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Population/Community Health Promotion Project:

Cape Henlopen High School

Makenzie D. Helsel

Delaware Technical Community College

NUR 330-2W1: Population & Community Health

Mrs. Dawnyel Furlong

April 25, 2021

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Population/ Community Health Promotion Project

Introduction

Public health nursing focuses on the promotion of physical and mental health. It can be

defined as “the practice of promoting and protecting the health of populations using knowledge

from nursing, social, and public health sciences” (Savage, 2020, p. 11). Public health nurses

utilize the promotion of health and wellbeing, disease prevention and treatment, community

resources, and education in order to optimize members of a community or population. The goal

of their work leads to focusing nursing outside of a healthcare setting to meet the health needs of

certain populations. Public health nurses core competencies involve advocacy, health education

and health promotion, regulatory activities, ongoing education and practice evaluation, and

professional relationships and collaborations (Savage, 2020).

The purpose of this paper is to identify health needs of a community or population while

focusing on goals and interventions needed to promote optimal care. The focus of this health

promotion project will be that of adolescent students found at Cape Henlopen High School,

located in Lewes, Delaware, as well as the role of the school nurse at this location. Identified

needs and health disparities of the adolescent population will be discussed, goals for health

promotion will be identified, and community resources will be discussed.

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Data Analysis

Cape Henlopen High School is located in Lewes, Delaware. Lewes, Delaware is often

referred to as “the first town in the first state”. Lewes is considered a historic town after it was

first founded in 1631 (Lewes Chamber of Commerce, n.d.). Cape Henlopen High School, which

is located between King’s Highway and Savannah Road, originally opened in 1969. However,

the high school has further developed and expanded to meet the demands of an ever-growing

community. A noticeable change to the high school came after the 2009 renovation and

expansion. Nevertheless, Cape Henlopen High School is yet again expanding as they are

currently undergoing construction to accommodate nearly 500 additional students.

According to the Cape Henlopen High School snapshot found on Delaware.gov, the high

school had 1,637 enrolled students as of September 2020. When considering demographics, the

largest population of students at Cape Henlopen High School are Caucasian, accounting for

65.97 percent of all students. Following include Hispanic at 15.39 percent and African

American at 12.16 percent (Delaware Report Card, n.d.). Although Caucasian students account

for more than half of the school’s total population, the school recognizes and promotes their

diversity. “Diversity reflects the fact that groups and individuals are not all the same but differ in

relation to culture, ethnicity, and race” (Savage, 2020, p. 7). Within Cape Henlopen High School

there are students ranging from age 14 to 19. The overwhelmingly spoken language in English.

However, 3.24 percent of students are considered English learners. As the second highest

ethnicity within the school is Hispanic, Spanish is also commonly spoken among students.

As mentioned previously, a public health nurse is one that focuses on disease prevention

and promotion of health. Cape Henlopen High School’s nurse is considered a public health

nurse. The lead school nurse is Mrs. Barbra (Barb) Cilento (MSN, BSN, RN). Barb has over 42
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years of nursing experience. After graduating with her BSN in nursing, Barb went on to receive

two master’s degrees in education and nursing. Barb’s background in nursing focuses on critical

care medicine, particularly working in many Intensive Care Units (ICU). She maintains many

nursing certifications including Basic Life Support (BLS), Advanced Cardiac Life Support

(ACLS), Pediatric Advanced Life Support (PALS), and Critical Care Registered Nurse (CCRN).

Barb’s transition from bedside nursing to nursing education included her role at different

facilities as the ICU Clinical Nurse Specialist. Additionally, she taught nursing students as well

as military nurses. After many years working in level one trauma centers, Barb and her husband

retired to Lewes, Delaware where Barb started working at Cape Henlopen High School as the

lead school nurse.

One may think the role of a school nurse is widely different then that of a bedside nurse.

However, many similarities between these roles exist. Advocacy is a huge part of the nursing

career. Advocacy is described as the responsibility of a nurse to speak for populations and

communities that may lack resources (Savage, 2020, p. 15). At Cape Henlopen High School, the

population of the school nurse is adolescents, therefore the nurse must advocate for the safety

and wellbeing of every student within the school. Public health nursing also focuses on health

education and promotion. This includes utilizing teaching and learning methods to assist in

addressing health issues, as well as implementing health education within the community

(Savage, 2020, p. 15). School nurses, as well as all public health nurses, focus on education.

