Running head: A NURSING PLAN FOR MASSILLON OHIO 1 A Nursing Plan for Massillon Ohio Angeline Barbato, Emily Dehnke, Sarah Henderhan, Eric Manson, Tricia Neff, Megan Nichols, Ashley O’Neal, Lori Risner, Taran Sentieri, and Katie Zollinger Kent State University Stark College of Nursing A NURSING PLAN FOR MASSILLON OHIO 2 Community Assessment of Massillon The city of Massillon Ohio possesses a variety of unique attributes which make it a positive area for individuals to reside. Massillon community has a multitude of resources which are made available to its inhabitants. These resources include but are not limited to: food stamp programs, Women, Infants and Children (WIC), National School Lunch Programs, health and wellness fairs, geriatric nutrition programs, and support groups to name a few. These resources assist in reducing the number of health disparities which are cause for concern for the community health nurse. Members of Massillon community also have access to Affinity Hospital and numerous clinics and health resource centers in the area. A positive characteristic which assists Massillon to community unity and pride is the residents’ focus on football. The support of the program and the school system provides entertainment and community togetherness necessary to make the city of Massillon a positive area to live. Despite the many resources which are made available to the residents of Massillon community, a lack of awareness of the availability of resources leads a large number of individuals to still encounter health care issues. Following a thorough assessment of the community of Massillon, weaknesses and health care problems which negatively impact the inhabitants became evident. A main concern impacting these issues relates to the number of residents who fall below the average socioeconomic status. This relates to the high number of unemployment rates as well as the number of individuals living below the established poverty line. Within Massillon city schools, a large amount of children are eligible for free or reduced priced lunches which all stems back to the socioeconomic status of the community. As a whole, childhood obesity rates within the community are higher than the national average. Mortality rates relating to heart disease are also growing. After reviewing statistics and these issues, A NURSING PLAN FOR MASSILLON OHIO 3 researchers were able to develop a main nursing diagnosis for Massillon community. The formulated nursing diagnosis reads: Risk Prone-Health Behavior Secondary to Inadequate Nutrition related to lack of knowledge and low socioeconomic status as evidenced by the amount of children eligible for free or reduced priced lunches, the increased unemployment rates, the increased availability of fast food restaurants, the percentage of Massillon’s population below poverty line, the childhood obesity rates higher than the national average, and the growing mortality rates secondary to heart disease. Researchers involved developed a care plan for Massillon community to help alleviate and prevent further health problems in relation to this issue. Part Three: Review of Literature Nutrition The vast majority of the American public lacks a basic knowledge of nutrition. Proper nutritional intake is essential in maintaining health and recovering from illness (Fletcher, 2009). Less than Body Requirements Malnutrition is a common problem that frequently goes unrecognized and therefore untreated (Dunne, 2009). A recent research study revealed that there are barriers to eating a healthy diet (Whiting, Vatanparast, Taylor, & Adolphe, 2010). These barriers include knowledge, income, accessibility, health, and preferences (Whiting et al.). If these barriers are not overcome, the individual places themselves at risk for becoming malnourished. Dunne (2009) stated that patients who suffer from malnutrition face unfavorable effects including prolonged hospital stays, a decreased quality of life, and negative impacts on treatment outcomes. According to table 1 (Dunne), there are many health related consequences that are the A NURSING PLAN FOR MASSILLON OHIO 4 result of malnourishment. These include, but are not limited to: weight loss, impaired immune function, decreased muscle strength, reduced respiratory muscle strength, and impaired wound healing (Dunne). Risk factors. There is a common perception that only older adults and hospitalized individuals suffer from malnutrition (Kendall-Raynor, 2009). Kendall-Raynor found this statement to be misleading and fabricated. The article stated that “93 percent of people affected live in the community and, contrary to popular belief, the majority at risk of malnutrition are under 65” (Kendall-Raynor, p. 12). There are risk factors associated with having a poor diet; these include pre-existing health conditions and living in poverty (Kendall-Raynor). These risk factors increase the probability of developing complications resulting from malnutrition. Pre-existing health conditions. The gastrointestinal tract is a key organ when considering