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Assignment Questions

Community Nurse Diabetic Clinic

This is a nursing scholary project

The name of the project is Community Nurse Diabetic Clinic

The target market is the Hispanic Community in Allentown Pennsylvania.

I need a Table of Contents Introduction , Scope of Problem , Project( Business Plan for a Nurse Managed Free Diabetic Community Clinic) , Literature Review( please include stats ) , Demographics etc , everything that is needed in a thesis and also the Appendix( demographics) , charts, tables. i don’t need a Hypothesis Chapter or a Methodology chapter or Discussion Results , I do however need the other chapters.
I will send over the corrected version from my professor , please include my own notes and build upon it, unfornately a lot of things are not cited so you may or may not be able to use it , but you’ll have a general idea. This paper is like an introduction to the Business Plan , so it has to lead into the Plan that I have written to create a Nurse Managed Diabetic Clinic.

Please see below notes , it is choppy , wordy and the transitions are not there.

I really need help . Please make sure it is in APA with page # and Title Page included . Please make sure works cited throughout paper are all listed on the Reference Page. Please also check for all of the other items your company has stated they would include.

Please see below notes:

Community Nurse Diabetic Clinic

Renee Wilson


Scope of the Problem

Roughly 41.3 million people in the United States today are Hispanic. That breaks down to one in every seven people. Hispanic Americans represent the second-largest and fastest-growing minority group in the United States.
According to the 2003 U.S. Centers for Disease Control and Prevention report, more than 1.5 million Hispanic Americans had diabetes, up from less than 1.2 million in 1997. This high rate of diabetes does not include undiagnosed cases.

Disease Prevention and Treatment by the Life Extension Foundation states that roughly 5.4 million people in the United States have diabetes and are unaware of it. “Minorities are at particular risk. Compared with Caucasians, blacks have a 60 percent higher risk of developing diabetes and Hispanics have a 90 percent increased risk.” According to the National Diabetes Information Clearinghouse (NDIC), Hispanics are 1.9 times more likely to have diabetes than whites.

Pennsylvania had a significant rate of increase in diabetes hospitalizations; accounting for more less than ten per cent over the last two years. Eight per cent of adults of this state are affected by diabetes, which is higher than one per cent above the national average. Moreover patients from various counties in Western Pennsylvania have high rates of end-stage kidney disease , one complication of diabetes.

In 2004, diabetes was the principal diagnosis in 23,725 admissions in Pennsylvania hospitals, accounting for 132,000 hospital days and more than $673 million in hospital charges. 15.4 percent of patients with diabetes were hospitalized two or more times. Multiple hospitalizations were more common among certain populations, such as Hispanics and including Medicaid and Medicare recipients.

In the United States, one especially important determinant of access to care is whether or not one has health care benefits. In 2005, there were 46 million uninsured people in the United States (about 16% of the population). The uninsured rate and number of uninsured increased from 2002 to 2003 for non-Hispanic Whites (from 10.7 % and 20.8 million to 11.1 % and 21.6 million, the number of uninsured increased for Hispanics (from 12.8 million to 13.2 million), their uninsured rate was unchanged at 32.7 %. The number of people who are inadequately insured is much larger. There are 52 million people in the U.S. who are uninsured or underinsured. The development of community based diabetic clinics aims to focus on those that are at the greatest risk; the uninsured and underinsured. This project will aim to address those needs by providing free diabetic health care.

This project is to develop a business plan targeting the Hispanic Community of Allentown Pennsylvania; this business plan will guide the development of a community nurse managed diabetic health care center. This project will serve as a basis for further DNP work and implementation of this business plan.

Literature Review

Diabetes is a chronic disease affecting approximately 760,000 Pennsylvanians . Many people have no symptoms and learn they have diabetes only when they seek help for one of the many complications. At the present time there is no cure for diabetes, but research has shown that complications of diabetes can be greatly reduced with proper blood sugar control through healthy eating, physical activity, and use of medications. Still, diabetes is one of the leading causes of death in the United States and is responsible for nearly 3,600 deaths in Pennsylvania each year. (PA Department of Health, Bureau of Health Statistics and Research).