This includes providing students education on health promotion, safety, infection prevention, and

disease management. Additionally, the nurse will utilize their nursing experience to educate the

community. Public health nurses in particular must focus on public health regulatory activities.

This is described as “identifying, interpreting, and implementing public health laws, regulations,
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and policies” (Savage, 2020, p. 15). Since the COVID pandemic has particularly affected the

school systems, Barb’s role as the school nurse this year has been altered to include

implementing and educating on COVID related regulations and policies set in place by the

school district. These include having to implement infection prevention, conduct contact tracing

for exposures, and ensuring policies such as handwashing and wearing masks are followed.

Ongoing education and practice evaluation is another topic of public health nursing. This

includes the nurse’s responsibility of enhancing one’s knowledge and skills (Savage, 2020, p.

15). Nurses have a duty to not only themselves, but others, to commit to lifelong learning.

Lastly, with public health nursing, there is a large focus on maintaining professional

relationships. This is described as effective partnerships with communities and stakeholders,

thus providing the mechanism for moving the public health agenda forward (Savage, 2020, p.

15). Barb includes that as part of her role she must maintain close and therapeutic relationships

not only with her students, but their parents. Additionally, she works closely with not only

teaching staff, but administration, the school’s psychiatrist, counselors, etc. Also, due to the

pandemic this year, she has maintained a partnership with the Delaware Division of Public

Health (DPH) in the collaboration with infection prevention and contact tracing.

Disease prevention and promotion of health are priorities at Cape Henlopen High School.

Education surrounding health topics are widely utilized within the school. Infection prevention

has always been a priority. However, with the current pandemic, this has now been a crucial

topic. The school utilizes its own resources, as well as community resources to enhance

student’s overall health.

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Disparities & Health Barriers

Epidemiology can be defined as the “study of the distribution of disease and injury in

human populations” (Savage, 2020, p. 56). When exploring the topic of epidemiology, it is

imperative that you acknowledge and address how diseases impact individual populations.

Aspects of this include determining defining characteristics on where and when a particular

population is being affected. Epidemiology factors to consider for any population include

socioeconomic status, physical and mental health, and access to healthcare and necessary

resources. Health determinants that may affect individuals within a certain population include all

aspects of social, economic, and environmental factors.

One of first, and potentially the most important, health care needs affecting the

adolescent population at Cape Henlopen High School has to do with poverty. Data collected in

2018 stated that of Delaware’s population of 940,786 individuals, 117,242 were actively living in

poverty (Talk Poverty, 2021). Additionally, 18.5 percent of children in Delaware were living in

poverty, 10.5 percent of which experienced regular hunger and food insecurity (Talk Poverty,

2021). Poverty often predominately affects Hispanic and African American families. Already

faced with racial inequalities, these families suffer with the added burden of poverty as well.

Children raised in families who are living in poverty are often placed at an overall disadvantage

as poverty can affect multiple aspects of their overall health. These can include access to basic

health care, nutrition, and purely that of a safe environment. Children living in low-income

homes have an increased susceptibility to chronic health conditions including asthma, obesity,

diabetes, and behavioral or mental health disorders (County Health Rankings & Roadmaps

(CHR&R), n.d.). Particularly at Cape Henlopen High School, 0.67% of students are homeless

and 16.19% of students are considered low-income (Delaware Report Card, n.d.).
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Poverty has poorly affected academic performance in many children. Low-income

children are less likely to graduate in comparison to their other classmates. Graduation data from

Delaware public schools in 2018 suggests that of the enrolled 139,144 students, 43,780 children

were considered low-income, that of which had only a 78 percent graduation rate (Rodel, 2020).

This collected data is particularly important for the school system to recognize as not only

education a large focus but managing the overall wellbeing of the students is also a top priority.

School provided meals may be the only source of nutrition for a child living in extreme poverty.

A set of data collected from 2018 suggests that in Delaware, Sussex county had the highest

number of children living in poverty, majority of which were Hispanic/Latino (CHR&R, n.d.).

The identified problem of this population surrounding poverty is that students who fall into the

low-income category may struggle with access to appropriate nutrition and food security.

