Running head: PLANNING PAPER PART II

Village Pointe Planning Paper Part II

Shannon Harris, Victoria Grigorita, Sonny Pascale, Aubrey Hogge, Marian Gemender, Melissa
Johnston, Laura Pozo, Jessica Chamberlin, Cecile, Perez-Collantes
Old Dominion University

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Village Pointe Planning Paper Part II

The purpose of this assignment is to utilize the Health Planning Model to improve
aggregate health and to apply the nursing process to the aggregate within a systems framework.
Our aggregate is comprised of the residents living at Village Pointe (VP), a 60-unit retirement
facility that provides affordable housing for older adults. All residents must be 62 years of age or
older to apply to live at VP. The residents are diverse in age, gender, race, ethnicity, and marital
status, but all are well accepted into the VP apartment community. This aggregate was selected
due to the variety of health issues that are present in the older population in general, the
socioeconomic status of the residents at VP, and the established rapport between the School of
Nursing from Old Dominion University and VP. Utilizing previously gathered assessment data
and having an identified nursing diagnosis with specific outcomes, we implemented
interventions and evaluated outcomes to enhance the nutritional aspects of the aggregate as well
as improve overall well being and quality of life.
Planning
Health Problems of Aggregate
Health problems in the Village Pointe population were determined based on assessment
data gathered through surveys and open discussions with the residents during the assessment
phase of our planning project. The priority diagnosis for the aggregate is readiness for enhanced
nutrition related to deficient knowledge about healthy and proper food choices. This was
evidenced by 75% of the aggregate having doctor-diagnosed hypertension, 25% having doctordiagnosed diabetes, and the majority of the aggregate admitting to a lack of proper education on
appropriate nutrition. This diagnosis was made to assist in managing or preventing hypertension
and diabetes in the aggregate as well as to prevent continual consumption of non-nutritious food

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items. It was apparent that members of the aggregate lacked proper education on appropriate
nutrition because of statements they made about their diet consisting of food such as canned
vegetables, pre-packaged lunch meat, chips, and sodas as well as eating large portion sizes. This
priority diagnosis was made based on assessment findings and interest from the residents on
nutrition education.
The second diagnosis is impaired physical mobility related to decreased muscle
endurance and pain experienced from certain disease processes evident in the elderly population.
Readiness for enhanced self-care with regards to dental hygiene is the third diagnosis, which is
related to expressed interest about dental health and lack of knowledge on the importance of
regular dental checks. The fourth diagnosis, based on the previous assessment phase, is chronic
pain related to disease processes experienced by the aggregate as evidenced by 30% of the
residents stating that they experience chronic pain. The final diagnosis is knowledge deficit
related to advanced directives as evidenced by residents stating not being familiar with advanced
directives or not having one and expressing interest in learning more about them.
Priority Diagnosis with Goal and Objectives
Our priority diagnosis identified for our aggregate is readiness for enhanced nutrition
with a focus on managing hypertension and diabetes through an incorporation of a healthy diet,
which would also provide additional, associated health benefits. This diagnosis is related to a
lack of knowledge within the aggregate on what constitutes a healthy diet. Widespread interest in
initiating and maintaining a healthier diet was noted, including a desire for information on
nutritional items, recipes, and what foods to consume and what to avoid. This diagnosis is also
related to the 75% of residents with doctor-diagnosed hypertension, the 25% of residents with

