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Understanding the health care system at a local level is important when researching evidence-based practice. Determining the needs and perceptions of a population that are being studied and attempted to change is an important factor. If the local area that is being researched is rural, resources will be limited to health care. If urban areas are being researched, there are more resources and populations to consider. If the health care system issues are not of interest or don’t apply to areas, then they are less likely to be supported for change. The United States health care system continues to struggle and “our nation struggles with persistent health disparities and rising health care costs, nurses have a moral obligation to shape health and social policy in ways that will advance the health and well-being of the public” (Mason, 2016). Nurses can continue to bring crucial perspectives to promote safety and healthy well being to our communities and neighborhoods. 

     Working with my preceptor, one of Adventist Health Sonora uses redesign projects that call for a pre-op nurse navigator to coordinate evidence-based practices for optimization of the pre-op patients like BMI, smoking, diabetes. The position is not held so working on ways to accomplish pre-op optimization in a way that patients are still getting these practices. A care redesign example is for care of patients with cellulitis/soft tissue injury and the algorithm includes consulting with an on-call podiatrist and/or limb salvage center and that position is not held so this has been adapted by the Wound care team for consults. 

     Increasing one’s knowledge about communities and health disparities can be accomplished in many ways. Understanding the needs of the local levels can increase the ability to care for patients of these populations.