Baltimore Heart Disease, Research Paper Example

Introduction

            The development of a successful framework for managing heart disease in any community requires an effective understanding of the demographics and the challenges that groups face in support of developing strategies to improve outcomes. In particular, heart disease is a challenging condition that must be considered and evaluated in order to reduce risks and improve outcomes for community members. The following discussion will evaluate heart disease in Baltimore, MD in order to identify different strategies that might be useful in expanding knowledge and information regarding this condition to prevent serious complications.

This discussion will also address the importance of communication within nursing practice as a means of exploring the different dimensions of care and treatment that is required for communities such as Baltimore, MD. Nursing possesses a series of different ideas and expectations within the culture that must be addressed in an effort to produce successful outcomes in the area that emphasizes various communication strategies. These efforts will provide support in determining how to best utilize group communication as well as one-on-one communication to identify and solve problems effectively. These efforts will demonstrate the importance of nursing communication in supporting successful patient care and treatment outcomes at all times.

Part 1: Community/State Demographics      

Baltimore, Maryland is a very diverse community with many different health concerns and a strong necessity to facilitate health promotion activities. Heart disease is a number one killer throughout the United States and carries a high degree of risk for many communities, including the Baltimore area. With the 2012 Census, the city of Baltimore had approximately 621,342 residents, of which 52.9 percent are females and 63.6 percent are African Americans (US Census Bureau, 2012). Whites make up 31.5 percent of the population and only 4.3 percent are of Hispanic or Latino origin (US Census Bureau, 2012). Almost 80 percent of this population has a high school diploma and 26 percent has earned a Bachelor’s degree or higher, with 50% owning their own homes (US Census Bureau, 2012). The median household income for 2007-2011 was $40,100 and 22.4 percent of the population is below the poverty level (US Census Bureau, 2012).

In the State of Maryland, there are 5,884,563 residents, with females comprising 51.6 percent of the population, while 61.1 percent are White, 30 percent are African American, and 8.4 percent are Hispanic or Latino (US Census Bureau, 2012). Within the State, 88.2 percent of the population has earned a high school diploma and 36.1 percent has earned a Bachelor’s Degree or higher, with a home ownership rate of 68.7 percent (US Census Bureau, 2012). Finally, the median household income for the State is $35,751 and 9 percent of the population lives below the poverty line (US Census Bureau, 2012). Based on these statistics, the City of Baltimore faces greater socioeconomic challenges than those of the State of Maryland, including the potential for greater health disparities. Therefore, it is important to identify these disparities and to address cardiovascular disease within the City as a serious health issue and a formidable threat to this population.

Part 2: Health Status

The Baltimore City Health Department routinely provides reports regarding the health status of its local residents and identifies specific health disparities that require further consideration. Although some areas have experienced slight improvement, there continue to be many health disparities that must be addressed to improve outcomes throughout the city (Baltimore City Health Department, 2010). In general, the city fares worse than the State of Maryland in such areas as heart disease and infant mortality; therefore, the City must utilize its available resources in order to accomplish improved health outcomes throughout this community (Baltimore City Health Department, 2010).

Within Baltimore County, cardiovascular disease claims approximately2,000 lives annually; therefore, this community must identify methods to better manage existing disparities and to encourage greater compliance to improve health and wellbeing (Baltimore City Health Department, 2009). An agenda was established by the City Health Department in an effort to reduce the risks associated with cardiovascular disease and included such topics as reducing salt intake, expanding blood pressure screenings, enhancing health education by using Faith-based approaches, and smoking cessation efforts (Baltimore City Health Department, 2009). These efforts demonstrate the important impact of health promotion for this population group in order to reduce disparities and to improve outcomes (Baltimore City Health Department, 2009).

Within the City of Baltimore, there were approximately 200 deaths per 100,000 members of the population as a result of coronary heart disease in 2008, which is 53 deaths above the state average (Maryland Department of Health & Mental Hygiene, 2009).These findings suggest that Baltimore residents do not manage their overall cardiovascular health and face critical challenges that require additional education and guidance from community members (Maryland Department of Health & Mental Hygiene, 2009).Within the City of Baltimore, evidence also demonstrates that African Americans experience higher rates of death as a result of cardiovascular disease as compared to other population groups, thereby mandating additional education and prevention efforts within this community (Johns Hopkins Urban Health Institute). Furthermore, African Americans within the city have a higher rate of obesity than Whites (Johns Hopkins Urban Health Institute). These statistics provide further evidence that cardiovascular disease in Baltimore is higher in some population groups than in others, supporting the belief that these groups experience greater health disparities (Johns Hopkins Urban Health Institute).