nutritional health (Fletcher, 2009). With this being said, research has shown that patients with known gastrointestinal disorders have an increased risk for developing malnutrition as they are unable to properly digest foods and absorb nutrients. Malnourished individuals may also develop further GI complications or dysfunction as a result of their lacking diet (Fletcher). Socio-economic status. Review of an article written by Bowman (2009) found that economical resources are a major contributing factor in determining an individual’s nutritional status. This research study stated that 21.3% of Caucasians and 40.4% of African Americans live in low income households A NURSING PLAN FOR MASSILLON OHIO 5 in their specified community (Bowman). These results are slightly elevated compared to poverty levels in the city of Massillon. The assessment performed for this community found that 12.0% of Caucasians and 39.9% of African Americans lived below the poverty level. Living in poverty can be very detrimental to the health of the individuals living it. According to an article based on food insecurity, a study found that individuals who live in poverty are at an increased risk for not adhering to their medication regimen in order to direct funds towards food (Bengle, Sinnett, Johnson, Brown, & Lee, 2010). Bengle et al. stated “In response to financial pressures, individuals may stop taking medications, split pills, delay refills, skip doses, or avoid new prescriptions” (p. 171). This in turn may further deteriorate personal health status. Insufficient funds may also cause an individual to adopt harmful coping strategies (Bengle et al.). Risk reduction programs. The community of Massillon has several programs geared towards the reduction of nutritional deficiencies. These programs include the food stamp program, Women, Infants and Children (WIC) and National School Lunch Programs. A review of literature determined that these programs were very beneficial to the residents in need of nutritional supplementation. Food stamp program. The food stamp program, also known as SNAP, is currently the largest nutrition program in the United States (Shenkin & Jacobson, 2010). By definition, SNAP is intended to “help lowincome people and families buy the food they need for good health” (Shenkin & Johnson, p. 1562). After a review of current literature, it is determined that many individuals abuse these benefits by purchasing non-nutritional foods instead of ones that will increase their health status A NURSING PLAN FOR MASSILLON OHIO 6 (Shenkin & Jacobson). This could potentially increase the risk of obesity and lead to other health problems, such as diabetes mellitus. Shenkin & Johnson believe that in order to improve the diets of those receiving these benefits, non-nutritious foods should not be able to be purchased with these funds (Shenkin & Jacobson). WIC. Research on the Women, Infant, and Children (WIC) program has shown positive outcomes for those who participate in the program. WIC provides “specific food and nutrition education services to eligible low-income families” (Sigman-Grant, Rye, Loesch-Griffin, & Mitchell, 2008). A research study was performed that looked at the educational material this program offers to the eligible participants. The educational segment related to nutritional needs of women and children was mostly limited to providing handouts to needing mothers and displaying information on bulletin boards in the office (Sigman-Grant et al.). No classes were offered solely to provide nutritional information (Sigman-Grant et al.). School lunch programs. The National School Lunch Program is the largest government school program for children offered in the United States (Mirtcheva & Powell, 2009). It was determined by a literature review that the main purpose of this program is to provide children of low income with a nutritious lunch with little or no cost to the family (Mirtcheva & Powell). It has been determined that lunches needed to provide children with the nutrients that they may otherwise not have access too. In order to assure that these needs are met, the government improved the guidelines of the National School Lunch Program (Mirtcheva & Powell). A NURSING PLAN FOR MASSILLON OHIO 7 Even though this program offers meals at reduced or no cost to the children, some children choose not to participate in it related to the stigma associated with it. Mirtcheva & Powell (2009, p.486) researched this area of concern and determined that “almost 94% of children attended schools offering the school lunch program, and among those children 20.5% never ate the school lunch.” This suggests that these children did not receive adequate nutrition for that meal. This program has the potential to increase the health of the children who attend the school, as long as the children participate as anticipated. More than Body Requirements Obesity is a serious problem in our society today. Hernandez, Francis and Doyle (2011) state that obesity rates among school children ages 10-17 increased 