A Community Health Nursing Plan of Care

1. Lack of Health Care Providers In Mecosta County • A Community Health Nursing Plan of Care Pam Beringer, Erin Burdi, Debra Francik , and Ashley Jacobson

2. Assessment & Analysis Epidemiological Concepts Host: Due to the “rural” classification of Mecosta County, residents of this community are at an increased risk for a shortage of Health Care Providers (HCP’s) .

3. Assessment & Analysis:Epidemiological Hosts • Rural areas (also referred to as "the country," and/or "the countryside") are settled places outside towns and cities (Farlex, 2010, para 1). According to the US Census Bureau, the classification of “rural” includes all territories, populations, and housing units located outside of an Urbanized Area (UA) or Urban Cluster (UC) (2000).

4. Assessment & Analysis:Epidemiological Host In the year 2000, the Mecosta County total population census was 40,553 (MSUE,2007). The rural population of Mecosta County was 28,780 residents or 70.6%of the total population (US Census Bureau, 2000) *27,642 (96% )of these residents lived in Non-Farm areas & 1,138, (4%) of residents lived in farm areas (MSUE, 2007, p.5)

5. Assessment & Analysis Rural Population Comparison United States 21% 59,061,367 281,421,906 Michigan 25.3% 2, 518,987 9,938,444 Mecosta 70.6% 28,780 40,553 Percentage of Population Rural Population Census Total Population *According to Census Data, Mecosta County has a greater percentage of rural resident population than both the State & National census combined! (US Census Bureau, 2000)

6. Vulnerable Groups • “To be considered vulnerable, a person or group generally has aggravating factors that place them at greater risks for ongoing poor health status then other at-risk persons” (Fisher, pg. 533). • An example : “ A middle-aged obese man with a sedentary lifestyle and hypertension would be considered at risk for cardiac problems. If that man also had an income below the poverty level, no health insurance, and stressors related to living conditions, he would be more likely to be vulnerable to ongoing poor health status then a man with similar risk factors but with an adequate income and health insurance. The man in poverty would be more likely to experience difficulties obtaining and maintaining a relationship with a primary care provider, would have problems accessing tests and procedures for diagnosis and ongoing monitoring, and would have difficulty obtaining and paying for the appropriate medications”(Fisher, pg. 5330.

7. Specific groups this especially effects • According to Fisher, “A vulnerable population is a group or groups that are more likely to develop health-related problems, have more difficulty accessing health care to address those health problems, and are more likely to experience a poor outcome or a shorter life span because of those health conditions” (Fisher, pg. 533). • Characteristics, traits , and different circumstances enhance the potential for poor health (Fisher, pg. 533). • “Department of Health and Human Services, had identified certain groups as more vulnerable to health risks, including the poor, the homeless, disabled, the severely mentally ill, the very young, and the very old” (Fisher, pg. 533). • Not all people at risk for poor health are considered vulnerable

8. Assessment & Analysis Community Groups of Interest • “What is it like to live in a small rural town? What do nurses know about rural populations and their nursing needs? Although each community is unique, the experience of living in a small town is similar in all 50 states” (Fisher, pg. 820-821). • The typical rural lifestyle is characterized by the following: • Greater spatial distances between people and services • An economic orientation toward the land and nature • Work and recreational activities that are cyclic and seasonal • Social interaction that facilitate informal, face-to-face negotiations, because most, if not all, residents are either related or acquainted (Fisher, pg. 821)

9. Assessment & Analysis Community Groups of Interest • “There is increasing evidence that community members who are informed and active in planning their health care system are more likely to use and support that system” (Fisher, pg. 825). • The community decision making model helps to identify a problem and try to come up with a solution. The steps in the model are: • 1. Identify the problem. • 2. Assess the community’s perspective • 3. Analyze the data • 4. Develop a long-range plan • 5. Take action • 6.Evaluate the program

10. Assessment & Analysis Existing Health Resources in Mecosta • “There is ongoing debate as to whether anything is unique about rural nursing practice, because nursing care is similar regardless of the setting” (Fisher, pg. 822). • There is little information in periodical and in nursing texts on what actually makes community/public health nursing different in rural settings (Fisher, pg 824).

11. Assessment & Analysis Community Groups of Interest • “In brief, for rural residents, a small town is the center of trade for a region, and its churches and schools usually are the centers for socialization” (Fisher, pg. 821). • This helps for planning and implicating public health and community nursing programs for rural clients (Fisher, pg. 821).

