Part I: Project Details

Project Title

The title of our project is “Flu Shots: A Must in Our Community.” Our project initially

began as a campaign to assist Bellevue Hospital Center in educating their patients and staff in the

importance of influenza vaccination. This was not possible due to Bellevue policy, so we

implemented our project as flu education and vaccination at New York City College of

Technology on November 12 &19, 2013.

Members

Team Leader: Alison Miller

Recorders: Shayna John, Michelle Bazil & Sabrina Azeez

Powerpoint Coordinator: Sabrina Azeez

Data Collection Analyst: Tina Mahler

Research Associate: Juliette Coombs-Puranda

Community Assessors: Sonia Preston-Campbell & Michelle Bazil

Vendor Procurement: Christina Ming

Project Analyst: Tashiba Thomas

Data collection

Various phases of data collection were performed on the following dates:

10/1/2013, 10 am: HHC and NYS DOHHS contacted for print materials on flu

vaccinations

10/15/2013, 10 am: Call to Sue Marchione of Infection Control at Bellevue Hospital

Center

10/22/2013, 10 am: Call to Jalal, Nursing Supervisor of outpatient clinic at Bellevue

Hospital Center

10/22/2013, 12:30 pm-1:00 pm: Community assessment walk around to northern border

10/29/2013, 12:30 pm-1:00 pm: Community assessment walk around to southern border

11/5/2013, 10 am: Internet data collection and printing of statistics and demographics

Sources of Information

In addition to our wealth of information gathered from Internet sources, such as the

Bellevue Hospital Corporation website, New York City College of Technology website, and

various health and human service websites, we received an abundance of print information from

the New York State Department of Health and Human Services. Examples of such are provided

in the “Materials” section.

The following are contacts that were used in our data collection:

Sue Marchione, Senior Assistant Director of Infection Control at Bellevue. She assisted

us with information about Bellevue’s flu shot program.

Jalal, Nursing Supervisor in the Bellevue Outpatient Clinics. She helped us understand

flu shot administration for staff at Bellevue.

Roxanna Melendez, Director of the Student Wellness Center at New York City College

of Technology. She helped us plan and implement our flu shot education and

administration program at NYCCT on November 12 and 19, 2013.

Registered Nurse in the Student Wellness Center at New York City College of

Technology. She also helped us plan and implement our flu shot education and

administration program at NYCCT on November 12 and 19, 2013.

Part II: Description of the Community Assessment

Community Boundaries

It was breathtaking to stroll down 1st Ave on October 22, 2013, and October 29, 2013 to

look around the vicinity of the hospital. As I walked along the Ave, I could smell the aroma of a

mixture of foods from the street vendors. The aroma filled the air. As I enjoyed the aroma, my

nostrils were then disappointed by the smell of smoke as pedestrians puffed on their cigarettes,

an unhealthy habit. New York University stretches from 30th-33rd and is neighbor to the famed

BHC. At 34St is the Triboro Bridge. Hunter College is also neighbor to BHC.  There is a City

bank located across the avenue from the hospital, and a Chase bank on 2nd Ave.  As I assessed

the community by walking along the Avenue and researching, I realized that the community has

gained much strength from the high educational level and high employment rate as evidenced by

the many educational institutions ranging from nursery to universities, and employment

industries and professions.

The total area is 0.55 square miles. Total land area is 0.55 square miles. Bellevue hospital

center is located in the Kips Bay section of New York City. The population consists of mainly

white and unmarried residents. The median age is 33 years for males and 32 years for females.

The zip code 10016 is in the Eastern time zone at 42 degrees latitude, and 74 degrees longitude.

It is 27 feet elevation above sea level.

Summary Statement of the Community

Bellevue Hospital Center has been in operation since 1736, it serves patients regardless of

immigration status or ability to pay. It consists of 750 beds, six ICU’s, world-class Emergency

and Trauma center. BHC today is a major provider of healthcare including long-term and acute

care in New York City. BHC is the primary teaching hospital of the NYUSM, and an integral

component of the NYU Medical Center Residency Programs. Attending physician house staff is

1,200, and a staff of 500 residents and interns.  Annually, the hospital treats approximately

27,000 inpatients, 500,000 outpatients, and 89, 000 emergency service visits in over 90 adult and

pediatric ambulatory care clinics. Twelve percent of the ambulatory clinic patients are white.

BHC’s new ICU Pavilion, one of the largest in the nation opened in 2004, and a state-of-the-art

208,000 square-foot Ambulatory Care Pavilion, designed by I.M. Pei.

Commute-The residents in this neighborhood utilize private transportation, carpools,

bus, train, walking, bikes, skateboards, and rollerblades to get to work and other places of

business.

Housing-Apartment buildings with multiple units are the major type of home structure in

this neighborhood.