10% between 2003 and 2007. During the 2007-2008 school year, they found that 30% of school age children were overweight and 20% were obese. Furthermore, they found that low income children have a higher incidence of obesity; this may be attributed to a higher concentration of fast food restaurants in poorer areas, stressful living environments and less access to physical activities. In Stark County Ohio, which includes Massillon, adult obesity rates are 30.3% compared to the state average of 29.1%. Pre-school (low income) obesity rates in this county are 12.5% compared to the state average of 11.9% (City-Data, 2011). Risk factors. A study conducted by Gade, Gade, Collins, Schmit & Schupp (2010) states that while genetics play a significant role in obesity poor eating habits learned in childhood carry over to the adult years as well. Eating is a source of pleasure and comfort for many people, and advertising geared toward making unhealthy foods appealing is widespread. A NURSING PLAN FOR MASSILLON OHIO 8 Obesity carries with it not only social stigmas, but a myriad of serious health risks. Overweight and obese individuals are at a high risk for developing diabetes, various forms of cancer, liver disease, reproductive disorders, sleep apnea, stroke, osteoarthritis, vision problems and cardiovascular diseases (Gade et al., 2010). Socio-economic factors. Obesity causes significant health issues, frequently requiring medication regimens to control. As previously stated, lower income individuals frequently cannot afford medications, thus placing them at a higher risk for complications (Bengle et al., 2010). Although the community of Massillon is slightly below the national average with regard to poverty, there is still a very real concern in this area. Risk reduction programs. The city of Massillon offers many services for early risk detection and weight management. Residents may visit the city’s health department for blood pressure screenings and child and adolescent wellness exams. Affinity Medical Center offers cholesterol and glucose screenings, blood pressure checks and support groups for those with Diabetes Mellitus. Aultman Hospital West provides a travelling program called Wellness on Wheels (WOW) which offers height/ weight and BMI assessments as well as educational materials and a variety of health screenings at locations such as schools, churches and community centers throughout the area. Also, the local YMCA offers memberships on a sliding scale (including free for those who qualify) based on income to provide access to exercise classes and equipment. A NURSING PLAN FOR MASSILLON OHIO 9 Part Four: Content Extent of Community Problem The community of Massillon is struggling to live a life focused on practicing healthy behaviors. With a lack of knowledge on healthy living many issues arise. Massillon as a community has many individuals living below the poverty level. When individuals are living in poverty, personal health becomes less of a concern. Living with a low socioeconomic status is also common for some individuals in the community of Massillon. With low income rates individuals are more likely to eat at fast food restaurants since they are cheap and quick. Constantly eating fast food takes a toll on our bodies which could possibly cause obesity and/or heart conditions. Statistics Massillon is a community located in Stark County. The following will compare and contrast significant statistics of Massillon and Stark County specific to the problems previously stated. Median income rate in Massillon is $38,437 compared to the $44,999 average in Stark County. The percent of Massillon residents living below poverty is 11.5% compared to the 9.6% accounting for the entire Stark County. Since fast food restaurants are a common place individuals go for dinner, it is important to look at the mortality rates secondary to heart disease. In Massillon the mortality rate of heart disease is 134 compared to the 325 of Stark County. It is obvious by reading these various statistics there is an issue requiring attention. Barriers Related to Risk Prone Health Behavior Massillon Ohio has many barriers related to risk prone health behavior secondary to inadequate nutrition. The community has 14.8 percent of individuals below the poverty line. Poverty is defined by Stanhope and Lancaster (2010) as “lacking resources to meet basic living A NURSING PLAN FOR MASSILLON OHIO 10 expenses for food, shelter, clothing, transportation, and medical care.” The poverty line for a typical family of four is 21,954 dollars (U.S. Census Bureau, 2010). For individuals who are below the poverty line, good nutrition and medical care are not part of their daily budget. There are plenty of fast food restaurants in Massillon Ohio. Fast food restaurants can be less expensive than nutritional meals, or organic foods bought at a local grocery store. Gas or electric stoves to make meals on can also prove to be a problem related to the cost. Poverty affects the health of everyone in the family. Stanhope and Lancaster indicated