Community hlth planning_project_final 2


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Community hlth planning_project_final 2

  1. 1. Running head: COMMUNITY HEALTH<br />Community Health: Health Planning Project<br />Keithlee Aquino, Verona Bullecer, Kristen Burritt, Chad Hagedorn,<br />Trinay Jeffries, Candace Johnson, Lauren Lowe, Nirosha Rathnayake,<br />Stefanie Setzer, Whitney Smith<br />ODU On Campus<br />Submitted in partial fulfillment of the requirements in the course<br />NURS 470: Community Health Nursing I<br /> in the School of Nursing <br />Old Dominion University<br />NORFOLK, VIRGINIA<br />Fall, 2010<br />Community Health: Health Planning Project<br />The Health Planning Teaching Project was organized by Old Dominion University School of Nursing and supported by Sentara Health Prevention to give the students an opportunity to assess a population within the community. This group worked with the congregation of Miles Memorial United Methodist Church (MMUMC) and assessed the aggregate. After analyzing data and formulating a nursing diagnosis, a plan was organized to address and educate the population on their health issues. The purpose of this assignment was to gain access into a population within a community using the Health Planning Model and applying the nursing process to an aggregate.<br />Assessment<br />Study Aggregate<br />The aggregate that the students of ODU school of nursing was assigned to be of assistance to, were the faith-based group of MMUMC located in Norfolk, Virginia. In partnership with Sentara, the group aimed to provide morbidity prevention and education to the church congregation and surrounding communities. This population would benefit from thorough interventions such as education, screenings, and activities promoting a healthier lifestyle. The composition of the church’s congregation are mostly older adults, although children begin to truly participate in the church around age 11 as an active youth group. Through various assessments such as the use of surveys and interviews with several church members, the group determined the aggregate were concerned with a number of health needs (See Appendix A for assessment survey). Furthermore, the community health group partnered with Sentara through its representative Dr. Susan Tweed. Sentara and Dr. Tweed provided necessary supplies and educational information for the group in order to carry out interventions in this aggregate.   <br />In order to gain entry into the aggregate, the community health group arranged a meeting with two representatives of the church.  A meeting was held with Gary and Meredith Coldren during which various activities, expectations, goals, and previous activities performed by preceding nursing students were discussed.  The group was given further information about the community and the church members, which served as an important data source in order to help assess the aggregate. Through the meeting, the group noted important activities such as, health screenings, health fairs, and survey handouts.  Consent was given to the group to survey the congregation in order to assess them for the study.  Using surveys from previous nursing groups as a basis, this group was able to create a similar survey to hand out to the church members during several church services.  In addition, e-mail played an important role in allowing the community health group to contact with the representatives of MMUMC.  Overall, the community health group and MMUMC joined together, forming a mutually beneficial association. <br />Socio-demographics<br />The demographic data was collected through surveys, MMUMC’s website, flu shot clinics, church visits and through meetings with church members and leaders. Because this is a faith-based group with a specific church, religious similarities involving beliefs and practices are similar across all participants. Other demographic data based on the survey analysis include age, gender and economic status. It shows that majority of the aggregate are women ranging from their mid twenties to late eighties. As far as other age-group populations, there is also a good amount of children and young adults in the group. Economic status can be indicated by the significant amount of people who have health insurance and adequate access to healthcare. Almost all of the population has health insurance. Also, one of the church leaders indicated that MMUMC’s location contains a mixture of lower- and middle-class populations. Ethnicities were analyzed through church visits, meetings and flu shot clinics. The church is composed of Caucasians, African Americans, Asians, and Hispanics but the majority of the group is Caucasian. It was further evaluated by visiting the church on Wednesdays when bible school and youth group activities are held. Also, there were more girls than boys present. Health status is analyzed through the health screening and flu shot clinics. High blood pressure of older adults is the most prevalent health issue and concern. Therefore, this health planning project can focus on high blood pressure, health promotion, and prevention.<br />Health Status<br />The survey asked about current health problems and in response, hypertension and allergies received the most tallies with 15 and 12, respectively. Obesity and depression were the next most frequent problems both with nine people experiencing these issues. The remaining option choices were heart disease (7), asthma (4), diabetes mellitus (3), gastrointestinal disorders (2) and chronic obstructive pulmonary disorder (2). Four members checked the “other” choice and filled in back problems, high cholesterol, tetanus and two people wrote hypothyroidism. <br /> Respondents were also asked what health problems they would like more information about. The most popular response was weight control, which received 20 tallies. The next category was stress and it received 12 responses. Nutrition received nine, blood pressure was seven, home safety received five and sleep had four. Immunizations only received two replies, but the one “Other” response asked for information about immunizations for traveling abroad. Smoking cessation and the allergies/asthma categories both received only one response.