Running head: BIG PRAIRIE CARE PLAN

Big Prairie Care Plan

Amanda Mathy, Hunter Dolan, Marc Johnson, Erin McCann
Ferris State University

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Big Prairie Care Plan

Newaygo County is home to close to 48,000 people. This county belongs to western
Michigan and is largely a rural area with only 57 people per square mile. The white population makes
up 96.1% of Newaygo County compared to 80.1% throughout Michigan. The Hispanic population is
1.1% higher in Newaygo compared to the Michigan average (5.7% and 4.6% respectively). Newaygo
is right on pace with the state percentage of high school graduates. However, they dramatically lack
in the number of bachelors degree or higher trailing by 12.3%. The job quality of Newaygo County
is low with a higher percent of people who have jobs then the Michigan average and still 2% more
people live in poverty. The average Newaygo household also make $5,000 less per year (District
Health Department, 2013).
Risk Factors
Many risk factors exhibited by the Newaygo population are above the Michigan average.
Newaygo County is higher than the Michigan average in smoking, lack of physical activity, binge
drinking, and obesity rates. One stand out risk factor is obesity. Newaygo is 6.9% below the
Michigan average and 1.9% below the Health People 2020 target. Many risk factors exhibited by the
Newaygo population shows a direct correlation to the leading causes of death. Leading causes of
death in Newaygo County that are above the Michigan average include cancer, COPD, diabetes, and
diabetes related deaths (District Health Department, 2013).
Health Problems
Many of these health problems can be related back to the levels of poverty in these areas as
well as the lack of health care providers. Across Michigan, there are an average 1,271 people per
physician and 2,827 people per mental health provider. In Newaygo, there are 2,305 people per
physician and 16,136 people per mental health provider. In addition to the lack of local health care

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providers, 19.3% of the Newaygo population is uninsured, which is 4% higher than the Michigan
average respectively (District Health Department, 2013).
Nursing Theory
A nursing theory that can explain these health risks of the Newaygo population is the SelfCare Deficit Theory. According to nursingtheory.org (2013), this theory explains that there is a
universal self-care requisite which contains 5 daily activities to promote natural human structure and
function. These 5 activities are the maintenance of sufficient intake of air, food, and water, provision
of care associated with the elimination process, a balance between activities and rest, as well as
between solitude and social interaction, the prevention of hazards to human life and well-being, and
the promotion of human functioning (Self care deficit theory, 2013, para. 2). These objectives are
placed on the individual to achieve a healthy life. Many people of this community do not avoid
hazards to human life and well-being. Not everything can be avoided but many could be cut out such
as smoking, excessive alcohol consumption, and lack of exercise (District Health Department, 2013).
The Nurses Difference
Where the nurse makes a difference for the community is by teaching and help meet the
demands of the community. For individual help a nurse must be able to guide a person to appropriate
medical assistance, explain the effects and results of their condition, teach the individual to carry out
medically prescribed measures, build self-acceptance of the patients current health, and teach the
individual to carry our ADLs with their current conditions (Ulbrich, 1999). Through education and
interpersonal relationships with an individual or community, a nurse can help the population make
educated positive life changes to help health promotion (Self care deficit theory, 2013).
Specific Groups
Although the Newaygo community lives in poverty, certain groups of individuals are
particularly affected by the health risks. Younger populations between the ages of 0-17 and older

