Nursing Reflection The role opportunities for nurses in a community of mostly elderly people, farming as the main occupation, and lack of health resources are endless. According to city-data.com, the adult obesity rate for Conecuh County is 32.6% whereas the state of Alabama is 31%. The rate of child obesity is 18.9% and the state is 13.5% (City-data.com, 2013). The first nursing diagnosis is imbalanced nutrition: more than body requirements (obesity) among residents of my community related to increased food consumption and insufficient energy expenditure for intake. The first goal for this diagnosis is to reduce the prevalence of obesity among the residents. An objective for this goal is that 50% of the obese residents will engage in an exercise plan that will promote adequate weight loss. The interventions for this objective include establishing a community wide exercise program or fitness plan that will promote weight reduction; and develop a meal plan that will enhance weight loss and promote better eating habits. We will work with local health care providers to provide sample menus and meal plans for the citizens who will participate in the weight reduction program. A second objective states that residents will lose 5% of total body weight over a period of six weeks. The interventions used to make this objective a reality include motivating residents by organizing a competition program to see which team can lose the most weight in a specific time period; and establishing a specific day of the week for "weighing in" to see exactly how much weight is being lost per week. The second goal for this diagnosis is to educate residents about long-term complications and risks associated with obesity. An objective associated with this goal will be that residents will organize a support group for those whom are overweight. The interventions include encouraging residents to discuss their perception of obesity and how they think it correlates with health problems; and educating residents about risks of obesity, such as diabetes mellitus and hypertension. A second objective for this goal is to educate individuals and/or families who are at risk for obesity and inform them of the risks that are associated with obesity. The interventions include having area nursing students to provide education classes about healthy eating habits and exercise regimens. Also to have the local health department to provide free screenings for aggregates at risk. Evaluation of the interventions would be for the community to express their concern with health disparities. They will understand that education concerning hypertension, obesity and their relating factors must take precedence before a change will occur. They will understand that screenings must be consistent and the regimen prescribed by the healthcare professional must be followed. Consequently, the community will experience an improved health status. The community members will express concerns about the lack of neighborhood health facilities. They will participate fully in the building and establishment of a neighborhood gym. The citizens will encourage each other to participate and obtain information concerning the improvement of their health. Conclusively, the community will report an increase in fitness activities and a decrease in blood pressure and weight. The Office of Minority Health has a $4,000,000 grant, Partnerships Active in Communities to Achieve Health Equity. The purpose of this grant is to address social determinants and environmental barriers to healthcare access; and increase access to and utilization of preventive health care, medical treatment, and supportive services through integrated community-based networks. The program will address at least one, but no more than three, of the following health areas: asthma, behavioral health, cancer, cardiovascular disease, diabetes, HIV/AIDS, infant mortality, obesity, substance abuse, and unintentional injuries/violence (U.S. Department of Health and Human Services, 2010). The second nursing diagnosis is risk of trauma related deaths related to excessive usage of farm equipment longer waits for emergency response, and longer transport distances to hospitals. The first goal for this diagnosis is to increase access to health care services and decrease barriers to care in rural settings. An objective for this goal is that ambulance transfer time will decrease by 10%. The interventions are to have an ambulance stationed at the local fire department and arrange for personnel to be available 24 hours a day. In fact, a 30-minute wait for EMS response has been found to increase the risk of death sevenfold. The average EMS response time in the rural United States is 18 minutes, more than eight times the response time in urban areas (Clark, 2008). The second goal is to education the emergency personnel on farm injuries and the farmers on safety. Objective for this goal is that the EMS will correctly demonstrate proper protocols for farm injuries and farm injuries will reduce by 50% by the end of the year. EMS personnel in rural areas are more likely than their urban counterparts to be volunteers and to lack adequate protocols for triage and transfer decisions (Clark, 2008). The interventions would be for the EMS to attend injury protocol class, ensure they have their licensure to practice, and to have mock farming injuries for practice. Another intervention for this goal is to hold seminars at the farmer’s market and local co-op building on farm safety, teach CPR to all the local farmers and community people. Evaluation of the interventions would be for the community to participate and succeed in farm safety courses and CPR classes. One of the Healthy People 2020 objectives is to reduce the proportion of unpaid caregivers of older adults who report an unmet need for caregiver support services. A nursing diagnosis for this objective would be Caregiver Role Strain related to lack of community resources. The typical caregiver support services provided through the aging services network include: information about available programs and services; assistance in gaining access to programs and services; services such as individual counseling, support groups, and training to assist caregivers in the areas of health, nutrition, financial knowledge, and to make decisions and solve problems related to their care giving roles; respite care to temporarily relieve caregivers from their responsibilities by providing a short-term break through home care, overnight care in an adult home or nursing home, adult day care and other community-based care; and supplemental services to complement the care provided by the caregiver, such as a personal emergency response systems, assistive equipment, home modifications, home delivered meals, transportation, etc. (National Alliance for Caregiving, 2004). The community of Sand Cut, Alabama was interesting to assess. Even though the community's weaknesses include obesity, heart disease and lack of health care facilities; the community will show its strengths through programs created for improvement. We identified these problems because they ultimately lead to more serious problems. It is important to start at the source so that primary prevention can play a major role in the solution. The community assessment was completed both during midday and afternoon. It was used to assess the houses, businesses, highways, and people of Sand Cut. As a result of the community assessment, I am better able to assess the needs of the community. It is important for me to work with the community leaders and businesses to help with the community residents’ needs. As a nurse, assisting, facilitating, educating and empowering the community to recognize and implement healthy changes is the overall goal.

References
City-Data.com (2013). Retrieved from: http://www.city-data.com/county/Conecuh_County-AL.html
Clark, M.J. (2008). Community Health Nursing: Advocacy for Population Health (5th ed.). Prentice Hall, Inc: A Pearson Education Company. Retrieved from University of Phoenix eLibrary
National Alliance for Caregiving. (2004). Caregiving in the U.S. Retrieved from http://www.caregiving.org
Stanhope, M. and Lancaster, J. (2012). Public Health Nursing: Population-Centered Health Care in the Community (8th ed.). Maryland Heights, MO: Mosby Elsevier
U.S. Department of Health and Human Services (2010). The Office of Minority Health. Retrieved from: http://www.minorityhealth.hhs.gov