Running Head: A NURSES ROLE IN CHILDHOOD OBESITY PREVENTION

A Nurses Role in Childhood Obesity Prevention Carly Macklin Ferris State University

A NURSES ROLE IN CHILDHOOD OBESITY PREVENTION Abstract Nurses play a key role in the process of healthful community change. Due to the nature of the profession, the role of the nurse may vary greatly, while still providing impactful service on a

single issue. Childhood obesity is a growing concern and epidemic within the United States. The nursing profession can work together to implement healthful changes that work toward the reduction of these obesity rates among the youthful generation of our country. This can be understood by examining the role of the school health nurse, which has direct contact with the population at hand. Additionally, also poised for impactful change is the public health nurse leader, such as the nurse chair of the Michigan Public Health Association (MPHA). While these roles differ, they both strive to positively educate and advocate for the community, which makes them key players in the fight against childhood obesity.

A NURSES ROLE IN CHILDHOOD OBESITY PREVENTION A Nurses Role in Childhood Obesity Prevention

In the state of Michigan and in the United States of America childhood obesity has risen to epidemic proportions. According to the Center for Disease Control and Prevention (CDC), the percentage of children aged 2-19 years with a body mass index (BMI) in the 95th percentile or greater, thus classifying them into the obese weight range, is 17% (CDC, 2013). This area of health concern is relevant and present in the Kent County, Michigan as well, and has been chosen as the topic for a community change proposal for registered nurses (RN) taking a course on community nursing. The nurse role has the ability to impact and reach many people, making this profession well positioned to be influential in preventing, identifying, and treating obesity and promoting advocacy efforts for multilevel policy changes necessary to create less obesigenic environments (Budd & Hayman, 2008, para. 2). The importance of the nurses role in an issue such as childhood obesity can better be understood by reflected on specific positions within this profession that possess varying responsibilities which impact the matter at hand. The school nurse has direct contact with youth in an influential setting providing prime opportunity for education and prevention measures. In contrast, nurse administration and leadership roles, such the RN chair holder of the Public Health Nursing branch of the Michigan Public Health Association (MPHA) addresses this issue in a less direct manner by providing and guiding the efforts of nurses working in the health department setting, while also advocating for community health issues at a governmental level. Direct Contact School Nurse In the state of Michigan, in both private and public school systems, the role of the school nurse is commonly found in the elementary setting, providing direct care to students by way of first aid and medication administration. Additionally, according to the Michigan Association of

A NURSES ROLE IN CHILDHOOD OBESITY PREVENTION School Nurses (MASN) (2009), their mission is to aid in the identification of potential health concerns while also promoting health and safety. Shirley Schantz, RN, EdD, ARNP, believes

that this setting is critical in fighting the childhood obesity epidemic, stating, School nurses can reinforce evidence-based nutrition and physical activity behaviors, and they can promote research, evidence-based guidelines, and policy strategies in schools. School nurses are the health experts in schools (Schantz, 2011, para. 5). As such, these individuals are the voice of advocacy for the young members of society. In addition to the direct care they provide, addressing acute and chronic conditions, the school nurse must be a leader, increasing health education and advocating for healthful nutritional and physical activity activities and policies within the school setting. As summarized by Bryan, Broussard and Bellar in their 2013 article, Effective Partnerships: How School Nurses and Physical Education Teachers Can Combat Childhood Obesity, The school nurse can advocate for children because they have the expertise to provide advice and initiate direct contact with the parent or guardian. Furthermore, due to their expertise, they have the unique ability to impact policy and decision making with other school personnel and decision makers outside of the school environment (p. 21). Without a doubt, the school nurses is a clear key player in the against childhood obesity. Leadership Traits In order to be an effective nurse leader in the school health environment, the nurse must possess excellent communication skills. Since providing education to youth is key in the fight against obesity prevention, the school nurse must seek to accomplish health teaching in encounters with students and families, in the classroom, in individual counseling sessions, and in group meetings (Harkness & DeMarco, 2012, p. 239). In addition to the ability to provide assertive and instructive communication, the nurse must be an active and compassionate listener,

