Nrs 303 - Health Promotion Paper PDF

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Running head: THE HEALTH PROMOTION MODEL

Application of Pender’s Health Promotion Model College of Staten Island: CUNY

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THE HEALTH PROMOTION MODEL

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This paper shows the importance of the Health Promotion Model (Pender et al., 2010) and how it relates to not only all individuals but specifically the individual written about. After interviewing the individual using the Health Assessment Tool (Lunney, 2009) and identifying their current health needs, a plan of action is then put into place to address those needs. To accomplish this, a few nursing diagnoses are decided upon that each fit the interviewee’s current problems. Two of these nursing diagnoses were then chosen to benefit the client. Using critical thinking, the goal is to work in collaboration with the interviewee to decide upon the best interventions and outcomes possible. This is done to create the most beneficial plan of action that the interviewee will be likely to follow. Using both the Health Assessment Tool (Lunney, 2009) and the Health Promotion Model (Pender et al., 2010) simultaneously is an excellent tool for nurses to apply with all patients.

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Application of Pender’s Health Promotion Model After contemplating on who to interview with the Health Assessment Tool (Lunney, 2009) the choice is clear to me. The assignment was to use the findings from the assessment tool to develop the best quality health promotion outcomes for the interviewee. The person I decided to interview and use the Health Promotion Model (Pender et al., 2010) on was an 85-year-old woman who I will only use their initials for throughout this paper to preserve their identity. After interviewing this person and identifying their top health promotion needs I will develop a plan of action that can best help them. Health Promotion Assessment In my scenario, the woman interviewed with the Health Assessment Tool (Lunney, 2009) was an 85-year-old woman who will be referred to as O.L. in this paper. The interview started with asking questions related to her health perception/ health management pattern. This individual had a unique perspective on health and defined it as not only achieving optimal wellness for herself but also seeing her family and friends healthy as well. When asked what this meant O.L. said that seeing them healthy adds to her health and prevents her from having unneeded stress. O.L. lives with her daughter, her son-in-law, one of her granddaughters and her son who has Down syndrome. She doesn’t leave the house often, only when taken to the doctor and tries to stay active by taking care of her handicapped son even though he is starting to go through an early stage of dementia. O.L. describes herself as healthy but she has frequent urinary tract infections and is going through an early stage of dementia herself. O.L. has fallen a few times in the past year and is afraid of it happening again. She has a home health aide that comes 6 days out of the week that she has had for over 2 years now. O.L. eats healthy and has all of her

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meals prepared for her with fresh ingredients. She is at a normal weight and looks physically healthy. O.L. either grooms herself or has help from the aide daily. She stated her major concern is the frequent urinary infections. With the help of a plan of action, her family, friends, and aide I think that she will able to both overcome this health problem and the other health problems she is currently dealing with. Individual Characteristics and Experiences Individual characteristics and experiences, as stated in the Health Promotion Model Manual (Pender et al., 2010), are “prior related behavior and personal factors: biologic, psychosocial, sociocultural.” These are both important to assess because they make it easier to determine if the individual knows how to deal with a specific health problem if they have dealt with it in the past. The following sections discuss the results of these after using the Health Assessment Tool (Lunney, 2009) on O.L. Prior Related Behavior Prior related behavior, as stated in the Health Promotion Model Manual (Pender et al., 2010), are “frequency of the same or similar health behavior in the past”. This is important to assess to determine if the health problem occurring is a new one or has happened before. O.L. stated that her major concern was the frequent urinary tract infections that she has been having for the last year. This health problem is affecting her ability to sleep normally. She is frequently urinating and doesn’t want to consume as many liquids throughout the day. O.L. is also experiencing an early stage of dementia. She has had frequent falls over the last year. Personal Factors: Biologic, Psychosocial, Sociocultural Personal Factors: Biologic, Psychosocial, Sociocultural, as stated in the Health Promotion Model Manual (Pender et al., 2010) are “general characteristics of the individual that influence

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health behavior such as age, personality structure, race, ethnicity, and socioeconomic status.” This is important to determine because after finding out these characteristics it is easier to understand their health behaviors. The age of O.L. is 85-years-old so how that influences her health behavior is different from how a 21-year-old’s age influences theirs. The main priority for this individual, even more so than her heath was her family. Throughout her life, she has maintained a healthy lifestyle and therefore she is most likely going to follow a proper health promotion plan if given one. The only problem she would have with following the plan would be the early stage of dementia that she is dealing with. O.L. lives in a middle-class income family but no amount of money is an issue when it comes to the health of either her or her family. It’s hard to tell if it is her religion, age, personality structure, race, ethnicity, or socioeconomic status that makes her who she is but the fact that she puts the health of everyone else in front of her own is extremely admirable. Behavior Specific Cognitions/Affect Behavior specific cognitions/affect, as stated in the Health Promotion Model Manual (Pender et al., 2010), are “perceived benefits of action, perceived barriers to action, perceived self-efficacy, activity-related affect, interpersonal influences, and situational influences.” These are all important to assess because they make it easier to determine how likely a person is to follow a health promotion plan of action. All the following sections discuss the results of these after using the Health Assessment Tool (Lunney, 2009) on O.L. Perceived Benefits to Action Perceived benefits to action, as stated in the Health Promotion Model Manual (Pender et al., 2010), are “perceptions of the positive or reinforcing consequences of undertaking a health behavior.” This is important to discuss because if you know why you should fix a problem and

