Adult Family Health Promotion, Term Paper Example

Abstract

Health promotion has become an essential aspect of health care delivery internationally to the extent that the Adult Nurse Practitioner’s role in delivery of such care has become more complex. In the following pages of this document health promotion from the perspective of the advanced nurse practice will be outlined. Aspects related to roles and responsibilities in maintain health and well-being within a family structure whose loved one is diagnosed with Obstructive Pulmonary Disease (COPD) will be embraced.

Introduction

Family Description

Mr. JM is a retired professor of a renowned university in the city. He is 70 years old and lives with his 68 year old wife to whom he was married for 40 years. Together they have five adult children, four girls and one boy ages 38, 36, 34,30 and 28.The boy is 34 years old and works as a medical professor at a university hospital. Two of the four daughters are state attorneys with the third daughter working in her own business as respectable entrepreneur.Thefourth daughter is a nursing administrator.

Altogether there are 10 grandchildren, five boys and five girls ranging from the ages of 18 to five. Two of the 10 grand children attend college while the others attend high, middle and elementary schools, respectively. The extended family structure encompassed Mr. JM’s 95 year old father and his wife’s 90 year old mother who both reside in Assisted Living facilities. Adult family members own their own homes and reside in affluent communitiesaround the city.All adult children are married. The family religious tradition is Christian.

Family Roles

Roles in the family are shared among adults and children. Husbands function as the main providers even though women work outside of the home as well. Women are the main homemakers even though they employ helpers to take care of smaller children and conduct house chores. Children have daily house chores after completing homework. These include washing dishes, clothes, cleaning up their rooms and play places.

Training of children becomes the responsibility of adult parents. Parents ensure that there is a strong relationship between/among them as well as their siblings. They model how to be modest, kind and express simplicity. This is a traditional value transferred from generations. Also, there is a strong bound of sharing financialresponsibilities. They pool resources to keep out of debt and enhance the family’s economic progress.

Health Practices/Needs

The family tradition focuses on a belief in scientific medicine. Even though Mr. JM smoked tobacco relentlessly for over 50 years he still keeps doctors’ appointments. His wife is hypertensive and currently takes atenolol 10 mgs. Reports are that she does not take the medicationevery day because she is trying to loseweight. This was in response to what she understood her primary care physician to have said. However, she has a blood pressure monitor and takes the blood pressure daily.

Mr. JM was diagnosed 10 years ago with chronic obstructive pulmonary disease. His primary care physician advised that he quits smoking, but according to this wife he continues doing it anyway because he was smoking since a boy. However, he has a persistent cough; coughs up light yellow sputum and occasionally becomesbreathless.He is obese and has an unusually high abdomen, which sometimes adds to the abdominal discomfort he experiences.

When taking the family history Mr. JM admitted that his father was diagnosed with the same condition years ago being a smoker from his youth too. His commendation was that is father is still alive smoking occasionally and doing fine. He proposed doing the same until he dies in his defense for continuing to smoke.

Chronic Obstructive pulmonary disease is the third leading cause of death in the United States of America. Smoking is known to have had the greatest effect on progression of the disease being its main source (Nathaniel et.al, 2007). Intervention in Mr. JM’s case points towards the need of controlling progression of the disease and maintaining a high quality of functioning.

His wife who appears to be much healthier is responsible for preparing his meals and seeing that he takes his medication. Sometimes, she complained that he refuses the pills because he feels that they were making him put on weight and feel worse. When his children visit they would advise him to take his medication, but cannot make him do it.

Family Relationships/Roles

ANP Specific Role Functions in Relation to Family Needs

The Adult Nurse Practitioner (ANP) renders health services complimentary to a primary care physician. Generally,they augment other health care professionals as team leaders, but can also function as a primary care provider.ANPs have the opportunity of makingautonomous decisions and are held accountable for them (Leik, 2008).

Specifically, their role encompasses receiving patients with undiagnosed conditions, conducting an assessment, making a diagnosis, planning and implementing strategies for their care. Adult nurse practitioners conduct their intervention from a highly evidence based perspective and the skills that they receive during training prepare them to function at a much higher level than a Registered Nurse in caring for adults ( Leik, C. (2008).