A NURSES ROLE IN CHILDHOOD OBESITY PREVENTION knowing that obesity impacts a diverse population with varying backgrounds. Due to this diversity, the nurse must be flexible with the ability to modify her approach based on the

demographic she is connecting with. Furthermore, the school nurse should be positive and set the example she teaches, as healthful choices require igniting motivation in others. ANA Standards of Professional Practice The school nurse role is in line with many of the American Nurses Associations (ANA) Standards of Professional Practice. Specifically, the nurse in this direct contact setting requires skill in the implementation of interventions that have been developed to address a specified cause. In the case of childhood obesity, an educational plan must be developed that will guide those children in the academic environment towards health choices. Once materials and a manner of approach is established, the education must be delivered by the nurse and those working in this setting. Personal and direct consultation with children and their families may also be implemented with children screened as high risk or already in the danger zone of obesity. Additionally, the professional standards of communication and leadership are necessary, as previously noted (ANA, 2010). Public Health Nurse Chair In regard to how a nurse may impact and prevent childhood obesity, a role of leadership in the administrative field of public health nursing differs from that of the school nurse. The Michigan Public Health Association (MPHA) is an interdisciplinary society of health professionals and other citizens who are concerned about problems and issues affecting public health in Michigan (MPHA, 2013, para 1). Within this association is a branch devoted to public health nursing. The individual holding the chair position for this division is Naomi Ervin, RN,

A NURSES ROLE IN CHILDHOOD OBESITY PREVENTION

PhD. Although this RN, and those in similar working environments has less direct contact with individual patients, this nurse works to protect the health of the community as a whole. The role of this RN and the public health nursing branch members of the MPHA is summarized into two goals; Goal 1: To provide information sharing, networking, leadership and recognition among Public Health Nurses (PHN). Goal 2: To inform elected officials (local, state and federal), other health professionals, and the public regarding public and community health issues (MPHA, Public Health Nursing, 2013, para 6). Educating the population of Michigan on obesity risks and health related education and decision making is a stated area of focus on the MPHA Public Health Nursings informative website. Nurse leaders within this setting play a key role in the proposal for community change working to improve the health of youth by reducing obesity rates. Not only do they provide direction for public health nurses, they also advocate for issues at the legal and governmental level. Leadership Traits A nurse in an administrative and management position such as the chair holder for the public health nursing branch of the MPHA must possess a wealth of leadership skills. In order to direct and oversee the membership of the association, while providing information and guidance to public health nurses within the state of Michigan must be assertive and motivating in order to successfully address the issues at hand. Furthermore, confidence and vision is required in order to appropriately advocate for the community at a state government level. In order to be a true activist and supporter of the population at large, the nurse cannot be meek. Similar to that of the school nurse, excellence in communication skills would also be a necessary trait, which must be paired with cultural competence due to the diverse population of the state of Michigan.

A NURSES ROLE IN CHILDHOOD OBESITY PREVENTION ANA Standards of Professional Practice While the position of a nurse leader in the public health domain is in step with many aspects of the professional practice standards outlined by the ANA, this role specifically implements the ANAs Eight Domains of Public Health Nursing Practice, with policy development and program planning skills at the forefront (Harkness & DeMarco, 2012). With the use of the required communication, analytic assessment and leadership skills, the public health nurse leader acts as a driving force in the construction, implementation and direction of community health programs. The nature of this professional role allows for the nurse to be a spokesman for many within the nursing profession and therefore bares a great deal of responsibility. Analysis In many ways, the roles of the school nurse and the public health nurse leader share characteristics. Each of these positions can positively impact a cause by their ability to

implement action with the health and care of others in mind. Each of these nurses are required to be leaders within their own setting, with communication skills and the ability to motivate others of ultimate importance in order for planned interventions to be successful. These roles both have the potential to address issues and advocate for changes to policies and regulations within their working environment. Additionally, these individuals must possess the ability to be culturally aware and understanding due to the diverse and changing populations with which they work. Each of these roles has the ability to impact an issue such as childhood obesity, within the political arena. In a general sense, all nurses is called to advocate for their patients, regardless of position. Holding an administrative position is not a requirement for political activism. The

