Running head: COMMUNITY PLAN OF CARE

Missaukee County Community Plan of Care

Wingman Group
Whitney Ayers, Heather Hulien, Kelli Koop, Jordan Lentz,
Jessica Schultz, Elyse Sincler, & Matt Vivian
Ferris State University

COMMUNITY PLAN OF CARE

Missaukee County Community Plan of Care

What Makes a Healthy Community? We all do. Many factors combine to determine the
health of a community. In addition to disease, community health is affected by substance abuse,
education level, economic status, environmental issues, and the personal choices of all of us who
live, work, and play in the community (Munson, 2013, para. 1). All of these factors and more
are studied and can be found on the CDC website under the individual county. Each counties
local health department also keeps the records on hand. No one individual, community group,
hospital, agency, or governmental body can be entirely responsible for the health of the
community. No organization can address the multitude of issues alone. However, working
together, we can understand the issues and create a plan to address them (Munson, 2013, para.
1).
Community Assessment
Established in 1871, Missaukee County is located in the central part of Northern Lower
Michigan. The County's resources consist of Christmas Trees and rich farmland, supporting
Dairy, Livestock, and Crop Farming. The pristine countryside also makes Missaukee County
very attractive to Tourism, with its Inland Lakes, Rivers, Hunting, and Fishing (Missaukee
County, 2013, para 1).
Missaukee County consisted of 14,911 people in 2011 according to the US Census
Bureau (Center for Disease Control and Prevention, 2011). Missaukee County prides itself on
being a fun filled outdoor community with plenty of activities year round for both visitors and
residents. The Chamber of Commerce welcomes people with the following statement; we
would like to welcome you to Lake City, the "Four Seasons Fun" community. We feel quite sure

COMMUNITY PLAN OF CARE

that you will find the quality of life that you are seeking for vacationing, living or working here
in our area (Lake City area Chamber of Commerce, 2013, para. 1). Missaukee County has over
4,800 acres of inland lands available for recreation, 180 campsites, and over 100,000 acres of
wild public land open for hunting, fishing, hiking, biking, or whatever suites your fancy (Lake
City area Chamber of Commerce, 2013). There are maps provided of the county in Appendix B.
The community has many strengths and weaknesses. Missaukee Counties strengths
include; its promotion for outdoor activities, the property provided for all for recreation, 86.5%
are high school graduates, 75% of the community has access to healthy foods, and there is a
farmers market ran in Lake City all summer and fall and they do accept EBT(food stamps),

(Lake City area Chamber of Commerce, 2013). Their weaknesses include; its a rural community
(transportation is issue for some), 31.6% of the community is uninsured, 23% of children live in
poverty, 61.8% of children are on WIC, and 32.7% of the adult population is obese, while
33.5% of adults are overweight (Center for Disease Control and Prevention, 2012, slide 4, 5, &
14).
Benchmarks
Missaukee County is part of a ten county district. District Health Department #10 is
responsible for covering Crawford, Kalkaska, Lake, Manistee, Mason, Mecosta, Missaukee,
Newaygo, Oceana, and Wexford Counties. Kalkaska County is north of Missaukee and Wexford
County is west. Below is a table comparing the 10 counties together to Missaukee as well as both
Kalkaska and Wexford to Missaukee. I chose to compare Wexford and Kalkaska Counties to
Missaukee as they have many similarities, are closer in population in comparison, and are direct
neighbors.

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Missaukee County Benchmarks 2012

Counties

District #10 Missaukee

Kalkaska

Wexford

Population

261,901

14,911

17,160

32,718

High School Graduates

85.9

86.5%

86.0%

87.8%

Tabl

Smoking while pregnant

30.1%

20.5%

41.9%

29.7%

Obesity/ Overweight

31.1%/39.1% 32.7%/33.5% 29.5%/39.8% 37.0%/39.6%

infor

Lack of Physical Activity 26.1%

34.4%

22.5%

26.7%

mati

Uninsured

20.0%

36.1%

16.3%

22.5%

on

Diabetes

11.4%

19.3%

15.4%

9.6%

(Cen

ter for Disease Control and Prevention, 2012)