that poverty is associated with increased incidence of infant morbidity and mortality, complex health problems, increased chronic diseases and complications from asthma, diabetes, and hypertension, higher levels of iron deficiency anemia, increased risk of infections, and increased risk for homelessness. Unemployment rates are also high in Massillon community which can lead to poverty and homelessness. Homelessness is associated with difficulty accessing health care services, and acute and chronic conditions (Stanhope & Lancaster). Having a low income can also affect education and literacy levels. Having an education is important to make prudent health care decisions. The Institute of Medicine (IOM) wrote a report brief in 2004 addressing health literacy. Health literacy is defined as “the degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions (Kindig et al., 2004). Individuals who have a low health literacy level are more apt to use expensive services such as the emergency department, are less likely to use preventative health services, and are less able to understand health information (Kindig et al.). The inability to understand how nutrition can affect the body can have detrimental effects. Massillon’s mortality rate last year was 134 secondary to heart disease. These individuals may not grasp the concept that high fat diets can A NURSING PLAN FOR MASSILLON OHIO 11 lead to heart disease, hypercholesterolemia, obesity, and a cerebral vascular accident. A diet high in salt such as microwavable processed foods and fast food can lead to hypertension and a myocardial infarction. In the health care environment, these individuals may be too ashamed to ask questions about health teaching and may not understand what they are being taught. Massillon Ohio also has individuals who do not speak English. Language barriers and culture can be a problem in regards to risk prone health behavior secondary to inadequate nutrition. All menus at restaurants, ads in the newspaper, and nutrition information on food products are written in English in the community. Some people do not speak English and consequently cannot make educated nutritional decisions. Stanhope and Lancaster (2010) suggests that individuals are educated about their culture as children through language, food, dress, and socialization. If the foods that individuals of these cultures eat are not nutritious, it can affect their health. According to Stanhope and Lancaster, African-Americans prefer fried food, bread, lard, and pork; Asians desire rice, soy sauce, and pickled dishes; Hispanics prefer fried food, chili, beans, and carbonated beverages; and Native Americans favor game, fish, and cornmeal. Most of these foods are associated coronary heart disease, diabetes, obesity, heart and liver disease, malnutrition, and stomach ulcers. Changing a whole cultures way of eating is difficult and probably not ideal to them. Health care professionals should be culturally competent about different nutritional practices and be able to construct treatment regimens that would not conflict with their cultural food practices (Stanhope & Lancaster). Resources Available for Risk Prone Health Behavior Massillon Ohio offers some resources to assist individuals of the community who cannot afford nutritious meals. The Salvation Army of Massillon offers grocery distribution Monday A NURSING PLAN FOR MASSILLON OHIO 12 thru Friday free of charge. Individuals must provide proof of income, proof of address and bills, and a social security card for each member of the household. The Salvation Army also provides a soup kitchen the last Friday of the month. Other grocery distribution sites in Massillon include TOSM’s helping hands pantry located at the Massillon senior center, First Assembly of God, Bread of Life, St. Barbara Catholic Church, St. Vincent DePaul Society of St. Mary’s Church of Massillon, and St. Johns United Church of Christ. There is state assisted aid available for the community. The Stark County Jobs and Family Services Department offers the food stamp program for individuals who do not make enough money to feed themselves or their family. A case worker is assigned to each person to evaluate their unique situation (U.S. Welfare System, 2011). Women, Infants, and Children (WIC) program is offered to give pregnant women, infants, and children foods such as cereal, milk, formula, and cheese to keep them healthy. Medicaid is a federally funded health insurance plan for low income individuals and families (U.S. Welfare System). This insurance plan provides the community with access to health care. Massillon community has adult education programs for low literacy. The Adult Basic and Literacy (ABLE) program allows teenagers age sixteen and adults to obtain their General Education Diploma (GED). This class is offered at the former Washington High School library and is free of charge. Students attending these classes enhance reading, writing, and math skills. ABLE also assists students for the transition to college with college remedial