In an examination of statistics evaluating specific neighborhoods of Baltimore, every single neighborhood that was evaluated, from wealthiest to poorest, reported heart disease as the leading cause of death (The Baltimore Sun, 2011). Therefore, it is important to identify different methods to promote the expanded delivery of healthcare services and health promotion activities to improve outcomes for this population group (The Baltimore Sun, 2011). In addition, it is important to recognize the value of surveys and discussion groups to identify health disparities in order to improve outcomes and to reflect on existing frameworks to achieve greater results. According to a study conducted by the National Heart, Lung, and Blood Institute (NHLBI) in public housing units in Baltimore, “Public housing residents had a preexisting knowledge and awareness of heart healthy lifestyles and CVD risk factors…One cardiovascular risk behavior, cigarette smoking, is pervasive among the demographic groups probed (excluding teen females) and accordingly smoking cessation is a critical element of any community outreach strategy that would be developed. Stress, from environmental and personal stimuli, is also cited by participants as a major barrier to improving health, including young adults ages 15–18. In fact, many participants cite stress as a primary risk factor for heart disease and a barrier to heart disease prevention” (NHLBI, p. 2). Based upon these indicators, it is necessary to evaluate the conditions that are evident within this community in an effort to improve knowledge and prevention strategies to reduce cardiovascular risks (NHLBI). The efforts that are made to conduct interventions throughout Baltimore are likely to be effective in providing knowledge and information to local residents who might improve their own health outcomes in the process.

One of the most staggering discrepancies in Baltimore regarding the health of its population is life expectancy, which differs by 20 years in some communities (Cohn and Marton, 2012). For example, the Roland Park community has a much higher life expectancy rate and a higher median income at $90,000, while Upton has a much lower life expectancy rate and a lower median income at $13,000 (Cohn and Marton, 2012). Nonetheless, heart disease is the number one killer in both communities; however, prevention and awareness of the disease vary dramatically (Cohn and Marton, 2012). These findings suggest that the residents of Baltimore in throughout all communities must be aware of the risks associated with heart disease, but that those in lower income communities must be provided with greater interventions in order to improve their cardiovascular health and wellbeing over time (Cohn and Marton, 2012). It is important to recognize these disparities and how to overcome the discrepancies in the health of Baltimore residents so that the risks associated with heart attack, stroke, and other conditions are reduced as best as possible (Cohn and Marton, 2012). In addition, this population group must be provided with the appropriate level of access to healthcare screenings and services in an effort to produce successful outcomes for individuals and families who are at the greatest risk for cardiovascular disease (Cohn and Marton, 2012).

Finally, the development of a successful approach to prevent heart disease and improve disease management to prevent high mortality rates requires an effective understanding of the disparities that exist throughout Baltimore, particularly those that occur across minority groups. Since there are significant discrepancies in Baltimore in regards to specific populations, it is important to evaluate these differences and to take the steps that are necessary to provide local residents across different communities with     the tools and resources that are required to improve their health and reduce their risk of heart disease through healthy lifestyle choices and other factors that will improve their health and wellbeing in different ways.

Part 3: Communication Methods

Nurses must exercise different methods of communication in the workplace and in working specifically with patients. One of the key factors to consider in this practice is time because there is typically limited time to address concerns with patients and with colleagues in the face of significant workload concerns (Hemsley et.al, 2012). Therefore, time is a critical component in managing communication between nurses and patients in different settings and in supporting the development of new perspectives to ensure that patient care is not compromised as a result of time constraints (Hemsley et.al, 2012). These efforts are important because they provide greater evidence of the ability of time to play a substantial role in how communication is addressed between nurses and their patients in different ways (Hemsley et.al, 2012).

