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Clinical Application Community Health Project Paper

Mariah K. Hart

School of Nursing, Old Dominion University

NURS 492: Community Health Nursing

Professor. Ka Lee Gustafson

November 4, 2022
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Clinical Application Community Health Project Paper

THRIVE Peninsula is my community aggregate for this course. THRIVE

Peninsula is a non-profit organization that serves the community of Newport News, VA

in several ways including: food distribution, financial application assistance, shoe drives,

and school supply/toy drives (M. Retzlaff, personal communications, September 7,

2022). I have currently volunteered in their food pantry since September 7, 2022. My

initial draw to working with THRIVE was my desire to work with a community

organization that addresses hunger. I initiated my correspondence with THRIVE via

email and was trained on site. Conversations that took place while at the site informed me

of their areas of service (M. Retzlaff, personal communications, September 7, 2022).

THRIVE Peninsula depends on volunteer’s time to support their mission and has about

10 employees on their payroll (M. Retzlaff, personal communications, September 7,

2022).

Assessment/ Compare and Contrast

THRIVE Peninsula is located in Newport News, VA and is considered to be a

part of the Oyster Point area demographically (M. Retzlaff, personal communications,

September 7, 2022). On a larger scale, Newport News is one of the coastal communities

in Hampton Roads, VA (Reyes, 2019). Unfortunately, Newport News has community

members that struggle to obtain adequate food for themselves and their respective

household (Reyes, 2019). The latest food insecurity rate for Newport News, VA is

12.4%, the state average for VA is 7.7%, and the national mean is 10.2% (Feeding

America & Conduent Healthy Communities Institute, 2022; Feeding America, 2020;

USDA, 2022). Therefore, based on statistical data, Newport News residents experience
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food insecurity at higher levels than the state and national averages (Feeding America &

Conduent Healthy Communities Institute, 2022; Feeding America, 2020; USDA,

2022). Furthermore, the poverty rate of Newport News, VA is 14.8%, Virginia’s current

rate is 10.2%, and the national average is 11.6% (United States Census Bureau, 2021;

United States Census Bureau, 2021; United States Census Bureau, 2021). THRIVE

Peninsula’s financial assistance department works with clients to develop plans and

achievable steps towards financial stability (M. Retzlaff, personal communications,

September 7, 2022).

Literature Reviews

PhD Researchers from Ohio University studied and reviewed 5 years of research

completed on food insecurity and its negative impact on health (Thomas et al., 2021).

The researchers chose to study the correlation of food insecurity (FI) to four chronic

illnesses including: “obesity, type 2 diabetes, cardiovascular disease, and mental health”

(Thomas et al., 2021, p.1). The researchers chose these four health concerns because they

are globally prevalent among the 2 billion people who face food insecurity (Food and

Agriculture Organization of the United Nations as cited in Thomas et al., 2021).

According to research, FI affects genders disproportionately, and women were reported

to have higher rates of Type II DM within their respective locality (Strings et al., 2016 as

cited in Thomas et al., 2021). Researchers are still trying to determine the root cause of

why food insecure women are more susceptible to developing Type II DM (Thomas et

al., 2021). A suggested causation is elevated insulin resistance levels due to the

physiological process of managing stress due to food insecurity (Walker et al., 2019 as

cited in Thomas et al., 2021). Obesity is an issue within the food insecure population;
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unfortunately women see a higher rate of prevalence (Rodriguez et al., 2021 as cited in

Thomas et al., 2021). A contributing factor to obesity within the food insecure

population is the unbalanced eating habits, at times an individual may overeat to

compensate for periods when food is not readily available (Brown et al., 2019 as cited in

Thomas et al., 2021). Over eating can also alter biological processes, which encourages

the retention of fat (Nettle et al., 2017 as cited in Thomas et al., 2021). Conversely, food

insecurity can lead to individuals becoming underweight from insufficient caloric intake

(Brown et al., 2019 as cited in Thomas et al., 2021) Cardiovascular disease is an issue

that affects both men and women experiencing food insecurity (Liu and Eicher-Miller,

2021 as cited in Thomas et al., 2021). In a 2021 study completed by Banerjee and

colleagues, individuals suffering from food insecurity experienced a 58% higher

likelihood to die from cardiovascular disease compared to those not experiencing FI

(Banerjee et al., 2021 as cited in Thomas et al., 2021). Cardiovascular disease is within

the top 5 reasons for mortality for Newport News, VA residents (Riverside, 2016; 2019).

Mental Health was the most broadly studied amongst the four chronic diseases, however,

research supports that not knowing where one’s next meal will come from increases

stress levels amongst FI individuals (Pourmotabbed et al., 2020 as cited in Thomas et al.,

2021) Arenas and colleagues research supported that food insecurity correlated with

higher rates of depression (Arenas et al., 2019 as cited in Thomas et al., 2021).

Nursing researchers from American University embarked on a study to determine

the impact of food insecurity on mental and physical health in America (Hawkins &

Panzera, 2021). Unfortunately, 50 million Americans are victims of food insecurity,

which contributes to a higher percent of their household income being spent on medical
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care from a poor diet (Berkowitz et al., 2018 as cited in Hawkins & Panzera, 2021).

