Health Promotion, Research Paper Example

Health promotion is important to the present day United States because we are now a country defined by chronic illnesses and increased morbidities. While many Americans strive to make healthy choices, a good majority of the country participates in the habits that have caused an increase in hypertension, diabetes, and heart disease (World Health Organization, 2012). The goal of health promotion is to use a combination of education, one’s environment, and organized activities to support the positive living conditions that are conducive to the positive quality of health for an individual or group of individuals (Pender, Murdaugh, & Parsons, 2006). This article aims to examine an adult and family, the relationships and roles incurred within, and offer a prevention and health promotion plan geared towards achieving better health.

Adult/Family Description/Profile/Relationship/Roles

R.D. is an 80 year old white male born in Russia and has lived in the United States for the past 36 years. He is married to S.D., but she is currently in rehab suffering from a broken hip and her health status has been progressively declining. Currently, R.D. is living with his son, Q.D. on a temporary basis and is not adjusting to this situation well. R.D. is suffering from depression due to the loss of his independence because of health reasons and the fact he feels as if he is imposing on Q.D. and the family. R.D. is in a wheelchair and has a history of diabetes mellitus, hypertension, increased cholesterol, gout, and spinal stenosis. Q.D. previously reported his father experiencing facial drooping, aphasia, and significant dysphagia. He was admitted to an acute care facility, and then discharged to a rehab facility before being fully discharged into the supervised care of his son.

Health Practices/Health Needs

R.D. is currently having a problem following his self-guided regimen due to his overwhelming anxiety concerning his wife. However, under normal circumstances, his health needs and practices would fall into the classification of self-care and individualistic needs for as long as R.D. has the ability to care for himself. When he loses that ability, the self-care approach may still apply, albeit under a different classification due to it being a dependent-care approach because Q.D. would essentially be the individual administering care to his father.

R.D. is treated for hypertension with Lisinopril 10mg twice per day. Due to the recent CVA incident, it was decided that he should add Amlodipine 5mg once per day and strive to maintain a goal for his blood pressure to remain at a level of less than 130/80 mm/Hg. Because of his high cholesterol and recent CVA, R.D. was also prescribed Lipitor 10mg once per day. One of the largest risk factors for heart disease is high cholesterol. Over time, the cholesterol circulating in an individual’s body will harden on the walls of the arteries and they will become smaller, thus inhibiting blood flow and increasing blood pressure as well as predisposing an individual for heart disease or a heart attack. It is also a known fact that diabetes will increase an individual’s chances for heart disease as well. Our patient suffers from both conditions (World Health Organization, 2012).

R.D. has a chronic condition with diabetes mellitus and it is most likely due to being overweight. Chronic obesity is a known precursor to Type II diabetes mellitus and also is a known cause of a host of other secondary conditions such as retinopathy, neuropathy, heart disease, liver problems, and kidney problems. Diabetes can be controlled in most instances with both diet and exercise or a combination of medication and diet/exercise (World Health Organization, 2012). He was educated on the importance of decreasing and monitoring his blood glucose level as a way to control his condition. He was prescribed Levemir 25 units once per day.

Family Relationship/Roles

Due to the more recent changes in the delivery of healthcare, nurses are finding themselves as participants in more roles with regard to the delivery of care to a patient. There is now an ample opportunity for advanced practice nurses to provide quality care at a superior level that has not historically been seen. This will essentially set a precedent for other nurses in the future to follow and will guide the entire nursing community as the field of nursing evolves (Furlong & Smith, 2005).

The roles of an ANP are currently defined as being a leader, educator, researcher, consultant, clinician, and case-manager. R.D. is not adhering to his current medication regimen because of the anxiety he feels regarding his wife and her decreasing health; however, it is important that the ANP serve in these defined roles so he can return to his previous regimen with the added medications and achieve optimal blood pressure, glucose levels, and overall health in order to gain back some of his much desired independence.

Leader, Educator, Researcher, Consultant, Clinician, and Case- Manager

Leader/Educator. The definition of leadership can be surmised best by describing it as both an art and science where an individual or group of individuals is encouraged to move towards the achievement of positive goals. This can include using various strategies, plans, and dynamics to envision this change and following through with its implementation. ANPs teach evidence-based methods and strategies for how best to handle situations when patients’ needs are concerned (Bryant-Lukosius, DiCenso, Browne, & Pinelli, 2004).

