a community health nursing plan of...

A Community Health Nursing Plan of Care

Pam Beringer, Erin Burdi, Debra Francik , and

Ashley Jacobson

Assessment & Analysis

Epidemiological Concepts

Host: Due to the “rural” classification of

Mecosta County, residents of this community

are at an increased risk for a shortage of

Health Care Providers (HCP’s) .

Assessment & Analysis:

Epidemiological Hosts

Rural areas (also referred to as "the country," and/or

"the countryside") are settled places outside

towns and cities (Farlex, 2010, para 1).

According to the US Census Bureau, the classification of “rural” includes all territories, populations, and housing units located outside of an Urbanized Area (UA) or Urban Cluster (UC) (2000).


Epidemiological Host

In the year 2000, the Mecosta County total

population census was 40,553

(MSUE,2007).

The rural population of Mecosta County was

28,780 residents or 70.6% of the total population (US Census Bureau, 2000)

*27,642 (96% )of these residents lived in Non-Farm areas & 1,138, (4%) of residents

lived in farm areas (MSUE, 2007, p.5)


United States 21% 59,061,367 281,421,906

Michigan 25.3% 2, 518,987 9,938,444

Mecosta 70.6% 28,780 40,553

Percentage of

Population Rural Population

Census Total Population

Rural Population Comparison

*According to Census Data, Mecosta County has a greater percentage of

rural resident population than both the State & National census combined! (US Census Bureau, 2000)

Vulnerable Groups

“To be considered vulnerable, a person or group generally has aggravating

factors that place them at greater risks for ongoing poor health status then

other at-risk persons” (Fisher, pg. 533).

An example : “ A middle-aged obese man with a sedentary lifestyle

and hypertension would be considered at risk for cardiac problems. If that

man also had an income below the poverty level, no health insurance, and

stressors related to living conditions, he would be more likely to be

vulnerable to ongoing poor health status then a man with similar risk

factors but with an adequate income and health insurance. The man in

poverty would be more likely to experience difficulties obtaining and

maintaining a relationship with a primary care provider, would have

problems accessing tests and procedures for diagnosis and ongoing

monitoring, and would have difficulty obtaining and paying for the

appropriate medications”(Fisher, pg. 5330.

Specific groups this especially effects

According to Fisher, “A vulnerable population is a group or

groups that are more likely to develop health-related problems,

have more difficulty accessing health care to address those health

problems, and are more likely to experience a poor outcome or a

shorter life span because of those health conditions” (Fisher, pg.

533).

Characteristics, traits , and different circumstances enhance the

potential for poor health (Fisher, pg. 533).

“Department of Health and Human Services, had identified certain

groups as more vulnerable to health risks, including the poor, the

homeless, disabled, the severely mentally ill, the very young, and

the very old” (Fisher, pg. 533).

Not all people at risk for poor health are considered vulnerable


Community Groups of Interest

“What is it like to live in a small rural town? What do nurses know about rural

populations and their nursing needs? Although each community is unique, the

experience of living in a small town is similar in all 50 states” (Fisher, pg. 820-

821).

The typical rural lifestyle is characterized by

the following: Greater spatial distances between people and services

An economic orientation toward the land and nature

Work and recreational activities that are cyclic and seasonal

Social interaction that facilitate informal, face-to-face negotiations,

because most, if not all, residents are either related or acquainted

(Fisher, pg. 821)



“There is increasing evidence that community members who are informed and active in planning their health care system are more likely to use and support that system” (Fisher, pg. 825).

The community decision making model helps to identify a problem and try to come up with a solution. The steps in the model are:

- 1. Identify the problem.

- 2. Assess the community’s perspective

- 3. Analyze the data

- 4. Develop a long-range plan

- 5. Take action

- 6.Evaluate the program


Existing Health Resources in Mecosta

“There is ongoing debate as to whether anything is unique

about rural nursing practice, because nursing care is similar

regardless of the setting” (Fisher, pg. 822).

There is little information in periodical and in nursing texts on

what actually makes community/public health nursing

different in rural settings (Fisher, pg 824).



“In brief, for rural residents, a small town is

the center of trade for a region, and its

churches and schools usually are the centers

for socialization” (Fisher, pg. 821).

