Public health in the 21st century. Santa Barbara

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Practicum Journal Entries

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Practicum Journal Entries

Practicum: Journal Entry Week 5

Week five involved a lot of activities creating an opportunity to acquire practical knowledge on behaviors that increase risks to diseases and health complications. The practicum took place in Harris County. The county has a population of 4,337,000 dominated by Whites (CDC, 2014). In December 2014, the unemployment rate of the county stood at 7 percent and median household income was 54,100 dollars. The use of alcohol, drugs, and tobacco is common in the county. Similarly, Harris is home to a number of fast food outlets because of the readily available market created by its population. According to the 42 percent of 11th graders and below reported using alcohol and other drugs between 2009 and 2011 while 31 percent of the adults drink alcohol (Finkel, 2011). With respect to smoking, the county has 18 percent of its population smoking. Most significantly, the report revealed that physical activity (walking and exercise) is rare among children and adults of Harris. There are many producers and sellers of fresh produce in the county. However, the low income of many households limits their ability to purchase such produce consistently. Nonetheless, the county has limited incentives to promote production and distribution of fresh produce in different corners of the county (Begley et al., 2008).

Health Risk Behaviors

Binge drinking is a common practice among many adults in Harris County. Such activities promote the prevalence of alcohol thus causing many health risks to users. Logically, most binge drinkers tend to smoke tobacco or use drugs during binge activities. Accordingly, use of alcohol, drugs, and tobacco poses a serious threat to users, their families, and unborn babies. For example, these substances enhance the risks for cancer, diabetes, and lung diseases among others (CDC, 2014). Based on the 2013 Data Report on Harris, residents’ preference to drive to work or board public transport over short distances robs them the chance to engage in physical activities needed for fitness. The county has only three major recreational parks located across the county. However, a significant number of residents do not use these parks effectively, for recreation, exercise, and other physical activities (Begley et al., 2008). Lack of physical activity coupled with many restaurants for fast food creates a platform for lifestyle diseases such as obesity, diabetes, hypertension, and heart complications. Finally, residents in rural settings as well as a significant number in urban settings do not visit physician offices regularly for medical checkups or consultations that can enable them live healthy lives.

Practicum: Journal Entry Week 6

During week six, I met a number of patients suffering from or complaining of different diseases and symptoms respectively (Finkel, 2011). Many of the patients visiting the facility for the first time had felt sick or seen their symptoms for at least four days, before they decided to visit a medical officer. With respect to age, there was reasonable representation of teenagers, adults, and the elderly. Parents or elder siblings brought their younger brothers and sisters to the facility.

Health Determinants

With respect to health determinants, a number of factors played out in the population I worked with during this week (ODPHP, 2015). The main determinants of health in the county include age, alcohol, smoking, and other drug use, physical activity, diet, accessibility to health care services, and environment (ODPHP, 2015). Based on these determinants, it is clear that lack of public awareness as well as education is a serious contributor to the many diseases and ailments reported in the county. For example, proper information on the significance of physical activity and nutrition requirements for families can improve the health and physical fitness of residents of the county (ODPHP, 2015). Nonetheless, public awareness campaigns should enlighten people on the dangers of smoking, binge drinking, and drug abuse. Many health facilities exist in the region but lack of insurance coverage is a major impediment to access (Williams et al., 2008). In addition, high costs of services prevent many people from seeking health services when they become sick or develop symptoms. For instance, many people prefer to wait until sickness develops fully. In some cases, others wait for the condition to become critical then visit emergency rooms for services (Begley et al., 2008).

Modifiable health determinants are controllable to have different impact on people’s health (ODPHP, 2015). The local government, schools, health facilities, and social organizations can modify the health determinants of Harris County by enabling people acquire information, providing locals with skills on health, and managing situations proactively. Schools and hospitals can teach locals about nutrition and diet to enable them eat healthy (ODPHP, 2015). Campaigns against alcohol and drug abuse can discourage people from abusing these substances if they understand the effects. Other health improvement strategies can take place in informal settings such as churches and meetings among locals in designated places (CDC, 2014).

Challenges to Improving Health

First, lack of public awareness or education on health limits ability to improve health. A population informed and interested about their health will always take personal initiatives towards improving their health. Therefore, lack of public awareness and education is the topmost challenge.

Second, health coverage in Harris is average. For example, 25.1 percent of persons aged below 65 years old do not have health plans (Williams et al., 2008). Since these people constitute the majority of the population, it implies that many adults and young people cannot access medical services easily.

Third, widespread availability of fast food restaurants promote an unhealthy lifestyle in which people prefer quickly prepared meals or meals rich in calories, sugars, salts, and fats (Finkel, 2011). Many families no longer take time to prepare healthy meals at home. Accordingly, the popularity of these outlets and their products makes it challenging to address issues of obesity, diabetes, and heart diseases among others (Begley et al., 2008).