In the context of quality patient care, nurses must demonstrate their willingness to communicate with their patients through the utilization of structure and leadership in supporting effective communication between patients and with colleagues (Baird et.al, 2012). Nurse leaders must recognize that communication is a critical component of nursing practice and that nurses must identify areas of strength and weakness to ensure that patient care is not compromised in any way (Baird et.al, 2012). In addition, nurse leaders must establish the tone and an example for other nurses to follow in their efforts to develop effective communication in group settings and in one-on-one exchanges (Baird et.al, 2012). Also, nurses must develop effective skills to encourage interdisciplinary collaborations with colleagues to promote greater quality of care and treatment in these settings (Coeling and Cukr, 2000). Collaborations of an interdisciplinary nature are designed to strengthen knowledge and address weaknesses within team-based settings to facilitate improved quality of care over time (Coeling and Cukr, 2000). Similarly, team-based environments often encourage new approaches to common patient care problems and facilitate holistic strategies to promote care and treatment that not only support patients, but also clinical staff members in their own learning (Kvarnstrom, 2008).

Effective Communication Strategies

Communication throughout nursing practice requires an effective understanding of the different elements that support idea sharing and positive outcomes. To be specific, “The main intention of communication and interaction in the health setting is to influence the patient’s health status or state of well-being… The process of communication is often described with a phase model; communication often happens during other interventions and tasks. In general, influencing factors can be organized into the categories of provider variables, patient variables, environmental and situational variables” (Fleischer et.al, 2009). From this perspective, it is important to demonstrate that nursing communication strategies are dependent on specific models and indicators that are grounded in other experiences to ensure that patient care experiences and interactions are not compromised (Fleischer et.al, 2009). At the same time, it is important to identify the specific phases of communication that are common in nursing practice in order to accomplish the needs of patient care and treatment in different ways to improve patient wellbeing (Fleischer et.al, 2009).

Many different communication strategies are available to nurses to enable communication to be effective in their associations with other nurses and with patients. Therefore, one strategy to consider is collaborative communication, whereby “Collaborative communication and teamwork are essential elements for quality care and patient safety. Adverse patient occurrences are an extremely common outcome of communication failures…Although improving communication has been included as a Joint Commission’s National Patient Safety Goal for hospitals since 2003, in 2006, handoff communications were included as a specific communication subset” (Beckett and Kipnis, 2009). Under these conditions, it is expected that effective nursing care and treatment will be achieved through the continued efforts by nurses and nurse leaders to exercise effective communication at all times and to demonstrate the importance of collaborative communication in supporting all aspects of patient care at all times (Beckett and Kipnis, 2009). In particular, situations involving handoffs of patients to the next shift are particularly important in demonstrating that nurses are capable of handling communication in an effective manner (Beckett and Kipnis, 2009). These efforts are also important because they convey the importance of specific needs and challenges that patients face when nurses are unable to communicate effectively with their colleagues and with patients (Beckett and Kipnis, 2009). For many organizations, the basic task of shifting communication styles is important because it provides significant evidence that there are improvements in patient communication by nurses once these strategies are rolled out (Beckett and Kipnis, 2009). Therefore, it is important to identify the strategies that are likely to be most effective in this process and to ensure that they are executed as best as possible in nursing settings and across all population group (Beckett and Kipnis, 2009). This practice is essential to the discovery of new ideas and techniques to demonstrate the successful impact of patient care and treatment in a manner that is consistent with nurse professionalism and strength (Beckett and Kipnis, 2009).

Barriers to Communication

In working with specific population groups, nurses must also demonstrate their ability to engage patients by expressing communication with respect to culture and language differences. Therefore, nurses must be able to effectively communicate with all patients and to recognize that in some cases, there are likely to be barriers to this communication unless interventions are conducted for these patients, such as the use of an interpreter for patients who speak a different language (Fatahi et.al, 2010). This is particularly important when providing technical information to patients to remove language barriers whenever possible so patients better understand what is taking place (Fatahi et.al, 2010).

