social and non-social attributes that make such an ethnic group very vulnerable to provision of health.

For this discussion, we define a health disparity as the presence or difference in health care availability across diverse populations. Information on the impact of disasters on healthcare is limited and no sufficient study has been done on the same topic. However, there is evidence enough to suggest that an exacerbation of health services occurs with the onset of a disaster and the worst hit are the marginally served in a community. Poor communities as the African Americans living in Gadsden can be labeled as being medically underserved. Such areas have been indexed by the US Department of Health and Human Services Health Resources and Services Administration as based on criteria that considers the following indicators: population aged 65 and older; population ration of health provider to general population; the population living below the poverty line; and infant mortality rate.

In 2006, a third of the population in Gadsden had an experience with delayed Medicare access or were even unable to obtain access in medical care. Unmet needs and persistent in nature contribute greatly to underlying health disparities in healthcare in Gadsden and in the African American and Latinos populations. Deferred cases and disparities pose serious threats to health in times of disaster. A lack of technical innovations, few medical facilities, specialty practices and number of providers is chiefly to blame for the situation of marginalized communities receiving substandard care. African Americans in Gadsden are characterized with low income, people of color, lower education levels, unemployed and being under insured. All these factors combine to give rise to the debasing conditions that make access to health subpar. A quarter of the US total population lives in rural areas with this number being afflicted by poverty, a fifth of it is below the poverty line (Becker, 2004).

The barriers to health are out of a myriad cause and each cause is a barrier to a timely response and recovery from a disaster. Disasters mainly occur in two major categories either natural or technological or even a mix of the two. Natural disasters are outside the scope and control of humans while technological disasters are mainly the breakdown of human made systems. Evidence of threats to public health in times of disaster are quite evident. At the wake of a disaster, acute illnesses and injuries that are life threatening emerge. Healthcare systems are immediately overwhelmed by the capacity to respond to all the emergency calls. A surge in demand of medical services can overstretch the provision of medical aid to such an extent that most acute illnesses evolve to become chronic illnesses. There are long term needs of people documented after disasters like the collapse of the trade center and forest fires around the country after exposure to the surrounding conditions of the site of disaster.

Very little has been done in surge capacity modeling in Gadsden. Strategic planning needs to be accounted for in addressing community level factors to response planning. As this is done the healthcare disparities that are inherent in such communities need to be considered. Disaster epidemiology is an upcoming field and it needs to be applied first and foremost for pilot studies in marginalized groups in Gadsden to understand the required response and timely planning. This knowledge of responding timely to disasters in areas of huge disparities is important as global climate change looms in the horizon.

Numerous studies in health disparities have shown that residents of Gadsden and those living in disadvantaged neighborhoods in similar environments across the country have little or no support to health behaviors and these increases the health disparities. Fast food chains and its similar establishments have targeted the low income racial minorities as a growing market for their products. High priced food marts and inadequate access to healthy affordable food has been linked to the ever-rising cases of obesity amongst African Americans. Obesity has been a precipitator of many chronic illnesses like hypertension and heart diseases. Convenience and cost is a strong influence to African Americans and all other people of low income areas. Fresh fruits, vegetables and lean meat are more expensive to buy than processed foods that are not very healthy in contrast to the former.

Obesity as diagnosed by nurses and healthcare professionals has become an enormous problem across American for all people of color. Plans and strategies in place to tackle this have been put in place and include national programs to improve the quality of diet and the overall health and especially amongst African Americans and all other people of color. Body and Soul is a collaborative effort is a research by American universities to improve and study dietary interventions for African Americans under real conditions.

There is need to strengthen intervention measures for the African Americans by increasing the knowledge and information base of proper eating habits to improve the overall health. The aggregate in Gadsden is becoming health conscious and has been seeking health screenings and treatment (Kramerow, 1999). A more health awareness campaign needs to be conducted in these areas as an intervention plan and especially amongst the elderly. Awareness in this group is based on levels of age and generations. The older African American group is suspicious of clinicians because of past experiences with healthcare. These are reluctant to share family and historical details and building a relationship based o trust is essential for them. The most direct measure of well-being in any level is probably the rate of disease and death. In Gadsden, premature disease and death is because of chronic health issues; these need prolonged intervention and management strategies over the course of life (Kramerow, 1999). It is therefore necessary to have synergistic efforts to improve the environment, institute proper planning for emergency disaster response and improve socio economic factors of African Americans living in Gadsden, Alabama.


















Black City Info. (2016). Black/African American Gadsden. Alabama Travel, Businesses – Entertainment, Events and City Guide. Retrieved 28 November 2016, from

Becker, G., Gates, R. J., & Newsom, E. (2004). Self-care among chronically ill African Americans: culture, health disparities, and health insurance status. American Journal of Public Health94(12), 2066-2073.

Centers for Disease Control and Prevention. (2005). Health disparities experienced by black or African Americans–United States. MMWR: Morbidity and mortality weekly report54(1), 1-3.

Hill, R. (2007). A Strengths Perspective’ on Black Families. Retrieved from on 13th December 2016

Kramerow, E., Lentzner, H., Rooks, R., Weeks, J., & Saydah, S. (1999). Health and aging Chartbook. Hyattsville, MD: National Center for Health Statistics.










Phase 6: Implementation of the Care Plan

The discussion of the implementation of the care plan will focus on three families with young children in Gadsden, Alabama. This particular target group has individuals across various age groups, which would have an enormous impact on the implementation of any health intervention. Children heavily rely on their background to shape their beliefs and future through the availability of vital resources in life.

In Alabama, statistics indicate a high prevalence of health disparities among the families resulting from harsh economic conditions (Xu, Town, Balluz, Bartoli, Murphy, Chowdhury, & Jones, 2013). The African Americans in the county have poorer access to medical care; poorer health outcomes as well higher mortality rates as compared to their White counterparts, which indicates the need for community interventions (Alabama Department of Public Health, 2009).

I would like to implement health literacy as a portion of the implementation plan, as it would enable the target population access medical information and other types of knowledge that would ensure it leads a healthy and disease free lifestyle.

The health literacy intervention would tackle the obesity problem in the County by providing necessary information regarding healthy nutrition habits and physical activity among individuals all age groups (Lie, Carter-Pokras, Braun, & Coleman, 2012).

I expect lifestyle change among the African-Americans living in Gadsden with a majority observing affordable healthy foods such as vegetables and fruits as well as engaging in physical activities.

I plan to implement the intervention through schools’ and community-based programs that would target every community member reaching out to the entire target population.

I will require educational materials such as pamphlets and posters communicating some of the healthy foods to the community. More so, I will need some items such as skipping ropes, balls among other sporting materials that would encourage the community to engage in physical activities helping to maintain the desired BMI.

After five months, the community and health stakeholders should be able to identify differences and reductions in the health complications and mortality rates among the African- American population through reduced mortality rates and hospital admissions with lifestyles conditions.











Alabama Department of Public Health. (2009). Retrieved 13 January 2017, from

Lie, D., Carter-Pokras, O., Braun, B., & Coleman, C. (2012). What Do Health Literacy and Cultural Competence Have in Common? Calling for a Collaborative Pedagogy. Journal of Health Communication17(0 3), 13–22.

Xu, F., Town, M., Balluz, L. S., Bartoli, W. P., Murphy, W., Chowdhury, P. P., … & Jones, C. K. (2013). Surveillance for certain health behaviors among States and selected local areas—United States, 2010. MMWR Surveill Summ62(1), 1-247.

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