Running head: NURSING’S LEADERSHIP ROLE
Nursing’s Leadership Role in Population Based Issues: Kent County Obesity
Dawn A. Platt
Ferris State University
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Abstract
Obesity in Kent County Michigan is definitely a healthcare challenge with percentages of obese
and overweight adults that are similar to obesity nationwide. Community nurses have a
responsibility to advocate for healthcare change when healthcare issues become apparent. Two
roles that community nurses can play in an effort to promote healthcare change are nurse
educator and nurse professional expert. As nurse educator, nurses can provide education to the
community so they have the necessary information about proper nutrition and physical exercise.
As nurse professional expert, nurses can perform research about obesity and present the
information to the appropriate officials who can assist in healthcare change and allocate any
funds needed to sustain the change. This paper explores how these two nursing roles can
implement change in an effort to conquer the obesity epidemic and target the adolescent
population.
Keywords: obesity, overweight, nutrition, exercise, adolescent
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Nursing’s Leadership Role in Population Based Issues: Kent County Obesity
It is well known that poor nutrition and obesity in the United States are issues that
directly contribute to healthcare problems. Kent County in Michigan is keeping up with this
trend with “approximately 30% of adults [being] obese and another 35% [being] overweight”
(Michigan Public Health Institute, 2012, para. 6). In addition, “one out of ten youth in Kent
County are obese” (Michigan Public Health Institute, 2012, para. 7). Some of the contributing
factors to these high percentages of obesity may be the lack of proper nutrition and physical
exercise due to the fact that “only 26% of adults and 34% of youth in Kent County report eating
healthy balanced meals . . . , 20% of adults are not physically active . . . , [and] 45% of youth
report being physically inactive” (Centers for Disease Control and Prevention (CDC), 2013,
para. 4). Furthermore, “since 1993, the rate of obesity in Kent County has continued to increase
[from 17% to 29%]” (CDC, 2013, para. 2), and if interventions or preventions are not put into
place these numbers will continue to rise. Knowing this information, it is the responsibility of
community nurses to advocate for the health of the community by providing education about
proper nutrition and adequate physical exercise and by sharing professional expertise about the
negative effects of obesity and positive effects of proper nutrition and physical exercise in an
effort to implement change to promote healthier living.
Role of Direct Contact Nurse
The role of nurse educator is very important in getting the information to the patients and
community. According to the American Nurses Association (ANA) (2010), “the registered nurse
provides health teaching that addresses such topics as healthy lifestyles, risk-reducing behaviors,
developmental needs, activities of daily living, and preventive self-care” (p. 41). Adolescents
are already actively engaged in academic education and, therefore, are a prime target group for
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nurses to provide education about proper nutrition and adequate physical exercise. However, it
is important for the nurse to remember that while the nurse must practice effective leadership
skills, the nurse must be able to effectively engage the adolescents in a fashion that will ensure
that the adolescent will practice the preventions and interventions taught. The goal of this type
of leadership is to provide the necessary education that can be practiced through adulthood. The
skills that are necessary in teaching this audience are patience, understanding, and the ability to
establish trust. According to Hartston and Leifer (2004), the following must be remembered in
teaching adolescents:
The first step in effectively teaching adolescents involves establishing a trusting
relationship. Communication must be supportive and not threaten their sense of
independence or autonomy. If they are informed in a respectful way and understand the
value of their behavior, they are more likely to use the information wisely. (p. 159)
Pbert et al. (2012), who performed a study that researched “school nurse-delivered
intervention for overweight and obese adolescents” (p. 182), reported the following:
The delivery of weight management counseling to overweight and obese adolescents by
school nurses has tremendous potential, leveraging existing resources by capitalizing on
the placement of skilled health care providers in the school setting and reducing barriers
to adolescents seeking and receiving treatment. (p. 191)
Another statement that Pbert et al. (2012) reported was that “school nurses in the school health
setting are in an excellent position to tackle the growing problem of adolescent obesity, given the
well-documented need for feasible, cost-effective behavioral intervention that can be delivered in
readily accessible settings” (p. 191). The results of this study illustrate that utilizing the
community schools to provide education about treatment and prevention of overweight and
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obesity can have very positive effects.
Another skill that nurses must have to address the adolescent group is the ability to be
technologically savvy. The increased use of technology and computer-based education,
especially with adolescents, necessitates the need for nurses to have this type of skill.