Through their review of research they discovered that food insecurity contributes to a

higher prevalence of detrimental health conditions ranging from obesity, heart disease,

and diabetes (Ferrer et al, 2019; Liu et al, 2014; World Health Organization and Calouste

Gulbenkian Foundatio, 2014 as cited in Hawkins & Panzera, 2021). Additionally, poor

mental health status was reported at higher rates within the food insecure population

(Martin et al., 2016 as cited in Hawkins & Panzera, 2021). Moreover, women reported

higher rates of mental health conditions compared to their male counterparts (Martin et

al., 2016 as cited in Hawkins & Panzera, 2021). Individuals experiencing food insecurity

reported feelings of humiliation and despair for being unable to take advantage of

existing mental health programs due to their lack of cognitive skills and education

(Afulani et al., 2018; Bergman et al., 2019; Jones, 2017 as cited in Hawkins & Panzera,

2021). Food insecure communities are susceptible to two nutritional phenomena known

as food deserts and food swamps (Ver Ploeg et al., 2009 and Hager et al., 2017 as cited in

Hawkins & Panzera, 2021). A food desert refers to a lower socioeconomic area that is

distant from places the constituents can obtain fresh food, i.e a supermarket (Ver Ploeg et

al., 2009 as cited in Hawkins & Panzera, 2021). A food swamp is an area that contains

establishments that serve fast food, which offer high caloric content with little nutritional

value. Food swamps contribute to a higher prevalence of obesity (Hager et al, 2017 as

cited in Hawkins & Panzera, 2021). A community garden was established in Newport

News, VA near Zion Baptist Church that was built out of the need to address food

insecurity and the food desert in this region (Rao, 2021). Patrons are able to obtain fresh
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produce and for those who have insecure transportation, volunteer drivers are available to

deliver the fruit and vegetables (Rao, 2021).

Doctors from the University of Arkansas developed a screening survey tool to

assess food insecurity within their patient population (Kopparapu et al, 2020). The

researchers were motivated to complete this examination based off of USDA results that

showed Arkansas had a food insecurity rate of 17.2% or roughly 500,000 individuals

(United States Department of Agriculture Economic Research Service, 2019 as cited in

Kopparapu et al., 2020). The physician researchers were in a dichotomy because they

wanted to address food insecurity involving their patients, but did not want their survey

to be intrusive and offend their clients (Kopparapu et al., 2020). The survey administered

was comprised of eight questions modeled after the USDA screening metric and given to

the patient upon arrival to the clinics (Stuff et al., 2004 as cited in Kopparapu et al.,

2020). The survey window was for a five-month period in 2018, and in total 284 patients

were assessed (Kopparapu et al., 2020). The participants were provided the questionnaire

prior to seeing the physician and were informed that they were free to decline answering

the survey questions (Kopparapu et al., 2020). At the conclusion of the survey period,

83.9% of those surveyed agreed that the screening tool was a positive addition to their

doctor’s visit (Kopparapu et al., 2020). Surveying is an important tool that THRIVE

Peninsula utilizes to assess client’s needs prior to accessing pantry items (M. Retzlaff,

personal communications, September 7, 2022). Questionnaires provided to clients are

utilized to gain insight on allergies, food preferences, and best available times for the

respective individual to pick up their food (M. Retzlaff, personal communications,

September 7, 2022).
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Nursing researchers studied the correlation of food insecurity and

medication noncompliance due to cost for older American adults (Caouette et al., 2020).

The researchers reviewed six studies and all past subject members were at least 60 years

old, with the average age of the test population ranging between 74-75 years old (Afulani,

2015; Bengle et al., 2010; Pooler & Srinivasan, 2019; Srinivasan & Pooler, 2018; Sattler

et al., 2014; Sattler & Lee, 2013 as cited in Caouette et al., 2020). Five studies reviewed

showed a correlation with poorer health outcomes for food insecure individuals due to the

inability to afford to adhere to the recommended medication regiment (Bengle et al.,

2010; Pooler & Srinivasan, 2019; Srinivasan & Pooler, 2018; Sattler et al., 2014; Sattler

& Lee, 2013 as cited in Caouette et al., 2020). While THRIVE doesn’t offer services that

assist with the management of medication, there are individuals who work with clients to

apply for medical insurance (M. Retzlaff, personal communications, September 7, 2022).

