Community Assessment Paper CPR

Running Head: COMMUNITY ASSESSMENT PAPER 1

A Community Heath Nurses Role With Cardiopulmonary Resuscitation (CPR)

David Theobald-RN

Empire State College


1. Introduction

Purpose

A. The purpose of this community assessment paper is to increase awareness of the

importance of Automatic External Defibrillators (AED’s) and Cardiopulmonary

Resuscitation (CPR) training in the City of Saratoga Springs New York.

Population Aggregate/ Statistics

B. Population Aggregate- Saratoga Springs has population of 26,727 people. The

community is involved with youth sports teams. Statistic ―Heart disease is the leading

cause of death for both men and women. More than half of the deaths due to heart

disease in 2009 were in men. About600,000 Americans die from heart disease each

year—that’s 1 in every 4 deaths. Coronary heart disease is the most common type of

heart disease, killing more than 385,000 people annually‖(CDC 2012 Web).

Community Health Nursing Model

D. For this Project we will be using the Interventions Wheel Model. ―The model consists

of 17 identified community health nursing interventions that cross over three levels of

population-based practice: individual-focused, community-focused, and systems-focused

practice. Individual-level interventions are focused on change in individual health status,

knowledge, or skills (Clark, 2008 p 75).

Community Health Nurse Role

E. Community Health Nurse Role in promoting heart health and implementing CPR and

AED programs.


COMMUNITY OVERVIEW

A. Saratoga Springs NY is small city rich with history and culture. There are many

Population by Gender
Male 12,837 48.28% 12,433
Female 13,749 51.72% 13,753

Population by Age
Persons 0 to 4 years 1,087 4.09% 1,395
Persons 5 to 17 years 3,430 12.90% 3,672
Persons 18 to 64 years 17,881 67.26% 17,380
Persons 65 years and over 4,188 15.75% 3,739
community sports programs and recreation leagues in the community. The setting is

recreation fields and youths sports complexes. One target population is the Saratoga

Lacrosse League.

B. Demographics based on 2010 US Census Bureau Total 26,586

C. Education Retrieved from National Center for Educational Statistics

Population 25 years and over 17,127 100.0%

Less than 9th grade 588 3.4%

9th to 12th grade, no diploma 1,297 7.6%


High school graduate (includes equivalency) 4,011 23.4%

Some college, no degree 3,009 17.6%

Associate degree 1,557 9.1%

Bachelor's degree 3,595 21.0%

Graduate or professional degree 3,070 17.9

D. Ethnicity 2010 Census

Population by Race
American Indian and Alaska native alone 55 0.21% 63
Asian alone 521 1.96% 271
Black or African American alone 701 2.64% 815
Native Hawaiian and Other Pacific native alone 7 0.03% 8
Some other race alone 170 0.64% 168
Two or more races 589 2.22% 368
White alone 24,543 92.32% 24,493

E. Poverty Level, Unemployment ratethe data is based upon 2010 estimates.

Saratoga Springs employment information

Index Saratoga Springs New York
Income per capita $31,762 $31,957
Median household income $54,607 $67,635
Median household income owner occupied $74,316 $79,472
Median household income renter occupied $32,481 $41,550


Median earnings male $35,233 $45,665
Median earnings female $19,281 $26,443
Unemployment rate (2000) 4.3% 4.5%
Unemployment rate (2010) n/a 8.2%
Unemployment rate (2012) n/a 8.0%
Poverty level 8.8% 8.8%
F. Employers

Many people that live in Saratoga Springs either work for small businesses or commute

to larger employers in out lying areas. Below are some of the largest employers in

Saratoga Springs NY.

1000+ employees Town # of employees

Stewart's Ice Cream Co. Saratoga Springs 1550

500-999 employees

Saratoga Springs City School District Saratoga Springs 988

Quad Graphics, Inc. Saratoga Springs 825

Saratoga Hospital Saratoga Springs 823

G. Type of Government For The City Of Saratoga Springs NY

Commission Form:

The Saratoga Springs charter specifies a commission form of city government. In the

news there have been efforts to amend the charter. The charter change proposal will

appear on the ballot of the November 2012 election.