Whittemore, Jeon, and Grey (2012) performed a study about “an internet obesity prevention
program for adolescents” (p. 339). “The results of this study . . . indicate that school-based
internet obesity prevention programs are appealing to adolescents, as demonstrated by high
participation and satisfaction” (Whittemore, Jeon, & Grey, 2012, p. 445). Internet-based
programs can be a very effective, efficient way to provide education about nutrition and obesity
to individuals and the community. In addition it also provides “the ability to present content in
an engaging and interactive format that is part of the world of today’s adolescents, to provide
individualized feedback, and for students to learn at their own pace” (Whittemore, Jeon, & Grey,
2012, p. 445). Utilizing technology is an excellent opportunity for nurses to reach a large portion
of the community. The ANA (2010) states that the registered nurse “uses information
technologies to communicate health promotion and disease prevention information to the
healthcare consumer in a variety of settings” (p. 41). However, with recent academic and
educational cutbacks, consideration must be taken regarding any increased financial
responsibilities this may incur on the schools.
Role of Leader/Manager Nurse
Therefore, the second nursing role involves performing research and providing
professional expertise regarding how early intervention of proper nutrition and adequate exercise
at the adolescent level can ultimately result in decreased healthcare expenses over a length of
time. “To develop a plan for a community program or initiative, it is necessary to identify the
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community of interest that will affect, benefit from, or participate in the planned change”
(Harkness & DeMarco, 2012, p. 137). In addition, “once a community has become sufficiently
aware of the need for change or sufficiently dissatisfied with the current conditions through
increasing awareness of an issue or as the result of a crisis, the process of changing or transition
may begin” (Harkness & DeMarco, 2012, p.144). As the information in the first paragraph
indicates, it is evident that obesity and poor nutrition are healthcare conditions that need to be
changed. When the nurse provides professional expertise about these conditions in a manner that
is accepting of the community, the community is more likely to support the proposed change.
Presenting information of the negative effects of obesity and the positive effects of
healthy nutrition and adequate exercise to school boards, at township meetings, and to
government officials can assist these officials to make appropriate choices in accurately
dispensing funding to promote healthy nutrition and adequate physical exercise. McGeary (2013)
discusses the results of a “preliminary study of the impact of federal spending on nutritioneducation programs on the three commonly examined weight outcomes: BMI, obesity, and
overweight” (p. 67). McGeary (2013) reports that “the increased funding for nutrition-education
programs could achieve a reasonable benefit in reduced direct medical costs alone as nutrition
education improves obesity rates and BMI” (p. 77). As leaders in the healthcare industry, it is
the responsibility of community nurses to present information found in studies such as this to the
proper officials in an effort to advocate for healthier lifestyle for the community. According to
the ANA (2010), “the registered nurse integrates evidence and research findings into practice . . .
[and] shares personal or third-party research and findings with colleagues and peers” (p. 51). The
ANA (2010) also states that the registered nurse “advocates for health care that is sensitive to the
needs of the healthcare consumers, with particular emphasis on the needs of diverse populations”
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(p. 38). Therefore, in regards to the needs of Kent County in relation to obesity, proper nutrition,
and adequate exercise, the community nurse must implement leadership skills of being an
advocate.
Analysis
The roles of nurse educator and professional nurse expertise are different in the fact that
the educator will provide direct care and education to the individual or community regarding
proper nutrition and adequate physical exercise. The professional expert will share information
to the appropriate officials to support the need for funding to initiate and sustain a nutritioneducation program, especially one targeted towards the adolescent population. While they each
have different roles to play in the prevention and interventions to tackle obesity, they each
depend on the other to perform their parts of leadership in community nursing for appropriate
implementation to occur. The nurse educator depends upon the professional expert to present the
information in a way that will be accepted by the appropriate officials, and the professional
expert depends upon the educator to implement the community change in a way that supports the
research that was presented to the officials. However, one nurse can perform both of these roles
or two different nurses can independently perform the roles so each can focus solely on the
different aspects of each role.
The interventions suggested involve implementing some type of community education
program targeted towards the adolescent component of the community. Nevertheless, the
general education requirements for graduation in Michigan are quite strict already, and,
therefore, the proposed education interventions may have a negative impact in the political arena.
While nurses may advocate that nutrition-based education is recommended to improve the health
of the community, others may refute that there is no room for more academic classes or that the
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current academic course is appropriate and none of the current classes can be replaced with a
nutrition-based academic class. In addition, the officials are going to need absolute proof of
where the funding would come from and that the funding will be appropriately used. This is
where it is imperative that the nurse practice the professional roles of leadership, nurse educator,
nurse researcher, and nurse professional expert.