12. Assessment & Analysis Community Groups of Interest • Community Groups that might be interested in helping are: • Churches • Nursing Students • Volunteers • Nurses • Community Centers • American Red Cross

13. Assessment & Analysis: Epidemiological Environment There are Three Major Factors that Influence Rural Health • Availability of Services • Accessibility of Services • Acceptability of Services (Maurer & Smith, 2009, p.815)

14. Assessment & Analysis: Rural Health Influences Availability of Services “refers to the existence of services and sufficient personnel to provide those services” (Maurer & Smith, 2009, p.815)

15. Assessment & Analysis: Rural Health Influences Acceptability of Services “refers to the degree to which a particular is offered in a manner congruent with the values of a target population” (Maurer & Smith, 2009, p.816)

16. Assessment & Analysis: Rural Health Influences Barriers to Acceptability Traditions of Handling personal problems without professional Help Beliefs about the Cause of a Disorder & the Appropriate Healer Knowledge Deficit Specific Conditions and Value of Prevention and Treatment Confidentiality & Anonymity in a “Everybody knows Everyone” community setting . Urban Orientation of most HCP’s (Maurer & Smith, 2009, p.816)

17. Assessment & AnalysisRural Health Influences Accessibility of Services “ refers to the ability of a person to obtain and afford needed services” (Maurer & Smith, 2009, p.815) Common Barriers to Accessibility Include: Long Travel Distances Lack of Public Transportation Lack of Telephone Services Shortage of Health Care Providers Inequitable Reimbursement policies Unpredictable Weather Conditions Inability to Obtain Entitlements (Maurer & Smith, 2009, p.815)

18. Multiple factors also affect specific groups • Lower socioeconomic status • Lifestyle behaviors • The psychological impact of poverty • Genetic inheritance • Race • Ethnicity • Gender • Poor education • Poor health • Sudden change in financial situation (Fisher, pf. 541)

19. Health Professional shortage areas • “Concerns about rural health care services, especially in regions with insufficient numbers of all types of health care providers,(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990’s” (Fisher, pg. 809). • “The U.S. Bureau of the Census estimates that there are 54 million people living in rural areas of the United States. They make about 1/5 (20%) of the total population but are spread out across 4/5 (80%) of the land area” (Fisher, pg. 809).

20. Assessment & Analysis Shortage of Health Care Providers As of 2005, Mecosta County had only 34 Practicing Physicians located in Big Rapids area to care for a Population of 42,391 That ‘s a 1 : 1247 Physician-Patient Ratio!!! As of 2005, in the State of Michigan there are 25,146 active physicians* with a State Population of 10,120,860 That’s a 1:420 Physician –Patient Ratio! *(excluding physicians with unknown addresses, inactive statuses, and osteopathy)

21. Assessment & Analysis: Epidemiological Agents Major Health Problems for Rural Areas Accidents & Trauma Chronic Illness Suicide & Homicide Alcohol & Drug Abuse

22. Assessment & Analysis: Epidemiological Agents Top Ten Causes of Death in Mecosta County 1. Heart Disease 2. Cancer 3. Chronic Lower Respiratory Disease 4. Stroke 5. Unintentional Injuries 6. Diabetes Mellitus 7. Alzheimer’s Disease 8. Pneumonia/Influenza 9. Kidney Disease 10. Intentional Self Harm (Michigan Surgeon General’s Health Status Report., 2010)

23. Assessment & AnalysisEpidemiological Agents • The Top Ten Causes of Morbidity/ Mortality for the State of Michigan where nearly identical to those of Mecosta County with only a slight difference in numerical order Mecosta County 1. Heart Disease 2. Cancer 3. Stroke 4. Chronic Lower Respiratory Disease 5. Unintentional Injuries 6. Diabetes Mellitus 7. Alzheimer’s Disease 8. Pneumonia/Influenza 9. Kidney Disease 10. Intentional Self Harm State of Michigan 1. Heart Disease 2. Cancer 3. Chronic Lower Respiratory Disease 4. Stroke 5. Unintentional Injuries 6. Diabetes Mellitus 7. Alzheimer’s Disease 8. Pneumonia/Influenza 9. Kidney Disease 10. Intentional Self Harm (Michigan Surgeon General’s Health Status Report., 2010)

24. Nursing Diagnosis Risk for Increased Mortality & Morbidity in Mecosta County related to Lack of Health Care Providers.