courses (Massillon City Schools, 2010). The Massillon Public Library also offers literacy programs. The Ready to Read program teaches adults how to help their children develop the skills needed for reading. The mentors teach parents six skills necessary for children before they can read at no charge. The mentors also give examples of how children can learn these skills and incorporate them into daily life (Massillon Public Library, 2011). Paws to Read is another program aimed at children A NURSING PLAN FOR MASSILLON OHIO 13 to improve literacy skills. This service is offered once a month at no cost. Children read to registered dogs at the library. Reading to a dog instead of a peer prevents children from being belittled and enhances self esteem. Children in this program have experienced improved reading skills, willingness to become involved in positive activities, and a sense of pride in their accomplishments (Massillon Public Library). Affinity Medical Center is located in Massillon. Affinity offers low cost cholesterol and glucose screenings, and free blood pressure checks at local industries and community organizations. The volunteer nurses who provide these services also teach these clients about cardiovascular disease and identify risk factors (Affinity Medical Center, 2011). This hospital also presents health information such as cardiovascular health, weight loss, nutrition, and exercise, mental health, and stress to professional organizations, church groups, educational groups, and local service clubs (Affinity Medical Center). Affinity has professional medical translators available to assist individuals who do not speak English. Accessibility and Utilization of Resources The resources must be accessible to the residents of the community. The Stark Area Regional Transit Authority (SARTA) is a public transportation system. Bus route 102 serves Tuscarawas Street and Lincoln way. This bus stops at Stark County Jobs and Family Services, and the Massillon Public Library. Route 123 stops at Affinity Medical Center and route 124 stops at Washington High School (SARTA, 2011). The cost of a single ride with SARTA is one dollar and fifty cents. Reduced fares of seventy five cents can be given to individuals age sixty five and older and people with disabilities. This public transportation system does not run on Sundays or holidays (SARTA). A NURSING PLAN FOR MASSILLON OHIO 14 Facilities that offer grocery distribution are located in different sections of the community. Some individuals can walk to these locations, and others can use public transportation. Most of the grocery distribution locations prefer individuals make an appointment to pick up their food. This can be a hardship to residents who do not make an appointment in time and consequently do not receive groceries. Screenings that Affinity Medical Center offers are free to low cost. Volunteer nurses stop at different community organizations and local industries to provide screening examinations. This organization accepts Medicaid and Medicare insurance plans for low income, elderly and disabled clients. Massillon community provides access to services for clients experiencing low income, decreased education, and language barriers. Community Expert Perspectives Erin Wise- R.D/L.D. (registered dietician/licensed dietician). While speaking with Erin Wise, R.D/L.D. and supervisor of the WIC program at the Massillon Health Department, she agreed that poor nutrition is a big problem in Massillon and that there is definitely a lack of education when it comes to eating healthy, especially with people of lower socioeconomic status. She has firsthand experience with this population because the Massillon WIC program serves women, infants, and children up to 5 years old at the 180% poverty level, with their largest population of women being from 17-23 year old (E. Wise, personal communication, June 1, 2011). She said that the children they see have a high prevalence of being overweight and the women are about 10% underweight, 25-30% recommended weight, and then the rest are all overweight (E. Wise, personal communication). Despite this impoverished, unhealthy situation, she said that education really can make a A NURSING PLAN FOR MASSILLON OHIO 15 difference because WIC programs have had proven studies decreasing morbidity and mortality rates in targeted populations (E. Wise, personal communication). They are a nutrition education based program and help provide some of the lacking nutrition education. She stated that “for every one of our patients, we always provide some kind of nutrition education each visit (E. Wise, personal communication).” When asked what some specific educational points WIC emphasizes consistently, Mrs. Wise said that WIC focuses on fluids, like drinking water and not drinking all juice or all milk for children and not drinking pop and juice all the time for adults (personal communication, June 1, 2011). Mrs. Wise (personal communication) brought up an interesting point: Rather than change their diet, which people