Running head: HEART DISEASE IN ADULTS 1

Heart Disease in the Adult Population of Osceola County

Evidence Based Community Nursing Intervention
Community and Public Health Nursing
University of South Florida
October 11, 2015

Heart Disease in the Adult Population of Osceola County

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Osceola County Geographic Location and Data

Osceola County is centrally located in the state of Florida. It boasts a vast array of
residential communities and is also the home of Walt Disney World. Osceola County is located in
Central Florida North of Orlando (Florida Counties Map, 2015). The county has a population of
268,687, and the land area is 1,327 with 202 persons per square mile (United States Census
Bureau, 2014). The top three employers in the county are Walt Disney World with 4,150
employees, Walmart Stores Inc. with 2,388 employees, and Florida Hospital with 1,500
employees (Florida Department of Transportation, 2015). Osceola County comprises of a variety
of healthcare providers Florida hospital being the largest, Osceola Regional medical center which
is a not for profit hospital is also a big provider of health care. There are other local community
hospitals and several departments of health facilities that provide a host of services like;
behavioral health, women and child care, geriatric care. The county provides for the lower
income population with the provision of the Mobile medical Express which caters for uninsured
and underinsured residence.
According to United State Census Bureau (2014) 17.9% of Osceola Countys population
lives below the poverty level, which is higher than the 16.3% that is reported for the state of
Florida itself. 83.8% of the population that is above the age of 25 years in Osceola County has
successfully completed high school or has a higher level of education, which is lowers than the
States 86.1% (U.S Census Bureau, 2014). The percentage of residents in the county that speaks
a language other than English at home is 47.9, which is very high when compared to the states
27.4% (U.S Census Bureau, 2014). Heart disease is the number one case of death in Osceola
County; hence this paper will focus on the contributing factors which surround this cause. The

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high percentage of non-English speakers will create a language barrier and health literacy and
poverty will most definitely play a role in this statistic (FDH, 2013).
Osceola Countys Strength and Weakness
Based on the health profile of Osceola County the strengths that must first be mentioned
are the numerus health care providers in the county along with the fact that the county makes
health care accessible to people from all socioeconomic status. Accessibility is very important for
the people living below the poverty guidelines. Another strength of the county is the
sophistication of the health care facilities; there are trauma centers, stroke centers and easy
access to a burn center. The equipment used by the facilities are top of the line and evidence
based medical care is very important to the healthcare facilities (FDH, 2013). The last strength
that will be mentioned is the number of large employers in the county; Walt Disney World,
Walmart, and Florida Hospital. These employers keep the county stable and influence the great
tourism industry, leisure and hospitality occupies 25% of the work force, hence a company like
Walt Disney is a part of Osceola Countys foundation (FDT, 2015).
Every County has areas that needs improvement, the areas that needs to be improved
upon in Osceola County are; 12.1% of the countys adult population have had a heart attack,
angina, or coronary heart disease. This number is quite high when compared to the states 10.2%
Osceola needs to improve on education to promote better eating habits and exercise since 29% of
the adult population is obese compared to the States 26% (FDH, 2013). The statistics show that
33.9% of the Countys population lives a sedentary lifestyle this is high because for the state
itself the rate is 27.7%. Another component is inactivity or insufficiently active, 58.9% of the
countys adult population is either inactive or is not active enough, this is extensive when
compared to the states 52.9% (FDH, 2013).

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According to FDH (2013) 538 persons per 100,000 dies from coronary heart disease in
Osceola County, this is a high rate when compared to the rate of the Florida State which is 475
per 100,000. This statistic is directly linked to poor eating habits and inactivity or not enough
activity, which causes obesity and promotes the development of heart disease (American Heart
Association, 2015). It is imperative that the county implement strategies to educate the residents
on the troubling statistic and a healthier lifestyle.
Determinants of Health Model
The individual health of residents in a county is multifactorial and can be determined by
economic and social environment, the persons own characteristics and personal behaviors and
also the physical environment. The determinant of health model can work as a guideline to
facilitate growth in the knowledge of the county and provide steps to improve their overall
health. Some of the steps or lifestyle modification that can be made includes; anaerobic
exercises, changes in diet include more fruits, vegetables, and whole grain. Another area for
improvement is completion of the annual well visit this will allow for healthcare provider to
assess the residents health statuses and develop individualized plan to improve their health
(World Health Organization, 2015).
Cardiovascular disease is the number 1 cause of death globally (WHO, 2015). The most
important determinants for heart disease are; unhealthy diet, tobacco use, and the harmful use of
alcohol. The consequence of behavioral risk may be seen in individuals as high blood pressure,
increased blood glucose, increase blood lipids, and overweight or obesity. These risk factors can
be measured at a primary care visit and indicates the likely hood of developing heart disease.
Reducing salt in the diet, tobacco cessation, consuming g more fruits and vegetables, along with
frequent exercise, and lowering or avoiding the harmful use of alcohol, has shown significant

