Putnam County is located in a central state of the United States. The total popu

Putnam County is located in a central state of the United States. The total population for Putnam County was 64,528 in 1910 and 74,113 in 2013. The county seat is located 20 miles from the state capitol. There is a large Air Force base located approximately 12 miles from the county seat, with easy access via an interstate. A large number of those stationed at the base live in the largest town in Putnam County due to a lower tax base. Many of those stationed at the Air Force base retire and stay in Putnam County. There is a medium-sized paper mill located in the far western part of the county, which employs approximately 150 employees from Putnam County and from two adjacent counties.
The county was formed in 1823. In 1922, a referendum was passed for the formation of the first full-time health department in the state. The Public Health Department is located in the county seat and is approximately 50 miles from farthest point in the county. The health department provides clinical, environmental, home health, and life care services, including maternal and child health services. Additional bio-monitoring case management is available for persons who are Medicaid eligible and have the following health conditions: diabetes, hypertension, and congestive health failure. Bio-monitoring includes free monitoring equipment such as glucometer, blood pressure, and/or a set of weight monitoring scales.
Because of the location of the county near a large interstate river, many of the smaller communities are subject to intermittent flooding. The most recent significant floods occurred in 1993 and 2008. During both of these events, there were substantial effects on agriculture and infrastructure.
A Windshield View of Western Putnam County
A drive through the western end of the county seat reveals depressed smaller communities, with single-family homes built of clapboard and/or brick and many mobile homes. The homes are in need of repairs. None of the smaller communities have fast food restaurants but many have small family eating restaurants that offer a meat and three vegetables at lunch 5 days a week. There are two high schools and one middle school to the west. Elementary students must travel to the county seat to attend public and/or private schools. There are numerous churches of almost all denominations located throughout the county. There are limited gas stations in the smaller communities. Services stations charge more for gas in the smaller areas of the county. In a few of the smaller areas there are liquor stores, several small pawnshops, and one pay day loan store. Banks are available only in the largest town in the county. There is one hospital with less than 100 beds providing basic medical and surgical care in the county seat. Limited specialties are available and citizens must travel approximately 70 miles from the farthest point in the county to a larger hospital.
The closest Veterans Hospital is more than 150 miles from the county seat. In one small town to the west of the county seat, groups of young men and women are seen sitting on or standing by cars in an abandoned quick stop store parking lot. Unsupervised children are noted playing in the street close to the store. A sign posted on the abandoned store states, “No Alcohol or Drugs on Premises” and “No Loitering.” There is one small primary care clinic in this area that is privately owned but accepts Medicare, Medicaid, and private insurance. The clinic has one physician and one nurse practitioner who provide basic primary care to approximately 50 patients per day. The major health problems in the county include CVD, diabetes, cancer, substance abuse, smoking, dental caries, under-immunization, and food insecurity.
Reference: Harkness, G. A., & DeMarco, R. F. (2016). Community and public health nursing: Evidence for practice (2nd ed.). Wolters Kluwer.
Case Study 2 Questions
Of the people living in the state where Putnam County is located, 18.4% are medically underserved. This presents a number of problems for those who are poor and/or have a low income in Putnam County.
What does this mean in terms of primary health care? How does this designation of medically underserved impact the role of the advanced practice nurses?
Putnam County is located in a flood-prone area and has experienced several floods in the past. Community health issues such as a shortage of potable water and increased risk for tetanus and mosquito-borne diseases are issues that need to be considered in regards to disaster planning. Read the World Health Organization Report at the website below and answer the questions:
https://www.who.int/health-topics/floods#tab=tab_1Links to an external site.
How can a community health nurse use the information from the World Health Organization Report to plan strategies to address health consequences in the case of future floods?
How would knowledge related to the differences in food-borne and waterborne illnesses help public health nurses manage health problems during natural disasters?
APRNs must use clinical judgment and knowledge regarding provision of nursing care during disasters and other emergency situations. One of the largest hospitals in the adjacent county has a simulation lab and has offered use of this lab to the Putnam County public health nurses.
How can APRN competency levels related to disaster planning and response be enhanced through the use of simulation technology?
Vulnerable populations are groups of people who have an increased risk or susceptibility to adverse health outcomes.
Search the internet to identify 2 creative strategies that involve technology in addressing the following Healthy People 2020 objective: Reduce the proportion of individuals who are unable to obtain or delay in obtaining necessary medical care, dental care or prescriiption medicines.
Two Registered Nurses, a primary nurse practitioner and a physician employed by the health department in Putnam County wrote a W.K. Kellogg Foundation grant with the goal of provide health care services to people in the poorest areas of Putnam County. The grant provided potable water to 100 families, holistic community health assessments of individuals 65 and older to ensure that they could reside safely in their homes, a school based health clinic for middle school students, and a faith orientated health ministry in the depressed area of the county.
What resources would nurses use to create a holistic assessment tool to accomplish the goal of keeping individuals 65 and older in their homes safely?
The major health problems for middle-school aged children in Putnam County include:
– Obesity
– Dental Caries
– Pediculosis (Lice)
– Asthma
– Autism and Attention Deficit/Hyperactivity Disorders (ADHD)
– Alcohol and tobacco issues
Given knowledge about the major health problems for the middle-school aged child in Putnam County, identify primary, secondary, and tertiary prevention strategies.
How would the APRN working in the school-based clinic, partner with the one school nurse for the entire county to address the identified health issues?
How could the school-based health clinic APRN involve parents in primary prevention?
What communication strategies would the APRN use to develop good working relationships with the families of the children?
The paper mill located in the far western part of Putnam County employs one APRN. The APRN understands that evidence, although inconclusive, demonstrates that pulp and paper mill workers are at an increased risk for malignant diseases, specifically an increased risk for lung cancer. Current evidence also shows that the socioeconomic status of paper mill workers is strongly related to stomach cancer. Shortly after employment, the occupational nurse learned that there were no health promotion programs offered by the mill.
How are the principles of epidemiology applied to this situation?
What is the role of the APRN in regards to education related to risk for malignant diseases?
What resources would the APRN seek to develop a health promotion plan for the paper mill?
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