The second identified need for this population is children with existing medical

conditions. Data collected from 2019 suggested that of the enrolled students in Delaware ages 6-

21 years, 22,797 children presented with existing medical problems, and of those students,

10,645 had a known learning disability (Delaware Department of Education, 2021). These

present challenges in the school system as special considerations must be made regarding

medical needs and learning challenges. During my time at Cape Henlopen High School, I was

able to see firsthand how students with medical conditions are affected during their school day.

Many students with intellectual disabilities are part of the Sussex Consortium program. This is a

program within the high school for students with intellectual disabilities, behavioral challenges,

or severe medical conditions that make it difficult for them to participate in normally structured

classroom environments. Many of these students are on multiple medications administered by

the school nurse. Currently, 378 students are enrolled in the Sussex Consortium, 20.63 percent
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of which are low-income students (Delaware Report Card, n.d.). Additionally, students with

other medical conditions such as diabetes are affected as well. These students must keep close

communication with the school nurse regarding their blood sugar levels, eating habits, and

needed insulin coverage. At Cape Henlopen High School, 11.97 percent of students are

considered students with disabilities (Delaware Report Card, n.d.). The identified problem of

this population, surrounding medical conditions, are that these students may not have access to

preventative health care or treatment for their underlying conditions.

The final identified concern for this population is mental health related disorders.

Although we are seeing an increase in the prevalence of discussing mental illness with

adolescents, historically they seem to go undetected. According to the World Health

Organization (WHO) (2021), depression is a leading cause of illness in the adolescent age group,

while suicide is considered the third leading cause of death from those aging 15 to 19 years. As

mentioned previously, most often mental health disorders go undiagnosed and therefore go

untreated. According to the Centers for Disease Control and Prevention (CDC) (2020), in 2019,

37 percent of high school students had experiences persistent feelings of sadness or hopelessness.

This number has increased from 26.1 percent in 2009. The data continues to show that these

students are overwhelmingly female. Additionally, 18.8 percent of high school students in 2019

considered attempting suicide, which again was overwhelmingly female students (CDC, 2020).

Regrettably, this data indicates that statistically we are moving in the wrong direction when it

comes to the mental health of our adolescent population. Mental health and suicide rates have

noticeably increased over the years.

When considering circumstances surrounding mental illness in adolescents, many factors

can impact the overall wellbeing of the child. Mental illness can be hereditary, as well as
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developed due to circumstantial causes. These factors can include poverty, violence, trauma,

etc. It is crucial for all individuals who are significant in the adolescent’s life, such as

pediatricians, counselors, and the school district, to be aware of a child’s individual risk factors

for developing a mental illness. By acknowledging the adolescent’s susceptibility to a mental

health disorder, individuals can be proactive in recognizing behavioral changes that may indicate

that the child may be struggling with an illness. If mental health conditions are undiagnosed and

therefore not addressed, these issues will continue to progress as the adolescent ages which may

impair their ability to function adequately as an adult. (WHO, 2021). Additionally, this can

result in serious negative outcomes such as “risky sexual behavior, illicit substance use,

adolescent pregnancy, truancy/school dropout, and other delinquent behaviors” (CDC, 2020, p.

58). The identified problem of this population, surrounding mental illness, is that students may

have undiagnosed disorders and may not have adequate access to appropriate care and treatment.
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SMART Goals

SMART Goals are defined as Specific, Measurable, Achievable, Realistic, and Timely

objectives used in order to reach a set goal. SMART Goals can be utilized to address each

concern for the population of Cape Henlopen High School as noted above.

1. The student will utilize the school provided meal program every school day, as well as

provide information to their school counselor at least once a semester regarding their

eating habits, access to foods at home, and what assistance they may need when outside

of school.

2. The student will enroll in the Cape Henlopen High School Wellness Program, as well as

meet with the nurse practitioner at least once a school year for chronic medical needs, in

addition to when needed for acute conditions.

3. The student will meet with the school’s psychologist and counselor at least once a

semester to discuss mental health conditions or concerns.

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Resources

The main identified resource for the students at Cape Henlopen High School is in fact the

resources provided by the school. The school nurse is responsible for medication administration,

first aid, and maintenance and treatment of acute or chronic medical conditions. Additionally,

Cape Henlopen High School has an in-house psychiatrist, as well as student counselors. As

mentioned in the SMART Goals, students should be required to meet with their counselors and

the school psychiatrist which is extremely important when discussing the topic of adolescent

mental health and wellness. The school also offers student meal programs that provide either

reduced price or free lunch to low-income students thus ensuring food security for students in

need.