Age Distributions-There are 3% of young children and babies; 2% of children 5-9 years

old; 1% of children 10-14 years old; 2% teens ages 15-19; 12% of youngest adults, 20-24; 31%

of 25-34 years old; 16% of 35-44 years old; 14% of 45-54 years old; 5% of 55-59 years old; 4%

of 60-64 years old, senior citizens 65-74 years is 6%; the elderly, 75-84 years is 3%; and

residents over 84 years old is 1%.

Using a different comparison, the total population in the 10016 zip code area is 51,217

residents. Males account for 47% which is 23,927, and females account for 53% which is 27,290.

18 years and older is 47,825, this is 22,208 males, and 25,617 females. 21 years and older is in

the legal drinking age is 46,417. Senior citizens 62 years and older are 2,253 males and 3,207

females. Residents who are 65 years and older total 5,460.

Ancestry Distribution-There are 55,191 total ancestries in this zip code area. These are from

Arabia, Czechoslovakia, Denmark, Netherlands, England, France, French Canadians, Germany,

Greece, Hungary, Ireland, Italy, Lithuania, Norway, Poland, Portugal, Russia, Scotland,

Slovakia, Sub-Sahara(Africa), and, Sweden.

Part III: Areas of Assessment

Focus on Community-Based Needs

Bellevue hospital center deals with eight priority issues of the community. These eight

issues are mental illness, diabetes, hypertension, substance abuse, health literacy, cancer, obesity

and HIV/AIDS/STDs.

Patterns of Morbidity and Mortality

NYC receives about 20,438 hospitalizations of patients a year with a diabetic diagnosis. That

is 355 persons per every 100,000.

People living in low-income communities higher morbidity rates.  (Kim, Berger and Matte,

2006)

Diabetes is listed as the underlying cause of 1,819 New York City deaths. Diabetes has a

mortality rate of 24 per 100,000 population. This makes diabetes the 4th leading cause of

death among New Yorkers.

Blacks have a higher diabetic mortality rate than any other race.

(Kim, Berger and Matte, 2006).

60% of adults in New York State are either overweight or obese. African Americans (66%)

have a higher morbidity rate than Caucasians (61%).

Between 2003 and 2007 obesity morbidity rate increased from 20% to 22%.

Obesity has a mortality rate of 16.6% in NYC. (New York Times, 2004).

Cancer morbidity rate in Manhattan: 560.9/100,000 (male) and 438.5/100,000 (female).

Cancer mortality rate in Manhattan: 191.0/100,000 (male) and 132.6/100,000 (female).

Hypertension morbidity rate increased an 11.3% since 2009.

Demographics-The population is diverse from various ethnic groups. The residents are

generally peaceful and live in harmony with one another. The breakdown of groups is as follows:

Hispanics are about 4,034, Mexicans are 372, Puerto Ricans are 1,469, Cubans are 246,

Other Hispanics or Latinos are 1,947, and others categorized themselves as not Hispanics

or Latinos are 92%. Bellevue Hospital Center serves patients from many different race

and ethnic backgrounds. Within its primary service area it provides service to 40%

Caucasian, 38.1% Hispanics, 21% Blacks, 15% Asians and 22.55 of people from other

races. (Pressman and Bohlen, 2013)

It is projected that by 2018 the Caucasian and Asian population will increase steadily,

while the African American and Hispanic population, which had been declining will

continue its downward trend. (Pressman and Bohlen, 2013)

According to the Bellevue 2013 community health needs assessment and implementation

strategy (Pressman and Bohlen, 2013), the Bellevue community has eight priority needs

that need to be addressed to better the health of the community. These eight needs are:

mental illness, diabetes, hypertension, substance abuse, health literacy, cancer, obesity

and HIV/AIDS/STDs.

Education-There are only two public schools: PS 116, Mary Lindley Murray, located at

210 E. 33 St. and Norman Thomas High School which is located at 111 E. 33St. The quality of

education is kept at a high standard, more than 7,920 students over three (3) years old are

registered in nursery to graduate schools. Nursery or preschool accounts for 383 youngsters,

kindergarten accounts for 112 children, and elementary school accounts for 1,101 students (first-

eighth grade). Teens attending local high school are 476 students. College accounts for 5,848

students, including colleges, professional schools, universities, law schools, medical schools, and

graduate schools.

Education Level-There are 1,048 residents who has below 9th grade level of education,

high school dropouts account for 1,678 residents, who obtained between 9th and 12th grade

education. Those who graduated high are 3,751 residents. 4,780 residents attended college, but

courses are not complete. Certificates of two-year courses from universities/technical schools

with associate degrees are 1,707. 16,562 residents obtained a bachelor’s degree, and 12,018

obtained a master’s degree or a Ph.D.

