Community Survey 1

Running head: COMMUNITY SURVEY

Community Survey of Hendersonville, North Carolina

Joseph M.G.W. Crawford, III

Graceland University
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Introduction

Hendersonville, North Carolina is located in the western part of the state and is located

120 miles from Charlotte, North Carolina and 12 miles south of Asheville, North Carolina,

where the nearest airport is located. Prior to its discovery by William Mills after the

Revolutionary War, the region was inhabited by the Cherokee. Mills received one the first land

grants that now make up what is called the Blue Ridge region, which has established the

community to be the sprawling city that it is today. The city was settled in 1788 and was named

after Leonard Henderson, Chief Justice of the Supreme Court of North Carolina. In 1840,

Hendersonville was laid out on land deeded by Mitchell King of Charleston, South Carolina.

(Historic Hendersonville, 2009).

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Demographic Information

Hendersonville is located in the western mountains of the state. The population of the city

in the year 2000 was 10,420. Eighty-one percent of the population is Caucasian. African-

Americans make up twelve percent of the cities population, while Hispanics account for 9.1%.

Eleven percent of the population is 65 years of age or older, while the average age is 47. In

regards to education 80.7 % of the population has a high school diploma with 30.5 % with a

bachelors degree or some form of higher education. Fifty-seven percent of the population owns

their own home with 2.10 persons per household. The average income is $ 39,111 with

approximately 25 % below the poverty rate. The majority of the population works in

manufacturing (18.9%), and services (23.8%) with retail trade at (12.8%), and education at

(17.4%) with an unemployment rate of 3.0%. Ninety percent of the population lives near a four-

lane highway (U.S. Census, 2009). According to U.S. census data only 4.7% of the population

rely on public transportation while 88% use personal transportation. The remaining 6.2% work

from home or walk. (Epodunk, 2009). Local media outlets in the area are the Hendersonville

Times-News a daily publication and the local web site, http://www.blueridgenow.com (Blue

Ridge Now, 2009).

Tourism also plays a major part in the local economy with the North Carolina Apple

Festival, which celebrates Hendersonville as the largest apple-production area in North Carolina

(North Carolina Apple, 2009). Balfore (personal communication, September 6, 2009) indicated

that during the festival the entire world comes to Hendersonville. The region is also home to the

historic Flat Rock Community Playhouse, which is the state theatre of North Carolina (Flat

Rock, 2009). In addition, in the area is the National Historic Carl Sandburg home (Carl

Sandburg, 2009).
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Hendersonville is protected by the Hendersonville Police Department whose mission is to

provide professional services and to make Hendersonville a safe destination. The local Drug

Abuse Resistance Education program (“D.A.R.E.”) was one of the first seven in the state. The

local chapter was also the first in the state to initiate the 8th grade D.A.R.E. curriculum

(Hendersonville Police, 2009). In terms of crime Hendersonville has a much higher crime rate

than the state average for violent crimes and property crime (Idcide, 2009)

Community Concerns and Priorities

There are major health concerns for the region according to Alexander (personal

communication, October 1, 2009) that are being addressed as part of the North Carolina 2010

Health Objectives. The lack of dental care for low-income children and adults has led to a 22%

rate of tooth decay in kindergartners in the region (Healthy Carolinians, 2009). North Carolina is

also 17th in the nation in regards to obesity (Alexander, personal communication, 2009). The

lack of school nurses in the region was another issue identified (Healthy Carolinians, 2009). The

current national recommendation for school, nurses is 1:750 students, with Hendersonville being

1:1,340 students (Henderson County Department of Public Health, 2009).

Health Care Facilities

The Department of Public Health of Henderson County and the two local hospitals, Pardee

Hospital and Park Ridge Hospital service the areas health care needs (Henderson County

Department of Public Health, 2009). A large population of the patient base in the region has to

seek specialty services in Charlotte or Asheville due to the limited number of physicians in the

area that practice in specialty areas (Alexander, personal communication, October 1, 2009). In
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addition, there are a number of large hospice and palliative care agencies and several free clinics

in Henderson County that service the region (Henderson County Department of Public Health,

2009).

