Integrated Health Promotion Plan for Patient with Diabetes

Introduction

Health promotion can lower morbidity and liabilities cost in health care today. In our practice, nurse take care of and deal with illness that patients has upon our interaction.  It is part of nurse’s duty to their patients to promote their health and wellness.  This is an essential piece of nurses practice to help prevent health risks factors and promote healthy patient outcomes.  Health promotion in nursing is how to empower patients to manage their health and control over their lives by focusing on their health and to recognized that health and illness has many dimensions. The purpose of this paper is to apply health promotion model to help nurse to understand the health behaviors and promote healthy lifestyles.

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 Health promotion and healthy living are an important part of reduction chronic disease. Lifestyle choices such as lack of exercise, poor dietary habits, tobacco and alcohol, are main leading cause of  chronic illness and disease. The problem of differing lifestyle lead to disease and premature deaths.  According to Van Sickle (2019), 467,00 deaths are related to high blood pressure, and tobacco use with obesity, lack of exercise results in 1 in 10 deaths. Education begins in the community to adapt healthier living choices. Healthy People 2020 and Control and Prevention (CDC) has concentrated efferent to educate in public health dept, schools, primary providers (Van Sickle,2019). In the nursing profession, nurses advocate for their patient in wellness and prevention, and educating the individual, families on healthy living will promote a reduction in disease such as hypertension, heart disease and lung disease.

The client of this paper (PE)  is a 55 year old Caucasian female that is married with three children that are in their 20’s. In her health history assessment and genogram, was identified medical issues to  (2)address in PE health and well being as well as her children was prevention of diabetes, hypertension and coronary artery disease. She has a medical history of spinal meningitis, lymes, borderline diabetic hypertension, rheumatoid arthritis and obesity.  She has trying to control these disease conditions with diet, exercise and medications.  She identifies herself as being happy with her life and considers herself religious but doesn’t rely on that when making medical decisions. Her strengths come from her family and has significant stress that occurs with work (as manager of store), she feels that it is handle well with activities like Girls Scout’s (crafts) and boating with her husband. In today’s society, both parents are working to provide financial stability to take care of their family’s basic needs for food, healthcare, and housing.

PE genogram showed that she had many family members on both her mother and father side that develop coronary artery disease, had stents and even heart attacks.  On her mother side there was 2 family members with diabetes and with PE being overweight she has diagnosed as pre- diabetic. Her grandmother was type 2 diabetic and one other aunt. PE was very anxious and terrified during the interview after she saw her health risks for heart attacks and being obese can cause more medical issues( Jarl et,.al, 2014).  She realized her risks for developing type 2 diabetes like many of her maternal relatives as it is linked to obesity and her lifestyle factors. Strengths in her self-care are getting a regular mammogram, PAP smear, seeing her primary physician for her hypertriton and pre-diabetes. She has not had a yearly eye exam and dental. She states she only performs occasional breast-self exams. The does take her medication for hypertension, but it is challenging to take it twice a day.

  She will be focusing on her promoting health prevention of diabetes and well-being for today and in the future. However, positive life style changes and various treatments can reduce these risks. She reported in her health assessment that she has been overweight since she was a teenage and the last year, she has put on 40 lbs. She realizes that eating out a lot, fast foods, fried foods and lack of exercise resulted  weight gain, hypertension and now pre diabetes.  She admits a poor diet of high carbohydrate diet and drinks a lot of soda. She has family history of hypertension (genetics), fatigue, stress from work and lack of exercise which may be resulted in her having hypertension, diabetes and being overweight.

PE has been diagnosed with hypertension, as a result of information in her health history/genogram, the following health promotion/disease prevention were identified and most important to PE :  1. Healthier lifestyle eating healthy diet, reduce sodium and following DASH diet, maintaining healthy weight and increase her physical exercised. She doesn’t smoke or drink alcohol.

PE has been diagnosed as pre-diabetic. As a result of information in her health history/genogram, the following health promotion/disease prevention were identified and are most important to PE:  1. Over weight-lose weight. 2.work with coach/nutritionist to eat healthy. 3 manage her stress and stay motivated.

PE has been diagnosed with high Bmi , overweight and risk for coronary artery disease. As results of information in her health/genogram, the following health promotion/disease prevention were identified and are important to her: 1. Better management of her hypertension with reduction in blood pressure, weight loss goal of 40 lbs. 3. Start an exercise program with a coach.

