Community Health Project

Community wellness Project- Part whiz Identifying the Projects Focus Kathleen Rogers King Walden University November 26, 2012 Community health Project-Part One -Identifying the Projects Focus This paper go away identify a monumental wellness issue and a particular macrocosm for a health guidance plan. choke for the signifi peckce of this health issue, and rationale for the plectron of this state go out be presented. consequence approximately the population give be examined and discussed in regards to matchless(prenominal) asset and one ch bothenge of this particular population.An get on to get by the issue and the rationale for this choice will be provided with a minimum of 5 remove references. wellness Issue and people Defined as turn out prior to 37 weeks gestation (ACOG, 2008), preterm stick outing affects about 12% of takes in the United States. Preterm induce is an all important(p) public health antecedence costing over $26. 2 trillion in 2005 acco rding to the March of Dimes (2011) musical composition on preterm consume. Prematurity is the second trail cause of death in children beneath 5 years, and the single almost important cause of death in the setoff month of life (March of Dimes, 2011).More than 15 one million million babies be born in addition soon, with 1 in 8 babies born ill- termd every year worldwide of these, over 1. 1 million preterm babies come about cod to complications of wrongness (CDC, 2012). The cost of the first year of lineage for a preterm infant is 10 measure great than for term infants (Howson, Kinney & international deoxyadenosine monophosphateere Lawn, 2012). Support and Rationale Women and infants are a vulnerable population. Maternal mortality and morbidness disproportionally affect vulnerable populations of women, much(prenominal)(prenominal) as those living in mendicancy, facing racial and ethnic discrimination, and having limited language skills (Anderson & chemical gro up A Stone, 2013).From a public health placement infant mortality is considered the measuring arrive for determining the health of the population, whereas enate mortality is the divider amidst wealth and poverty (Anderson, 2013). Eliminating racial, ethnic, and socioeconomic disparities is critical for quality health p confused outcomes (Shi & adenine Stevens, 2010). Preterm bring forths occur more(prenominal)(prenominal) often among certain racial and ethnic groups with non-Hispanic black captures being 1. 5 times more apt(predicate) to make water a preterm small fry, and that baby 3. times more likely to die than a non-Hispanic white baby (CDC, 2012). Sadly, although 90% of preterm babies in high-income countries will survive, 90% of preterm babies born in low-income countries will die (Presem & McDougall, 2012). The implications of being born too soon extend beyond the neonatal period and throughout the life cycle, resulting in serious consequences such as noetic palsy, and continuing lung disease, as well as, apt impairment, learning difficulties, poor health, vision and earshot loss (Institute of Medicine, 2007).In general, the more immature the preterm infant, more life- accompaniment is implyed, the riskinesss of re-hospitalization are greater, and the burden of life story problems more significant (IOM, 2007). Assets and Challenges Preventing preterm behave dust a gainsay (CDC, 2012). There is no test that can accurately call off a preterm birth, very little is cognize about the causes and mechanisms of preterm birth, or about how to prohibit a preterm birth, and few utile disturbance strategies are unattached (March of Dimes, 2012 WHO, 2009 IOM, 2007).Once a char is pregnant, most of the interventions to impede preterm birth solitary(prenominal) delay onset long decent to administer steroids to the m an some other(prenominal) to help interrupt respiratory distress in the infant after birth and transfer the mother a nd fetus to a hospital for the appropriate level of take (IOM, 2007). Studies indicate that many a(prenominal) of the factors associated the preterm birth frequently occur together, oddly in minority women, or those who turn in low socioeconomic status (IOM, 2007).Medical conditions such as chronic hypertension, diabetes, infections, and stress are associated with preterm birth, as are any write up of a preterm birth in a previous pregnancy, a family history of preterm birth, infertility, and a pregnancy of twins or triplets (IOM, 2007). all significant gains to be make in the study of preterm birth will be in the area of legal community and eliminating disparities (IOM, 2007). Feasible, sustainable, efficient care solutions can be made available by col drudgeation, cooperation and alignment of work (WHO, 2012).clinical research continues to identify ways to prevent preterm deliveries. For example, a progesterone medication (17-alpha hydroxyprogesterone caproate or 17P) may prevent preterm birth among women who have had a prior preterm birth (CDC, 2012). Approaches and Interventions Addressing preterm birth is now an urgent priority for reaching the WHO, millenary Development Goal 4 (WHO, 2012). Reducing child deaths by two-thirds by 2015 requires a rapid expansion of our worldwide commitments to implement change (WHO, 2012).Collaborative and partnership management modellings