Category: Health Promotion

Healthy People 2020 is a national effort that sets goals and objectives to improve the health and well-being of all people in the United States. One of the crucial topic goals and objectives for 2020 is to reduce the incidence of fetal and infant deaths that occur from Sudden Infant Death Syndrome (SIDS). The magnitude of fetal mortality related to SIDS is considerable; in 2017 there were 3,600 sudden unexpected infant deaths (SUID) in the United States (Centers for Disease Control [CDC], 2018). SUID include several subcategories such as SIDS, accidental suffocation in a sleeping environment, as well as other deaths from unknown causes. SIDS is the most prevalent of these categories, occurring mostly among infants less than 1 year of age and often during the second and third month of life (CDC, 2018). By identifying the specific disparities that correlate with the high number of SIDS cases, Healthy People 2020 aims to create awareness, improve population health and achieve health equity in the United States.

SIDS is a complex, multifactorial disorder where often infants appear to be healthy before succumbing to it. Due to its unknown cause and unpredictable sudden nature, SIDS has a particularly devastating toll on new mothers, caregivers and families as a whole. The two major disparities that have been identified by Healthy People 2020 as contributors to SIDS are both race/ethnicity as well as age. In 2016, it was found that per 1,000 live births, deaths occurred in 1.1 American Indian/Alaskan native infants and 0.77 African American infants as compared to 0.13 in Asian or Pacific Islander infants (Healthy People, 2020). It is incredibly important that disparities and risk factors related to the onset of SIDS are identified and promptly managed in order to lessen the overall occurrence, as well as promote inclusive safety in newborns. In order to properly tailor healthcare toward eliminating these disparities, reduce the overall risk factors for SIDS and common causes of mortality, it’s vital to develop and implement sound health promotion practices within these specific populations.

The first step to implement a successful health promotion program within a community is to understand the factors that make theses populations have the largest disparity. Minority groups in the United States such as African Americans, Asian or Pacific Islander and Hispanic populations who are also under 25 years of age experience a higher degree of health disparities when compared to the perceived majority groups such as the Caucasian Americans (Rice, Goldfarb, Brisendine, Burrows, and Wingate, 2017). Notably, the authors assert that the socially disadvantaged populations mentioned above carry the highest degree of likelihood to experience health disparities such as disease or pandemic burden, SIDS, and violence coupled with limited opportunities to access optimal healthcare services. It is believed that within these populations, SIDS may occur as a result from both their environmental and physical factors and therefore make infants more susceptible.

In recent decades, Sudden Unexpected Infant Deaths (SUID) was a common experience in the United States. However, recent studies have indicated a drop in the statistics although the rates have remained comparatively constant since the turn of 2000. For instance, Parks, Lambert, and Shapiro-Mendoza, (2017) sought to examine ethnic and racial trends in SUID in the US between 1995 and 2013 where they established that the disparity rates have been consistently high for American Indians or the Alaska Natives compared to other social groups, that is an average of 2.6%). The authors further assert that the infant mortality rate decreased significantly down the infant age starting from the age gap of 1-2 months. For instance, the age of death for infants between 0-4 months ranged from 76% to 86% with the lowest death rate occurring between 2011 and 2013, which stood at 76%. Precisely, Hispanic American women experience the highest prevalence of SIDS with infant death rate common for the age of 1-4 months. Given this assertion, the underlying objectives include raising awareness about fetal mortality and infant mortality with the aim of reducing SIDS and SUID prevalence, especially among Hispanic, American Indians and non-Hispanic black women.

A recent study by Mathews, Joner, Oden, Alamo, Moon (2015) showed that socioeconomic factors between ethnicities could also account for the disparity between ethnicities. The study compared infant care practices that impact risk for sleep-related infant death in African–American and Hispanic families. The goal of this study was to compare infant care practices relevant to sleep related infant deaths, including sleep position, bed-sharing, room-sharing, parental smoking and breastfeeding. Findings showed that African American women were significantly more likely to bed-share with their infants than Hispanic women (Mathews et.al., 2015). A similar study was done by Gaydos et al. (2015) to compare decision making regarding sleep practices for low-income, African-American women. and counseling practices of their providers to better understand how to effectively mitigate SIDS/SUID risk for this population. This study was intended to better understand how low-income, African-American mothers under 25 years of age understand and act upon safe sleep recommendations for newborns and how providers counsel these mothers. The large majority of mothers reported understanding, but not following, the safe-sleeping recommendations. None of the providers actively counsel their patients on risk-mitigating techniques if they decide to bed share.

Another contributing factor to the disparity may be related to provider teachings. A study exploring physicians’ knowledge, attitudes, and behaviors related to Sudden Infant Death Syndrome and infant safe sleep and identified barriers as well as enabling and/or reinforcing factors associated with providing infant safe sleep education in the prenatal environment. Out of 418 physicians, approximately half (55%) indicated via survey that it was important for them to discuss SIDS risk factors and/or infant safe sleep with prenatal patients. Physicians can influence the infant safe sleep choices that women make and therefore it is important to know whether they are providing education on this topic and what they are recommending [1] Providing information and embodying cultural completence are two of the main factors which contribute to a positive intervention strategy for African American women under 25.

The overarching research reveals that the socially underprivileged groups in the United States experience the highest degree of mortality. Therefore, it is necessary for relevant for health care promotions in conjunction with both federal and governments of respective states to design a means to eradicate or limit chances for infant and fetal mortality in the US. One of the feasible means of reducing SIDS-related mortality cases involves evaluation of the basics of bedtime aspects for babies and related behavior code for mothers. According to Hauck, Tanabe, McMurry, and Moon, (2015), rates of newborn deaths from sleep-related causes have remained constant in recent years. The authors add that lack of access to safer cribs, which could enhance adherence to sleep recommendations, have persisted despite awareness of sleep recommendations among mothers. To tackle this discourse, the Bedtime Basics for Babies (BBB) program was developed. The prime objective of the program is to distribute cribs to families that experience the highest degree of fetal and infant mortality, as in the case of Hispanic and non-Hispanic black women; this will contribute significantly towards reducing mortality-related cases.

The program stands to produce the greatest desired result when it is executed in an appropriate manner. Therefore, nurses should be sought after for the execution of the BBB program for maximum benefit. Loan et al. (2018) observe that nurses exhibit the highest degree of literacy discharge, that is, nurses provide excellent work when it comes to patient engagement, empowerment, and activation. Moreover, the authors indicate that healthcare-related programs or initiatives may not be achieved unless nurses are fully engaged. On this note, nurses come handy for the BBB program where they will be expected to create awareness of the program among the socially disadvantaged groups mentioned above. The nurses will assess and identify the most susceptible families, which require cribs and related Safe Sleep Kit that contain wearable blankets and pacifiers. This program is greatly important for the socially disadvantaged groups, especially the Hispanic and non-Hispanic black women. Most importantly, nurses remain privy to this program since they exhibit the necessary knowledge and experience for the success of this kind of program.

Wellbeing has been center of promotion, driving a holistic approach towards a positive overall health combining body and mind rather than dividing neutral state of mind from the physical. Health and wellbeing has been recognised as inconsistent, total health is not constant but ever interchangeable from circumstance and environmental factors therefore, overall health is valued to adaptation. It is the adaption of the individual that evidences overall health and wellbeing, framing health and wellbeing as a human aspiration not destination (Diener, 2009.) The concept of health and wellbeing has evolved holistically to incorporate both values of physical and mental health, unlike the traditional medical model which defines health as the absence of illness or disease and emphasises clinical diagnosis and intervention (Mcleod, 2018.) Public health England (PHE) published strategic objectives focusing on health improvements within the next four years, aiming for success by 2020 and incorporating the NHS five year forward view. Public Health England published strategic objectives focusing on the wider determinates of health, promoting a bio psychological theory to apply developments in primary intervention and prevention. Largely engaging with initial prevention rather than cure, promoting liaison and inclusion of local communities and authorities as assets to join alliance of services, bridging socioeconomical inequalities, encouraging holistic working in the application of working together in providing better care (Public Health England, 2016)

The world’s health organisation (WHO), definition of health mirrors models such as the biopsychological model that incorporates values of health to psychological, physical and social factors as dominates to overall health and wellbeing. WHO states health and wellbeing as being “a state of complete mental, physical and social wellbeing and not merely the absence of disease or infirmary” (WHO, 1948.) This definition is consistent with the biopsychological model and considers factors of interaction between factors for overall health and wellbeing. The WHO definition links health explicitly to wellbeing evidencing holistic evolvement and elements for optimal health to maintain and achieve (Crinson and Martino, 2007.) Modified from the late publication of the Ottawa Charter in 1886, which describes “a Link between health and participation in society” Analytically incorporating social inclusion and environment as a factored value to health and wellbeing (World Health Organization, 2019.)

Alternatively, this view can be seen as counterproductive and unrealistic as no one person experiences complete full mental, physical and social health at all times, as previously stated overall health and wellbeing is constantly changing in response to external stimuli, the environment and experiences leaving health and wellbeing subject individualisation, critically eliminating factors such as mental state, physical disability, individual external pressures, stress and also disregarding inequalities that are present throughout health and prominent within multicultural Britain (Crinson and Martino, 2007.)

Therefore, health and wellbeing are applied subjectively and individually. Many factors incorporate perception such as age, environment and social class, all of which fall under sub-categories of health inequalities. The major criticism of applying health and wellbeing as a generalisation to a whole population that it is unrealistic because it would leave “Most of us unhealthy most of the time” (Smith, 2008.)

