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Teaching nugget 1
- 1. Ben McClellan, BSN, RN April11, 2014 Health Promotion Project #5 A project to meet partial requirements For NRSG 520 Health Promotion Across the Lifespan Southern Adventist University School of Nursing Teaching Nugget
- 2. Introduction of Patient JM-Caucasian Male; DOB Ht-6’3” Wt-275 lbs. BMI 34.4 Married, father of one Employed by Life Care-Med Tech College-Nursing program Health Issues- obesity and HTN Health promotion focus-Improve overall health and decrease risks for other diseases Increase exercise routine and healthy eating habits
- 3. Healthy People 2020 Reaching high-quality, longer lives free from disease, injury and early death Promote quality of life, healthy growth and behaviors Achieve and maintain a healthy BMI Consume nutrient-dense foods Limit intake of unhealthy foods (Healthy People 2020, 2013)
- 4. Learning Theory Health Promotion Model was proposed by Nola Pender Defines health as a positive dynamic state, not just absence of disease HPM focuses on three areas: individual characteristics and experiences, behavior-specific cognitions and affect and behavioral outcomes The goal is health promoting behavior Terms include- prior related behavior, personal factors, perceived benefits, perceived barriers, interpersonal and situational influences (Health Promotion Model, 2012)
- 5. Change Theory Transtheoretical Model of Behavior Change Stages of Change: precontemplation, contemplation, preparation, action, and maintenance TTM is useful in guiding treatment and prevention Pros vs. Cons (The Transtheoretical Model, 2013)
- 6. Program Plan PRECEDE-PROCEED Model by Green and Kreuter Social Dx- Discuss importance of exercise and risk factors of obesity Epidemiological Dx- Acquire prevalence & severity of health issues Behavioral & Environmental Dx- Be informative on health issues of group Educational & Organizational Dx- Educating of equipment use & proper body mechanics Administration & Policy Dx- Local church gym and surrounding property (Green & Kreuter, 2005)
- 7. Program Evaluation PRECEDE-PROCEED Model by Green and Kreuter Implementation- acquiring staff, materials, and recruitment & advertising of class Process Evaluation- Is the intervention being conducted according to steps 2-5? Impact Evaluation- has the program led to any effect on the group? Outcome Evaluation- evaluates the effect of the program using Rapid Assessment of Physical Activity test at the end of 6 months (Simons-Morton, Mcleroy, & Wendel, 2012)
- 8. Rapid Assessment of Physical Activity Rapid Assessment of Physical Activity Physical Activities are activities where you move and increase your heart rate above its resting rate, whether you do them for pleasure, work, or transportation. The following questions ask about the amount and intensity of physical activity you usually do. The intensity of the activity is related to the amount of energy you use to do these activities. Examples of physical activity intensity levels: Light activities • your heart beats slightly faster than normal • you can talk and sing Moderate activities • your heart beats faster than normal • you can talk but not sing Vigorous activities • your heart rate increases a lot • you can’t talk or your talking is broken up by large breaths
- 9. RAPA How physically active are you? Check one answer on each lineI rarely or never do any physical activities YES NO I do some light or moderate physical activities, but not every week YES NO I do some light physical activity every week YES NO I do moderate physical activities every week, but less than 30 minutes a day or 5 days a week YES NO I do vigorous physical activities every week, but less than 20 minutes a day or 3 days a week YES NO I do 30 minutes or more a day of moderate physical activities, 5 or more days a week YES NO I do 20 minutes or more a day of vigorous physical activities, 3 or more days a week YES NO I do activities to increase muscle strength, such as lifting weights or calisthenics, once a week or more YES NO I do activities to improve flexibility, such as stretching or yoga, once YES NO
- 10. RAPA Scoring instructions RAPA 1: Aerobic Score as sedentary- yes to question #1 Score as under-active- yes to question #2 Score as under-active regular-light activities- yes to question #3 Score as under-active regular- yes to questions # 4 & 5 Score as active- yes to questions # 6 & 7 RAPA 2: Strength & Flexibility I do activities to increase muscle strength, such as lifting weights or calisthenics, once a week of more. (1pt) I do activities to improve flexibility, such as stretching or yoga, once a week or more (2pt) Both (3pt) None (0pt) (How physically active are
- 11. Results Barriers overcome Encouragement Give rewards when goals reached Download apps Prayer
- 12. References Green, L. W. & Kreuter, M. W. (2005). Health Promotion and Planning: An educational And Ecological Approach. (4th ed.). New York, NY: McGraw Hill. Health Promotion Model (2012). Nursing theories: a companion to nursing theories and models. Retrieved from http://nursingplanet.com/health_promotion_model .html Health Promotion Research Center (2013). Retrieved from http://depts.washington.edu/hprc/rapa. HealthyPeople.gov (2013). Retrieved from http://www.healthypeople.gov/2020/topicsobjectives20
- 13. References Simons-Morton, B., McLeroy, K. R., & Wendel, M. L. (2012). Behavioral Theory in Health Promotion Practice and Research. Burlington, MA: Jones & Bartlett Learning. The Transtheoretical Model of Behavior Change (n.d.). Retrieved from http://www.umbc.edu/psyc/habits/content/the_mo del/.