Economy/Employment by Industry-There are 41 residents employed in agriculture,

forestry, fishing, hunting, and mining combined. There are 360 residents employed in the

construction industry, and 1,513 employed in the manufacturing industry. The retail trade

industry employs 2,370 residents, and 3,669 are employed by the information industry. In

finance, insurance, real estate, rental, and the leasing industries, 6,296 residents obtained

employment. In scientific, management, administrative, waste management, and other

professional services industries, 7,961 residents are employed. The professions of education,

health, social services sector, teachers, lab assistants, doctors, nurses, and ward boys employ

5,137 residents. The Arts, entertainment, recreation, accommodation, and food services sector

employs 2,438 residents. 1,390 residents are employed in public administrations; these include

judges (magistrates), attorneys, and other bureaucrats.

Environmental Concerns

The types of heat used to maintain warmth in the homes are, utility gas, LP gas,

electricity, coal burning furnaces, and solar energy.

Social/ economic concerns: about 15% of the Bellevue service community population

is living twice below the poverty line (N.a, 2013). This can affect community health.

Living in poverty can contribute to poor health. It can increase resident’s chances of

obesity, hypertension, and substance abuse and can also contribute to a lower level of

health literacy understanding.  

Studies have shown that “the highest rates of obesity occur among population groups

with the highest poverty rates” (Drewnowski and Specter, 2004). This is often

because they are not privileged to buy the healthy foods that they need because

healthy foods cost more.  - Obese patients have a higher risk for cardiovascular disease, diabetes, and cancer.

Obese patients also have an increased likelihood of depression and social/economic

problems.

According to the 2013 Bellevue community health needs assessment and

implementation strategy, 1,524 patients have a diagnosis of diabetes. This number

represents 6% of the adult population in Bellevue who actively engage with a primary

care provider. According to the assessment (2013) four out of every five patients

visited the ED within the year and 2.5 of every five patients had an inpatient

admission. (Pressman and Bohlen, 2013)

Unhealthy eating and obesity can then lead to diabetes and hypertension.

The assessment shows that as of 2012, 41% of patients in the Bellevue care

community have a diagnosis of hypertension. Uncontrolled hypertension can lead to

heart disease and stroke. (Pressman and Bohlen, 2013)

According to the environmental Public Health and Sustainability Tracking Portal

(2013), 54.1% of adults 65 years and older were hospitalized for heart attacks.

Public Services

Child Day Care

Bellevue Childcare Center, located at 462 1st Ave

Educare Early Childhood Center, located at 484 2nd Ave, 2nd fl.

Educare Early Childhood Center #2, located at same address as above

Push my Swing, located at 148 E. 28St., Apt. 2C

International Preschools Inc., located at 28 E. 35th St.

La Petite Auberge Inc., located at 116 Lexington Ave.

Universities and Trade Schools

Electrical Training Course is located at 32 E. 31st St.

Institute For Integrative Nutrition is located at 3 E. 28St., Fl. 12.

Courts

The Amy Begel Court is located at 114 E. 32nd St.

Employment Agencies-There are one hundred fifty-seven (157).

Food Bank

Food bank located at 120 E. 32nd St.

Social Services

NYC food stamps office is at 225 E. 34St.

NYC Medicaid is at 466 1st Ave.

Aesthetics

Movie Theatres - There are four movie theatres.

The community surrounding Bellevue hospital is beautified by a wide array of

restaurants and cafes. Restaurants offering all types of cuisine such as Greek, Indian,

Mexican, African and Asians.

There are a few parks around the area also. The two closest parks are the Bellevue

South Park and the Vincent F. Albano Jr. Playground.

T he Asser Levy Recreation Center and the Asser Levy outdoor pool - Anyone in the

community is welcome to sign up for a membership at the center and the pool.

Members in the community can visit the recreation center and participate in

individual or group work. Exercise can help reduce obesity, which can in turn help

lower the risk for hypertension and diabetes.

Health-Related Facilities

Pet Services- There are ten pet services.

Veterinary-There are five veterinaries.

Dentists- There are one hundred eighty-four (184) dentists in this zip code area.

Health Clinics-There are five health clinics.

Free Clinics-There are five free clinics.

Family Services-There are eighty-seven family services.

Hospitals-There are thirteen hospitals in this zip code area.

Pharmacies- There are also many pharmacies in the area that residents can go to fill their

prescriptions and to also find out more about their medications. A few of the pharmacies

around the area are: Rite Aid, CVS, Duane Reade and a few other small neighborhood

brands such as Prohealth Pharmacy and Halpern Pharmacy.

Care Management Techniques

As a case manager managing care of patients in the community with hypertension,

diabetes, health literacy and obesity would realize that there would be greater outcomes when

community centers are utilize to promote disease prevention and management teaching. Also an

incorporation of exercise programs and nutritional counseling within the community. For

substance abuse, mentally ill, cancer and HIV/AIDS/STD patients offering more support

programs outside the hospital setting would be helpful.