Argumentatively, it fails to account for temporary spells of ill health, but also the growing number of mental illnesses; temporary or longstanding (Crinson and Martino, 2007.) Further to the debate it could be disputed that marketing complete health as a goal contributes to the overmedicalisation of society by selling suboptimal health states (Crinson and Martino, 2007.) Huber et al (2001) first proposed health and wellbeing to be newly defined as the ability to adapt and self-manage expanding opportunity for individual application to specific triggers for example, situational, which factors to temporary emotional or mental ill health (Huber et al, 2001) Marketing adaptation and self-management skills is acknowledgement of the responsibility of the individual which can however, be managed collectively.

Recent training opportunities within organisations such as the National Health Service Piloting Health aim to educate its staff to better coach patients in managing goal setting and recognising limitations and solutions (The King’s Fund, 2015.) Although this approach to health and wellbeing recognises the subjective element of health, differing in context of means from one individual to another, limitations appear when individualistic measures are placed and are unable to be objective or measured against value (Crinson and Martino, 2007.)

The failure to identify wider determinates or health, in which responsibility is placed upon individual value rather than collectively leaves little scope for generalised applications (Diener, 2009.) Broadening the definitions of health has been beneficial to the improvement and understanding of psychological dimensions of individual health and wellbeing (Crinson and Martino, 2007.) Increasing recognition is integral to public health connecting the relationship between physical health and mental health partnering to measure wellbeing. Since highlighting health and wellbeing, publication of Government strategies such as “no Health without mental health” published in 2011 and “#AskTwice” promoted by Time to change.org in 2019, the national health service in partnership with the government have been working to apply equality in respect to the relationship between mental and physical health (The King’s Fund, 2015.)

The current aim piloting recognition and remoulding the delivery, development and provision of health amongst varied care services and domains, aims to improve nationally on the populations’ mental health and wellbeing, recognising the relevance in the hopes of preventing the onset of mental and emotional distress, increasing resilience and improving inequalities amongst age, race and gender (The King’s Fund, 2015.)

Key aspects of public health today monitor the health status of the UK and identify needs using the health belief model. The physiological behaviour change model was developed within the 1950’s to determine and predict health relatable behaviours to predict and forecast uptake of services. The model suggests beliefs and issues, perceived benefits of action and predicted barriers to assume effectiveness and engagement in health promotion (Health belief model, 2012.) There were reportedly 8.2 million cases of anxiety across the UK 20% of which were adolescents and 10% were children between ages of 5-16years (NoPanic, 2019.) Critically health promotion has had to target a large and varied of audience leading to promotion of a wide variety resources such as the pyramid of transformation, the 5-tier cake of change, and the circle of self-help.

However, the health belief model comes with limitations, humans are not always rational. Anxiety is its own distortion, manipulating how the brain interprets information. The mind defies logical reasoning where environmental, emotional and physical cues are related to the mind’s psychological expectations, matching and mirroring irrational thinking and distorting an individual’s sense of reality.

Critically relating back to modelled theories of health measurement and assessment, the health belief model does not explain how these variables interact (Health belief model, 2012.) In many cases the sense of reality is distorted beyond function or symptom, paralysing the mindset (Shaikh, M.D., 2019.) The human brain and cognition are much more sensitive and complicated than it may at first appear, fragile to external stimuli environmentally, socially and emotionally. Individually unable to adapt, mental health conditions such as anxiety changes the chemical messenger levels in the brain, and once this process occurs the mind interprets and perceives information from distorted levels, deceiving the individual of a complete natural process (Shaikh, M.D., 2019.)

This can also apply to an individual’s ability to adapt to current situations debated previously. Therefore, applying Maslow’s theory could help specify individual areas of categorized deficiency specifically within an individualistic pyramid of need, such as the Maslow model 1943 (Cherry, 2019.) Applying a humanistic approach theoretically subjectifies the definitions referenced from the WHO 1948, adapted from the Ottawa charter 1886, combining health and wellbeing holistically. This defers from the medical model to provide an individualistic method to combat public health, serving greater significance in clinical practice and treatment. Therefore, which coincides treating the person as a whole, alternatively, to focusing purely on diagnosis and treatment coinciding with the NHS 5 year forward view published in 2014 (The King’s Fund, 2015.)

The most recent accessible and reliable data located within the publication of “fundamental facts about mental health 2016”, published by the mental health foundation critically reports outdated statistics of depression and anxiety last measured nationally between 2010-2011. The highest results were amongst those aged between 50-59 and those aged 80 years and older who recorded greater feelings of emotional and mental distress (Mental Health Foundation, 2019.) The fundamental factors that affect health and wellbeing amongst our elderly are most commonly discrimination, participation in meaningful activities, relationships and physical health (Age concern and the Mental health foundation, 2006.)

The age of the population nationally is growing rapidly, with over half the population being aged 65 and over this figure has doubled in the past 30 years, highlighting the need to supply resources into communities and care facilities to improve knowledge and interaction throughout all fundamentals of care. Working within the theory of applying the biophysiological model approach to the resource, it is possible to target specific values such as psychological, physical and social dominates, whilst working within WHO’s 1943 definition of health and wellbeing and applying domains of Maslow’s hierarchy of needs to promote health and wellbeing among the older adult. Provided for resource is the implementation of an accessible leaflet; simple argumentatively effective, easily assessable and generalizable to a wide scope of audiences. The ability for the resource to be vastly applied through its adaptability and basic nature acquires no medical knowledge and accessible from different environments such as GP surgeries and local care homes. I justify the resource by applying a Humanistic approach following Maslow’s hierarchy of needs, therefore, subjective to individualistic interpretation of psychological identification. As targeting retired audience’s predominantly the ability to replace or fill occupational occupancy, therefore applying psychological needs to esteem and accomplishment to domains of Maslow’s theory for self-fulfillment and self-actualization providing creative means through activities. Evidence of theory applied from studies relates meaningful activities to support older adults in retaining purpose, motivation and engagement (Mental Health Foundation, 2019.) Also related to both theory and application and included within studies is the link between social isolation and loneliness, suggested to be more common among older adults. Results collected by Age UK in 2014 found that 2.9 million older adults aged 65 and over felt lonely and forgotten (Age UK, 2014.) Likewise, reports from the international longevity center and WHO stated absence of physical health linked to depression and heart disease (ILCUK, 2019.) Therefore, promoting inclusion of local communities and authorities to join alliance of services, as promoted through the public health England strategic objectives could possibly see the union of communities with local group sessions and interconnections made if promoted within care homes. And so, applying Maslow’s theory applying belonging to psychological needs, consequently factoring social participation from the bio psychological model forming relationships and communities.

Ethical consideration such as language barriers and disabling conditions such as blindness can be overcome making it obtainable, comprehensive, efficient, effective and with minor cost (M. Carter et al., 2011.) Ethical deliberations such as accessibility to health information requires sufficient attention to be ‘Justice’ therefore measurable to a concept that emphasis fairness and equality among individuals, principles of medical framework applied though ethical values of Beauchamp and Childress (Aldcroft, 2012.)

Mirroring values of a biopsychological method to health and wellbeing of the elderly should target the areas of participation in meaningful activities and importance of physical health as factoring contributions to overall health. The influences valued in models, theories, definitions and approaches to evidence coping strategies corresponding with Huber et al in (2001) which debate that a new meaning to health and wellbeing is the ability to adapt and self-manage (Huber et al. 2001) and inclusion to Maslow’s building blocks to determine individual hierarchy of needs. Informal reading of a non – dynamic guide supporting range of movement which can be individualistic or alternatively group lead, additionally supporting social inclusion and community. Promoting engagement and stimulation benefits the physical, cognitive and life satisfaction of older adults retaining the abilities of self-purpose and independence.

References

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3. Cherry, K. (2019). How Maslow’s Famous Hierarchy of Needs Explains Human Motivation. [online] Verywell Mind. Available at: https://www.verywellmind.com/what-is-maslows-hierarchy-of-needs-4136760 [Accessed 5 Aug. 2019].
4. Huber, M., Knottnerus, A., Green, L., van der Horst, H., R Jadad, A., Kromhout, D., Leonard, B., Lorig, K., Isabel Loureiro, M., W M van der Meer, J., Schnabel, P., Smith, R., van Weel, C. and Smid, H. (2001). How should we define health?. [online] The BMJ. Available at: https://www.bmj.com/content/343/bmj.d4163 [Accessed 6 Aug. 2019].
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Dehydration is a fluid intake or retention that is less than what is needed to meet the body’s fluid requirement resulting in fluid volume deficit, especially plasma volume (Rebar, Ignativicius & Workman, 2018). Dehydration may indicate an actual decrease in total body water due to minimal intake of fluid or higher loss of fluids; however, relative dehydration can also occur due to fluid shifts from the plasma into the interstitial space without an actual loss of total body water (Rebar et al., 2018).

Dehydration can occur at any age in both genders depending on the underlying cause or factors that are contributing to this condition. However, the focus population that will be discussed are older Hispanic adults living in Chestnut Hill Nursing Home Center in Passaic, New Jersey. Older adults are more susceptible to dehydration than young and middle-aged adults due to the pathophysiological changes that occur with the aging process (El-Sharkawy et al., 2015). The thirst sensation in older adults is diminished due to the age-related increased thirst threshold; thus, before older adults become thirsty, the osmolality of body fluids can rise higher and can result in decreased fluid intake (Potter & Perry, 2017). Older adults, in comparison to young and middle-aged adults, have decreased lean body mass that also decreases the body water weight percentages (Potter & Perry, 2017). Renal function declines as a result of aging with glomerular filtration rate reducing by 50-63% from the age of 30-80 years, resulting in decreased ability to conserve water and concentrate urine (El-Sharkawy et al., 2015).