This helps for planning and implicating

public health and community nursing

programs for rural clients (Fisher, pg. 821).



Community Groups that might be interested

in helping are:

Churches

Nursing Students

Volunteers

Nurses

Community Centers

American Red Cross

Assessment & Analysis: Epidemiological Environment

There are Three Major Factors that

Influence Rural Health

1. Availability of Services

2. Accessibility of Services

3. Acceptability of Services (Maurer & Smith, 2009, p.815)


Rural Health Influences

Availability of Services

“refers to the existence of services and sufficient personnel to provide those

services”

(Maurer & Smith, 2009, p.815)


Rural Health Influences Acceptability of Services

“refers to the degree to which a particular is offered in a manner

congruent with the values of a target population” (Maurer & Smith, 2009, p.816)



Barriers to Acceptability

Urban Orientation of

most HCP’s




Accessibility of Services “ refers to the ability of a person to obtain and afford

needed services” (Maurer & Smith, 2009, p.815)

Common Barriers to Accessibility Include: Long Travel Distances

Lack of Public Transportation

Lack of Telephone Services

Shortage of Health Care Providers Inequitable Reimbursement policies

Unpredictable Weather Conditions

Inability to Obtain Entitlements


Multiple factors also affect specific groups

Lower socioeconomic status

Lifestyle behaviors

The psychological impact of poverty

Genetic inheritance

Race

Ethnicity

Gender

Poor education

Poor health

Sudden change in financial situation

(Fisher, pf. 541)

Health Professional shortage areas

“Concerns about rural health care services, especially in regions with insufficient numbers of all types of health care providers,(designated as health professional shortage areas [HPSA]) have become a national priority since the early 1990’s” (Fisher, pg. 809).

“The U.S. Bureau of the Census estimates that there are 54 million people living in rural areas of the United States. They make about 1/5 (20%) of the total population but are spread out across 4/5 (80%) of the land area” (Fisher, pg. 809).


Shortage of Health Care Providers

As of 2005, Mecosta County had only

34 Practicing Physicians located in Big Rapids area

to care for a Population of

42,391

That ‘s a 1 : 1247 Physician-Patient

Ratio!!!

As of 2005, in the

State of Michigan

there are 25,146 active

physicians*

with a State

Population of

10,120,860

That’s a 1:420

Physician –Patient

Ratio!

*(excluding physicians with unknown

addresses, inactive statuses, and osteopathy)

Assessment & Analysis: Epidemiological Agents

Major Health Problems for Rural Areas

Accidents & Trauma

Chronic Illness

Suicide & Homicide

Alcohol & Drug Abuse

Assessment & Analysis: Epidemiological Agents

Top Ten Causes of Death in Mecosta County

1. Heart Disease

2. Cancer

3. Chronic Lower Respiratory Disease

4. Stroke

5. Unintentional Injuries

6. Diabetes Mellitus

7. Alzheimer’s Disease

8. Pneumonia/Influenza

9. Kidney Disease

10. Intentional Self Harm

(Michigan Surgeon General’s Health Status Report., 2010)


Epidemiological Agents The Top Ten Causes of Morbidity/ Mortality for the State of

Michigan where nearly identical to those of Mecosta County

with only a slight difference in numerical order

Mecosta County 1. Heart Disease

2. Cancer

3. Stroke






9. Kidney Disease


State of Michigan 1. Heart Disease

2. Cancer


4. Stroke





9. Kidney Disease


(Michigan Surgeon General’s Health Status Report., 2010)

Nursing Diagnosis

Risk for Increased Mortality & Morbidity

in Mecosta County

related to

Lack of Health Care Providers.

Plan

Increase the availability of preventative

health resources and measures to citizens

of Mecosta County to decrease the

burden on current Health Care Providers

(HCP).

Rationale: If Residents of Mecosta County have Access to Preventative

Care & become Proactively Involved with Personal Health, the

Over-all Community will Benefit from Improved Health &

Reduction of Health Services Required.

Michigan Center for Rural Health

“Supporting and engaging rural Michigan communities and their residents in eating healthy, being physically active, and achieving and maintaining a healthy weight should reduce the burden of chronic disease and also contribute to an improved quality of life. Collaborative efforts involving communities, schools, worksites, families, and others are needed to create environments that support sustainable healthy behaviors.”