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how to overcome it then you can live a healthier, more stress-free life. Frequent urinary tract infections are taking over her life and she is voiding as frequent as every 20 minutes. This is preventing her from sleeping throughout the night in fear which is causing other health problems. The early stage of dementia needs to be discussed and she can also learn the best possible way to deal with this. Lastly, O.L. falling can benefit from action and can be easily fixed through different interventions. These will all be discussed in detail later in the paper. Perceived Barriers to Action Perceived barriers to action, as stated in the Health Promotion Model Manual (Pender et al., 2010), are “perceptions of the blocks, hurdles, and personal costs of undertaking a health behavior.” These are important to address because without confronting these barriers a proper plan of action cannot be created. There are multiple barriers that can prevent proper action from being done. Unfortunately, the primary barrier is one that is difficult to fix which is her taking care of her 57-year-old son with Down syndrome who is going through an early stage of dementia. Fortunately, O.L. also lives with other people but this is still a barrier that needs to be addressed. O.L. also has the barrier of going through an early stage of dementia so following any plans of action without the help of other people might be difficult. Perceived Self Efficacy Perceived self-efficacy, as stated in the Health Promotion Model Manual (Pender et al., 2010), is “judgment of personal capability to organize and execute a particular health behavior; self-confidence in performing the health behavior successfully”. This is important to assess to determine how well the person relies on other people and can follow a plan of action by themselves. As many problems as I’ve listed for O.L. she still seems to be very self-efficient. Even with these challenges she overcomes and considers herself very efficient. She prepares

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meals, cleans, and lives her life through the best of her abilities. O.L. was always a hardworking individual and doesn’t let her health problems impede her living. She doesn’t leave the house much but she still has a strong self-esteem and holds herself in a positive light. Even with these problems she truly considers herself to be healthy and tries to be the primary caretaker of her handicapped son. O.L. states no concerns with her body other than her urinary problems which she has no control over. Activity Related Affect Activity related affect, as stated in the Health Promotion Model Manual (Pender et al., 2010), are “subjective feeling states or emotions occurring prior to, during and following a specific health behavior.” This is important to ask about because to devise a plan of action to best suit the interviewee you need to first determine the person’s feelings or thoughts with a health behavior. Her thoughts vary day to day on her health problems. One day O.L. might feel confident in her abilities to take care of herself and the next day feel dependent on her home health aide or family members. She can take care of herself most days with such matters as bathing, dressing, toileting. When dealing with frequent urinary tract infections O.L. feels helpless. Interpersonal Influences: Family, Peers, Providers, Norms, Support Interpersonal influences, as stated in the Health Promotion Model Manual (Pender et al., 2010), are “important sources of interpersonal influence that can increase or decrease commitment to and engagement in health promoting behavior”. This is important to assess to determine who can help the best in a plan of action. It is important to let all influences know the plan to best help get the individual to live as healthy a life as possible. In O.L.’s scenario she is extremely close to her family and always has been. She has 3 daughters, one of which she lives

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with, one son, 6 grandchildren and dozens of other family members that she considers herself close to. O.L. still considers herself as a provider and tries to stay busy in the house doing various activities. O.L. loves her handicapped son and has provided for him his whole life and continues to do so. Her health status hasn’t affected her bonds with her family and friends. Just as she has supported her family throughout her life, they support her now through her more difficult health times. O.L.’s daughter who lives in the same house as her takes care of her medications and tries to form plans of care for her by herself but she isn’t a medical professional. O.L. considers herself blessed to have such a caring and compassionate family. Situational Influences Situational influences, as stated in the Health Promotion Model Manual (Pender et al., 2010) are “perceptions of the compatibility of life context or the environment with engaging in a specific health behavior”. This is important to assess to determine what influences the interviewee’s surroundings have on them that can either benefit or impede the plan of action for the health promotion. O.L. lives in the lower floor of her home where there are no stairs. There are 2 bathrooms that are situated next to both bedrooms in this area of the house which makes them easier to navigate to. Her daughter, her son-in-law and granddaughter live upstairs and have monitors in place so they can see what is going on downstairs. Her family drives her to all her doctor’s appointments and anywhere else that she needs to go. Even with all this O.L. still is the primary caretaker of her handicapped son and both are going through an early stage of dementia. Immediate Competing Demands and Preferences Immediate competing demands and preferences, as stated in the Health Promotion Model Manual (Pender et al., 2010), are “alternative behaviors that intrude into consciousness as possible courses of action just prior to the intended occurrence of a planned health behavior.”

