Advanced Practice Nursing: Health Promotion Proposal Essay
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Health Promotion proposal
Physician shortages and rising costs of health care are two of the foremost challenges facing the U.S. health care system. Treatment of chronic lifestyle diseases is a major component of health expenditure that places enormous strain on resources. With the implementation of Affordable Care Act more people will be covered by Medicare. There is enough evidence to show that prevention is much more cost effective than treatment. Community based health promotion using low-cost innovative strategies can help reduce the burden of chronic diseases by a comprehensive risk reduction and behavior modification intervention.
Obesity is an important risk factor predisposing to ischemic heart disease, diabetes, hypertension and stroke. It is also a risk factor for conditions like osteoarthritis, breast cancer and gastro intestinal malignancies. According to Johnson, et al. (2014to be effective ), more than half of all deaths in 2011 were attributed to heart disease and cancer, both being causally linked to obesity. Ogden et al (2014) claimed that over 78 million adults and 12 million youth in U.S. are currently obese. (Ogden, Carroll, Kit & Flegal, 2014). Moreover, according to Khan et al. (2009) only 21% adults and 27.1% school children respectively can be categorized as physically active (at least 60 min. daily).
Rationale: Interventions for primordial prevention of chronic diseases are backed by evidence and recommended. Programs targeting risk factors like obesity, diabetes and hypertension have demonstrated their efficacy and cost effectiveness. ACA envisions an increasingly important role of APNs in improving access, coverage and lowering the costs of health care. APN is a trained cadre capable of providing primary care services that are comparable to that by physician. Especially in underserved communities, APN-led primary care services can plug the coverage gaps.
The intervention draws heavily from the CDC framework of ‘Public Health Action Plan to Prevent Heart Disease and Stroke’. Key themes of the intervention include ‘’Taking Action, Strengthening Capacity, Evaluating impact, Advancing Knowledge and Local Partnerships’’ (CDC 2013)
Objective: To institutionalize an innovative, low cost, sustainable, APN-led community-based health promotion program based out of rural public health facilities.
Target population: The program targets the entire population living in the catchment area of the rural health facilities. However, ethnic minorities, immigrant community, school children and patients receiving curative services in health facilities will be prioritized.
Patients receiving treatment services in health facilities benefit from institutionalization of health education as an integral part of health care at the government health facilities.
Health facilities have the capacity to deliver simple health education messages in a language that they understand
Community network of community volunteers is in place to deliver health promotion messages using interpersonal communication techniques
A working group co-chaired by APN and a local community leader and consisting of local stakeholders, will meet on a monthly basis for review of activities and solving any problems or barriers faced by the program.
A partnership between health facilities, schools, local NGOs, officials of Head Start program and local government body facilitates the implementation of the program
Mobilization of community & Collaboration with local leaders, local NGOs, Head Start school local officials
Baseline data on morbidity and risk factor prevalence (quantitative data from public health database) and qualitative data from n no. of of focus group discussions in each catchment area (
Assess staffing gaps,
Planning for data collection, tools,
Mapping of catchment areas special interest target groups and communities
Data review from health facilities
Resource planning: Health education materials, other inventory, training materials, funding requirement, etc.
Phased program of training of health facility staff, community nurses and auxillary health workers provided by ‘n’ no. of APNs per each district/county
Training of clinical nurses by APN
Sensitization sessions in schools as per planned program of activities
Training of community health workers in inter personnel communication and key health messages
Weekly compilation of data
Ongoing data review
Formative Assessment: Monthly review meetings, Field supervision activities, Program data
Modification of plan if required
Modifications, if any
CDC (2013): Comprehensive public health strategy and the five essential components of the plan (Chap 2) in ‘A Public Halth Action Plan to Prevent Heart Disease and Stroke’. Available online at http://www.cdc.gov/dhdsp/action_plan/pdfs/action_plan_4of7.pdf. Accessed 02.02.2015.
Ogden CL, Carroll MD, Kit BK, Flegal KM (2014). Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. JAMA. 2014;311(8):806-814. doi:10.1001/jama.2014.732.
Johnson NB, Nicole Blair Johnson, Locola D. Hayes, Kathryn Brown, Elizabeth C. Hoo, Kathleen A. Ethier (2014). Program Performance and Evaluation Office, CDC. CDC National Health Report: Leading Causes of Morbidity and Mortality and Associated Behavioral Risk and Protective Factors- United States, 2005-2013. MMWR/Oct 31, 2014 / Vol. 63 / No. 4 (Pg 3-15).
Khan LK, Sobush K, Keener D, Goodman K, Lowry A, Kakietek J, Zaro S (2009); Centers for Disease Control &Prevention. Recommended community strategies and measurements to prevent obesity in the United States. MMWR Recomm Rep. 2009 Jul 24;58(RR-7):1-26.
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