H. Safety Fire, Police


Fire Department: Paid Department

―The Saratoga Springs Fire Department is dedicated to the protection of life, property and

the environment for those who live, work, or visit our community. We will accomplish

this by using well trained and dedicated personnel pledged todeliver the highest quality

fire suppression & prevention, public education, advanced emergency medical services,

which are capable of responding to all disasters, natural or man-made.‖(City Saratoga

Springs.org)

Police Department: City Paid Department

―We are a team of law enforcement professionals committed to setting the benchmark for

quality police service by promoting strong community partnerships and upholding the

highest ethical standards. Our mission is to provide a professional, effective, and timely

response to crime and disorder, and to enhance traffic safety in our community.‖(City

Saratoga Springs.org)

I. Hospital

Saratoga Hospital Saratoga Hospitalis a 207-bed community hospital serving Saratoga
County and the surrounding areas.

J. Recreation-The Saratoga Springs Recreation Department offers sports leagues for

youth girls and boys. Currently, the City offers soccer, basketball, t-ball, and flag football

lacrosse, field hockey, and volleyball.

K. Media –Saratoga news paper,WNYT and capital district YNN news.

I. Wind Shield Survey


Windshield
Survey
City
Saratoga Springs, NY
By David Theobald & Sully
Empire State College 10-12-12
Party Cloudy Temp. 68 degrees


Map of Saratoga Springs NYWindshield Survey City 29.0 Sq. miles Coordinates 43

’4’31’N 73 46’57”W

• Saratoga Springs NY First Settled 1776

• Area 29.0 Square Miles

• Population 26,586

• Government Mayor Scott T. Johnson


• Major Attractions Horse Racing, The Springs, Performing Arts, Art’s and

Entertainment

• Education Empire State College and Skidmore College

• The Saratoga City School district six elementary schools, one middle school and

one high school grades 9-12

• Private School’s Saratoga Central Catholic High School, St Clements's, Waldorf

School and Saratoga Independent School

• Population Census by race 2000

• White alone - 24,005 (90.3%)

• Hispanic - 839 (3.2%)

• Black alone - 661 (2.5%)

• Asian alone - 516 (1.9%)

• Two or more races - 505 (1.9%)

• American Indian alone - 41 (0.2%)

• Other race alone - 15 (0.06%)

• Native Hawaiian and Other Pacific Islander alone - 4 (0.02%)


Housing

Saratoga Springs ranked 75 of the 100 best places to live in US. According to CNN

Money

Saratoga Springs downtown district is a very sought after market. Houses are well

kept and prices reflect that.


Affordable Housing

William Ford Jefferson Terrace Vanderbilt Terrace

Neat and clean units both single and mul family apartments.

Housing Windshield Survey
The rules and regula ons for Public Housing and Sec on 8 program are determined by the U.S.
Department of Housing and Urban Development (HUD). The purpose of both Public Housing and the
Sec on 8 Program is to provide affordable housing to eligible low- and moderate-income families.


Public Parks & Open Spaces for the Community
Many Public Parks and Recreation Areas for the Community to Use


Open Spaces & Parks

Saratoga Spa State Park, distinguished by its classical architecture and listed as a

National Historic Landmark, is noted for its diverse cultural, aesthetic and recreational

resources. In addition to the nationally-known Saratoga Performing Arts Center, the Spa

Little Theater, the National Museum of Dance, the Saratoga Automobile Museum, the

Gideon Putnam Resort and Roosevelt Baths and Spa, the park offers a multitude of

traditional recreation opportunities.

The Peerless Pool Complex consists of a main pool with a zero-depth entry, separate

slide pool with a 19' double slide and a children's wading pool with a mushroom fountain.

The Historic Victoria Pool is a smaller pool surrounded by arched promenades. Both pool

areas include food and beverage areas.     The Saratoga Spa State Park Golf


Course offers two beautiful golf courses; a championship 18-hole course and a

challenging 9-hole course, complete with pro shop and restaurant. The gentle terrain

offers picnic areas, shady streamside trails, suitable for the nature-lover or the casual

walker, as well as certified running courses used by joggers and high school and college

athletes. Winter activities include: cross-country skiing on approximately 12 miles of

trails, ice skating, ice hockey.

Many Public Parks with Natural Springs
There are currently 17 public mineral springs in various locations throughout
Saratoga. Each one is naturally carbonated.