Researcher/Consultant. The role played by an APN in research also aids the nursing community by using the knowledge obtained from evidence-based practice and bridging the gap with research trends to further apply this knowledge in other settings and thus obtain new information which could be utilized in a variety of settings for the future. This helps in the APN’s consultant role as well because it requires planning, strategy, and practice in order to follow through from beginning to end (ICN, 2012).

Clinician/Case Manager. An APN is effective as a clinician due to the skills and knowledge that he or she has acquired in the diagnosis and treatment of diseases in a multitude of patients and environmental settings (ICN, 2012). The case-manager role is primarily associated with collaboration, assessment, evaluation, and implementation of various services to help with the healthcare needs of individuals as well as the costs associated with the treatment of these illnesses (Bryant-Lukosius, DiCenso, Browne, & Pinelli, 2004).

ANP Specific Role Functions re Family Needs

To have a successful health promotion plan for R.D., it is important for the APN to utilize all of the previous roles explained. In terms of leadership, the ANP should be key in the creation of goals and strategies that will motivate R.D. to achieve optimal health and decrease his hypertension, high cholesterol, and glucose levels. In terms of education, it is vital that the ANP educate the entire family about the chronic conditions that R.D. has because these are sometimes genetically predisposed and the son should especially understand the benefits of taking control of his life in a positive manner now rather than suffer a chronic illness later. The APN will serve as a researcher in the development of R.D.’s personalized health promotion plan tailored to him and based on evidence-based practices. The ANP will utilize the consultant’s role to collaborate with other professionals in order to ensure R.D. is adequately being assessed in case he should later be referred for another consultation. As a clinician, the ANP will create a plan directly aimed at increasing R.D.’s quality of health. In the role of case-manager, the ANP will ensure the above needs are all met while keeping health costs as low as possible.

Influence of Family Member Roles on Health

Families who have support systems will normally have a more positive influence in the achievement of their healthcare goals and will improve their lifestyle rather than those families who lack the support system needed for this to happen (Whitehead, 2003). Health promotion is important for encouraging patients to adapt to a new lifestyle so they may live a longer and healthier life free from chronic illnesses or with these illnesses under control. Families should be evaluated as to whether or not the support network is there when considering this method of promotion in the assessment plan for a patient (Whitehead, 2003).

Prevention and Health Promotion

Plan: Prevention/Health Promotion for Adult Family

In this particular case, ANPs have the ability to make a difference by implementing strategies to help the patient steer his health back on track and educate the family on the avoidance of diabetes mellitus, hypertension, high cholesterol, and obesity through a combination of diet and exercise. These two steps would be the beginning of a health promotion plan. In order to manage the chronic conditions, R.D. should have the ability to help set his own goals and mechanisms that will motivate him to meet those goals. This will help with his feeling of independence.

Health Promotion Plan for Adult Family

Effective Discussions. Open communication is vital when educating the family on the importance of proper nutrition, increased physical activity, and the measures needed to avoid obesity (Whitehead, 2003). It is essential that the APN have an open-mind and not appear judgmental in the conversation because topics such as these are often looked down upon and this will only cause the problem to become worse over time.

Goal Setting. In order for this health promotion to move forward, R.D. and the APN should work as a team in setting attainable goals for the reduction of his blood pressure and glucose levels (World Health Organization, 2012). It has been proven that a decrease in one’s weight will, more often than not, reduce blood pressure, decrease glucose levels, reduce cholesterol, and help with a vast array of other problems, many of which R.D. could likely be suffering from…albeit in silence. It is realistic to attempt ¼ to ½ a pound per week due to the fact R.D. is now confined to a wheelchair. Studies have shown, however, that increasing one’s heart rate modestly will help in the fat burning process and overall reduction of weight (World Health Organization, 2012), which is R.D.’s goal. This would likely help with his need for more independence.

