Team One Community Plan of Care - Mason County, Michigan NURS 340 - Community Nursing

1. Team One Community Plan of Care - Mason County, Michigan NURS 340 - Community Nursing Carrie Hallihan, Kati Pahssen, Ryan Pienta, Melinda Routhier, & Erin VanderHorst

2. Mason County, Michigan

3. Community Assessment Mason County, Michigan

4. Assessment: Community as Partner Model

5. Community Strengths: Windshield Survey Cohesive community evidenced by: • Religious activity • Political activity • Environmental protection activity • Numerous local outlets of communication • Local health services by a regional provider • Community commitment to seniors • Public transportation • Educational opportunity, including a community college • Zoning • Evidence of a variety of recreational activities • County and city government activity • Past history of success in solving community level problems

6. Who Can Help With a Community Plan of Care:

7. Health in Mason County: Determinants of Health: “Factors that affect outcomes of health status, such as physical environment , social environment, health behaviors, and individual health, as well as broader factors such as access to health services and overall policies and intentions” (Harkness & DeMarco,2012,p.45). The community health assessment of Mason County identified that the population struggles with health disparities related to these determinants of health.

8. (US Census, 2014) Demographic Determinants: Mason County Population is Aging, Rural, and not Diverse. (District Health Department #10, 2013)

9. Economic and Educational Determinants of Health Disparity (District Health Department #10, 2013)

10. Health Behaviors Cause Health Disparity (District Health Department #10, 2013)

11. Summary: Mason County Health Weaknesses: • Demographic: rural and poor area, under educated population, and aging non diverse population • Access to health care: uninsured, lack of primary care providers, and high cost of health care • Health indicators: high mortality rate, cancer, diabetes, smoking, overweight, smoking during pregnancy Strengths: • Low incidence of cancer, cardiovascular mortality • Low obesity, infant mortality • Adequate fruit and vegetable consumption • Adequate physical activity

12. A Salient Problem: Smoking Scope of the problem in Mason County: • 24.3% of the population smoke, more than Michigan: 20.3%, more than Healthy People 2020 target:12%. • Leading causes of death in Mason County: • Heart disease: higher than District 10 and Michigan • Cancer: higher than Michigan • Chronic lower respiratory disease: higher than District 10 and Michigan • Stroke: higher than District 10 and Michigan (District Health Department # 10 , 2013) Prevalence of lung disease in Mason County: • Pediatric Asthma: 571 cases • COPD: 1,836 cases • Adult Asthma: 2,330 cases • Lung Cancer: 20 cases American Lung Association ( 2014)

13. Why The Disparity In Mason County: The Health Belief Model: Healthy behavior dependent on four concepts • The severity of the potential illness or physical challenge • The level of conceivable susceptibility • The benefits of taking preventative action • What stands in the way of taking action toward the goal of health promotion.(Harkness & Demarco, 2012, p.77) Current Resources: • Lack of Educational Based Resources • Lack of Community Health Based Resources • Lack of Law Enforcement Assets

14. Evidence Exists that Smoking is Appropriate for a Community Nursing Intervention • Community health nursing focuses on health promotion, disease prevention, and risk reduction (Harkness & Demarco, 2012). • Tobacco is a risk factor for cancer, heart disease and other leading causes of death. • The literature suggests nurses can make a difference: • Public health nursing plans affect change in communities, (Kulbok, Thatcher, Park and Meszaros, 2012)

15. Diagnosis Mason County, Michigan

16. Population most likely to smoke: • Men are more likely to smoke than women • Aged 25-64 • White • Less educated • Poor (CDC, 2013)

17. Mason County - Community Focused Nursing Diagnosis Based on the strengths and weaknesses of Mason County: Community Diagnosis: Risk of heart disease, cancer, chronic lower respiratory disease, and stroke. (District Health Department #10, 2013) Among men more likely than women, aged 25-64, poor, and less/under educated. (CDC, 2013) Related to smoking