As you can see based on the table, obesity and overweight values are very similar across
the board. Kalkaska County has twice as many women who smoke while pregnant than
Missaukee and Missaukee County has the greatest number of uninsured people. Despite the
counties attempt to promote physical activity and all of its opportunities for it, it has the highest
percentage of people lacking physical activity. The lack of physical activity is a factor explaining
why Missaukee County has a greater overweight and obese population compared to the 10
counties as a whole. Both statistics for obesity and overweight and lack of physical activity can
also contribute to the higher diabetes rates in Missaukee County. The Diabetes Prevention
Program (DPP), a large prevention study of people at high risk for diabetes, showed that lifestyle
intervention to lose weight and increase physical activity reduced the development of type 2
diabetes by 58% during a 3-year period. The reduction was even greater, 71%, among adults

COMMUNITY PLAN OF CARE

aged 60 years or older (Center for Disease Control and Prevention, National diabetes fact sheet,
2011, slide 12).
Theory to Explain the Difference
The Health Belief Model was developed by both Hochbaum and Rosenstock. It specifies
that individual family, or community, health related behavior depends on (1) the severity of the
potential illness or physical challenge, (2) the level of conceivable susceptibility, (3) the benefits
of taking preventive action, (4) what stands in the way of taking action toward the goal of health
promotion (Harkness & DeMarco, 2012, pg. 77, para. 1). This model focuses on giving people
cues and hints to help their behaviors. It is goal is to remind people of healthy behaviors and to
promote these actions (Harkness & DeMarco, 2012, pg.77, para. 1).
This model can explain the difference in health in the community and shows it is lacking
in the community. Methods to remind people of healthy behaviors can be as small as setting a
reminder in your phone to walk 15-30 minutes a day. Buying smaller plates could also be a
reminder to help control portion sizes at meals. Placing a Got Milk? billboard in the
neighborhood (community/population) (Harkness & DeMarco, 2012, pg. 77, para. 1) is a great
way to involve the entire community in the plan. There are no billboards or advertisements
currently in Missaukee County encouraging such behaviors.
If people think they are healthy, they will not adhere to a preventative health program
(Harness & DeMarco, 2012, pg. 77, para. 1). That is a problem here as the community is not
currently educated outside of health class in the local school on healthy norms. If the community
believes they are healthy they will not make attempts to seek healthy behaviors and are at a
greater risk for developing risk prone behaviors.

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The groups affected by this consist of the overweight and obese population in the
community, as well as the under or uneducated pertaining to health and health seeking behaviors.
When referring to the table above it clearly states that 34.4% of the population lacks physical
activity and 66.2% of the community is overweight or obese. The population is 14,911 people
therefore, approximately 5,129 people lack physical activity and 9,871 people are overweight or
obese. With numbers this high and so much available in the community to encourage physical
activity, community awareness may be to blame as well as a lack of the community to seek
healthy behaviors.
Existing resources to address this problem are available at the Lake City Area Chamber
of Commerce Website. Maps of the community are available as well as lists of local activities
including, hiking, camping, hunting, fishing, skateboarding, tennis, 5K activities, volleyball
tournaments, farmers market days, and a list of the local beaches (Lake City area Chamber of
Commerce, 2013.).
The health department is also an available resource for those seeking healthy behaviors or
those currently suffering with illness due to lack of. District Health Department #10 in Lake City
covers the entire county of Missaukee County and is available for counseling, home visits, and
often holds group clinics throughout the year.
Based on the numbers of obese and overweight people as well as people lacking physical
activity the resources are not adequate in Missaukee County. As mentioned above, the
benchmarks, other counties have fewer issues with obesity and they are more active.
The existing problems of obesity, being overweight, and lacking physical activity are all
appropriate problems for a community nursing intervention as all listed problems contribute to or

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cause disease. Healthy People 2020 identified overweight and obesity as a major health issue in
the United States (Harkness & DeMarco, 2012, pg.100, para. 1). Every phase of community
and public health nursing involves the provision of health education whenever the opportunity
arise. Lifestyle patterns are modifiable (Harkness & DeMarco, 2012, pg. 100, para. 2). These
problems are obvious indicators for intervention. The problems of obesity and lacking exercise
can be lifestyle patterns and as life style patterns are modifiable these conditions can be
improved.
Disciplines Involved
The Behavioral Risk Factor Assessment System (BRFSS) and Center for Disease Control
and Prevention (CDC) are working together to monitor these problems currently on a national
level. The goal of this surveillance system is to collect, analyze, and interpret specific
behavioral risk data that can be used to plan, implement, and monitor health promotion and
disease prevention programs (Harkness & DeMarco, 2012, pg. 98, para. 4). The BRFSS
conducts research about health factors related to obesity and gathers data about preventative
health services (Harkness & DeMarco, 2012). Healthy People 2020 is also involved in
developing state and community plans to improve the health of the people. Once these plans are
determined they are made available to Nurses and health care providers to aid in creating
educational plans (Harkness & DeMarco, 2012).
As mentioned above Nurses are involved as well as governmental agencies. Schools are
also involved in healthy eating programs aimed at preventing improving the current problem of
obesity. As students return to school in 2013-14, school cafeterias across America will be
entering their second year of serving healthier USDA school lunches based on updated nutrition
standards that feature whole grains, low-fat milk, more fruit, and a healthier mix of vegetables.

