A community is defined as a group of individuals sharing the same geographical location and sharing a similar culture, norms, customs, behaviors, beliefs and values. A community has distinctive characteristics that have developed over a period of time. Community-based nursing’s goal is to assess the community using a holistic approach and improve the overall health of the community. The nursing process assist nurses to determine community needs and strengths, diagnose problems, devise solutions, implement a plan and evaluate goals. The nurse works in a partnership with the community to accomplish the goal of health promotion and treatment (Stanhope ; Lancaster, 2014).
The community that was assessed is District 1 in the Bronx. District 1 is composed of three neighborhoods: Melrose, Mott Haven and Port Morris. These three neighborhoods are located in the southern part of the Bronx, better known as the “South Bronx”. According to the community health profile of 2015 by the City of New York, district 1 neighborhood boundaries
are drawn from East 149 Street up to Park Ave continuing with East 159 Street, Third Ave and East 161 Street going south Prospect Ave and East 149 Street. The community also borders the East River and Bronx Kill. In the 50’s, 60’s and 70’s district 1 vitality diminished with the migration of middle-income white families to the suburbs, racial tensions, high crime and poverty. District 1 community is also known for its cultural richness, the roots of hip-hop and its diversity (Community Health profile, 2015). In the 80’s District 1 began showing signs of improvement with the building of new infrastructure and businesses. I choose to asses this community because I lived in it part of my life, I’ve past by from time to time and I have noticed new businesses opening up, new residential buildings, new parks and a busier commute. I wonder how these new structures will help. Today, District 1 is in a better place it was before, however, there remains similar and new issues.
Today, as describe by the nyc.gov Community health profile (2015), there is an estimated 94, 377 individuals and 72 % or about 68,000 are Hispanic with Puerto Ricans and Dominicans having a strong presence, 25% or 23,500 are Black, 2% white, 1% Asian and 1% other. It’s no surprise that Spanish is the most spoken language at home (66 %), followed by English, French and certain African languages (Ibo, Twi, Yoruba, Bantu, Somali) (Population of Mott Haven, 2015). Language barriers is a challenge for health care workers within this community, 36 % have limited English proficiency. 29% of the population is under 18 years old, 13 % is 18 to 24 years old, 28% is 25 – 44 years old, 21% is 45 to 64 years old and 10 % is 65 and older. 50% of the population is Female and 49 % male. Teen birth rate is 4th highest in District 1 with 43.0 per 1,000 (Community Health Profile, 2015)
Poverty limits individual’s opportunities to quality healthcare. Studies have shown that those with a higher education have a longer life expectancy and better health. District 1 community life expectancy is 76.1 years that’s 6 years shorter than the average life expectancy in NYC. The Mott haven and Melrose residents live in the third poorest community in NYC with 43% living below the Federal poverty level. 45% of Adults 25 years and older have not completed high school and only 14 % have a college degree. Other factors contributing to poor health is unemployment and unfordable housing, 1 in 6 residents in district 1 are unemployed and 59 % are burden with rent. One third of district 1 community leave in the 14 NYCHA affordable housing units. The average gross income for a family of four is $24,000 with 30% of it going towards rent monthly. Family structures and household composition can have an influence on health outcomes. The majority of residents Mott Haven/Melrose reported never being married, 54% of females and 60 % of males while 21% females and 28 % males reported Married. The household type is overwhelming compose of single mothers with children 61 % and 29 % married with children.
Second pressing matter for the community board is the increase in domestic violence. Community board leaders state “the rise in intimate partner domestic violence involving our teen is a concern”. Community assessment (2015) ranks district 1 community, number two citywide for non-fatal injuries hospitalizations cause by community violence. In addition, the incarceration rate is 304, twice the Bronx rate. The Mott Haven/Melrose community is serviced by the 40th precinct. According to the NYPD crime map, between January 2017 and June 2018 there were 3,594 crimes (399 per 1,000) in this community, 1,164 of those crimes were felony assaults, 14 murders and 64 rapes. The increase in violence and incarceration rates within this community are contributed to concentrated poverty, unemployment rate and lack of resources (). Individuals who experience stressors such a physical abuse and are incarcerated have “higher rates of mental illness, drug and alcohol addiction and other health conditions” (Community Health profile, 2015). Consequently, the hospitalizations rate related to alcohol use is 2,333 per 100,000 putting district 1 community in the second-highest in NYC. The drug related hospitalizations are 2,669 per 100,000 making district 1 fifth-highest city wide.