aren’t willing to do most of the time, we try to change their fluids. It’s an easier change to make to just not drink that can of pop or two each day than change someone’s whole eating style. Also, a lot of time people, even dieticians, think it’s too expensive to eat healthy, so that’s another reason why we ask them to cut out $5.00 of soda each week- that way it’s more economic and maybe they can buy those healthier fruits and veggies with that extra money. Mrs. Wise also stated that when it comes to nutrition, “part of the problem is that there isn’t a lot of education in the school curriculum related to nutrition, so we lag behind in that knowledge area (E. Wise, personal communication).” She mentioned that the WIC program hasn’t worked alongside the school lately, but if the schools request that something be done or that they want help with some education, they are willing to try to accommodate the schools (E. Wise, personal communication). In that situation, they would normally speak directly to the kids about nutrition education or provide in-service education sessions for the school nurses so they A NURSING PLAN FOR MASSILLON OHIO 16 can then teach the kids the information; however, they have only done that one time in the last seven years (E. Wise, personal communication). When asked if she thought that should happen more to improve nutrition education, she said that those in-service sessions are the easiest solutions and are workable, but the problem is that they have to target the right population (E. Wise, personal communication). “School nurses honestly don’t have much contact with the students so the biggest thing that needs to be done as a whole is that the nutrition needs to be figured out how to be put in the school curriculum (E. Wise, personal communication).” She really emphasized that the teachers are the ones who need to buy into the nutrition education because those are the people that have the most one-on-one communication with the students (E. Wise, personal communication). Nancy Barstow- R.N. (registered nurse). While speaking with Nancy Barstow, school R.N. (registered nurse) of Washington High School, she agreed that inadequate nutrition is definitely a problem in the Massillon school system and that the nutrition education in schools has to be improved. However, she was rather positive about the whole situation and said that the schools have been trying to improve in the last couple of years by adding more salads and low calorie snacks, as well as encouraging exercise with physical education but it is a slow process (Nancy Barstow, personal communication, June 2, 2011). Mrs. Barstow said: I see a little more of trying to get healthy choices in the school lunches and trying to incorporate better nutrition, especially due to so many kids getting reduced and free lunches; basically, the kids get a lot of their nutrition at school because they eat breakfast and lunch at school five days of the week. A NURSING PLAN FOR MASSILLON OHIO 17 Mrs. Barstow also mentioned that there have been some laws passed mandating that schools take a more hands-on approach to improving school children’s nutrition. She specifically mentioned that Ohio Senate Bill 210, also known as the Healthy Choices for Healthy Children Act, was passed June 18, 2010 (Nancy Barstow, personal communication, June 2, 2011). She said that this bill mandates that schools do BMI (body mass index) checks in Kindergarten, third, fifth, and ninth grade and send home the report to the children’s parents; if the child is in a high-risk category, there will also be a letter sent home to the parents recommending them to consult with the child’s physician (Nancy Barstow, personal communication, June 2, 2011). She said she imagines that because of this law, more physicians will see the high risk kids and be able to point them in a healthier direction (Nancy Barstow, personal communication, June 2, 2011). Schools can sign a waiver every year in order to opt out the law, which Massillon city schools did for the 2010-2011 school year due to the fact that they didn’t have any time to plan for the program right before school (Nancy Barstow, personal communication, June 2, 2011). Mrs. Barstow said that the school is now ready to launch the program and will implement the law for the 2011-2012 school year. Part Five: Community Nursing Diagnosis The nursing diagnosis for the community of Massillon reads: Risk Prone-Health Behavior Secondary to Inadequate Nutrition related to lack of knowledge and low socioeconomic status. This diagnosis is supported when considering the amount of children eligible for free or reduced priced lunches. The increased unemployment rate as well as the percentage of inhabitants that are placed below poverty line relates to the risk Massillon community possesses in relation to nutritional status. Other data which supports the selected diagnosis include: the increased availability of fast food restaurants, the childhood obesity rates A NURSING PLAN FOR MASSILLON OHIO 18 within the community