REBECCA AVERY, RN BSN · Web viewThese deliverables can be located in appendices A through F....

Running head: IMPLEMENTING HEALTH EDUCATION

Implementing Health Education for the Maple Alley Inn

Rebecca Avery, RN, Erik Bratz, RN, Ivana Devic, RN

Western Washington University

NURS 432 – Community-Based Care for Vulnerable Populations

William Lonneman, DNP, MN, RN

Tom Carson, MN, RN

May 23, 2017

1

IMPLEMENTING HEALTH EDUCATION

Implementing Health Education for Maple Alley Inn

Introduction

In March of 2017, the RN-to-BSN program of Western Washington University (WWU)

paired with Maple Alley Inn (MAI) of Bellingham, WA to incorporate a new healthcare

education intervention. The primary purpose of MAI, a subsidiary of the Opportunity Council of

Bellingham, Washington is to bring free, healthy meals to disadvantaged individuals. Patrons

who utilize these services are typically homeless or of low-income. This program does not

screen the guests and there are no requirements to utilize these services.

The MAI serves three meals per week, one breakfast and two lunches at two locations in

north Bellingham. Typical attendance varies between 80 and 150 guests per meal, with smaller

turnouts for breakfast. As previously stated, the intended purpose is to serve low-income

populations, which tends to attract individuals without permanent housing and the homeless.

While working with these populations, the operations director, Anne Poulson, has seen an

increasing need to incorporate a healthcare component to the program.

With limited resources, the MAI opted to incorporate healthcare seminars tailored to

address the highest priority health concerns of their patrons. To help facilitate this initial

program, WWU was asked to create a teaching seminar that focused on foot care. With the

intent to produce a teaching seminar related to foot care, three RN-to-BSN students conducted

several assessments to determine the feasibility and the program’s readiness for change to adopt

this intervention. To implement healthcare education, an assessment of three components to the

MAI were required: the community in which it resides, the readiness of the program, and the

populations being served.

2


Assessment

Community Assessment

Whatcom County is a coastal community safe-guarded by an island archipelago, the San

Juan Islands. Despite these barriers to open ocean weather, this region is susceptible to above

average levels of rainfall throughout the year. Whatcom County experiences four seasons

annually but remains wet and cold for the majority of the year. These characteristics yield highly

fertile soil that has cultivated the northern aspects of the County into a successful berry and dairy

farm industry. For reference, Whatcom County is the world’s largest raspberry producer and due

to the nature of industries like this, high volumes of low-income migrant workers reside here

(Bellingham Whatcom County Tourism, 2016).

There are approximately 33,328 people who fall below the poverty line including an

estimated 719 homeless (Whatcom County Coalition to End Homelessness, 2016). Information

gleaned from a windshield survey of the area indicates that large populations of low-income

families reside in north Bellingham. As the MAI aims to support this population, their facility

has been strategically placed to meet their nutritional needs.

Maple Alley Inn Assessment

Assessing the internal dynamics of the program, it is evident that the MAI is in the initial

stages of implementing healthcare seminars in conjunction to their meal services. Ascertained

from an interview with Anne Poulson, the attempts to incorporate healthcare education have had

minimal success. The greatest obstacle identified has been the recruitment of volunteer

healthcare professionals to create and implement education seminars. Successful courses taught

in the past have included care of feet, wounds, diabetes, and a tentatively planned seminar on

dental health. It was reported that the number of participants per course drew approximately 8 to

3


10 people and was held after the meal service had completed. The individuals who chose not to

participate were reported to have left the facility immediately upon completion of the meal.

Currently, there are multiple active and retired RNs volunteering to serve food, not

conduct the seminars. With minimal patron interest and no dedicated personnel to conduct the

seminars, the internal barriers to incorporating these interventions indicate that the MAI is not

adequately prepared to implement this method of education.

Key Informant Assessment

Several key informant interviews were conducted with patrons of the MAI. The purpose

of these interviews was to determine health priorities and baseline knowledge of health literacy.