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reduction in the risk of developing heart disease. Furthermore drug treatment of hypertension,
diabetes and high blood lipids might be imminent in reducing the overall risk and prevent heart
attacks and strokes. Health policies that generate opportune environments for making healthy
choices affordable and available are crucial to motivate people in adopting and sustaining healthy
behavior (WHO, 2015).
Population Diagnosis
Osceola Countys subgroup is Caucasian White; the intension of a community nurse
would be guided toward Caucasian White and adults with risk factors for heart disease due to
unhealthy lifestyle. There were 206 Caucasian White persons per 100,000 who died from heart
disease which is very high compared to the 152 per 100,000 for the state of Florida. This shows
the eminent risk for Caucasian Whites getting heart disease (FDH, 2013).
Evidence Based Intervention
The objective of the community nurse in primary level of prevention should be the
achievement of good health for the community. The recipients at this level would be individuals.
The best intervention for the decreasing the incidence of heart disease in the community would
include; health education, health promotion and proper nutrition. The most effective prevention
strategies require knowledge and proper understanding of people, communities, and
environments, as well as variations in Cardiovascular Disease risk (Bagheri, N., Gilmour, B.,
McRae, I., Konings, P., Dawda, P., Del Fante, P., & van Weel, C., 2015). The healthcare provider
are the stakeholder and would facilitate these interventions by giving specific guidelines for
nutrition; limiting salt and fat intake, adding more fruits and vegetable and quitting some of the
personal behaviors such as smoking and limiting alcohol consumption. The role of the nurse

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would be to educate the patient about the risk factors associated with heart disease and
screenings that are applicable in identifying early signs (Institute for Work and Health, 2015).
The second level of prevention should be directed toward recipients who have already
been diagnosed with heart disease. The intervention should be aimed at slowing progression,
modifying the modifiable risk factors and seeking early treatment. This level will reduce the
impact of the disease, hence regular exams and screening test will be recommended. The stake
holder at this level will be the community; their responsibility is to implement programs aimed at
returning people to their previous health and function to prevent long-term problems. The nurses
role at this level is to educate individuals about the disease process and the importance of
following their medication regimen, also smoking cessation and limiting alcohol intake (Institute
for Work and Health, 2015).
The tertiary level of intervention aims to decrease the impact of the ongoing illness,
which can be done by assisting people in managing health problems and decreasing the effect of
the disease progression. The stakeholders should be individuals whose aim is to implement
rehabilitation programs or chronic disease management programs and to identify support groups
that can share their experience and strategies for living well. The recipients would be individuals
who have heart disease. The role of the community nurse at this level is to facilitate the patients
need for community resources to aid in recovery. The nurse would continue education on the
disease process and advice the recipients to follow up on all appointments and seek counseling
(Institute of Work and Health, 2015).
Health Policy Proposal
Health policy changes should look both at the local and state level, the health of the
community should be placed at the fore front in order to promote and sustain good health of all