Nursing Diagnosis/Plan/ Intervention

Individuals who are food insecure are less likely to be able to access foods that

provide their bodies with proper nourishment to function (Food and Agriculture

Organization of the United Nations as cited in Thomas et al., 2021). An appropriate

nursing diagnosis for this population could be “Imbalanced Nutrition: Less Than Body

Requirements related to economic factors” (Ackley & Ladwig, 2011, p. 575). A plan of

care for this client could be connecting the person to community resources that provides

food such as THRIVE Peninsula (Ackley & Ladwig, 2011). Additionally, assessing the

patient’s ability to feed their self independently (Ackley & Ladwig, 2011). From a

nursing standpoint assessing an accurate weight would also be important to ensure weight
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was being gained from sustenance consumed (Ackley & Ladwig, 2011). An expected

patient outcome would be, the client would be able to steadily gain weight to meet

appropriate BMI within two months of working with community partner (Ackley &

Ladwig, 2011)

For the adult population, chronic stress is a recognized factor linked with food

insecurity (Afulani et al., 2018; Bergman et al., 2019; Jones, 2017 as cited in Hawkins &

Panzera, 2021). A suitable nursing diagnosis for this community would be: “stress

overload related to inadequate financial resources” (Ackley et al., 2011, p. 804). A plan

of care for this client would include identifying the current stressors in regards to food

insecurity (Ackley et al., 2011). Client could be connected to positive community

resources to reduce level of stress (Ackley et al., 2011). The nurse should assess the

patient’s support system and ensure client has effective coping mechanisms for managing

stress (Ackley et al., 2021). An expected patient outcome would be the patient is able to

verbalize a stress reducing technique after one week of teaching (Ackley et al., 2021).

Conclusion

In conclusion, food insecurity is a multidimensional problem that impacts

the Newport News, VA area (Feeding America & Conduent Healthy Communities

Institute, 2022). Community involvement and awareness can assist those in need with

feeling less ashamed for seeking help (Rao, 2021). Destigmatizing food assistance

resources is a potential way to reduce the food insecurity rate in Newport News, VA

(M. Retzlaff, personal communications, September 7, 2022).

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Honor Pledge

I pledge to support the Honor System of Old Dominion University. I will

refrain from any form of academic dishonesty or deception, such as cheating or

plagiarism. I am aware that as a member of the academic community it is my

responsibility to turn in all suspected violations of the Honor Code. I will report to a

hearing if summoned.

Signed: Mariah Hart

Date 11/04/2022
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References

Ackley, B., & Ladwig, G. (2011). Imbalanced Nutrition: less than body requirments. In

Nursing Diagnosis Handbook (9th ed., p. 575). Mosby Elsevier.

Ackley, B., Ladwig, G. & Como, J. (2011). Stress Overload. In Nursing Diagnosis

Handbook (9th ed., pp. 804-805). Mosby Elsevier.

Caouette, S., Boss, L., & Lynn, M. (2020). The relationship between food insecurity and

cost-related medication nonadherence in older adults: a systematic review. AJN

The American Journal of Nursing, 120(6), 24-36.

Feeding America & Conduent Healthy Communities Institute. (2022, October). Food

Insecurity Rate. ghrconnects.org. Retrieved November 4, 2022, from

https://www.ghrconnects.org/indicators/index/view?

indicatorId=2107&localeId=2990&localeFilterId=281263

Feeding America. (2020). Food Insecurity among Overall (all ages) Population in

Virginia. feedingamerica.org. Retrieved November 4, 2022, from

https://map.feedingamerica.org/county/2020/overall/virginia

Hawkins, M., & Panzera, A. (2021). Food insecurity: A key determinant of health.

Archives of Psychiatric Nursing, 35(1), 113-117.

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Kopparapu, A., Sketas, G., & Swindle, T. (2020). Food insecurity in primary care:

patient perception and preferences. Family Medicine, 52(3), 202-205.

Rao, S. (2021, July 20). Urban farm in Newport News aims to reduce food insecurity. It’s

not a “handout” its a “hand up.” Daily Press. Retrieved November 4, 2022, from

https://www.dailypress.com/news/vp-db-hampton-roads-agriculture-072121-

20210720-7otndqvow5ghbm4gfblyyqikvi-story.html

Reyes, J. (2019, March 21). Statewide discussion on reducing hunger coming to Newport

News. Daily Press. Retrieved November 4, 2022, from

https://www.dailypress.com/news/newport-news/dp-nws-newport-news-

notebook-20190319-story.html

Riverside. (2016; 2019). Community Health Needs Assessment: Exhibit I-C Mortality

Profile, 2016. In riversideonline.com.

https://www.riversideonline.com/about/community/community-health-needs-

assessments

Thomas, M. K., Lammert, L. J., & Beverly, E. A. (2021). Food insecurity and its impact

on body weight, type 2 diabetes, cardiovascular disease, and mental health.

Current Cardiovascular Risk Reports, 15(9), 1-9.

United States Census Bureau. (2021). QuickFacts Newport News City, Virginia.

census.gov. Retrieved November 4, 2022, from

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https://www.census.gov/quickfacts/fact/table/newportnewscityvirginia/

PST045221

United States Census Bureau. (2021). QuickFacts Virginia. census.gov. Retrieved

November 4, 2022, from https://www.census.gov/quickfacts/VA

United States Census Bureau. (2021). QuickFacts United States. census.gov. Retrieved

November 4, 2022, from https://www.census.gov/quickfacts/fact/table/US#

USDA. (2022, October 4). Food Security and Nutrition Assistance. usda.gov. Retrieved

November 4, 2022, from https://www.ers.usda.gov/data-products/ag-and-food-

statistics-charting-the-essentials/food-security-and-nutrition-assistance/