Based on eleven interviews, the following information was elicited about the program’s patrons:

There is low health literacy among these populations;

Knowledge of Bellingham health resources is not well-known;

Bellingham is a hub for transient populations seeking travel to Canada and Alaska;

MAI guests are predominantly male, 80%;

Approximately 25% of guests are homeless;

Immediate health priorities for the homeless include foot care, burns, mental health

services, and access to health services;

There is hesitancy to seek help from healthcare professionals;

This population does not know when to seek professional help;

Food assistance was identified as the reason to attend the MAI, not health education;

Patrons are more interested in treatment as opposed to education seminars;

The healthcare system is too complex to navigate;

4


There is a lack of access to basic hygiene resources for proper treatment of most

healthcare needs.

Information obtained by observation of patrons at the MAI:

Few patrons take time to read the Opportunity Council resource assistance binders;

When meal services are completed, the patrons quickly disperse from the facility.

Intervention Considerations

In order to meet the goals of the MAI, the following interventions were considered based

on the program’s current resources. Our first considered intervention was based on the request

of the MAI. This intervention included developing and conducting a teaching seminar tailored to

the highest priority health needs of their guests. In addition, teaching resources would be

designed to allow future educators to follow and teach again. This intervention aligns with

previous implementation strategies and directly meets the request of the agency. The benefits of

this strategy allow for a question and answer component to address more specific issues.

Barriers to this strategy include the seminar being a stand-alone event and attendance levels were

less than ten percent of the population. It is repeatable, but would require a dedicated volunteer

healthcare professional to implement.

A second intervention was also considered which included the development of self-taught

poster boards related to the priority healthcare needs of the patrons. The poster board forum

would relay the same information but be self-driven by those with concerns regarding the issues

being presented. The benefit of implementing self-taught poster boards eliminates the need for

additional healthcare volunteers, information can be presented weekly, and is accessible to the

entire population. Teaching materials would also be included, identical to the didactic option, in

the event a seminar was conducted.

5


Barriers to adopting a poster-board forum have also been identified. One concern with

implementing this teaching style stems from the amount of information that can be presented.

Poster boards have limited space for information and may not address all material. In addition,

access to poster information relies on basic English reading abilities.

Recommendations

Based on the assessments of both the MAI and its patrons, it was determined that

implementing weekly teaching seminars would not be in the best interest of the identified goals.

Our findings indicate that there were not enough volunteer healthcare professionals available to

conduct the proposed idea. Therefore, to implement an immediate and repeatable intervention,

the use of a self-taught poster board has the potential to meet these goals without the addition of

further resources. The MAI has had success with implementing didactic sessions, but to develop

a one-time teaching session would limit the number of patrons who could benefit. In addition,

since the MAI program operates out of two locations that reach two separate groups, producing a

transportable poster allows dissemination to more people.

The creation of the poster boards needs to accommodate people who have low health

literacy. From key informant interviews, it was found that patrons of the MAI had extremely

low health literacy and require information to be presented in a way that is understandable and

succinct. Essentially, any information presented needs to be conveyed in layman terms in

conjunction with any medical terminology. The poster boards should include visual aids that

exhibit the severity of an injury, which will direct them to seek professional help with the use of

universal symbols. In addition, the writing content should be tailored to the equivalence of a

third-grade English reading level to maximize comprehension.

6


Based on the eleven interviews, the main health concerns identified were foot care and

burn injuries. Because this population lacks access to proper medical supplies, the purpose of

the poster boards would be to provide information on signs and symptoms of injuries and when it

is appropriate to seek professional help. It was determined that providing information on how to

treat these injuries was not indicated as it would require resources that were not financially

available to this population. Instead, each poster board should include prevention

recommendations for their respective injury. Using these parameters, the WWU RN-to-BSN

students produced two informational healthcare poster boards; one for foot care as it relates to

athlete’s foot, ingrown toenails, and trench foot; and one poster pertaining to contact and

inhalation burns.

To help draw attention to potentially under-utilized resources, a resource utilization map

of the local Bellingham region was also adopted to assist transient and long-term homeless

populations. With the use of the resource notebooks that are presently available, a map with

organizations and their associated hours of operation, contact information, and services being

rendered was included. The map focuses on basic necessities such as healthcare, nutritional,

transportation, housing, and employment services.

