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Nursing care plan: Based on Epidemiological Model

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    Nursing care plan: Based on Epidemiological Model

    Introduction

    In this assignment the community and public health of Springdale community, Ohio will be assessed in order to develop a community nursing care plan in order to promote and protect the health of the populations of this community using knowledge from nursing, social, and public health sciences. It will be population-based, community-oriented care plan based on this community’s problems. The goal of such care is prevention of disease and disability for all people through interventions designed for that specific population.

    Community Health Problems

    A population based survey was designed to do a systematic health assessment to identify the most important public health issues of this community. Epidemiology is the study of the distribution and determinants of health-related states or events in human populations and the application of this study to the control of health problems. The core of epidemiology is the use of quantitative methods to study disease and risk factors in human populations. These epidemiologic tools are conventionally great tools in assessing the prevalence and risk factors of any health problems in the community. These procedures analyze the demographic data to discover the causative association between a health problem and the population. Therefore, these would be acceptable tools to design a community nursing intervention to prevent the health problem. The two most important local community problems identified were obesity related to sedentary lifestyle and poor dietary choices and cardiovascular diseases.

    Community Epidemiologic Data and Population Based Surveillance

    It is a city with a population of 10,000. In this population 73% of the people had lack of physical activity, 65% had high blood pressure, 62% was obese, 61% had poor eating habits, 59% of the adults smoked and had heart disease, 55% had diabetes, 53% abused alcohol, and 50% had high cholesterol. The statistics indicated that in comparison to other surveyed parameters, these are more prevalent. Analysis of these data indicated that in that community, the most prevalent community health problem is lack of physical activity, and sedentary life style combined with poor eating habits has resulted in obesity. Moreover high prevalence of hypertension, diabetes, obesity, alcohol, smoking, high cholesterol has predisposed to heart disease in this community (Springdale Community Health Assessment, 2005).

    Local Community Problems

    Obesity related to sedentary lifestyle and poor dietary choices
    Cardiovascular diseases
    Nursing Care Plan and Interventions

    Since these problems are associated with unawareness of the population, this indicates self-care deficit according to Orem’s self-care deficit model, and an educative supportive intervention according to Orem can influence the health-related behaviour from Johnson’s behavioral systems model. Once educated, people will automatically tend to protect themselves from harmful influences of unhealthy health habits according to Neuman’s system model, where they would themselves feel the need for protection from the problem which can be remedied through nursing interventions. For both these identified problems, these theoretical frameworks are applicable.

    Interventions

    Obesity related to sedentary lifestyle and poor dietary choices
    To promote physical activity, people will be encouraged to use the Community Center. To generate awareness about this resource and about the need for physical activity educative health promotion activities will be undertaken.
    More public education about the harmful effects of obesity and beneficial effects of healthy diet will be instituted. Topics of education may include appropriate foods and foods that contain high fat and cholesterol.
    People will be encouraged to use community parks.
    Health Department should be requested to disseminate more health promotion about obesity and appropriate food.
    Motivating programs such as health and exercise competitions and creating social networks that promote healthy food habits and need to reduce weight through diet control and exercise.
    Cardiovascular Diseases
    Health education through involvement of the Health Department on importance of cardiovascular health and its risk factors such as high cholesterol, hypertension, diabetes, diet, smoking, exercise, obesity, and alcohol and need for lifestyle changes.
    Utilization of local parks, community center, hospital clinics, local physicians, and other community workers to disseminate information and education in the community.
    Smoking and alcohol reduction campaign utilizing the school students.
    Community-based diabetes awareness program
    Encouragement of personal responsibility to induce a lifestyle change as described in part A.
    Evaluation

    Following implementation of these interventions, the incidence of obesity, changes in food habits, and incidence of cardiovascular disease can be assessed again based on community surveillance studies, and the data can be compiled to assess the improvement or deterioration. While implementing these interventions, it is important to remember that many interventions are also designed on education of the healthcare professionals. The diet and weight may be assessed on direct interview with the family. As expected both weight, food habits, and other parameters of lifestyle-associated cardiovascular risk factors to ultimately culminate into reduction in heart disease and changes in food habits and exercise patterns. The disease prevalence may be assessed from hospital records.

    Conclusion

    All the members of the community are vulnerable, and it is expected that these interventions would help reduce the incidence. Since this care plan is based on epidemiologic data after 6 months of time, implementation of these interventions would lead to positive results. This can be reflected in another population based survey in this community that would result in decreased prevalence of the conditions mentioned earlier.

    Part II

    In this section, telephonic interviews were conducted in the same community of Springdale, Ohio. A home health nursing organization, a parish nursing organization, a school nursing organization, and a hospice service was contacted, and they were questioned about different parameters of the outcomes of care that they provide to this community in order to examine whether the outcomes were met. Based on these interviews, the following narratives were constructed.

    Home Health Nursing

    Presently the services provided by LifeSphere in this community are modern and technically sophisticated. They provide care with increasing autonomy to individuals and families, but not to aggregates and communities based on nursing theories. They integrate clinical judgment in professional decision-making and implementation of the nursing process in the community health care setting. They strictly follow the 1986 Standards of Home Health Nursing Practice by ANA. These standards are applicable to both generalist and specialist home health nurses, which this service provides in this community. The spokesperson said that the nurses must demonstrate competence and flexibility in practice and ethical standards. Their care also includes effective communication between other providers and families including health promotional activities. Their practices are dependent on established roles, where newer additions in practice such as stoma care nurses are occurring on regular basis, and they are capable to provide cost-effective quality care in both structured and unstructured settings. They collaborate with both consumers and other healthcare providers, and since they often provide care at unstructured settings, they must demonstrate leadership skills. They believe in the philosophy of life-long learning process and are consistently involved in upgrading themselves with continuing education. They incorporate evidence-based practice in professional nursing care with accountability for personal actions, and there is a system of professional development in their programme where special training and further education can help them gain better expertise (LiveLife, 2005).

