LAKE COUNTY MICHIGAN Community Health Promotion and Prevention Project Nursing 340 Adam Ratliff ~ Nichole Roback ~ Ashley Yotkois ~Amy Boge

LAKE COUNTY MICHIGAN

Community Health Promotion and Prevention Project

Nursing 340

Adam Ratliff ~ Nichole Roback ~ Ashley Yotkois ~Amy Boge

Problem Statement: Risk of heart disease among residents of Lake County under the age of 75 related to obesity and smoking rates that are

higher than Michigan average.

Lake County 180.3 Michigan 201.6

Healthy People 2020 target rate is 12.0%Healthy People 2020 target rate is 30.6%

Evidence Supporting Need for Nursing Intervention

Cardiovascular Health issues/problems are the second highest leading cause of death (behind cancer) in Lake county

One in five adults report general health as being classified as fair or Poor 43.1% of Lake population is considered obese, and 27% of the

population is classified as smoking

9.6 % of the population of Lake County have been classified as sustaining a heart attack, this is almost double than that of the statewide average and DHD#10

16.1% of all preventable hospitalizations were related to Congestive Heart Failure, and was the number 2 reason overall for requiring hospitalization

sorry lost my chat box for some reason. OK.... so....groups Lets look at it by targets. we are targeting an older population. Lake county is primarily 65 yrss old and up.-bart33-

so.... church groups, clubs such as LIONS and K of C. But we also want to prevent.... so look at schools daycares etc to promote good diet and no smoking-bart33-

or am I not following you?-bart33-

yeah I am following you. Are they needing to be already established community resources or ones that would be useful if present?-ratlifa1-

I guess we should look at increasing awareness in the older generation and promotion and prevention in the younger-bart33-

who is the moose? is that Amy?-ratlifa1-

Ithink as long as we clarified what is present and what the needs are... you could do both-bart33-

ok that part I am going to need to research a little bit more. What do you think about the evidence for the problem? enough information, do we need more?-ratlifa1-

oh... I have a koala bear...lol-bart33-

we may have to condense a bit. idk how many slide we are allowed to have-bart33-

I think there is a lot of evidence that there is a problem.... Plus if you look at my web of causation thingy (took like 2 hours today) there is a lot of room for improvement-bart33-

better to have too much and condense than need more!-ratlifa1-

I agree! if we decide on a certain theme ... I would be happy to make them all thee same as far as color font etc.-bart33-

I think if you just pick one that would be better.....haha-ratlifa1-

lol.... ok. not a problem either. you are giving me entirely too much power right now. lol-bart33-

I wont. It will be aesthetically(sp) pleasing for men and women alike!-bart33-

haha just dont make it too girly :)-ratlifa1-

on a different note, what did you think about the interdisiplinary part? Can you think of anything else that would be helpful?-ratlifa1-

Haha well said!-ratlifa1-

I didn't see anything wrong with it or lacking.... except did I miss a nursing role slide?-bart33-

hello all...i made it-nroback1971-

Hey Nicole.... Ashley and adam-bart33-

Adam is ratlifa1-ratlifa1-

who is ratlifa1 and bart33?-nroback1971-

hey guys....lot of work has been done on thisalready-nroback1971-

I just changed the title page...my name was spelled wrong.-nroback1971-

that's my fault. I had some extra time this am and was trying to do some extra. look it over. We may have to condense depending on the rubric. however.... I think these sessions can be used to help one another and make our portions flow together.-bart33-

I spoke with Professor Jo this AM and she said if we need anything to call her. just want to give a word of advise.....don't do what i did! For the windsheild survey i took the sample template and added my content to it.....oooops that is a big no no. It has other professors comments on it and she thought I cheated and copied someone elses paper.....WTH! OMG-nroback1971-

yeah....thought I was going to get kicked out but she is very very understanding!!-nroback1971-

omg....that's awful-bart33-

I dont get these little animal things! why do they keep changing?!?!-ratlifa1-

:/ eeek! was she pretty understanding once you told her what happened?-ratlifa1-

on slide nine it says cardiac disease is #1 cause.....I read on the PPt Jo put out cancer rate is 233.2....wouldn't that be the first and cardiac be 2nd?Not sure about the animals either-nroback1971-

Oh by the way I did NOT cheat!! :)-nroback1971-

haha. I saw cardiac disease as #2 and CA was #1-ratlifa1-

yes.... was that my slide? we can fix that. some of those charts are confusing. is everyone ok with web of causation model and did I leave anything out>-bart33-

yes it was #9. I put it in my slide #6 too.-nroback1971-

OK....quick question of the subject....where does everyone live? and is Amy here?-nroback1971-

lol ... ok. I live an hour north of bay city. Au Gres. IDK if amy is here. I know she had to work last night-bart33-

