Community Health Nursing Plan
Elevating Prostate Cancer Awareness in Orange County among African American Men University of Central Florida Community Diagnosis Health seeking behavior: prostate cancer screening among African-American men ages 40 and older related to the fact that African American men are 50% more likely to develop prostate cancer than any other racial or ethnic group (Maurer & Smith, 2005, p. 43) and risk factors: family history of prostate cancer, a diet high in fat, and non-participation in screenings as evidenced by a total prostate cancer mortality rate of 84 deaths per 100,000 population in 2009-2011and an incidence of 606 per 100,000 population in 2009-2011 in Orange County, Florida; and Healthy People 2020 C-7 reduce the prostate cancer death rate: Baseline: 23. 5 prostate cancer deaths per 100,000 males and Target: 21. deaths per 100,000 population; and Healthy People 2020 C-19 (Developmental) Increase the proportion of men who have discussed with their health care provider whether or not to have a prostate-specific antigen (PSA) test to screen for prostate cancer. (Florida Charts, 2010; U. S. Department of Health and Human Services, 2011). Review of Literature PICO: In African-American men, are focus groups using audio-visual methods of prostate cancer risks and early detection better than videography in increasing knowledge about the importance of early prostate screening, diagnosis, and treatment?
According to the American Cancer Society (2012), African American men who are diagnosed with prostate cancer are more likely to die than any other race or ethnicity. Prostate cancer ranks fifth in overall cause of death among African American men aged 45 and over. From 2009-2011, 42. 5 per 100,000 African American men died from prostate cancer in Florida. Studies show that this disproportion is due to African American men not being screened in the early stages of the disease and delaying treatment in the later stages of disease progression (Carter, Tippett, Anderson, Tameru, 2010).
It is estimated that over 230,000 men will be diagnosed with and over twenty nine thousand men will die of prostate cancer in the year 2013 (American Cancer Society, 2012). Prostate cancer is the second leading cause of cancer death among men, with the exception of lung cancer. Among African American men, disparity in incidence has been attributed to lack of access to healthcare screening, decreased awareness of cancer symptoms, and various environmental and biological factors (Rivers, Underwood, Jones, 2009). Among 4,782 groups of men, only 37. percent report use of available cancer screenings and only 14 percent reported a high level knowledge among prostate cancer. African American men experience a higher mortality rate than white men, and this may be attributed to the fact that they present with more advanced stages of the disease and thus worsens the outcome of survival rates. This paper attempts to identify the cause and incidence of prostate cancer among African American men in Orange County, FL and facilitate an increase in prostate cancer awareness early in the disease. Why is this diagnosis a health problem for this target group?
Prostate cancer is responsive to early detection, and more than 75% of prostate cancer cases are diagnosed when the disease is locally confined and curable. “The U. S. Preventive Services Task Force (USPSTF) found that although early detection and treatment might prevent some prostate cancers from spreading, screening is also likely to detect other cancers that would have grown slowly and not caused health problems” (McBride, 2009). Although routine screening for prostate cancer is a contentious issue, prostate cancer screening offers the only possibility of early detection for individuals at high risk.
African American men have the highest prostate cancer incidence and mortality rates worldwide, but have lower screening rates compared with Caucasian men. Risk factors such as age and genetic factors play host to disease progression and warrants an even closer look to the availability of healthcare screening for prostate cancer. Studies show that having a brother or father increases the risk of prostate cancer by two fold, with the risk even higher for a biological brother with history of the disease (America Cancer Society, 2012).
Prostate cancer risks rises rapidly after age 50, with almost 2 out of 3 prostate cancers found in men over the age of 65. African Americans have also shown the detection of prostate cancer at an earlier age, younger than 45, a factor that is associated with more aggressive disease and poorer treatment outcomes (Baker, 2008). Healthcare screening access, lack of knowledge, and cultural attitudes regarding cancer seems to be factors associated with the discrepancy in prostate cancer incidence among racial groups.
In one study, fear of prostate cancer was the main culprit of African American individuals delaying their prostate screening (Baker, 2008). What are the current nursing interventions for this problem? What interventions have been successful and what interventions have NOT been successful? A study conducted by Arras, Boyd, Gaehle, (2009) using a one hour video on prostate cancer risks and screening, showed only 12 % of participants gained knowledge from the video using a 19-item post test questionnaire.
One of the biggest challenges facing African American men is the lack of underrepresentation in research and clinical trials. A study done in Virginia showed that word of mouth and social networking were found to be an important recruitment strategy in enrolling a population that has been to be challenging to recruit for research (Jones, Steeves, Williams, 2009). A study conducted by Friedman (2012) found that focus groups along with an open-ended questionnaire, resulted in 69% of the participants to participate in phase two of the project.
In another study, subjects were given a one hour church based educational seminar delivered through an African American health educator and awareness scores increased from 26% to 73% after the session (Holt, 2009). A fourth study in which test subject were given a letter to come to the clinic for prostate screening, and the control group was given print material and telephone contact show that on review, the group that received the “two-step” intervention was more compliant with adherence to screening (Reynolds, 2008). Plan
Title: Elevating Prostate Cancer Awareness among African American Men in Orange County The target audience for this plan is Orange County African American men age 45 and older. Short Term: The prospective participants will voluntarily sign up for focus group program at local community events such as churches, physician offices, events, etc. Three Measureable, Time Specific Learner Objectives: 1. At the end of the three-day program, participants will verbalize importance of prostate screening and its associated benefits. 2. At the end of the three-day program, participants will name 3 risk factors of prostate ancer 3. At the end of the three-day program, participants will be able to verbalize benefits of early treatment and prognosis if diagnosed. This plan seeks to educate this target population to promote prostate cancer screening among a high-risk group through knowledge base, discussions, focus groups, and audio-visual methods there by increase the proportion of African American men to undergo prostate screening. The three-day program taught by student nurses will include teaching on benefits of early detection, importance of prostate screening, risk facts, associated symptoms, PSA test, and prognosis.
