Running head: Capstone Formative Paper Project 1

Capstone Summative Paper Project

Robert M. Williams
University of South Florida













Capstone Formative Paper Project 2
Summarize local, state and national data
Hillsborough County is Floridas largest rural county in the entire state, and has
an estimated total population of 1,229,226 (Enterprise Florida, 2010). According to the
website City-Data, Hillsborough County has a combined land and water area of 1,266.3
square miles, along with a population density of 1,174 people per square mile.
Hillsborough County has many different industries that provide this population
employment. Trade, transportation and utilities, professional and business services and
education and health services are the three leading among those industries (Enterprise
Florida, 2010). Specifically, J.P. Morgan Chase, H. Lee Moffitt Cancer Center and Citi
are the three largest employers in the entire county (Enterprise Florida, 2010). The
Countys major health and medical services include Brandon Regional Hospital, H. Lee
Moffitt Cancer Center, James A. Haley V.A. Medical Center, South Florida Baptist
Hospital, St. Joseph's Hospital, Tampa General Hospital, Town & Country Hospital and
University Community Hospital-Medical Center (Enterprise Florida, 2010).
Analyze, interpret and prioritize data
There are many socioeconomic indicators that are quantified for both the entire
state of Florida and Hillsborough County, but this section will focus on three of those
indicators. First, the percentage of families below poverty level in Hillsborough County
as of 2010 was 10.7 percent in comparison with the entire states percentage of 9.9.
Second, the percentage of the population over the age of 25 with a high school diploma in
Hillsborough County as of 2010 was 14.2 percent in comparison to the entire states
percentage of 14.7. Lastly, the percentage of the population over the age of 5 that could
not speak English well in Hillsborough County as of 2010 was 10.2 percent, compared to
Capstone Formative Paper Project 3
the entire states average of 11.8 percent. These socioeconomic indicators help in
analyzing both the strengths and needs of not only Hillsborough County, but for the
entire state of Florida as a whole. (FDH, 2013)
Every state and county in this country has health indicators that are both strengths
and weaknesses. This next section will focus on both of those aspects for Hillsborough
County, with strengths being the first of these covered. Beginning with the area cancer
screenings. Cancer screenings are a health indicator defined by 11 different sub
categories, ranging from adults over the age of 50 who have received a blood stool test in
the past year to women who have had a hysterectomy (FDH, 2013). Hillsborough County
in comparison with the entire state is in the first or second quartile in 7 of the 11
categories, in which these quartiles are positive indicators when talking about cancer
screenings (FDH, 2013). Hillsborough County has a higher percentage than the entire
state for 4 of the 11 categories, again those percentages that represent positive indicators
for the county (FDH, 2013).
The health indicator referred to, as Disability will be the next strength for
Hillsborough County covered. Disability is limited in its sub categories, but focuses
mainly on the issue of whether adults are limited in any way, shape or form by physical,
mental or emotional illness. Hillsborough County was in the first quartile in terms of this
health indicator. This means that Hillsborough County is in the lowest 25 percent of the
state in terms of adults limited by physical, mental and emotional illness. (FDH, 2013)
Health care access and coverage is the third and final strong health indicator to be
discussed for Hillsborough County. Health care access and coverage is defined by 5 sub
categories that include, but is not limited to adults who could not see a doctor in the past
Capstone Formative Paper Project 4
year due to cost, and adults with any type of health care insurance coverage. When
talking about adults who could not see a doctor in the past year due to cost, Hillsborough
County was almost 4 percent lower than the entire states average in 2010 for this
category. The County was also almost 2 percent higher then the states average when it
came to adults having any type of health care insurance coverage in 2010, and was
positively in the first quartile for both the category of adults who could not see a doctor
and that of insurance coverage. (FDH, 2013)
Hillsborough County has its share of health indicators that are negatively below
the states average, but the three most urgent of these will be examined and discussed.
Sexually transmitted diseases (STDs) will be the first of the negative health indicators
covered for this section. From the years 2009 through 2011, Hillsborough County had a
3-year average per 100,000 people of nearly 747 cases of Gonorrhea, Chlamydia and
Infectious Syphilis. This number coming in at almost 250 more cases during that same
time period for the entire states average. Hillsborough County was negatively in the
fourth quartile for the number of individual cases of Gonorrhea, Chlamydia and
Infectious Syphilis when compared to that of the entire state. (FDH, 2013)
Maternal and child health is also a negative health indicator for Hillsborough
County. Specifically focusing on the area of infant deaths. This indicator is defined by the
number of infant deaths (0-365 days), neonatal deaths (0-27 days) and postneonatal
deaths (28-364 days) per 1,000 births. Hillsborough County has a higher death rate in
these 3 categories then that of the entire state of Florida. (FDH, 2013)
Diabetes is the third and final negative health indicator to be discussed for