3.Section 2 – Health promotion plan:

 In developing a holistic integrated health promotion plan a range of health and wellbeing issues were acknowledged and identify to improve the health of PE. According to Burk(2019), “ bio-psycho-social-spiritual person is in the state of constant dynamic interaction with the environment; changes occurring in any of these aspects create change in all the other aspects of the person and the environment within which the client. When interview PE for her health history and genogram, she discovered that she had health risks based on genetics, ages, lifestyle. Her health issues, pre-diabetic, obesity and hypertension are putting her at risk for her family genetic history of heart attacks, cardiovascular disease and diabetes. She realizes there are some factors that can’t be change such as genetics, healthy aging, gender or ethnicity. Even though she sees her primary doctor on routine checks and sick, she realizes her understanding of disease and health practices limited. She started working with interprofessional team of her primary doctor, nurse, pharmacist, physician assistant, nutritionist about her diet and Health coaches for physical exercise program.

In healthcare today, nurses play a role in the multidisciplinary team. Working with the team can ensure better communication for the patient and providers. The team approach enhances patient-physician relationship with creating efficient, comprehensive and tailored healthcare plan and improving better patient outcomes (Nester,2016). The focus of the team is to ensure the social well being of the patient and improve coping mechanism. The physician can evaluate the patient for genetic assessment for risks. The nurse is responsible for ensuring the overall wellbeing coping of the patient on daily challenges.

 In my nursing experience, team-base care approach improved in patient outcome and patient satisfactions. Collaborating with team about patient medical needs helped improved their care during their admission and when they were discharged. Having this experience will help with collaboration with her team of doctors, coaches and dietitian to make sure she is able to keep on track with her plan, goals and ensure she is able to obtained her weight loss to reduce her disease of hypertension and pre diabetes. . She realizes that she will need to meet every 2 -4 weeks with the team to achieve her weight loss goal of 40 lbs and maintain a healthy lifestyle

In healthcare, it is essential that nurse understand the different cultural beliefs, values of patient that they view on health, wellness and death.  If there is a language barrier, having an interpreter there or language line will help ensure that they understand their medical needs are address and incorrupt into plan of care. In taking care of patients, it is important to show respect, responsibility, and compassionate good care.  Nurses have to have critical thinking and problem-solvers when taking care of their patients, integrate information, outcomes and experience into plans and solutions for patients.

 In healthcare effective communication is important on the quality of patient outcomes, satisfaction and decrease adverse outcomes.  Communication tools with use of white board/goal sheets share information about patient goals, concerns and plans. Team rounds with the doctors, nurses and social workers are performed at the facility where I work every day. According to Turin (2015), collaboration with professionals in the community resources, agency and program for patients to access improve patient outcomes.

The following planning steps are meant to be a guide for developing a health plan for PE;  her goal: to improved  cardiovascular disease and quality of life through detection, prevention and treatment of risk factors for heart attack and with reduction in her hypertension. Identifying her risk factor for disease or disorder that can be decrease or eliminated with modified health behavior is part of plan. Risk factors are related to poor life style choices, poor dietary habits, less than five portions of fruits and vegetables a day and motivation. Having a body mass more than 25%-(her 35.8). According to Mortin (2013),that there are health promotions that work together for patients to be successful: education, medical, behavior modification societal change and client-center. 

 Disease prevention priority issues

1. The risk for coronary artery disease related to obesity, poor manage hypertension, as evidence by secondary lifestyle, obesity poor diet, missed dose of antihypertension medicine.

2. The risk for diabetes type 2 related to her obese, pre- diabetic, hypertension, weight gain as evidence by poor diet, poor administration of antihypertensive medications.

3. The risk for hypertension related to her genetic predisposition by paternal uncles diagnose with hypertension, cardiac stents, being overweight, her age and poor diet.

NIC

1. Cardiac Risk Management 4050 (NIC)

  1. Instructed the patient and families on strategies for healthy-heart diet with the use of a dietician incorporating the patient culture and personal experience.

2Instruct the patient on the need to achieve exercise goals in incremental periods of 10 minutes multiple times daily, if tolerant to sustained 30-minute activities in collaboration with an exercise physiologist.

3. Instruct the patient on patient and family on therapies to reduce cardiac risks to include medication regimens with the collaboration of her employer health coach program that provides phone apps that remind patient to take their medications.