Each session will be of one-hour duration with 20 participants in each focus group. The three-day program will be repeated weekly over the course of a month, for a total of 80 men educated in a month’s time. To gain the trust of our population, African American student nurses will teach the program. The education program will be a church based session, in hopes to promote familiarity and confidence. Participants will receive a $15 incentive gift card upon completion of the educational program and transportation will be offered through local church services as a complimentary.
To measure retention and knowledge gained from the program, participants will be given a 10-item, multiple-choice exam, with a 85% score needed to demonstrate comprehension. Participants who score below, will be given reinforcement and allow for discussion on material. Budget |Item |Price |Quantity |Frequency |Total | |Student Nurses |$14. 00/hr |3 student nurses |3 hours/week for 1 month |$504. 0 | |Gift Cards |$15 |80 |Upon completion of program |$1,200. 00 | |Church |$0 |One |3 days/week for 1 month |$0 | |Transportation |Free |1 bus with 20 occupants |3 days/week for 1 month |$0 | |Print Material |8 cents/page |80 |80 participants for 4 weeks |$64. 0 | | | | | |$1,768 | Nursing Process- Intervention and Evaluation |Objectives |Learning Domain |Topical Outline |Evaluation | |1.
At the end of the three-day|Cognitive |Primary: The student nurse will teach the signs and |The client will be given a 10-item, multiple-choice | |program, participants will |Affective |symptoms of prostate cancer, available diagnostic |exam regarding prostate cancer risk factors, signs and| |verbalize importance of | |exams and laboratory data to discuss with their |symptoms, early treatment modalities, prognosis if | |prostate screening and its | |health care provider. detected promptly, and importance of annual prostate | |associated benefits. | |Secondary: The student nurse will assess client’s |screening for AAM older than 45 years old with an 85% | | | |ability to recall importance of PSA tests and DRE, |score needed to demonstrate comprehension. | | |and allow for questions on how exams are performed. |Participants who do no succeed on first attempt, will | | | | |review exam and discuss with the student nurse. | | | |Re-examination will take place the same day and an 85%| | | | |is needed to show competency and comprehension of | | | | |educational program. |2. At the end of the three-day|Cognitive Psychomotor |Primary: The student nurse will teach risk factors |The client will be given a 10-item, multiple-choice | |program, participants will | |of prostate cancer, give print material, and show |exam regarding prostate cancer risk factors, signs and| |name 3 risk factors of | |DVD on risk factors and African American men. symptoms, early treatment modalities, prognosis if | |prostate cancer. | |Secondary: The student nurse will perform a focused |detected promptly, and importance of annual prostate | | | |health history, family history, social habits, |screening for AAM older than 45 years old with an 85% | | | |diet/nutrition, and provide feedback.
Referral to |score needed to demonstrate comprehension. | | | |providers as applicable. |Participants who do no succeed on first attempt, will | | | | |review exam and discuss with the student nurse. | | | |Re-examination will take place the same day and an 85%| | | | |is needed to show competency and comprehension of | | | | |information. |3. At the end of the three-day|Cognitive |Primary: The student nurse will teach evidence based|The client will be given a 10-item, multiple-choice | |program, participants will be |Affective |statistics and prognosis if diagnosed early. exam regarding prostate cancer risk factors, signs and| |able to verbalize benefits of | |Secondary: The student nurse will teach client |symptoms, early treatment modalities, prognosis if | |early treatment and prognosis | |available options for early treatment and importance|detected promptly, and importance of annual prostate | |if diagnosed. | |of annual prostate screening. screening for AAM older than 45 years old with an 85% | | | | |score needed to demonstrate comprehension. | | | | |Participants who do no succeed on first attempt, will | | | | |review exam and discuss with the student nurse. | | | |Re-examination will take place the same day and an 85%| | | | |is needed to show competency and comprehension of | | | | |information. | References American Cancer Society. (2012, February 27). Prostate key statistics. Retrieved March 26, 2013, from http://www. ancer. org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics Arras-Boyd, R. , Boyd, R. , & Gaehle, K. (2009). Reaching men at highest risk for undetected prostate cancer. International Journal Of Men’s Health, 8(2), 116-128. Baker, S. A. (2008). Prostate cancer screening intention among african american men: An instrument development study. University of South Florida). ProQuest Dissertations and Theses, 149. Retrieved from http://ezproxy. net. ucf. edu/login? url=http://search. proquest. com/docview/304467092? accountid=10003. (304467092) Carter, V. L. & Tippett, F. Anderson, D. L. & Tameru, B. (2010). Increasing prostate cancer screening among african american men. Journal of Health Care for the Poor and Underserved 21(3), 91-106. The Johns Hopkins University Press. Retrieved March 21, 2013, from Project MUSE database. CHARTS Generated Report. (2011). FloridaCHARTS. com – Florida Health Statistics and Community Health Data. Retrieved from http://www. floridacharts. com/charts/DisplayHTML. aspx? ReportType=7244=48=2011=32 Friedman, D. , Johnson, K. , Owens, O. , Thomas, T. , Dawkins, D. , Gansauer, L. , & … Hebert, J. (2012). Developing