have evolved for addressing action and prevention programs such as, the World Health establishments Every Woman, Every Child, Global scheme for Women and Childrens Health, March of Dimes, Save the Children, born(p) too miserable, The Partnership for Maternal, freshborn & Child Health (PMNCH), and the United Nations Millennium Development Goals (MDGs 4 & 5) which aim to save the lives of 16 million women and children by 2015 (Howson et al, 2012 WHO, 2009).Nationally, the framework is complete since 1980, the CDCs Healthy People series has been ground on core public c oncepts population surveillance, population health, prevention and early intervention, acknowledgment of root causes, outcome assessment, and continuous feedback so that interventions can be adjusted appropriately (Manderscheid, 2009). To achieve the Healthy People objectives, it is inhering to monitor improvement regularly to manipulate the resources are directed appropriately and efficaciously (Shi & Stevens, 2010).A set of ten mensural leading health indicators (LHIs) was developed, which also invent the risks of preterm birth these are physical activity, obesity, baccy use, substance abuse, sexual behavior, mental health, scathe and violence, environmental quality, immunization, and access to health care (Shi, 2010). Implementation and Rationale Implementing priority, present-based interventions for prevention intromit reducing unplanned adolescence pregnancies, short time gaps amongst births, un red-blooded pre-pregnancy weight (underweight or obesity), substanc e abuse (e. g. tobacco use) and chronic disease (e. . diabetes, hypertension). Screening for infectious sexually transmitted disease (e. g. HIV, syphilis), and implementing early handling can also help trim back the incidence of preterm labor (WHO, 2012). Internationally, all countries need to ensure universal access to encyclopedic antenatal care, quality childbirth work and emergency obstetrical care (WHO, 2012). In addition, workplace policies need to promote well-informed pregnancies and reduce the risk of preterm birth including regulations to defend pregnant women from physically demanding work, and exposure to subtle pollutants (WHO, 2012).Greater provision for life-saving medications, supplies and services, as well as the resources and policies are needed to enable women and children adequate access to health care, especially proficient care at the time of birth (WHO, 2009). Empowering, and educating girls, providing health promotion, access to care for cost-efficien t interventions in contraception, and encouraging preconception family think can join on the likelihood of healthy planned pregnancies, and improve preterm birth prevention according to the WHO, Born Too Soon Global Action Report on Preterm Birth (Presem & McDougall, 2012).In addition, Kangaroo Mother precaution (skin to skin incubation with mother) can curb preterm deaths in half saving an estimated 450,000 babies a year (Presem & McDougall, 2012). The provision of cut-rate antenatal corticosteroids and antibiotics is estimated to reduce the risk of respire difficulties in premature babies, saving near 370,000 lives a year (WHO, 2012). Fontenot and collins Fantasia (2012) reason that 100mg of progesterone vaginally every night between 24 and 34 weeks gestation resulted in lower incidence of preterm labor, birth, and delivery.Approach and Action A recent article in The fishgig (2012), claims from a panel of experts, that five prove interventions could begin lowering p reterm birth rate of 5 percent across 39 high-resource countries, including the United States, by 2015, and would prevent prematurity for 58,000 babies a year and $3 one thousand thousand in health and economic be (March of Dimes, 2012) * Eliminating early cesarean section deliveries and inductions of labor unless medically indicated * Decreasing embryo transfers during support reproductive technologies * Helping women quit grass Providing progesterone supplementation to women with high risk pregnancies * Cervical cerclage for spoiled women with short cervix. The bulk of preterm births occur spontaneously with no cognize cause, recent studies show that a short cervix is the single best forecaster of preterm birth. Slager and Lynne (2012) propose screening for shortened cervical length, a universal risk factor, in conjunction with a proven clinical intervention by transvaginal ultrasound.Although not available in all areas, transvaginal ultrasound is the most reliable method to evaluate cervical length, it is found to be most effective for risk estimates under 30 weeks gestation, and predictive results were improved by combining with obstetric history (Slager, J. & Lynne, S. , 2012). The combination of ordained fetal fibronectin (fFN) testing and cervical length less than 25 mm is a strong predictor of impending preterm birth (Tharpe, Farley, & Jordan, 2013).As a MSN educator, my goal will be to educate nursing, midwifery, and medical students in the principles and methods of assessment, prevention and early intervention of preterm birth indicators. On the Perinatal Special anxiety Unit of my employment, a new brass of antenatal education will be proposed to administration detailing the benefits of group antenatal care in reducing low birth weight in premature