Chapter 6 Health Promotion & the Individual Lecture 2 NRS 216 * Nursing Focus on Wellness Assisting to maintain/obtain optimal health Accomplished through nursing process Assessment, diagnosis, outcome criteria, process criteria, implementation, evaluation Health promotion: Assessment of strengths, not only deficits North American Nursing Diagnosis Association (NANDA); nursing diagnoses Includes life processes, health promotion Nursing Assessment Dynamic, ongoing process that uses observations & interactions to: collect information, recognize changes, analyze needs, and plan care (Hunt, 2005) Subjective data ? what the client says, interview & health history Objective data ? observations, exam, lab/test results Reflects ?whole person? with environment Systematic approach = GFHP (gordons functional health patterns) Goal ? formulate a nursing diagnosis (es), ie, problem identification, risks, strengths, etc. Healthy People Examples of National Health-Promotion & Disease Prevention Objectives for Individuals FP-10 & 1113-6a. Increase the proportion of sexually active people who use condoms. PA-2.l 22-2. Increase the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30 minutes per session. (FITT) TU-1 27-1a. Reduce cigarette smoking by adults. Functional Health Pattern Framework Gordon?s (2007) framework Concept of functional patterns and pattern interaction Depicts individual?s lifestyle Definition Individual viewed as whole being using interrelated behavioral areas Typology: 11 functional areas * Functional Health Pattern Framework (cont?d) Characteristics/focus Pattern: Examine patterns over time (e.g., blood pressure) Individual-environmental: Environmental influence within patterns Age-developmental: Individual developmental task fulfillment Functional: Individual performance levels on tasks (e.g., activities of daily life [ADLs]) Cultural: Influence developmental health patterns * Functional Health Pattern Framework (cont?d) Rationale for use: Centers on health; focus on nursing knowledge; provides structure/ flexibility Health Patterns Eleven Interdependent Patterns Expression Pattern/sequencing of behaviors Role of environment Developmental influences Pattern characteristics Functional (strength) Dysfunctional (nursing diagnosis) Potentially dysfunctional (at risk) Nursing goals: Assess individual knowledge, ability to manage health promotion, and value placed on health promotion Problem in one area clue to dysfunction in other patterns Gordon?s Functional Health Patterns Health Perception-Health Management Nutritional-Metabolic Elimination Activity-Exercise Sleep-Rest Cognitive-Perceptual Self Perception-Self Concept Roles-Relationships Sexuality-Reproductive Coping-Stress Tolerance Values-Beliefs Pg. 150 Health-Perception?Health-Management Pattern An individual?s perceived health and well-being Affect lifestyle and ability to function Health promoting activities-pattern clues to improve or maintain optimal quality of life Assessment: Parameters such as current health/safety practices, previous patterns adherence, use of health care system, health care access, health perceptions/beliefs Past health management predictor Nurse needs to identify/address reason for past failures to promote success for interventions (e.g., belief systems, finances, literacy) Nutritional-Metabolic Pattern Individual?s typical food and fluid consumption in relation to metabolic needs and perceived problems Indicators of nutritional adequacy Nutrient intake ? (24 hour recall, mechanical considerations with eating) Metabolic demand ? varies between individuals and with different activity levels, stress (height, weight, temperature, etc.) Objective indicators: Skin, mucous membranes, dentition, hair Education needs are important Elimination Pattern Adequacy, control, and regularity of an individual?s bowel, bladder, and skin excretion of waste (perspiration, drainage, wounds) Normal pattern varies between individuals How much water do you drink a day? How often do you urinate Guess amount ml/day Prolonged time = linked to UTI Perception ? determines whether dysfunctional Affects interpersonal relationships Assessment data includes changes, pain, perceived problems, explanation problem, self-treatment Closely related to nutrition pattern assessment Activity-Exercise Pattern Individual?s activity level, exercise, leisure activities Selected parameters: Movement capability, activity tolerance, self-care activities, use of assistive devices Activity level Limitations affect self-care abilities Sedentary lifestyle linked to obesity/overweight Affected by environment Activity-Exercise Pattern (cont?d) Assessment Pattern of activities requiring energy and adequacy of pattern Exercise patterns: Assess Type, frequency, duration, intensity Modes of transportation Barriers to exercise Response/subjective complaints Objective measures to assess function Developmental norms Assess infant/toddler development Sleep-Rest Pattern Adequacy of an individual?s sleep and relaxation Subjective reports of fatigue/energy levels Problems cause stress response, decreased immune system response, unhealthy relationships Data include difficulties in sleep onset, interruptions, sleep disturbances Assess sleep quality and quantity Interventions focus: Counseling, medical referral, development bedtime routine, relaxation techniques Cognitive-Perceptual Pattern Individual?s ability to understand and follow directions, retain information, make decisions, solve problems, use language appropriately Perceptual and sensory patterns, including (vision, hearing.) When was their last exam? Pain Scale? 