Version: / 1
Author: / Prepared by Eithne Ni Dhomhnaill, Nursing Matters.
Ratified by: / Education and Steering Committee, Nursing Homes Nursing Projects.
Issue Date: / August 2008
Review date: / August 2010
Authorised by:
1.0Policy Statement:
The promotion of health and psychosocial well-being will be achieved through
a)the development of a health promotion strategy(Appendix 2) that will be reviewed annually and involve all nursing home personnel and residents.
b)care planning that reflects the needs and preferences of individual residents for promotion of health and psychosocial well-being.
2.0Purpose:
To ensure that the promotion of health and psychosocial well-being of residents is integrated into all care delivery activities of the facility.
3.0Objectives:
3.1To create a culture of enablement that addresses the individual and collective needs of residents for health promotion and psychosocial well-being.
3.2To ensure that the facility has an evidenced based health promotion strategy that identifies key priority areas, goals and an action plan to meet these goals.
4.0Scope:
This policy applies to all nursing home personnel.
5.0Definitions:
5.1Health Promotion:Health promotion is a process of enabling people to increase control over and to improve their health. The process focuses on health as opposed to illness; empowerment of clients; the recognition that that health is influenced by a number of factors and that health is multidimensional (World Health Organisation, 1986; Casey, D. 2007).
5.2Psychosocial: Relating to the integration of social factors and individual thought and behaviour (Oxford Concise Dictionary, 2001).
5.3Well-being refers to feelings about self and social relationships (Inter-RAI, UK., 2000)
5.4Promoting psychosocial well-being:According to the Centre on Ageing, Hong KongUniversity, 2007, Psychosocial wellbeing for older adults could be simply defined as they are living well emotionally and socially in old age.There are several dimensions of psychosocial wellbeing which are illustrated as below:
5.4.1Self Reliance – The ability to remain independent and maintain autonomy. It is related to self-esteem and a positive self-image which contribute largely to emotional wellness.
5.4.2Personal Growth – The continued growth and development of one's capacity within limitations of environment. Older adults are able to continue growth by participating actively in the society with an understanding of their own assets and limitations.
5.4.3Purpose – Finding meaning in one's life. Older adults with their experience and wisdom could remain active and productive in the society.
5.4.4Harmonious Relationship – Developing & keeping a trusting and caring relationship with family, relatives and friends. People will cope better with change and loss in old age if they have confiding interpersonal relationship.
(Centre on Ageing, University of Hong Kong, 2007)
5.5Health Promotion: Health promotion is a process of enabling people to increase control over and to improve their health. The process focuses on health as opposed to illness; empowerment of clients; the recognition that that health is influenced by a number of factors and that health is multidimensional (World Health Organisation, 1986; Casey, D. 2007).
5.6Autonomyis ‘the perceived ability to control, cope with and make personal decisions about how one lives on a day-to-day basis, according to one’s own rules and preferences’ (World Health Organisation, 2002).
6.0Quick Reference Guide – Promoting Health and Psychosocial Wellbeing.
7.0Responsibilities.
Actions
/Responsible Person.
This policy will be disseminated to all nursing home personnel involved in providing healthcare for residents.
/Director of Nursing or delegated to another named nurse.
A record will be kept of all those who have signed the policy acknowledgement forms.
/Director of Nursing or delegated to another named nurse.
Where a new version of this policy is produced, the previous version will be removed and filed away.
/Director of Nursing or delegated to another named nurse.
On induction, all new nursing staff, care assistants and other healthcare professionals involved in the direct care of residents will be given an explanation of this policy.
/Director of Nursing or delegated to another named nurse.
Nurses and care staff will be provided with the opportunity to attend training /updates on promoting health and psychosocial well being for older people every two years or where there is a significant change to practice in this area.
/Director of Nursing or delegated to another named nurse.