There are two major expressways running through district 1, the Bruckner Expressway ( I-278) and the Major Deegan (I-87). The 145 St. Bridge, Madison Ave. Bridge, Triborogh Bridge, 3rd Ave Bridge and the Willis Ave. Bridge serve connect district one to Harlem and Manhattan. 89% of residents use public transportation (buses and trains) and on average expend 41 minutes on commute similar to citywide commute. Majority of the residents stated “their neighborhood was accessible via public transportation, with 91% agreeing that their neighborhood was close enough to buses and 81% agreeing that their neighborhood was close enough to trains / subways”; however, they described the commute a nuanced because of the overcrowded trains and buses.
Smoking, a sedentary lifestyle and poor-quality diet are risk factors for hypertension, obesity, diabetes, and heart disease. Residents of district 1, smoke at a similar rate when compared citywide 16%. 38% of adults report having 1 or more sugary drinks a day, 77% reports having at least one serving of fruit and vegetables a day (the lowest in NYC). Consequently, 33 % adults are obese and 16% are diabetic. Heart disease is the number 1 cause of death, diabetes second and strokes the sixth. According to the Bronx District Public Health Office, underserved communities such as District 1 lack the resources for physical activity and access to healthy foods.
The Mott Haven/Melrose community is also lacking health insurance. One out of four residents had no health insurance in 2015. With the implementation of the affordable health care act that number has decrease. However, one in six went without needed medical care, the highest in the city. This despite there being 35 urgent care hospitals, diagnostic/treatment centers and school-based facilities and that is including Lincoln hospital an adult level 1 trauma center. Residents have expressed their frustration with Lincoln hospital’s long emergency room wait which is 93 minutes, one of the highest nationwide as a result 15% of those who visit Lincoln hospital ER leave without medical assistance, the highest in the city.
Healthy People 2020 is a national and global agenda outlining health objectives for all individuals with an ultimate goal of “a society in which all people live long, healthy lives” by promoting health, preventing illness and improving quality of life (Stanhope & Lancaster, 2014). Healthy People 2020 is used by many local programs and government agencies in order to identify health inequalities and vulnerable populations within the community. District 1 in the Bronx has several health issues that can be addressed using the Healthy People 2020 agenda. The health topic that will be discussed for the Mott Haven/Melrose community is Violence and injury prevention. I choose this health topic because while there is a decrease in violence citywide, violent crimes in district 1 has increased, homicide went up in 2016 from 9 in 2015 to 14. According to statistical report by the 40th precinct there has been a 66% increase in felony assault from 2001 to 2017. In addition, to the increase in violence, victims of violence are unaware of the resources available within their own community. A report by who survey violence victims concluded “that many victims of domestic violence are unaware of the resources available to them. Only 19 percent said they had ever sought free legal or housing advice or counseling” (Dabney, 2016)
It is important for community health nurses to know how to assess domestic violence victims and to implement the proper protocol when violence victims visit the emergency rooms.
Although there is more that needs to be done about violent crimes in district, there are resources already in place within the community to assist the victims. The Lincoln Hospital has several assistance programs for children, women and LQBTQ community suffering from abuse including the Domestic violence program, Teen center and the child advocacy center. There is a social work department providing support group and counseling, in addition the program “focus on the dynamics of domestic violence and warning signs of an abusive personality or relationship”. According a local community newspaper, Mott Haven Herald, Hostos Community college host the annual Bronx Domestic Violence Roundtable symposium. This symposium is open to the public and is an excellent resource for victims and families of victims wanting to learn about abuse and resources available in their community (Dabney, 2016).
The Mott Haven community partnership program is another resource that provides a list of resources and services directory with the names of local agencies that provide different services to the community such as farmer markets, housing assistance and domestic violence aid. There are 13 domestic abuse victim services listed in this directory, for example, the Dominican Sisters family health services assist families with at risk of child abuse with case management, parenting and anger management. The Jewish Board of Family and Children’s services help families find legal services, court accompaniment and mental and physical providers are on site to assist.
Boom! Health is a nonprofit organization with two locations in district 1. Their services range from HIV/AIDS health promotion and prevention, substance abuse assistance and pro-bono legal representation for those in need. Boom! Health has made an important difference in reducing the annual HIV transmission in district 1 community as well as helping substance abusers seek help. They hope to do the same with the “Legal Advocacy Program provides representation, advice and advocacy to Bronx residents living with HIV/AIDS. We provide legal assistance – free of charge – to our clients in a broad range of civil matters. Each year, we help hundreds of clients avoid eviction, keep themselves safe and their families intact, and maintain the income necessary for them to meet their basic needs” (Mott Haven Community partnership, 2015).
Nurses are one of the mandated reporters by law, to report child and elderly abuse or neglect as well as domestic violence. Quality and thorough assessment of abuse will assist nurses a identifying victims and reporting it to the proper authorities. To avoid revictimization, a community health nurse will have to go beyond reporting. A team comprise of social worker, physician, case manager, law enforcement, families and educational facilities will be important in targeting victim-specific cases as well as community wide.