In a review of over 10 million hospital records from a US healthcare provider, 17% of elderly with a principal diagnosis of dehydration as per the ICD classification died within 30 days of hospital admission with a 1-year mortality of 48% (El-Sharkawy et al., 2015). The prevalence of dehydration in older adults in nursing homes ranges from 12-50%, with the United States around 30% (Masot et al., 2018). The real incidence of dehydration is unknown due to the lack of standardized methods, and a variety of ways to determine whether an individual is dehydrated or not (Masot et al., 2018). In nursing homes, many older adults may be mildly dehydrated with no clinical manifestation until dehydration becomes more severe (Masot et al., 2018). Furthermore, dehydration in older hospitalized patients can be a major concern for safety and contributes to a significant public health burden with high-cost implications (El-Sharkawy et al., 2015). Dehydration may lead to further health problems such as falls, orthostatic hypotension, and hypovolemic shock, resulting in further hospital stays and higher healthcare costs for the client despite being a preventable problem (Rebar et al., 2018)

As previously mentioned, the population-focused that will be discussed are Hispanic older adults living in Chestnut Hill Nursing Home Center in Passaic, New Jersey. Thus, it is important to create a unique and independent plan for the population to develop an effective primary prevention and health promotion strategy. According to the U.S. Census Bureau, 42.3% are Hispanic, and 14.5% are persons 65 years or older in Passaic, New Jersey population (United States Census Bureau, 2017). Also, languages other than English that are spoken at home are at 48.2% in Passaic, New Jersey (United States Census Bureau, 2017).

First, it is essential to evaluate the population’s readiness to learn. Ensuring their readiness to learn will provide better collaboration with healthcare providers to achieve positive health outcomes and behavior. Prochaska and DiClemente developed the Transtheoretical model that includes five stages of behavioral change that will help guide nurses to understand the process of readiness to learn in patients; the five stages are pre-contemplation, contemplation, preparation for action, action, and maintenance (Giddens, 2017). This change model is effective in understanding that changes occur gradually in small steps and relapses are inevitable in the process of reaching a larger goal of lifelong change. At first, people may be unwilling to change during the early stages, but eventually, develop a proactive and committed approach to changing their behavior. In the focused population, the state of readiness to learn is important to consider as it will be helpful for them to engage and participate in developing primary prevention strategies to prevent dehydration.

In terms of reading level and learner engagement, it is important to determine the population’s educational and literacy level to develop an effective teaching approach. According to the U.S. Census Bureau, only 27% of the population carry a bachelor’s degree or higher, and 83% of the rest have a high school or some college as the highest level of education in Passaic City (United States Census Bureau, 2017). Therefore, as a nurse, considering the target population’s level of education and literacy can be beneficial to develop an individualized plan and material within their reading level and help them improve their basic health literacy.

Primary prevention can include educating the target population regarding the importance of adequate fluid intake and understanding the clinical signs of dehydration. This can be done in the large community room in Chestnut Hill Nursing Home Center in Passaic. Teaching sessions may be scheduled in mid-morning after breakfast when patients’ energy levels are high, and consider splitting longer sessions on different days to avoid lengthy session that may fatigue the audience (Potter & Perry, 2017). Also, the use of medical terminology must be minimalized and replaced with lay terms (Potter & Perry, 2017). Presentations can be done and educational materials such as brochures that are appropriate to the audience’s language and literacy level can be provided that includes information on recommended fluid intake, the risk of dehydration, and possible solutions (Konings et al., 2015). As a result, elderly patients may develop a new appreciation and understanding of the importance of water and hydration in health and can be incorporated into their lifestyle (Picetti et al., 2017). In addition to the presentation, a set of questions can be asked during sessions and provide a survey to evaluate the effectiveness of teaching.

Culture and family are important in terms of health promotion to prevent dehydration. As mentioned, the population of Hispanic in Passaic City is about 42.3% which corresponds with higher Hispanic culture that includes often use of Spanish language at home (United States Census Bureau, 2017). Thus, Spanish speaking older adults may face difficulties engaging in the plan of care due to language barriers that are present between them and the healthcare provider. Furthermore, diet can be a huge factor that may contribute to dehydration. The Hispanic population has a higher risk for type 2 diabetes due to hereditary, uncontrolled blood glucose, and lifestyle (CDC, 2017). Some of the clinical manifestations of type 2 diabetes that can lead to dehydration include increased urination, and increased thirst (Rebar et al., 2018). The typical diet of a Hispanic culture includes higher consumption of rice and sodium and less consumption of vegetables, which may contribute to the development of type 2 diabetes (Hispanic and Latino Diet, 2019). Family is another important variable that should be considered when caring for older Hispanic adults. Hispanic families tend to use less long-term or home care services because of their cultural values and beliefs about caregiving services and practices (Miyawake, 2016). Familism is one of the core values of a Hispanic culture where family members play the major role as the primary caregiver for elderly members and have a sense of obligation and reciprocity to respect and give back the love and support extended to them when growing up (Miyawake, 2016).

Finances is another variable that has an impact on health promotion for dehydration. In the United States, about 10.8% of the total population is uninsured (CDC, 2017). However, the total Hispanic or Latino origins that are uninsured in the United States are at 21.4%, with Mexican or Mexican American being the largest part of the Latino origin uninsured at 24.1% (CDC, 2017). Also, the median household is only at $34,920 with a poverty percentage of 33.1% in Passaic, New Jersey (CDC, 2017). Thus, many of the Hispanic older population in Passaic City have low socioeconomic status and may have difficulty obtaining healthcare, especially for undocumented older adults.

Support from family and friends can influence one’s health beliefs and practices, which can contribute to the psychosocial variable aspect. Social support, optimism, and strong familial and social ties are common among Hispanic families which can help alleviate stress and potentially be protective among Hispanics despite their higher risk profile (Rodriguez et al., 2014) Thus, families and support systems should be involved during education about the importance of hydration to prevent dehydration as they can help support and motivate individuals to adhere to the plan of care and achieve better health outcomes. Furthermore, elder Hispanic Immigrants tend to have a smaller social network outside of their kin members due to the complex and advancement of technology (Miyawaki, 2016). Thus, nurses can assist them by demonstrating how to use mobile phones to connect with other family and friends to prevent social isolation (Miyawaki, 2016).

References

1. DC Features. (2017, September 18). Retrieved from https://www.cdc.gov/features/hispanichealth/index.html
2. El-Sharkawy, A. M., Watson, P., Neal, K. R., Ljungqvist, O., Maughan, R. J., Sahota, O., & Lobo, D. N. (2015). Hydration and outcome in older patients admitted to hospital (The HOOP prospective cohort study). Age and Ageing, 44(6), 943–947. doi: 10.1093/ageing/afv119
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9. Rodriguez, C. J., M. Allison, M. L. Daviglus, C. R Isasi, C. Keller, E. C. Leira, L. Palaniappan, I. L. Piria, S. M. Ramirez, B. Rodriguez, and M. Sims. 2014. ‘Status of Cardiovascular Disease and Stroke in Hispanics/Latinos in the United States: A Science Advisory From the American Heart Association.’ Circulation 130 (7): 593-625.
10. Potter, P. A., RN, MSN, PhD, FAAN, Perry, A. G., RN, EdD, FAAN, Stockert, P., RN, BS. (2017) Fundamentals of Nursing. [Pageburstls]. Retrieved from https://pageburstls.elsevier.com/#/books/9780323327404/
11. https://www.cdc.gov/features/hispanichealth/index.html

Health advancement is nevertheless one of the essential objectives in the present day nursing. Wellbeing elevating practices can prompt a patient’s generally speaking feeling of prosperity as well as assurance from ailment and interminable diseases. Pender’s health advancement hypothesis offers a comprehensive perspective on the patient, surveying the patient’s foundation and self-perceptions to enable the attendant to mediate and build an arrangement in like manner. The wellbeing advancement hypothesis can in a perfect world be connected to all populace’s but is particularly significant in the juvenile populace since they are at a basic time in their life for settling on free human services choices. A careful scrutinizes of this hypothesis shows that this model can be valuable in the pre-adult populace yet maybe ought to be adjusted in different approaches to be effective. It can likewise be reasoned that a lot more examinations should be finished applying this model to the immature populace.

Nola Pender’s Health Promotion Model (HPM) was made to fill in as a ‘multivariate worldview for explaining and foreseeing wellbeing advancing segment of way of life’ (Pender, 1990, p.326). The model is utilized to survey an individual’s foundation and saw impression of self among different components to foresee wellbeing practices. Before the HPM was distributed, another comparative model had been formed which also considered these elements to anticipate wellbeing practices. This model, the Health Belief Model (HBM), fixated on the possibility that fear or danger

Health Promotion Theory of malady is the indicator for positive wellbeing practices (Peterson and Bredow, 2009). Studies bolster the HBM as being a disease avoidance model (Galloway, 2003). Pender be that as it may, needed to characterize wellbeing as not simply being free of ailment. Her meaning of wellbeing incorporates measures taken to advance great wellbeing and incorporates the patient‟s possess perspective on themselves and their lifestyle (Peterson and Bredow, 2009). Considering her extended perspective on wellbeing, she originally distributed the HPM in 1982. Because of a specific study using her model, she then revised it in 1996 (Pender, 1996; Peterson and Bredow, 2009). Pender’s model is intended to be a ‘manage for investigation of the complex biopsychosocial forms that persuade people to take part in practices coordinated toward the improvement of health’ (Pender, 1996, p. 51). Pender made this model to be ‘appropriate to any wellbeing conduct in which „threat‟ isn’t proposed as a noteworthy wellspring of inspiration for the behavior'(Pender, 1996, p. 53). Since the model doesn’t depend on potential danger of sickness as a wellspring of inspiration, it tends to be relevant in a lot more circumstances over the life expectancy (Pender, 1996). This and the way that the model tends to assets, which teenagers may need, make it particularly valuable for use in young people.