After multiple conversations with Anne Poulson, key informant interviews, and the

virality of the 2016 influenza strain, it was also determined that there was a substantial need to

preemptively develop a vaccination clinic for the 2017 flu season. As our assessment found, this

population is predominantly uninsured and do not necessarily have access to affordable

healthcare. Developing this intervention would greatly benefit those without health insurance

and those currently covered due to the current flux in health insurance laws.

7


In addition to the flu vaccine, epidemiological findings of Whatcom County indicate that

there is a high incidence of whooping cough (Pertussis) (Whatcom County Health Department,

2017). Addition a Tdap (Tetanus, Diphtheria, and Pertussis) vaccine or booster would also

increase immunological protection. In collaboration with the Whatcom Health Department,

Bellingham Technical College, and hopefully PeaceHealth St. Joseph Medical Center

(PHSJMC), a free vaccination clinic will be conducted in late October 2017 to decrease the

incidence of flu within this susceptible population. Implementation of this clinic would utilize

free flu and Tdap vaccines donated by PHSJMC and have them administered by Bellingham

Technical College nursing students and faculty under the supervision of the Whatcom Health

Department.

Evaluation

To determine the effectiveness of these interventions, it is recommended by this group

that evaluation surveys be available for patrons who utilize the poster boards. This will help to

identify further gaps and methods to improve the dissemination of pertinent information.

Effectiveness of the vaccination clinic will be determined by the percentage of patrons who

participate in the event should it be conducted in the fall of 2017. This group determines success

with a vaccination rate of one-third of its patrons or greater.

The deliverables presented to the MAI includes digital and hardcopy versions of the foot

care, burns, and map poster. For subsequent WWU RN-to-BSN cohorts, a blank digital poster

board template has also been delivered with the intent to expand healthcare topics. In addition,

teaching plans for both foot care and burns have been provided. The teaching plans provide

enough detail so that non-healthcare volunteers can teach the information. The purpose of this

type of deliverable is for volunteers to provide basic information on said care without the need

8


for additional healthcare professional volunteers. These deliverables can be located in appendices

A through F.

Conclusion

Based on the initial assessments, key informant interviews and conversations with the

program director, it was determined that self-taught poster boards as well as a resource map were

the best interventions for the patrons that the MAI serves. The program was not prepared to

implement teaching seminars due to a lack of volunteer healthcare professionals, thus requiring

an alternative method of conveying pertinent health information. It is our hope that the patrons of

MAI will seek proper help when foot care and burn concerns arise. This type of intervention

allows for future WWU RN-to-BSN program cohorts to expand on.

Summaries

Becky’s Summary

One lesson learned is to not only take advice about what the agency needs from the staff,

but to perform interviews with the patrons. In completing several interviews the group was able

to not only identify 2 different subjects that were deemed important education points to the

patrons of Maple Alley Inn. During 11 interviews with clientele the group was able to focus our

posters on what would be most relevant information: recognition of different skin conditions and

when to seek help. We also discovered there was a gap in the information available to the

recently homeless or homeless who are new to Whatcom County. A map was needed in order to

show where the different services are located in Bellingham.

Ivana’s Summary

The Maple Alley inn Practice Experience has taught me that the best sources of

information are the patrons themselves, especially when it comes to healthcare needs of the

9


population that MAI serves. Although it was informative to know what the program’s directors

wanted the WWU RN to BSN students to focus on this quarter, the key informants were the best

self-advocates. The patrons knew what their immediate needs were, which were information on

foot care and burns. Because of that were able to tailor our self-taught poster boards and the local

resource map to those needs. It was informative to understand how the MAI program is sustained

and supported by the community. There is a high population of homeless people in Bellingham,

something that was unbeknownst to me. Working with the MAI this quarter has taught me how

important it is to be aware of different populations within this community and how to help raise

awareness for those in need.

Erik’s Summary

The greatest lesson I learned from this project encompasses the process in which it takes

to create change in healthcare. My group and I acted in a very small capacity with the project at

the Maple Alley Inn, but it still required a great deal of planning and dedication to implement it.