Studies show where ANPs play a very significant role in Adult family health. 95 % of the adult nurse practitioners indicated that they are privileged to prescribe medications in their current practice; 87%reported that they were required to have a physician collaborator or supervisor in their practice setting, and 48% had hospital visitation privileges. Further, 40 % of their time was spent with aging adults 65 years and older such as MR. JM.64% of ANP researched admitted to spending 30-49 hours per week with their clients (National Survey Results, 2008).Therefore, in discussing the role of an ANP in addressing the needs of this family, inevitably the functions of leader, educator, researcher, consultant, clinician and case manger must be embraced.

Leader and Educator

The nurse concept embedded in the portfolio ‘Adult Nurse Practitioner’ places this professional as leader of the nursing service team. Importantly, he/she is more thorough in making assessments beyond the boundaries of a community health nurse. As such, nursing service relies on these skills for guidance in the decision making process. In this adult family assessment, the ANP can provide advanced leadership care in restoring Mr. JM’s health and serve as a primary health care provider for the family.Importantly, Adult Nurse Practitioners provide leadership in several areas of nursing management.

In relation to the role of educator ANPs  have the capability of referring this family for additional educational counseling due to their medication management misinterpretations or conduct these sessions themselves. They are endowed with problem solving techniques relevant to executing education programs for resolving smoking problems and adjusting cultural beliefs that could affect the outcome of a person’s health as in the case of Mr. JM’s family.

Researcher and Consultant

Adult Nurse Practitioners conduct research by adding to the body of evidence based knowledge. They apply their practice to individual needs by collecting data that would assist in the assessment, planning and implementation of projects suited for adults with chronic illnesses. In many cases, adults such as Mr. JM become prime research candidate for a case study regarding chronic smokers and sequel of the disease.

In the capacity of a consultant ANPs examine patients for undiagnosed problems. Through an advanced nursing process framework they assess health care needs from the perspective of a contemporary knowledge base inclusive and beyond those exercised by nurses. These pertain towards conducting physical examinations; ordering diagnostic testing and evaluation for early signs of illness. The process is continued by making differential diagnoses using decision-making and problem-solving skills (Mundinger et.al, 2000).

Clinician and Case manger

Functioning as a clinician the ANPcollaborates with other health professionals and disciplines in extending care to adult clients. For example, if Mr. JM’s condition deteriorates and the intervention of a respiratory therapist becomes necessary the ANP would collaborate services in managing the client’s respiratory distress. Also, they would link skillsin ordering appropriate investigations as well as provide treatment intervention from both the individual and family perspective. This team work creates a wider scope for addressing each issue form a specialty paradigm.

As a case manager the ANP’s responsibility is to plan appropriate health care interventions for Mr. JM’s COPD. This should include referral to agencies that would assist in physical exercise of a therapeutic nature to keep him active throughout his illness.  The ANP can refer him tosocial workers who can suggest alternatives to his tobacco addiction. Coinciding with these roles, ultimately the ANP has the authority to admit or discharge patients from his/hercaseload or refer JM to other health care specialists as it seems appropriate.

Influence of Family Members’ Role on Health

This family culture relates towards respect for health care professionals and health intelligence. Mr. JM’s son is a Medical Doctor and one of his daughters is an Advance Practice Nurse Manager. Obviously they must be counseling him on his tobacco smoking and the dangers to his health. Even Mrs. JM declared that her husband insists on smoking his tobacco, which seems to be a family culture because his 95 year old father still smokes even though is diagnosed with the same condition.

The nursing dilemma lies in influencing Mr. JM to desist from smoking as many packs of tobacco per day to none. A very strong influence is Mr. JM’s father who is still alive at 95 and living with the condition. Emotionally, the family appears to be very closely knit with each one felling responsible for the other’s wellbeing. However, Mr. JM has his unique secret health paradigm as a professor.

Prevention and Health Promotion Strategies

Plan

Five standards of care have been espoused by the Chronic Respiratory Disease Service Improvement Framework (CSIF). They are COPD prevention; early diagnosis of COPD; management of stable COPD; treatment and support during acute exacerbations, and care and support at end of life (Department of Health, Western Australia, 2012).

JM’s health promotion strategy wouldencompass mainly the third and fourth standards pertaining to management of stable COPD and treatment and support during acute exacerbations. Prevention techniques would be developed from the premise of preventing exacerbations through active appropriate management of stable COPD.