Two hypotheses underlie Pender’s model which are significant for understanding the ideas she portrays. These two hypotheses are the anticipation esteem hypothesis and the social psychological hypothesis. The hope esteem hypothesis depends on the possibility that the game-plan will probably prompt the ideal result, and that this result will be of constructive individual worth (Pender, 1996). The social intellectual hypothesis depicts the idea of saw self-viability which is ‘a judgment of one’s capacity to do a specific strategy’ (Pender, 1996, p.15)

Health Promotion Theory Pender predicts that a high certainty level will prompt more noteworthy probability that the conduct will be performed. There are three noteworthy ideas in Pender’s model which are further subdivided into smaller, increasingly explicit concepts. The real ideas are singular qualities and encounters, conduct explicit insights and influence, and social result. Every idea in the model applies to a particular territory of patient evaluation or activity. One concept that was incorporated into the HBM that has been deliberately let well enough alone for the HPM is seen danger of malady.

Nursing Science Quarterly, October 2006 The Garcia et al. (1995) study demonstrated that background characteristics, specifically gender, played a significant role in determining exercise behavior. The study also supported the HPM as a useful model for explaining physical activity health-promoting behavior among teens. However, whereas the HPM purports a direct relationship of self-efficacy and interpersonal influences toward health-promoting behavior, this study demonstrated an indirect effect of self-efficacy and social support related to physical activity behavior.

A Study across School Transition the Garcia et al. (1995) study examined a cross-section of students from two grade groupings. In a follow-up longitudinal study, Garcia, Pender, Antonakos, and Ronis (1998) explored physical activity beliefs and behaviors across the transition from elementary to middle school among 132 participants. The purpose of the study was to determine how much variance in exercise behavior following junior high transition was explained by HPM variables.

The model is exceptionally valuable in that it considers each individual‟s conduct and inclinations. This enables the medical caretaker to build up a special consideration plan that considers these practices. Pender (1996) suggests utilizing the nursing procedure including utilizing nursing findings and model-based appraisals, for example, the Health Promoting Lifestyles Profile II. She plots a multi-step process in building up an arrangement of consideration dependent on client‟s qualities and preferences.Peterson and Bredow (2009) attract from different investigations to take note of that ‘fitting intercessions has been found to expand mediation adequacy’ (p. 297).Many other studies have additionally demonstrated valuable in clarifying differences in conduct in wellbeing advancement (Peterson and Bredow, 2009). The HPM has been additionally adjusted to be progressively valuable in youths. Dark colored (2009) surveys ponders that have utilized the Physical Activity Lifestyle Model (or PALM) which is like the HPM yet has been increasingly valuable in the necessities of adolescents.

Peterson and Bredow (2009) precisely note that this model has changed the focal point of the job of the medical attendant from basically infection counteractive action to wellbeing advancement. Pender’s model is valuable to the attendant since it grows their job to advance great wellbeing instead of simply diminishing their hazard for winding up sick. The nurse’s objectives are presently planned for ‘fortifying assets, possibilities, and capacities’ for every patient and giving assets and instruction to advance improved wellbeing and a superior personal satisfaction (Peterson and Bredow, 2009, p. 292).

The extent of the hypothesis is constrained to foreseeing and recognizing wellbeing advancing practices without including illness evasion as an inspiration for wellbeing conduct. The model doesn’t restrict itself to a particular sort of wellbeing conduct performed, and thusly can be connected in a wide sense to various settings. Pender(1996)discusses a wide range of settings the hypothesis can be utilized in including the work environment, schools, and medical clinics yet in addition in a more extensive scale including wellbeing advancement inside families and in the community. Pender likewise diagrams explicit systems in her book for building plans for people for wellbeing advancement. Points of interest incorporate sustenance data for people everything being equal, practice projects, and stress the board.

Introduction

Diabetes is defined as those people having a fasting blood glucose value of greater than or equal to 7.0 mmol/L or on medication for diabetes/raised blood glucose. Since the last 30 years there has been an epidemic rise in the number of people between ages 20 to 60 with diabetes especially in Asia. The purpose of this essay is to debate who the experts in health promotion are. The aim of this essay is to investigate the literature regarding the high incidence and causes of Diabetes Mellitus in Asians, and to develop a health promotion campaign for empowering people to tackle the problem locally. WHO defines empowerment as “a process through which people gain greater control over decisions and actions affecting their health”. People’s empowerment is a process of developing understanding, knowledge, and skills to perform a task in an environment that recognises community and cultural differences and encourages patient participation.

Background

WHO estimates that, globally, 422 million people over 18 years had diabetes in 2014, the highest numbers living in South-East Asia and Western Pacific Regions. Prevalence of diabetes has risen from 4.7% in 1980 to an average of 8.5% globally in 2014. 7.1% were found in Africa, 8.3% in the Americas, 13.7% in the Eastern Mediterranean Region, 7.3% in Europe, 8.6% in the South-East Asia Region, and 8.4% in the Western Pacific Region (currently 13.7%). Since the last 10 years, it has risen four times in developing countries from 108 million to around four times higher. (Ref 1 Global Report on Diabetes, WHO 2016)

In the UK, about 1.3 million suffer with diabetes Type 2 and has increased in all groups of people, especially in black and other ethnic groups. The UK National Service Framework (NSF) for Diabetes has set out 12 standards to drive up service quality and primary care. Each NSF sets national standards, identifies the interventions that will help meet those standards and the milestones against which NHS performance will be measured. (Ref. 2 National Service Framework for Diabetes; Standards).

Discussion

Worldwide, and especially in Asia, increased fast food consumption, increased use of cars, and urbanisation has increased the BMI (Basal Metabolic Rate) and diabetes risk factors. In China, diabetes has increased from approximately 1% in 1980 to currently 9.7%. South Asians are 6 times more likely to develop diabetes than Europeans according to a

study published in the August 2011 edition of the Journal of Nature Genetics (Ref.3). Scientists from Glasgow University discovered that South Asians have skeletal muscles which do not metabolise fat as well as Europeans, and during exercise burn 40% less fat than Europeans due to insulin resistance. Also, nearly 50% of adult men in Asian countries smoke regularly, which is linked with higher abdominal fat and increased risk of men developing diabetes. Experts believe that diet, a reduced sensitivity to insulin and lifestyle have resulted in the storage fat in different ways in the body, while genetically south Asians are susceptible to diabetes and heart disease more than any other group of people and have poorer diabetes management (Ref. 4. NHS 17 Nov. 2016). Also, Asian countries have their own treatment regimes. (Ref. 5 Diabetes in Asians (Eun-Jung Rhee, Endocrinology and Metabolism, 2015). Lawton et al (Ref. 6. Diabetic Medicine. 2010) points out that South Asian people blame external factors for their diabetes. South Asian food has also been blamed by them

Asians mostly do not know the risks of complications, and especially for heart disease. The relationship between fatalistic beliefs and diabetes treatment is inconclusive and needs further study. (Ref. 7 The Role of Illness Beliefs and Social Networks in South Asian People with Diabetes: Rankin and Bhopal, 2001; Misra et al, 2009).

Other studies have shown that men develop the disease by gaining much less weight than women at lower Basal Metabolic Rate (Ref. 8. NHS. Men ‘develop diabetes more easily’. 2011). It is also theorised that men store fat around their organs rather than under the skin like women do. A new report shows that due to different lifestyles, men between 35-54 years are twice more prone to diabetes (Ref. 9. Public Health England. 2014)

Currently, only 7 of 11 countries in South-East Asia have policies for diabetes, either stand-alone or integrated with other policies. Lack of staff training, people’s knowledge belief and attitudes, bias towards generic drugs, poor logistics of medicines, and weak referral systems are all to blame. Also, the political economy of a country determines how health services are structured and delivered, while public health and health promotion are social and political issues. (Ref. 10 Salvatore B (2009). They override health promotion efforts that prop up the health system. To be effective there is need for integration within social and political contexts and require specific responsibility and behaviour of people through joint efforts and coordination.

I would plan a campaign within a specific Asian population seeking to change their current behaviour. Health Promoters increase the confidence of people, informing them that knowledge is available. When promoting a message it is important to use medical practitioners to communicate the correct message. (Ref. 11 Strategies for Developing a Health Promotion Campaign. Loti Popescscu et al, Common Health, 2000)

Debate

Health promoters may however be people from different backgrounds. They are ideally people trained in the basic provision of health care services, in the prevention of disease, and in the promotion of health in their communities (e.g. In Malaysia). However, they are mostly trained in a number of diverse health topics, whereas knowledge of health is becoming more complex and the balance between individual, community, and government responsibility appears to be continual tilting. So who should be the ‘expert’ in a health promotion campaign? It is important to consider the bigger picture as many factors influence health (environmental, social, political, and economic) that do not fall within the domain of the health sector and the control of the people who work for it. (Ref. 12 Journal of medical ethics 2004: Debates and Dilemmas in Promoting Health. J Clarkson). Social marketing skills are also required. Ralph Lefebvre argues that social marketing is misunderstood and has frequently been under used by health promoters. Peter Townsend encourages us to “think globally, act locally”. Taking the above limitations and statements into consideration, the skills required by Health Promoters are exhaustive and they require ongoing education and training in their communities. I would consider the ‘experts’ to be local health practitioners who will take ownership of the program on a longer term. They have a wide range of knowledge and skills which can be upgraded. This could be myself as a Health Promoter if I meet all the requirements to qualify as an ‘expert’.