A NURSES ROLE IN CHILDHOOD OBESITY PREVENTION school nurse serves as an expert in her field which impacts the health and safety of every child that is in the school setting. This means that the school nurse is one of the best advocates

possible for the population he or she works with. Addressing issues by petitioning for change to local and state government officials is not out of the scope of the direct contact nurse. The nurse working in the public health arena in a leadership position also can impact policy and practice in the political arena. Yet, this professional nurse leader setting has an edge over the school health nurse. Due to the public and visible nature of the position, it allows for a more ideal forum for political advocacy, with a larger scope of data and far reaching impact available to this nurse leader. While many similarities can be identified, there are clear differences. The scale and manner in which these nurse roles impact the population will differ greatly. While the school nurses capacity for change may be limited to the school district that she is employed by, the public health nurse leader may impact a larger demographic, such as a city, county or state. Additionally, the nurse holding a chair position in a state public health association, such as the MPHA, has a greater ability to network and direct the actions of fellow nurses within the public health field, again creating a far reaching influence due to the nature of this position. Personal Reflection These two different roles a nurse can assume in the process of community impact and change, I can personally identify with certain aspects and skills that I feel confident that I possess. In regards to the school health nurse, I feel that my interests and professional goals are most appropriate for this position, which compared to that of the public health nurse chair. The smaller scope of practice, that of the school setting feels fitting for me personally as I would enjoy the challenge of working directly with children and their families, believing it to be a

A NURSES ROLE IN CHILDHOOD OBESITY PREVENTION highly rewarding job of service. My compassion for working with children and implemented positive change through planned interventions for this demographic suits my interests and personality.

On the other hand, I believe that my background is a home care nurse manager in Grand Rapids, Michigan has provided me with a deeper cultural awareness that has strengthened my communication skills. This broader understanding and strength would serve me well in an administration position as a public health nurse leader. Despite this, this role would be more challenging for me due to its highly visible nature. While I often strive to lead by my example, Im not an individual that seeks to be in control or head of a group, department, or situation. Therefore, this position lays outside of my comfort zone. In order for me to actually assume either of these nursing roles, additional education and training would be required. I currently possess an associates degree in nursing and have work experience in cardiology and home care. Prior to working in the school health setting, additional experience in pediatrics would be beneficial, if not absolutely necessary. In order to assume the leadership role of public health nurse chair, an advance graduate degree would be appropriate in order to be better prepared educationally to be a key player in the health cause political arena. As showcased, the professional nurse working in a public health setting can impact their community in both big and small ways. The nurse can work to combat childhood obesity by working with the population directly, manage a larger network of nurses, develop and implement professional guidelines, or advocate for patients on this issue at the political level. Individually, each type of nurse can make change happen, and together strengthen the field of nursing as a whole.

A NURSES ROLE IN CHILDHOOD OBESITY PREVENTION References American Nurses Association. (2010). Standards of professional nursing practice. Scope and Standards of Nursing Practice. Retrieved June 20, from http://www.ferris.edu/HTMLS/colleges/alliedhe/Nursing/Standards-of-ProfessionalNursing-Practice.htm. Bryan, C., Broussard, L., & Bellar, D. (2013). Effective partnerships: How school nurses and physical education teachers can combat childhood obesity. NASN School Nurse, 28(1), 20-23. doi: 10.1177/1942602X12460891 Budd, G.M., & Hayman, L.L. (2008). Addressing the childhood obesity crisis: a call to action. The American Journal of Maternal/Child Nursing, 22(2), 111-118. doi: 10.1097/01.NMC.0000313419.51495.ce Center for Disease Control. (2013). Basics about childhood obesity. Overweight and Obesity. Retrieved June 19, 2013 from http://www.cdc.gov/obesity/childhood/basics.html. Harkness, G.A., & DeMarco, R.F. (2012) Community and public health nursing: Evidence for practice. Philadelphia, PA: Wolters Kluwer Health | Lippincott Williams & Wilkins.

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Michigan Association of School Nurses. (2009). Definition of school nursing. MASN. Retrieved June 19, 2013 from http://www.michiganschoolnurses.org/. Michigan Public Health Association. (2013). Public health nursing. MPHA. Retrieved, June 20, 2013 from http://www.mipha.org/public-health-nursing.php.

A NURSES ROLE IN CHILDHOOD OBESITY PREVENTION Schantz, Shirley. 2011. The role of school nurses in childhood overweight and obesity intervention. Medscape Education. Retrieved June 20, 2013 from http://www.medscape.org/viewarticle/744434_transcript.

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