Transportation
Saratoga has Buses, Taxies, Amtrak, major highways and well
maintained roads and plenty of traffic lights and easy to follow signs.


Quality Health Care
Saratoga Hospital is a 207-bed community hospital serving Saratoga
County and the surrounding area. Major employer for the area

Good Side Walks and Free Parking
Saratoga has had challenges with parking especially with tourism.
The city just built a large parking garage for the public to use.


Many Services Available For Those in Need
Although not as bad as other areas Saratoga did suffer from the difficult
economic times, which meant many individuals called upon the help and
services of The Salvation Army.

Four Winds
Health and Social Services

Four Winds is a Private inpatient, partial hospital, intensive
outpatient and outpatient for mental heath and substance abuse.


Crime Rates Comparison From Area Connect
Saratoga Springs is one of the safest Cities in the Capital Region.

Economics
Saratoga Springs is a growing community. There are many new buildings and
businesses under construction. The major employers are Stewarts Shops,
Quad Graphic, Saratoga Hospital


Challenges
Although Saratoga Springs is doing well in this economic climate and there appears to be quality
health care delivery systems in place some challenges could be identified. The challenges
identified, More low income housing. More agencies may be needed to support the increase
number of mentally ill and chemical dependent residents.

Schools
Education Empire State College and Skidmore College The Saratoga City School district six elementary
schools, one middle school and one high school grades 9-12
Private School’s Saratoga Central Catholic High School, St Clements's, Waldorf School and Saratoga
Independent School


Saratoga Protective services for it’s residents
Fire Department, Police Station, much of the cities public services
are located in the down town district. Many officers patrol on foot.


Down Town
Saratoga has many Shops and stores that are tailored to Tourism. Down
town has grocery stores, drug stores, clothing shops and many restaurants.
Saratoga many dog friendly stores.

Religion In Saratoga Springs
The Saratoga region has a number of faith-based organizations and places to
worship. The area houses numerous churches, temples and missions, along
with many other organizations.


Thank You!


Key Informants

Key Informant (KI) number one is a Registered Nurse that works and lives in Saratoga

Springs New York. The informant is 46 year’s old and has been working in the

Emergency room at Saratoga Hospital for the last 5 years. The Key Informant is a

married white female who’s native language is English. Highest level of education:

Bachelors of Science in Nursing. During tis interview the informant will be asked a

series of questions about the community.

Key Informant number two (KI2) is a 28-year-old white male from Schenectady NY.

He is a bartender at a local restaurant now living in Saratoga Springs NY. (KI2) has his

high school diploma and speaks English.

1. What are the strengths and assets of the community?

(KI)- ―Saratoga Springs is a safe place to raise a family. Lots of community events

and activities. Our community has quality healthcare and cares about our residents.‖

(KI2) ―Fun city many good restaurants and clubs. I like the race track and Saratoga

performing arts center.‖

2. Areas of Improvement for the community?

(KI) – ―Improving services that expand job growth in the community.‖

(KI2) ―Better jobs and more businesses.‖

3. Concerns of Community Members?

(KI)-Saratoga springs has increasing number of residents that have chemical

dependencies and mental illness. The increasing number of patients being seen for


drug abuse and mental illness is increasing. Having more resources to handle the

influx is essential.‖

(KI2)- ―Expensive to live here.‖

4. Do patients have access to quality healthcare?

(KI)- ―The people of Saratoga Springs have a community hospital that is expanding

its services to meet the need of the community.‖

(KI2)-― I can’t afford health insurance even if they offered it to me it’s difficult to

live in this city unless your have a good job.‖

5. What do you think it is like for the working poor living in this community?

(KI)- Given the demand for real estate there is a much higher cost of living. The

working poor are struggling to buy the essential items needed to live. Minimum

wage workers have a very tough time getting by in this community.‖

(KI2) It’s hard and everyone is struggling to make ends meet.‖

6. How safe do you believe your community is?

(KI)- ―Saratoga Springs is very safe. We have dedicated and professional

firefighters, EMT and police that keep our residents safe.‖

(KI2) Pretty safe we have an occasional bar fights or petty crimes but all in all safe

compared to my home town.‖

7. Who has political power in the community?

(KI) Saratoga has a commission form of Government. The Mayor and the elected

officials have the political power.‖

(KI2) ―The mayor of Saratoga all the city spend sit’s money on is making it look

nice for the tourists.‖


8. Are there opportunities for the poor and vulnerable population to become involved

in the political process? Do you believe there voices are heard?