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populations between the ages of 65 and older are at a high risk of health issues. Due to a 43,180
dollar household income and lack of medical access, the younger population grows up in an
environment where poverty is inevitable. With a lack of medical knowledge, transportation, and
expenses, the younger population has a bigger chance of acquiring bad habits, such as smoking,
binge drinking, lack of physical activity, and having poor nutrition. The older population is targeted
with health risks because they lack medical knowledge as well as medical attention, which could be a
prevention strategy of possible diseases. Their older age and lack of mobility also leads them to
higher chances of obesity and cardiovascular issues. As for race, Caucasians make up 96.1% of the
community meaning they are more affected by certain health risks than other racial groups (District
Health Department, 2013).
Resources
There are a few existing resources available to address the problems in the community. Some
resources include a local church, personally-owned establishments, and medical professionals from
the nearest hospital. Community members affiliated with the church are there for help and comfort in
times of need. Medical professionals in the hospital setting are available for educational opportunities
and advice on health issues. Personally-owned establishments have a closer relationship with
community individuals which can provide support as well as price flexibility due to high poverty
rates. These existing resources are not adequate to address the problems because of lack of medical
knowledge and establishment. Although the church can provide comfort, they do not have the
expenses or resources to help all individuals in the population. They also lack medical access in order
to help with medical conditions. Medical professionals are great resources for education on medical
issues and daily habits; however, the distance and mode of transportation makes it a barrier for quick
and easy access. Personally-owned establishments are not fully established which means they have a
lower risk of management and financial skilled employees.

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Evidence
The evidence that indicates that the problem is appropriate for community nursing
interventions is based on the Newaygo county statistics compared to the Michigan statistics. The
higher rates of smoking, obesity, binge drinking, and lack of physical activity habits in the Newaygo
county are dramatically higher than Michigans statistics as well as Healthy People 2020.
Community nursing interventions are needed in order to meet the goals of Healthy People 2020. Due
to the high incidences of diabetes, cancer, and COPD along with lack of transportation and medical
attention, mortality rates are increasingly higher in this community as well. Interventions are
appropriate in the community in order to decrease mortality rates and overall well-being of
individuals (District Health Department, 2013).
Disciplines
Other disciplines that would be involved in addressing this problem would include dietician
consultants, physical therapy, occupational therapy, social work, psychiatrists, and other government
funded agencies such as Medicare, Medicaid, and Meals on Wheels. These disciplines can work with
individuals mobility, psychosocial skills, and adequate health care resources. When these disciplines
work together in a community, they can help all individuals make the best of a less than ideal
situation.
Possible Resources
Groups located in the community that could be valid resources in addressing the issue are
members of the town hall, nursing students from other universities or medical settings, or home care
nurses. .Members of the town hall could get together and discuss health and poverty issues in the area
and what programs should be implemented. Examples of programs applicable for this community

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would be a smoking cessation program and alcohol anonymous. Due to the high rate of lung cancer
in Big Prairie, smoking cessation programs would be very beneficial to eliminate risk factors
(District Health Department, 2013). In this particular close-knit and low socioeconomic population,
telephone counseling of smoking cessation would be the ideal intervention. Instead of receiving care
from a health care team, telephone counseling will give the low socioeconomic population
motivation to quit their smoking habits without high expenses (Haas, etal., 2015). Other valid
resources would be nursing students driving from universities or other medical settings to help with
education on proper nutrition. These students could also help with blood pressure screenings, which
would help prevent future diseases. Home health care nurses could help with educational purposes
specifically with diabetes control and proper blood glucose monitoring.
Problem Statement
The problem statement we came up with is risk for ineffective health maintenance among the
population in Big Prairie, MI related to limited health care access as demonstrated by a high cancer
mortality rate, diabetes mortality rate and infant mortality rate. As a group, we drove through the
town and noticed that the nearest hospital was at least eighteen miles away. We thought this was a big
problem because if people do not have a means of transportation then they wouldnt be able to get to
the hospital easily. It is also inconvenient which could also cause problems with the willingness of
the community to see a doctor regularly (District Health Department, 2013).
Unfortunately, when health care services are so far away, people tend to be less likely to see a
doctor regularly. Less frequent visits to a physician can be caused by inconvenient locations,
especially for people in rural areas like Big Prairie, and lack of transportation (Mattson, 2010). A
SMART goal for this problem is: the population of Big Prairie will have a decrease in mortality rates
by 5% within two years time.
Goal Requirements