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doctor-diagnosed diabetes, and the continual consumption of foods high in salt, such as
processed foods, and foods high in sugar, such as cookies and sodas.
Our ultimate goal is that the aggregate will report having improved knowledge about
healthy and balanced nutrition. Our first objective to achieve this goal is that 85% of the
aggregate will verbalize three benefits of adopting a healthy eating pattern by the end of the
teaching sessions carried out. Our second objective is that 80% of the aggregate will list a
minimum of three dietary recommendations that can assist in managing hypertension and
diabetes by the end of the teaching sessions carried out. The third objective is that 80% of the
aggregate will demonstrate appropriate selection of weekly meal planning that incorporates at
least five recommendations of healthy eating by the end of the teaching sessions carried out. The
fourth objective is that 85% of the aggregate will describe three snacking habits/patterns or
emotions that are detrimental to nutritional change by the end of the teaching sessions carried
out. Our final objective is that 90% of the aggregate will identify at least three positive benefits
to assist them in maintaining dietary changes by the end of the teaching sessions carried out.
These objectives were mutually agreed upon by the students and the aggregate through group
discussions and surveys that aimed to determine what topics the residents would be most
interested in learning about.
Alternative Interventions
An alternative intervention to accomplish our objectives of managing healthy nutrition
would be couponing. The residents at VP are low-income older adults with a limited amount of
money to buy groceries. Some residents stated that they have tried to buy healthier options for
certain food items but were unable due to financial restraints. Couponing would be a successful
alternative intervention for this aggregate due to the ease of being able to find coupons in the

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newspapers, which are delivered to VP, as well as being able to use Internet access to find
coupons online. Through implementing this intervention, residents would be able to choose
healthier items that they would be able to afford to ensure they are maintaining a healthy diet.
Another alternative intervention that would be beneficial for our aggregate is discussing
the benefits of shopping at a farmers market. There are various farmers markets in Norfolk and
surrounding cities that residents can attend whether through personal transportation or VP
transportation. The farmers markets have fresh fruits and vegetables available for purchase.
Furthermore, VP can receive vouchers that can assist in purchasing these items at a lower cost.
This alternative intervention would be successful for the aggregate because farmers markets
provide affordable, fresh produce that can directly assist in maintaining a healthy diet for this
population.
Intervention
The interventions implemented were chosen based on the research findings that the
students located. Poor eating habits and inadequate nutrition knowledge are major problems in
the United States, which can eventually lead to malnutrition and other chronic conditions,
including diabetes, hypertension, and coronary artery disease (CAD) (Craven, 2012). Living
with these issues significantly reduces the quality of life among the aging population. One
research study was conducted in order to assess the nutritional status and dietary habits of older
adults and analyze their association with nutritional knowledge (Turconi, Rossi, Roggi, &
Maccarini, 2012). Two hundred older adults took part in the survey. According to the results,
only 30% of the participants demonstrated adequate nutritional status and good dietary habits,
while the majority of subjects were overweight (Turconi, Rossi, Roggi, & Maccarini, 2012, p.
51). Moreover, people with healthy weight demonstrated greater knowledge in nutrition than

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people with a high body mass index (BMI). Based on these findings and the results of the
nutrition surveys that we conducted last semester, we concluded that our aggregate needs a better
understanding of healthy nutrition. By providing various educational sessions on how to improve
nutrition, the gap that has formed between knowledge and poor habits will be filled, which will
improve the overall health status of the aggregate.
Using teaching as an intervention will enable all those present to benefit from the
information provided, because teaching can serve both primary and tertiary levels of
interventions. Teaching represents a primary intervention for the portion of the aggregate that
does not currently have the disease in which the education provided is about; therefore,
prevention by education is implemented for those individuals. Teaching also represents a tertiary
level of intervention for the portion of the aggregate that is currently diagnosed with the
particular disease process. In this case, teaching is beneficial to help manage health conditions
and prevent further complications associated with them. The ultimate goal of teaching about
healthy nutrition practices is to maximize the quality of life for the aggregate. One systematic
review of 15 randomized control trials (RCT) was conducted in order to evaluate the
effectiveness of nutrition interventions for older adults implemented in community settings
(Bandayre & Wong, 2011). According to the results, nutritional education positively influenced
diet choices and helped to improve physical function among the participants. Moreover, the
authors concluded that more active forms of interventions, which involved active participation
and collaboration, demonstrated the most promising outcomes. We applied these findings as our
rationale by actively involving our aggregate in the teaching sessions. For example, we
incorporated food tasting, cooking class, question and answer sessions, and food label readings.