Explanation of plan

In management of stable COPD patients/clients such as Mr. JM who have long history of the disease ultimately exacerbations will occur. Already he experiences episodes of breathlessness and still smokes. Therefore, it is imperative that he be alerted to the signs and symptoms of acute exacerbations to quickly contact a health care provider. Precisely, his unique management intervention would encompass techniques for replacing smoking with a healthier activity/ past-time. So far he has never been hospitalized for the condition, which is great for his prognosis.

Social Support for the Family

Fortunately, Mr. JM COPD is not yet critical he has been managing well even though he still smokes. He has never had an exacerbation to keep him hospitalized neither visit the emergency department. Presently, his wife who has to take care of his dietary needs appears comfortable with her duties. However, she is hypertensive and obese.  Obviously, she can benefit from a visiting community health nurse periodically to help in validating her concerns of Mr. JM’s insistence on smoking. Also, while the ANP is quite capable of accomplishing this task Mr. JM may respond to an unfamiliar professional differently.

Application of specific nursing theory

Lemmens (2010) and her counterparts posit that theory-driven models improve the design and evaluation of disease management programs. Its aim is to ensure that health outcomes are favorable. Their study embraced the preposition that a theoretical approach to health care intervention enables the evaluation designs of complex implementation processes to be more transparent. With regards to Chronic Obstructive Pulmonary Disease Management evidence proved that a theoretical approach was beneficial in realizing favorable outcomes (Lemmens et.al, 2010).

The theoretical approach informing JM’s COPD is adopted from the caring theory.This theory embraces three assumptions. First is the carative factor, which involves attending to the individual from a holistic perspective, spiritual, social and physical. Second, pertains to establishing a transpersonal caring relationship whereby the nurse and the patient develop way to resolve health issues leading to wholeness. Thirdly, caring moments when the ANP devotes  considering time to educate, counsel and listen uninterruptedly to the client and family’s concerns (Watson, 1988).

This family care plan embraced these three major assumptions in achieving a favorable outcome of Mr. JM‘s COPD intervention. Management of stable COPD displayed a caring model by taking time to educate and evaluate for predisposing issues that cause an exacerbation. A transpersonal approach was adopted when family roles played a great part in influencing Mr. JM’s response to caring.Devoting time to this family to listen Mr. JM and wife is another strategy derived from the caring model.

Conclusion

The foregoing discussion embraced an Adult Family health promotion intervention. Mr. JM was identified as the focus of a nuclear family structure. He has a family history of COPD and continues to smoke regardless of encouragement to quit. The ANP’s role was fully addressed functioning as leader, consultant, researcher, clinician, case worker and educator. A COPD plan was developed based on the five standards of care for patients afflicted with the disease. Finally, explanations of the caring theoretical model were integrated to show how it informed Mr. JM’s health care planning.

References

Department of Health, Western Australia (2012).Chronic Obstructive Pulmonary Disease Model of Care. Perth:  Health Networks Branch, Department of Health, Western Australia.

Horrocks, S., Anderson, E., & Salisbury, C. (2002). Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. British Medical Journal, 324, 819-823.

Lemmens, K. Nieboer, A. Rutten-Van Mölken, M. van Schayck, C.  Asin. J.  Dirven, J., & Huijsman, R. (2010). Application of a theoretical model to evaluate COPD disease management. BMC Health Services Research, 10(81)

Leik, C. (2008).Adult Nurse Practitioner Intensive Review: Fast Facts and Practice Questions. New York. Springer Publishing company.

Mundinger, M.O., Kane, R.L., Lenz, E.R., Totten, A.M., Tsai, W.-Y., & Cleary, P.D. (2000). Primary care outcomes in patients treated by nurse practitioners or physicians: A randomized trial. Journal of the American Medical Association, 283(1) 59-68.

Nathell, L. Nathell, M. Malmberg, P., & Larsson, K. (2007). COPD diagnosis related to different guidelines and spirometry- techniques. Respiratory research 8 (1): 89

National Survey Results (2008).2008 Role Delineation Study: Adult Nurse Practitioner. ANNC

Watson, J. (1988). Nursing: Human science and human care. A theory of nursing (2ndprinting). New York: National League for Nursing.