Mental Illness : identifying patients is key to treatment. Integrate primary care and mental

health services and improve access to outpatient services.

o Screen parents/caregivers to provide supportive services, if needed.

o Integrate more behavioral health practitioners within the primary care setting in order

to provide a one-step model of care for those in need.

o There are currently 25,805 patients in the Bellevue Hospital Center (BHC) primary

care population. Out of those patients 608 per 1000 had emergency visits and 242 had

admissions. By implementing these strategies BHC hope to decrease these numbers

by 5 percent (Pressman and Bohlen, 2013).

Diabetes : Bellevue hospital participates in the diabetes chronic disease collaborative. All

patients with a diagnosis of diabetes are entered into the chronic disease registry to facilitate

measuring compliance with care and outcome.

o Each patient should have an individual care plan to fit his or her specific needs.

o “At risk” patients are set up with care coordination and/or care management. At risk

patients are patients who have poor compliance, have more than one ED visit within

one-year period and/or one or more admissions during that same period and as those

who have more than one socioeconomic factor such as homelessness.

o There are 1,524 patients with a diagnosis of diabetes registered in the diabetes chronic

disease registry. This number represents 6% of BHC adult patient population. By

implementing these strategies it is expected that there should be a 10% improvement

in ED visits and admission because of diabetic complications (Pressman and Bohlen,

2013).

Hypertension : Bellevue Hospital Center (BHC) is connecting patients to primary care

providers to help promote the continuity of care/disease management.

o Extend access to HTN management services such as regular blood pressure checks,

counseling on diet and exercise and medication management.

o Work with dietitians to develop culturally appropriate diets for patients. Group

classes will be offered targeting topics such as healthy cooking and stress

management.  

o In the BHC there are currently 41% of patients in the adult primary care that have a

diagnosis of HTN. By implementing these strategies, there is an expectation that 64%

of these patients will have control of their blood pressure (Pressman and Bohlen,

2013).

Substance abuse : Bellevue Hospital Center (BHC) participates in New York State’s Health

Home program (HH). This program enrolls “high Utilizers” of emergency and inpatient

services. Substance abuse patients are one of the groups that are considered “high utilizers”.

o Patients in this program will receive care management, care coordination, primary

care, substance and mental health services.

o Each patient receives a care plan that is actively managed by his or her care team

(Pressman and Bohlen, 2013).

Health literacy : Bellevue Hospital Center (BHC) uses the HealthPix graphical display,

developed by Dr. Shonna Yin from the Department of Pediatrics, to teach parents how to

administer medications to their children. The goal is to use the HealthPix model to explain

other literatures such as diet, exercise and medication management for adults. Using this

model can be very instrumental when conducting discharge teaching.

o As of 2013 BHC has begun using iPads in the clinic setting to conduct surveys on the

effectiveness of patient teaching understanding. Results show that 88% of

participants replied “always”. The goal is to raise that number to 95% (Pressman and

Bohlen, 2013).

Cancer : BHC is having primary care providers screen patients for lifestyle habits that are

known to put patients at an increased risk for developing cancer.

o BHC is hoping to increase and expand cancer screening and treatment services into

the community setting (Pressman and Bohlen, 2013).

Obesity : BHC is tackling the obesity epidemic by utilizing primary care and specialty care

services. They are including intensive medical treatment, evidence-based diet programs and

psychological counseling to identify psychosocial risk factors.

o The BHC Nutrition and Fitness Program (BENUFIT) is being utilized to provide

comprehensive evaluation and treatment for patients through weight management

programs (Pressman and Bohlen, 2013).

HIV/AIDS/STDs : BHC is working to be a “one-step shopping” service for persons with

HIV/AIDS.

o Enrolling patients into BHC’s harm Reduction Recovery Readiness and Relapse

Prevention Program (HRR). Data show that 40-50% of the patients enrolled in the

program had received individual counseling. The goal is to increase it to 80%

(Pressman and Bohlen, 2013).

Influences on Resource Allocation

New York City Health and Hospitals Corporation (HHC) started an initiative for

palliative care, which grew overwhelmingly after it began in 2006. This was necessary for

patients needing palliative care services in inpatients and outpatients. Hospitals accounted for 33

percent and outpatients accounted for 89 percent last year as reported by HHC.

HHC announced that this is a $3 million program that includes a multidisciplinary team who is

trained to assist the patients and their families as they experience decrease health or life-

threatening illnesses. An in-house information collection web application is necessary.

HHC stated, “This application works in harmony with the National Palliative Care Registry, but

was developed by in-house palliative care experts in consultation with HHC’s information

technology team.” “It is notable for converting a global patient functionality scale for electronic

use, as well as the ability to manage allocation of resources and provide better quality of care to

the patients.”