(Michigan Center for Rural Health, 2008, pg.23)

Primary Prevention

“Primary prevention is aimed at altering the susceptibility or reducing the exposure of persons who are at risk for developing a specific disease” (Fisher, Pg. 170).

“Primary prevention includes general health promotion and specific protective measures in the pathogenesis stage, which are designed to improve the health and well-being of the population” (Fisher, pg 170).

Plan: Primary Prevention

Sources for Volunteers & Community Venues

Volunteers *Professors & Nursing Students

from Ferris State University

located in Big Rapids

*Health Care Personnel from

Local Mecosta County Hospital

& Private Practices

* Church Volunteers

Venues

*Churches

*Community Centers

*County Hospital

*Urgent Care Centers

Plan: Primary Community

Prevention Utilize Local Volunteers & Venues to Educate &

Encourage Preventative Health Measures & Provide Free Health Screenings that Target Top 10 Causes of Morbidity & Mortality in Mecosta

County.

*For the purpose of this power

point we will only show examples

for the top three causes of

morbidity & mortality in Mecosta.

Plan: Primary Prevention Services

Heart Disease Provide Free Blood Pressure Screenings

Free Cholesterol Quick Tests

Free Risk Factor Assessment

Education

Proper Exercise & Nutrition According to American Heart Association

Guidelines

Stress Reduction

Early Signs & Symptoms of Heart Attack


Cancer

Assessment of Risk Factors (Genetics, Lifestyle, & Environmental)

Education

Different Types of Cancer

Nutrition

Exercise

Early Detection: Signs & Symptoms

Self Screening Tools

(Self-Breast & Testicular Exams)

Smoking Cessation


Stroke

Risk Assessment (Genetics, Lifestyle, Environmental)

Education Nutrition & Exercise

Smoking Cessation

Stress Reduction

Early Detection-Signs & Symptoms!!

Blurred Vision

Plan: Secondary Prevention

“Secondary prevention is aimed at early detection and prompt treatment either to cure a disease as early as possible or to slow its progression, thereby preventing disability or complications” (Fisher, pg. 171).

Examples:

1.Preventing transmission of a communicable disease

2. Preventing or slowing of a disease

3. Preventing complications from a disease

(Fisher, pg. 171)

Plan: Tertiary Prevention

“ Tertiary prevention is aimed at limiting existing disability in persons in the early stages of disease and at providing rehabilitation for person’s who have experienced a loss of function resulting from a disease process or injury” (Fisher, pg. 171).

We need to provide:

Education to people

Nursing Care

Referrals

Resources

Plan

Offer Incentives for Future HCP’s to

Practice in the Mecosta County area.

Rationale: Through offering Incentives for HCP’s to practice in the

Mecosta area, one can increase the number of HCP’s to residents.

Reason Healthcare Providers Avoid

Practicing in Rural Areas

“The reasons given for not wanting to practice

in rural areas had less to do with the amenities

or social activities associated with urban areas

than with the patient base (large numbers of

uninsured or poor people) or the quality of the

facilities” (Health Professions Resource Center,

2006).

Plan: Recruitment & Retention

Recruitment and Retention of HCP’s is a

challenge for rural areas.

Nationally, there is a projected provider shortage

along with a projected increase in demand for

services, as the baby-boomer population reaches

retirement age.

Recruitment and Retention was identified as an

issue in all three components of the rural

community health assessment (Michigan Center for Rural Health, 2008, pg.23)

The Michigan Center for Rural Health has developed a plan to increase the

number of practicing health professionals in rural Michigan

Increase by 20% the number of rural health sites approved as Michigan State Loan

Repayment sites.

Increase by 10% the number of rural providers participating in the State Loan

Repayment Program. (MSLRP).

Increase by 20% the number of rural health sites approved as

National Health Service Corps sites; from 127 to 152.

Increase by 10% the number of National Health Service Corps

provider placements at rural sites.

Develop a retention model to assist rural hospitals, certified rural health clinics and

federally qualified health centers in their retention planning efforts.

Develop a rural component to the “Practice Michigan” campaign to promote the

benefits and positive aspects of rural practice.