<br />Internal and External Influences Affecting the Aggregate<br />The faith- based group at MMUMC is affected by internal and external influences. Some internal influences are education, history and money. One internal influence that may affect this group is history due to this church having relationships with ODU nursing students in the past. The members may not want to participate in any more surveys or tests. How the congregation feels about health care and western medicine may be different. Some people may have a difference of opinion and education levels about medicine. The selection bias was based on the location and who showed up to church on the days of the surveys and blood pressure screening. The survey did not take into consideration the amount of income a family receives, but this is an internal factor that arises in eating healthy foods and making smart decisions about one’s health care. Also health insurance was taken into consideration. <br />External influences affecting the church members could include socioeconomic status, means of transportation and location. Socioeconomic status could influence some members of the congregation to precipitate in free flu shots and blood pressure screenings. Transportation or lack there of, is something to consider when planning and implementing health programs. Some members may take a bus, ride a bike, or even rely on someone as a main means of transportation. Furthermore, the location of MMUMC is another external influence; the only people that might attend would be in a 10-mile radius. In inclement weather, these people may not want to come out just to go to church. Lastly, the people that live closer to MMUMC may prefer to get health care at the church because it is closer than their doctor’s office. <br />Literature Review<br />Several reviews of literature have been conducted that look at the characteristics and needs of the identified population. A literature review performed by Babatsikou and Zavitsanou (2010) examined surveys regarding the prevalence of hypertension as it relates to the populations in the United States and Europe and looks at the features that accompany it. Many databases were utilized in the search along with certain keywords such as “Hypertension, epidemiology, elderly, prevalence, incidence, risk factors, mortality, morbidity, treatment, and prevention” (Babatsikous & Zavitsanou, 2010, p.24). After analyzing the surveys, the results showed that hypertension rates increased with age, affected more African Americans than Caucasians, and postmenopausal women had a higher incidence. High blood pressure is more prevalent in Europe than in the United States and is associated with many risk factors, such as smoking and unhealthy eating habits (Babatsikous & Zavitsanou, 2010). This relates to the aggregate of MMUMC because the characteristics used in this review of literature fits the general demographics of the congregation. By knowing that the aggregate is at greater risk for hypertension, working towards reducing this condition makes this project more significant to the community. <br />A nursing-based systematic review took a more direct look at the elderly population with hypertension and discovered falls as a safety issue. It showed that several meta-analyses and studies proved that the elderly taking multiple medications including antihypertensives are at an increased risk for falls. Several side effects, such as syncope, orthostatic hypotension, urge incontinence and dizziness can all contribute to a client falling as a result of taking medications to control hypertension (Sirkin & Rosner, 2009). After reviewing the studies, finding a proper balance with medication prescriptions for the at-risk elderly became an important implication for nurse practitioners. A number of the population was in or near geriatric age and some of them already ambulated with assistive devices or had an impaired gait. Respondents of the surveys indicated that they were taking medications for their hypertension. Maintaining the aggregate’s safety should be a top priority as this project progresses towards the implementation stage. <br />Another nursing study focused on women with hypertension. The purpose of the study was “To test the feasibility of a stage-specific education/counseling intervention aimed at improving exercise outcomes in women with elevated blood pressure” (Daley, Fish, Frid & Mitchell, 2009, p. 46). The study used a group of 40 middle-aged Caucasian women. Interventions included one-on-one sessions, individually determined aerobic exercises, phone calls to review diaries and thoughts about exercise plan, and a follow up face-to-face visit. The study found that “85% of women moved to or remained in the action or maintenance stages of change” (Daley et al., 2009, p. 45). It also showed improvement in exercise benefits and self-efficacy, as well as a reduction in barriers for the study subjects. This indicates the importance for nurses to recognize that each patient is different and that interventions should be individualized. Many women in the US are busy and including an exercise regimen in their schedule is sometimes a difficult task to achieve. This correlates with the women in the aggregate who take on many roles and responsibilities, such as volunteering within the church, taking care of their families, and being employed full-time. Incorporating hypertension-reducing interventions in their busy lives could seem like an added stressor. By progressing with this project within the church setting, the nursing students can help reduce high blood pressure in the aggregate without taking them outside of their normal routine. <br />Aggregate Comparisons <br />The age range of this aggregate begins under 11 years old and extends past 90 years old. According to our survey results, most of the participants considered themselves to be overweight and were concerned about ways to control it. The aggregate was also worried about stress and how to handle it. There are many stressors in everyday life, including work and home problems. Participants were also concerned about controlling their blood pressure.  