Hillsborough County. Diabetes covers 5 sub categories that include, but are not limited to,
Capstone Formative Paper Project 5
adults with diabetes who have been educated on diabetes self-management and adults
with diagnosed diabetes. Hillsborough County is nearly 5 percent below the entire states
average of adults who have been educated on self-management of the disease. The
County also had a higher percentage than the entire state when it came to adults
diagnosed with diabetes. That category also showed negative progression from the
averages in 2004 and 2007, when Hillsborough County actually had a lower percentage
than the entire State of Florida. That percentage rose from 6.3 in 2004, to that of 11.4 in
2010. (FDH, 20130)
The priority health issue for Hillsborough County to be focused on for this paper,
chosen from the health indicators discussed above is that of sexually transmitted diseases.
STDs are a very high priority health issue because they are actually one that can be
readily prevented. Although there are many negative health indicators in Hillsborough
County, the STD rate in comparison with the entire country is scarily high. According to
the CDC, in the year 2010 the entire United States had an average of 531 cases of
Gonorrhea, Chlamydia and Infectious Syphilis combined per 100,000 people (CDC,
2010). This number in comparison with Hillsborough Countys average of nearly 747
cases of the same STDs. (FDH, 2013) With these statistics compared, there is obviously
a large discrepancy and need for change when it comes to Hillsborough Countys STD
rate.
Comprehend, discuss and apply community health models
Determinants of health are defined as the range of personal, social, economic and
environmental factors that affect health status (Healthy People, 2012). These
determinants are found spread out among the areas of policymaking, social factors, health
Capstone Formative Paper Project 6
services, individual behavior and biology and genetics (Healthy People, 2012). Other
areas that affect what makes people healthy or not include education, gender and
socioeconomic status (WHO, 2013). All of these factors that contribute and determine a
persons health status can be used by a community nurse to develop interventions for a
population based health issue. This is achieved through careful examination of which of
the determinants are affecting the population in a positive way and which of the
determinants are affecting the population in a negative way. By finding out these
determinants of health that are negatively affecting the population, the community nurse
can then focus attention on developing interventions to create positive change for these
negative affects on the population.
The health system, lifestyle and human biology all contribute to the priority health
issue identified for this paper, which are Sexually Transmitted Diseases. Access to health
care directly affects STDs, and a population where access to higher quality health care is
not available generally correlates with higher rates of STDs (Health People, 2013).
Many lifestyle factors have direct affects on STDs. One of these lifestyle factors can be
the partner a person chooses to have sexual relations with. Even though that person may
only be sleeping with that one partner, the partner could be involved in sexual relations
with many other people themselves. Lastly, human biology most definitely plays a role
when it comes to STDs. This can be indentified in how the human body reacts to the
acquirement of an STD. Many STDs either do not show symptoms of the disease or have
symptoms so insignificant that a person may never seek health attention (Healthy People,
2013). This is turn can lead to the unknown spread of STDs to different sexual partners.
Capstone Formative Paper Project 7
The population of Hillsborough County receives a negative nursing diagnosis of
increased risk for STD contraction due to the populations increased incidence of
reported STD cases. Hillsborough County by the numbers, is far above the rest of the
states average in terms of number of STDs contracted (FDH, 2013). By taking
Hillsborough Countys average annual number of STD cases from the years 2009 through
2011 and comparing them to the rest of the United States during that same time period in
2010, there is a definitive difference between the numbers (FDH 2013). When talking
about Gonorrhea, Chlamydia and Infectious Syphilis, Hillsborough County averaged just
less than 1 in every 133 people to have contracted STDs (FDH, 2013). Compared to that
of the United States, which averaged 1 in every 192 people to have gotten an STD (CDC,
2010).
Develop and discuss evidence based interventions according to community health
models
Primary prevention of STD contraction requires an individual, community and
system-wide participation. In order to prevent the contraction and spread of STDs, many
people and systems must be working together to achieve this goal. In school education
classes that are age appropriate (Middle and High School), adolescents can be taught the
practices of safe sex, and ways to go about getting the resources in order to do so. These
classes would not only be dealing with the issue of health promotion, but would also be
aiding in risk factor modification. Community members, public officials, legislators,
health care providers and funding sources would all be involved in the prevention effort.
The parents, school area community members, city council members, Governors,
Congressmen, nurses, doctors and the government as a whole would all be involved in
Capstone Formative Paper Project 8
making school based STD education classes possible. The community health nurse in