(Michigan Center for Rural Health, 2008, pg.29-30)

Plan: Recruitment & Retention

The Michigan Center for Rural Health

Measurable Outcomes

Increased number of HCP’s in Mecosta County

Decrease in HCP to Patient Ratio.

Attendance Rate of > 60% to Local Prevention

Seminars & Screenings.

Less admissions into the hospital.

The Availability of Health

Care in rural areas is

challenging for health care

providers to promote

primary care and

preventative measures.

The community health

nurse can use the statistics

from previous years to

observe the trends and the

growing need for

interventions.

(Beringer, 2010)

Intervention

“An intervention is an

interference so as to

modify a process or

situation.” “An intervention is

designed to improve the

health of a patient or

change the conditions

which have negative

impact on the well-being

of the patient.” (Farlex, 2010)

The State Rural

Health Plan

serves as a

guide to aid in

providing care

to rural areas in

Michigan.

The approved goals by the Advisory Group for

rural residents are:

Access to dental care

Access to mental health

Access to primary care & specialty care

Practicing health professionals

Targeted education & training opportunities

The number of applications and admissions into health professions & training programs

The rate of obesity

The activity level of the population

Healthy eating in the community

The communities can use this plan as a

guide to develop interventions that

increase care to patients in rural areas

(Michigan Center for Rural Health, 2008, pp. 1-2)

Available Services In Mecosta County

34 Physicians

Hospice care

Nursing Care

Social services

Home care aide or homemaker services

Volunteer care

Physical, occupational, and/or speech therapy

Respite care

Grief support

Spiritual care

EMS Services:

(Jacobson, 2010)

Recruitment & Retention in Mecosta County

☼Recognize the shortage of health care providers

☼Evaluating the ratio of health care providers to the number of patients

☼Showcase the environment to draw health care workers to the area

☼Describe the different religious organization

☼Illustrate the different cultural groups in the area

☼Highlight the civic activates and cultural arts available in the area

☼Offer incentives for relocation

☼Illustrate the recreation activities that are offered in the area

Health Care Providers

Mecosta County has one 74 bed hospital

located 45 minutes North of Grand Rapids

Mecosta County Medical Center. (2010)

Mecosta County Medical Center provides services in:

●Maternity

●Cardiopulmonary & Rehabilitation

●Critical Care Unit

●Emergency Care

●Home Health Care

●Inpatient Medical Rehabilitation

●Laboratory Services

●Medical Imaging

●Nutrition and Dietary Services

●Occupational Medicine

●Outpatient Physical Rehabilitation

●Pharmacy

●Specialty Clinics

●Surgical Services

Mecosta County

is classed as a

Micropolitan area

with two Rural

areas bordering it.

There are no free

clinics located in

the county or

surrounding

counties.

(Michigan, 2010)

The shortage of Health Care Providers is an

issue with today’s economy. Extending care

and services suffer due to cut back in the

budgets. The existing care institutions

needs to reach out to communities and other

business’s to facilitate the growing need for

health care providers and facilities.

Community involvement can increase

awareness of services in the community.

Showcasing Mecosta County

Mecosta County offers diverse terrain

Rolling hills

Marsh land for wild life

(Ertman, 2010)

Northern woods for stunning color

The Congregations In Mecosta County Allows For Varied

Religious Practice

United Methodist Church - 9

Lutheran Church - 2

United Church of Christ - 1

The Wesleyan Church - 3

Evangelical Lutheran Church in America - 1

Evangelical Free Church of America - 1

Free Methodist Church of North America - 4

Christian Churches and Churches of Christ - 3

Wisconsin Evangelical Lutheran Synod - 2

Church of Jesus Christ of Latter-day Saints - 1

Episcopal Church - 1

Presbyterian Church - 1

Church of God – 3

Old Order Amish - 3

Christian Reformed Church in North -America - 1

General Association of Regular Baptist Churches - 1

Assemblies of God - 2

Church of God (Cleveland, Tennessee) - 1

Conservative Baptist Association of America - 1

Church of the Nazarene - 1

Community Church of Christ - 1

Seventh-Day Adventist Church - 1

Sothern Baptist Convention - 1

Churches of Christy - 1

Baha’i – 15 members (no congregations)