(KI) ―During the city elections all city residents that own homes and are register

with the city can vote. No I feel most of the poor probably don’t own properties

therefore are not allowed to vote on city issues.‖

(KI2) ―Are beeping kidding me? No only the rich folks have say.‖

9. What housing is available to people with limited resources? Do you believe it is

Adequate? ― (KI) a waiting list for housing assistance in Saratoga and not enough

new low income housing being built.‖

(KI2) ― I share an apartment with two roommates because it’s expensive to live

here.‖

10 Is Public transportation available? (KI) ―Yes we have a good bus system.‖

(KI2) ―Everything is close in the city and if you need a bus there are stops.‖

11. What do you perceive as environmental hazards in the community?

(KI)―Saratoga Springs is a clean community that is recycling minded. I do not

perceive any environmental hazards in the community at this time.‖

(KI2) ― Acid rain and other pollution from surrounding areas.‖

12. Do you believe the public education system meets the needs of the working poor

In this community‖ How?


(KI) Saratoga Springs public schools are ranked in the top 10% in the area. Every student

regardless of social class or wealth can receive the same quality education.‖

(KI2) I hear the schools are good. I graduated from Schenectady where we ranked poorly

for academics. Saratoga is made up of a bunch of rich kids with no worries.‖

13. Are English as a second Language classes available to the working poor?

(KI) ―I do believe that there is a growing need especially during the Racetrack. Saratoga

springs has many Spanish-speaking workers during the summer months. Many times the

workers come in to the ER because they are ill or injured. This creates a language

barrier.‖

(KI2) ―I am not sure but sounds like a good idea.‖

14. Are there vocational/technical programs available for the working poor? (KI) I do

know of a group called Unlimited Potential that provides training to over 50 people with

mental disabilities. I am not aware of all the programs for the working poor.‖

(KI2) ―I am not aware of any programs other than the ones offered by the library but I

think those are not free.‖

15.Describe your perceptions of the health of the community? (KI) ― The community

overall is very health conscious. Many people exercise and are active. On the other scale

while working in the emergency room unhealthy health issues are more apparent.

Obesity, mental illness, and substance abuse are frequently associated with the working

poor.‖

(KI2) I see a lot of active people running, walking, biking. It seems like a healthy place.‖


16. How adequate and accessible are health services? (KI) ―For the most part very

accessible. The hospital has outpatient centers and urgent care centers located in the city

and neighboring communities. Our hospital also has a 16-bed inpatient mental health

unit. Four winds is a large chemical dependency and mental health treatment center

located in Saratoga Springs. Not all patient’s can go there because it is a private. This

does pose a problem for the working poor.‖

(KI2) Thankfully I never had to us the local health services. I hear the hospital sucks. My

friend was there for a broken foot and he was there for six hours before someone even

looked at him.‖

17.How is the community information transmitted? Is it effective and is it in other

languages? (KI) Mostly all the community news is posted in the Saratogian our local new

paper. Other areas include bulletin boards and news radio. The language is English and I

find it to be largely effective.‖

(KI2) Papers and TV

18.How do the working poor and vulnerable population get important health information?

(KI) ―All emergency room patients revive discharge instructions along with the necessary

referrals for follow-up. These can be for primary care, mental health, chemical

dependency to social services.‖

(KI2) ―I am not sure but guess from the community health centers?‖


19. How does the economy of the community affect the health and social well being of

the community? Poor? Is healthcare affordable? (KI) ―I feel the economy is doing well

but this doesn’t tickle down to affordable healthcare. The good thing is that our

community is caring. Many people donate time and money to the local shelters and food

banks especially during the holidays.‖

(KI2) ―There are not enough high paying jobs for individuals that do not have a good

education. The poor just collect welfare and other free things while the rest of community

works hard to support them. I have no tolerance for lazy people.‖

20.What opportunities for fun and recreation are available for the working poor and are

they utilized? (KI)