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The first teaching session covered positive benefits of healthy eating and how to
accurately read food labels. Discussion of how to read food labels is important to implement in
this aggregate, due to the high rates of those with hypertension and diabetes, to ensure they
understand how to find the amounts of sodium and sugar in products they purchase. The
aggregate was provided with a handout of examples of food labels to follow along with the
discussion and to identify certain sections of the label when asked (See Appendix A, figure 1).
Rationale for this intervention is supported by a study that was conducted in order to determine
whether knowledge in food label reading impacts quality of nutrient intake (Post, Mainous, Diaz,
Matheson, & Everett, 2010). The study surveyed about 3,700 adults with and without knowledge
in food labeling. According to the results, those who had knowledge of reading food labels
consumed fewer amounts of calories, saturated fat, and sugar and consumed greater amounts of
fiber. These results suggest that implementation of teaching on how to read food labels is of great
benefit.
The second teaching session introduced healthy eating patterns and the use of MyPlate in
order to increase awareness of portion sizes. Each member was given a plate that was divided
into recommended portion sizes, and in each section there was a list of foods that should be used
to fill that portion of the plate during meals (See Appendix A, figure 2). The next few teaching
sessions had a focus on diabetes and hypertension in order to present the residents with
information that is helpful for their specific health issues. The pathophysiology of each condition
was discussed as well as signs and symptoms and how nutrition can be used to help manage the
conditions. Also, handouts were utilized in these sessions for the aggregate to have something to
look at while they listened (See Appendix A, figures 3 and 4). Another teaching session was
focused on meal planning so as to provide the residents with healthy meal suggestions. The

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aggregate was provided with reduced sodium recipes for full meals and also received a sample of
one of the reduced sodium crock-pot meals.
The next nutritional teaching focused on healthy snacking because the majority of the
aggregate admitted to snacking throughout the day. The rationale for this intervention is that
snacking plays a vital role in daily nutrition intake. One RCT was conducted to find an
association between snacking and nutrient intake among 123 postmenopausal women with high
BMI (Kong et al., 2011). According to the findings, snack meals served as a good source of daily
fruit, vegetable, and fiber intake. However, the findings also demonstrated that unhealthy choices
of snacks might lead to weight gain. Therefore, in order for our aggregate to benefit from
snacking, during this session, the residents were given suggestions and handouts on how to shop
for and prepare easy and nutritious snacks (See Appendix A, figure 5). In addition, nutritious and
easy-to-make snacks were provided, including frozen yogurt-covered fruit and
cucumber/cheese/turkey sliders.
The final nutrition teaching was implemented by a registered dietician. The dietician
answered questions that the residents had about nutritional aspects of hypertension, diabetes, and
other conditions (e.g., arthritis) that could assist in managing and/or preventing them. Having the
registered dietician assisted with tertiary intervention by helping residents diagnosed with
hypertension and diabetes manage these conditions. Also, it assisted with primary intervention by
preventing these conditions in residents who have not been diagnosed. This intervention was
successful because it allowed the residents to have questions answered by someone who has
more experience in the nutritional world and provided them with more clarity in different aspects
of nutrition with certain health conditions.

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Secondary intervention was also implemented throughout the semester by monitoring

vital signs, height, and weight weekly. The vital signs were taken first before any teaching
session, which helped get the group active to participate in the teaching discussions. The
rationale for this intervention is that weekly tracking of blood pressure and heart rate is one
method for early detection of hypertension and can also be used to note when a known case of
hypertension is not being controlled by medication and diet. Hypertension is one of the major
problems in the US; however, it can be easily treated, preventing life-threatening complications
such as stroke and CAD (Craven, 2012).
Regular blood pressure screenings are of great benefit and easy to implement in
community settings; however, they are not routinely done. The authors of one study conducted a
blood pressure screening in a rural area on a random sample of 150 adults that were 50-years-old
and above (John, Muliyil, & Balraj, 2010). According to the results, hypertension was detected in
almost half of the participants, but only 25% of those people were aware of their status prior to
the study (John et al., 2010, p. 68). Furthermore, 64% of those who were referred for further
evaluation initiated hypertension treatment within three months (John et al., 2010, p. 68). These
findings suggest that there is a tremendous benefit to implementation of blood pressure screening
for detection and initiation of treatment for hypertension. If done on a regular basis, blood
pressure screening can help to detect prehypertension, which would help in preventing the
development of hypertension itself. Therefore, regular blood pressure screening that we
implemented with VP residents is of great benefit and supported by research. Taking vital signs
enriched teaching sessions regarding healthy nutrition due to their significance when it comes to
eating habits and changes needed.