Each resident will have an assessment of their needs for health promotion and psychosocial well being as part of their comprehensive assessment and routinely every three months or where there is a significant change to their care and / or condition. A care plan to meet these needs will be developed as per the assessment and care planning protocol outlined in this policy.
/Named nurse.
A staff member will be designated with responsibility for co-ordination of the provision of activities and leisure pursuits in the facility.
/Director of Nursing.
A schedule of weekly activities will be prepared in a format that is easy to read and understandand displayed in a prominent position at the beginning of each week.
/Designated activities co-ordinator.
Residents with sight impairment will be kept informed of weekly activities.
/Designated activities co-ordinator.
Outside agencies arranging or providing activities or leisure pursuits for residents will be checked as to the appropriateness of arrangements in place to safeguard the safety and well being of residents taking part in such activities.
/All nurse managers.
Residents response to and satisfaction with activities will be reviewed as part of their care planning process and through feedback from the residents committee.
/Designated / named nurse and Director of Nursing.
A health promotion strategy will be prepared, reviewed and distributed to all staff on an annual basis.
/Health promotion committee.
A health promotion committee will be set up to prepare the annual health promotion strategy and oversee its implementation.
/Director of Nursing.
Compliance with this policy will be monitored using audit.
/Director of Nursing or another nurse designated by the Director of Nursing.
8.0Assessment and Care Planning Protocol: Health Promotion and Psychosocial Well being.
8.1Assessment for Health promotion needs.
8.1.1Comprehensive assessment of each resident should be conducted as assessment and care planning policy.
8.1.2Assessment should focus on ability as well as self-care deficits.
8.1.3Assessment should identify potential for improvement /re-enablement in all domains of assessment.
8.1.4Assessment should identify specific health promotion / education needs for each resident related to:
- Prevention of functional loss / decline /injury.
- Potential to restore function and maximize independence.
- Restoring abilities to a level that allows the resident function with fewer supports.
- Providing information in a format suitable to the resident to enable them to make informed choices.
- Providing appropriate aids / devices to enable the resident have more independence and control over his/her life.
8.2Assessment of psychosocial needs.
8.2.1Comprehensive assessment of each resident should include assessment of psychosocial well being and any needs and /or problems the resident may have in this domain.
8.2.2Positive indicators of psychosocial well-being include:
The resident is at ease of interaction with others.
The resident is at ease doing planned /structured activities.
The resident is at ease doing self-initiated activities.
The resident pursues involvement in the life of the home.
The resident accepts invitations to most group activities.
8.2.3Negative indicators of psychosocial well being include:
Withdrawal from care / activities.
Conflict with family / staff / other residents.
Recent loss of family member / friend.
Absence of contact with family / friends.
Increasing or persistent sad and / or angry mood.
Increasing frequency of disturbed behaviour.
Preoccupation with the past.
Does not adjust easily to change in routine..
Expresses sadness/anger/feelings of loss over changes to life / status.
Resident feels that their daily routine is very different to previous life.
8.2.4Other factors contributing to poor psychosocial well-being:
Cognitive impairment.
Communication difficulties.
Change in room allocation.
Mobility deficits.
Dementia.
Depression.
Physical restraint use.
Unease communicating and / or interacting with others.
8.3Care Planning.
8.3.1The care plan should include agreed goals and interventions in collaboration with the resident as far as he/she is able.
8.3.2The care plan should include involvement of other healthcare professionals involved in the resident’s care in the facility as well as the views and observations of the resident’s representative in accordance with the requirements for consent.
8.3.3Goals and interventions should be realistic and achievable and reflect the resident’s known needs, wishes and preferences.
8.3.4Care plans for promotion of health and psychosocial well being should include prevention and enablement activities in areas such as:
Falls prevention.
Healthy eating.
Oral dental health.
Promotion of independent functioning such as breaking down tasks to enable the resident carry out more self care.
Identification of aids / devices required to increase independence.