18. Mason County - Community Focused Nursing Diagnosis As demonstrated by: Leading cause of death in Mason County is heart disease 202.5/100,000 as compared to Michigan at 201.6/100,000. Cancer runs second leading cause with 185.6/100,000 as compared to Michigan at 177.2/100,000. Chronic lower respiratory disease 61.2/100,000 with Michigan at 45.9/100,000. Stroke coming in fourth with 53.8/100,000 compared to Michigan at 38.7/100,000. statistics for population of Mason county who currently smoke are also high with 24.9% compared to Michigan at 20.3%. (Michigan Department of Community Health, 2011)

20. Planning & Interventions Mason County, Michigan

21. Mason County - Planning & Interventions Possible community interventions based on our diagnosis: •Health education programs •Screening & information, referral •Establish services •Set policy & implement •Community self-help & empowerment •Changing power structures

22. Intervention Incentive Program • Modeled from NYC Health eQuits Program funded by CDC • Showed cessation interventions increased from 20% to 64% • Work with local community health centers • Spectrum Health, District 10 Health Department, West Michigan CMH • Ask to document smoking status in patients’ EMR • Ask to document smoking cessation interventions • Qualifying interventions (physician counseling, cessation medication prescriptions, and quit hotline referrals) will reward health center with a monetary incentive, based on available funding • Request health centers to reinvest that money into their smoking cessation programs and interventions • Enables us to increase smoking cessation interventions, but difficult to monitor success rates (Centers for Disease Control and Prevention, 2014)

23. Funding Funding will be acquired through grants made available from the following local organizations: • Pennies from Heaven • United Way of Mason County • Community focus area: “Obtain and maintain a healthier lifestyle through diet and exercise and decrease the rate of substance abuse” (United Way of Mason County, n.d., para. 3). • Community Foundation for Mason County • Funding area of interest: “Promote healthy lifestyles through education and prevention programming” (Community Foundation for Mason County, n.d., para. 6).

24. Mason County - Implementation of Plan Our team’s proposed plan of action is put into play. This will occur over a set period of time and then we will revisit to evaluate how effective our plan was in comparison to our goals and objectives. We will need to help the healthcare facilities in Mason County to institute assessment of smoking statues of their patients to find how much of the population is smoking. • From this we may identify a target age group or population who smoke more than others. Based on these findings there may be ways to better target this select population. • We will need permission from other facilities to participate in our project. Resistance to change is normal; collaborate, coordinate, and consult with others in healthcare to stop smoking in Mason County.

25. Plan: How do we stop the public from smoking? • Address smoking status of individuals on all medical records - current smoker, former smoker or passive smoke exposure. • Spread the word! Post images, flyers, educational handouts describing what smoking can do to one’s health. • Use social media to spread “STOP SMOKING!” (Facebook, Instagram etc.) • Show images of health lungs and heart vs. heart and lungs of smokers. • Make the current smoking cessations programs more well known in Mason County. • Programs already in place within schools, churches and hospitals. • Online Smoking Cessation Programs

26. Smoking Cessation Inform the public on ways to stop smoking: • Decide to quit and make a plan! • Medication -Nicotine replacement (Nicorette gum/patches/E-cig) • Exercise & healthy diet • Smoking cessation groups/meetings, family & friend support Rewards of quitting smoking- • Better overall health (heart & lungs) • Decrease likelihood of cancer • Whiter teeth, better tasting foods, distinct smell goes away from clothing, and no more yellow fingernails

27. Evaluation of Plan Mason County, Michigan

28. Mason County - Evaluation of Plan After implementation has occurred, the desired outcome would be that over a period of time (let’s give 3 months), we would eventually see a decrease in smoking among the community. Overall, we want to see less people smoking after we’ve given time for our implementation process to occur. “Ultimately, the health program ought to have an effect on the health of the individual program participants or on the recipients of the program intervention if provided to the community or a population” (Issel, 2004, pg 13). Evaluation of how effective our plan was can be measured by: • The percentage of the community that go forward with smoking cessation interventions compared to those who do not within the community. • Sending out surveys to those who visited in the hospital, asking how their smoking cessation is going after nursing/health care associate interventions. • Completing phone call backs to those who visited in the hospital and/or community health centers, asking how their attempt at quitting smoking is going. • Observing people’s behavior and response to education given. • Head count of those involved with education programs, school assemblies, church programs, hospital programs, and services available. • Monitoring smoking status when admitting patients into the hospital using the smoking questionnaire per patient’s EMR. • Monitor smoking status of patients being seen in the local community health centers. • Checking the status of a Facebook page that was started to help advocate and support those interested in quitting smoking. • Visiting local stores to see if they have experienced a drop in tobacco sales.