Community Organizations

There are a variety of community health services, which include Rotary Clubs,

Kiwanis Clubs, Lions Clubs, American Business Women’s Association, Daughters of the

American Revolution, and the AARP. In addition, there are several local non-profit

organizations such as the YMCA, Girt Scouts, Boy Scouts, Salvation Army, Literacy Council,

and Parents, Families, and Friends of Lesbian and Gays (PFLAG). The majority of these

organizations operate under grants, public donations and large donations from organizations such

as the United Way. (Henderson County Department of Public Health, 2009).

Client Profile

Physical Dimension

The patient was a 16-year-old white male, 6 feet 4 inches/76 cm, 164.4 lbs/83.8 kilos that

was admitted following a suicide attempt. The patient’s vital signs were within normal ranges

and were as follows: Temperature 97.8, respirations 16, pulse 77, and blood pressure 124/68.

(Jarvis, 2008, pps. 179-183) The patient was awake, alert, oriented to time, place, person and

situation.

Health Problems

The patient consumed a large quantity of acetaminophen and Nyquil after having a verbal

confrontation with his mother over several failing grades in school and the possibility of losing
 Community Survey 6

his driver’s license. The patient was found by his mother, approximately one hour after ingesting

the polypharmacology after she arrived home and discovered he had left a suicide note on the

kitchen counter. Polypharmacology is defined as the excessive use of prescribed, over-the-

counter medications, or recreational drugs that results in undesirable side effects or interactions.

(Venes, 2005) The patient acknowledged that he had had suicidal ideations during the past six

months but had not acted out on the ideations. Suicidal ideation is defined as when a person

thinks about and looks for ways to commit suicide. Suicide is the second leading cause of death

among individuals fifteen to twenty-four years of age with males committing over 72% of all

suicides in the United States. Predisposing factors include psychiatric disorders, substance abuse,

chronic medical illnesses and persons with a family history of depression or suicide.

(Videbeck, 2006, p. 335)

Physical Assessment

I. Skin, hair, nails

The patient's integument was uniformly pink in color, warm, dry and intact, showing no

signs of jaundice. Assessment of the patients skin turgor should reveal no decrease in elasticity.

The patient exhibited no skin lesions or birthmarks. The patient was nonedematous bilaterally in

all extremities. The patient had normal hair distribution that was clean and blond in color. The

patient’s nail beds were pink and firm and upon assessment the patient should exhibit a normal

capillary refill of less than three seconds.

II. Head and neck

The patient’s cranium was atraumatic. There were no lumps, lesions, tenderness, scaling

or parasites. The patient’s face was normal and symmetric. There were no signs of weakness or
 Community Survey 7

involuntary movements. Assessment should reveal the normal findings of the trachea being

midline, and the thyroid should be nonpalpable and non-tender. The neck was atraumatic and

supple.

III. Eyes

The patient’s eyes were equal and symmetrical and exhibited normal confrontation in all

fields upon examination. The extraocular muscles were intact. There were no signs of ptosis, lid

lag, crusting, or discharge. The patient’s conjunctiva was clear, sclera white, with no lesions or

redness noted. The pupils were equal, round, and reactive to light and accommodation.

Assessment should reveal the normal findings that the red reflex was visible, and the patient

showed no signs of cataracts.

IV. Ears

The patient’s ears were equal and symmetrical, and the pinna and auricles were normal

upon examination. There were double piercings bilaterally in each lobule. There were no masses,

lesions, scaling, or discharge. Assessment should reveal the normal findings that the patient did

not have any tenderness upon palpation and that the patient could hear whispered words

bilaterally.

V. Nose/sinus

The patient showed no signs of deformities or tenderness. The nares were patent, and the

patient’s septum was midline. Assessment should reveal normal findings that the mucous
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membranes were pink, moist, and intact. The patient should also not verbalize any tenderness

upon palpation of the sinuses.

VI. Mouth/throat

The patient’s oral cavity was moist, pink, and intact. There were no lesions or swelling.

The patient appeared to have all dentition intact and caries had been repaired as evidenced by

dental fillings. The tongue was midline, and the patient did not appear to have any lesions or

ulcerations. The buccal mucosa should show no signs of leukoplakia. Upon phonation of

“ahhhh”, the uvula should rise to midline. Assessment should reveal that the patient’s tonsils

were not present since they had been removed along with the adenoids at two years of age. The

tongue upon depression should also exhibit the gag reflex.