I liked the information on slide 6 in the comment section.....-nroback1971-

I live in Gaylord....great white north! AND I hate snow...lol-nroback1971-

I live in Allendale, 30 min west Grand Rapids. IDK where Amy is, I was afraid I wasnt going to hear my alarm, I too work last night.-ratlifa1-

idk.....all I know is this is easier to use than the wiki.... that things was awful....and we can chat. so... the part I was having trouble with is my demo graphics. whe wants to know who this will affect.... what groups. look over my slide will ya? and is everyone good with the web of causation model? that is good info and not necessarily something we need to put on a slide. those notes will be good for guiding our narrator for the voice over-bart33-

The web of causation is busy but once i looked at it closer I sort of figured it out.-nroback1971-

So, the first section needs to be analysis....what slides and what info goes next.....what shall the purpose say?-nroback1971-

yes i too was a little confused when looking at all of the arrows at first but i was then able to figure it out.-ratlifa1-

that's how it is in the book.... I could change some colors and make a legend so it is easier to read.-bart33-

that would be a good idea-nroback1971-

it is actually a really good model and very fitting for this... in my opinion. unless someone has another idea . very open to suggestion.-bart33-

i like the color changes to make it easier to read. i think it should stay in.-nroback1971-

agreed-ratlifa1-

Can the details from slide 7 go into slide 5?-nroback1971-

okay.... I will make those changes. I don't see why not. um... listen.... I gotta go. my 11 month old just opened an entire thing of bubble bath and is spreadingit all over the bathroom floor. ugh.-bart33-

Can slide 6 be used as next slide after the purpose statements slide ....a.ccording to ruberic analysis is next and that is a good start of analysis....we can add details from slide 3 and then slide 9. THoughts to that?-nroback1971-

Will you make changes now so we can see what it looks like before we sign off ??-nroback1971-

Community Assessment

Lake County has excellent emergency care, ambulatory/emergency transport, nursing home care, oncology, and in-home care.

Conversely, there is a lack of dermatology, OB/GYN, oral surgery, podiatry,mental health treatment for severe/persistent disorders, and pediatrics.

There is a lack of primary care providers for children and the underserved.

Although a variety of programs and services exist, residents often have to travel outside of the area to access care. Usually this is due to a referral for specialized care, surgery, or cancer treatment.

Causative Factors That Contribute to the High Risk of Heart Disease

Modifiable Risk Factors

∗ Poor dietary intake∗ Sedentary Lifestyle∗ Smoking∗ Alcohol Consumption∗ Stress∗ Lack of Healthcare

Provider/Insurance which can result in not monitoring of blood pressure, cholesterol levels

Non-modifiable Risk Factors∗ Age∗ Gender ∗ Family history of

Heart disease∗ Living

Conditions/Location∗ The next slide is a Web

of Causation for Lake County

Interventions * Healthy Cooking classes

* Partner with local grocery stores to develop a “healthy shopping list”

* Involving local farmers at a farmers market to donate/ offer reduced priced fresh fruits and vegetables

* Free Weekly workout classes, in a central location and easy access, partnering with a local gym to offer classes

* Public Vegetable garden where the public can grow healthy foods

* Smoking quit kits

* Support group for Smokers trying to quit and quitting using the buddy system to support each other

* Every three month blood glucose testing, vital signs check, weight check, lipid panel and individual counselling regarding results.

* Diet and exercise Journal

Barriers to Interventions

* Socioeconomic status* Transportation* Unemployment rates* Level of poverty and

education * Poor support system* Health status

* Lack of Knowledge* Long waits at hospitals* Inconvenient hours* No access to certain

specialties* Lack of Insurance* Perception of healthcare and

health resources in the community

Interdisciplinary Team Social Work:

Would prove to be useful in that many individuals are considered to be living with low income and classified as being in poverty

Would help supply and make connections for topics such as prescription coverage, help navigate Medicare/Medicaid

Dieticians This specialty would help try and improve the rate of obesity by educating

individuals on proper dietary choices and selections Could help develop meal plans and ideas, especially for those living with

congestive heart failure to help prevent the need for hospitalization

Increase in Physician presenceLake County has very low proportion of number of persons to health care provider (1 PCP: 5,758 people)

Community Business Owners

Readiness for Enhanced Self-Care* Assessment* Pt will describe their perception of improved self-care and their attitude towards use

health care and community services* Pt will turn to family, friends, and community members and groups for support* Defining Characteristics* Community members will express their desire to improve their health, enhance their

knowledge regarding healthy living, as well as their strategies to improve self-care* Expected outcomes* Patient will demonstrate positive decision making toward maximizing improved self-care.* Patient will express satisfaction in assuming responsibility in planning self-care.* Patient will collaborate with staff, family, and other community members in developing

strategies to improve self-care.* Interventions* Assist community members in developing a plan to increase responsibility improving self-

care.* Support implementation of program to sustain health-seeking behavior and promotes

autonomy in self-care.* Encourage community members and their families to participate in community support

groups that promote increased self-care* Evaluation* Patient expresses awareness regarding their need to improve self-care.* Develop, maintain, and update plan for self care* Involves staff, family, and community in developing self-care strategies.