Salvation Army - 1

Buddhists - 1

(Rousseau, 2010)

Population Affiliation Percentage

in Mecosta County

(Rousseau, 2010)

Mecosta County Is The Home To Many Different Cultures

And The Most Common Reported Are:

• German (26%)

• English (11%)

• United States or American (10%)

• Irish (9%)

• Polish (5%)

• Dutch (4%)

• French (except Basque) (4%)

Amish also reside in the area

(Dixon, 2010)

Highlighting The Activities That Are Provided In The Community

Can Enhance The Benefits Of Living In A Small Rural Area

Monthly Rise ‘N’ Shine’s

Monthly Business After Hours

Mecosta County Community and Family EXPO!

Pioneer Group Chamber Open

Annual Morley Free Festival / Bike Show

Annual Labor Day Arts and Crafts Festival

Bulldog Bonanza

Annual Mecosta County Community Holiday Gala

Showing the activities that are monthly & annually gives a feel of community closeness

( Rousseau, 2010)

Offering Incentives For Relocation Can Draw New Health

Care Providers To An Area

▪Institutions sometimes offer incentives

with signed contracts that will insure a

bonus after so many years of service.

▪Repaying student loans

▪Health care workers that work in the more

remote areas receive higher pay

(Shinohara, 2010)

Mecosta County Offers A Wide Range Of Recreation For Everyone

☺City Parks - 14

☺Lakes and Rivers - 5

☺Hiking

☺Camping – x3 local areas

☺Mountain Biking – x4 different areas

☺Ferris State Racquet & Fitness Center

☺Hunting

☺Snowmobiling

☺Cross Country Skiing Francik, 2010

Promotion Of Healthy Lifestyle Decreases

The Work Load Of Health Care Providers

Interventions are needed to promote good health in the community

Primary, secondary, and tertiary preventive care

is ideal, but the services that provide this care

may be hard for rural areas to access.

⌂ Reaching out to the local venues for participation

⌂ Provide health fairs

⌂ Promote community physical activities

⌂ Provide screening services in different areas of the community

⌂ Provide workshops on good nutrition

⌂ Provide stress management classes

⌂ Provide information on social support in the community

(Pender, 2006)

Ways to reach out and help other people

Primary Medical Care Providers

53 free clinics are located in Michigan with only 10 located in the northern

part of Michigan

Air Ambulance is used in many areas to transport critical patients to qualified Medical Centers

(Michigan Center for Rural Health, 2008)

Provide primary care that is reimbursed by health care payers

Eight counties in the northern part of Michigan have no hospitals. Out-patient

clinics is the only available health care facility

Health departments are shared with other larger districts

There are 7 sites of Federally Qualified health Centers located in Micropolitan areas

with 36 sites in rural areas in Michigan

There are three Rural Health Clinics in Mecosta County and 156 in the state

Objectives ◘ Form a committee to target healthy eating and fitness to decease

heart disease

Encourage school participation by:

Replacing vending machine with water & health alternatives

Encourage the use of healthy models when preparing lunches

Have healthy eating seminars for families

Encourage the local farmers and markets to form a partnership with

school for lower rates for food purchases

Develop exercise programs that include the whole family at

affordable rates

Encourage a partnership with Ferris State Racquet and Fitness Center

Decreasing health problems decreases the work load of HCP’s


Increase Education

◘ Provide adequate educational material to the community

Increase awareness of eating healthy and eating fruits and vegetables

Provide educational means at different times of the day and week to facilitate

the whole community

Develop web resources with learning material, premade meal planning, quick and

easy to follow recipes, tips on sales and coupons, and interactive games on

healthy living for the family

Advertise with healthy eating commercials on television and the radio

Provide links on the web site to state-wide nutritional sites


Provide informational hotlines for the community to call

Vulnerable members of the community

◘ Identify vulnerable members of the community

Form a committee to identify the vulnerable members of the community

Identify the members that are elderly, handicapped, poverty stricken, and

people with lack of transportation

Provide information on Meals on Wheels, Women Infant and Children (WIC),

and transportation alternatives schedules

Encourage local venues to assist with transportation, shopping, and

companionship,


An evaluation is a critical appraisal

or assessment; a judgment of the

value, worth, character or

effectiveness of that which is being

assessed (Farlex, 2010).