Identification of appropriate leisure and social activities to promote psychosocial well being using the activity therapy assessment (Appendix 1) and for residents with dementia, the therapeutic activity kits (Appendix 2) can be used.
8.4Monitoring and review.
8.4.1The care plan should include a schedule to review the resident’s response to interventions.
8.4.2Reassessment of needs for health promotion and psychosocial well being should occur as part of the comprehensive assessment three monthly or where there is a significant change in the resident’s care and / or condition.
9.0Guidelines for Developing a Health Promotion Strategy.
9.1Underpinning principles.
The health promotion strategy will be underpinned by the following principles:
- Person-centred care that recognizes the values, biography and uniqueness of individual residents.
- Promotion of autonomy and choice.
- Advocacy.
- Informed consent.
- Consultation and participation.
- Balancing the rights of individual residents with responsibilities for risk management.
- Enablement / re-enablement.
- ‘10 steps to Healthy Ageing’.
- Ultimately improving the lives and autonomy of residents already affected by illness and / or impairment.
9.2Identification of Key Priority Areas.
The facility should identify key priority areas before developing action plans. Identification of key priority areas can be derived from WHO; European and national policies; the national co-coordinator for the Health promoting Residential Care Initiative and feedback from the resident’s committee. Key priority areas could include:
- Falls prevention.
- Mental Health and wellbeing.
- Promotion of physical activity
- Polypharmacy and inappropriate use of medications.
- Smoking and substance abuse
- Nutrition, including meals and mealtimes/menu planning.
- Promotion of a positive risk taking environment (See appendix 3).
- Social engagement and connectedness, including local community groups.
- Purposeful activities.
- Education and training for residents and staff.
- Oral/dental health.
- Hearing and vision.
- Foot care.
- Healthy hearts.
- Outdoor mobility
- Use of technology / computer skills.
This list is not exhaustive. (Explain how to do this)
9.3Development of Action Plans.
Having identified key priority areas, the committee will develop action plans that outline:
- Goals.
- Actions.
- Responsibilities.
- Evidence supporting the action plan.
- Timeframes.
- Methods of evaluating the effectiveness of the plan.
9.4Involvement of External Agencies.
Representatives of external agencies may be involved at various stages in developing the strategy and drawing up action plans. These agencies include:
- The Health Promoting Residential Care Initiative: The National co-coordinator for this initiative should be consulted at the earliest stage to advise on the ’10 steps to Health Ageing’ initiative which is focused on the residential care setting.
- National Council on Ageing and Older People.
- Age Action.
- Age and Opportunity, who provide the Activity in Care programme for staff in the home.
- Alzheimer’s society.
- Dementia Services Information Centre.
- Nutritional Advisory Services.
- Health Promotion Unit in AMNCH, Tallaght regarding falls prevention strategy.
- Other experts as needs arise when formulating action plans.
9.5Co-ordination of Activities and leisure pursuits in the facility.
9.5.1A designated person will be responsible for the co-ordination of activities in the facility.
9.5.2The designated activities co-ordinator will liaise with nursing staff so that each resident’s involvement in activities and leisure pursuits will be in accordance with his/her needs, abilities and preferences.
9.5.3Nursing staff will communicate any relevant information regarding individual resident’s needs to the activities co-ordinator.
9.5.4The resident’s response to and satisfaction with activities in the facility will be reviewed according to their care plan.
9.5.5The designated activities co ordinator will ensure that the schedule of activities for each week is displayed in a prominent place and written in a format that is easily to read and understand.
9.5.6The designated activities co-ordinator will ensure that resident’s with reading difficulties are provided with information about the weeks activities in a format that they can understand.
9.5.7The designated activities co-ordinator will liaise with all nurse managers when preparing schedules of activities so as to ensure that there is sufficient variety of activities to suit all needs and abilities, with specific reference to residents with cognitive and physical impairments and those with dementia.
9.5.8Choice and range of activities will be driven by the needs and wishes of residents through liaison with nurse managers and feedback from the residents’ committee.
