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Application of Community Health and Population Focused Nursing

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Submitted By nsawc1
Words 2277
Pages 10
Running Head: Application of Community Health


Ann Coddington

Western Governors University


This paper focuses on the health status of Yakima Valley in Washington State from numerous published data and interviews.

A. Identification of Community/Windshield Survey This paper focuses on the health status of the Yakima Valley in Washington state.
Yakima Valley is located in Washington state 150 miles southeast of Seattle. Yakima is the largest city in the county. The 2010 census places the city as the ninth largest city in Washington. The city's total population is 91000 and with a metropolitan population of 243,231. The Yakima county is divided into upper and lower valleys. The city of Yakima is in the upper valley which is more urbanized. The lower valley is less populated and has more agriculture. Yakima Valley is an agricultural community noted for wine, apple and hop production. This area produces 77% of all the hops grown in the United States. ( Yakima County, 2012) The Yakima River is the primary water source for irrigation. The river runs from its source at Lake Keechelus to the Columbia River. Yakima Valley has a steppe or semi-arid climate. Because of the semi-arid climate, vegetation is dominated by grasses or shrubs. Precipitations are low year round with only 8 inches annually. December is the coolest month with a mean temperature of 28.5 F. The hottest month is August with a mean temperature of 89.2. (Yakima County, 2012).
Population Economic Status: The Yakima Valley is home to a population of 243,000. The racial makeup is 48.2% Hispanic, 44.5% Non-Hispanic White, 7.3% Other. In 46% of households have children under the age of 18. The average household size is 2.68 and average family size is 3.3. The median household income is $39,706. The per capita income is $20,771 with 21.3% of the population below the poverty line. The Yakima valley has more than 11,000 acres of vineyards. It has the largest concentration of wineries in the state of Washington. In all 40% of Washington's yearly wine production is made in the Yakima Valley. In addition the Yakima valley has a strong production of fruit orchards. The most prolific are apples, cherries, nectarines, peaches and pears. In 2014, the GDP for Yakima County was 7.5 billion. At 15.6% agriculture is the highest percentage of Yakima GDP. Agriculture sector GDP was 1.2 billion dollars for 2014. The second largest economy in Yakima Valley at 10% is wholesale trade. ( “An economic”, 2015) The population economic data shows factors which will impact the overall health picture of Yakima Valley (i.e. younger population, increased number of undocumented workers). According to the community health needs assessment for Yakima Valley, there is a disparity of the medically uninsured between races. In 2011, there were 20% Caucasians, 45% American Indian and 37% Hispanic that were uninsured. Because of the high migration of undocumented workers in the agricultural sector the uninsured population is thought to be higher but data is hard to obtain. Because of the inability of the under insured and the uninsured to access medical treatment regularly, acute and chronic illnesses are a significant drain on the economy especially for hospitals (“Health Needs”, 2013).
Disaster assessment and planning guide Yakima County has had several environmental disasters most notably major floods, ash fallout from Mt St Helen and landslides that clogged the Naches river which caused extensive flooding. Since 1956, Washington Department of Emergency Management has declared 13 federal disasters. Yakima Valley Office of Emergency management develops and coordinates the Hazard Mitigation Plan (HMP) which assists interested parties in planning for natural hazards. The following are the Yakima Valley Emergency management plans for environmental disasters:
Flooding continues to be a major problem in Yakima County. In 1996, flooding caused $18 million worth of damage. Because of increasing industrial and residential development vegetation has been decreased and storm water and melt water develop streams which flows into the rivers directly instead of being absorbed by the soil. This causes floods to intensify and flood damage increased. According to a 2015 report, Yakima county can expect an average cost of $3 million in flood damages annually . In order to mitigate these concerns, Yakima County has passed ordinance that protect streams, wetlands and vegetation buffer zones from development. This provides floodwater storage. In 2015, Yakima county has set aside 51,000 acres for flood buffers. Also, the county is purchasing land along the Yakima and Naches Rivers so they can remove or move existing levees. The levees constrict the flow of the rivers and causes additional flooding.
2. Although rare in Yakima County, geological hazards such as landslides, volcanic eruption and earthquakes can cause extensive and wide ranging damage. For instance, a landslide which occurred in the Nile valley in 2009, destroyed state road 410, blocked the Naches river and lifted up the riverbed by 30 feet and caused $8 million dollars worth of damage. By mapping potential landslide and debris flow areas the county can identify the locations and develop plans such as replacement of vegetation which keeps surface soils in place. In 1980, Mt St Helens erupted. While Yakima Valley was spared lahar flows, the county was covered in ash. In Yakima city alone nearly 600,000 tons of ash was removed. The ash caused major damage to storm water drains and cost the city $5.4 million in cleanup and damage. Yakima county has identified geologic hazards such as landslides and debris flows. The map identified more than 600,000 acres which is in hazardous areas for geological damage. An additionally 515,000 acres that can only be developed at a low density residential area (City of Yakima, 2015).
Population Health Scavenger Hunt: The Yakima Valley workers clinic began in 1973 for migrant/seasonal farm workers because health care was non-existent. Today the clinic is the largest community based health center in the pacific northwest. The clinic has expanded to serve under insured persons as well as non documented residents. Their services include: primary care, psychological care, dental care, drug services and geriatric services. They also have outreach programs for chronic health conditions, HIV/AIDS and neonatal/ infant care. This includes education classes, referrals, transportation services for appointments and help to qualify for state/federal programs. They take private insurance, medicaid/medicare, and have a sliding scale for non insured. The providers and staff are bilingual (English and Spanish) since over 50% of their client base primary language is Spanish. The clinic is easily accessible by multiple sites and a continually traveling clinic. They also have 1-800 numbers for appointments. Another programs which is essential to Yakima County is the Women, Infant and Children offices (WIC). Most of the staff are also fluent in Spanish and English due to the large Hispanic population. They have pamphlets available for clients at an information counter in their main office. Also they advertise in most medical offices as well as grocery store. The office serves low to moderate income pregnant women, women who recently gave birth and infants/children up to the age of 5. WIC conducts training on nutrition and wellness programs, such as breast feeding, and pre natal care. These classes are free. WIC gives checks for food that can be redeemed at local grocery stores. The main Boys and Girls Club of Yakima Valley is located in Yakima city. There are satellite clubs in neighboring cities and towns. The club offers after school and summer programs for children on a sliding scale. The facilities have a game room, art and craft room, homework center staffed by local high school and college students. They also offer low cost music, dance and art lessons. The Yakima Valley Harman Senior Center offers many programs and classes for the senior members of the community. The staff is bilingual to better serve the Hispanic population. The center offers classes that highlights healthy aging, wellness and community involvement. They offer a volunteer program which pairs a senior citizen with a young children who do not have grandparents. They plan activities like board game night, ice cream socials and classic movie nights. This is a wonderful inter-generational program which enriches the emotional and mental health of both generations. With a 75% of increase in prescription drug abuse effecting Yakima Valley in the last 3 years, there has been a growth in treatment centers. The Triumph treatment services is a publicly funded treatment facility in the city of Yakima. They offer full service outpatient treatment program which offers child care and parenting classes. They also offer a men's residential treatment program that includes inpatient, recovery house and dual diagnosis treatment. The women's residential treatment program offers programs for pregnant and parenting women, transitional housing for women and their children. They offer a large permanent housing program for individuals, couples and families who are in recovery. They serve about 700 people yearly. Since funding is provided by grants, local/state/federal agencies, individual cost are minimal. However the increase in opiate addiction has hit this community hard and they have an extensive waiting list. Because treatment is hard to acquire increase in crime associated with addiction is also on the increase in Yakima Valley (ADAI, 2015). Department of Ecology of Washington's Yakima Valley office must contend with the damage caused by pesticides used at farms in Yakima Valley. A report conducted in 2015 found that 12% of wells in the Yakima Valley area do not meet current drinking water standards. many people depend on groundwater especially outside of the cities in the valley as a drinking water source. The water tested have elevated levels of nitrates. Because nitrates reduce the ability of red blood cell to carry oxygen, infants and pregnant women are predominantly at risk. They can develop serious health concerns such as methemoglobinemia which prevents methemoglobin to break down into hemoglobin (“Lower Yakima”, 2014) The Washington's legislature has allocated $2.3 million to reduce nitrate levels. nearby dairy farms were found to be the cause of nitrate-contaminated groundwater. The farms and the Washington' s ecology agency have developed plans to reduce cattle manure into the water sources (Prengaman, 2013).