Behavioural economists say that people have a bias towards the present and choose things that will provide immediate benefits rather than benefits in the future (better health). So they are not so motivated towards future benefits. During pre planning, I would design a health promotion campaign for preventing diabetes within a specific population taking all above considerations into account to guide me. . I must manage a number of elements at each stage including participation of key stakeholders, time frames, money and resources, data-gathering and interpretation.

A specific strategy will be developed selecting two elements from the Ottawa Charter for Health Promotion, namely strengthening community action and creating supportive environment. I have selected these two because they provide the communities with self empowerment and the best chance of a cost effective result and long last effect regarding behaviour change. They address the core issues that need to be changed, not only the structural changes. Building healthy public policy, reorienting health services and/or developing personal skills can be expensive and by themselves may not guarantee a long lasting change in behaviour of individuals and communities.

Strategy A. Strengthening community action to become an integral part of health promotion practice. Grace Spencer (Ref. 13. 2013) has postulated that there are 6 distinct forms of empowerment, namely impositional, dispositional, concessional, oppositional, normative and transformative which define the different elements of power that determines people’s empowerment. Our actions will be guided by these theories in order to better enforce empowerment. Focus group discussions will be conducted to share knowledge on the dangers of diabetes and to understand, how diabetes impacts people’s health and society. They will be informed about the methods of prevention, treatment, and long term management of the disease to prevent complications. Advocacy will focus on political, economic, social, cultural, environmental, behavioural and biological factors affecting health. A comprehensive health communication campaign will be developed to use a combination of media, interpersonal and community events involving an organised set of communication activities. Mediation will ensure that different people are involved.

Strategy B. Creating a supportive environment

It is important to involve key community members, especially those that are most knowledgeable about the affected people, the environment, cultural habits, and which health communication messages are effective. Individuals and organisations with an interest in diabetes should be involved in all stages of health promotion. It is important to know who supports it, who can sabotage it, and who has good knowledge about it. Individuals should not be seen representing a particular form of culture (Csordas, 2002), and family units, groups of people and communities as a whole will be targeted. Enablement of communities will develop a supporting environment, flow of information, and the life skills and opportunities for empowering people in making healthy choices. ‘Expert’ is someone who has local experience and knowledge of the problems in the community.

Target population: I have selected Belabo sub district of Narsingdi District in Bangladesh. Belabo has a population of 145,708 (1991 census). 98% are Bengali and remaining are Biharis or other groups; Perceptions about diabetes include perceptions about food, linking together sugar, bone marrow and semen as causes of diabetes (Choudhury et al, 2009). The lack of sweating and difficult labour was also attributed to diabetes (Greenhalgh et al, 1998). Eating bitter gourd is said to be a treatment for diabetes (Choudhury et al, 2009). These beliefs may cause people not to seek treatment or delay starting it (Choudhury et al, 2009).

I would like to change these perceptions of the population for better health seeking behaviour. I will consider the fact that in South Asia the dynamics of managing type 2 diabetes is family oriented and to bring about lifestyle changes it was expressed that it would be helpful to educate the family unit instead, as expressed by Madhur, from Bangladesh. I will identify the specific audience (adults aged 20-60 years old), estimate the required resources, and prepare a budget.

Specific indicators of performance will be developed that can be monitored and evaluated at each step of the process. Then specific activities will be developed. (Ref.14 Public Health Ontario 2012). Program timeframe: 2 weeks planning, 3 months for developing materials and implementation of the campaign, and one year for monitoring and evaluating the community’s ability to become an integral part of health promotion practice.

Goal: To change the health seeking behaviour of adults aged 20-60 years old within

Belabo subdistrict of Narsingdi District in Bangladesh

Specific objectives will then be developed that will be specific, measureable, achievable, replicable and time bound (SMART).

Activities. Specific activities will be developed:

1. Conduct a situational analysis: A systematic collection and evaluation of economical, political, social, and technological data, aimed at (a). identification of internal and external forces that may influence the choice of my strategy (b) assessment of the community’s strengths and weakness by doing a Strengths, Weaknesses, Opportunities & Threats analysis (SWOT). In consultation with my team and key stakeholders, I will gather, analyse, synthesise and. communicate data to inform planning decisions. I will recruit the participation of the ‘experts’ i.e. local health practitioners who have knowledge about local disease patterns and incidence and peoples health seeking behaviour. These experts will be given the opportunity to independently address different sources of uncertainty (Ref. 15 Ferson and Ginzburg 1996) & (Ref. 16 Regan et al. 2002). They will be the key implementers of the campaign and will ensure continuity of the health promotion activities after project closure. I will conduct a stakeholder workshop or informal meetings to ensure their ownership. I will look at political agendas of individuals and parties. I will investigate the political, economic, environmental, social and technological factors that could potentially affect the project (PEEST analysis). The risk factors (killer assumptions) will then be monitored at every step.
2. Analyse and segment the audience: Segmenting audiences will enable me to focus on those people who are most essential to reach and also to design the most effective and efficient strategy for helping each audience with specific needs and preferences to adopt new behaviours.
3. Select channels of communication: Various channels to be considered alone or combined will include:

• a. Interpersonal channels- one to one communication, home visits, and group discussions.
• b. Broadcast channels, such as radio and television to provide local coverage.
• c. Print channels, like pamphlets, flyers, and posters, are generally considered best for providing reminders of important communication messages

I will use also use Doctor-patient communication, focus-group discussions, self-help groups, mass media campaign and events. An initial big event will build up to a grand finale.

Design campaign messages and produce the materials

Behaviour change requirements for development of the messages will include current behaviour, benefits of behaviour change, acceptance of change, social or medical consequences, skill level, knowledge, attitudes, practices, behaviour etc. Effective messages will be designed which are attractive, eye-catching, appropriate and logical. The experts to be used for project implementation will have excellent communication skill, are mature, non-judgemental, confident and culture-sensitive. They will be able to interact well with diverse groups of people and should have good problem solving skills.

Messages will be context-specific and sensitive and will be technically correct.

Pilot and implement the campaign

All materials will be pre-tested on the target population before use. I will allocate resources according to needs and time frame. The health communication process will utilise learning processes. Wherever possible, I will use expert medical opinion to communicate facts.

Evaluate and maintain the campaign

I will then make an impact assessment, followed by an outcome assessment which will define the result and tell me if the goals and objectives have been achieved, especially specific behaviour changes. This will be done by ongoing monitoring and enforcement of the critical messages about behaviour change.

Conclusion

There is huge increase in the incidence of diabetes mellitus worldwide since the last decade. The difference in increase is greatest in Asia where modernisation and changing lifestyle have caused this increase. Each region of the world has its unique culture and belief system which determines what causes diabetes. It is highly affected by existing political, environmental and social factors. I discussed the relationship between political economy, public health, and health promotion. Government, community, and individual awareness, commitment and effort are required to halt this ‘tsunami of diabetes’. Health promotion efforts needs to be accelerated and health systems strengthened at all levels. An example of how health promotion within a specific population can be conducted is outlined in this essay and I identified that local health practitioners at community level are the real ‘experts’.

Pregnancy and Risk Factors

During pregnancy, there are many factors that can affect the fetus and/or the mother. It is important, as a healthcare provider, to incorporate health promotion into obstetrics care. My patient, JW, is on her third pregnancy, and is around 8 weeks and 3 days pregnant. Previously, she endured a spontaneous abortion in 2008. In 2015, at 36 weeks gestation, she went under an emergency cesarean section due to oligohydramnios, which means deficient amniotic fluid. The baby was born weighing 4 pounds and 9 ounces, so this complication was likely caused by intrauterine growth restriction of the fetus due to maternal smoking of cigarettes. She is currently still smoking and admittedly will be throughout this pregnancy, but she stated she will be cutting down on how often she smokes. JW noted smoking one pack a day, but when she found out she was pregnant, she has slowly cut down to four cigarettes a day. JW is 5’ 5”and weighed 226 pounds before pregnancy with a body mass index of 38. Currently, she weighs 223 pounds, making her body mass index 37, and she lost three pounds since conception. She is considered obesity class II, putting her at a higher risk during pregnancy. JW is unemployed, engages in a sedentary lifestyle, and admits to an unhealthy diet. Her diet did not consist of enough vitamins and nutrients before pregnancy, and now she has been nauseated since her last menstrual period. She has had to spread out small meals throughout the day to fill up and decrease nausea. Although this pregnancy was not planned, so very little preparation care was performed, she seems excited about this experience. A lot of education is needed to ensure a successful and, hopefully, healthy pregnancy for both JW and her baby. The purpose of this paper is to apply health teaching and knowledge to help to create a healthy outcome during pregnancy for both the mother and the baby. In this case, two big risk factors JW have are obesity and smoking cigarettes.

Prenatal Risk Factors

There are a handful of risk factors involved with JW’s pregnancy. She weighs more than 91 kilograms, smokes cigarettes, smokes marijuana, has depression, has a poor diet, and has a low-income level. All of these risk factors are considered modifiable because they can be improved upon or even controlled. For example, cessation of smoking cigarettes and marijuana, employment to increase income, weight loss/control, and medication/therapy control of depression. This pregnancy would be considered high risk because of the multiple factors that increase the risk of health problems in both the mom and the baby. Smoking is a major risk factor because they deemed this the likely cause of oligohydramnios in her previous pregnancy.