Tools for Success. The APN should also provide the family with information about how exercise and diet modifications will benefit their overall health in the long term. This will be beneficial to them from a health education standpoint because it will allow them a chance to ask any questions they may have and also serve as a constant reminder if there is an area they might not fully understand later when they are in their own individual implementation phases with the health promotion plan. There are many tools that offer education from a health standpoint and are patient friendly as well as informative (Pender, Murdaugh, & Parsons, 2006). The APN would be required to research these tools and choose the one that best fits R.D.’s situation and that of his family.

Outcome Measures. Because R.D. is confined to a wheelchair, his weight loss will be slower than that of an otherwise healthier person; most individuals lose an average of 1 to 2 pounds per week when dieting and exercising properly and are successful at sustaining this. R.D. should begin his endeavor with ¼ to ½ a pound per week and move up from that point as the APN deems necessary based on his diet and motivation (World Health Organization, 2012). It will be necessary for him to have routine visits during this time in order to stay on his course and also receive additional encouragement if needed.  

Social Support Needed by Adult/Family

In order for long term success to be achieved, there should be some kind of support system, as previously stated. There is a strong correlation that emotional support offered from family and friends will help with motivation and encouraging words will help during a time of need (Bryant-Lukosius, DiCenso, Browne, & Pinelli, 2004). R.D. seems to have a support network because he lives with his son and it is assumed that his son wants to provide the best care possible for his father. Also, R.D.’s wife could be a source of quiet support because if he feels that his improvement in health would make her happier, this may very well be the motivation needed to push him the right direction when all else might fail.

Also, if R.D. could find other peers similar in age that he could talk with and socialize with a few times per week, it would help with the social factor and most likely would decrease his feelings of depression. This could also take some of the stress off of his son, Q.D., as he would begin to notice his father feeling better and essentially looking better as a result.

 Nursing Theory Application re Plan/Implementation

The health promotion concept found to be closely related to the events presented in the above article would be most applicable to Dorothea Orem’s Theory of Self-Care. It is applicable in this case because the self-care aspect can be used on R.D. as he attempts to care for himself with a regimen of medication, diet, and exercise. It can also be applicable with the dependent care component as applicable to Q.D., the son, as he attempts to care for his father once the father’s independence fails and it is necessary for someone to oversee this medication and healthcare regimen (Smith, 1989).

The use of Orem’s Theory of Self-Care in this situation would prove helpful and provide the APN with the ability to incorporate the knowledge and skills acquired in nursing as well as utilize the roles of an APN to educate the patient and his family on the proper way to carry out the health promotion plan. While there could be more than one applicable theory to use in this situation, this theory best resonates with this author because it allows for the APN to first, provide care for an individual, and then educate that individual and the family about the subject so they may begin taking responsibility for their own health issues.

Summary

While it is important to treat the patient and ensure the proper delivery of care is met, often the family of the patient is in need of proper education so they have the ability to remain informed and be proactive as well. This is especially true if the care in question concerns a chronic disease process that could possibly be avoided such as diabetes mellitus or obesity. Health promotion is essential to the field of nursing because it allows the nurse the ability to treat both the patient and the family of the patient, when possible, in order to ensure as many individuals as possible are educated on the proper way to achieve optimal health and also offer support to their loved one who is suffering from the chronic condition. This will go far in ensuring that he or she received the emotional support and motivation needed to meet his or her goals.

References

Bryant-Lukosius, D., DiCenso, A., Browne, G., & Pinelli, J. (2004). Advanced practice nursing roles: Development, implementation and evaluation. Journal of Advanced Nursing, 48, 519-529.

Furlong, E., & Smith, R. (2005). Advanced nursing practice: Policy, education and role development. Journal of Clinical Nursing, 1055-1066.

ICN. (2012). Definitions and Characteristics of the Role. Retrieved from International Council of Nurses: http://www.icn-apnetwork.org

Pender, N., Murdaugh, C., & Parsons, M. (2006). Health promotion in nursing practice (5th ed.). Upper Saddle River, NJ: Pearson Prentice Hall.

Smith, M. (1989). An application of Orem’s theory in nursing practice. Nursing Science Quarterly, 2, 159-161.

Whitehead, D. (2003). Evaluating health promotion: A model for nursing practice. Journal of Advanced Nursing, 41(5), 490-498.

World Health Organization. (2012). Data and statistics. Retrieved from WHO: http://www.who.int/research/en/