Oncology nurses, for example, barriers to communication are a common phenomenon that is characterized by the development of specific limitations in communication as a result of the poor translation of information by other healthcare providers, perhaps on different shifts or in different departments, thereby leaving patients and their family members confused regarding the information that they have received (Wittenberg-Lyles et.al, 2013). In addition, the article indicates that “Physician assumptions about nursing left nurses feeling uncomfortable asking for clarification, creating a barrier to team communication processes. Patient-centered communication and care cannot be actualized for nurses unless team roles are clarified and nurses receive training in how to communicate with physicians, patients, and family” (Wittenberg-Lyles et.al, 2013). This example demonstrates that there are significant barriers to effective communication by nurses to patients and their family members, often based upon confusion created by other healthcare providers (Wittenberg-Lyles et.al, 2013). These efforts are important because they convey that there are considerable weaknesses in the communication practices of other nurses and physicians, thereby creating much communication across different departments and nursing units (Wittenberg-Lyles et.al, 2013). As a result, it may be difficult for organizations to overcome these barriers unless additional training and clarification is provided to nurses to ensure that these barriers are eliminated or minimized as best as possible (Wittenberg-Lyles et.al, 2013).

For nurses working with children and parents, there are other types of barriers and challenges that may exist that must be addressed as best as possible. However, some nurses might not possess the appropriate method of working with these patients and should be sensitive to the needs of this specific population group (Redsell et.al, 2010). Therefore, these needs must be met through the understanding of nursing-based perspectives and how these might influence communication in different ways so that the needs of this population are better met during nursing communication practices (Redsell et.al, 2010). The efforts that are made also demonstrate the attitudes of nurses regarding their patients and the treatments that they receive, because in some cases, these perceptions could be distorted by specific beliefs or judgments that are not beneficial to patients (Redsell et.al, 2010). As a result, it is important to identify the specific indicators of communication that are necessary to ensure that patient care is optimized at all times (Redsell et.al, 2010).

For nurses seeking to improve their communication skills, it is important to recognize the value of developing new perspectives and approaches to nursing practice that will enhance communication in different ways. This may involve interventions that are likely to identify problems in such settings as chronic care, for example, so that there are sufficient opportunities to recognize problems to improve communication as best as possible (Boscart, 2009). In many organizations, ”Positive nurse–patient communication in chronic care is crucial to the quality of life and well-being of patients. Despite this, patients are dissatisfied with these interactions and nursing staff indicate the need for additional training” (Boscart, 2009). Therefore, it is necessary to identify specific areas where communication might be improved to reduce barriers and to expand patient compliance in chronic care settings (Boscart, 2009).

Collaborative learning requires successful communication and the elimination of barriers through role clarification and trust amongst team members (U.S. Office of Personnel Management). This is best accomplished through flexibility and a full commitment to the team’s purpose and function (U.S. Office of Personnel Management). Furthermore, the development of effective critical thinking skills is essential in promoting productivity and encouraging a clear approach to a given problem in order to develop an effective solution (Elder and Paul). Higher level thinking and analysis must evolve so that individual contributions to teams and to the patient care experience are effective (Elder and Paul).

Health Assessment

            Baltimore, MD is a large metropolitan community that faces similar health risks to other communities with respect to heart disease and related conditions. It is important to identify the specific population groups that are most affected by this condition and to determine how to best approach disease management in order to facilitate optimal outcomes for this community. The City of Baltimore faces a great risk of heart disease that is not that unique from other communities; however, Baltimore has its own set of population demographics that must be properly identified and addressed so that the proposed action plan will be most effective for this community. Therefore, nurses and other healthcare professionals must take the steps that are necessary to create an action plan that will target this community and provide the necessary benefits as effectively as possible. An effective community-based assessment is critical to the success of a given strategic approach to improve public health initiatives and wellbeing (Williams, 2009; Walker et.al, 2011). Health assessments also require an analysis of specific populations in order to improve health promotion activities across these groups (Harris-Roxas and Harris, 2011).