VII. Respiratory

The patient’s chest expansion was normal and symmetrical. The anterior/posterior

diameter was less than the transverse. Assessment should reveal the normal findings that the

lungs exhibited resonation in all fields with tactile fremitis, as well as the patient’s diaphragmatic

excursion being equal bilaterally. Further assessment should also reveal the normal findings that

the chest expansion was equal, breath sounds were clear, with no wheezing, crackles or rales.

VIII. Cardiovascular

Assessment should have revealed normal findings that there were no abnormal pulsations

or heaves upon palpation of the patient’s precordium. The apical impulse would be audible at the

5th intercostal space in the left midclavicular line. There would be no thrills. The patient should
 Community Survey 9

exhibit a spilt S2 upon auscultation of the pulmonic valve area at the left intercostal space. This

was noted on the patient’s history. A split S2, is described as a normal physiological occurrence

that is audible at the end of inspiration in a percentage of the population. The closure of the

aortic and pulmonic valves is normally somewhat synchronized. Due to the respiratory effects on

the heart, the timing of the closure of the valves is separated by inspiration. The sound of the

valves closing is heard as a T-DUP, which is the closure of the aortic valve approximately 0.06

second prior to the closure of the pulmonic valve. (Jarvis, 2008, p. 508) The jugular veins should

also be flat, and the carotid arteries should be palpable at a 2+ and equal bilaterally. The patient’s

radial pulses should be palpable at a 2+ and bilateral dorsal pedal pulses 2+.

IX. Gastrointestinal

The patient’s abdomen was flat and showed no signs of distention. The skin was smooth

with no lesions or scars. Assessment should reveal normal findings that the auscultation of the

patient’s bowel sounds were present in all quadrants. There should be no masses or tenderness

upon palpation, no organomegaly, and the liver should be palpable on the right at the

midclavicular line. Upon percussion of the abdomen, tympany should be resonant in all

quadrants.

X. Breast/axillae

The patient’s breast and axillae appeared normal and were symmetrical. There should be

no masses or tenderness upon palpation. There also should be no drainage or lesions.

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XI. Genitourinary

The genitourinary should also exhibit no signs of lesions or drainage. The color of the

patient’s urine was normal yellow in color with no sedimentation visible upon inspection. The

urinary output was consistent and within the daily requirements. The patient was assessed to be

at Tanner Stage 5. The patient’s pubic hair should show a pattern of adult distribution and

showed a spreading pattern to the medial thigh area. The patient did have a line of hair

distribution midway to the umbilicus along the linea alba. The patient’s penis and testes should

be of normal size and show no signs of lesions or masses. The patient’s secondary sex

characteristics were evidenced by facial hair and the quality, pitch, and tone of the voice had

deepened.

XII. Musculoskeletal

The patient upon visual assessment exhibited no deformities. There was full extension

and muscle tone was symmetrical bilaterally in all four extremities. The patient should able to

maintain flexion against resistance and be able to perform active range of motion in all four

extremities bilaterally. Cervical range of motion was not impaired and was movable in all

directions. The patient upon ambulation exhibited slight muscle weakness in the lower

extremities, and gait was at a slower pace than expected.

XIII. Neurological

The patient’s appearance, behavior, and speech were appropriate. The patient was alert to

person, place, and time. The patient’s thought processes were organized, appropriate, and

coherent. The patient’s memory was intact except for the period of time where consciousness
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was lost shortly after the suicide attempt and when the patient initially awakened in the

emergency room. The cranial nerves II through XII appeared to be intact and were not tested.

The finger to nose test should be intact, and the patient should able to identify objects in his

hands. The patient’s sensation to light touch should also be intact and deep tendon reflexes

should be normal at 2+. The patient should have a positive Romberg test.