Bellevue Hospital Center is one of the highlights in HHC where resources are transferred

into palliative care services. The Palliative Care consultation at BHC has the largest

interdisciplinary team with many therapies, including psychological, physical, and occupational

which are involved in case conferences. Child life specialists are maintained on the Bellevue

team, as they care for the necessities of the children whose parents are experiencing life-

threatening illnesses. BHC is now producing a palliative care clinic for outpatients, concentrating

on the control of pain for home care, nursing facilities or those not in hospice.

Part IV: Application: Diagnostic Community Statements

Overall Assessment of Community

For the overall assessment of the community we decided to adopt the data available at

Bellevue Hospital Center’s (BHC) website (2013 Community Health Needs Assessment and

Implementation Strategy). Approximately 50% of BHC’s outpatients (excluding visitors to the

emergency room) reside in 27 different neighborhoods, in other words, 27 different

“communities.” Clients originate from various neighborhoods in Manhattan, Brooklyn and

Queens. Only 3.21% of the outpatient visitors (excluding visitors to the emergency room) live

within the zip code zone 10016, the Kips Bay neighborhood in Manhattan in which Bellevue is

located (p. 3-5)

The communities that BHC serves are largely White and Hispanic. The Asian population

is increasing (p. 6).

The communities that BHC serves are impoverished. “Over 22% of all families and over

31% of families with children live below Federal poverty guidelines.” BHC accepts patients

regardless of their ability to pay, and patients who are otherwise not able to access health care

through private physicians or voluntary hospitals depend on BHC as a crucial point of access. A

large proportion of BHC’s patients are “self-pay” (uninsured) and Medicaid recipients. “This

adds to the complexity of providing health care and in managing population health” (p. 3-4, 7).

Diagnostic Statements with Rationale and Identified Problems

For the diagnostic statements with rationale and identified problems, we decided to adopt

the data available at Bellevue Hospital Center’s website (2013 Community Health Needs

Assessment and Implementation Strategy). BHC provided a total of 1,172,700 clinic visits to

patients in the year July 2011 to June 2012 to clientele drawn from incredibly diverse

neighborhoods throughout the City (p. 3). It is impressive and instructive to learn how BHC

strategized to overcome these complexities in developing its community health needs assessment

and implementation strategy. BHC gathered information from two types of sources. The primary

type of source was focus groups. The secondary type of source was data gathered from a variety

of primary and secondary sources, including the websites of the U.S. Census, New York City

Health and Hospitals Corporation, New York City Department of Health and Mental Hygiene

Community Health Surveys, city boroughs’ statements of Community District Needs, and New

York State Department of Health (p. 8).

Three focus groups were conducted in March 2013, each with a different set of

participants. One focus group consisted of patients, a second of community stakeholders, and a

third of healthcare providers at BHC. The patient focus group consisted of clients who each came

from a different zip code. As mentioned earlier, zip codes are utilized to organize information

about the communities in which patients reside. The community stakeholder focus group

included local residents and representatives of community-based organizations. The healthcare

providers focus group consisted of healthcare providers representing a wide variety of disciplines

at BHC (p. 8).

The three focus groups met separately with each group lasting about 90 minutes. The

groups were moderated by a facilitator who followed a prescribed plan that allowed for

maximum group participation and responses. Records of verbatim responses were kept and were

analyzed by facility leadership in order to determine the most important healthcare needs to be

addressed by the implementation plan. For instance, patients were asked these questions:

1. “What are the greatest health care needs in your community? Or, put another way, what

health problems do you see the most among your family members and neighbors?

2. “On a scale from 1 – 5 (1 being the lowest), how does this hospital respond to each health

need listed?

3. “Tell us about the greatest problem you and your family members face getting health care

at BHC?

4. “What changes can this hospital make so it can better respond to the needs and problems

you’ve just mentioned?

5. “What do you think are the greatest strengths of BHC?”

The community members were also asked five questions, and the providers were asked

five questions (p. 8-9).

The purpose of the assessment that was developed was to identify “existing and emerging

healthcare needs of the local community” so that services could be developed “to further the

goals of the State and Federal health care agendas.” The three different focus groups identified

different needs. Then from the priorities listed by each group, commonalities were identified.

Eight priorities were finally decided upon. In deciding upon these priorities, community assets in

the primary service area (hospitals and clinics that provide services) were identified to determine

the facilities available to deal with these priorities (p. 10 – 12).

The identified priorities are (1) mental illness, (2) diabetes, (3) hypertension, (4)

substance abuse, (5) health literacy, (6) cancer, (7) obesity, (8) HIV/AIDS/STDS (p. 13).