29. Mason County -Evaluation of Plan Our goals and objectives for this plan were met as evidence by: Short-term • Less people are smoking within the community from random polls, callbacks, surveys, etc. that were completed, compared to before starting the community plan of care. • Increased interest and positive behavior in smoking cessation among the community. • The number of people interested in additional information, resources, and their eagerness of spreading the word to others in the community has increased. • Length of days a recent smoker has not smoked has increased since their last use (pick random sampling from the population to assess patient smoking status). • Increased interest (likes or shares) on Facebook support page. • Local stores have seen a decrease in selling smoking products (monitoring local sale of tobacco). • High level of attendance within the smoking programs offered, with continued interest going forward.

30. Mason County -Evaluation of Plan Our goals and objectives for this plan were met as evidence by: Long-term • Patients who revisit the hospital or community health centers show positive results (their smoking cessation is working and they haven’t touched a tobacco product since their last visit when being admitted or seen by healthcare professionals) • Blood pressures have decreased among patients who formerly smoked and were part of this community plan of care • Decreased heart and lung disease, cancer, and stroke percentages over the entire community, compared with percentages before implementing the community plan of care • Increased energy and ability to exercise among patients who formerly smoked • Money saved by individuals from not buying tobacco products • Overall health of the community has improved compared to before the community plan of care was implemented

31. Conclusion Our goal is to increase awareness of smoking cessation in Mason County, as well as decrease the percentage of smokers within the county. Through community interventions like health education programs and working with local healthcare facilities we were able to promote smoking cessation within Mason County. Some goals met in our short three month period were an increase in public interest in regards to wanting information regarding smoking cessation. We hope with further education and smoking cessation within Mason County, we will be able to see a dramatic decrease in the number of smokers in the coming years.

32. References American Lung Association, (2014). Estimate prevalence and incidence of lung disease. Retrieved from http://www.lung.org/finding-cures/our-research/trend-reports/estimated-prevalence.pdf Centers for Disease Control and Prevention. Current smoking among adults in the united states. Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/ Centers for Disease Control and Prevention. (2014). Increases in smoking cessation interventions after feedback and improvement initiative using electronic health records. Morbidity and Mortality Weekly Report. 63(41). 921-924. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm634 1a2.htm Community Foundation for Mason County. (n.d.). Grant priorities. Retrieved from http://www.mason-foundation.org/rec0eive/grant-priorities District Health Department #10, (2013). Health profile chartbook 2013: Mason County. Retrieved from http://dhd10.org/images/Mason_Chartbook_2013__Feb_18_2014.pdf Harkness, G. & De Marco, R. (2012). Community and public health nursing: Evidence for practice.Philadelphia, PA. Lippincott Williams & Wilkins

33. References: continued Issel, M.L. (2004). Health Program Planning and Evaluation: A Practical, Systematic Approach for Community Health. Sudbury, MA: Jones and Bartlett Publishers Karmeisool, E. (2015, January 17). Bridging the gap: A talk with dr. ryan.The Ludington Daily News, pp A1, A5. Kulbok, P.A., Thatcher, E., Park, E., Meszaros, P. S. (2012) Evolving public health nursing roles: Focus on community participatory health promotion and prevention. OJIN:The Online Journal of Issues in Nursing, 17(2). doi: 10.3912/OJIN.Vol17No02Man1 Spectrum Health (n.d.). Implementation plan for needs identified in community health needs assessment for memorial medical center of west michigan.Retrieved from http://www.spectrumhealth.org/documents/Ludington/mmc%20implementation%20plan.pdf United States Census Bureau (2014). Population estimate july 1, 2010 ludington/ mason county michigan/ michigan. Retrieved from http://www.census.gov/quickfacts/table/PSTO45214/00,26105,2649640 United Way of Mason County. (n.d.). Community focus areas. Retrieved from http://www.uwmasoncounty.org/content/community_focus_areas