COMMUNITY PLAN OF CARE

They will begin implementing new breakfast standards that similarly improve the nutritional
quality of breakfasts (Guthrie & Newman, 2013, para. 1). Schools also offer athletics, gym
classes, and health class to improve the health of their students.
The health department can be resourced for information from the BRFSS, CDC, and
Healthy People 2020 to disperse to anyone who is interested. Nurses, Physicians, and other
healthcare providers can also be resourced in addressing these problems. Nurses can educate on
the risks involved and techniques for improvement.
Nursing Diagnosis

According to Muecke (1984), a nursing diagnosis refers to human responses to actual or

potential problems that nurses are licensed to treat. Its structure is comprised of three
components: concise statement of a problem, identification of factors etiologically related to that
problem, and statement of the signs and symptoms that are characteristics of that problem (pp.
24) In general, Missaukee Countys community-focused nursing diagnosis is as follows: riskprone health behaviors related to lack of education and physical activity as evidence by an
overweight or obese population. The obese and overweight population has an impaired ability to
modify lifestyle and behaviors in a manner that improves their health status; they demonstrate
this by failing to take action that prevents health problems (Ladwig, 2011, pp. 203).
Problem Statement
The problem statement specifically identifies the components of the community-focused
nursing diagnosis: who is at risk of what, related to what changeable factors, as evidenced by
what measurable indicators. The community of Missaukee County as a whole could be identified
as the targeted population because everyone could possibly be involved in some type of risk-

COMMUNITY PLAN OF CARE

prone behavior. However, for Missaukees nursing diagnosis, there is a focus on the obese and
overweight individuals in the community. These individuals are involved in risk-prone behavior
because of their weight status. Obese and overweight individuals are at an increased risk for

developing cardiovascular disease (high blood pressure, high cholesterol), Type 2 diabetes, bone
and joint problems, stroke, osteoarthritis, and many different types of cancer such as breast,
kidney, and pancreas (Center for Disease Control and Prevention, 2013). There are many
contributing factors for the cause of obesity. Some possibilities are as follows: genetics factors,
because obesity can be inherited from parents; environmental factors, such as unhealthy food
offered in restaurants; and personal factors, such as lack of willpower and self-control, lack of
physical activity, and lack of education (Lusk, 2013, pp. 14). Missaukees nursing diagnosis is
focused on personal factors contributing to the obese population. Risk-prone behavior has
proven to be a problem because of the number of individuals who are obese and overweight in
the community. Currently, 33.5% of Missaukee Countys community is overweight and 32.7% is
obese (Michigan Department of Community Health, 2012). It is predicted that the funding,
education, pedometers, screen time pamphlets, and other related components would be
established by April of 2014. After the interventions (Appendix A) are implemented, it is
expected that the overweight or obese population will decrease by at least 5% by April of 2015.
Conclusion
Missaukee County has many resources for its residents to obtain and maintain a
healthy lifestyle. The problem of obesity is directly related to the lack of exercise in the
community. With the introduction of a quality, evidenced based, health plan the community can
greatly benefit. A vast array of hobbies can be developed and year round activities are available.
All the community is lacking is motivation and education which the wingman group is proposing

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to introduce to them. The goal for the community to decrease the prevalence of obesity by 5% by
April 2015 is very attainable and will result in only positive outcomes for the entire community.

