The nursing process And health promotion
Assessing Components of this assessment are the health history and physical examination, physical fitness assessment, lifestyle assessment, spiritual health assessment, social support systems review, health risk assessment, health beliefs review, and life-stress review.
1. Physical Fitness Assessment:
During an evaluation of physical fitness, the nurse assesses several components of the body’s physical functioning: muscle endurance, flexibility, body composition, and cardiorespiratory endurance.
Specific guidelines for obtaining measurements and the optimal values for men, women, and children can be found in physical fitness texts.
Older adults need to be monitored carefully for fatigue during strength and endurance tests.
2. Lifestyle Assessment
Lifestyle assessment focuses on the personal lifestyle and habits of the client as they affect health. Categories of lifestyle generally assessed are physical activity, nutritional practices, stress management, and such habits as smoking, alcohol consumption, and drug use.
Other categories may be included.
Several tools are available to assess lifestyle.
The goals of lifestyle assessment tools are to provide the
following:
1. An opportunity for clients to assess the impact of their present lifestyle on their health
2. A basis for decisions related to desired behavior and lifestyle changes.
3. Spiritual Health Assessment
Spiritual health is the ability to develop one’s inner nature to its fullest potential, including the ability to discover and articulate one’s basic purpose in life; to learn how to experience love, joy, peace, and fulfillment; and to learn how to help ourselves and others achieve their fullest potential
4. Social Support Systems Review
Understanding the social context in which a person lives and works is important in health promotion. Individuals and groups, through interpersonal relationships, can provide comfort, assistance, encouragement, and information.
Social support fosters successful coping and promotes satisfying and effective living.
The nurse can begin a social support system review by asking the client to do the following:
• List individuals who provide personal support.
• Indicate the relationship of each person (e.g., family member, fellow worker or colleague, social acquaintance).
• Identify which individuals have been a source of support for 5 or more years.
5. Health Risk Assessment
(HRA) is an assessment and educational tool that indicates a client’s risk for disease or injury during the next 10 years by comparing the client’s risk with the mortality risk of the corresponding age, gender, and racial group.
The client’s general health, lifestyle behaviors, and demographic data are compared to data from a large national sample.
Individual risk reports are based on statistics for the population group that match the individual’s surveyed characteristics.
The HRA includes a summary of the person’s
health risks and lifestyle behaviors with educational suggestions on how to reduce the risk.
Occupational health nurses can identify risk factors and subsequently plan interventions aimed at decreasing illness, absenteeism, and disability.
6. Assessment of clients’ health beliefs provides
the nurse with an indication of how much the clients believe they can influence or control health through personal behaviors.
Several cultures have a strong belief in fate: “Whatever will be, will be.”
If people hold this belief, they do not feel that they can do anything to change the course of their disease.
An example is doing diabetic teaching, which often requires many lifestyle changes in diet and exercise
and close control of glucose to prevent complications
7. Life-Stress Review
A tool that assigns numerical values to life events. For example, life changes (e.g., death of a spouse, divorce, marital separation, pregnancy, etc.) have an impact score.
The individual adds up all of the current life events and compares the total life-changes score to the likelihood of illness in the near future.
Studies have shown that a high score is associated with the increased possibility of illness.
Diagnosing
Nursing diagnoses accepted by NANDA International have generally focused on impaired or imbalanced health patterns or problems.
Previously, NANDA included a wellness diagnosis. This diagnosis, however, was eliminated because it was already within the health promotion nursing diagnosis category.
The definition of the NANDA health promotion domain is “the awareness of well-being or normality of function and the strategies used to maintain control of and enhance that well-being or normality of function”.
Health promotion diagnoses can be applied to any health state and do not require current levels of wellness.
When the nurse and client conclude that the client has positive function in a certain pattern area, such as adequate nutrition or effective coping, the nurse can use this information to help the client reach a higher level of functioning.
The following examples are included in the
NANDA International
•Readiness for Enhanced Religiosity
• Readiness for Enhanced Coping
• Readiness for Enhanced Nutrition
Health promotion diagnoses provide a clear focus for planning interventions without indicating that a problem exists.
This type of diagnosis does not need to include related factors in the diagnosis format because it is a wellness diagnosis.
Planning
Health promotion plans need to be developed according to the needs, desires, and priorities of the client. The client decides on health promotion goals, the activities or interventions to achieve those goals, the frequency and duration of the activities, and the method of evaluation.