Based off of the survey results, this population wanted educational programs about weight management. <br />Nearly one-fifth of the more than one billion people in China are overweight. They were once thought to be one of the populations in which the people were smallest. Over the years, they have become overweight more similarly to western populations. The Chinese are gaining more weight because their diet has changed and exercise has decreased or stopped (Wu, 2006).  The Chinese’s lifestyle is similar now to that of an American. Many Americans lead sedentary lifestyles because the necessary physical activity may be less enjoyable than relaxing and doing no true activity. Obesity contributes to many health problems such as increasing the risk for having high blood pressure. If people exercise and lose weight, it can decrease their risk of having high blood pressure (Wu, 2006).<br />According to Wyatt, Winters, and Dubbert (2006), 60% of adults in the United States are overweight. It is predicted that this percentage will continue to rise. Being overweight can also lead to diabetes mellitus and high cholesterol.  It is considered to be the top health problem in the United States. Many people in the United States know that they are overweight, but they just do not want to endure the physical activity that is required to lose the weight. (Wyatt, Winters, & Dubbert, 2006). According to the surveys used in this project, about 46% of the aggregate considered themselves to be overweight which is less than the national average. Similar to the article, it seems that this aggregate does not want to do all of the physical exercise to lose weight. They know that is necessary, but their sedentary lifestyle does not motivate them to actually do it.<br />Identification of Health Problems of Population<br />According to the multiple surveys distributed to the church congregation, hypertension and obesity were the most commonly reported health problems.  These health problems were reported in age groups as young as 26 years old.  Other highly reported health problems among this aggregate includes allergies, depression, and heart disease.  The most reported learning interest was about weight and stress management. These learning interests were reported in age groups as young as 11 years old.  The other most reported learning interests included nutrition and blood pressure. The most commonly requested screenings by the congregation were blood pressure monitoring and body mass index monitoring. The calculation of body mass index monitoring was requested by 18 members, and blood pressure screening was requested by 13 members.<br />The most appropriate nursing diagnosis for this healthcare problem and aggregate is deficient knowledge.  The deficient knowledge is related to the definition, risk factors, complications and treatment for hypertension. This deficiencyt in knowledge is evidenced by the congregation displaying interest in learning about hypertension as well as requesting and participating in blood pressure screenings. The top health priority for this aggregate is reducing and maintaining a normal, healthy blood pressure. This is the highest priority because according to the surveys, the most commonly reported health problem among the congregation is hypertension. Weight and stress reduction and management are second in priority because they were the most reported learning interests.  <br />Planning<br />Intervention Goals<br />One important process of community health nursing is forming a realistic plan to improve the health of the community. By forming partnerships between Sentara Healthcare, MMUMC and ODU, the student nurses established a plan to improve the health of the aggregate of the MMUMC. After conducting a series of meetings with Dr. Linda Bennington, Dr. Susan Tweed, Reverend Gary and Meredith Coldren and the student nurses at ODU, the plan of care was established.  <br />The results of the collected data concluded that hypertension, high cholesterol, obesity and depression were the major health problems of aggregate. The majority of the aggregate were interested in receiving health education on nutrition and weight and stress management. It was determined that interventions were necessary to meet these needs because the majority of the respondents had high blood pressure and high cholesterol. After careful consideration of all of the data collected from surveys, observations, discussions, and interviews another appropriate nursing diagnosis for MMUMC aggregates is health-seeking behaviors. This diagnosis is related to altered health status, absence of interpersonal support and lack of knowledge about the health promotion behaviors. This is evidenced by an expressed desire to seek a higher level of wellness, concerns about current health status and ability to control it and actively seeking resources to increase wellness and knowledge.     <br />The interventions agreed upon between the ODU student nurses and aggregate representatives were the Biggest Loser challenge and a health fair. Because the Biggest Loser challenge focuses the nutrition, exercise, weight and stress management, it was identified as the priority nursing intervention for the aggregate.  