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References
Centers for Disease Control and Prevention. (2011) National diabetes fact sheet: national
estimates and general information on diabetes and prediabetes in the United States.
Atlanta, GA:U.S. Department of Health and Human Services, Centers for Disease
Control and Prevention, 2011. Retrieved from
http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf
Center for Disease Control and Prevention. (2012). Health profile chartbook. Retrieved from
http://dhd10.org/images/Missaukee_Chartbook_2012_April_2_2013.pdf
Center for Disease Control and Prevention. (2011). Missaukee county health profile. Retrieved
from http://dhd10.org/images/Missaukee_Co_profile_2010.pdf
Center for Disease Control and Prevention. (2013). Childhood obesity facts. Retrieved from
http://www.cdc.gov/healthyyouth/obesity/facts.htm
Guthrie, J., Newman, C. (2013). Eating better at school: can new policies improve childrens
food choices? United States Department of Agriculture. Retrieved from

http://www.ers.usda.gov/amber-waves/2013-september/eating-better-at-school-can-new
policies-improve-children%E2%80%99s-food-choices.aspx#.UoWSn_msiGQ
Harkness, G. A., & DeMarco, R. F. (2012). Community and Public Helath Nursing, Evidence for
practice. Philadelphia: Wolters Kluwer Health/ Lippicott Williams & Wilkins.
Ladwig , G., & Ackley , B. (2011). Mosbys guide to nursing diagnosis. (Third ed.).
.MarylandHeights: Mosby, Inc
Lake City area Chamber of Commerce. Lake city area. (2013). Retrieved from
http://www.lakecitymich.com/lake-city-mi-area.html
Lusk, J.L., & Ellison, B. (2013). Who is to blame for the rise in obesity?
Appetite. 68, 14-20.
Michigan Department of Community Health. (2012). Missaukee county health profile
Summary 2012. Retrieved from
http://dhd10.org/images/Summary%20Missaukee%20Chartbook%20April%2030%2020
13.pdf
Missaukee County. (2013) Missaukee County, Michigan. Retrieved from

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http://www.missaukee.org/
Muecke, M. (1984). Community health diagnosis in nursing. Public Health Nursing. 1(1), 23-35.
Munson healthcare. Community health needs assessment. (2013). Retrieved from
http://www.munsonhealthcare.org/CHNA

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Appendix A
Missaukee County Community Health Analysis
The health crisis in the United States in regards to obesity and inactivity has been

increasing in the recent years. As people are becoming more and more inactive, the health of our
nation is becoming more and more at risk. Nearly two-thirds of adult Americans are overweight
or obese (Marks, 2013). Despite all the efforts to inform and educated people about the harmful
effects of being overweight, the number continues to climb. The prevalence of obesity has more
than doubled in the last forty years as has the number of people with chronic illnesses. In past
history our ancestors hunted and gathered off the land, and their diets consisted mainly of low fat
meats and whole grains. As the country has changed, the quality and nutrition of the food we
consume has changed dramatically. As fast food and all-you-can-eat buffets have emerged, the
obesity rates have gotten out of control. The portions of the food in todays society are much
larger than they were in the past, and the price of nutritious food is much higher than that of low
nutritional food. The food is not the only guilty party in this case, as Americans gain weight,
their activity levels decrease. Americans that are not physically active usually eat between five
and eight hundred more calories than is needed to maintain their weight. If this is the case, they
will be gaining a pound and a half every week, escalating the problem (Marks, 2013).
With the many problems that can arise from being overweight, our group decided to
focus on specific interventions to help improve the obesity problem in Missaukee County. Our
first intervention is to implement a walking program in Missaukee County. The plan is to get
local businesses to donate money to purchase pedometers to distribute to the public. There will
be set times to meet, and a buddy system will be used in order to keep people motivated. There
will be a meeting at the end of every month to get the records form the individuals in the
community. We even thought about doing small prizes for those who recorded the most distance