Part V: Planning and Implementation

Goals of Project

1) To educate ourselves and our fellow students of New York City College of

Technology about all the aspect of influenza (flu) including key facts and myths about

seasonal flu, flu virus, symptoms and severity, spread of flu, prevention of flu and the

population at greater risk.

2) To educate students to get vaccinated

3) To provide free flu shots for students who do not have health insurance

Date of project

Health Fair -November 12, 2013 and November 19, 2013

Site of Project

New York City College of Technology

300 Jay Street (ground floor/ first floor)

Brooklyn, NY 11201

Number of Participants Attending

Health Fair –All nine group members participated in health fair

Number of students who were attended and educated about flu literature – about 50

students

Total number of students vaccinated – 35 students

Community Organizations that provided assistance with project

New York City Department of Health – Provided with all requested poster and brochures

about flu

Department of Student Wellness Center of NYCCT – Posting flyers, flu vaccine, consent

forms for vaccination of students, and assistance from school nurse providing supplies for

administering the flu vaccine

Department of Nursing – Nursing faculty assisted group members to be able to

administer flu vaccine in the student wellness center

Implementation of Project

At the beginning of this semester, we were informed that we needed to implement a

service-learning project. After two to three weeks of clinical, we did not have a topic for our

project. Following the fourth week of the clinical day, we found out that many people in the

community still believe myths about the flu vaccine and declined to vaccinate themselves, and

also many health care workers declined to do so. Finally, we discussed with our clinical group

and decided to do literature about flu vaccine and to administer flu vaccine at our clinical site

Bellevue Hospital. We identified our team leader and team members, then, we outlined our

project. Finally, each member was assigned a role and responsibility with an interest towards

each member and area of member’s expertise. Following role distribution, we discussed using

Blackboard as a way of communication between members about progression of our assigned task

and responsibilities. Unfortunately, we did not get permission to implement our project at

Bellevue Hospital because of the process to go through as a student nurse to be able to give flu

shot at the hospital due to computer documentation.

Our second plan was conducted with assistance of our two nursing faculty, Dr. Elaine

Leinung and Dr. Aida Egues, and arranged to be carried out on campus. We kept some ideas of

our original plan and added some new ideas to our new plan. Among these ideas we made a plan

to give away free gifts during our literature section and we decided to get products that helped

prevent spread of flu, other infectious disease and to help promote healthy behavior. We initiated

our plan by sending out letters to Purell, Kimberly and Johnson and Johnson Company to

provide us with donations or samples of product such as hand sanitizer, tissue packs and hand

lotion. We also made calls to some companies to get donations and for product supplies too.

After a long journey of finding out how to get product donations and putting our effort of

sending out emails and letters, unfortunately our effort was rejected by the company stating due

to overwhelming number of organizations that seek donations from their companies. We ended

up with giving away some sweets during our literature section in an attempt to get attention from

our fellow students.

Publicity Attained for Event and Means of Advertisement

A week before our health fair, an announcement was made in class to our classmates to join

our health fair on campus, and each member also invited friends from other classes to stop by at

our table on campus for our health promotion. The day before the activity the student wellness

center assisting in posting flyers about providing the free flu vaccine on campus, and sent out an

E blast advertising them as well. Our team members were actively went around the area that

most students gather, like the cafeteria, to educate students to get vaccinated. Team members

who participated in administering the vaccine also used word of mouth method to already

vaccinated students to convey information about our health fair on campus and free flu vaccine

to their friends and classmates.

Activities Presented

On the day of the health fair, we choose to set up our table in the hallway of the Atrium

ground floor, where we thought a lot of students would pass by, and close to the elevator that

most students would use. We split up into two groups for two days of the health fair at school.

The first week four group members were split into two teams, two of whom did the literature on

the ground floor of the school and two of whom administered the flu shot at the student wellness

center. On the second week, five students participated in the health fair. Three students

participated in literature and two students were involved in vaccinating students. Team members

who were involved in the literature section made sure our fellow students got facts and myths

about flu and more students to get vaccinated. Team members who were involved in giving the

vaccine also answered all concerned questions about flu from students who got vaccinated and

explained any side effects they may feel after the vaccination was administered.

Cost of Project

Binder, dividers, and cover graphic– donated by Alison Miller and Joseph Cardenas

Document sleeves – donated by Tina Mahler

Photos – donated by Sabrina Azeez//

Stationary and give away sweets- donated by Christina Ming

Part VI: Evaluation

Goals to Accomplish

The goals of our project were to encourage as much as the community as possible to get

the flu vaccine. We wanted to ensure community members were well informed on what the

influenza virus is as well as the signs and symptoms. According to the New York State

Department of Health; 36,000 people die from the seasonal flu. This meant we had to educate the

community on the benefits of the getting vaccinated. We also wanted to dispute any myths about

the flu vaccine such as getting vaccinated will lead to you getting sick or experiencing side

effects. In reality the side effects from the flu vaccine are a mild fever and soreness at the

injection site. We wanted to promote simple methods on how to prevent the spread of the flu,

such as good hand washing techniques, using a tissue when sneezing or coughing, and throwing

the tissue away after you use it. We wanted to educate the community on the frequency and time

frame of the vaccination. The flu vaccine is offered seasonally during the fall to winter season.

