Task 2 Revised - Avoiding the Lost Years of Life

1 Task 2: Avoiding the Lost Years of Life 2 Task 2: Avoiding the Lost Years of Life A. Advanced Professional Nurse as Advocate Two differences can be highlighted in how an advanced professional nurse advocates for an individual patient in the clinical practice setting versus how an advanced professional nurse advocates for an at-risk population in the community. According to Nsiah et al. (2019), patient advocacy in the clinical setting is described as an action taken to attain goals on behalf of oneself or others. The nurse works directly one on one with patients and hears each of their individual concerns, complaints, and needs and provides care based on needs that have affected the individual. Conversely, the nurse advocating for at-risk populations within the community considers policies and greater conditions that can improve social and economic situations among the disadvantaged groups (Williams et al., 2018). Another difference that can be noted between the two is that when a nurse advocates for the patient in a clinical practice setting, the nurse will likely utilize only internal disciplines such as nursing, physical therapy, respiratory therapy, or dietary therapy. These are departments that are traditionally thought of in providing care to a patient. However, when an advanced professional nurse advocates for a larger population, that nurse will utilize external partnerships that are more non-traditional, such as community-based partnerships, that will address social needs and invest in the communities around them (Williams et al., 2018). B. Interprofessional Collaboration The advanced professional nurse applies two evidence-based strategies to promote interprofessional collaboration within an Advocacy Action Team (AAT). The first strategy would be to partner with a local Farmer’s Market, the Barton County Health Department, and the 3 Kansas Senior Farmers Market Nutrition Programs (KSFMNP), which is funded by the United States Department of Agriculture Food and Nutrition Service. The nurse will invite the three partners to work together to increase the availability of fresh fruits and vegetables to low-income seniors and assist with a healthy, active lifestyle (Kansas Department of Health and Environment [KDHE], n.d.-b). This will assist in increasing food security among the seniors in the community (Williams et al., 2018). The Health Department would serve as the liaison that would coordinate the KSFMNP with the local farmer’s market. They also would be responsible for distributing the applications and checks to the approved individuals. If a senior is unable to conduct their own transactions, they may assign a proxy who can obtain the items for them. The second strategy would be to utilize SBAR communication between all members of the team. SBAR stands for Situation, Background, Assessment, and Recommendation and is a communication tool frequently utilized in healthcare. Evidence supports that use of SBAR will permit the partners of the interdisciplinary team to communicate quickly, effectively, and thoroughly. The predictable design of the communication gives the message sender the confidence to relay the most important information and allows the message receivers to anticipate the type of information that will be delivered next. (Achrekar et al., 2016). C. Data Driven Health Issue According to County Health Rankings & Roadmaps (n.d), Barton County, Kansas is ranked in the lower middle ranges of counties in Kansas for both health outcomes and health factors. The 2022 rankings indicate that there have been 8,700 years of life lost in Barton County as compared to 7,500 years for the state of Kansas average and 5,600 years nationwide. One of the leading causes of death in individuals under the age of 75 within Barton County is Diseases of the Heart (Centers for Disease Control and Prevention [CDC], n.d.-a). According to Kansas 4 Health Matters, Barton County, Kansas has 172.2 deaths per 100,000 population related to heart disease. This is higher than both the Kansas and the national averages (Kansas Health Matters, n.d.). This measure is trending upward and getting worse (County Health Rankings & Roadmaps, n.d.). Heart disease causes early death and years of potential life lost. A sedentary lifestyle, or lack of activity, leads to the increase in heart disease. Healthy People 2030 includes an objective to reduce the proportion of adults who do no physical activity in their leisure time. The most recent data from 2018 indicated that 25.4 percent of adults ages 18 and over engage in no leisure-time physical activity. The goal is to reduce that number to 21.2 percent or less. Physical activity is one of the most important ways individuals of all ages can help delay, prevent, or manage many chronic diseases, including heart disease (Office of Disease Prevention and Promotion, n.d.). D. Characteristics of At-Risk Population The at-risk population are adults ages 18 and older who reside in Barton County, Kansas. Characteristics of the population include a lack of access to safe, affordable exercise areas and inability to budget for a pay for service facility. Another characteristic is of those most at-risk is residents with non-modifiable health risks such as a familial history of cardiovascular disease and being a male between the ages of 55 and 64. Although this policy will focus on all adults ages 18 and older, males between the ages of 55 and 64 will benefit from a new policy as they have a disproportionate increase in premature deaths related to heart disease (CDC, n.d.-a). E. Social Determinant of Health A specific social determinant of health (SDOH) in the county predisposing the at-risk population to years of potential life lost is the domain of Neighborhood and Built Environment. 5 As mentioned in the Interprofessional Collaboration section, the CDC and KDHE recommend every adult have 150 minutes of moderate intensity physical activity a week and musclestrengthening activity at least two days a week (KDHE, n.d.