Obesity in pregnancy can increase risks of health problems in both the mother and the baby. The mother can have an increased risk for hypertension. Both chronic and gestational hypertension puts the mother at a higher risk for preeclampsia. Obesity increases the risk for gestational diabetes and diabetes mellitus, which can cause further complications that could affect the mother and the baby. Cephalopelvic disproportion can occur as a result of obesity in pregnancy. This is when he baby’s body or head is too small to fit through the pelvic opening, leading to the need of a cesarean section because obesity can increase the risk of macrosomia. The fetus has decreased nutrition and perfusion due to the increased blood pressure to the fetus. In order to decrease risk factors, the mother can participate in safe exercise for 30 minutes, 5 days a week. Walking and yoga are great examples of safe exercise for pregnant women to become more active and lose weight. The mother can be referred to a nutritionist who will guide her to eat healthier for both her and her baby’s wellbeing. During pregnancy, there are parameters of healthy weight gain, but if the mother is obese, it is recommended that she gain only 11 to 20 pounds throughout the nine months.

Smoking cigarettes can cause health problems in anyone with this habit, so a pregnant woman can hurt both themselves and their baby. Cigarettes risk many health problems in both the mother and the baby. The mother has increased risk of hypertension because smoking causes vasoconstriction. Just like in other people, smoking can cause cancer in the mother. Also, because of the vasoconstriction, there is poor placental perfusion, leading to decreased oxygen and nutrients to the fetus. In return, the fetus can have intrauterine growth restriction and be small for gestational age. These factors can lead to a premature delivery in order to save the baby. The biggest intervention in this risk factor is cessation of smoking. It can help lead to a healthier pregnancy and the best way to convince a mother of this is education on the health risks and the benefits of quitting.

This patient tested positive and admitted to the use of marijuana, even during pregnancy. There have been limited studies on the correlation with marijuana use during pregnancy, so there is not a lot of knowledge surrounding this act. It is thought that the use of marijuana during pregnancy can increase the risk for abruptio placentae. Abruptio placentae is when the placenta prematurely detaches from the uterus. The mother is also at higher risk for poor nutrition due to drug use. Marijuana use has been linked to withdrawal-like symptoms in the newborn. The baby may have increased tremors and crying that can last for a few days. Smoking marijuana has been seen to decrease oxygen in the blood, similarly to smoking cigarettes. This decrease in oxygen can cause malnutrition and intrauterine growth restriction, and in return, the baby can be small for gestational age. The main interventions to prevent these harmful effects would be cessation of marijuana use and education provided of the consequences involved.

During pregnancy, hormones changes cause mood swings and affect the pregnant woman constantly. Having a history of depression can put a woman at higher risk. Medications can be taken, but in JW case, she has completely stopped her medications months before she became pregnant. Depression is modifiable in that there are medications to aid the symptoms and therapy is always an option, but these interventions do not cure the mental illness. Having a sturdy support group may be helpful in woman with depression, as well. After giving birth, a woman’s hormone levels drop to normal levels. In a woman without depression, she is at risk for postpartum depression, so this mental illness puts her at a higher risk. Postpartum depression can lead to neglect or abuse of the child if no interventions are taken advantage of. Medications or therapy may need to be used to help the mother cope and deal with symptoms.

A nutritional, well-balanced diet is important for a healthy pregnancy and baby. JW admitted to having an unhealthy diet and did not understand the importance of prenatal vitamins. Especially during the first trimester, these nutrients are important in the development of the fetus. Prenatal vitamins contain a lot of essential vitamins, but folic acid is a vital component of these vitamins. Folic acid aids in the development of the fetus’ brain and spinal cord. These birth defects, also known as neural tube defects can cause meningoceles and myelomeningoceles, which are different types of spina bifida. Iron is another very important vitamin while pregnant. Iron aids in the production of red blood cells, and during pregnancy the woman’s blood volume must increase in order to increase oxygen and nutrient perfusion to the fetus. This impaired perfusion can lead to fetal malnutrition and intrauterine growth restriction, causing the baby to be small for gestational age. Deficient iron intake can cause anemia in many people. A woman needs more iron in her diet during pregnancy, so inadequate intake can lead to anemia. A poor diet can lead to too much weight gain if the woman is eating more than body requirements. This would endanger this woman more considering she is already obese. Studies have shown that a poor nutritional intake can increase the risk of a preterm birth. Although preeclampsia and eclampsia are not completely understood, they have been linked to high body fat and poor nutrition. The woman should be referred to a nutritionist in order to be taught the proper nutritional intake needed for a healthy pregnancy. Prenatal vitamins are also a vital part of a healthy pregnancy. They need to be taken daily throughout the pregnancy to promote a healthy development of the fetus.

JW explained that she has a low-income level. Both her and her boyfriend are unemployed and live with her father, and many others. This can lead to worsening problems that she already exhibits, such as poor nutrition. She may not spend the money on healthier foods and not take prenatal vitamins as often, if at all. She admitted to not having prenatal vitamins to take yet, so she will be receiving a prescription. Having a low-income level puts her at risk for insufficient or late antenatal care. Good nutrition and compliance with prenatal vitamins are important for the baby’s health and her own. Also, because of the increased risk for poor nutritional intake, she is at a higher risk for preeclampsia. Without the proper nutrients and antenatal care, preeclampsia is more prevalent, and she may not have the proper monitoring to detect these symptoms. The newborn can be born with a low birth weight and be small for gestational age due to the improper diet control. Without knowing the proper status of the baby, there can be intrauterine growth restriction and the baby is also at higher risk for a premature birth. There are many programs to help a low-income family during pregnancy and afterwards. These families can be referred to a social worker. Social workers can help the woman find certain necessities for pregnancy or the postpartum period, such as a breast pump for breastfeeding. They are a support person for the mother and family during this stressful life event. The social worker can assist to find certain programs that can be beneficial for a low-income family. Women, Infants, and Children (WIC) is a program made for low-income women to supplement nutrition for these families. Federal grants are provided from Women, Infants, and Children to support nutrition and health care referrals. This aid is continued throughout pregnancy, postpartum women, infants, and to children until the age of 5 if there is a need. Medicaid is an insurance program for people who are considered low-income and do not carry another insurance plan. This program can aid in prenatal, postpartum care, and the newborn care. The newborn can be insured under either Medicaid, or they can have the Children’s Health Insurance Program, or CHIP. Children’s Health Insurance Program covers healthcare for the newborn until adulthood. This health insurance covers doctor’s visits, vaccinations, medications, emergency visits, etc. These insurance programs are extremely beneficial to the low-income family and can promote wellness in both the mother and infant. Another program that is beneficial to these families is Healthy Beginnings, which is a program Geisinger hospitals provide. Healthy Beginnings provides a variety of aid to the pregnant and postnatal women. The hospital helps pay for prenatal visits and can pay for transportation if necessary. This program can give food to the family at a low cost or for free. A lot of education topics are covered as well to make sure the pregnant woman understands the importance of this care and care for her newborn. Some topics they cover are breastfeeding, formula feeding, preparing for delivery, caring for a newborn, etc.

Critique of Teaching and Anticipatory Guidance

After watching this new prenatal visit, I feel like the teaching provided for JW was lacking in a lot of areas. As listed above, she carries a lot of risk factors and this pregnancy is considered high risk, but there was not sufficient teaching provided. There was no information given on proper weight gain during pregnancy for an obese woman, let alone a normal body mass index. The patient stated that she has not taken any prenatal vitamins, so the nurse told JW she would get her a prescription. She educated JW on the importance of these vitamins in order for her to understand and move towards a healthier pregnancy and development of her baby. The nurse gave JW a booklet with information about the antenatal and postpartum period. She read and explained a section describing the foods to be avoided during pregnancy and how many calories to increase by during pregnancy. Also, the nurse provided a booklet about smoking cessation and the risk factors it causes during pregnancy. The smoking cessation hotline was given to the patient to help her quit if she decides to. There wasn’t much information given about marijuana use during pregnancy. The nurse told the patient there has not been a lot of research related to this situation, but there was no other information provided. The patient informed the nurse that she used to be on medications for depression but stopped taking them before she became pregnant. Her depression “comes and goes,” and she felt she no longer needed them. The nurse educated her on the hormone changes during pregnancy and about the increased risk for postpartum depression. The warning signs of postpartum depression were provided. She was told that if she starts to feel like she cannot handle the symptoms anymore, especially after childbirth, to seek help from a medical provider as soon as possible. The nurse recommended healthy beginnings as an aid in the client’s prenatal/postpartum care. The nurse also educated the client on different the different programs that could aid financially for both her and the baby such as, WIC, Medicaid, and CHIP. The client refused a social worker, but the nurse educated her about what they could do for her and informed her that she can request a social worker at any time during the prenatal and postpartum period.

The nurse asked the patient if she had any learning difficulties in order to provide the best care possible that will be beneficial for JW. JW noted having difficulties with reading comprehension, but she has no other learning disabilities. The nurse provided her with the typical prenatal information booklet, which is all written information. She read through most of the booklet with the patient explaining it in further detail to help the patient understand. Since she has problems with reading comprehension, I feel a booklet isn’t a very beneficial educational source. Videos or other visuals would be a great source to use for information.

Family-centered teaching is important in hopes that it will make the information more accepted and understood. In this case, the client’s boyfriend was involved in the teaching and education. When talking about smoking cessation, the nurse informed the boyfriend that it would be easier for JW to stop if he stopped with her. Also, she informed him how second-hand smoke works and how it can affect the fetus if the mother is breathing it in, even if she has stopped. She asked about other children in their lives and how involved they will be. The father of the baby has two other children, but they do not live with him and he does not see them often. JW has one other child that lives at home with her, her boyfriend, and father.

Some of the teaching regarding prenatal vitamins and programs for low-income families seemed to be successful. She agreed to take the prenatal vitamins and understood the benefits, and she is going to take advantage of the WIC and Healthy Beginnings. I think there was a lot of missing information during this teaching, such as weight loss, smoking cessation, and basic nutrition. The education could have been more effective if there were different methods used to pass the information on.