In fact, the Biggest Loser challenge could lower cholesterol, blood pressure, weight and stress of the aggregate. Therefore, the ultimate goal from these proposed interventions is to reduce high blood pressure by increaseing the knowledge of the participants. This will increase the overall health among members of MMUMC by lowering existing health problems. <br />The ultimate goal is to receive active participation from the aggregate to meet the established outcome objectives. The outcomes will be accomplished through a 10 week period with designated activities and educational sessions offered by the Biggest Loser challenge.  Based on aggregate needs and interests, four outcome objectives were established. The first objective is that the aggregate will verbalize three activities, i.e. healthy eating, exercise, and compliance of medication to reduce blood pressure and cholesterol by week five. The second objective is to demonstrate a weight loss of 10% upon the completion of the 10 week period. The third objective is that at least 60% of the participants will show a reduction in blood pressure by the end of the 10 week period. The final objective is that participants will verbalize two ways to reduce anxiety and depression by week four.<br />Alternative Interventions <br />After thoroughly assessing the population, interventions to meet the established outcomes have been created. The group came up with interventions to address weight loss and nutrition in an effort to accommodate the listed health concerns. Also, creating interventions involving the entire family could be more effective. Plans have been created to address health concerns to all ages of the church in an age appropriate manner.<br />Results from the original surveys showed that the population wished to continue the Biggest Loser weight loss competition started by the previous group of students. However, the previous competition did not yield successful results. In order to have a more successful program with greater participation, it is best to assess the population for convenience. If the program is suited to the needs and lifestyles of the participants then a successful outcome is more likely. The survey evaluated information such as best day and time (See Appendix B for Biggest Loser Convenience survey). Also, it determined what the goals of the population were, such as walking or running one mile. The population was given choices between walking, running, chair exercises, yoga and weight training. After assessing the collected data, an official plan of action will be created and begin in January 2011. With New Year’s resolutions, the hope is that many will seek out this weight loss competition as an effective strategy to meet their personal goals.<br />Another event that being planned by the student nurses is a health fair that is scheduled to take place in April 2011. Other community health groups will be invited to join, as well as university and community resources. University resources the group hopes to collaborate with will include students representing the Schools of Dental Hygiene and Physical Therapy. Community resources that will be invited include the local fire department and the American Red Cross. The fire department will be useful in giving fire safety tips as well as car seat safety checks and information. A blood drive is also intended to be hosted on this day. American Red Cross has been contacted and will be a good incentive to attract guests to this health fair. To make it a family event, donations are currently being taken for an inflatable bounce house for the children’s amusement. Also, another resource likely to attend is the Ident-a-Kid. The Biggest Loser competition is planned to be concluded on this day with the announcement and awarding of prizes to the winners.<br />Education on nutrition is an important part in reducing obesity and hypertension. Using the 5-4-3-2-1-Go approach, families will be educated on its meaning and its importance to healthy functioning. This program states that an individual should consume five fruits and vegetables, four glasses of water, three servings of dairy, have two hours or less of screen time, and at least one hour of physical activity on a daily basis. The 5-4-3-2-1-Go is an easy concept to grasp at all levels, and makes following diet regimens easier. The population is more likely to stick to a diet regimen if it can be easily followed (5-4-3-2-1-Go!, 2009).<br />Reaching the adolescent population is another goal and is an important part in prevention. After gathering the youth of the church, educational games about sexually transmitted diseases will be implemented. Using colored cards that represent different diseases will achieve this goal. Although this topic is controversial, education about sexually transmitted diseases is very important part in prevention and health maintenance for this population. Lastly, a Wii family night will be implemented . Through the use of the Wii interactive gaming system all family members can participate in healthy competition in order to promote exercise. <br />Conclusion<br />The group has identified health problems related to the aggregate. Statistics and characteristics of the aggregate were included to support data findings. The aggregate of MMUMC was meticulously assessed through literature review, internal and external influences, and comparisons to similar populations on various levels. The nursing diagnoses of deficient knowledge and health seeking behaviors were attributed to this population based on assessment results. Thorough assessment has leadled to the development of a plan of interventions, which will be implemented during the first several months in 2011. <br />References<br />5-4-3-2-1-Go! (2009) Live Well Omaha Kids. Retrieved November 30, 2010 from<br />Babatsikou, F., & Zavitsanou, A. (2010). Epidemiology of hypertension in the elderly. Health Science Journal, 4(1), 24-30.