We wanted to inform the community; the flu vaccine is offered in a variety of settings that

include college campuses, hospitals, clinics, private doctor offices, and pharmacy stores

(Walgreens, Rite Aid and Duane Reade). We wanted the community to know the flu vaccine is

covered under all medical insurances and given free in many locations. Overall we wanted to

educate the community members the flu vaccine is safe and recommended for everyone over 6

months of age. It is highly recommended for individuals with chronic diseases such as diabetes,

respiratory diseases, kidney disease and liver disease, as catching the flu will exacerbate these

conditions.

Collaborative Process

Our collaborative process for achieving our goals included a comprehensive assessment

of the community. Our identified priorities for the community are: diabetes, HTN, mental illness,

cancer, obesity, substance abuse, health literacy and HIV/AIDS/STDS. Bellevue hospital is the

oldest and largest operating hospital in the United States. There are eight primary service area

neighborhoods the hospital serves. From the data we gather from our research we decided to

conduct a flu fair educating the community on the importance of getting vaccinated. Our

methods to accomplish our goals were by providing the community with flyers, brochures and

pamphlets on the benefits of getting vaccinated and methods on preventing the spread of the flu.

Keeping in mind language barrier is a significant problem noted in the healthcare system, which

affects the ability to communicate significant health care needs. We provided these flyers,

brochures and pamphlets in multiple languages to accommodate the multiple diverse cultures

residing within the community. Prior to our flu fair date we posted flyers and posters around the

area. We contacted well-known companies for products we could share out to the community.

Johnson and Johnson for hand lotion, Kimberly Clark Professional for tissue packs and pure

hand sanitizes. We also utilized our therapeutic communication skills by directing speaking with

students as they walk by our advisement table. We conducted our flu health fair on two separate

dates to maximize our chances to achieve our goals.

The group worked together in person and on Blackboard to share information and to

arrange meetings. Community walk-arounds were done in small groups within the group.

Enduring materials were distributed, as a group, to the student wellness center at City Tech, as

well as to the City Tech childcare center on the third floor of the General Building.

Goals accomplished

Our goals were accomplished; many City Tech community members were effectively

educated on the benefits of receiving the vaccine. We provided the community with resources on

how to prevent the spread of the virus and recognizing the symptoms of the flu. We did not have

a projected numeric value of how much people we wanted to get vaccinated, but were successful

in vaccinating a total of 35 students.

Benefits of Project to Community

During our clinical experience as Community Health Nurses at Bellevue Hospital center

we have provided direct care, promoted a healthy living lifestyle in the prevention of disease and

other health problems. Our group at Bellevue collaborated with the Delete Blood group to put on

a very successful health fair at our college with the help of our professors. We have incorporated

health promotional and health education activities into our nursing practice. It is at this time of

year, the flu season, where the focus is on the prevention of diseases that we have chosen to

promote the avoidance of life-threatening complications from influenza by educating and

administering the Flu Vaccine. Our motto is “prevent influenza, get vaccinated”. We

administered 26 vaccines altogether to students who did not have health insurance.

We were very vigilant in or quest to get the message out in the community about

Influenza or the seasonal flu and getting vaccinated because it is a serious disease that causes

illness, hospitalizations, and deaths every year in the United States. The influenza is a sickness

that affects mostly the lungs, throat, nose and other parts of the body and is easily spread from

one person to the other. In addition, the flu comes on suddenly and is a very contagious

respiratory illness. Some symptoms includes feeling very tired, having a high fever, headache,

dry cough, sore throat, runny or stuffy nose and fore muscles. Children may have stomach

problems and diarrhea and coughing that can last about two or more weeks. Each year in the

United States over 36, 000 people die from the seasonal flu (New York State Department of

Health flyer, 9/09, p. 2438). Handouts were distributed at our college health fair. In addition, we

emphasized the importance of covering of the mouth when coughing and sneezing, because tiny

droplets fly through the air and others can become sick from the droplets if they land in the nose,

eyes, or mouth; disposed used tissue in a waste basket and do proper hand washing because the

flu virus can be transferred if, for example, if an infected person touches a table or a doorknob.