This process required us to see things from both an “expanded” and “detailed” perspective.

From the beginning of this project, we were given the “expanded” view (goal) of what the MAI

wanted to accomplish. But arriving at a finished product required the necessary information to

be gleaned from a “detailed” perspective. It required gathering data from all aspects of this

community; key informants, program personnel, community observation, parent company

support, and intercity business collaboration to name a few. Working on a project such as this

signifies one important lesson to me: in order to implement change, it takes an understanding of

all the internal components of an issue to create effective change. For me, understanding the

issues from the point of reference of the Maple Alley patrons allowed me to conceptualize the

appropriate interventions for this population.

10


References

Bellingham Whatcom County Tourism. (2016). Agricultural. Retrieved from

www. bellingham.org/activities/farm-agriculture/

Whatcom County Coalition to End Homelessness. (2016). A home for everyone:

Whatcom county coalition to end homeless 2016 annual report. Retrieved from

http://www.whatcomhsc.org/wp-content/uploads/2016/06/FINAL_Whatcom-2016-

homeless-count-report_05312016_updated061616.pdf

Whatcom County Health Department. (2017). Communicable diseases: Pertussis. Retrieved from

http://www.whatcomcounty.us/1000/Pertussis

11


Appendix A

12


References for Foot Poster

[Athlete’s Foot Image 1]. Retrieved May 18, 2017 from

http://www.keyword-suggestions.com/cGVlbGluZyBza2luIG9mZiBmZWV0/

[Athlete’s Foot Image 2]. Retrieved May 18, 2017 from http://www.medicinenet.com/image-

collection/athletes_foot_1_picture/picture.htm

[Athlete’s Foot Image 3]. Retrieved May 18, 2017 from https://en.wikipedia.org/wiki/Athlete

%27s_foot

[Athlete’s Foot Image 4]. Retrieved May 18, 2017 from http://healthh.com/athletes-foot/

[Athlete’s Foot Image 5]. Retrieved May 18, 2017 from https://www.youtube.com/watch?

v=0xXYU0NLQ08

[Athlete’s Foot Image 6]. Retrieved May 18, 2017 from http://diseasespictures.com/athletes-foot/

[Athlete’s Foot Instructions Image 1]. Retrieved May 18, 2017 from

http://www.nizoralshop.com/en/content/49-tinea-pedis-athletes-foot-best-ways-to-treat-it

[Healthy Foot Image]. Retrieved May 18, 2017 from http://www.seagateworld.com/2017/02/all-

natural-tips-for-healthy-fingernail-toenails/

[Ingrown Toenail Image 1]. Retrieved May 18, 2017 from http://www.medicinenet.com/image-

collection/ingrown_toenail_picture/picture.htm

[Ingrown Toenail Image 2]. Retrieved May 18, 2017 from

https://en.wikipedia.org/wiki/Ingrown_nail

[Ingrown Toenail Image 3]. Retrieved May18, 2017 from http://www.allhealthsite.com/ingrown-

toenail-pictures-remedies-treatment-and-surgery-options.html

13


[Ingrown Toenail Image 4]. Retrieved May 18, 2017 from

http://www.merckmanuals.com/professional/dermatologic-disorders/nail-disorders/

ingrown-toenail

[Ingrown Toenail Instructions Image 1]. Retrieved May 18, 2017 from

http://www.silvesterfootclinic.com/practice_areas/stop-the-pain-of-ingrown-toenails.cfm

[Ingrown Toenail Instructions Image 2]. Retrieved May 18, 2017 from

http://healthylearn.com/hc/ingrown-toenails.html

[Trench Foot Image 1]. Retrieved May 18, 2017 from http://diseasespictures.com/trench-foot/

[Trench Foot Image 2]. Retrieved May 18, 2017 from

http://www.foot-pain-explored.com/trench-foot.html


http://www.guardianfirstaid.co.uk/index.php/trench-foot-is-back/

[Trench Foot Image 4]. Retrieved May 16, 2017 from http://footwiki.com/trench-foot/


http://www.theprepperjournal.com/2015/06/03/bug-out-nightmare-stop-trench-foot-

before-it-stops-you/

[Trench Foot Image 6]. Retrieved May 18, 2017 from http://mrjsblogs.co.uk/year5/page/2/