25. Plan Increase the availability of preventative health resources and measures to citizens of Mecosta County to decrease the burden on current Health Care Providers (HCP). Rationale: If Residents of Mecosta County have Access to Preventative Care & become Proactively Involved with Personal Health, the Over-all Community will Benefit from Improved Health & Reduction of Health Services Required.

26. Michigan Center for Rural Health “Supporting and engaging rural Michigan communities and their residents in eating healthy, being physically active, and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life. Collaborative efforts involving communities, schools, worksites, families, and others are needed to create environments that support sustainable healthy behaviors.” (Michigan Center for Rural Health, 2008, pg.23)

27. Primary Prevention • “Primary prevention is aimed at altering the susceptibility or reducing the exposure of persons who are at risk for developing a specific disease” (Fisher, Pg. 170). • “Primary prevention includes general health promotion and specific protective measures in the pathogenesis stage, which are designed to improve the health and well-being of the population” (Fisher, pg 170).

28. Plan: Primary Prevention Sources for Volunteers & Community Venues Volunteers *Professors & Nursing Students from Ferris State University located in Big Rapids *Health Care Personnel from Local Mecosta County Hospital & Private Practices * Church Volunteers Venues *Churches *Community Centers *County Hospital *Urgent Care Centers

29. Plan: Primary Community Prevention Utilize Local Volunteers & Venues to Educate & Encourage Preventative Health Measures & Provide Free Health Screenings that Target Top 10 Causes of Morbidity & Mortality in Mecosta County. *For the purpose of this power point we will only show examples for the top three causes of morbidity & mortality in Mecosta.

30. Plan: Primary Prevention Services Heart Disease Provide Free Blood Pressure Screenings Free Cholesterol Quick Tests Free Risk Factor Assessment Education Proper Exercise & Nutrition According to American Heart Association Guidelines Stress Reduction Early Signs & Symptoms of Heart Attack

31. Plan: Primary Prevention Services Cancer Assessment of Risk Factors (Genetics, Lifestyle, & Environmental) Education Different Types of Cancer Nutrition Exercise Early Detection: Signs & Symptoms Self Screening Tools (Self-Breast & Testicular Exams) Smoking Cessation

32. Plan: Primary Prevention Services Stroke Risk Assessment (Genetics, Lifestyle, Environmental) Education Nutrition & Exercise Smoking Cessation Stress Reduction Early Detection-Signs & Symptoms!! Slurrred Speech Dysphasia Facial Droop Hemi-paresis Numbness &Tingling • Blurred Vision

33. Plan: Secondary Prevention • “Secondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression, thereby preventing disability or complications” (Fisher, pg. 171). • Examples: • 1.Preventing transmission of a communicable disease • 2. Preventing or slowing of a disease • 3. Preventing complications from a disease (Fisher, pg. 171)

34. Plan: Tertiary Prevention • “ Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for person’s who have experienced a loss of function resulting from a disease process or injury” (Fisher, pg. 171). We need to provide: • Education to people • Nursing Care • Referrals • Resources

35. Plan Offer Incentives for Future HCP’s to Practice in the Mecosta County area. Rationale: Through offering Incentives for HCP’s to practice in the Mecosta area, one can increase the number of HCP’s to residents.

36. Reason Healthcare Providers Avoid Practicing in Rural Areas “The reasons given for not wanting to practice in rural areas had less to do with the amenities or social activities associated with urban areas than with the patient base (large numbers of uninsured or poor people) or the quality of the facilities” (Health Professions Resource Center, 2006).

37. Plan: Recruitment & Retention Recruitment and Retention of HCP’s is a challenge for rural areas. Nationally, there is a projected provider shortage along with a projected increase in demand for services, as the baby-boomer population reaches retirement age. Recruitment and Retention was identified as an issue in all three components of the rural community health assessment (Michigan Center for Rural Health, 2008, pg.23)

38. Plan: Recruitment & Retention The Michigan Center for Rural Health The Michigan Center for Rural Health has developed a plan to increase the number of practicing health professionals in rural Michigan • Increase by 20% the number of rural health sites approved as Michigan State Loan Repayment sites. • Increase by 10% the number of rural providers participating in the State Loan Repayment Program. (MSLRP). • Increase by 20% the number of rural health sites approved as • National Health Service Corps sites; from 127 to 152. • Increase by 10% the number of National Health Service Corps • provider placements at rural sites. • Develop a retention model to assist rural hospitals, certified rural health clinics and federally qualified health centers in their retention planning efforts. • Develop a rural component to the “Practice Michigan” campaign to promote the benefits and positive aspects of rural practice. (Michigan Center for Rural Health, 2008, pg.29-30)

39. Measurable Outcomes Increased number of HCP’s in Mecosta County Decrease in HCP to Patient Ratio. Attendance Rate of > 60% to Local Prevention Seminars & Screenings. Less admissions into the hospital.