<br />Daley, L., Fish, A., Frid, D., & Mitchell, G. (2009). Stage-specific education/counseling intervention in women with elevated blood pressure. Progress in Cardiovascular Nursing, 24(2), 45-52.<br />Sirkin, A. & Rosner, N. (2009). Hypertensive management in the elderly patient at risk for falls. Journal of the American Academy of Nurse Practitioners, 21(7), 402-408.<br />Wu, Y. (2006). Overweight and obesity in China. British Medical Journal, 333(7564), 362-363.<br />Wyatt, S. B., Winters, K. P., & Dubbert, P. M. (2006). Overweight and obesity: Prevalence, consequences, and causes of a growing health problem. The American Journal of the Medical Sciences, 331(4), 166-174. <br />Appendix A<br /><ul><li>What is your age group?__7-10 __11-17 __18-25 __26-39 __40-49 __50-59 __60-69 __70-79 __80-89 __90+Are you __Male __FemaleWhat topic would you be interested in learning more about? __Nutrition __Immunizations __Home Safety __Blood pressure management __Sleep disturbances __Weight management __Smoking cessation __Stress management __Asthma/Allergies in children __Other (specify)Do you have adequate access to healthcare?___ Yes ___ NoDo you have health insurance? __Yes __No6.Do you have any of the following medical conditions? __High blood pressure __Obesity __Diabetes __Heart Disease __Asthma __GI disorders __Depression/ADD __Allergies __COPD/emphysema __Other (specify)7. Would you be interested in receiving Health Screenings for (mark if interested):__Blood Pressure __Blood Glucose (Diabetes)__Cholesterol __Body Mass Index/Body Fat measurements8. Which service do you primarily attend?__8am __11am __Sunday School 9:30am__Wednesday evenings 6:30pm9. Is there any additional medical interventions/information that you would like made available to you?10. Is there anything you would like to see done with this nursing group that seemed to work in the past (such as with other nursing groups)?Thank you for participating!!</li></ul>Community Assessment Survey<br />Appendix B<br />Biggest Loser Competition Convenience Survey<br />1. What day is best for you to participate? (Check all that apply)<br />SUN MON TUES WED THUR FRI SAT<br />2. What time of day is best for you?<br />List times___________________________________<br />3. What activities would you like to see implemented into the competition?<br />Walking Running Chair exercises Yoga Weigh bearing (using small weighs)<br />4. Any other suggestions of exercises you would like to add?_____________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________<br /> <br />Honor Code:<br />“I pledge to support the Honor System of Old Dominion University. I will refrain from any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of the academic community, it is my responsibility to turn in all suspected violators of the Honor code. I will report to a hearing in summoned.”<br />Sign: Signature: Keithlee Aquino, Verona Bullecer, Kristen Burritt, Chad Hagedorn, Trinay Jeffries, Candace Johnson, Lauren Lowe, Nirosha Rathnayake, Stefanie Setzer, Whitney Smith<br />Date: December 17, 2010<br /> Health Planning Project: GRADING CRITERIA:<br />Assessment Points: 60<br />SEQ 1_0 * ALPHABETIC r 1A.Identify aggregate selected for study. Provide a general orientation to the aggregate. Include why this aggregate was selected and the method used for gaining entry. (10 points)<br />SEQ 1_0 * ALPHABETIC nB.Describe specific characteristics of the aggregate including:<br />SEQ 2_0 * Arabic r 11.Socio-demographic characteristics (must utilize a minimum of four data collection sources) (10 points)<br />SEQ 2_0 * Arabic n2.Health status (actual and perceived). Include (when possible) input from clients regarding their perceptions of needs. (10 points)<br />SEQ 2_0 * Arabic n3.Internal and external influences affecting the aggregate<br /> (5 points)<br />Provide relevant information gained from literature review, especially in terms of characteristics, problems or needs that one would anticipate finding with this type of population. (10 points)<br />Include comparison of health status of chosen aggregate with other similar aggregates, the community, the state, and/or the nation. (10 points)<br />Identify health problems and/or needs of specific population based (Nursing Diagnosis) on comparative analysis and interpretation of data collection and literature review. Give priorities to health problems and/or needs and indicate how these priorities are determined. (5 points)<br />Instructor’s Comments: <br />This was extremely well covered and presented! 60 points<br />II.Planning Points: 25<br /> <br />tc l 4 "II.Planning 25"SEQ 1_0 * ALPHABETIC r 1A.Select one health problem (Nursing Diagnosis) and/or need for intervention and identify the ultimate goal of the intervention. Identify specific, measurable objectives as (mutually agreed on by student and aggregate, when possible) (15 pts)<br /> <br />SEQ 1_0 * ALPHABETIC nB.Describe alternative interventions necessary to accomplish objectives. Select and validate intervention (s) with highest probability of success. (Note: Interventions may include using existing resources and/or developing resources.) (10 points)<br />Instructor’s Comments: <br />Both of these were covered extremely well and thoroughly! 25 points<br />C. Appropriate resourcesPoints: 5<br />D. FormatPoints: 10<br />Grammar, sentence structure, honor code, <br />Spelling & APA format<br />Instructor’s Comments: <br />Resources were right on target for every intervention 5 points.<br />With the exception of some minor grammatical errors, everything was beautifully done! 9 points.<br />Great job everyone!<br /> Total: 100 points<br /> Group Score: _____99__________<br />