9.5.9The range of activities should include both indoor and outdoor activities.
9.5.10The activities co-ordinator should explore the possibility of creating links with the local community with a view to facilitating residents who are able to have involvement in community activities as far as each resident is able. The activities co-ordinator should liaise with nurse managers and the Director of Nursing where outside community activities are being arranged.
9.5.11Each nurse manager should ensure that where any resident in their care is attending any activity that is arranged by an outside agency, that the agency has sufficient and appropriate arrangements in place to safeguard the welfare and safety of the resident.
9.5.12Outside of scheduled activities, all nursing and care staff have a role and responsibility to ensure that needs of residents for meaningful and purposeful activities are addressed.
10.0References.
- Health Information and Quality Authority (2007) Draft National Quality Standards
- For Residential Care Settings for Older People – A Consultation Document/
- Reed, J. (2004) Involvement. Empowerment and advocacy in European Healthcare Management Association. Integrating Services for Older People: A resource book for managers.
- National Council on Ageing and Older People, (1998) Adding Years to Life and Life to Years: A Health Promotion Strategy for Older People. National Council on Ageing and Older People. Dublin.
- Health Services Executive, (2007) A Study to Examine the Effects on Residents of Moving from a Traditional Care of the Older Person Ward Environment to a New Dementia Care Unit.
- InterRai Uk (2000). UK Long Term Care Resident Assessment Instrument Users Guide.
- National Council on Ageing and Older People, (2006). Improving the Quality of Life for Older People in Long-Stay Care Settings in Ireland. National Council on Ageing and Older People. Dublin.
- Whitehead, D. (2001). A stage planning programme model for health education/promotion practice. Journal of Advanced Nursing. Vol. 36(2) pp.311-320.
- Casey, D. (2007) Nurses’ perceptions, understanding and experiences of health promotion. Journal of Clinical Nursing. Vol.16 (6). Pp. 1039-1049.
- Swedish National Institute for Public Health (Co-funded by the European Commission) (2006). Health Ageing: A challenge for Europe. The Healthy Ageing Project. Accessed at
- World Health Organisation, (2002) Active Ageing: A Policy Framework accessed at
Amendments / Comments to Policy Document for local use.
Document Title and Code: / Promotion of Health and Psychosocial Well-being. NHNP-HP
Version: / 1
Name of Facility.
Issue Date: / August 2008
Review date: / August 2010
Authorised by:
Point Number / Comments / Amendments to Policy for Local Use.
Point Number / Comments / Amendments to Policy for Local Use.
Appendix 3: Sample Template for Health Promotion Strategy.
Name of Organisation.Health Promotion Strategy.
Month 2008 /2009
Members of the Strategy Development Group/Committee:
Name. / Role. / Responsibilities:
Name. / Role. / Responsibilities
Name. / Role. / Responsibilities.
Name. / Role. / Responsibilities.
Name. / Role. / Responsibilities.
Date of Approval
Review date:
Signatures of development group/committee:
Key Objective Areas: / Eg,
1)Falls Prevention.
2)Nutrition.
3)Activities.
Falls Prevention.
Goals:
Eg to increase staff knowledge of assessment and care planning for falls.
To promote an environment that protects the safety and welfare of resident at risk of falling.
Actions: / Timeframe / Person Responsible.
Eg. Arrange in service education for all staff.
Carry out an audit of the physical environment.
Nutrition
Goals:
Actions: / Timeframe / Person Responsible.
Activities
Goals:
Actions: / Timeframe / Person Responsible.
Eg. Arrange in service education for all staff.
Carry out an audit of the physical environment.
Amendments / Comments to Policy Document for local use.
Document Title and Code: / NHNP-
Version: / 1
Name of Facility.
Issue Date: / 2008
Review date: / 2010
Authorised by:
Point Number / Comments / Amendments to Policy for Local Use.
Point Number / Comments / Amendments to Policy for Local Use.
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