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In order to meet this goal we first want to find out if there is a means of public transportation
for this community, and then inform the community what their options are. For example, agencies in
the area that provide transportation if a person has a disability and is unable to drive include,
Newaygo County Department of Human Services; Disability/Connection West Michigan; and
Newaygo County Commission on Aging (Newaygo County Transportation Options, 2012). We also
want to implement free educational clinics to the population. We want to hold it in the town hall
because it is a really public place that a lot of people could meet in. In these clinics we would teach
preventative measures that will help prevent the development of diabetes. The things we will teach
about prevention are aimed at preventing type II diabetes. We will talk about weight control,
exercise, eating a well-balanced diet, quitting smoking, and limiting alcohol consumption (Simple
Steps to Preventing Diabetes, 2015). We will also teach those who are diabetic already how to
monitor and control their blood sugars. This is aimed at control for type I and type II diabetes. We
can also talk about limiting intake of simple sugars, regular use of insulin (if they need it), getting
enough exercise, and checking blood sugars regularly throughout the day. In addition to teaching the
community about diabetes, we will also teach them about risks for developing cancer (i.e. genetics,
smoking, lack of exercise, sun exposure, usually without sunscreen) and signs and symptoms of
cancer in general. Signs and symptoms include, unexplained and unintended weight loss, fever,
tiredness, pain, skin changes, bowel changes, and several more that are more specific to certain kinds
of cancer (Learn About Cancer, 2015). We could also teach women how to check their breasts for
lumps, and men how to feel for lumps for testicular cancer. Lastly, we want to teach the community
about the importance of seeking prenatal care, which is because health care professionals can check
the development and health of the fetus and prevent complications that could lead to the death of a
baby.
Interventions

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It will be important for us to stress the importance of seeing a primary health care provider
every year. Even though these doctors are located twenty miles or more away, it is very important
that this community see a doctor regularly. These types of doctors can do well checks and physicals
and help detect preventable diseases early. It is important that things such as diabetes, cancer, and
pregnancy be monitored because they can be managed well with the right care. In order to evaluate
whether or not our interventions have been effective we will check the health departments census,
and see what the mortality rates are for cancer, diabetes, and fetal deaths. If theyve gone down then
our clinics were effective (District Health Department, 2013).

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References

District Health Department (2013). Health profile chartbook: Newaygo county. Retrieved from
http://dhd10.org/images/Newaygo_Chartbook__2013__Feb_18_2014.pdf
Haas, JS., Linder, L., Park, E., Gonzalez, I., Rigotti, N., Klinger, E., Kontos, E., Zaslavsky, A.,
Brawarsky, P., Marinacci, L., Hubert, S., Fleeger, E., & Williams, D. (2015). Proactive
Tobacco Cessation Outreach to Smokers of Low Socioeconomic Status: A Randomized
Clinical Trial. JAMA Intern Med, 175(2) 218-219. Retrieved from http://0archinte.jamanetwork.com.libcat.ferris.edu/article.aspx?articleid=2020290
Learn about cancer (2015). American Cancer Society. Retrieved from
http://www.cancer.org/cancer/cancerbasics/signs-and-symptoms-of-cancer
Mattson, J. (2010). Transportation, distance, and health care utilization for older
adults in rural and small urban areas. Small Urban and Rural Transit Center.
Retrieved from http://www.ugpti.org/pubs/pdf/DP236.pdf
Newaygo county transportation options, 2012. Disability Connection of West
Michigan. Retrieved from http://www.dcilmi.org/programs/transportation?id=51
Self care deficit theory (2013). Nursing theory. Retrieved from: http://www.nursingtheory.org/theories-and-models/orem-self-care-deficit-theory.php
Simple steps in preventing diabetes (2015). The President and Fellows of Harvard

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College. Retrieved from http://www.hsph.harvard.edu/nutritionsource/preventing-diabetesfull-story/
Ulbrich, S. L. (1999). Nursing practice theory of exercise as self-care. Image- The Journal of
Nursing Scholarship, 31(1), 65. Retrieved from http://0search.proquest.com.libcat.ferris.edu/docview/236431984

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