The Cape Henlopen Wellness Center is one of the most important resource available to

the high school students. This program is in partnership with Beebe Healthcare and the

Delaware Department of Public Health. “With the range of physical, psychological, and

sociological issues facing adolescents today, students at Cape Henlopen High School reap great

benefits from Beebe Healthcare’s Cape Wellness Center” (Beebe Healthcare, 2020). The goal of

the wellness center is to promote healthy lifestyles, encourage preventative health care, and offer

access to community resources. They assist in maintenance of acute and chronic illnesses, as

well as prevention measures. The services provided at the wellness center are funded through

state funds and insurance reimbursements. These services are provided to students at no charge.

The services provided focus on physical health, education, mental health, and nutrition. They

provide students with STD and HIV testing and treatment, oral and implanted birth control,

sports physicals, counseling, dieticians, etc. After graduation, students are referred to other

wellness centers that offer services at reduced costs.

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The Cape Henlopen Food Basket is a service that provides emergency food free to

residence of Delaware’s Cape Henlopen School District. This is a not-for-profit organization

with a sole purpose to provide food to individuals and families in need (Cape Henlopen Food

Basket, n.d.). As previously discussed, poverty affects many students and families of the Cape

Henlopen School District which affects student’s ability to ensure adequate nutrition and food

security. In 2019, 2,107 requests were successfully processed to families in need. Another food

related resource is the Food Bank of Delaware. Similarly, this program offers nutritious foods to

Delawareans in need while facilitating long-term solutions to hunger and poverty (Food Bank of

Delaware, n.d.).

As stated above, mental health is a serious topic in adolescent wellbeing. Although the

high school and wellness center both offer psychiatric assistance, an additional resource that

should be offered to students is Delaware’s crisis hotline. This is a number that adolescents can

call for emergency help with mental health or substance use related issues. Additionally, this

serves as a youth suicide prevention and response support service. Another resource for students

is the Delaware Guidance Services for Children and Youth. The mission of this program is the

“provide quality therapeutic services to children, youth, and their families to increase their social,

emotional, and behavioral wellness” (Delaware Guidance Services, 2021).

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Contact Information for Provided Resources:

Cape Henlopen High School

(School Nurse, Counselor, Psychiatrist, Student Meal Program)
1250 Kings Hwy
Lewes, DE 19958
(302) 645-7711

Cape Henlopen Wellness Center

1250 Kings Hwy
Lewes, DE 19958
(302) 644-2946

Cape Henlopen Food Basket

37510 Oyster House Rd
Rehoboth Beach, DE 19971
(302) 227-3528

Delaware Crisis Hotline

(800) 969-4357

Delaware Guidance Services for Children & Youth

31168 Learning Lane
Lewes, DE 19958
(302) 645-5338

Food Bank of Delaware

1040 Mattlind Way
Milford, DE 19963
(302) 424-3301
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Interventions & Recommendations

Adolescent students at Cape Henlopen High School may face many health-related

concerns. These include the previously discussed issues surrounding poverty, medical

disabilities, and mental health. Many negative outcomes can stem from these health disparities.

As mentioned previously, students in poverty are at risk for poor academic performance, food

insecurity and malnutrition, and poor overall health. Students with undiagnosed or untreated

mental illness are at risk for suicide, drug or alcohol abuse, teen pregnancy, and other risky

behaviors. This is why it is extremely important that we implement interventions to avoid these

negative outcomes and institute positive plans for prevention.

When discussing the issue of poverty, and therefore food insecurity, the SMART Goal

identified instructed students to utilize the available school provided food program. This would

secure a nutritious meal for breakfast and lunch for low-income students either for reduced price

or at no cost. Additionally, students should meet with their counselors. The counselor’s role in

identifying at-risk students is imperative. By identifying these students, additional community

resources can be offered, such as the Food Bank of Delaware and the Cape Henlopen Food

Basket. A recommendation for the school system would be a weekend food plan for those

students who have the highest rate of food insecurity. This could be meals sent home with the

adolescent on Friday. This would ensure that the student had secured meals for the weekend

when they are not able to utilize the school provided meals. As well as monitoring at-risk

students in relation to food security, an intervention should be in place for the supervising low-

income students and family’s ability to receive yearly wellness checks and preventative care.