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This is important to assess to determine what the patient does instead of the proper plan of action when the health problems should be addressed. In O.L.’s situation one of her problems is frequent urinary tract infections. Instead of addressing the problem she seems to stay up most nights anticipating the next time she will need to get up. There are other actions that can be done to prevent her from going to the bathroom. O.L. also deals with frequent falls and feels helpless when walking. She would feel more confident if interventions were put in place to deal with this problem. With a proper health promotion plan O.L. should be able to zone out the immediate competing demands and preferences. Commitment to a Plan of Action Commitment to a plan of action, as stated in the Health Promotion Model (Pender et al., 2010), is “intention to carry out a particular health behavior including the identification of specific strategies to do so successfully.” This is important to assess to determine how likely the individual is to be committed to following a plan of action. O.L. is going through an early stage of dementia so it not completely likely that she would follow a commitment to a plan of action. This wouldn’t be because she doesn’t want to follow the plan of action but because she would forget what exactly she should do. Fortunately, O.L. lives with multiple family members that would make sure that she would follow the plan of action. With the help of not only her family members but also her home health aide, O.L. should be able to successfully follow a plan based on my assessment.

Summary of Case Study

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In the first part of the paper we were told to interview a person of our choice using the Health Assessment Tool (Lunney, 2009). The person chosen was an 85-year-old woman who was referred to as O.L. during the first half. O.L. was chosen for many reasons, one of them being that it was known that she has health needs that could benefit from a successful health promotion plan. Some of the needs include frequent urination which is preventing her from living a peaceful life and having a difficult time walking because of a history of falls. O.L. is also living with an early stage of dementia so that could be addressed as well. NANDA nursing diagnoses must be thought of before implementing a health promotion plan. In this part of the paper diagnoses will be discussed based on O.L.’s health needs. One of these nursing diagnoses will be eliminated but 2 others will be accepted and these will be included in the final plan. With the partnership of O.L., the proper nursing diagnoses, nursing interventions classifications (NIC) and nursing outcomes classification (NOC) will be decided upon. By the end of this paper a successful plan will be discussed with O.L. Diagnoses Considered After interviewing O.L. in the first half, a few NANDA nursing diagnoses were considered that could benefit her. One of these nursing diagnoses was eliminated but 2 others were accepted. Based on these accepted diagnoses, NIC and NOC were decided upon so that O.L. could implement them into her routine. It should be stated that none of the NICs or NOCs were decided upon without the involvement of O.L. The one eliminated nursing diagnosis was “Altered thought processes related to loss of memory as evidenced by memory deficit or problems.” As important as it is to address this topic, O.L. didn’t accept this diagnosis. Without her help, establishing NICs and NOCs will not be successful. O.L.’s early stage of dementia will make it harder to follow a plan of action in the future and will need to be addressed at some

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point. Not taking care of her altered thought processes will make it difficult to accomplish other goals. This diagnosis will be discussed in the next section. The next 2 nursing diagnoses that will be discussed were accepted. As mentioned, without the involvement of O.L. the interventions won’t succeed. One accepted diagnosis that will be discussed with the help of O.L. was “Risk for falls related to weakness, poor vision, and balancing difficulties.” This was a priority mentioned by O.L. because of her history of falls. Another accepted diagnosis that will be discussed further was “Altered patterns of urinary elimination related to frequent urinary tract infections as evidenced by dysuria, frequency, nocturia and urgency.” This was an accepted diagnosis because the altered patterns of urinary elimination that O.L. is experiencing is an inconvenience that she is dealing with daily and it isn’t resolving. Both priority nursing diagnoses will be discussed further in this paper.

Altered thought processes r/t loss of memory AEB memory deficit or problems This nursing diagnosis as mentioned was rejected. O.L. is going through an early stage of dementia and this diagnosis relates to her. This is a future priority to address because if you don’t resolve the problem of her memory loss then it will be difficult to help achieve the NOCs of other possible diagnoses. O.L. must be willing to come to terms with her early stage of dementia before being able to accept this diagnosis which she is not quite ready to do. The NICs and NOCs that will be discussed here are some that will be implemented in the future when this diagnoses is more likely to be accepted. According to Jaffe (1991, p. 81), you want to use the following NICs for this diagnosis. The NIC of assessing cognitive functioning, memory changes, thinking pattern, disorientation, sleep, and communication difficulty is one that could be used. Another NIC used for this

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diagnosis mentioned is introducing new ideas and activities slowly with time for gradual adaptation. The rationale included for this NIC is narrowing interests cause difficulty in accepting new ideas or changes. A third NIC mentioned is to limit sensory input and decisions to be made unless able to maintain own role, involvement in activities and independent decision making. The rationale included for this NIC was that it decreases frustration and distractions from the environment; self-assertive attitude may be channeled and promote security. Because O.L. is going through an early stage of dementia it is best to involve family in the plan of care. O.L. might forget ideas that you mention and family can remind her of what should be done. Some NOCs that can be set for O.L in the future include that she can mentally function at an optimum level with modifications and alterations in environment to compensate for deficits, and that she maintains an optimum awareness of environment and orientation preserved (Jaffe, 1991, p. 82). Each of these NOCs should receive a decent score on the 5-point scale, with 5 being the best. The main reason that this diagnosis was rejected was because O.L. had a lack of acceptance for this diagnosis which would make it difficul...