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Barriers
Barriers confronted during the Village Pointe experience included weather, attendance
issues, financial barriers to the students, and physical barriers to exercises. Weather played a role
in attendance due to heavier snowfall during the winter months that accumulated on the ground.
This limited both the residents ability to traverse the property in order to make it to the Village
Pointe community room from Village Gardens and also the students ability to commute to
Village Pointe for one of the regularly scheduled events. This was handled by combining
multiple teaching sessions into the following meeting time.
A concentrated effort was paid towards building up attendance with weekly flyers and
attempts to go door to door. Weekly flyers were created and sent to Delores Harris who posted
them on the Village Pointe and Village Gardens announcement boards. Unfortunately, there was
a restriction on door-to-door outreach. Supervision was required and this outreach could only
occur at certain times of the day, and because of government housing restrictions, any form of
solicitation needed to be approved in advance. Despite the restriction, the students were given
approval to go door-to-door, but due to communication issues amongst the Village Pointe staff,
those attempts were canceled. Instead, the students continued to use flyers to promote
attendance.
Another barrier the students faced was the financial expense of attracting residents to
participate in weekly events. Residents requested games and prizes to be present every week. To
address this barrier, the students explained to the residents that entertainment was funded by the
students and not by the university. However, students made use of limited financial resources by
shopping for prizes at dollar stores and limiting the number of prizes given to two or three per

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meeting. As a result, the number of residents in attendance decreased over time to a smaller but
more consistent group.
With respect to exercise, the students had to address the barrier of limited mobility among
the aggregate. Limits in strength, balance, and endurance were addressed by implementing
stretching exercises as opposed to more physically active exercises, encouraging the residents to
use chairs to support themselves during stretching exercises, and by slowing the pace of the
exercises so as not to fatigue the aggregate. Positive reinforcement, one on one instruction and
assistance, and easy-listening music were incorporated to help make a more positive experience
for the aggregate.
Evaluation
The main goal, or the expected outcome, of our interventions is that the aggregate will
report an increase in knowledge about balanced nutrition. In order to achieve this main goal,
different interventions were implemented, such as how to read nutrition labels, appropriate snack
options, dietary recommendations to control hypertension and diabetes, and positive benefits of
eating a healthy diet. After six weeks of implementing the necessary nutrition-related
interventions, we administered a brief, twelve-question post-quiz to the residents based on the
five objectives established during the assessment phase (See Appendix B). We determined that a
multiple choice post-quiz would be an adequate form of evaluation because it enables the
residents to recall information that was covered. This post-quiz was written at a seventh-grade
reading level, questions were simple and brief, and familiar vocabulary was used with the
intention of making the post-quiz easy for the aggregate to comprehend, which would enable a
more reliable evaluation of outcome achievement. Also, a large print (14 point font) and a simple
style type (Times New Roman) were used to make the post-quiz easy to read. To ensure that our

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evaluation tool could be easily read and understood, technical jargon, medical terminology, and
multiple connective words were avoided (Bastable, 2007).
In order to evaluate the effectiveness of our interventions, the questions in the post-quiz
were individually graded and grouped by which objective they tested. The scores of the questions
covering the same objective were then averaged together in order to determine what percentage
of the aggregate met the objective. There were two multiple choice questions that covered
information regarding the first objective, which focused on verbalizing two methods of adopting
healthy eating patterns. Residents scored 100% on these questions, surpassing our goal of 85%.
Our second objective, which covered dietary recommendations to manage hypertension and
diabetes mellitus, was evaluated with four multiple-choice questions. Our goal of 80% was not
met, as only 64% of the aggregate correctly answered these questions. The third objective, which
focused on appropriate selection of weekly meal planning, was evaluated with two more
multiple-choice questions. This objective was unmet because while our goal was 80%, only 64%
of the aggregate answered these questions correctly. Our fourth objective, which covered
snacking habits, was met because 93% of the aggregate answered the evaluation questions
correctly. Our fifth goal regarding positive benefits of dietary changes was also met because the
residents scored 100% on the respective questions. A chart comparing our expected and actual
outcomes can be found in Appendix C, figure 1.
Also, blood pressure and weight were measured weekly. Although all of those who
attended meetings had their vitals taken, there were 8 residents who attended meetings on a
regular basis. The data gathered from weekly blood pressure and weight assessments can be
found in Appendix C, figure 2. There was a decrease in a majority of the systolic and diastolic
blood pressures among the residents based on our assessment from both semesters. The