Additional Teaching or Anticipatory Guidance

Obesity

I would teach JW the risks with obesity during pregnancy and the ways to promote wellness for her and her baby. Dutton, Borengasser, Gaudet, Barbour, and Keely note that women with obesity are at a higher rate for spontaneous abortions and decreased fertility rates, making it harder to become pregnant and continue through a pregnancy full-term. I would explain the risks to JW and provide visual education tools to accommodate her reading comprehension difficulties. Videos providing information and pictures showing the effects on her and her baby might be the most beneficial. For example, showing JW a picture of a baby that has macrosomia because there is an increased risk, compared to a baby that is average weight for gestational age. The most beneficial action to take to minimize risks would be weight loss before conception, but in this case, JW is already 8 weeks pregnant. So, my main teaching point with JW would be limiting gestational weight gain. The recommended weight gain for an obese pregnancy is between 11-20 pounds total throughout the pregnancy. Weight gain should be at its highest during the second and third trimesters because nutritional intake should not be increased during the first trimester. Gaining too much weight during this time increases her risk for gestational diabetes and increased birth weight of her baby. Showing a video with his information may also be a good teaching method for JW because it would include visuals and auditory explanations, rather than written information.

Poor Nutrition

Weight gain is an inevitable and important part of pregnancy. Kominarek explains that the weight gained consists of the baby, amniotic fluid, placenta, increased blood volume, and other body changes during this time. Calorie intake should not increase during the first trimester, but in the second and third trimesters, the woman should increase 300 calories a day (Kominarek, 2016). A woman with a normal body mass index should gain around 25 to 35 pounds throughout the pregnancy, but it is recommended that a woman with a body mass index over 30 should gain 11 to 20 pounds. This is vital information for JW to be taught to aim towards a healthy pregnancy. Again, I would use visuals such as videos and pictures to provide education that would be beneficial to this patient. A picture showing proper portion sizes with an increase of around 300 calories a day in healthy foods. Using the teach-back method may be useful for this patient as well. If she is able to teach the information back to you, it shows that she understands the education. Another topic that needs to be taught to JW would be the nutritional intake during breast feeding. She has a plan to breast feed and pump breast milk after the baby is born. Breastfeeding burns a lot of calories, so in return, she will need to increase calorie intake more than she already has. It is recommended to increase 500 calories more each day than a nonpregnant woman. JW would need to be taught the importance of this increase, in order to continue milk production, and provide her baby with the proper nutrients. Educational videos would be beneficial, in this case, to provide JW with proper education. I would, also, refer her to a nutritionist for better information about proper diet while pregnant. Breastfeeding classes, such as La Leche League, would be beneficial to educate JW about the nutrients needed while breastfeeding her baby.

Conclusion

JW is on her third pregnancy, and this pregnancy is considered high risk. She has many factors that come together to consider her high risk. She is considered obesity class II with a body mass index of 37. She is currently still smoking cigarettes, which has affected one of her pregnancies in the past. Her most recent pregnancy needed an emergency cesarean section to save her newborn. Her baby had oligohydramnios resulting from smoking cigarettes during pregnancy. She, also, is using marijuana throughout her pregnancy and eats a poor diet. She is low-income, putting her at risk for insufficient antenatal care, but with the help of Healthy Beginnings and Medicaid, she is able to receive care in the clinic and receive prescriptions for prenatal vitamins and a breast pump. JW has a history of depression and used medications, but currently has taken herself off of the medications, putting her at a higher risk for postpartum depression. All of these risk factors are considered modifiable, so with the right healthcare provider and education, the pregnant mother should be able to decrease her risk factors and have a healthier pregnancy. In this case, the nurse provided some of the prenatal education well, but I feel like there was some information missing. This patient would have benefited from a more visual or hands-on educational experience. Without proper teaching, a high-risk pregnancy can become worse as time goes on. If a risk factor is modifiable, it is vital to address the situation, so the mother can make educated decisions on how she is going to handle it. Health promotion is an important component when working with pregnant women because these women are generally healthy and health risks are the most prevalent issue.

References

1. Davidson, M., London, M., & Ladewig, P. (2016). Maternal-newborn nursing & women’s health. USA: Julie Levin Alexander.
2. Dutton, H., Borengasser, S. J., Gaudet, L. M., Barbour, L. A., & Keely, E. J. (2018). Obesity in pregnancy: optimizing outcomes for mom and baby. Medical Clinics of North America, 102(1), 87-106. https://doi.org/10.1016/j.mcna.2017.08.008
3. Kominarek, M. A. (2016). Nutrition recommendations in pregnancy and lactation. Medical Clinics of North America, 100(6), 1199-1215. https://doi.org/10.1016/j.mcna.2016.06.004

As Singapore continue to progress and prosper, health issues will forever be a cause of concern for us. From Statistics, one in nine Singaporeans has diabetes. Almost twenty-four percent of Singaporeans have high blood pressure. Singapore Promotion Board, a government organisation committed to promoting healthy living in Singapore, has also implemented a few measures to encourage individuals in order to improve their lifestyle which will improve health issues of Singaporeans. One of the programs is the Healthy 365 mobile application whereby Singaporeans will be encouraged to use the application to exercise regularly and take note of their diet as well. We will discuss the health communication theories and effectiveness of the program in the subsequent part of the essay.

One of the measures that Health Promotion Board took to reduce health issues in Singapore was introducing the Healthy 365 health and diet tracking mobile application. This mobile app enables users to track the number of steps that they took, the distance they travelled, how much calories are being burnt as they move as well. They can also record down what type of food they have consumed for the day and know how much calories they need to burn for the day. There are many challenges in the app such as the National Steps Challenge whereby participants will accumulate the amount of steps they will take and earn health points as well. Health Promotion Board will be given free heart-rate monitoring fitness tracker to aid in the tracking of steps at various community centres and schools as well. After reaching 10,000 steps per day, participants will not only be able to receive 40 health points, but also two free lucky draws which give them amazing deals sometime. After collecting up to 750 points, participants can claim rewards such as NTUC vouchers, AsiaMalls e-vouchers and more.

We will talk about how Fogg Behaviour Model is being utilized in this case. The model explains that for a target behaviour to occur, the person must have reached a certain amount of motivation, ability and an effective trigger. Health Promotion board wants Singapore Citizens to exercise or take note of the food they consume by persuading them to use the Healthy 365 health and diet tracking mobile application. The behaviour of using the Healthy 365 app is the target behaviour.

One of the important factor in FBM is motivation. We know that there is always low motivation to downloading an app unless there is a reason for it as there are already many different fitness application that have the features that Healthy 365 has. In order to tackle this issue of low motivation, Health Promotion Board has introduced the National Steps Challenge whereby health points can be earned and traded for rewards and lucky draws. At the same time, free heart-rate monitoring fitness tracker are given out at community centres which are near where most people stay as well. These actions by the Health Promotion Board increased the pleasure of the individuals which in turn increased the level of motivation of individuals to use the Healthy 365 app.

The next important factor in FBM is ability. The ability to use Healthy 365 app is definitely not very high as users will just need to download the app from the app store of their respective phones which many already have the experience of doing it. There is an instruction manual that is accompanied by the fitness tracker. At the collection points of the trackers, there are people guiding them to link the trackers with the app as well. There is no cost involved in using this app. it is routine as well as walking is a natural thing for most humans as they would need to walk from places to places. Therefore, having no cost involved to use the Healthy 365 app, low physical effort to use the Healthy 365 app and the routine task to do which is walking for the National Steps Challenge, it will increase the ability of the individual to use the Healthy 365 app.

The last important factor in FBM is trigger. Healthy 365 app uses notifications from the app to trigger the individuals to use the Healthy 365 app. The notifications will tell the user about their previous incomplete steps and encourage to work harder if they did not manage to complete 10,000 steps for the previous day. The notification uses spark as trigger if individuals have low motivation to complete if their fatigue level is higher for the day. Therefore, spark trigger is being used in the form of notifications from the app which leads to more people using the Healthy 365 app.

In Conclusion, we can see how FBM is being used in the Healthy 365 mobile app and how the three factors (motivation, ability and trigger) leads to one’s individual behaviour. I believe that the Healthy 365 mobile app can be further improved by using the self-determination theory(SDT). It was found that using extrinsic motivation such as rewards will result in decreasing intrinsic motivation as individual’s autonomy needs are being manipulated. (Gagne & Deci, 2005) . Thus, rather than increasing motivation to encourage the behaviour that Health Promotion Board wanted, rewarding a behaviour with rewards might in turn make a person feel controlled and reduce their intrinsic motivation. Lewis, Swartz, and Lyons (2016) suggested that this issue can be having verbal rewards or rewards of glory instead. Verbal rewards includes emotions or likes that can be provided by others maybe community instead. Rewards of glory includes titles of certain achievements that can provide bragging rights such as ‘1,000,000 steps accomplisher’ or ‘consecutive 30 days challenger’.

Langford et al., (2018) Describes the behavioral and genetic beliefs in line with developing hypertension (HTN) using sociodemographic factors and reports based on self HTN status as well as individuals with a history of HTN, evaluating the association between the behavior change attempts and HTN related causal beliefs. Langford et al., (2018) uses a data elicited from the 2014 Health Informational National Trends survey to base the evaluations. Some of the questions based on beliefs in this article include, how do health behaviors like smoking, exercise, and diet relate to HTN or high blood pressure. The other question raised in this article is the relation between genetics passed from one person to another and high blood pressure or HTN.