From an environmental perspective, it is important to identify specific indicators that may impact health assessments and promotion activities within communities (Collins and Koplan, 2009). Team-based activities are critical during the assessment process and support the expansion of activities for a given purpose (Elder and Paul), while also considering the impact of these activities in the team setting (U.S. Office of Personnel Management). Perhaps one area to consider is specific needs assessments for elderly persons versus younger age groups, with the former more likely to require advanced directives due to age and other factors (Taylor, 2012). Miller (2005) demonstrates that communication within a given setting is critical to the success of a healthcare directive and should be utilized in team settings to facilitate positive outcomes. Furthermore, collaborative efforts in a community-based setting should signify a commitment to the initiative and the people that it serves through effective communication channels, rather than weak ones (Kvarnstrom, 2008; Coeling and Cukr, 2000). Laverack (2006) encourages community empowerment through the development of specific initiatives that are designed to promote health and wellbeing. A successful example is the Kaiser Permanente Community Health Initiative, which has been effective in providing tools to local residents who otherwise might not have access (Cheadle et.al, 2010). Some community members may possess specific beliefs regarding therapies that may support improved health, but these are not always easily understood, including the use of alternative therapies to treat chronic illnesses (Fennell et.al, 2009; Hassan et.al, 2010; Ndao-Brumblay and Green, 2010).

For the City of Baltimore, approximately 200 deaths occur per 100,000 members of the population resulting from coronary artery disease, which is well above the state average (Maryland Department of Health & Mental Hygiene, 2009). Therefore, it is strongly evident that many residents in Baltimore who face a greater risk of heart disease may not recognize this risk or are not taking the steps that are necessary to improve and maintain their own health (Maryland Department of Health & Mental Hygiene, 2009). In particular, African Americans face the greatest risk as a result of this condition and their needs must be addressed as a key component of a larger community-based effort to promote heart health and wellbeing, including the reduction of obesity rates within this population group (Johns Hopkins Urban Health Institute).

According to the Baltimore City Health Department, “Baltimore, home to 637,455 people, is located in the wealthiest state in the nation, yet has nearly 20% of its residents living in poverty. Many of these are the working poor who cannot afford health insurance and who are frequent, but inefficient users of the healthcare system” (Baltimore City Health Department, 2009, p. 4). Under these conditions, it is important to identify the specific factors that play a critical role in the continued growth of the heart disease epidemic within Baltimore, given that poverty impacts approximately one-fifth of the City’s population (Baltimore City Health Department, 2009). Under these circumstances, outreach and prevention are difficult to accomplish when this population group do not have access to health insurance and services at all, or this access is severely limited (Baltimore City Health Department, 2009). These findings suggest that it is necessary to identify specific indicators that may reduce the risk of heart disease within this population through the development of an action plan that will address these concerns in a comprehensive manner to improve overall awareness of heart disease and the risks associated with this condition throughout the City of Baltimore.

Action Plan

            An action plan to reduce the risk of heart disease for Baltimore residents requires an effective understanding of the specific risks and challenges of this group and their level of understanding of this condition and how it impacts their daily lives. Some of the most important factors to consider include the following: “Cardiovascular disease behavioral risk factors include: inadequate physical activity and exercise, poor dietary habits, tobacco abuse and excessive alcohol intake. Community-based approaches seek to understand and address aspects of the socio-cultural environments that impact behavioral risk factors. Using the affected communities as the setting for intervention allows increased awareness and better understanding of the barriers and facilitators to behavior change” (Baltimore City Health Department, 2009, p. 9). These circumstances coincide with the lack of understanding of the specific factors that contribute to negative outcomes for this population and the challenges that they face, either without any form or health insurance or very limited coverage, both of which may lead to considerable consequences for their health and wellbeing (Baltimore City Health Department, 2009). Under these conditions, it is important to identify the specific factors that are represented by these phenomena in order to determine how to best move forward with action plan that is most appropriate for the needs of this population (Baltimore City Health Department, 2009).

The utilization of local community-based services and principles is essential to the discovery of new perspectives and strategies to improve the cardiovascular health and wellbeing of Baltimore’s population. This is challenging because it requires an effective understanding of the limitations placed on residents due to their lack of knowledge and experience with cardiovascular disease and how it impacts their health in different ways. It is likely that a lack of knowledge regarding diet, nutrition, physical activity, tobacco use, and alcohol consumption are key contributors to the elevated risk of heart disease within this community (Baltimore City Health Department, 2009). Therefore, it is recommended that there must be additional factors in place that will promote a successful action plan for widespread implementation throughout this community (Baltimore City Health Department, 2009).