Emotional Dimension

The patient’s cognitive abilities seemed to have developed as suspected for someone of

his age. At first impression, the patient portrayed a young man that was perhaps mad at the world

and defiant. He seemed coarse in language and almost “thug-like.” However, first impressions

are almost always misleading. During the interview and assessment, it was interesting to note

that the patient had a teddy bear and was rubbing it against his cheek to feel the softness. When

asked about the teddy bear, he never once showed displeasure, and seemed to draw a sense of

comfort from the toy. Regressive behaviors often emerge in times of great stress and discomfort,

or when the psyche functions to preserve the patient’s energies. The regressive stroking of the

teddy bear is another way for the patient to cope with the stress and demonstrates that given time

they will be able to move towards the end of the health wellness continuum. (Hockenberry,

Wilson, and Winkelstein, 2005, p.401)

There were also periods during the interview that one could almost see that given the

opportunity and focus this young man could have a bright future ahead. During the interview, he

expressed sadness and distress over not knowing what his life would be like or how his peers

would perceive him. He seemed torn between what he wanted in life and what he thought was
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expected. The patient verbalized during the interview when asked about his career aspirations

that he wanted to either be a cosmetologist or a power line repairman. Two completely different

occupations with one considered more feminine and one masculine. The patient had expressed

intense fears of failure and overwhelming feelings of failure so extreme that he felt that he could

not and did not want to live. Although this type of confusion is evident during this period of

development, most adolescents work through this stage with little difficulty. The challenges of

the conflict and the overwhelming stress may involve deeper issues that could be rooted in

homosexuality and could be a causative factor in the patient’s suicide attempt and suicidal

ideations.

Psycho-social Dimension

The patient is the only child of a single parent home. The patient’s father having had

several problems with alcohol and substance abuse had a successful suicide attempt when the

patient’s mother was pregnant. The mother seems to try and involve herself in her son’s life, but

also allows him to smoke cigarettes in the home and buys him alcohol. She seems to be

somewhat interested in her son’s education, but also states that she wants him to get involved in

Job Corps, which in a sense would take him out of the home. There seems to be some

incongruence in that she wants to be involved in his life, but also wants him out of the home.

This internal conflict is evident when interviewing the patient. He stated at one point that he felt

that his mother had tricked him into committing suicide to get financial resources that would be

needed to get him into a new school and allow to keep his driver’s license due to medical

problems and not because he was failing at his current school or would be forced to drop out.
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Spiritual Dimension

The patient expressed feeling spiritually let down by God and the church. He stated that

he was Catholic and had recently spoken to a church official about his emotional problems and

his wanting to commit suicide. He stated that the official told him that it was wrong in God’s

eyes to end ones life, but offered no assistance in helping him receive help outside of the church.

Intellectual Dimension

The patient’s cognitive development was intact. The patient at one point tried to

abstractly conclude that since he had not killed himself taking several bottles of acetaminophen,

he did not see why taking tobacco “dip” would affect him either. He also seemed to theoretically

understand basic concepts in relation to algebra and geometry and went into detail verbalizing

several theories including the Pythagorean theory and how a grade curve appeared in a parabolic

form if the testing were accurate. (Hockenberry, Hockenberry, Wilson, and Winkelstein, 2005,

p.89)

Environmental Dimension

The patient expressed feeling depressed and sadness in relation to the suicide attempt. He

repeatedly has verbal discussions with his mother and is verbally abusive. In addition, his

verbalizations often contain slang and vulgar terminology. The patient also has a past medical

history of attention deficit hyperactivity disorder. Attention deficit hyperactivity disorder is a

recurring pattern of behavior characterized by the inability to maintain attention, hyperactivity,

and impulsivity. Individuals diagnosed with attention deficit hyperactivity disorder often

manifest other signs and symptoms during adolescence, which can include, but not limited to,
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sexually promiscuous behavior, low self-esteem, risky behaviors, and depression. (Videbeck,

2006, p. 448) Individuals that are prone to erratic and impulsive behavior are also at a higher risk

of committing suicide due to increase in risk taking behavior. (Videbeck, 2006, p. 335)

Community Resources

Although the patient appears to be a healthy 16-year-old male adolescent, he is in need of

further evaluation and treatment for the underlying cause of his suicidal ideations, depression,

low self-esteem, and role identity confusion. The patient is at increased risk over the next two

years and specifically the first three months after the suicide attempt to repeat the attempt. The

patient is also of increased risk for suicide given that his father had a successful attempt in 1991.