Teachable Moments

The actual location of this practicum had Whites as the majority and Blacks as the minority group. Accordingly, the dominant language in this place is English. While handling a sick boy from the African American community I imparted various skills and knowledge on how to remain healthy. For example, I took the little boy through the process of washing hands and fruits before eating. Similarly, I encouraged him to avoid unhealthy food in restaurants and roadside joints (CDC, 2014). He promised to teach his friends the same as well as start preferring food made at home.

Practicum: Journal Entry Week 7

The clinic for this practicum had already adopted and installed electronic health record systems. Accordingly, records for all patients visiting the clinic must be stored into the system, as per the regulations of the facility. When handling a patient, the information collected and stored by the caregiver about the patient includes personal background in terms of name, age, sex, parents, siblings, and occupation among others. Thereafter, caregiver must collect information concerning complaints, symptoms, with reference to when they started. Other critical information include subjective data, history of present illness (HPI), drugs used before, allergies or preexisting conditions, past medical history (PMH), past surgeries, and immunizations among others depending on the patient (Amugi-crouch & Meurier, 2011).

General include Skin HEENT, Neck, chest, and lungs. Respiratory information entails Cardiovascular: Gastrointestinal: Peripheral vascular: Musculoskeletal: Psychiatric: Neurological: Hematologic: Endocrine: Objective Data, which includes the Vital Signs: BP HR RR Pulse Ox, Temperature, BMI. If applicable (Pediatric) BP %, Weight %, Height %. Neurological assessment including differential diagnosis, lab, imaging plan, health promotion and disease prevention (Amugi-crouch & Meurier, 2011).

Lastly, I did the behavioral and psychosocial assessment then stored the information in the EHRs system (Amugi-crouch & Meurier, 2011). The EHRs system facilitates coordinated care because all caregivers in the facility can access the information from their offices. Accordingly, it prevents redundancy of services and at the same time provides a platform to base future visits by patients.

Practicum: Journal Entry Week 8

One of the patients handled during the practicum needed specialized care thus I had to refer him to a place where she could obtain help. Mrs. Jenny is a 23-year-old single mother who has experienced a lot in her short life. She gave birth at the age of 17 years to a baby girl suffering from brain deformities. The problem has caused a rift between Jenny and her 25-year-old boyfriend. Jenny does not work but the boyfriend works in a local supermarket. Financial problems limit Jenny’s ability to provide good care and medical services to the young girl. In addition, the problems with the boyfriend have taken an emotional and psychological toll on her life. Without specialized help, I believe Jenny may continue suffering and do something bad to herself or the baby.

Based on these observations and conclusions, I decided to refer jenny to a specialized pediatrician who can help her with the complications affecting the baby. Accordingly, I wrote a letter to the pediatrician and made a follow-up call to explain further about the issue. The pediatrician promised to offer help or refer Jenny to a better place. In addition, I introduced Jenny to a social worker in the clinic. She has worked with many women to help them overcome domestic problems that affect their health and wellbeing (Amugi-crouch & Meurier, 2011).

Jenny deserved these referrals because of the urgent need for specialized rather than generalized care. Nonetheless, Jenny appeared demoralized and hopeless in finding a solution to these problems. Without effective help, she could harm the baby or herself in the process (Amugi-crouch & Meurier, 2011). In my opinion, Jenny appreciated my concerns for the problems she faced. Accordingly, she accepted the recommendations and promised to follow some of the tips I gave her concerning the baby as well as her relationship with the boyfriend.

In my effort to ensure that Jenny visits the specialists recommended and open up about her problems, I will use the following strategies. First, I will accompany Jenny to the specialists and give her the moral support needed to talk with these people. I will encourage her to explain everything in detail and avoid leaving anything she may consider immaterial. Second, I will make follow-up calls to both Jenny and the specialists to check on the progress. Follow-up calls will make Jenny feel it is important to visit these specialists so that she can find proper help (Amugi-crouch & Meurier, 2011).


Amugi-crouch, A., & Meurier, C. (2011). Vital Notes for Nurses: Health Assessment. Oxford: John Wiley & Sons.

Begley, C. E., Hickey, J. S., Ostermeyer, B., Teske, L. A., Vu, T., Wolf, J., … & Rowan, P. J. (2008). Integrating behavioral health and primary care: the Harris County Community Behavioral Health Program. Psychiatric services (Washington, DC)59(4), 356.

CDC (2014). Harris County, Texas Retrieved from

Finkel, M. L. (2011). Public health in the 21st century. Santa Barbara, Calif: Praeger.

Office of Disease Prevention and Health Promotion, ODPHP (2015). Determinants of health. Healthy People. Retrieved from

Williams, P., Hacker, C. S., Hewett-Emmett, D., & University of Texas Health Science Center at Houston. (2008). How health care delay and avoidance decisions are affected by finances and health insurance. (Masters Abstracts International, 46-5.)

The post Reflect on health risk behaviors you have identified in your practicum setting. Explain why these health behaviors put patients at risk for disease or health complications. Provide evidence-based support for your explanation.

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