Evaluation

Evaluations are needed in

every plan of care to see if

the plan is working

There are five steps in the evaluation process

► Plan the evaluation

► Collect evaluation data

► Analyze the data

► Report the evaluation

► Implement the results

The plan is evaluated periodically

(depending on the time set in the

beginning) during the course of the

process.

Our evaluation would consist of:

∆ Did the number of HCP’s increase during the time frame?

∆ If the number of HCP’s increased did the work load decrease?

∆ Did attendance increase at the screenings, seminars, and other events held?

∆ Did the hospital admissions decrease and was it due to our interventions?

Did the number of HCP’s increase during the time frame? ●If the number of HCP’s did not increase, different means of recruiting,

incentives and advertising may be needed.

If the number of HCP’s increased, did the work load decrease?

●This is based on the increase of the HCP’s. If the number of HCP’s did not

increase the work load would not decrease

●If the number of HCP’s increased, did the work load decrease?

Outcomes

●If the attendance increased and was above 60% as planned, what was more

beneficial the screenings, seminars, and/or the events held?

●If the attendance was below 60%, reevaluation of the area held in, time held,

and type of screening, seminar, or event was held.

●Did hospital admission drop and what type of admission have decreased.

●If hospital admissions did not drop, what type of patients continue to get admitted?

Did attendance increase at the screenings, seminars, and events held?

Did the hospital admissions decrease and was it due to our interventions?

Conclusions and Recommendations

Conclusions from the data would

be formed with all involved parties

&

Recommendations are made and

changes are made if needed

Federal Authority in Health Care

Responsible for protecting the health of its population.

Regulates, interprets the law, and administers services mandated by law.

Responsible for supervision and compliance with health law regulations.

Involved indirect services.

Maurer & Smith, 2009, p. 64

State Authority in Health Care

Finances care of the poor and disabled.

Manages Medicaid programs.

Operates state mental health hospitals.

Oversees licensure and regulation of health providers and facilities.

Attempts to control health care costs.

Regulates insurance companies.


County Authority

Health department

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

State Children's Health Insurance Program (SCHIP)

School health programs

Mental health programs

Community health education


Hypothetical State Superagency

Incorporating the Health Department


0 20 40 60 80

100 62

81 80 80 84 66

79 61

81

Race/Ethnicity

Race/Ethnicity

Percentage

83 percent of persons under age 65 years were covered by health insurance in 1997.

Note: Age adjusted to the year 2000 standard population

Increase the Number of People with Health Insurance

(Healthy, 2010)

0

10

20

30

40

50

60

70

80

90

FEMALE MALE

FEMALE

MALE

Increase the Number of People with Health Insurance

Female vs. Male

83 percent of persons under age 65 years were covered by health insurance in 1997.

Note: Age adjusted to the year 2000 standard population

(Healthy, 2010)

0%

20%

40%

60%

80%

100%

66% 69%

91% 83%

80% 83% 83%

FAMILY INCOME LEVEL

FAMILY INCOME LEVEL

Increase the

Number of

People with

Health

Insurance at

the Family

Level

83 percent of persons

under age 65 years were

covered by health

insurance in 1997.

Note: Age adjusted to the

year 2000 standard

population (Healthy, 2010)

(Wolf, 2010)

Percentage of Uninsured Rises In USA

Uninsured Increase Cost to Area

Hospitals in 2000

Hospital

Name

Uninsured

Patient Pay Costs

Uninsured State

Costs

Total Uninsured

Costs

Uninsured Payments

Net

Uninsured Costs

Mecosta County

General Hospital

809,784

0

809,784

15,455

794,329

Memorial Medical

Center of West

Michigan

958,577

0

1,123,980

953,934

170,046

Metropolitan

Hospital, Grand

Rapids Michigan

7,861,364

0

8,604,570

1,028,514

7,576,056

(Citizens, 2000)

Public Policy Implications Form a committee/coalition to work with local

agencies to support the recruitment of primary care providers.

Offer incentives to attract primary health care providers.

Increase the availability of free health clinics.

