Better than a Triple Crown

1
Better than a Triple Crown

• A Nurse Managed Wellness Center
• is Off and Running
• at Philadelphia Park Racetrack
• Mary Ellen Miller, Vanessa Smith-Doughty,
• Sharon Starr, Lia Rijswijk

2
Philadelphia Park

• Located in Bucks County, Pennsylvania
• Racetrack in Bensalem, Lower Bucks County
• a lower median income as compared to the state

3

• Population
• 1000 people work the Backstretch
• 200 people live at the track
• 150 men, 50 women
• 1500 Horses
• 39 Barns

• Human Residents
• Majority are Latino
• Ages 18-70,
• Mean age 40
• 75 leave during the winter months

4
Backstretch Life Vulnerable Populations

• Daily schedule
• Work from 430 1030 am and again 3 - 5 pm
• Hot walkers Walk horses after the horses
  exercise
• 200-225/week
• Grooms Clean horses and stalls
• 400 500/week
• Exercise Rider Exercise horses
• 500-600/week

5
Health Strengths

• The Philadelphia Thorobred Horsemans Association
  offers horsemen and women the opportunity to use
  the Neighborhood Nursing Center
• Weekly health clinic serves 20-30 horsemen
• Annually 348 horsemen served
• 189 Caucasian, 15 Black, 144 Hispanic
• 10 (34) female
• Annual encounters 1009

6
Health Challenges

• Horsemens jobs are physically demanding
• Living conditions
• Small dorm rooms, shared toilet facilities on
  each block, close to the animals
• Backstretch residents do not have cooking
  privileges (eat at the Backstretch Café)
• Poverty
• Uninsured status
• Émigré
• English as a second language
• Away from family and friends
• Idle time, limited recreation

7
Cultural Challenges

• Ethnicity of Population
• Trust and respect for the horsemen and their
  heritages
• Relationships of Horsemen
• With LSNNC staff and students
• With each other

8
Nursing Diagnosis

• At risk for diminished health status secondary to
  physical job requirements, environmental issues,
  insurance status, and migratory lifestyle.

9
Interventions

• Blood pressures screenings
• 1009 blood pressures measured 55 (5) abnormal
• Glucose screenings
• Influenza vaccine distributed
• 120 doses
• Tetanus immunizations
• 20 doses
• Blood pressure screening and education
• Diabetes screening and education
• Weight control, nutrition and other health
  education
• Referrals to volunteer doctor or a community
  agencies

10
Staffing Issues

• Staffing consistent staffing with population,
  need for Spanish speaking nurse
• Support from a medical provider
• Support from the county health department and
  other social support agencies

11
Student Issues

• Classes cycle fall, spring, summer, graduate
• Projects short-term, community assessments,
  health education and health fairs
• How can students interface with clients in this
  environment?

12
Costs and Replication

• Costs
• Staffing
• Lab fees
• Medical supplies
• Medical waste removal
• Refreshments
• Office supplies
• Replication
• Can this practice be replicated in other sites?
• What would you need to begin a similar practice?

13
The Triple CrownLessons Learned at Philadelphia
Park

• Know and respond to community health needs
• Consistent staff, mentored students, Spanish
  speaking staff
• Support the community with services
• Immunizations, health education, referrals and
  follow-up
• Support the community with policy development
• What can we do to bring health into the forefront
  of Backstretch management?