DISCUSSION A West Philadelphia has an urban vibe, filled with murals, great food, and deep -rooted history, it’s a melting pot of different cultures, races, backgrounds, and socioeconomic groups.

Anyone not from Philadelphia typically correlates West Philadel phia to Will Smith or to his tv show ‘Fresh Prince of Bel -Air’, but there is so much more to it. Having grown up in the West Philadelphia area, I have seen the diversity and uniqueness that it has to offer. Main Line HealthCare Medical Clinic provides serv ices to patients living in West Philadelphia and to the suburban counties nearby. Determinants of health for my topic on sexually transmitted diseases (STDs) in young adults aged 18 -30, fall under the category of Health services. The high cost or lack of i nsurance coverage leads to unmet health needs and a delay in receiving appropriate care. All of which would also hinder education in preventative services. For the city of Philadelphia, one of the most prevalent health problems is associated with poverty. According to Alan Yu, the environment in which people live, where they live, their ability to afford to pay their bills, and ease of acquiring healthy food at affordable costs, continue to be some of the biggest problems in Philadelphia. In addition to pov erty, HIV infections and opioid misuse round out the top three health issues for Philadelphia, which actually has the highest poverty rate of the ten major US cities in the. According to Robb Reichard, an executive director of the nonprofit AIDS Fund, peop le living in poverty with HIV will struggle a lot more with getting regular treatment (Yu, 2019). In fact, “place -based health inequity” can be used to describe this difference in health outcomes between affluent and underprivileged communities (Glasper, 2 013). I have chosen to do my practicum project on STDs in young adults aged 18 -30. Working in the Emergency Department, I see so many patients in this age group who come in for STD testing.

Most of these young adults do not know what symptoms to look out for until they are overtly exhibiting them. Some do not know any preventative measures, but most of them require education on what is considered to be safe sex DISCUSSION B I live in a city in central Wisconsin that has a population of 66,773 citizens (“QuickFacts”, 2019). In 2019, the median household income was $50,892 (“QuickFacts”, 2019). There is about a 17% poverty estimate (“QuickFacts, 2019).

9.7% of people under the age of 65 have a disability, and 6.2% do not have insurance (“QuickFacts, 2019). Of this population, 91.1% are a high school graduate or above, and 25.6% have a Bachelor’s degree or higher (“QuickFacts”, 2019). The Caucasian race comprises 90.7% of the population, with a small amount of 6 other races identified (“QuickFacts”, 2019). In this urban setting, there is a State mental health facility in which I currently practice. On average, this facility usually runs with a patient population census of around 150 -200. It accepts involuntary admission only; one may not enter and request inpa tient admission. One huge determinant of health specific to my practice setting is policymaking. What we are able to provide for services depends greatly on this.

Health services, in the form of lack of insurance coverage, is another determinant of health in the community. As Winnebago County, Wisconsin has a high rate of suicide and substance abuse, individual behavior would be a third health determinant. Socioeconomic status also appears to be a health determinant based upon the percentage of pover ty and higher education. Mental health is a prominent issue in Winnebago County, Wisconsin. There is a high rate of suicide that likely correlates with a lack of mental health treatment.

Based upon 2017 data, there was 25 deaths by suicide in Winnebago Cou nty alone (“Wisconsin Department”, 2021). The lack of mental health treatment is not only prominent in Winnebago County but throughout the Nation. Those with a substance use disorder have an increased threat of suicidality (ideation or attempts). Opiates, tobacco, and alcohol are the top substances that are impacting those in Winnebago County. Alcohol and other drug abuse as underlying or contributing cause of death statistics in 2017 are as follows: 68 deaths by alcohol, 22 deaths by opiates, and 12 deaths by other drugs (“Wisconsin Department”, 2021). In 2017 it was reported that there were 1,224 cases of patients hospitalized due to mental health disorders (“Wisconsin Department”, 2021). DISCUSSION C Briefly describe your community and then describe yo ur practice setting. Minnesota is a wonderful state with strikingly beautiful lakes, rivers, forests, and grasslands; vibrant urban, suburban, and rural communities; numerous passionate and committed civic - minded people; many world -famous institutions; and a robust economy (Minnesota Department of Health, 2017). My practice setting is at Ridgeview Medical Center. It is an independent, nonprofit, regional health care system serving the southwest metro region of the Twin Cities. Ridgeview is one of the larg est employers in Carver County, with more than 2,200 employees and 300 volunteers supporting the organization (Ridgeview, 2021). I work on the medical/surgical/telemetry floor, which has 32 beds. I work with a multi -interdisciplinary team to provide care f or adults ages 18 - 100+. What are the determinants of health in your community? My community's determinants of health include individual and social determinants such as personal behavior, health outcomes, diet, physical activity, alcohol, cigarette use, and handwashing (Healthy People, 2021). Social determinants of health reflect the environment's social factors and physical conditions in which people are born, live, learn, play, work, and age (Healthy People, 2021). What are the most pre valent health problems in your community or in your practice? A prevalent health problem in my community is chronic health issues in the elderly. When elderly patients are in the hospital, they are at a greater risk for hospital -acquired delirium. In the hospital, delirium is a potent risk factor for complications, a longer length of stay, and discharge to a post -acute nursing facility ( Marcantonio, 2017) . Population at Risk. Vulnerable people are at greater risk for poor health status (Stanhope & Lancaster, 2020). Examples of vulnerable populations of concern to nurses are persons who are poor, homeless, displaced, victims of abuse or neglect, rural residents, incarcerated or have special needs or are suffering from stigmatizing diseases such as me ntal illness (Stanhope & Lancaster, 2020). Hospital acquired delirium is a significant issue in the elderly population at my hospital. These patients need advocacy and the correct interventions to minimize symptoms and keep them safe during their stay. Ba sic needs are often missed, and these patients end up with extended stays, falls, and over -medicated.

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