• Goal Example: Pt reduce her blood pressure down to 130/80 at recheck in 4 weeks.

https://search-credoreference-com.vlib.excelsior.edu/content/entry/ehsnic/cardiac_risk_management_4050/0

2. Health Screening 6520 (NIC, 2013)

1. Instruct on the rationale and purpose of health screening and self-monitoring in collaboration with an optometrist and nutritionist.

2. Provide appropriate self-monitoring information during screening in collaboration with the health coach monitoring labs, weight, and blood pressure readings with positive reinforcement.

• Goal Example: Pt will have followed up blood work, blood pressure reading in 4 weeks.

https://search-credoreference-com.vlib.excelsior.edu/content/entry/ehsnic/health_screening_6520/0

3. Nutritional Counseling 5246(NIC,2013)

1..Determine patient’s food intake and eating habits

Establish realistic short-term and long-term goals for change in the nutritional status Discuss nutritional requirements and patient’s perceptions of the prescribed/ recommended diet        

2.Discuss nutritional requirements and patient’s perceptions of the prescribed/ recommended diet        

• Goal Example- Pt will meet with dietician in 4 weeks to review diet, and weight loss plan.                https://search-credoreference-com.vlib.excelsior.edu/content/entry/ehsnic/weight_management_1260/0

NOC

1.     Risk Control: Cardiovascular Disease 1914 (NOC, 2013).

            1. The patient will return in 4 weeks to be weighed again with 4-8  pound weight loss and adherence to her twice a day antihypertensive medications after making contact with her health coach, exercise physiologist and dietician. The patient will use technology apps to help remind her to take her medications. https://search-credoreference-com.vlib.excelsior.edu/content/entry/ehsnoc/risk_control_cardiovascular_disease_1914/0

2. Risk Control : weight Loss Behavior 1627 (NOC,2013) – assisted with healthy eating plan, and control food portions. She needs to establish an exercise routine. Patient will follow up with dietician and health coach in 3 weeks with weekly log of weigh loss. https://search-credoreference-com.vlib.excelsior.edu/content/entry/ehsnoc/weight_loss_behavior_1627/0

3.  Exercise Participation 1633 (NOC, 2013)- to maintain adequate physical activity.  Since she hardly performs any kind of exercise, we set some goals that can tie into his schedule. Patient will keep a log of how much weight loss each week (3 lbs), then follow up with physical coach.https://search-credoreference-com.vlib.excelsior.edu/content/entry/ehsnoc/exercise_participation_1633/0

4. Knowledge: Healthy Diet1854 (NOC,2013)- to assist with making better food choices.  This is to make sure that she knows what is healthy, and how she can enjoy what she wants with some healthier adjustments. Pt will work with dietician on DASH diet to reduce her hypertension, and low carbohydrate diet with follow up visit in 2 week. https://search-credoreference-com.vlib.excelsior.edu/content/entry/ehsnoc/knowledge_healthy_diet_1854/0

Evaluation of the Health Promotion Plan

PE will return in 4 weeks to be re-weight with a weight loss of 4-8 lbs. She will present a daily food, exercise and weight log that twill demonstrate well balance meals and progressing towards healthy body weight and BMI.  She will verbalize the utilization of a support group and dietician. She will be weighing and calculate new BMI. She will return in one month to determine if she is meeting targets and goals, what strategies she is finding success with, and if there is anything still hindering her.  She will have her daily log of her blood pressure with goal from 150/90 down to 120/80. She will have rechecked of blood work and check of her blood sugar to ensure that she is down to 70-110 range.

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Client feedback questionnaires after undergoing the interventions in a month will be influential in evaluating the effectiveness of the health promotion plan. The sessions will be conducted twice a week for four weeks, and the questionnaires will be filled in the fourth week. An analysis of client feedback will help to understand whether they have benefited from the health promotion program and continually analyze the effectiveness intervention as needed

Section 4: Research Integration:

One of the highest risk factors for cardiovascular disease is hypertension. Obesity and hypertension are often link in adults and 53.5 percent that have hypertension are poorly controlled ( Jarl et.al.,2014).  Obesity in U.S. is more than 30 % and Healthy 2020 object is to decrease to 15 % in adults. (p.499). Addressing these health issues in primary care setting, healthcare professional have opportunity to promote healthy life styles through diet, weight control, and physical activities. They working towards improving hypertension and cardiovascular disease prevention in clinical setting. According to Jarl, et.al(2014), Nurse Practitioners(NP) focus on interventions on counseling on  diet, lifestyle that had a measurable impact on group that had hypertension and were overweight. Interventions on education of low sodium diet ( DASH-Dietary Approaches to Stop Hypertension),and lifestyle changes over 2 months.  The patients had 45 minutes counseling in group classes and two 20 minutes phone consult lead by NP.  Patients that used the DASH diet had weight and BMI reduction. There was weight loss of 3.6 lbs over 8 weeks period. The study used measure outcomes that included REAP and PIH. Another health issues that my client family history had was Cardiovascular disease (CVD).Risk factors that people can’t change is genetic, age, gender. Modified-risk factor that people can change is smoking, weight, blood pressure and high lipid protein levels.  According to Imes, & Lewis.(2014), 32.8 % of deaths are from CVD and perceived risks important to change healthy behavior. Its important that they know how the risks affect them and health related behaviors reduce their risks. According to Turin( 2015), in adults with health issues, there is a decrease in physical activity. Intervention with counseling and education to with understanding of patient circumstance to develop a exercise prescription. Methods they used were internet guide to physical activity and NP were motivators/ facilitators to their program. They were able to collaborate and found community resource for their physical plan. Brisk walking 20 minutes, 5 times a week in am before work, 2 day a week in evening and weekends. Health promotion with lifestyle changes, strategies to prevent disease and improve patient outcomes. Education and diet along with attaining healthy lifestyle, can reduce risk of hypertensions and obesity. The articles give strategies and plans that can help improve nurses knowledge and

Conclusion

It’s important to maintain a healthy life style to reduce the risk for heart attack. By exercising regularly, monitoring cholesterol level, hypertension and reduce fatty foods can reduce risk to getting the disease.  While healthy habits should be encouraged despite the risk factors, understanding what is genetic in your family give you the heads-up screening/lifestyle habits and possibility to prevent the disease.

References

• Burke, A.(2019. Health Promotion and Disease Prevention: Nclex RN. Registered Nursing. August 8, 2019. Retrieved from: https://www.registerednursing.org/nclex/health-promotion-disease-prevention/
• CdC. (2018).  The CDC Guide to Strategies to Increase Physical Activity in the Community. May 8, 2018. Retrieved from: https://www.cdc.gov/obesity/resources/strategies-guidelines.html
• Healthy 2020. (2019). Nutritional and Weight status. ODPHP. Retrieved from:  Health.gov
• Nester, J. (2016). The Importance of Interprofessional Practice and Education in the Era of Accountable Care. North Carolina Medical Journal. March-April, 2016. 77, 128-132. Retreived from: https://ncmedicaljournal.com
• Imes, C. C., & Lewis, F. M. (2014). Family History of Cardiovascular Disease, Perceived Cardiovascular Disease Risk, and Health-Related Behavior. Journal of Cardiovascular Nursing, 29(2), 108. Retrieved from: http://ovidsp.dc2.ovid.com.vlib.excelsior.edu/sp-4.02.1a/ovidweb.cgi?&S=IP
• Jarl,J.,Tolentino, J.,Jerlyn,C.,James,K.,Clark,M., Ryan. M.(2014). Supporting cardiovascular risk reduction in Overweight and Obese Hypetensive Patients though DASH Diet and Lifestyle Education by Primary Care Nurse Practitioners.Journal of the American Association of Nurse Practitioners. Volume 26, 498-503.September 2014: Retrieved from: http://ovidsp.dc2.ovid.com.vlib.excelsior.edu/sp-4.02.1a/ovidweb.cgi?&S=JJGOFPPPPCEBHCMLIPCKNFOGAJCEAA00&Link+
• Morton, K. (2013). Implementing evidence-based health promotion strategies. Nursing Standard, 27(33), 35-42. Retrieved from: . Retrieved from http://www.nursing-standard.co.uk/
• Turin, R. (2015). Physical activity prescriptions in healthy populations. The Nurse Practitioner, 40(2), 45–54. doi: 10.1097/01.NPR.0000459731.77403.c1. http://ovidsp.dc2.ovid.com.vlib.excelsior.edu/sp-4.02.1a/ovidweb.cgi
• Van Sickle, R. (2019). Health Promotion and Disease Prevention. RN Journal. January 2019. Retreived from : http://rn-journal.com/journal-of-nursing/health-promotion-and-disease-prevention