Editor's Notes
- Hello, my name is Ben McClellan and this is my teaching nugget for health promotions across the lifespan project #5
- JM is a 43yom, that is married with a teenage daughter. He works full-time at Garden Plaza, night shift, for life care. He also is currently enrolled at CSCC in the nursing program. He is morbidly obese which increases his risk for DM, CAD, HTN, CVA, certain CAs, and OA. He wishes to lose the excess weight he has gained over the past 10 years, thereby decreasing his risk for the previously mentioned illnesses. He also wishes to see his daughter walk down the aisle and knows that the road he has been going down will only lead to an early death. He plans to increase his current exercise routine and change his eating habits to achieve this goal.
- Objectives:NWS-8:Increase the proportion of adults who are at a healthy weight.NWS-9:Decrease the proportion of adults who are obese.Interventions & ResourcesSimply-Color, variety, and freshness Start slow-make changes that will last Every change made to improve diet mattersNutrient dense foods include whole grains of bread or pasta, fruits, vegetables, low fat or fat free milk or milk products- cheese or yogurt, and lean meats and other protein sources- nutsUnhealthy foods are those with saturated fats and trans fats, cholesterol, added sugars, salt and alcohol- candy, sodas, chips, fast foods are just a few examples of foods to avoid.
- HPM notes that every person has unique personal characteristics and experiences that affect their actionsPrior related behavior- JM was raised to eat/eating healthy food, get plenty of exercise, rest and to drink water instead of sodas.Personal factors- JM is strong willed to lose weight once he sets his mind to it.Perceived barrier- school, work, time, money, and weatherInterpersonal infl.-family and friends provide a support system for JMSituational infl.-family get together, holidays, or super bowel partiesCompeting demands-time with family, work, and schoolThese experiences of JM, positive or negative, can motivate him to change his way of living.Health promoting behavior should result in improved health, enhanced functional ability and better quality of life
- TTM is an integrative, biopsychosocial model that conceptualizes the process of intentional behavior change. It consists of 5 stages-precontemplation, contemplation, preparation, action, and maintenance.TTM allows for JM to make changes, either regression or progress from precontemplation to action in just a few weeks.It is important to teach patients the pros of losing weight-the changes should be individualized to each individual. This will enable the patient to progress forward. Relapses can happen when temptations are greater than the patients will to change.Experiential processes- consciousness raising, dramatic relief, environmental reevaluation, self-reevaluation, social liberationBehavioral Processes- reinforcement management, helping relationships, counter conditioning, stimulus control, self-liberationWhen this all started JM was in the preparation stage- he was ready to change and knew the pros outweighed the cons. He decided to start walking daily and to increase his diet to nutrient dense foods to help reach his goal of a BMI<30.
- The PRECEDE-PROCEED model stands for predisposing, reinforcing, enabling constructs in educational diagnosis and evaluation. It consists of 5 phases: 1 social diagnosis, 2 epidemiological diagnosis, 3 behavioral and environmental diagnosis, 4 educational and organizational diagnosis, 5 administration and policy diagnosis
- The staff was gathered from the church and local college nursing students by the me the leader. We posted flyers in mailboxes around town and by word of mouth. The class was offered free of charge to encourage participation.Using the RAPA at the beginning of the program, the leader as able to make changes along the way for those individuals who needed more assistance than others. The RAPA allows for the group to come together in different activity levels based on their previous activity level prior to the class. Short-term goals, weigh-ins, labs-HDL, LDL, glucose levels were measured at weeks end with a decrease noted glucose and weights in 75% of group participants. At the end of the 6 month period LDL and HDL labs were drawn and showed a 15% improvement in 80% of the group participants. The inactive group showed the largest improvement. Throughout the program each individual was allowed to go at their own pace with personal coaching and encouragement with each phase. Exit interviews were conducted to assess individuals overall health. 90% expressed an increase in their activity level and being comfortable enough on machines in which they could use on their own. Their confidence was much higher at the end of 6 months. They said they have not had to go to their PCP as often with the improved blood work since starting the fitness program. They have told others about their success, which in return has led to interest of other parties in living a healthier lifestyle.
- Light activity-walking leisurely, stretching, vacuuming, or light yard workModerate activity-fast walking, aerobic class, strength training, or swimming gentlyVigorous activity-stair machine, jogging or running, tennis, racquetball, or badminton
- Here is a questionnaire of the RAPA that was used at the beginning and end of the 6 month program
- This is how the group was graded based on the answers they gave in the questionnaire
- Barriers overcame in the program were lack of knowledge with exercise machines, proper stretching and food and beverages choices The staff was always available during and after the class for words of encouragementThe group was encouraged to give themselves rewards when they met their goals for the week- small vacation to a favorite place to hike or relax..no food rewards though.Down loading apps that keep track of calories is a great way to monitor intake.Prayer is the key however. Keeping God first allows us to conquer any goal or task.
- Here are the references. I hope you learned a lot and enjoyed my presentation. Have a good day!