Nursing's Leadership Role in Population Based Issues



Nursing's Leadership Role in Population Based IssuesAnnie CordovaFerris State UniversityAbstractThis paper will discuss the roles of a school nurse and a community health nurse as they relate to the issue of childhood obesity. The responsibilities of each nurse will be discussed in detail. The differences and similarities of their roles will be addressed as well as the leadership and educational qualities possessed. In addition a self assessment of the author's skills will be evaluated in relation to the roles of both nurses. Health IssueAfter looking at the Healthy People 2020 initiatives as well as the issues affecting the health of Michigan residents, it was determined obesity was a significant threat to the overall wellbeing and future of the state. This knowledge combined with an effort to provide the citizens of Kent County methods for improving health through a decrease in the percentage of obese residents has lead to the realization that this can be done by targeting childhood obesity. According to an article in the Online Journal of Issues in Nursing (OJIN), there is an enormous amount of evidence to support childhood obesity as a "significant risk factor for future health problems"(Berkowitz & Borchard, 2009). This epidemic carries a hefty price tag as well with an estimated " price tag of $14 billion annually, and with a majority of these children becoming obese adults, their health care costs will continue and possibly escalate" (Jones, 2010). This is a staggering realization when looking at Kent County's current rate of adult obesity. The rate of obesity has continued to increase steadily since 1993 (Spectrum Health, 2014). The national benchmark for adult is 25% and Kent County's percentage of obese adults is currently 30% (County Health Rankings, 2013).Role of the Direct Care NurseThe battle against childhood obesity is not an easy one for nurses. Often children do not come into contact with nurses until they are already suffering from obesity related health issues. An exception to this is the nurses present in local schools. According to Harkeness and DeMarco, the definition of school health nursing is “a specialized practice of professional nursing that advances the well-being, academic success and lifelong achievement of students” (2012). The role of the school nurse is regulated by the American Nurses Association (ANA) as well as having practice guidelines provided by the Centers for Disease Control (CDC). Some of the recommendations for a school health program that pertain directly to obesity include nutrition services, counseling/ psychology services, and parent involvement (Harkness and DeMarco, 2012). An additional part of the school nurse role is to perform regular health screenings for students which include hearing, vision and blood pressure. These exams should also include criteria to determine if the child is overweight or obese which means looking at their height compared to weight and also assessing body mass index (BMI). The American Academy of Pediatrics recommends completing this assessment on a yearly basis (Schantz, 2011). School nurses must be willing to take the lead on ensuring the required screenings, education and collaboration with staff and community are in place for children. There is legislation in place, such as the Child Nutrition and WIC Reauthorization Act of 2004, that mandates schools have a complete wellness plan if they receive federal funding (Schantz, 2011). Therefore nurses must take the initiative to develop, implement, and evaluate the policies in place to ensure they are beneficial to the children as well as the nurse(s) (Schantz, 2011). In addition they must be willing to promote policy changes related to diet and activity within the school as well as the community. Finally these nurses must be willing to directly interact with the children, parents and community. Nurses in this role are faced with numerous challenges that require them to be strong leaders. These nurses are faced with conflicting priorities such as the need to treat acute issues as well as advocating for prevention of certain health conditions (Schantz, 2011). This requires a nurse in this role to not only possess good time management skills but also a strong sense of prioritization. A school nurse must have a good understanding of advocacy and methods to reduce conflict especially when dealing with administrators and parents. Role of nurse manager/leaderA community nursing role affecting childhood obesity would be a nurse working for the Kent County Health Department. As mentioned previously the rate of obesity has continually grown in this county over the past 20 years and while it currently remains below the Michigan average it is above the national level (County Health Rankings, 2013). In order for the community health nurse to impact childhood obesity there must be a evaluation of the community environment. Since this is a community based approach versus an individual approach the use of a community readiness assessment should be implemented (Berkowitz & Borchard, 2009). Utilizing the Community Readiness Model, which is a "tool used to measure a community's readiness to change