Students with little access to preventative health care, or students with chronic medical

conditions can utilize the Cape Henlopen Wellness Center, as noted in the SMART Goals. By
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using this program, at-risk students will establish access to preventative care, such as yearly

physicals and disease screenings. Additionally, they will have the ability to optimize their

overall health and wellbeing by employing the wellness center’s nurse practitioner,

dietician/nutritionist, and counselor. An intervention that would be beneficial to ensuring

students are involved with this resource would be promoting the wellness center through a school

health fair. This would allow families and students to be aware of the resources provided, while

encouraging a mass enrollment in the wellness center. Additionally, this could be a way for

educating not only students but their families as well. Basic information of optimizing

individual health, disease prevention, and supportive care may be provided. This health fair

could also provide free basic health and disease screenings. These could include checking vital

signs (blood pressure & heart rate), STD screenings, disease screenings (heart failure, diabetes),

etc.

Lastly, when discussing the topic of mental health, an intervention would be to

administer a survey to all students to access their mental health needs. Recommendations for

students meeting with their counselors frequently, as well as the school psychiatrist should be

encouraged and implemented. If these preventative techniques to mental illness become part of

the expected standards for students, then the topic of mental health and wellbeing will be a

priority.
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Evaluation Plan

To evaluate the outcomes of the proposed recommendations and interventions,

assessments of their effectiveness should be performed. The school nurse, in collaboration with

the wellness center, psychiatrist, and counselors, should review the effectiveness of the resources

and interventions set in places, as well as perform evaluations on how the student has been

influenced. For poverty related issues, these assessments should include nutrition screenings.

Assess low-income students nutritional status each year, including weight loss or gain.

Additionally, the student’s participation in the school provided food program and the community

resources outside of school. For mental and physical health, the evaluation plan should include

assessing the student’s utilization of the provided resources. These include the wellness center

and psychiatrist. Meeting with the students’ teachers and parents may give an indicator on the

student’s behavior as well to determine the effectiveness of promoting positive mental health.
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Conclusion

In conclusion, public health nursing focuses on the community and population as a

whole. A public health nurse focuses on promoting optimal physical and mental wellbeing.

Cape Henlopen High School is stiving to meet the needs of the adolescent population in which it

serves. The adolescent population is burdened with many circumstances out of their control,

including poverty. Cape Henlopen High School is implementing interventions designed to

encourage healthy living and foster positive outcomes in the adolescent students. By utilizing

the resources offered, and establishing appropriate goals, positive outcomes in the lives of the

students can be achieved.

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References

Beebe Healthcare. (2020) Cape Wellness Center. Retrieved from

https://www.beebehealthcare.org/locations/cape-wellness-center

Cape Henlopen Food Basket. (n.d.). Retrieved from https://capehenlopenfoodbasket.org/about-2/

Centers for Disease Control and Prevention (CDC). (2020). Youth risk behavior survey: Data

summery & trends report 2009-2019. Retrieved from

https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBSDataSummaryTrendsReport2019-

508.pdf

County Health Rankings & Roadmaps (CHR&R). (n.d.). Delaware. Retrieved from

https://www.countyhealthrankings.org/app/delaware/2020/overview

Delaware Department of Education. (2021). District and charter performance. Retrieved from

https://www.doe.k12.de.us/Page/3829

Delaware Report Card. (n.d.). Cape Henlopen High School. Retrieved from

https://reportcard.doe.k12.de.us/detail.html#aboutpage?

scope=school&district=17&school=726

Food Bank of Delaware. (n.d.). Retrieved from https://www.fbd.org/about/

Lewes Chamber of Commerce. (n.d.). The first town in the first state. Retrieved from

https://www.leweschamber.com/visit/our-town

Rodel. (2020). Delaware public education. Retrieved from

https://rodelde.org/ataglance/#:~:text=There%20are%20more%20than

%20139%2C000%20students%20enrolled%20in%20Delaware%20public
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%20schools.&text=Students%20of%20color%20have%20come,of%20the%20overall

%20student%20population.

Savage, C. L. (2020). Public/community health and nursing practice: Caring for populations (2nd

ed.). F.A. Davis Company.

Talk Poverty. (2021). Delaware. Retrieved from https://talkpoverty.org/state-year-

report/delaware-2019-report/

World Health Organization (WHO). (2021). Adolescent and young adult health. Retrieved from

https://www.who.int/news-room/fact-sheets/detail/adolescents-health-risks-and-solutions