which are higher than the national average, and the mortality rate related to heart disease for individuals living in Massillon. Part Six: Recommendations for Action Interventions The Community of Massillon needs to make changes to reduce their risk prone health behavior and inadequate nutrition that are results of the lack of knowledge and low socioeconomic status. The kind of changes recommended for this community are called life style modifications. Life style refers to the way one lives their life, how they eat, how they exercise, and how they cope with stress. Life style modification is often the first type of treatment recommended by physicians. It is a positive approach towards health and wellness by making appropriate changes in one’s life style. Life style modifications are sometimes viewed as painful or even impossible (Black & Hawk, 2009). However, it is possible to break your usual routine and start making healthier life style choices by making gradual changes. Even small changes can make a significant impact on one’s health (Black & Hawk). Health literacy plays an important role in all communities. Healthy People 2010 defined Health Literacy as, “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Health literacy is a concern in urban communities like the Community of Massillon. Providing education to the community about life style modifications would be a great benefit. When educating a community you have to consider the literacy level of the audience, and consider language barriers. Organized learning experiences for all age ranges and ethnic back grounds provide the most appropriate learning environment. Getting the group involved and participating may be a good way to make the learning experience interesting. Also, it is important to have the A NURSING PLAN FOR MASSILLON OHIO 19 group give a return demonstration or summarization of what they learned. This reinforces the education while at the same time checking for any confusion. Community Health Nurse Participation Educating the community is a primary way to promote life style modifications regarding diet and exercise. An emphasis on diet education needs to be placed on school aged children. A healthy diet is needed by these children to ensure proper development and to create healthy eating habits. This is important because of the large percentage of students in Massillon receive free or reduced lunch or breakfast at school. A study by Li and Hooker (2010) found that the “Use of free or reduced-cost lunch or breakfast programs at public schools is positively correlated with children’s Body Mass Index (p. 101)”. Recently the United States Department of Agriculture abandoned the traditional food pyramid and replaced it with a program called “My Plate” to help children and adults have a better understanding food choices and proportions. Unhealthy eating habits are a key contributor to the development of diabetes and a wide range of cardiovascular disorders. Educating the community about the benefits of exercise and implementing programs to reduce obesity rates are also needed in Massillon. The Center for Disease Control recommend that adults exercise at least 150 minutes with moderate intensity a week, but they also state that greater health benefits can be obtained with 300 minutes a week of exercise. Regular exercise will not only reduce the obesity rates, but it will help to reach our goal of reducing the mortality rate. Exercise will help prevent cardiovascular disease, which is the leading cause of death among men and women (Kravitz, 2007). Community exercise programs can also lower the A NURSING PLAN FOR MASSILLON OHIO 20 mortality rate by decreasing the incidence of diabetes in the community and reducing diabetic complications. Part Seven: Implementations of Recommendations Intervention One Intervention Each member of the community will participate in 30 minutes of physical exercise every day. How Measured Each client will exercise a day and achieve their target heart rate: Age 20: 100-170bpm Age 25: 98-166bpm Age 30: 95-162bpm Age 35: 93-157bpm Age 40: 90-153bpm Age 45: 88-149bpm Age 50: 85-145bpm Age 55: 83-140bpm Age 60: 80-136bpm Age 65: 78-132bpm Age 70: 75-128bpm Rationale To receive the benefits of 30 minutes of exercise per day a target heart rate must be maintained. Source American Heart Association. (2011). Target Heart Rates. Retrieved from, www.americanheart.org. HealthyPeople.gov. (2010). Healthy People 2020. Retrieved from, www.healthypeople.gov/2020. Impact on Community Goal Met: Each member of the community participated in 30 minutes of physical exercise every day and their target heart rate was achieved. A NURSING PLAN FOR MASSILLON OHIO Intervention Two Intervention The community will be provided with lifestyle modification material including exercise and nutrition education at a local health convention. Local Community Fitness Centers and Pricing: Massillon Family YMCA 131 Tremont Ave SE Massillon, OH 44646 (330) 837-5116 Prices: Joining fee: $20-50 depending on age Senior couple: $36/mo