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aggregate as a group lost 2.6 pounds with one aggregate losing approximately 8 pounds (See
Appendix C, figure 2).
Limitations
There were several limitations to the process used in evaluating the desired outcomes.
The sample size of those who took the nutrition post-quiz was only seven, which is significantly
less than the 10 to 20 residents who attended teaching sessions in the previous semester. Because
the attendance of the events is optional and Village Pointe prohibits soliciting, this could be
resolved by making events more enticing with more games and prizes. Also, some of the
residents were not attentive while taking the post-quiz, which may have influenced the scores,
resulting in lower scores, specifically in the hypertension and diabetes sections. This could be
resolved by reading the questions aloud to enable the aggregate to fully understand and fully
participate in the evaluation process. The environment where the evaluation was conducted
might have also affected the results. Residents trickled into the community room while the postquiz was being taken, which provided distraction and made it difficult for the aggregate to focus.
Also, creating one post-quiz as opposed to multiple post-quizzes was a limitation to the
evaluation process. It would have been more beneficial to create a post-quiz after each teaching
session to better evaluated the residents understanding of each topic. Finally, recording of vital
signs was inconsistent because some residents either refused to have their vital signs
assessed/recorded or some did not attend events regularly.
Recommendations
After spending two semesters with the aggregate, recommendations have been
established for future groups of nursing students working with Village Pointe. The first
recommendation is to create a questionnaire for the aggregate members to take upon first

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meeting with them. The questionnaire would be a way to determine what they are interested in
learning about during their time with the nursing students. By catering the lectures or activities to
what the aggregate is interested in, there is an increased probability for maximal participation.
Another suggestion to take into consideration during the first meeting with the aggregate is to
refrain from including games or food as rewards right away. The members love to play bingo and
enjoy trying new foods, but students noticed that if these activities were not advertised for the
next meeting, fewer residents would attend. Bingo was a popular activity to include occasionally
as long as the residents know that there will not be games every week.
A positive addition to the Village Pointe meetings would be collaboration with the
physical therapy students at ODU. Weekly exercises were already established in the residents
routine with the nursing students, but this interdisciplinary approach can increase their
knowledge on mobility, proper body mechanics, and appropriate exercises for individuals with
arthritis. A final recommendation is to create assessment and evaluation tools that are appropriate
for the aggregates education level. The wording should be simple and easy to understand. It is
also suggested that instead of having the aggregate members read each question themselves, one
nursing student should read the questions and answer choices aloud. This may keep residents
more focused and can make it easier for the aggregate to comprehend each question.
Implications and Conclusion
Through time spent with the aggregate at Village Pointe, teaching was implemented to
include nutrition and its use to manage hypertension and diabetes. Through surveys and ongoing
assessment it was determined that this teaching was effective in community health education.
Nurses can utilize this process, including assessment, implementation, and evaluation within a
community setting to provide preventative and curative education to a specific population. For

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example, community health nurses can provide nutritional education as a method of treating or
preventing common health issues, such as diabetes and hypertension. Another implication for
community health nursing involves the importance of providing access to the older population
for regular vital sign check-ups, especially blood pressure, as a means of early detection and
treatment of hypertension. The interventions implemented at Village Pointe show that the nursing
process can be used to successfully provide care in the community setting.