Cultural Assessment Tool Yakima Valley has a rich racial and cultural diversity. Because the Hispanic community has continued to grow there are both challenges and opportunities to the region's healthcare system. As stated earlier over 48% of the valley is Hispanic. Also there is a thriving American Indian community because of the large Yakima Reservation. The cultural demographics are as follows: WA State Yakima County Hispanic 48.2% ,Non-Hispanic Multiracial 1.8%, Non-Hispanic Native Hawaiian / Pacific Islander 0.1% , Non-Hispanic Asian 1.1% , Non-Hispanic American Indian / Alaska Native 3.6% ,Non-Hispanic Black 0.7%, Non-Hispanic White 44.5%. The information gleamed from an interviews conducted at a local senior center and WIC education class mirror findings from a county wide study conducted in 2014. The unintended pregnancy rate was higher than Washington state as a whole at 47% for Yakima Valley vs. 38% for Washington state. Also teenage pregnancy rates are 50% percent higher in Yakima than Washington state as a whole. Although teenage and unintended pregnancy were higher in Yakima prenatal care was about the same as the state at 80% but premature births were higher at 12% vs. 9% at the state level. This could be do to the higher teenage pregnancy rate since teenage pregnancy tend to have more premature births (“Chronic Disease Profile”, 2015). In adults over 65, the biggest issues related in the interview were chronic conditions such as COPD, heart disease, obesity. Inactivity and lack of exercise was also a concern. According to data from the State of Washington department of health, about 65% of senior adults are living with chronic conditions in Yakima valley and about 50% do not get regular exercise. Interviewers found Caucasians which were more likely to have good quality private insurance rated their overall health as good where as Hispanic and native American who were more likely to be under insured or have medicare/medicaid rated their overall health as fair. All groups rated a need to increase physical activity. This interviewer found adults across all racial boundaries understood the importance of physical activity for improved health but very few followed the recommendation (“Chronic Disease Profile”, 2015).


City of Yakima ( 2015). City of Yakima Hazard Mitigation Plan (Data file). Retrieved from Yakima-Hazard-Mitigation-Plan-2015.pdf.
Department of Ecology State of Washington. (2014). Lower yakima valley groundwater uality (Data file). Retrieved from,
Office of Financial Management. (2012). Yakima County (Data file). Retrieved from
Prengaman, Kate. (2013, December 1). Lower yakima valley groundwater group struggles to make progress on nitrate pollution. Tri-City Herald. Retrieved from http://www.tri
University of Washington. (2015). ADAI (Data file). Retrieved from
Washington State Department of Health. (2015). Chronic disease profile (Data file). Retrieved from ChronicDiseaseProfileYakima.pdf.
Yakima County Development Association. (2015). An economic development report card for yakima county (Data file). Retrieved from %20071513.pdf.
Yakima Memorial Hospital. (2013). Health Needs Assessment 2013 (Data file). Retrieved from 2013.pdf.…...

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