The patient and family are interested in seeking out alternative schooling for the patient

due to him not feeling challenged at his current school and feelings that this is the reason his

grades are not what they should be. The patient seems to be willing to learn more about what

caused him to attempt suicide and expressed a desire to complete his education and get out on his

own. The patient also expressed a desire to begin a smoking cessation program and substance

abuse counseling. In addition, the patient also verbalized that he was sexually active, and he

wants to learn more about abstinence and the prevention of sexually transmitted diseases.

Discharge planning for this patient should include referrals to a cessation of smoking

program and continuation of outpatient counseling. The patient could also receive a referral to

the Children and Family Resource Center (Children and Family, 2009). The referral source

works with the patient as they work on new patterns of behavior while allowing them to keep

their current network of friends and family, which in turn helps them receive desirable and

lasting results. The Boy Scouts could be a potential resource for this patient in the community in
 Community Survey 15

that they could provide positive role models and guidance (Daniel Boone, 2009). In addition,

Hendersonville also offers several drug and alcohol rehabilitation programs and addiction

treatment centers in the area. The Brian Center Health and Rehabilitation is potential resource

for recovery, addiction, and mental health that could be beneficial for this patient’s treatment.

(Brian Center, 2009).

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References

Blue Ridge Now. (2009). Blue Ridge Now Times-News Online. Retrieved September 25, 2009,
from http://www.blueridgenow.com.

Brian Center. (2009). Brian Center Health and Rehabilitation. Retrieved October 3, 2009, from
http://citehealth.com/nursing-homes/north-carolina/cities/hendersonville/brian-center-
health-rehab-hendersonville.

Carl Sandburg. (2009). Carl Sandburg Home. Retrieved October 3, 2009, from
http://www.nps.gov/carl/index.htm.

Children and Family. (2009). Children and Family Resource Center. Retrieved October 3, 2009,
from http://www.childrenandfamily.org.

Daniel Boone. (2007). Daniel Boone Council Boy Scouts of America. Retrieved October 3,
2009, http://www.danielboonecouncil.org.

Epodunk. (2009). Epodunk the Power of Place. Retrieved October 3, 2009, from
http://www.epodunk.com/cgi-bin/incomeCommute.php?locIndex=19365.

Flat Rock. (2009). Flat Rock Playhouse. Retrieved October 3, 2009, from
http://www.flatrockplayhouse.org.

Healthy Carolinians. (2009). North Carolina 2010 Health Objectives. Retrieved October 3,
2009, from http://www.healthycarolinians.org/healthobj2010.htm.

Henderson County. (2009). Henderson County Health Department. Retrieved October 3, 2009,
from http://www.hendersoncountync.org/health/web%20pages/communitydata.htm

Hendersonville Police. (2009). Hendersonville Police. Retrieved October 3, 2009, from

http://www.hendersonvillepolice.org/Home1.htm.

Historic Hendersonville. (2009). Historic Hendersonville & Historic Flat Rock, N.C. Retrieved
October 3, 2009, fromhttp://www.historichendersonville.org.

Hockenberry, Wilson, and Winkelstein. (2005). Wong’s essentials of pediatric nursing. (7th ed.).
St. Louis, Missouri: Mosby.

IDcide. (2009). IDcide - Local Information Data Server Retrieved October 3, 2009,
http://www.idcide.com/citydata/nc/hendersonville.htm.

Jarvis, C. (2008). Physical examination and health assessment.

(5th ed.). St. Louis, Missouri: Saunders.
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North Carolina Apple. (2009). North Carolina Apple Festival. Retrieved October 3, 2009, from
http://www.ncapplefestival.org.

U.S. Census. (2009). U.S. Census Bureau. Retrieved October 3, 2009, from http:/
http://www.census.gov.

Venes, D. (2005). Polypharmacology. In Taber’s Cyclopedic Medical Dictionary (Vol. 20,

p.1730). Philadelphia: F.A. Davis Company.

Videbeck, S.L. (2006). Psychiatric mental health nursing. (3rd ed.). (p. 448) Philadelphia:
Lippincott Williams & Wilkins.