In addition to the nursing roles previously stated, another very important nursing role
involves setting the example for the patient or community to follow. Nothing can deter an
individual quicker than a nurse trying to teach them about proper nutrition and physical exercise
when the nurse does not follow these guidelines. This is especially true for adolescents who are
particularly influenced by others’ behaviors and not necessarily by others’ words. According to
Pender, Murdaugh, and Parsons (2011), “modeling recommended eating behaviors, as well as
managing issues that surround maintenance of positive nutritional practices, will indicate
sincerity and commitment to good health practices that speak louder than words to clients” (p.
189). Considering that according to the CDC (2012) “in 2009-2010, 35.7% of adults were
obese” (para. 1), setting that positive example of proper nutrition and physical exercise along
with appropriate weight will be very challenging, because nurses are not excluded from that
35.7% quoted. However, nurses can take this opportunity to realize and share with the
community that they too are human and not exempt from the tribulations of obesity.
Furthermore, the nurse who is providing the teaching then can also participate in the preventions
and interventions that will be implemented in the community.
Reflection
As a nurse, my skills and desires guide me towards the educator role. I love the
education and teaching aspect of nursing and can find different ways to present the information
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so that the individual understands the material. I thrive on mentoring new nurses and certified
nursing assistance and providing knowledge to patients and residents of the community. I am
very technologically savvy and love using technology as a teaching tool. In addition, I was
blessed to grow up with a mother who was a nutrition instructor, and I had learned as an
adolescent proper nutrition and how to read nutrition labels. Therefore, before I ever entered
nursing school, I had strong skills regarding proper nutrition. My nursing education simply built
on this previously formed foundation. However, I do have the ability to effectively perform
research and present the information to individuals in a way that will effect change.
For me the most challenging requirement of the role of nurse professional expert would
be the time needed to be spent on researching the necessary information and studies to be
presented to the appropriate authorities. If I were a community nurse and if this were part of my
requirements of my position, I would be able to make the time to perform such research.
However, with my current position as clinical care coordinator in a long-term nursing facility,
my current academic requisites, and my obligations as wife and mother, it would be very
difficult to allocate extra time to research information to promote change in my community.
However, I do believe I am competent in either role and, if expected of me, could
perform each role competently and effectively. I have the skills to perform research thoroughly
and utilize my resources effectively to obtain the proper information to support the change. I
also have very good teaching and mentoring skills and can modify my teaching to reach the
appropriate audience, including adolescents. In addition, I have the necessary strong leadership
skills to effectively implement change. Obesity is a tough healthcare challenge to tackle, but it
can be tackled with strong nursing advocacy and leadership skills.
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References
ANA. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD: The
Publishing Program of ANA.
CDC, Kent County Health Connect. (n.d.). In Kent county: Obesity. Retrieved from
www.kchcct.com/TheFacts.aspx
Harkness, G. A. & DeMarco, R. F. (2012). Community and public health nursing: Evidence for
practice. Philadelphia, PA: Wolters Kluwer, Lippincott Williams & Wilkins.
Leifer, G. & Hartston, H. (2004). Growth and development across the lifespan: A health
promotion focus. St. Louis, MO: Saunders Elsevier.
McGeary, K. A. (2013). The impact of state-level nutrition-education program funding on BMI:
Evidence from the behavioral risk factor surveillance system. Social Science & Medicine
82, 67-78. doi:10.1016/j.socscimed.2013.01.023
Michigan Public Health Institute, Kent County Community Health Improvement Plan (CHIP).
(2012). Ensure access to healthy foods. Retrieved from
www.Kentcountychna.org/pdfs/KentCoCHNA_Final.pdf
Pbert, L., Druker, S., Gapinski, M. A., Gellar, L., Magner, R., Reed, G., Schneider, K., &
Osganian, S. (2013). A school nurse-delivered intervention for overweight and obese
adolescents. Journal of School Health 83(3), 182-193. Retrieved from CINAHL database.
Pender, N., Murdaugh, C., & Parsons, M. A. (2011). Health promotion in nursing practice (6th
ed.). Upper Saddle River, NJ: Pearson.
U. S. Department of Health and Human Services, CDC. (2012). Prevalence of obesity in the
United States, 2009-2010. Retrieved from
http://www.cdc.gov/nchs/data/databriefs/db82.pdf
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Whittemore, R., Jeon, S., & Grey, M. (2012). An internet obesity prevention program for
adolescents. Journal of Adolescent Health 52, 439-447.
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