In 2017, Mayor Deblaso created a Task Force to combat domestic violence in NYC boroughs. The Task force outlined recommendations to assist domestic abuse victims although this a started the Task Force fails to conclude that concentrated poverty, poor housing conditions and lack of educational resources is a major stressor for abuser and victim. District 1 is the third poorest community in the Bronx (NYC Criminal Justice, 2017). Government agencies need to take a bigger role in promptly providing these individuals with affordable housing and quality education. In addition, policymakers must make laws that will assist the victim faster an don’t put up so many roadblocks. According to the Bronx Intimidate partner violence report, “agencies require proof that abuse is happening, such as an order of protection or a police report, when victims apply for government assistance” such situations discourage the victim from getting out of the cycle of abuse (NYC Criminal Justice, 2017). Law enforcement is one of the first to respond to violence calls, police officers need to be train adequately at identifying and documenting abuse as well as following up with victim and abuser.
Teachers are also by law mandated reporters of child abuse and neglect. In service training should be provided to teachers lacking the skills to identify a child going through abuse. Educators can make a difference “by embedding teaching on healthy relationships into the curriculum so that young boys and girls are taught, from an early age, that violence is unacceptable” (Horley, 2014). Peer health exchange is a nonprofit organization that trains college students to teach health curriculum that are lacking in low income high school, such as abusive relationships, where to get help and who to call. Teachers can advocate for such programs to be integrated into their schools.
Hispanic culture is strongly male dominates, “machismo” rules Latino culture and women have little to no say. Women and their families need a source of empowerment to take action and break the cycle of abuse. Abusers need to take responsibility of their actions and analyzed their pattern. Abusers are often victims too, recognizing that they need counseling, support groups. If it is safe for the victim’s family therapy can help heal emotional and psychological wounds.
Health care workers such as nurses have an ethical duty to care for women and their children. Research has shown that abuse and violence affect women’s and children’s health as a consequence nurse have a role in prevention, health promotion and early intervention. Community nurses often visit client’s home and it is where they can make a detailed screening and assessment of home environment that may demonstrate signs of abuse (O’Doherty, 2015). Nurses and other healthcare providers should be provided with training on how to effectively screen victims of abuse and how to proceed when identifying victims. Nurses can identify family dynamics, identify family strengths and weaknesses and teach parents parenting skills or offer mother’s a way out of the relationship (Rivas et al., 2015)). Nurses and social workers can create a plan for a safe way out when in danger of abuse and offering a list of safe places to go. Nurses should know where to referred victims whether to call child protective services or find shelter for batter women.
Educating our community members from a volunteer to a physician will only strength how quickly victims of abuse can be assisted. The ultimate goal is to have health and thriving families, that begins with providing everyone equal healthcare assistance and eliminating stressors. District 1 and every other underserve community can be helped with a team willing to fight for them.
Census profile: NYC-Bronx Community District 1 & 2–Hunts Point, Longwood & Melrose PUMA, NY. (n.d.). Retrieved from https://censusreporter.org/profiles/79500US3603710-nyc-bronx-community-district-1-2-hunts-point-longwood-melrose-puma-ny/??
Community Health Profiles: District 1. (2015). Retrieved from https://www1.nyc.gov/site/doh/data/data-publications/profiles.page
Dabney, C. (2016, October 5). DV Survivors Need Enhanced Services, Survey finds. Retrieved from http://www.motthavenherald.com/2016/10/05/assistance-for-dv-victims-is-flawed-survey-finds/
Horley, S. (2014). Addressing domestic violence through support and prevention. British Journal Of School Nursing, 9(1), 35-37.
Lincoln Hospital Medical Center (2013, May 30). The Heart of the South Bronx: Community Health Needs Assessment. Retrieved from http://www.nyc.gov/html/hhc/downloads/pdf/community-assessment/hhc-chna-lincoln.pdf
Mott Haven Community Partnership (2015). South Bronx Community Resources and Services Directory. Retrieved from http://www.bxconsortium.org/uploads/2/5/2/4/25243029/south_bronx_community_resources_and_services_directory_2016.pdf
NYC Criminal Justice. (2017). NYC Domestic Violence Task Force 2017 goals and recommendations. Retrieved from https://www1.nyc.gov/assets/ocdv/downloads/pdf/DVTF-2017-Recommendations.pdf
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Power, C. (2017). Domestic Violence: What Can Nurses Do?. Alabama Nurse, 44(4), 18-20.?
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Stanhope, M., ; Lancaster, J. (2014). Foundations of Nursing in the Community: Community-Oriented Practice (4th ed.).