During the planning process the nurse acts as a resource person rather than as an adviser or counselor.
The nurse provides information when asked, emphasizes the importance of small steps to behavioral change, and reviews the client’s goals and plans to make sure they are realistic, measurable, and acceptable to the client.
Steps in Planning
These steps actively involve both the nurse and the client:
1. Review and summarize data from assessment. The nurse shares with the client a summary of the data collected from the various assessments (e.g., physical health and fitness, nutrition, sources of stress, spirituality, health practices).
2. Reinforce strengths and competencies of the client. The nurse and the client come to consensus about areas in which the client is doing well and areas that need further development.
3. Identify health goals and related behavior-change options.
The client selects two or three top priority personal health goals, prioritizes them, and reviews behavior-change options.
4. Identify behavioral or health outcomes.
For each of the selected goals or areas in step 3, the nurse and client determine what specific behavioral changes are needed to bring about the desired
outcome.
For example, to reduce the risk of cardiovascular disease, the client may need to stop smoking, lose weight, and increase activity level.
5. Develop a behavior-change plan.
A constructive program of change is based on client “ownership” of those behavior changes selected for implementation within everyday life.
6. Reiterate benefits of change. The positive benefits will probably need to be reiterated by both the nurse and the client even
Implementing
Implementing is the “doing” part of behavior change.
Self-responsibility is emphasized for implementing the plan.
Depending on the client’s needs, the nursing interventions may include supporting, counseling, facilitating, teaching, enhancing the behavior change, and modeling.
Providing and Facilitating Support
A major nursing role is to support the client..
A vital component of lifestyle change is ongoing support that focuses on the desired behavior change and is provided in a nonjudgmental manner.
Support can be offered by the nurse on an individual basis or in a group setting.
The nurse can also facilitate the development
of support networks for the client, such as family members and friends
Individual Counseling Sessions
Counseling sessions may be routinely scheduled as part of the plan or may be provided if the client encounters difficulty in carrying out interventions or meets insurmountable barriers to change.
In a counseling relationship, the nurse and client share ideas.
In this sharing relationship, the nurse acts as a facilitator, promoting the client’s decision making with regard to the health promotion plan.
Telephone or Internet Counseling
Regular telephone sessions or online computer interaction with the client may be provided to help answer questions, review goals and strategies, and reinforce progress.
The client may find that scheduling a weekly interaction is helpful or may wish to initiate a call if a problem occurs.
The client is asked, “Is your plan working?” If the plan is not working, the nurse asks, “What would you like to do?” The client may wish to continue or may wish to change the plan to a more realistic one.
Telephone support is efficient for the busy client who may not have the time for in-person sessions.
Group Support
Group sessions provide an opportunity for participants to learn the experiences of others in changing behavior.
Group contact gives individuals a renewed commitment to their goals.
Groups can be scheduled at monthly or less frequent intervals for over a year.
Facilitating Social Support
Social networks, such as family and friends, can facilitate or impede the efforts directed toward health promotion and prevention.
The nurse’s role is to assist the client to assess, modify, and develop the social support necessary to achieve the desired change.
Providing Health Education:
Health education programs on a variety of topics discussed earlier can be provided to groups, individuals, or communities.
Group programs need to be planned carefully before they are implemented
Enhancing Behavior Change
Whether people will make and maintain changes to improve health or prevent disease depends on many interrelated factors.
To help clients succeed in implementing behavior changes, the nurse needs to understand the stages of change and effective interventions that focus on progressing the individual through the stages of change.
Modeling:
Through observing a model, the client acquires ideas for behavior and coping strategies that can be used with specific problems.
The client is not expected to mimic the sequence of actions or behavior patterns of the model.
The nurse and client should mutually select
models with whom the client can identify, since the cultural and ethnic backgrounds and age of the nurse and client often differ.
Models should be people the client respects. Nurses should also serve as models of wellness. To model effectively, nurses need to have a philosophy and lifestyle that demonstrate good health habits.
Evaluating:
Evaluation takes place on an ongoing basis, both during the attainment of short-term goals and after the completion of long-term goals.
Goals are written during the planning phase, and a date is determined for attaining the specific results or behaviors that are desired to promote health or prevent illness.
During evaluation, the client may decide
to continue with the plan, reorder priorities, change strategies, or
revise the health promotion-prevention contract. Evaluation of the
plan is a collaborative effort between the nurse and the client.