0-10 Cognitive-perceptual functioning * Cognitive-Perceptual Pattern Individual?s ability to understand and follow directions, retain information, make decisions, solve problems, use language appropriately Perceptual and sensory patterns, including pain Cognitive-perceptual functioning Affects Capacity for independent functioning Need for environmental control Must be assessed within context of environment * Cognitive-Perceptual Pattern (cont?d) Assessment Language capabilities, cognitive skills Sensory deficits (hearing/vision, sensation) Use assistive devices Pain scales Education, memory changes, learning style Appropriate appearance, dress, hygiene Behavior, attention span Use of assessment tools (i.e., Folstein mini-mental exam) Cognitive data/sensory abilities guide care Individualized teaching plan Self-Perception?Self-Concept Pattern Individual?s sense of personal identity, goals, emotional patterns, feelings about self, self-image, self-worth Developmental level affects/affected by pattern Erickson: eight stages of human development Havighurst: task of building wholesome attitudes (self-esteem) Bruhn et al.: self-concept development Environmental imact: family and relationship Does the family notice any differences? Self-Perception?Self-Concept Pattern (cont?d) Assessment Clues to identity confusion, disturbed self-esteem Elicit data regarding cognitive, affective, psychomotor domains Anxiety, fear, depression Description of emotional patters General appearance of affect (nonverbal) Influence in care Affects individual-nurse interaction Information-sharing may help goal setting and intervention planning Roles-Relationships Pattern Position (s) assumed by an individual Associations engaged in by the individual that are connected to the position (s) Satisfaction with the position (s) and associations CASE STUDY OF CINDY 167-168 Roles-Relationships Pattern (cont?d) Assessment Describe patter of relationships/roles Family, work, and community focus Parameters include structure, tasks, communication patters, power, decision making, stress, social support Relationships affect whole person?may exhibit in other areas/patterns Sexuality-Reproductive Pattern Individual?s satisfaction and dissatisfaction with sexuality and reproduction Related to self-perception and relationship patterns Sexual identity linked to body image, self-concept, role, gender identity Individual development influences reproductive capacity Sexual expression influences Environment Cultural/family norms * Sexuality-Reproductive Pattern (cont?d) Assessment objectives Describe behavioral problems/difficulties Assess knowledge of sexual functioning/health practices Parameters Sexual self-concept Sexual functioning Reproductive patterns Level of satisfaction Firm, trusting relationship needed for discussion Sexual education important for sexual understanding and increased satisfaction Coping?Stress Tolerance Pattern General coping and ability to effectively manage stress Stress Necessary Problem: Weak tolerance and disruption of daily activities Individual?s perception of events Perception related to development, amount of stress, current levels of stress, social support Coping: Learned behavior Individual behavioral response to stress Problem-solving ability Use of defense mechanisms Coping?Stress Tolerance Pattern (cont?d) Assessment Objective: determine stress tolerance and past coping behaviors Parameters include Coping task Coping style Coping strategies Consider variety, flexibility, health-promotion value Coping effectiveness Stress interventions Are they able to replace unhealthy coping strategies Do they employ stress management techniques, what kind? Assessment of Alcohol Consumption: CAGE CAGE C Have you ever felt you should Cut down on your drinking? A Have people Annoyed you by criticizing your drinking? G Have you ever felt bad or Guilty about your drinking? E Eye opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover? The CAGE can identify alcohol problems over the lifetime. Two positive responses are considered a positive test and indicate further assessment is warranted. Edelman page 148 Assessment of Alcohol Consumption: T-ACE T-ACE T Tolerance: How many drinks does it Take to make you feel high? A Have people Annoyed you by criticizing your drinking? C Have you ever felt you ought to Cut down on your drinking? E Eye-opener: Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? The T-ACE, which is based on the CAGE, is valuable for identifying a range of use, including lifetime use and prenatal use, based on the DSM?III?R criteria. A score of 2 or more is considered positive evidence of problem drinking during pregnancy. Affirmative answers to questions A, C, or E = 1 point each. Reporting tolerance to more than two drinks (the T question) = 2 points. Edelman page 148 Values-Belief Pattern Values, beliefs, and goals Perceptions of right and wrong Objective: Determine basis for health-related decision/actions Value clarification by summarizing, verifying, obtaining information Seek beliefs about self, relationships, society, purpose of life, sources of strength, expectations about health Base interventions on value system and health beliefs Facilitate effective health promotion * Individual Health Promotion and the Nursing Process Collection and analysis of data Problem identification/nursing diagnosis (NANDA) Problem, etiology, defining characteristics, contributing etiological factors, diagnostic variables Planning the care Project outcomes, prescribe interventions Implementing the plan Evaluating effectiveness of plan
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