[Trench Foot Instructions Image 1]. Retrieved May 18, 2017 from

https://jhartogs.wordpress.com/tag/trench-foot/

14


Appendix B

15


References for Burn Injuries Poster

[Full-Thickness (3rd Degree) Burn Image 1]. Retrieved May 18, 2017 from

http://fromisrael2lebanon.info/keywords/1/4th-degree-sunburn/

[Full-Thickness (3rd Degree) Burn Image 2]. Retrieved May 18, 2017 from

https://sereirathblog.wordpress.com/author/sereirath/

[Full-thickness (3rd Degree) Burn Image 3]. Retrieved May 18, 2017 from

https://plasticsurgerykey.com/burn-wound-management/

[Inhalation Burn Image 1]. Retrieved May 18, 2017 from

http://www.denverpost.com/2009/01/11/israel-accused-of-using-white-phosphorus/


http://ent4students.blogspot.com/2013/05/ent-pictures-nose_6.html


http://www.mirror.co.uk/news/gallery/smoke-fills-a-washington-metro-4969576

[Partial-Thickness (2nd Degree) Burn Image 1]. Retrieved May 18, 2017 from

http://healthh.com/athletes-foot/

[Partial-Thickness (2nd Degree) Burn Image 2]. Retrieved May 18, 2017 from http://ph-

online.ro/monden-national/item/62801-tratament-minune-si-100-natural-vindeca-chiar-si-

arsurile-de-gradul-iii-da-mai-departe-pentru-cei-care-au-nevoie

[Partial-Thickness (2nd Degree) Burn Image 3]. Retrieved May 18, 2017 from

http://ndla.no/nn/node/6911?fag=8

[Superficial (1st Degree) Burn Image 1]. Retrieved May 18, 2017 from http://reskin.eu/?

page_id=1719

16


[Superficial (1st Degree) Burn Image 2]. Retrieved May 18, 2017 from

https://doctorrennie.wordpress.com/tag/burn-classification/

[Superficial (1st Degree) Burn Image 3]. Retrieved May 18, 2017 from

http://www.aafp.org/afp/2000/1101/p2015.html

17


Appendix C

18


Appendix D

19


Appendix E

Poster Board Feedback

Please Circle Your Answers

1. What poster board is being reviewed?

Foot Care Burns Resources of Bellingham

2. Did the poster address your concerns?

No Somewhat Neutral Mostly Yes

(1) (2) (3) (4) (5) (N/A)

3. Is it clear when to seek medical help?

No Somewhat Neutral Mostly Yes

(1) (2) (3) (4) (5) (N/A)

4. What additional information would be helpful pertaining to this topic?

5. What healthcare related topic would you like more information on?

20


Appendix F

Ingrown Toenail

Symptoms:

Pain and/or tenderness along the nail

Redness

Swelling

Infection – seen as pus or drainage

When to see a doctor:

If the symptoms above get worse or spread

Have diabetes

Causes:

Improperly fitting shoes (tight around the toes)

Cutting toenails incorrectly (see diagram)

Injury

Complications:

Untreated: the injury can become infected and lead to a possible bone infection, lead to a blood infection (sepsis), or tissue death (gangrene).

Mayo Clinic. 2017. Diseases and conditions: Ingrown Toenail: Symptoms and causes. Retrieved

from http://www.mayoclinic.org/diseases-conditions/ingrown-toenails/symptoms-

causes/dxc-20273047

21


Athlete’s Foot

Facts:

“Athlete's foot usually causes a scaly red rash. The rash typically begins in between the toes. Itching is often the worst right after you take off your shoes and socks.

Some types of athlete's foot feature blisters or ulcers, chronic dryness and scaling on the soles that extends up the side of the foot.”

Causes:

“Athlete's foot is caused by the same type of fungus that causes ringworm and jock itch. Damp socks and shoes and warm, humid conditions favor the organisms' growth.

Athlete's foot is contagious and can be spread by contact with an infected person or from contact with contaminated surfaces, such as towels, floors and shoes.”