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References

Bandayre, K., & Wong, S. (2011). Systematic literature review of randomized control trials
assessing the effectiveness of nutrition interventions in community-dwelling older adults.
Journal of Nutrition Education & Behavior, 43(4), 251-262.
doi:10.1016/j.jneb.2010.01.004
Bastable, S. B. (2007). Nurses as Educator: Principles of teaching and learning for nursing
practice. Sudbury, MA: Jones and Bartlett Publishers.
Craven, R., Hirnle, C., & Jensen, S. (2010). Fundamentals of nursing: Human health and
function. Seattle, WA: Wolters Kluwer
John, J., Muliyil, J., & Balraj, V. (2010). Screening for hypertension among older adults: a
primary care "high risk" approach. Indian Journal of Community Medicine, 35(1), 67-69.
doi:10.4103/0970-0218.62561
Kong, A., Beresford, S. A., Alfano, C. M., Foster-Schubert, K. E., Neuhouser, M. L., Johnson,
D. B., & ... McTiernan, A. (2011). Associations between snacking and weight loss and
nutrient intake among postmenopausal overweight to obese women in a dietary weightloss intervention. Journal of the American Dietetic Association, 111(12), 1898-1903.
doi:10.1016/j.jada.2011.09.012
Post, R., Mainous, A., Diaz, V., Matheson, E., & Everett, C. (2010). Use of the nutrition facts
label in chronic disease management: results from the national health and nutrition
examination survey. Journal of the American Dietetic Association, 110(4), 628-632.
doi:10.1016/j.jada.2009.12.015
Turconi, G., Rossi, M., Roggi, C., & Maccarini, L. (2012). Nutritional status, dietary habits,

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nutritional knowledge and self-care assessment in a group of older adults attending
community centers in Pavia, Northern Italy. Journal of Human Nutrition and Dietetics,
26, 48-55. doi:10.1111/j.1365-277X.2012.01289

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Appendix A
Handouts

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Figure A1

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Figure A2
Figure A3

Figure A4

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Figure A5

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Appendix B
Post-Quiz

1. What ingredients can be used as a healthy substitute for salt? (Select all that
apply)
a. Butter
b. Black pepper
c. Garlic
d. Lemon
2. How can you decrease arthritis using nutrition?
a. Take vitamin E supplements daily.
b. Use butter as lotion over joints with pain.
c. Eat red and purple foods and take a fish oil supplement daily.
d. Eat green vegetables at least once a week.
3. What is an example of a healthy snack?
a. Popcorn
b. Blueberries and yogurt
c. Chips and salsa
d. Sugar free cookies
4. How many meals should you eat in a day?
a. One big meal at night
b. 3 portion-sized meals, with snacks in between
c. Only eat lunch and dinner
5. How many food categories should you divide your plate to have the
adequate nutrients according to the American Diabetic Association?
a. 3
b. 4

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c. 1
6. What are these food categories?
a. Vegetables, grains, and protein
b. Sweets, grease food, vegetables
c. Salty food, sweets, grains
7. Which of the following is a positive benefit of eating a healthy diet?
a. Decreases energy
b. Maintains/Decreases weight
c. Hinders self-esteem
d. Worsens hypertension/diabetes
8. Positive benefits of eating a healthy diet include promoting energy,
sharpening the mind, and improving digestion.
a. True
b. False
9. What are some ways we can manage DM?
a. Regular Blood glucose testing
b. Regular Exercise
c. Hemoglobin A1C testing
d. Drinking Alcohol Beverages
e. A B & C only
10.What are the two types of Diabetes Mellitus?
a. DM type 1 and type 2
b. DM Type a and type b
c. Cushing Diabetes
d. Parkinsons Diabetes
11.Which of the following can help manage high blood pressure? (select all that
apply)

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a. Reduce sodium intake

b. Increase calcium intake
c. Increase saturated fat intake
d. Choose foods with a heart-check mark
e. Rinse canned vegetables
12.True or false. The DASH diet is recommended to help manage high blood
pressure.
a. True
b. False

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Appendix C
Evaluation Charts

Figure C1

Figure C2