―Our city has many public parks and recreation areas around the city. From my

experience I believe parks and community areas events are utilized by all the social

classes.‖

(KI2) Public Saratoga State Park. There are also lots of walking paths and other cool

things. Not much is free anymore and expect many things to go up.‖

21. Can you tell me something about the cultural and spiritual/religious aspects of the

poor population an their family? (KI) There are many churches and community outreach

centers located in the city. The religious leaders in the community especially the salvation

army provide supportive services through ministry and faith.‖

(KI2) ―I am not religious but everywhere you turn there are churches.‖


22. In your opinion, do cultural beliefs of the population affect delivery of health care

services? How? ―I feel that our community is composed of many different believe

systems that are supportive of the poor and vulnerable. I see this the most during the

holiday season. The community uses their beliefs to do more good for the less fortunate.‖

(KI2) ―I don’t see that as a factor.‖

23. Is there anything else you would like to tell me that influences the health of the

community‖(KI) ―I believe the culture of Saratoga springs is rich in culture and history.

The city was founded on its healing waters and natural springs. I feel that history still

rings true to this day.‖

(KI2) ―The number of fast food restaurants.‖

3.Epidemiology-―is the study of the distribution of health and illness within a population,

factors that determine the population’s health status, and use of the knowledge generated

to control the development of health problems‖(Clark 2008 p.62). During my windshield

survey of the City of Saratoga Springs I’ve identified a community need based on the

population groups. According to Healthy People 2020 Heart disease remains the highest

percentage of all mortality rates in the nation. Although the city of Saratoga Springs is a

health conscious community the people are still at risk for heart disease and sudden

cardiac arrest. Chart 1.3 is from Healthy People 2020 and shows the greatest amounts of

deaths of all ages in the United States of America.


1.3 Source: Centers for Disease Control and Prevention, National Center for Health Statistics;
data from the National Vital Statistics System (2006). Data are not age-adjusted.

Based on the vital statistics from the CDC New York State including Saratoga County

NY is not immune to heart disease and sudden cardiac arrest. Developing a CPR and

AED teaching plan the community health nurse can have a significant impact on the

people of Saratoga Springs NY and the surrounding community. “Community health

nurses employ knowledge attitudes, and skills, in application of several specific processes

when providing care to individuals, families, and population groups”(Clark 2008 p.74).

The health problem of heart disease and cardiac arrest affects all communities and does

not discriminate against populations groups, racial/ethnic, rich or poor. In this community

assessment project I have identified nursing actions that will increase life saving

interventions for sudden cardiac arrest associated with heart disease.


4. Population aggregate and developmental stage-

According to the population aggregate ages 18-65 years old make up 67.2 % of the

people in the community. Using Eric Erikson’s eight stages of life we will examine the

early adulthood and middle age community members. Sudden cardiac arrest can impact

people of all ages but this population is the most at risk. Erikson describes early

adulthood “as development of one’s capacity for reciprocal relationships”(Clark 2008

p.497). The community involvement with CPR and AED training is a perfect prevention

tool for the community. Young and old people can make to make a difference in their

community. Being certified in CPR is helping both early adulthood and middle age

citizens participate in life having strategies to help any one suffering from sudden cardiac

arrest.

As a community nurse I will use this information to increase awareness about the risks of

heart disease and sudden cardiac arrest. Community health nurses help resolve health

problems through teaching and services.“Nursing services may include activities such as

health related education and influenza immunizations for older adults in an adult day care

center, blood pressure screenings and nutritional counseling at a community health fair,

stress management group discussion at a local church, or a cardiopulmonary resuscitation

(CPR class in a school”(Blais & Hayes 2011 p.348).


5.Political, Cultural, Economic and laws

The City of Saratoga currently teaches CPR to the community through local Emergency

Medical Services, Fire Departments, American Red Cross and the American Heart

Association. The economical issues are the cost for the training, which can be between

$25 to $50 dollars per person. Although some CPR training & AED is free most is

provided of a fee. This could inhibit community members from getting trained. The

media and community do support CPR training and offer training through community

centers and the American Red Cross. Recent laws in NYS are increasing awareness of

CPR and its importance in the community.