Diabetes is usually diagnosed in children and young adults and results from the body’s failure to produce insulin. Type 1 account for 5% to 10 % of all diagnosed cases of diabetes (Centers for Disease Control, National Diabetes Fact Sheet ). The most form of diabetes is Type II, this type accounts for about 90 to 95 % of all diagnosed cases of diabetes (Centers for Disease Control, National Diabetes Fact Sheet ). Pre- diabetes is a condition often present prior to the development of Type II diabetes. In pre-diabetes blood glucose levels are higher than normal, but not high enough to be considered diabetic. Pre-diabetes does not have to lead to the development of diabetes to controlling weight and increasing physical activity can prevent or delay the onset of diabetes. There are 41 million Americans who have pre-diabetes (Centers for Disease Control, National Diabetes Fact Sheet). There is extensive documentation regarding the correlation between diabetes and the increased death rates among Hispanics. In California where there is a large Hispanic community, diabetic related deaths are on the rise.
Collins (2009) noted that diabetes is killing Latinos in Ventura County at twice the rate it is claiming lives in other racial and ethnic groups. Nearly 6 percent of Latinos who died in Ventura County in 2005 and 2006 were killed by diabetes. The death records by The Star and Scripps Howard News Service indicate that the diabetes death rate is more than twice the rate for non-Latino whites and African-Americans. Doctors say those numbers are alarming but hardly shocking. (AMA, 2010) Diabetes has been increasing for years among Latinos, they say , not only among adults but also teenagers and young children. The diabetes death rate is at 10.4% for Hispanics because people with the disease often die from other conditions. (American Diabetic Association 2010) In those cases, diabetes would not be listed on the death certificate as the cause of death, although it often is a contributing factor.

Diabetes is an urgent health problem in the Latino community. The rates of deaths are almost double those of non-Latino whites. Disbursement of information to the Hispanic community about the seriousness of diabetes, risk factors and ways to manage the disease is essential

Demographic Profile of Spanish/Hispanics by State/County/SMSA is based on the 2000 Census. The Bureau of the Census classified Hispanic origin as those reporting their race as Mexican, Mexican-American, Spanish-American, Hispanic, Hispano, Latino, Puerto Rican, Cuban, Chicano, and “other Spanish/Hispanic” categories. This means that persons of Hispanic origin may be of any race. The Demographic table below provides some useful statistical data that reflects the geographical profile of Hispanics. Hispanics have been and will continue to be a major segment of the consumer market that is evident by the product information on many consumer products. See Table 1.

The Pew Hispanic Center released an extensive study of young Hispanics, those aged 16 to 25 and their uneven assimilation into mainstream American society. The Pew Hispanic Center points out that Hispanics accounted for roughly 60 percent of the growth of America’s uninsured between 1999 and 2008. By the end of that period, Hispanics represented less than 16 percent of the overall U.S. population but 31.4 percent of those who lacked health insurance at any given time, according to the Census Bureau . The 2008 National Health Interview Survey found that 34 percent of non-elderly (under age 65) Hispanics reported being uninsured, compared with just 14 percent of non-elderly non-Hispanics. About 43 percent of those uninsured Hispanics said they had never been insured, compared with only 15 percent of the non-Hispanic uninsured. As Samuelson i ndicates, the uncertainty of immigration flows makes it difficult to predict how many of the Democrats healthcare legislation would reduce the number of uninsured. Over the past few decades, the Hispanic population has exploded. Latin America provided half of all the immigrants who came to the U.S. between 1965 (when LBJ dramatically liberalized the immigration system) and 2008; Mexico alone provided 29 percent. While stronger border enforcement and the economic downturn have contributed to a steep drop in Mexican immigration since the mid-2000s, a July 2009 Pew study concluded that there had not been an increase in migration back to Mexico. Foreign born and less assimilated Latinos , those who mainly speak Spanish, who lack U.S. citizenship, or who have had only short tenures in the United States are less likely than other Latinos to report that they have a usual place to go for medical treatment or advice.
The Pennsylvania Commonwealth Fund 2002 report states that Hispanics are less involved in their health care than they would like, Hispanics find it harder to understand instructions from their doctors and do not fully understand their treatment plans. Hispanics also had more communication problems with their doctors and less satisfaction with their quality of health care.

Given the increasing growth of the Hispanic population in the United States, it is imperative that the American health system continue to develop cultural competence policies that address attitudes, knowledge and skills about cross-cultural education .