Readiness For Enhanced Knowledge r/t Improved Diet and Increased Exercise* Assessment

* Community demographics including education and income as well as health status including restrictions and limitations

* Defining Characteristics* Expresses interest in learning* Explains knowledge of topic and previous experience r/t topic.* Describes Behaves in a way that is consistent with knowledge* Expected Outcomes* Pt will identify new sources for enhancing knowledge in the topic of interest* Pt will make use of all relevant resources to enhance knowledge and will ask questions where

new information needs clarification* Pt will start to use new behaviors constructed from enhanced knowledge* Interventions* Determine what the community members know about diet and exercise* Provide information including classes, support groups, exercise classes, and how to grow a

vegetable garden and encourage other sources of information such as libraries, internet, and organizations.

* Be available to answer questions and clarify misconceptions and give feedback.* Evaluation* Pt is motivated to acquire additional knowledge using provided and additional materials. * Pt uses skills derived from learned information and asks questions when information is unclear.

Altered Health Maintenance r/t Presence of Adverse Personal Health Habits

* Assessment* Health status including healthy and unhealthy habits as well as exercise and eating habits* Defining Characteristics* Pt has decreased knowledge regarding healthy behavior* Failure to keep appointments and unable to follow instructions and programs for improved health

maintenance.* Expected Outcomes* Pt describes positive health maintenance behaviors such as keeping appointments and follow-ups,

participates in cooking and exercise classes.* Participates in community outreach projects including community vegetable garden, journaling diet and

exercise, and weekly healthy shopping list.

* Patient identifies and uses community resources* Interventions* Schedule every three month screening appointments* Involve family and other community members in health planning conferences.* Be available or how to be reached for clarifications.* Provide education on important behavior changes to improve health maintenance* Evaluation* Pt keeps appointments and overall health in improving, including but not limited to, weight loss, improving

BMI, improving blood pressure, improving blood glucose and cholesterol level and compliance with medical regimen.

* actively taking part in cooking and exercise classes as well as takes part in community vegetable garden* Participates in community groups including smoking cessation, alcoholics anonymous, weight watchers,

and narcotics anonymous.

*

⬜Health Initiative Flyer for Lake County

Indicators That Should Change When Proper

Interventions are Set in Place:* Healthy dietary intake* Increase activity to the recommended time* Learn appropriate ways to deal with stress

i.e. relaxation techniques, meditation, music* Arranging appointments with a Healthcare

Provider* Weight loss and improved lab results

ReferencesCounty Health Rankings: Michigan. (2013). Retrieved October 6, 2014 from University of Wisconsin Population Health Institute website, http://www.countyhealthrankings.org/Michigan

Health and Health Care Landscape of Osceola and Lake Counties. (2011). Retrieved on October 6, 2014 from Spectrum Health Care Website, https://www.spectrumhealth.org/documents/ Osceola_ and_ Lake_ Counties_ CHNA.pdf

Krantz, M. J., Coronel, S. M., Whitley, E. M., Dale, R., Yost, J., & Estacio, R. O. (2013). Effectiveness of a community health worker cardiovascular risk reduction program in public health and health sare settings. American Journal of Public Health, 103(1). ⬜ Lindsay, S., Smith, S., Bellaby, P., & Baker, R. (2009). The health impact of an online heart disease support group: a comparison of moderated versus unmoderated support. Health Education Research, 24(4). doi:10.1093/her/cyp001⬜ Michigan Department of Community Health, District Health Department #10. (2014). Health profile chartbook 2013: Lake County. Retrieved from http://dhd10.org/images/Lake_Chartbook _2013__ Feb_18_2014.pdf

Walton-Moss, B., Samuel, L., Nguyen, T. H., Commadore-Mensah, Y., Hayat, M. J., & Szanton, S. L. (2014). Community-based cardiovascular health interventions in vulnerable populations: A systematic review. Journal of Cardiovascular Nursing, 29(4).

⬜

https://www.spectrumhealth.org/

http://dhd10.org/images/

http://dhd10.org/images/

Documents

LAKE COUNTY MICHIGAN Community Health Promotion and Prevention Project Nursing 340 Adam Ratliff ~ Nichole Roback ~ Ashley Yotkois ~Amy Boge