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individual. The health of the community should be at the top of the priority list; hence it is
proposed that the health education of this population be improved upon. The goal of the proposal
is for the community to understand the importance of their health, and that early detection of
diseases increases the chance for better outcomes. The education should highlight yearly physical
assessments, self-exams and also prompt visits to a healthcare provider if a problem or sickness
is suspected. Research shows that the implementation of cardiovascular health promotion and
disease prevention activities will increase heart healthy habits in the community and there in
decrease heart disease overall (Balczar, H., Fernndez-Gaxiola, A. C., Prez-Lizaur, A. B.,
Peyron, R. A., & Ayala, C. 2015). As a community nurse the policy proposed would equip
healthcare workers with strategies to enhance and support individuals who have been diagnosed
with heart disease and also implementations to prevent or reduce the development of heart
disease. The community nurses aim is to have a healthier community and to educate individuals
with

heart disease on reducing modifiable risk factors, and to facilitate the rehabilitation of

each individual. Presently the individuals in Osceola County who are more susceptible to heart
disease are Caucasian Whites who are mostly living below the poverty guideline and is unable to
afford the necessary treatment for their diagnosis. The stake holder involved in this proposal
would be the members of the community and the sources that provide the funds. The members of
the community would be the supporting and the governing body the opposing, this will aid
negotiations since funding will be necessary for the implementation of the policy. The proposal
would need to be presented to a legislative body as well as health care workers and officials of
the government. The participants should agree on a plan that is sustainable and will promote the
health outcome of the individuals in the county. The major points for this proposal is to increase
the life expectancy of individuals who have already been diagnosed with heart disease by

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providing ongoing treatment, support, counseling and necessary rehabilitation. The proposal will
also provide education and screening for individuals that falls under the primary and secondary
level and who have higher risk factor for the development of heart disease.
Conclusion
Heart disease is the leading cause of death globally and should be taken seriously. In
Osceola County Caucasian Whites have a higher incident of the disease and should receive more
education on the risk factors and earlier screenings. There are lifestyle changes that can be made
to decrease the incidence of heart disease like; smoking cessation, limiting or avoiding alcohol
intake, exercise at least 30 mins 3 times per week and including more fruits, vegetable and whole
grain in their diets. If the population is educated on these risk factors and methods of prevention
then the practice of better eating habits and active lifestyle might more readily be adopted.

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References
America Heart Association. (2015). What is Cardiovascular Disease? Retrieved from:

http://www.heart.org/HEARTORG/Caregiver/Resources/WhatisCardiovascularDisease/What-isCardiovascular-Disease_UCM_301852_Article.jsp#
Bagheri, N., Gilmour, B., McRae, I., Konings, P., Dawda, P., Del Fante, P., & van Weel, C.
(2015). Community Cardiovascular Disease Risk, From Cross-Sectional General Practice
Clinical Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4344355/
Balczar, H., Fernndez-Gaxiola, A. C., Prez-Lizaur, A. B., Peyron, R. A., & Ayala, C. (2015).
Preventing Chronic Disease. Retrieved from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4362391/
Center for Disease Control and Prevention (2013). A public health action plan. Health Action
Plan to Prevent Heart Disease.
Retrieved from: http://www.cdc.gov/dhdsp/action_plan/pdfs/action_plan_full.pdf
Florida Department of Health. (2013). Florida charts. Major Causes of Death. Retrieved from:
http://www.floridacharts.com/charts/CountyHealthProfile.aspx?county=49&reportYear=
2014&tn=31
Florida Department of Health. (2013). Florida charts. Race. Retrieved from:

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http://www.floridacharts.com/charts/CountyHealthProfile.aspx?
county=49&reportYear=2014&tn=31
Florida Department of Transport. (2015). Osceola county freight and logistics. Major Private
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http://www.dot.state.fl.us/planning/systems/programs/mspi/pdf/Freight/onlineviewing/Os
ceola.pdf
Florida Counties Maps. (2015). Osceola county Florida cities. Kissimmee. Retrieved from:
http://www.floridacountiesmap.com/osceola_county.shtml
Institute for Work and Health. (2015). What Researcher means...Primary, Secondary, and
Tertiary Prevention. Retrieved from: http://www.iwh.on.ca/wrmb/primary-secondaryand-tertiary-Prevention
United States Census Bureau. (2014). People quick facts. Osceola County Florida. Retrieved
From: http://quickfacts.census.gov/qfd/states/12/12097.html
United States Census Bureau (2014) Geographic Quick Facts. Osceola County Florida.
Retrieved from: http://quickfacts.census.gov/qfd/states/12/12097.html
World Health Organization. (2015). Cardiovascular Disease. Retrieved from:
http://www.who.int/topics/cardiovascular_diseases/en/