Risk factors:

“Frequently wear damp socks or tightfitting shoes

Share mats, rugs, bed linens, clothes or shoes with someone who has a fungal infection

Walk barefoot in public areas where the infection can spread, such as locker rooms, saunas, swimming pools, communal baths and showers”

Complications:

“Athlete's foot infection can spread to other parts of your body, including:

Your hands. People who scratch or pick at the infected parts of their feet may develop a similar infection in one of their hands.

Your nails. The fungi associated with athlete's foot can also infect your toenails, a location that tends to be more resistant to treatment.

Your groin. Jock itch is often caused by the same fungus that results in athlete's foot. It's common for the infection to spread from the feet to the groin as the fungus can travel on your hands or on a towel.”

So Wash Your Hands! Any time you touch your feet

Mayo Clinic. 2017. Diseases and conditions: Athlete’s foot: Symptoms and causes. Retrieved

from http://www.mayoclinic.org/diseases-conditions/athletes-foot/symptoms-causes/dxc-

20235876

22


Trench Foot

Facts:

“Trench foot, also known as immersion foot, occurs when the feet are wet for long periods of time. It can be quite painful, but it can be prevented and treated.”

Symptoms:

Tingling/itching sensation Pain Swelling Cold and/or blotchy skin Numbness Prickly or heavy sensation “Foot may be red, dry, and painful after it becomes warm Blisters may form, followed by skin and tissue dying and falling off In severe cases, untreated trench foot can involve the toes, heel, or entire foot.”

Prevention and treatment:

“When possible, air-dry and elevate your feet, and exchange wet shoes and socks for dry ones to help prevent the development of trench foot.

Thoroughly clean and dry your feet.

Put on clean, dry socks daily.

Treat the affected part by applying warm packs or soaking in warm water (not hot!) for approximately 5 minutes.

When sleeping or resting, do not wear socks.

Obtain medical assistance as soon as possible.

If you have a foot wound, your foot may be more prone to infection. Check your feet at least once a day for infections or worsening of symptoms.”

Centers for Disease Control and Prevention. 2014. Natural disasters and severe weather: Trench

foot and immersion foot. Retrieved from https://www.cdc.gov/disasters/trenchfoot.html

Burns

23

https://www.cdc.gov/disasters/trenchfoot.html


Superficial (1st Degree) Burns

Symptoms: Redness, swelling and pain One example of a superficial burn is a sunburn

When to see a doctor: These types of burn typically get better in several days up to a week after injury Seek help if it becomes too painful or you can’t move the affected body part

Partial-Thickness (2nd Degree) Burns

Symptoms: Red, white or splotchy skin May be painful and swollen Usually a blister forms It looks wet or moist

When to see a doctor: If too painful or you can’t move the affected body part

Complications: Scarring Try not to break the blister. If the blister is broken, the risk of infection is high.

Full-Thickness (3rd Degree) Burns

Symptoms: Charred black or white skin Waxy or leathery skin

When to see a doctor:

If the burn is painful or you can’t move the affected body part If the burn is swollen or oozing clear or yellow liquid If the burn is on your face or over a large area of the body

Complications:

24


Full-thickness burns can cause nerve damage and the body part that is burned may be numb

Inhalation Burns

Symptoms: Coughing, scratchy throat, shortness of breath, stinging eyes, runny nose Chest pain or tightness Irritated sinuses

When to see a doctor: If you can’t breathe or experience any of the above symptoms

When it is ABSOLUTELY necessary to see a doctor: If the burn covers the hands, feet, face, groin, buttocks, or any large area of the body Deep burns (all layers of the skin are affected) are dangerous and should be treated by a

doctor immediately If burn is caused by a chemical or electricity If you have difficulty breathing

Mayo Clinic. 2017. Diseases and conditions: Burns: Symptoms and causes. Retrieved from

http://www.mayoclinic.org/diseases-conditions/burns/basics/symptoms/con-20035028

25

Date post:	29-Sep-2020
Category:	Documents
Upload:	others
View:	0 times
Download:	0 times

REBECCA AVERY, RN BSN · Web viewThese deliverables can be located in appendices A through F....

Documents