Currently, CPR is gaining national attention with bill S2491. This act is to amend the

education law, in relation to requiring schools to provide instruction for CRP as part of

their high school curriculum. If this bill becomes law it will have a significant impact on

saving life’s from sudden cardiac arrest. “In addition to measures of disease and

mortality, changes in the composition of a population over time are also important in

planning for health services (Shi & Singh 2008 p.71). This bill will provide life saving

measures that addresses the leading cause of death in the United States.

6. Community Diagnosis

Diminish risk of sudden cardiac arrest’s deaths in the City of Saratoga Springs through

expanding initiation of community CPR & AED training in the community.

7. Community Resource: Adirondack Health & Wellness


Adirondack Health & Wellness is a nurse owned and operated PLLC with locations in

Clifton Park and Saratoga Springs NY.

Company Mission: When it comes to employee health, it takes more than just offering

sick days to keep your employees healthy and productive. Prevention is the best

medicine. Adirondack Health & Wellness and health educators can then help them make

positive lifestyle changes for the long term, improving their health and well being. We all

need positive reinforcement, especially when it comes to change.

The philosophy of the company is doing good for the community you serve. Adirondack

Health & Wellness provides CPR & AED training to corporations and medical

professionals. Because of the corporate sponsors and members the company is able to

donate free CPR and AED’s to community sports leagues. This organization is working

with members of the community to identify area sports leagues in need of CPR & AED

training.

8. Community Health Nursing Role

The role of the community nurse in this setting is to become certified to teach CPR &

AED certification classes. “Community health nurses employ knowledge, attitudes, and

skills in the application of several specific processes when providing care to individuals,

families, and population groups”(Clark 2008 p.74).

The ideal nursing role for the community health-nursing model is the interventions wheel

fig 1.4. “The model consists of 17 identified community health nursing intervention that

cross over three levels of population-based practice: individual-focused, community-

focused, and systems-focused practice”(Clark 2008 p75). Using this model we can break

it down into primary, secondary, and tertiary prevention.


fig. 1.4 Minnesota Department of Health, St. Paul,

Minnesota 55164-0975, USA.

Primary prevention method for this population base oneducating the community on the

importance of AED’s and trained member’s of the community to use them. Another

primary prevention is advocacy in the community for increased awareness of the

importance of CPR & AED training in the community.

Secondary prevention can be accomplished with health teaching and diagnostic

screenings in the community. Free Blood pressure and cholesterol screening in the

community can help identify people more at risk for developing heart disease.


Tertiary prevention is the treatment if consequences through life saving CPR & AED

interventions in the community. Another highlight is prevention of recurrence by use of

AED’s in public places and more people trained to use them.

10. Conclusion for Community Assessment

Heart disease remains as the number one heath problem in the United States of

America. The City of Saratoga Springs is not immune from this epidemic. The

community assessment project gave me the skills to identify the dimensions of a

health problem and skills on preventing recurrences of the problem. ―The focus in

community nursing is the community: it is a practice that is comprehensive and

continues, takes place in a wide variety of settings, is directed toward all age-

groups, and commands the utilization of all professional nursing roles‖(Clark 2008

.344). In summery this project will provide a valuable benefit for the City of

Saratoga Springs. Through collaboration and communication with community

leaders more citizens will be trained in life saving CPR & AED. By creating this

program community health nurses are creating a safer place to live, work, and play.


References

Blais, K.K. and Hayes, J.S. (2011). Professional Nursing Practice: Concepts and

Perspectives, (6th ed.). Upper Saddle River, NJ: Prentice Hall

The Center For Disease Control. (November 27,2012) Retrieved

From:http://www.cdc.gov/heartdisease/

Clark, M., (2008). Community Health Nursing Advocacy For Population Health, (fifth

edition.). Peasron, Upper Saddle, N.J. 

Minnesota Department of Health. (December 7, 2012). Retrieved

from:(http://www.dhs.wisconsin.gov/phnc/InterventionWheel/index.htm

Schuster, P. and Nykolyn, L (2101). Communication for Nurses: How to Prevent

Harmful Events and Promote Patient Safety,(1st ed.) Philadelphia PA:F.A. Davis

Company

Shi, L., & Singh, D. A. (2008). Delivering health care in America: A systems approach

(4th ed.). Burlington, MA: Jones & Bartlett.

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