Moreover, the Flu Vaccination can reduce flu illnesses, doctors' visits, missed work due

to flu, as well as prevent flu-related hospitalizations and deaths. The influenza vaccine is mostly

given out in the fall season, one (1) dose annually. The recommendations for adolescent and

adults immunizations for influenza are as follows: The indications for ages 19-49 for persons

with medical or exposure symptoms; Adults 50 years, Clients with chronic conditions; During

influenza season for women in 2nd and 3rd trimester of pregnancy; Persons traveling to foreign

countries; Residents of nursing homes, long-term care and assisted-living facilities. The

contraindication to the flu vaccine is allergy to eggs. Everyone was screened for allergy to eggs

before the Flu vaccine was administered.

The benefits of our project to the community were providing the community with

resources and information about a preventable otherwise lethal virus. In worse cases influenza

leads to pneumonia, which can be fatal. We provided individuals without any medical insurance

the opportunity to get vaccinated. We believe that what we have accomplished will continue to

benefit our community and the individuals in it as a result of our hard work and determination.

Appendix

Exhibits Representing Bellevue Area Demographics

Exhibit 1: BHC’s Safety Net Burden shows that BHC provided a far higher proportion of

care to uninsured and Medicaid recipients than the average of New York City’s voluntary

nonprofit hospitals.

Exhibit 2: BHC Primary Service Area by Zip Code defines BHC’s primary service area as

27 zip codes that account for 50% of its outpatients (excluding individuals who had only an

emergency room visit).

Exhibit 3: BHC Primary Service Area Map illustrates that BHC’s “patient base resides

mostly in Southern Manhattan, Northern Brooklyn and Western Queens, with additional patients

from Northeast Manhattan and Southern and Central Brooklyn.” The number of residents in

BHC’s primary service area in 2010 were 1,811,222.

Exhibit 4: Bellevue Primary Service Area Population shows that between the year 2000

through the year 2010, the number of residents in BHC’s primary service area increased 3.8%.

Exhibit 5: 2010 Age Distribution, Bellevue Primary Service Area Compared to NYC

shows that when the age of BHC’s patient base is compared with that of New York City as a

whole, it is found that BHC’s patient base is slightly younger

Exhibit 6:2010 – Bellevue Service Area Race/Ethnic Distribution shows that BHC’s

primary service area has a large Hispanic population.

Exhibit 7: Trends in Race/Ethnic Distribution – Bellevue PSA & NYC shows that the

percentage of Hispanic population in BHC’s primary service area has been trending downward

since the year 2000; the percentage of White population has increased; the percentage of Black

population has decreased; and the percentage of Asians has increased. These trends are expected

to continue.

Exhibit 8: Poverty Rates in Bellevue PSA Compared to Brooklyn & NYC shows poverty

rates in New York City as a whole. Poverty rates are significantly higher in Bellevue’s primary

service area. In Bellevue’s primary service area “over 22% of families and over 31% of families

with children live below federal poverty guidelines.”

Exhibit 9: BHC Primary Service Area Residents’ Performance on Key Health Indicators

Compared to NYC. Bellevue Hospital Center utilizes the health indicators data of the New York

City Department of Health Community Health Survey to determine the health problems of the

communities within BHC’s primary service area. According to this data, BHC’s “service area

residents in some neighborhoods have higher rates of diabetes, obesity, high cholesterol,

hypertension, asthma and tobacco use than New York City as a whole.”

Exhibit 10: 2013 Origins of Language Spoken at Home by Primary Service Area (People

Aged 5 Years and Older) classifies the languages spoken in the 27 separate zip codes. Of note is

that the ratio of English-to-Spanish is approximately 7.5-to-6. Specifically, 743,642 persons

speak English at home whereas 591,823 speak Spanish.

Steps Taken to Obtain the Flu Vaccine Literature

The assigned task was to obtain educational materials for the health fair pertaining to

promotion of the flu vaccine. We looked on the internet at various governmental websites and

found that there was much literature available at the Federal, State, and City government levels.

We loved the pamphlets and posters on the Federal government’s website, especially those in the

Spanish language, but printing color materials would have required a larger budget. At the New

York City and New York State government websites were materials available that could be

mailed. We followed the directions at the New York City Department of Health and Mental

Hygiene’s website and called 311, the “Mayor’s Hotline,” and ordered several pamphlets and

posters in bulk. Some of the materials that we wanted to order, especially the materials in the

Spanish language, were out of stock. The New York State website had a different way of

ordering than the New York City website. On the New York State website was an order form

that we printed out and checked off the pamphlets and posters that we wanted. We mailed this

form to New York State Department of Health. Within the promised time, most of the materials

that We had ordered arrived at the college nursing office. The websites that we accessed were

www.nyc.gov/flu (New York City)

http://www.health.ny.gov/forms/order_forms/influenza_and_pneumococcal_prevention_campaig

n_materials.pdf (New York State)

www.Flu.gov (Federal government).