Offer primary care physicians financial support in caring for those who are uninsured to prevent and manage chronic illness.

Support Groups Healthy People 2010

American Nurses Association (ANA)

Institute of Medicine

State Children’s Health Insurance Program (SCHIP)

American College of Health Care Executives

Founded on data that enable progress and trends to be

tracked, Healthy People 2010 provides a set of 10-year

evidence-based objectives for improving the health of all

Americans.

The first goal of Healthy People 2010 is to help individuals of all

ages increase life expectancy and improve their quality of life.

The second goal of Healthy People 2010 is to eliminate health

disparities among different segments of the population.

(Healthy, 2010)

Healthy People 2010

Supports Access to Quality Health Care

American Nurses Association ANA believes health care is a basic human right that should be provided to all

individuals.

ANA believes that the health care system must ensure access, which means health care services must be affordable, available and acceptable.

ANA believes that all individuals should have access to a standard package of essential health care services.

ANA believes the health care system must be redirected from the overuse of more expensive, technology‐driven, hospital‐based services to a more balanced approach with greater emphasis on community‐based care and preventive services.

ANA supports incorporating into health policy changes the six major aims identified by the Institute of Medicine – safe, effective, patient‐centered, timely, efficient and equitable. (New Hampshire Nurses Association, 2010)

Institute of Medicine

Mission Statement is to serve as adviser to the nation to improve health.

The IOM asks and answers the nation’s most pressing questions about health and health care. Our aim is to help those in government and the private sector make informed health decisions by providing evidence upon which they can rely. Each year, more than 2,000 individuals, members, and nonmembers volunteer their time, knowledge, and expertise to advance the nation’s health through the work of the IOM.

Many of the studies that the IOM undertakes begin as specific mandates from Congress; still others are requested by federal agencies and independent organizations. While our expert, consensus committees are vital to our advisory role, the IOM also convenes a series of forums, roundtables, and standing committees, as well as other activities, to facilitate discussion, discovery, and critical, cross-disciplinary thinking. (National Academy of Sciences, 2010)

(National Academy of Science, 2010)

State Children’s Health Insurance

Program

The State Children's Health Insurance

Program, or SCHIP, was established by

the federal government ten years ago to

provide health insurance to children in

families at or below 200 percent of the

federal poverty line.

(National Center for Public Policy Research, 2010)

American College of Healthcare

Executives

An important role for healthcare executives has

always been to translate social values into workable

healthcare programs. In keeping with this role,

healthcare executives have the opportunity to

participate in public dialogue about new ways to

finance and deliver healthcare so no one is denied

care because of the inability to pay. (American

College of Healthcare Executives, 2008)

Healthcare Executives Developing and communicating access-to-care policies within their organizations

and to the community.

Managing their organizations efficiently to help underwrite healthcare costs

associated with uncompensated and undercompensated care.

Collaborating with other healthcare providers in their community to develop

shared approaches to ensure access to care.

Encouraging and assisting trade and other professional associations to take

proactive roles in access-to-care issues.

Promoting shared leadership and funding responsibilities among government,

healthcare organizations, employers, private insurers and consumers.

Organizing grassroots advocacy efforts to secure needed funding from local, state

and federal government bodies.

Organizing or participating in local, state and regional initiatives to resolve access

problems.

Spearheading discussions with key decision makers (e.g., legislators) and key

stakeholders (e.g., public agencies) to identify community health priorities so

available resources can be allocated equitably and effectively. (American College of Healthcare

Executives, 2008).

Recommendations Based on the provider responses, some possible ways to increase the supply of

health care professionals in rural areas include:

• Increasing the interest of high school students in medical professions,

especially in the rural areas, because providers who were raised in a rural area

appear more likely to practice in a rural area.

• Retaining students as they progress along the education pipeline from high

school through residency.

• Providing more incentives such as loan repayment.

• Providing incentives specifically targeted to those who will practice in rural

areas.

• Increasing awareness of the need in rural areas among healthcare providers

from other places.

• Promoting and advertising the positive aspects of living and working in rural

areas, including greater purchasing power.2

• Providing funds to upgrade the facilities and equipment in rural areas.

• Providing more opportunities for resident training.