particular could be involved in developing, carrying out and following up with this
prevention. The nurse could plan and teach one of these education classes at a local
school, and report back to that school to see how the students are using the education
information. (Manitoba Health, 2001)
The individual and community are the recipients of the secondary prevention
method for STD management and control. The secondary prevention method of contact
tracing, works at both preventing further negative impacts on health and decreasing the
spread of the disease. Contact tracing is the identification of people who had such an
association with infected people or environments that would result in the opportunity to
contract the infection (Biology Online, 2005). Contact tracing would work to decrease the
amount of cases where STDs are re-contracted, help to limit the amount of antibiotic
resistant STD strains and encourage infected persons to seek medical attention as soon as
they possibly can (Manitoba Health, 2001). Health care providers and community
members are the two most involved parties in the contact tracing prevention method.
Specifically, the community health nurse could work strictly with STD cases in order to
make the connections between infected people and their associates.
The individual is the main focus in the tertiary level of prevention due to the fact
that they are the one who is infected, but the community and systems are involved in
making this prevention possible. Proving better and more access to health care for the
treatment of STDs is a key process in prevention. Access to care is involved in dealing
with consequences, preventing further negative health impacts and preventing the further
spread of STDs. More funding is needed in order for those people who cannot afford to
Capstone Formative Paper Project 9
seek treatment to be able to have access to this care. In addition to this, the community
needs to be supportive and help to provide information to those individuals who need it.
Community members, public officials, legislators, health care providers and funding
sources are all participants in ensuring that better access to care for STDs is an
achievable goal. The community health nurse, with help from outside sources, could
reach out and set up community based events where free testing could be done.
(Manitoba Health, 2001)
Reflect & Synthesize for development of health policy proposal
The health policy proposal for this papers priority health issue is focused on the
primary level of prevention. This proposal takes sexual education classes for high school
aged students a step further. Instead of just having education classes on middle and high
school campuses, this health policy proposal suggests that during a selected time during
each school year, middle and high schools around the county would take a school wide
field trip to a specified location to learn more about safe sex practices and STDs. This
would bring more students of middle and high school age together since all the county
middle and high schools would meet at the same location for the field trip each year. The
education would teach about STDs and their consequences, ways to prevent contraction
and even free condom handouts for students who might not otherwise be able to afford or
buy the contraception themselves. In doing so, the goal would be to educate middle and
high school aged students on STDs and safe sex, which in turn would help prevent the
contraction and further spread of STDs among this population. Community members,
public officials, legislators, health care providers and funding sources would all be
affected by this proposed health policy. These same individuals would be proposed
Capstone Formative Paper Project 10
supporters as well as the opposition for this proposed policy. Reasons for the support
would be to enhance the education on safe sex and STDs for high school aged teens in
hope that they would be prevented from contracting an STD in their lifetime. They might
also oppose this idea for fear that some high school students are too young or immature to
be learning about safe sex and STDs. In order to make this policy possible, it would need
to be presented to not only the local countys school board, but also that countys
governing officials. By making this policy a reality, Hillsborough County could start
impacting the lives of its adolescent population. In doing so, it would start to improve the
health of the younger generation, while also educating them on how to spread the word
about safe sex and STDs to others.













Capstone Formative Paper Project 11
References
Biology Online. (2005, October 03). Contact tracing. Retrieved from
http://www.biology-online.org/dictionary/Contact_tracing
CDC. (2010). 2010 sexually transmitted disease surveillance. Retrieved from

http://www.cdc.gov/std/stats10/tables/trends-table.htm

City-Data. (2012). Hillsborough county, florida. Retrieved from

http://www.city-data.com/county/Hillsborough_County-FL.html

Enterprise Florida. (2010). Hillsborough county profile. Retrieved from

http://www.eflorida.com/profiles/CountyReport.asp?CountyID=54&Display=all

FDH. (2013). County health profile. Retrieved from

http://www.floridacharts.com/charts/mapp_report.aspx

Healthy People. (2012). Determinants of health. Retrieved from
http://healthypeople.gov/2020/about/DOHAbout.aspx
Healthy People. (2013, April 10). Sexually transmitted diseases. Retrieved from
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?
topicid=37
Manitoba Health. (2001). Sexually transmitted diseases. Retrieved from
http://www.gov.mb.ca/health/publichealth/cdc/std_strategy.pdf
WHO. (2013). The determinants of health. Retrieved from
http://www.who.int/hia/evidence/doh/en/index.html