Baltimore’s population faces risks that are not that different from other communities with respect to heart disease. Therefore, lessons learned across other populations might be useful in developing a strategy for this community and its people. The action plan that is chosen for implementation must consider the following key areas of development: long-term impact, the capacity for continuous development and expansion, improving policy, moving forward with an action strategy, and expanding collaborations with other communities (CDC). It is known that “The economic costs of heart disease and stroke rise each year. These costs include the numbers of people requiring treatment for risk factors or early signs of disease; emergency treatment for first or recurrent episodes of heart attack, heart failure, or stroke; and efforts to reduce disability and prevent recurrent episodes” (CDC, p. 4). These findings suggest that it is more important than ever to develop strategic approaches that will facilitate the support of new ideas and community-based initiatives to encourage cardiovascular disease prevention as best as possible for Baltimore residents (CDC).

The impact of a strategic action plan to reduce the risk of heart disease also requires an effective understanding of the risks associated with this condition. Behaviors are perhaps the key to understanding how individuals respond to heart disease and in establishing its overall impact on health and wellbeing for a given community. In Baltimore, this appears to be particularly relevant because lifestyle behaviors for many members of the affected population lead to greater risks, including poor dietary consumption, smoking, excessive sodium intake, and limited physical activity, amongst others. Under these conditions, it is important to identify the specific areas where behavioral improvements might occur so that cardiovascular disease risk is significantly reduced.

An action plan to reduce heart disease risk for Baltimore residents requires a detailed assessment of the population and its current lifestyle behaviors because this practice will facilitate the development of new ideas to promote positive lifestyle behavioral changes for the residents of Baltimore. Due to the costs of prevention programs and their limited impact in many cases, it is necessary to identify the specific factors that are relatively easy to measure and that might have a greater and lasting impact on the community at large. These efforts will demonstrate the importance of specific factors that will support long-term behavioral and lifestyle changes within this population.

From a public-based perspective, the development of a strategic approach to reduce the risks associated with heart disease requires public support and intervention not only through financial means, but also through the utilization of knowledge and experience that is present within the Baltimore community. This coincides with national public initiatives to improve health and promote awareness of heart disease and other conditions that impact communities throughout the United States. These factors play an important role in reducing these risks and in enabling community residents to better understand how their own behaviors impact their health and wellbeing in different ways. This is an important step towards the discovery of new insights and approaches that will positively influence outcomes for these residents.

Public health initiatives and other challenges must evolve so that there are significant opportunities for growth and development within communities such as Baltimore. In particular, this community faces significant racial disparities and such factors as low education levels and low incomes that may prohibit access to routine healthcare services (Shaya et.al, 2006). In addition, “People with lower socioeconomic status (SES) are more likely to be uninsured, have low-quality heath care, and seek health care less often; when they do seek care, the problem is more likely to be an emergency” (Shaya et.al, 2006, p. 140). Under these conditions, it is expected that there will be significant problems that continue over time that must be addressed through action plan efforts so that local residents will benefit from these initiatives and will improve their own cardiovascular health by utilizing these offerings (Shaya et.al, 2006).

Establishing an effective action plan for the Baltimore community also requires an effective screening tool that will be utilized on a regular basis within the community to support long-term growth and wellbeing for this population, and in particular, African Americans (Shaya et.al, 2006). These efforts must coincide with other strategies in place within the community and should also reflect a means of expanding knowledge and growth of specific factors associated with community-based support of these offerings (Shaya et.al, 2006). From a behavioral perspective, enabling this community to recognize the benefits of positive behavioral changes may make an important difference in their ability to remain compliant in these endeavors (Shaya et.al, 2006). These creative approaches must demonstrate the importance of specific interventions and other factors that are instrumental in shaping outcomes for this group of residents (Shaya et.al, 2006).