Senior single: $22/mo Family (1 Adult) $38/mo Family (2 Adults) $45/mo Adult (24-64yrs) $31/mo Teen/Young Adult (14-23yrs) $17/mo Youth (6mo-13yrs) $10/mo Curves 7924 Hills & Dales Rd. NE Massillon, OH 44646 (330) 833-1905 (or) 3154 Lincoln Way NW Massillon, OH 44647 (330) 832-3931 Prices: $34/mo (required to come 3 times per week) Anytime Fitness 5119 W Tuscarawas Canton, OH 44708 (330) 477-5000 Prices: Free 7 day trial pass $35/mo with onetime fee of $40 21 A NURSING PLAN FOR MASSILLON OHIO 22 Planet Fitness 4317 Whipple Ave NW Canton, OH 44718 (330) 493-9855 Prices: $9.99 start up fee $9.99-19.99/mo with annual membership fee $39 How Measured Each client of the community will voice 3 ways on how they will modify their lifestyle regarding exercise and nutrition to the health care professional. Rationale Physical activity can lead to a healthier lifestyle in several ways by decreasing body weight and body composition and even maintaining a healthy weight. Physical activity can also have psychological and social effects which lead to better eating habits. Source Soderlund, A., Fischer, A., & Johansson, T. (2009). Physical activity, diet and behaviour modification in the treatment of overweight and obese adults: a systematic review. Perspectives in Public Health, 129(3), 131-142. DOI: 10.1177/1757913908094805. Impact on Community Goal Met: The community was provided with lifestyle modification material including both exercise and nutrition education at a local convention held in downtown Massillon. Each member of the community voiced 3 ways on how they would modify their lifestyle. A NURSING PLAN FOR MASSILLON OHIO 23 Intervention Three Intervention The children of the community will be provided with free and reduced cost lunches at their schools based on the families’ income. How Measured School assesses child’s need of free or reduced lunches based on families’ income. Rationale School-interventions such as free or reduced lunches can improve health and academic performance. Source Hollar, D., Messiah, S.E., Lopez-Mitnik, G., Hollar, L., Almon, M., & Agaston, A. (2010). Effect of a Two-Year Obesity Prevention Intervention on Percentile Changes in Body Mass Index & Academic Performance in Low Income Elementary School Children. American Journal of Public Health, 100(4), 646-653. DOI: 10.2105/AJPH.2009.165746 Impact on Community Goal Met: Local schools provided the children of the community with free and reduced cost lunches based on families’ income. Part Eight: Conclusion Intervention Continuation By continuing the interventions mentioned, community health nurses are encouraging health promotion activities which will help to reduce the risk of inadequate nutrition to the inhabitants of Massillon community. Members are provided with three of many possible intervention strategies which will modify negative lifestyle behaviors in an effort to promote proper nutrition. Education within Massillon community is necessary while implementing these strategies in order to encourage community members to continue with these interventions throughout the year. These interventions should also be continued as they prevent further health problems from occurring and may lead to early identification within the school setting. This A NURSING PLAN FOR MASSILLON OHIO 24 early identification will allow Massillon community’s residents to be treated sooner and they are therefore less likely to suffer negative health issues. Who Would Continue By aiming health promotion and disease prevention techniques at whole communities, community health nurses are able to reach a larger patient population and treat both cultural and environmental causes for poor health. Nurses and other members of Massillon community may work together to ensure these interventions are continued following the completion of the implementation within the population. Nurses may develop teaching sessions in the school setting in which they instruct both students and teachers on proper nutrition and options to maintain positive health habits. Following these teaching sessions, teachers and other members of Massillon schools may do their part in ensuring that these interventions are continued. Nurses may also provide education at health and wellness fairs by handing out pamphlets that explain the importance of adequate nutrition and the positive effects exercise has on one’s health. These interventions can aid in improving the whole health of the residents of Massillon by addressing physical and nutritional aspects of well-being. By continuing with these interventions and promoting them in Massillon resident’s lifestyle, researchers hope to build a stronger and healthier community. A NURSING PLAN FOR MASSILLON OHIO 25 References Affinity Medical Center. (2011). Retrieved from http://www.affinitymedicalcenter.com/Pages/home.aspx American Heart Association. (2011). Target Heart Rates. Retrieved from, www.americanheart.org. Bengle, R., Sinnett, S., Johnson, M.A., Brown, A., & Lee, J.S., (2010). 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