babies (Massey, Schindler Rising, & Ickovics, 2006). snapshot maternity antenatal Care ModelCentering Pregnancy group antepartum care is an innovative model of care for addressin g the complex psycho tender needs of the mother and her family. Centering Pregnancy antepartum care promotes relationship-centered care, facilitates learning, develops vernacular support, and strengthens the opportunities for communication and nurturing among women. Centering Pregnancy prenatal care encourages social networking, supportive relationships with their significant other are developed, women experience less stress, fewer pregnancy complications, and fewer unbecoming neonatal outcomes (Massey et al, 2006).Research indicates that prenatal social support has been associated with improved fetal growth and greater infant birth weight. Good social support can improve birth outcomes measured in longer gestations and importantly larger babies, increase womens confidence, satisfaction, and increase self-nurturing (Massey, 2006). Centering Pregnancy is a model for group prenatal care that results in perinatal outcomes that equal or outmatch prenatal traditional care, especiall y for teens, and other cultures accustomed to group support (Anderson, 2013).Centering Pregnancy exemplifies an evidence-based best practice for nurse-midwives. This model places all three components of prenatal care- risk assessment, education, and support- into the group setting. It fosters a sense of empowerment as prenatal group members are promote to take responsibility for their own health care and group members are encourage to seek information about healthy behaviors and common concerns of pregnancy, which builds a partnership between patient and provider (Massey, 2006).Translating this model of providing prenatal care for our hospitalized high-risk antepartum patients is the approach I intend to take because the evidence for improved outcomes with group care for high-risk women seems compelling, and may even be a future model of care for other countries, and women of diverse cultures (Tandon, Colon, Vega, Murphy, & Alonso, 2012). References American College of Obstetric ians and Gynecologists (ACOG). (2008). commit of progesterone to prevent preterm birth. Obstetrics and Gynecology, 112, 963-965. American psychological Association. (2010).Publication manual of the American Psychological Association. (6th. ed. ). Washington, DC. Anderson, B. , & Stone, S. (2013). Best practices in midwifery, exploitation the evidence to implement change. Springer Publishing. New York, NY. Centers for Disease Control and Prevention (CDC). (2012). Preterm Birth. Retrieved from http//www. cdc. gov/reproductivehealth/maternalinfanthealth/PretermBirth. htm Fontenot, H. B. , Collins Fantasia, H. (2012). Vaginal progesterone to prevent preterm birth in high-risk women. Nursing for Womens Health. Association of Womens Health, Obstetric and neonatal Nurses. 37-241. ISSN 1751-4851 Howsen, C. , Kinney, M. , Lawn, J. (2012). The globular action compensate on preterm birth. Preterm birth matters. March of Dimes. 9-14 Lynch, E. , Dezen, T. (2012). Preterm birth can be prev ented with a few proven treatments, Lancet article says Global partners challenge 39 high-income countries. March of Dimes. http//www. marchofdimes. com/ parole/10898. hypertext markup language March of Dimes. (2011). March of Dimes 2011 premature birth report card. Retrieved from http//www. marchofdimes. com/peristats/pdflib/998/US. pdf Massey, Z. Schindler Rising, S. , Ickovics, J. (2006).Centering pregnancy group prenatal care Promoting relationship-centered care. Journal of Obstetric, Gynecologic, & neonatal Nursing, 35, 286-294. doi10. 1111/J. 1552-6909. 2006. 00040. x Manderscheid, R. (2009). Aiming for a healthy population by 2020 Moving our field toward prevention, early intervention, and population health. Behavioral healthcare 29, 1 Proquest Central. pg. 51 Presem, C. , McDougall, L. (2012). Born too soon The global action report on preterm birth. World Health composition (WHO). Retrieved from http//www. who. int/pmnch/media/news/2012/preterm_birth_report/en/index9. tml Shi, L. , & Stevens, G. (2010). under fire(predicate) populations in the United States (2nd. ed. ). Jossey-Bass. San Francisco, CA. Slager, J. , & Lynne, S. (2012). judging of cervical length and the relationship between short cervix and preterm birth. Journal of tocology & Womens Health, 57(1) S4-S11. doi10. 1111/j. 1542-2011. 2012. 00209. x Tandon, S. D. , Colon, L. , Vega, P. , Murphy, J. , Alonso, A. (2012). Birth outcomes associated with receipt of group prenatal care among low-income Hispanic women. Journal of tocology and Womens Health. 57(5). 476-481. doi 10. 111/j. 542-2011. 2012. 00184. x Tharpe, N. , Farley, C. , Jordan, R. (2013). Clinical practice guidelines for midwifery & womens health. (4th ed. ). Jones & Bartlett Learning. Burlington, MA. 198-201. World Health Organization (WHO). (2009). The worldwide incidence of preterm birth A systematic review of maternal morbidity and mortality. Bulletin of the World Health Organization, 88, 31-38. doi 10 . 2471/BLT. 08. 06255 World Health Organization (WHO). (2012). Born too soon The global action report on preterm birth. http//www. who. int/pmnch/media/news/2012/preterm_birth_report/en/index. html