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walked that month. We feel that this will get people motivated to get off the couch and out of the
house and get them moving. People in the community will be encouraged to bring their entire
family and participate as much or as little as they feel comfortable.
Promoting physical activity among the most inactive member of the community is a
leading aim in public health. Walking has been identified as a mode of physical activity most
likely to appeal to those that are the most inactive (Shaw et al., 2011). A study showed that a
recent systematic review of interventions to promote walking concluded that interventions
targeted at the individual, such as advice, and the use of pedometers could contribute
substantially toward increasing the activity level of the most sedentary. This article states that
there is growing evidence to suggest that pedometers, combined with goal setting programs can
be an effective short term motivational tool to increase walking by up to 2,500 steps a day (Shaw
et al., 2011).
There are many things that can be done in a community in order to make people
healthier. Everyone has to take steps and work together in order to successfully accomplish any
goal set as a community. Another area that we decided to focus on was the amount of screen
time people are using during the day compared to the amount of physical activity they are
getting. The American Academy of Pediatrics suggests that children and young adults should be
watching less than two hours of television, video gaming, or computer time each day. However
research has shown that over thirty-five percent of adolescents use more than three hours of
screen time each day (Ramirez et al., 2011). The amount of time people spend watching TV has
been shown to positively relate to metabolic syndrome, and hypertension. This sedentary
behavior has been shown to cause obesity and other chronic diseases. Time spent watching TV
as a child can predict the probability of being overweight and having low fitness in adulthood.

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15

The time that parents spend using screen time per day had a direct effect on the amount of time
their children use it (Ramirez et al., 2011).
We felt that this particular problem would be an easy and inexpensive area to focus in in
order to make the community healthier. The second intervention we have chosen is to limit the
amount of screen time per day children, adolescents, and adults in the community are using, and
get them more active. We have chosen to focus on children and adolescents in this section
because obesity in children is at the highest levels they ever have been. Fifteen percent of U.S.
boys are girls are overweight (Lanningham et al., 2006). These levels have been increasing
rapidly over the past thirty years. Sitting in front of a television, computer screen, or video game
has been associated with low levels of activity among younger people. Weekly screen time for
people of this age has been shown to be about fifty-five hours per week, and the average is about
eight hours per day. Although there are many programs designed to get people moving and get
off the couch, kids dont want to give up their screen time. One thing that has been done to try to
help solve the problem is to try and make active screen time. They now have games that help to
get kids off the couch, and engage them in fun physical activity. I wouldnt say that this is the
ideal situation, but it is a good place to start (Lanningham et al., 2006).

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References

Lanningham, L., Jensen, T., Foster, R., Redmond, A., Walker, B., Heinz, D., & Levine, J. (2006,
December 1). Energy Expenditure of Sedentary Screen Time Compared With Active
Screen Time for Children. Pediatrics, 118(6), 1831-1835.
http://dx.doi.org/10.1542/peds.2006-1087
Marks, J. B. (2013, October 30). Obesity in America: Its Getting Worse. Clinical Diabetes,
22(1). Retrieved from http://clinical.diabetesjournals.org/content/22/1/1.full
Ramirez, E., Norman, G., Rosenberg, D., Kerr, J., Saelens, B., Durant, N., & Sallis, J. (2011).
Adolescent Screen Time and Rules to Limit Screen Time in the Home. Journal of
Adolecent Health, 48(4), 379-385. Retrieved from http://0www.sciencedirect.com.libcat.ferris.edu/science/article/pii/S1054139X10003447
Shaw, R., Fenwick, E., Baker, G., McAdam, C., Fitzsimons, C., & Mutrie, N. (2011).
Pedometers cost buttons: the feasibility of implementing a pedometer based walking
programme within the community. BMC Public Health, 11(1).
http://dx.doi.org/10.1186/1471-2458-11-200

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Appendix B

Retrieved from:
https://www.google.com/search?q=map+of+missaukee+county+michigan&espv=210&es_sm=9
3&source=lnms&tbm=isch&sa=X&ei=rieEUsP6DcfZ2QXG8IGwDA&ved=0CAkQ_AUoAQ&
biw=1536&bih=765#facrc=_&imgdii=1XWIuuhK4rhWPM%3A%3BUV1XJSAqHFs7CM%3B
1XWIuuhK4rhWPM%3A&imgrc=1XWIuuhK4rhWPM%3A%3BQ4uqFCCpbTqlDM%3Bhttp
%253A%252F%252Fwww.davidrumsey.com%252Frumsey%252FSize2%252FD0073%252F00
732117.jpg%253Fuserid%253D2%2526username%253Drumsey%2526resolution%253D2%252
6servertype%253DJVA%2526cid%253D8%2526iid%253DRUMSEY%2526vcid%253DNA%2
526usergroup%253DRumsey3x%2526profileid%253D13%3Bhttp%253A%252F%252Fwww.da
vidrumsey.com%252Fmaps730117-22365.html%3B312%3B384

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Map obtained from: (Lake City area Chamber of Commerce, 2013)

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