Hispanics are regional and sub-group dominant with their own cultural peculiarities that health policies should include. Hispanics have demographic trends, historical traditions, traditional medicine knowledge, fundamental values and beliefs, legal status , language/communication needs that must be addressed.
Previous research by the U.S. Centers for Disease Control and Prevention has shown that Hispanics are about twice as likely as non-Hispanic blacks and three times as likely as non-Hispanic whites to lack a regular health care provider. Hispanics are a diverse community, and the 2007 Latino Health Survey explores not only their access to health care, but also their sources of health information and their knowledge about diabetes at greater depth than any national survey done to date by another research organization or the federal government.
The survey finds that among Hispanic adults, the groups least likely to have a usual health care provider are men, the young, the less educated and those with no health insurance. A similar demographic pattern applies to the non-Hispanic adult population that lacks a regular health care provider.
Four-in-ten (41%) non-citizen, non-legal permanent resident Hispanic adults state, that their usual provider is a community clinic or health center. Some 15% of Latino adults who are neither citizens nor legal permanent residents report that they use private doctors, hospital outpatient facilities, or health maintenance organizations when they are sick or need advice about their health.
An additional 6% of Latino adults who are neither citizens nor legal permanent residents report that they usually go to an emergency room when they are sick or need advice about their health .
Some 37% of Latino adults who are neither citizens nor legal permanent residents have no usual health care provider. More than one-fourth (28%) of the people in this group indicate that financial limitations prevent them from having a usual provider 17% report that their lack of insurance is the primary reason, while 12% cite high medical costs in general. This is where nurse managed centers and free community clinics could play a crucial role in the delivery of diabetic preventative care.
Nurse managed centers working collaboratively with physicians, clinical nurse specialists and other healthcare providers provide health care for the uninsured. Federal and state funding along with corporate grants, assist in providing primary, non emergent-care services that vary according to the healthcare needs of the communities served (Fox Rose, 2009).
Among those treated are people of low income who cannot afford health insurance, the underinsured, homeless people and those who have immigrated to the U.S. without financial resources or English skills. The promotion of disease prevention and wellness are universal clinic goals, as health teaching is central to care delivery systems (Joan Fox Rose, 2009).
In response to this problem, hundreds of communities across the country have found solutions by developing and supporting free clinics. The Free Clinic in Doylestown is an example of a successful clinic. Peggy Dator MSW is the Executive Director and founder of the clinic. Ms. Dator stated that this clinic was one of the first free clinics in Pennsylvania. It was founded in 1994 by local nurse practitioners and a local community hospital, to meet the medical needs of low income uninsured and underinsured, adults and children residing in the central Bucks County community. The Free Clinic of Doylestown provides free medical care to adults and children. Ms. Dator is the only paid full time staff and there are five nurse practitioners who volunteer in the clinic and two of which provide free care in their offices upon referral. Annually they serve 1,000 adults and children. To date they have served over 7,300 individuals and have provided almost 30,000 patients visits in their free clinic program.

Another example of a free clinic is the “Diabetes Drive-Thru”. This may conjure up images of fast-food indulgences and insulin overload, but the blood-sugar screening program at King’s Daughters Hospital in Temple, Texas, actually serves up something sweeter. In about five minutes, “customers” drive through three nurse-staffed stations and receive free tests, results, and information without leaving their cars (Nursing Spectrum Staff, 2009). Nurse-managed health centers have been the catalyst. They proved they’re effective, that they provide high-quality care. Over the past two years there’s been a lot of political support that recognized the importance that providers such as nurses can help strengthen the safety net. Funding is crucial for a successful clinic. Federal funding is limited however there is donations grants and philanthropy .

The Independence Foundation, a Center City-based nonprofit philanthropic organization founded in 1932 by steelmaker William H. Donner, has invested millions of dollars in twelve areas nurse-managed health centers (George, 2009). “We are proud of our support of this innovative model of care, but our support is not enough to sustain these centers,” said Susan E. Sherman, the foundation’s president, speaking at an American Academy of nursing media briefing earlier this year. “We need federal funding to bolster the private sector” (George, 2009).
Pennsylvania Gov. Ed Rendell spoke in favor of nurse-managed health centers, a component of his state health-care reform plan, at the same briefing. “Greater nurse practitioner involvement in chronic care and rapid response is the inoculation we need to prevent rising health-care costs and ensure greater access to health care,” Rendell said (George, 2009 ).
Generally free clinics focus on filling gaps in local services instead of attempting to provide comprehensive care so as to conserve their resources on unmet needs.
Pennsylvania free clinics care for an average of 1,128 patients annually, of which 530 are new patients. Annually, Pennsylvania clinics provide an average of 2,175 medical visits and 339 dental visits. The mean operating budgets of free clinics are $287,810 with a mean for Pennsylvania clinics of 223,868 and a median of 96,000. Only 69 % of Pennsylvania free clinics have any paid staff, and of those that have paid staff, 55 % have any full time paid staff and 48% have part time paid staff. Ms. Daton stated that 55 % of the funding came from individuals and their annual special events with the rest from foundation grants. They typically received only a small amount from local and state government sources and they receive a onetime grant from the federal government to reconstruct space for the clinic.
Another unique feature of free clinics is that free clinics tend to be highly collaborative with other organizations. Most free clinics have some arrangement with local hospitals to provide free or low cost outpatient testing. Most work with the pharmaceutical companies to obtain free medications. Most collaborate with other community agencies to maximize access to services. The Free Clinic of Doylestown, for example, shares space with the Lower Bucks YWCA to provide medical services at a low-income apartment complex.

Nurse managed centers of primary health care have emerged as one of the newest innovative models. With Managed care systems and state level reforms being introduced in an attempt to control health care costs, the nursing profession has increasing opportunities to demonstrate, the ability to contribute in the area of health care access, quality and cost effectiveness . This project will provide quality comprehensive diabetic health serviced to all people served with special attention to the uninsured Hispanic community of Allentown, Pennsylvania.

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