-a). However, the current neighborhood and built environment of Barton County, Kansas does not have adequate resources for adults to safely, and inexpensively, perform the recommended 150 minutes per week. My SDOH policy recommends creating areas that are safe for individuals to walk, bike, and exercise that are easily accessible and affordable. The concept would be that once the safe areas are made available, the target population would add activity and increase their cardiovascular health, thus reducing the incidents of heart disease and premature death. One of the top two causes of premature death in Barton County, Kansas for ages 18 and above is cardiovascular disease. However, the onset and development of that disease, and others, can be altered through physical activity. One study found that in overweight individuals with normal glycemic levels, adding low-intensity exercise, walking approximately 19 km per week, over a period of 7 to 9 months had the participants see a 22.3% decrease in body fat mass, reduce their LDL cholesterol, total cholesterol/HDL ratio, and C-Reactive Protein concentrations. Each of these items are factors involved with cardiovascular disease. This data indicates that increasing activity in a previously sedentary lifestyle will decrease the risk of cardiovascular disease, and thus likely decrease the risk of a premature death (Pinckard et al., 2019). F. Current Policy Currently, there are limited low-cost exercise opportunities available to residents of Barton County Kansas. The neighborhoods have sidewalks, but no walking or biking paths that provide a safe environment for pedestrians and bikers to get outside activity. The county has four golf courses and three exercise facilities, which all require memberships which hampers residents’ 6 access. The county lacks safe, affordable, accessible options for physical activity for the residents. G. Policy Proposal Research indicates that even adding some physical activity for a previously sedentary individual will have positive health effects and decrease the likelihood of premature death (Pinckard et al., 2019). The proposed policy change is that the Department of Parks and Recreation will make exercise equipment available in all city parks. Certain brands and styles of exercise equipment are manufactured to withstand all types of harsh weather and could be placed outside the locations. Studies have shown that whether equipment is placed along walking paths or concentrated in a “fitness zone,” the residents had substantially higher levels of physical activity (Sami et al., 2020). Each equipment piece, or station, would have the instructions on use and recommendations based on age. G1. Health Issue Impact The policy to install and maintain public exercise equipment throughout the county would serve to remove one barrier to increasing activity among residents of the county. The locations selected would increase exposure to the free equipment and permit people from all areas of the county the opportunity for use. If we can improve the access to more exercise opportunities the residents have by improving the neighborhood and built environment, residents will decrease the amount of sedentary time, improve their cardiovascular health, reduce the cardiovascular disease, and thereby reduce the years of potential life lost. The number of people who add activity to their leisure time will increase, the cardiovascular disease will decrease, and the potential years of life lost will decrease. 7 G2. Equitable Distribution of Resources Barton County has nearly 9% of households with Spanish as a primary language (United States Census Bureau, 2021). Therefore, all instructions and guidelines on the equipment will be presented in both English and Spanish in an easy-to-read format. Additionally, with placing the equipment in all public parks, homes within city limits should each be within walking distance of at least one of the equipment setups. G3. Ethical Provisions The ANA Code of Ethics is a driving force for all of nursing. These codes of ethics also apply when dealing with an at-risk population within the community. Provision 1 states, “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.” The first subsection in this provision is 1.1 Respect for Human Dignity. It details that a fundamental principle of the nursing practice is that we as nurses have respect for all individuals. Provision 2 states, “The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.” Within that provision is subsection 8.2 Collaboration for Health, Human Rights, and Health Diplomacy. This section explains that as nurses, we want to be able to do the most good so that not only individuals but also communities can develop to their greatest potential and live their lives to the fullest (American Nurses Association, 2015). These two provisions and their subsections are illustrated in the policy. By placing the equipment in the aforementioned areas within the city, all are welcome to use the equipment to increase their activity. This will reflect an improvement to the SDOH, neighborhood and built environment, within the county. G4. Barriers 8 The policy is beneficial to the community; however, it is not without actual or potential barriers that could impede the implementation of the policy proposal. The first barrier is funding. Equipment that is designed to be placed outdoors and withstand elements can run anywhere from $500 to $4,300 per item (GameTime, n.d.). The second barrier is seasons and environment. References indicate that the average climate for Barton County can have temperatures that range from 27 degrees Fahrenheit to 94 degrees Fahrenheit. It is not uncommon to spend days in the winter below zero-degree Fahrenheit and weeks above 100 degrees Fahrenheit (Best Places, n.d.). The equipment may be designed to withstand temperature extremes, the residents of the county may not want to continue their outdoor activities in the temperature extremes. Therefore, policymakers may not want to proceed if there is question of whether the residents will use the equipment. H. Policy Maker The policy maker best suited to move this proposal forward is Scott Keeler. Mr. Keeler is the Great Bend Director of Public Lands. Great Bend is the county seat for Barton County. H1. Rationale As the Director of Public Lands, Mr. Keeler is the head of the Parks and Recreation Department. He would understand and appreciate the importance of putting exercise equipment in easily accessible places to permit residents to increase their activity level. As the director, he would have the authority to review the proposed policy and revise the departmental budget to allow for the purchase of the exercise equipment. I. Strategic Next Steps 9 The first strategy I will employ as an advanced professional nurse to strengthen my professional practice as a policy advocate is to get involved in public forums regarding healthcare. If an opportunity arises to be able to speak as an expert in nursing, then taking it will also strengthen my professional practice. Public forums allow an advanced professional nurse to share knowledge and experience in specified areas with other experts and residents that have similar concerns and desire additional information. The second strategy employed is networking, which is an opportunity to meet and work with like-minded individuals. The idea of networking is often thought of as only beneficial when looking for employment, however, the true intention of networking is to connect and share information and services between people, businesses, and groups. By networking with others in the healthcare industry, areas of expertise can be brought together to address and improve various health issues affecting members of a community. J. Policy Summary (See Attached)