(Health Professionals Resource Center, 2006)

Unsupportive Groups Adding health care providers can change the cost of providing

services to a community causes conflict due to over stretched budgets and lack of increased government assistance.

The following may object to changes that will bring health care providers to the community:

Consumers who have private insurance and do not want there taxes increased to support those who lack health care.

Providers who may have to care for the uninsured without proper compensation.


References

●American Nurses Association. (2010, July). Nursing Agenda Fro Health Care Reform. Retrieved November

20, 2010, from http://www.nhnurse.org

●Barnes, J., Barnett, L., Wightman, T., Emge, A., Johnson, S. (2008). Michigan strategic opportunities for rural health improvement. Michigan Center for Rural Health, April. Retrieved from www.mcrh.msu.edu.

●Beringer, P,.(2010). Mecosta county assessment people: demographics: population and trends per race, ages, and genders, including levels of education.. Ferris State University. www.ferris.edu

●Boughton, B. (2009). Improving Healthcare Access, Quality, and Efficiency: An Expert Interview with Public

Policy Analyst Robert Doherty. Retrieved November 19, 2010, from Medscape Medical News:

htt://www.medscape.com ● Citizens Research Council of Michigan. (2000). Components of Uninsured Costs of Individual Hospital for 2000 Listed by Health System. Retrieved November 21, 2010, from CRC Online Almanac: http://www.crcmich.org

●Dixon, B., (2010). Mecosta county assessment people: culture. Ferris State University. www.ferris.edu ●Ertman, H., (2010). Environment: environmental quality. Ferris State University. www.ferris.edu ●Farlex. (2010). The free dictionary. Retrieved November 24, 2010, from http://medical dictionary.thefreedictionary.com/evaluation

●Francik, D., (2010). Mecosta county recreation. Ferris State University. www.ferris.edu

●Health People 2010. (2010). Healthy People. Retrieved November 20, 2010, from http://www.healthypeople.gov

●Health Professions Resource Center. (2006, September). Recruitment and Retention of Health Care Providers in Texas. Retrieved November 19, 2010, from http://www.dshs.state.tx.us

●Jacobson, A., (2010) Social systems: types of health care providers. Ferris State University. www.ferris.edu ,

●Maurer, F. A. (2009). Community/Public Health nursing practice: Health for families and populations (4th ed.). St. Louis, MO: Elsevier Saunders.

●Mecosta County Medical Center. (2010). Advance care with a personal touch. Retrieved November 23, 2010, from http://www.mcmcbr.com/nb_links.asp#

●National Academy of Sciences. (2010, October 10). Institute of Medicene. Retrieved November 20, 2010, from

http://www.iom.edu

●National Center for Public Policy Research. (2007). SCHIP Information Center. Retrieved November 20, 2010,

from http://www.schip-info.org

●New Hampshire Nursing Association. (2010, July). Nursing Agenda For Health Care Reform. Retrieved

November 20, 2010, from http://www.nhnurse.org

●Wolf, R. (2010, September 17). Number of uninsured Americans rises to 50.7 million. Retrieved November 19,

2010, from USA Today: from http://usatoday.com

●Michigan Surgeon General’s Health Status Report. (2010). Healthy Michigan 2010. Retrieved from:

http://www.michigan.gov/documents/Healthy_Michigan_2010_1_88117_7.pdf

●Michigan State University Extension Team . (2007, January 27). Mecosta County Profile. Retrieved from

http://web1.msue.msu.edu/countyprofiles/mecosta/Mecosta.pdf

●Pender, N. J., Murdaugh, C. L., & Parsons, M. A. (2006). Health Promotion in Nursing Practice. Upper Saddler

River: Pearson Education, Inc.

●Rousseau, S., (2010). Mecosta county religious system. Ferris State University. www.ferris.edu

●US Census Bureau . (2002, April 30). Census 2000 Urban and Rural Classification. Retrieved from

http://www.census.gov/geo/www/ua/ua_2k.html

●US Census Bureau. (2007, April). United States Summary: 2000. Population and Housing Unit Counts. Retrieved

from www.census.gov/census2000/pubs/phc-3.html

●Shinohara, R. (2010, February 15). Group advocates incentive to lure health care workers. Anchorage Daily

News. Retrieved from http://www.adn.com

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