Running head: A NURSING PLAN FOR MASSILLON OHIO
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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
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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,
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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
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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
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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
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(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).
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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.
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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.
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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
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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
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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
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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
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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).
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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
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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
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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.
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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
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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
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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
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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.
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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
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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). Food insecurity is
associated with cost-related medication non-adherence in community-dwelling, lowincome older adults in Georgia. Journal of Nutrition for the Elderly, 29(2). doi:
10.1080/01639361003772400
Bowman, S.A., (2009). Socioeconomic characteristics, dietary and lifestyle patterns, and health
and weight status of older adults in NHANES, 1999-2002: a comparison of Caucasians
and African Americans. Journal of Nutrition for the Elderly, 28(1). doi:
10.1080/01639360802633938
Dunne, A. (2009). A practical guide for managing the malnourished patient. Nursing &
Residential Care, 11(12). Retrieved from
http://web.ebscohost.com.proxy.ohiolink.edu:9099/ehost/pdfviewer/pdfviewer?sid=611a
1327-38d1-4990-849d-81172b653455%40sessionmgr4&vid=6&hid=24
Fletcher, J., (2009). Identifying patients at risk of malnutrition: nutrition screening and
assessment. Gastrointestinal Nursing, 7(5). Retrieved from
http://web.ebscohost.com.proxy.ohiolink.edu:9099/ehost/pdfviewer/pdfviewer?sid=611a
1327-38d1-4990-849d-81172b653455%40sessionmgr4&vid=16&hid=24
A NURSING PLAN FOR MASSILLON OHIO
26
Gade, W., Gade, J., Collins, M., Schmit, J., & Schupp. (2010). Focus: obesity and metabolic
syndrome. Failures of feedback: rush hour along the highway to obesity. Clinical
Laboratory Science, 23(1), 39-50. Retrieved from
http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=11&hid=10&sid=74aaee6fdc00-4405-979a-014ad7ad6072%40sessionmgr112
HealthyPeople.gov. (2010). Healthy People 2020. Retrieved from
www.healthypeople.gov/2020.
Hernandez, D.C., Francis, L.A., & Doyle, E.A. (2011). National school lunch program
participation and sex differences in body mass index trajectories of children from lowIncome families. Arch Pediatric/ Adolescent Med., 165(4), 346-353.
doi: 10.1001/archpediatrics.2010.253
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
Kendall-Raynor, P. (2009). Poor diets leading to increased risk of malnutrition in three million
under 65s. Nursing Standard, 23(24). Retrieved from
http://web.ebscohost.com.proxy.ohiolink.edu:9099/ehost/pdfviewer/pdfviewer?sid=611a
1327-38d1-4990-849d-81172b653455%40sessionmgr4&vid=32&hid=24
A NURSING PLAN FOR MASSILLON OHIO
27
Kindig, D., Dyanne, A., Chudler, E., Gaston, M., Meade, C., Parker, R., Smith, W. (2004).
Health literacy: A prescription to end confusion. Institute of Medicine of The National
Academics, 1-2. Retrieved from
http://www.iom.edu/~/media/Files/Report%20Files/2004/Health-Literacy-APrescription-to-End-Confusion/healthliteracyfinal.pdf
Kravitz, L. (2007). The 25 most significant health benefits of physical activity & exercise.
IDEAS Fitness Journal, October, 54-63. Retrieved from CINAHL Select
http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=3&hid=17&sid=abf777da4a38-4010-b80f-0e4dcdad0aa3%40sessionmgr4
Li, J., Hooker, N. H. (2010). Childhood obesity and schools: evidence from the national survey
of children’s health. Journal of School Health, 8(2), 96-103. Retrieved from CINAHL
Select
http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=4&hid=17&sid=abf777da4a38-4010-b80f-0e4dcdad0aa3%40sessionmgr4
Massillon City Schools. (2011). Retrieved from
http://www.massillon.sparcc.org/index.php?page=able
Massillon, Ohio. (2011). Obesity statistics. Retrieved from:
http://www.city-data.com/city/Massillon-Ohio.html
Massillon Public Library. (2011). Retrieved from
http://www.massillonlibrary.org/
A NURSING PLAN FOR MASSILLON OHIO
28
Mirtcheva, D.M. & Powell, L, M. (2009). Participation in the National School Lunch Program:
importance of school-level and neighborhood contextual factors. Journal of School
Health, 79(10). Retrieved from
http://web.ebscohost.com.proxy.ohiolink.edu:9099/ehost/pdfviewer/pdfviewer?sid=611a
1327-38d1-4990-849d-81172b653455%40sessionmgr4&vid=37&hid=24
Shenkin, J.D. & Jacobson, M.F., (2010). Using the food stamp program and other methods to
promote healthy diets for low-income consumers. American Journal of Public Health,
100(9). Retrieved from
http://web.ebscohost.com.proxy.ohiolink.edu:9099/ehost/pdfviewer/pdfviewer?sid=611a
1327-38d1-4990-849d-81172b653455%40sessionmgr4&vid=25&hid=24
Sigman-Grant, M., Rye, M.S. Loesch-Griffin, D., & Mitchell, D. (2008). How to strengthen and
enhance WIC nutrition education. Journal of Nutrition Education & Behavior, 40(5).
Retrieved from http://journals.ohiolink.edu/ejc/pdf.cgi/SigmanGrant_Madeleine.pdf?issn=14994046&issue=v40i0005&article=317_htsaewne
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.
Stanhope, M. & Lancaster, J. (2010). Foundations of nursing in the community: Communityoriented practice (3rd ed.). St. Louis, MO: Mosby.
Stark Area Regional Transit System (SARTA). (2011). Retrieved from
http://www.sartaonline.com/
A NURSING PLAN FOR MASSILLON OHIO
29
U.S. Census Bureau. (2010). Retrieved from
http://www.census.gov/hhes/www/poverty/about/overview/measure.html
U.S. Welfare System. (2011). Retrieved from http://www.welfareinfo.org/
Whiting, S.J., Vatanparast, H. Taylor, J.G., & Adolphe, J.L. (2010). Barriers to healthful eating
and supplement use. Canadian Journal of Dietetic Practice and Research, 71(2). doi:
10.3148/71.2.2010.