in six dimensions through key informant interviews" (Harkness and DeMarco, 2012). The six areas identified include "existing prevention efforts, leadership, community climate, community knowledge about the issue of obesity and available resources" (Berkowitz & Borchard, 2009). Based on the results of this assessment the nurse can then determine which areas need improvement. This nurse must be willing to work not only on the community level but also in the political arena. In the community the nurse must initiate community wellness programs that will help provide healthy nutrition to all families including those in the low income bracket. There must also be the development programs for parents that encourage healthy lifestyle habits like eating fruits and vegetables and increasing physical activity. Education for the community about these topics is crucial as well. The responsibility of "educating parents, children, families and communities about the devastating effects of childhood obesity "is a primary concern (Jones, June 2010). This nurse must get the word out through schools and community events like fairs and sporting events (Berkowitz & Borchard, 2009). As far as community and federal government are concerned the nurse must be willing to write and support legislation to provide parks and recreation areas with walking and bike paths, playgrounds, pools, etc. There must also be advocating for affordable healthy food options in the local grocery stores and farmer's markets (Berkowitz & Borchard, 2009). Community nurses must possess such characteristics as self direction and independence as well as the ability to inspire others. There must be knowledge of the target area as well as charisma since they will not be working one on one but in groups. They must have good speaking and writing skills. A passion for the bettering of their community and health is a must. AnalysisWhen looking at the role of a school nurse and health department nurse there are some obvious similarities including the need to address parents and community members about the current and future effects of childhood obesity. They must both be advocates and strong leaders. They possess self direction, the ability to multitask and ability to prioritize. There is a need for both nurses to address needs in the political arena through the initiation and support of legislation that affects childhood obesity.The differences between these role are more subtle and have to do mostly with their position in the community. The school nurse must do most of the work directly with children, parents ,educators, and administrators. They often deal with smaller groups and work regularly one on one with children and families. Community nurses often perform more behind the scenes and orchestrate programs and events to bring awareness rather than working directly with children and families. This role often requires more interaction with large groups. These nurses must possess the ability to speak with people on their level. For instance changing the tone and wording to address a child verses a senator. There may be differing levels of education required for these roles as well. The school nurse may be able to do the job well with an ADN or a BSN whereas a community nurse will need a BSN and/or an MSNReflectionMy nursing education coupled with my early childhood education background would serve me well in the role of the school nurse. I would be challenged in the area of pediatric acute care conditions since my nursing background is rooted in the care of adults. I may also struggle in the area of persuading administrators and educators on the need for implementing particular programs to reduce childhood obesity because while I am good at developing trusting relationship I am not always successful at remaining firm. Much of the same strengths and weaknesses would impact my role as a community health nurse. In addition, I struggle with using the correct tone when speaking and writing to instill the strong sense of urgency and need I feel is necessary when dealing with issues in the political realm. In order to be successful in either area there would be a need to continue my education and work on my advocacy skills. It is not a lack of passion that is my downfall rather it is my lack of ability to verbalize my conviction. I would benefit from some additional speech and writing courses if I decide to pursue a community nursing role. ReferencesAccess Kent. (2012). Health Education Programs. Retrieved from , B., & Borchard, M. (2009). Advocating for the prevention of childhood obesity: A call to action for nursing. The Online Journal of Issues in Nursing14, 1, Retrieved from Health Rankings. (2013). Kent county Michigan. Retrieved from Harkness, G. A. & DeMarco R. F. (2012). Community and Public Health Nursing: Evidence for Practice. Philadelphia, PA: Lippincott Williams & Wilkins.Jones, T. (2010, June). Fighting childhood obesity ANA Issue Brief, Retrieved from , S. (2011). The role of school nurses in childhood overweight and obesity intervention. Medscape, Retrieved from Health. (2014). Promoting healthy eating & active living. Retrieved from ................
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