From a compliance-based perspective, the ability of local residents to accomplish the objectives of the action plan requires a continuous effort from social service and healthcare providers to motivate residents so that they are able to reduce their risk of cardiovascular disease over time. This is an important and meaningful accomplishment for the community and requires a greater understanding of the different challenges and limitations that exist in supporting the development of new ideas and approaches to facilitate improvements not only in lifestyle behaviors, but also in the ability to access specific healthcare services within the community setting. This is a critical offering that must be provided through the efforts made with the action plan and should be effective in supporting the development of new ideas and approaches to encourage growth and change within the members of this community, and in particular, those who face the highest risk of cardiovascular disease. With these steps in mind, local residents are likely to experience greater benefits and will be empowered to improve their health and wellbeing through specific lifestyle changes and behavioral modifications to accomplish these efforts in an effective manner.

Key community organizations and professionals, such as nurses, social workers, pharmacists, churches, hospitals, clinics, schools, and others must identify areas where collaboration might be beneficial in supporting the long-term growth and sustainability of the chosen action plan. It is necessary to identify specific factors that are associated with positive outcomes for local residents that also address disparities in healthcare access, screening, and treatment for this population group. With these efforts in mind, it is necessary to also address methods of developing and sustaining an action plan that is cost effective and appropriate for the population in question and the needs of the local community at large. These efforts will provide significant and meaningful benefits to local residents in their efforts to achieve positive health outcomes for the foreseeable future. Since the risk of cardiovascular disease is significant for many residents of Baltimore, it is more important than ever to address these disparities and to consider the challenges of creating an environment that supports these objectives and developments over the long term.

Conclusion

The disparities in health in Baltimore are best represented by the development of strategic approaches in community –based settings in order to gather data and to develop specific frameworks that will generate healthier outcomes for this group. Within this context, it is important to recognize the value of interventions that provide education and support to those persons at risk for cardiovascular disease in order to improve outcomes and create new opportunities for expanded health. With a diverse range of life expectancy within the City of Baltimore, it is more important than ever to recognize the different concerns associated with lower income communities and how this impacts health over the long term. From this perspective, it is likely that organizations that work collaboratively towards a set of common goals and objectives will achieve greater than anticipated outcomes in different ways to reduce their risk of heart attack, stroke, and other cardiovascular concerns. For the residents of Baltimore, it is more important than ever to provide them with a framework for the achievement of successful outcomes and the development of healthier lifestyle choices to improve general health and wellbeing over time.

The identification and development of successful nursing-based communication strategies with patients and colleagues requires an effective recognition of the different challenges that exist in expanding communication to improve the quality of care. Recognizing barriers to communication is important in demonstrating the value of taking the steps that are required to improve communication to improve the quality of care. All populations deserve quality care and treatment from nurses at all times; therefore, continuous efforts must be made to accommodate these needs and to eliminate barriers to communication in order to promote successful outcomes and wellbeing for all patients. These contributions to nursing practice are critical because they shape the manner in which nurses identify with their patients and are able to communicate with them in different ways to ensure that patient care and treatment are not compromised in any way.

The people of Baltimore face significant risks associated with cardiovascular disease and its impact on their lives. In particular, African Americans face a greater risk of cardiovascular disease due to various disparities within the culture itself and in obtaining routine access to quality healthcare services. Community-based initiatives must be established to expand knowledge and awareness of heart disease and its overall impact on local community residents. It is important for local community members with experience in public health and social services to participate in these endeavors to ensure that local residents are taking the steps that are necessary to improve their health and to minimize their risk of cardiovascular disease. Therefore, greater access to healthcare services must be achieved to improve lifestyle behaviors, screening mechanisms, and other factors that are active contributors to the reduction of risk associated with cardiovascular disease within this community. Finally, it is important for local organizations and professionals to identify areas where disparities exist and to address those disparities as directly as possible to reduce the long-term impact of heart disease on the community as a whole. These efforts will demonstrate the importance of specific factors and approaches that will facilitate greater outcomes and that will utilize specific community-based knowledge and experience to develop efforts to improve outcomes for local community members that will be consistent and routine over time.

The proposed action plan must demonstrate that cardiovascular disease in the Baltimore area is taken seriously and requires a collaborative effort from a variety of community-based sources in order to accomplish the desired objectives and to facilitate successful results in reducing disparities and in shaping a healthier community for all residents. These efforts must utilize existing resources wisely and develop new strategies to facilitate growth and change within the Baltimore community setting. With these practices in place, the people of Baltimore will achieve greater than anticipated health outcomes and improved longevity over time.

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