40. The Availability of Health Care in rural areas is challenging for health care providers to promote primary care and preventative measures.

41. The community health nurse can use the statistics from previous years to observe the trends and the growing need for interventions. (Beringer, 2010)

42. Intervention “An intervention is an interference so as to modify a process or situation.” “An intervention is designed to improve the health of a patient or change the conditions which have negative impact on the well-being of the patient.” (Farlex, 2010)

43. The State Rural Health Plan serves as a guide to aid in providing care to rural areas in Michigan. The approved goals by the Advisory Group for rural residents are: Access to dental care Access to mental health Access to primary care & specialty care Practicing health professionals Targeted education & training opportunities The number of applications and admissions into health professions & training programs The rate of obesity The activity level of the population The communities can use this plan as a guide to develop interventions that increase care to patients in rural areas Healthy eating in the community (Michigan Center for Rural Health, 2008, pp. 1-2)

44. Available Services In Mecosta County 34 Physicians EMS Services: Spiritual care Hospice care Grief support Nursing Care Respite care Social services Home care aide or homemaker services Volunteer care Physical, occupational, and/or speech therapy (Jacobson, 2010)

45. Recruitment & Retention in Mecosta County ☼Evaluating the ratio of health care providers to the number of patients ☼Recognize the shortage of health care providers ☼Showcase the environment to draw health care workers to the area ☼Describe the different religious organization ☼Illustrate the different cultural groups in the area ☼Highlight the civic activates and cultural arts available in the area ☼Offer incentives for relocation ☼Illustrate the recreation activities that are offered in the area

46. Health Care Providers Mecosta County has one 74 bed hospital located 45 minutes North of Grand Rapids Mecosta County Medical Center provides services in: ●Maternity ●Cardiopulmonary & Rehabilitation ●Critical Care Unit ●Emergency Care ●Home Health Care ●Inpatient Medical Rehabilitation ●Laboratory Services ●Medical Imaging ●Nutrition and Dietary Services ●Occupational Medicine ●Outpatient Physical Rehabilitation ●Pharmacy ●Specialty Clinics ●Surgical Services Mecosta County Medical Center. (2010)

47. Mecosta County is classed as a Micropolitan area with two Rural areas bordering it. There are no free clinics located in the county or surrounding counties. (Michigan, 2010)

48. The shortage of Health Care Providers is an issue with today’s economy. Extending care and services suffer due to cut back in the budgets. The existing care institutions needs to reach out to communities and other business’s to facilitate the growing need for health care providers and facilities. Community involvement can increase awareness of services in the community.

49. Showcasing Mecosta County Mecosta County offers diverse terrain Rolling hills Northern woods for stunning color Marsh land for wild life (Ertman, 2010)

50. The Congregations In Mecosta County Allows For Varied Religious Practice United Methodist Church - 9 Lutheran Church - 2 United Church of Christ - 1 The Wesleyan Church - 3 Evangelical Lutheran Church in America - 1 Evangelical Free Church of America - 1 Free Methodist Church of North America - 4 Christian Churches and Churches of Christ - 3 Wisconsin Evangelical Lutheran Synod - 2 Church of Jesus Christ of Latter-day Saints - 1 Episcopal Church - 1 Presbyterian Church - 1 Church of God – 3 Old Order Amish - 3 Christian Reformed Church in North -America - 1 General Association of Regular Baptist Churches - 1 Assemblies of God - 2 Church of God (Cleveland, Tennessee) - 1 Conservative Baptist Association of America - 1 Church of the Nazarene - 1 Community Church of Christ - 1 Seventh-Day Adventist Church - 1 Sothern Baptist Convention - 1 Churches of Christy - 1 Baha’i – 15 members (no congregations) Salvation Army - 1 Buddhists - 1 (Rousseau, 2010)