    Parish Nursing

    The Church of the Nazarene offers Parish nursing services in Springdale. Parish nursing does not provide care with increasing autonomy to individuals, families, aggregates, and communities in a variety of health care settings based on theories and principles of nursing and related disciplines. It is rather based on religious aspect of health that works on faith, although the “minister of health” is a trained and registered nurse with additional congregational training. It does integrate clinical judgment in professional decision-making and implementation of the nursing process in the community health setting and implement professional nursing standards by practicing within the legal definitions of nursing practice and acts in accordance with the nursing code of ethics and American Nurses Association (ANA) standards of practice. These nurses communicate effectively with client populations but not with other healthcare providers in managing the healthcare of individuals, families, aggregates, and communities. The nurses do not practice in established roles that conventionally provide cost-effective, quality healthcare to consumers in structured and unstructured settings. On the contrary, they work in an unstructured environment where religiousness is the basic concept. They do demonstrate leadership skills and collaboration with consumers but collaboration with other health care providers in direct care or delegation of responsibilities within all levels of health care is not in their area. They do not accept accountability for personal and professional development as part of the life-long learning process. They do not incorporate evidence-based practice in the provision of professional nursing care to individuals, families, aggregates, and communities. They work on the tenets of faith healing (Church of the Nazarene, 2008).

    School Nursing

    No school nurse organization could be located in Springdale, however, one school in the community was located, and the school nurse was interviewed. School nurses do not provide care with increasing autonomy to individuals, families, aggregates, and communities in a variety of health care settings based on theories and principles of nursing and related disciplines. Their work area is in advancement of wellbeing, academic success, and life-long achievement of the students in the schools. Thus their area is not in integrating clinical judgment in professional decision-making or in implementation of the nursing process in the community health setting. They rather target positive student responses, promotion of health and safety, and provision of case management services. They do not implements professional nursing standards by practicing within the legal definitions of nursing practice and acts in accordance with the nursing code of ethics and American Nurses Association (ANA) standards of practice. They belong to National Association of School Nurses, Ohio. They communicate effectively with client populations and other healthcare providers in managing the healthcare of the students in the schools. Their area of family intervention is related to building the student capacity, so family and student can manage self and learning. Their practice has established roles, but it is mostly not designed to provide cost-effective, quality healthcare to consumers in structured and unstructured settings. Their roles are mainly to prevent potential health problems and intervene when actual health problems occur in the students (Ohio Association of School Nurses, 2008). They demonstrate leadership skills and collaboration with consumers and other health care providers in direct care or delegation of responsibilities within all levels of health care, but their role is mainly promotion of well being targeted toward academic success and life-long achievement of the school students. They accept accountability for personal and professional development as part of the life-long learning process. They incorporate evidence-based practice in the provision of professional nursing care to individuals, families, aggregates, and communities (NASN, 2008).

    Hospice

    CrossRoads Hospice was contacted. According to them, hospice does not provide care with increasing autonomy to individuals, families, aggregates, and communities in a variety of health care settings based on theories and principles of nursing and related disciplines. This is a care concept to provide comfort and support to the patient and family at the end of life. Therefore, it does not extend care in the clinical area, and it is a clergyman work. This it does not integrate clinical judgment in professional decision-making and implementation of the nursing process in the community health setting. This does not implements professional nursing standards by practicing within the legal definitions of nursing practice and acts in accordance with the nursing code of ethics and American Nurses Association (ANA) standards of practice. This communicates effectively with client populations and other healthcare providers in managing the healthcare of individuals, families, aggregates, and communities, but the practices does not involve any established roles to provide cost-effective, quality healthcare to consumers in structured and unstructured settings. The practitioners demonstrate leadership skills and collaboration with consumers and other health care providers at the end of life and are not involved in direct care or delegation of responsibilities within all levels of health care. They do not accept accountability for personal and professional development as part of the life-long learning process, and there is no responsibility to incorporate evidence-based practice in the provision of professional nursing care to individuals, families, aggregates, and communities (CrossRoads Hospice, 2008).

    Reference List Part I

    Springdale Community Health Assessment, (2005). Springdale Health Department, 11700         Springfield Pike, Springdale, Ohio 24246

    Reference List Part II

    Church of the Nazarene (2008). http://www.swonaz.org/women/index.html accessed on December 5, 2008

    CrossRoads Hospice (2008). Expect More From Us, We do.            http://www.crossroadshospice.com/Files/consumer.pdf accessed on December 5, 2008

    Friedman, Y., (2005). Mapping the literature of home health nursing. Available at            http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1463031, Accessed on         December 4, 2008

    LiveLife (2005). LifeSphere HomeHealth. Available from http://www.lifesphere.org/lsw/          accessed on December 5, 2008

    NASN, (2008), Position Statement, Available at http://www.nasn.org/Default.aspx?tabid=61,   Accessed on December 4, 2008

    Ohio Association of School Nurses (2008). School Nurses. http://www.oasn.org/ accessed on    December 5, 2008

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