Langford et al., (2018) uses a multivariate logistic regression to evaluate the relationship between HTN causal beliefs and change in behavior such as diet, exercise, and manageable weight. A population of 1,602 is reported to have HTN from a possible population of 3,555 which is 33%. The logistic models demonstrated that more strong people who was believed to be developing behavior on HTN, they had high chances of behavior attempts. However, this article does not associate beliefs on genetic causes of HTN to behavior change attempts. Women were seen to have high olds as compared to men of increasing fruit and vegetable uptake, limiting soda intake and weight loss. Blacks, as well as Hispanics, were in high chances of losing weight as compared to whites.

Strengths

Langford article uses a sufficient survey of 3,555 out of which 33% are found to be susceptible to HTN. This is a good sample size population. It as well uses all age sets and gender as it compares men and women and found women to have high chances of losing weight as compared to men. The regression models used by Langford et al., (2018) are also inclusive of general data and hence capturing all data in beliefs on behavioral and genetic causes of HTN.

Limitations

There is however a generalization in the data by comparing whites, blacks, and Hispanics in relation with losing weight. Blacks and Hispanics are found to have high olds in losing weight. Langford is now assuming that genes are associated with HTC, but from his conclusion, the behavior is associated with HTC other than genetic causes.

Evaluation of Actions, Barriers, and Facilitators to Limit Dietary Sodium in the Healthcare Setting

Lacey et al., (2018) evaluates the actions, barriers, and facilitators in limiting uptake of sodium in a health care setting as a way of reducing hypertension. Lacey et al., (2018) uses a survey which is administered to food service administrators in the healthcare setting and LTC in Ontario. The results indicated that 63% of the institutions had a sodium target of 900–4,000 mg/day. The percentage had a perception that limiting sodium intake was good for inpatient and resident menus. Group purchasing organizations were however reported to be having a reduction in sodium on lower sodium foods (85.2%), government resource provision and support (74.1%), the improved taste of lower sodium foods (74.1%) and stepping up the availability of pre-packaged lower sodium foods (77.8%). This study, however, found sodium reductions practices to varying from all food service operations.

Strengths

Lacey et al., (2018) uses a good approach in using health care setting as the study areas. In this case, this measured the healing process of the patients in line with sodium intake hence making it efficient to justify sodium uptake. The study also compares several food purchasing organizations and government resources providing support on sodium uptake.

Limitations

The sample area used is quite general. Lancey et al., (2018) generalizes the entire population of health care institutions from only those in Ontario, Canada. In this case, the results were biased from only one region.

From the results in Lancey et al., (2018), there is the need for making coordination and policies in the regulation of sodium uptake in hospitals as well as long-term care setting. In this case, the multi-sectorial government institutional support and industries have to join hands in ensuring there is a reduction of sodium uptake. Langford et al., (2018) associates beliefs on behavioral causes of HTN rather than genetic. future prohealth behavior change is incorporated on behavioral beliefs and the sociodemographic factors.

References

1. Lacey, M., Chandra, S., Tzianetas, R., & Arcand, J. (2018). Evaluation of actions, barriers, and facilitators to reducing dietary sodium in health care institutions. Food Science & Nutrition, 6(8), 2337–2343. https://doi.org/10.1002/fsn3.814
2. Langford, A. T., Solid, C. A., Gann, L. C., Rabinowitz, E. P., Williams, S. K., & Seixas, A. A. (2018). Beliefs about the causes of hypertension and associations with pro-health behaviors. Health Psychology, 37(12), 1092–1101. https://doi.org/10.1037/hea0000687

Public health as a whole is focused on ensuring a population stays healthy and is protected from any potential threats to their health (National Health Service (NHS), 2015). This was summarised by Acheson (1988) when he defined public health as the ‘art and science of preventing disease, prolonging life and promoting health through the organized efforts of society’. The importance of this is highlighted by the World Health Organisation (WHO) who explain that public health helps increase the effectiveness of public health services through sustainably promoting health and well-being and reducing any inequalities that are associated with them.

Health promotion is one of the three strands that public health consists of, alongside prevention and protection which are used to reduce avoidable disease, shown by the Royal College of Nursing (2019). It is described as ‘the process of enabling people to increase control over and improve their health’ by WHO (1986) giving the idea that it is about individuals having the knowledge and skills needed to look after their own health. A nurse’s role is important in encouraging health promotion, in the Nurses 4 Public Health Report (2016) it is suggested that the skills nurses have and the places in which they work, such as hospitals, schools and in the community, makes them the ideal people to act upon and promote any health challenges that may be in the public. This is highlighted in the All our Health Framework (2018) which helps nurses and other medical professionals make as much of a difference as they can using health promotion. There are 5 different approaches that nurses can use to support patients with health promotion. This includes medical, behavioural change, educational, social change and empowerment (Naidoo and Wills 2016)

The main aims of public health and health promotion are shown in the Public Health Outcomes Framework 2016-2019, this essay will be focused on one indicator in particular under the framework’s second objective; ‘2.09 Smoking prevalence – 15-year olds’ (Department of Health, 2016). An intervention will be discussed as to how this indicator may be promoted through the skills of a student nurse. This will be done to a target audience of students in a specific year 10 class. One of the reasons in which the framework explains that smoking in 15-year olds is an issue is because it is one of the largest reasons for avoidable and premature morbidity (Department of Health, 2016). There is a lot of evidence to support this claim and underline the fact that this issue needs addressing. For example, it has been found that the younger the age you start smoking the greater risk you are at for developing diseases that are related to this (Seddon, 2007) These include diseases such as lung cancer, heart disease and chronic obstructive pulmonary disease (Action on Smoking and Health (ASH), 2015). It is not only physical problems that smoking can lead to, but also mental health issues. Arday (1995) found that students who were regular smokers ‘were more likely to have seen a doctor or other healthcare professional for an emotional or psychological complaint. This suggests smoking is doing a great deal of harm to teenagers, as this is the time when important psychological changes are taking place in the transition from childhood to adulthood (Kipke, 1999). Poorer grades have also been found to be associated with smoking (Dappen, 1996), demonstrating how smoking can have long term negative effects on the lives of teenagers who smoke if they are unable to get appropriate grades to get jobs etc in the future. By addressing this indicator, it may also have some economic benefits, smoking costs England around £12.6billion a year according to ASH (2018) with money being spent in many areas such as healthcare, social care and housefires. By stopping smoking before it is about to begin, as 9 out of 10 smokers start before the age of 18 (U.S Department of Health and Human Services, 2014), it would save England huge amounts of money that could be put towards other important causes.

There are reasons as to why these students would make the decision to smoke, for instance, if they are brought up in a household where smoking is a common practice then they are going to be more likely to carry out this action themselves. Otten (2007) found that weather or not parents smoke is predictive of the smoking status of adolescents, giving an understanding as to how much of an influence parents can have on their children. This can also be related to the economic backgrounds of the clients. Those who come from more deprived areas are four times more likely to smoke than those in least deprived areas (Office for National Statistics, 2016), this will have to be kept in mind when thinking about why the students are making the choices they do about their health. If the school is in a more deprived area or some students are less well-off then it may be more challenging to get them to change their outlooks on their health where smoking is concerned. Another factor that could impact these choices is the presence of peer pressure. This is an extremely powerful force, especially on teenagers as Evens (1978) discovered that the social pressure of peers can have more of an effect on adolescence to smoke than the deterrence of knowing how smoking engagers their health.

To promote this indicator to the target audience, with permission from the school and in co-ordination with the school nurse a workshop would be set up for a specific year 10 class, with students who consent to taking part. This may also be correlated with non-smoking day if the school is doing anything around this, as it will mean some issues surrounding smoking may already have been brought to light for the students. A volunteer who suffers from chronic obstructive pulmonary disease (COPD) could be brought in to talk to the students. Bringing in a volunteer rather than just giving the students information should have more of an impact on them. This is because the brain makes its strongest connections through concrete experiences (Wolfe, 2010), so in this situation it will be more effective seeing the volunteer rather than them just being an abstract thought. They could speak about the struggles that a disease like COPD brings, such as loss of social activity resulting in loosing important relationships and breathlessness creating anxiety and panic attacks (Barnett, 2005). This would give them a first-hand look at what smoking can lead to. Ideally the volunteer would be another teenager or young adult, this will allow the students to relate to them more, as adolescence are more likely to be influenced by peers (Watson and Skinner, 2004). In addition to this an email could be sent out to the parents of the students taking part, this would give them an insight of what their child is learning and also raise their awareness too.

This intervention takes an educational approach towards smoking prevalence in 15-year olds. The workshop will empower the students to make their own decisions based on the information they are given (Naidoo and Wills). This seems like the best approach for this indicator, as with the target audience being so young it has the ability to stop the issue before medical intervention is needed due to its consequences. In turn this will lead to lower costs for the NHS, with money being saved on treatments. For those in the class who already are smokers, it may also be seen as a behavioural-change approach as it may start the cycle of change needed for them to give up the habit. It may lead them to the contemplation or preparation stage of Prochaska and DiClemente’s (1982) cycle, meaning they are aware of the problem and potentially intend on taking some sort of action to help it.

Although these approaches seem like the most appropriate method there are still some factors that may stop the students from making a change to their health. For instance, even though they will know and be able to see the effects smoking can have it still might not deter them from smoking. Research has shown that 95% of smokers do have the knowledge of the health risks associated with smoking but in 70% of these people it is little concern (Dappen,1996) this could easily be the case for this target audience as well. A different way in which the approach may be hindered is by the parents. The email sent to them is designed to prompt family involvement of the issue as its been found that adding family-based components to school interventions is more effective than just using the school (Thomas, 2015). It is not guaranteed that the email will be read, or brought up to the students by the parents, especially if they are smokers themselves. As a result, the intervention may be less effective and not have the desired effects. In contrast, seeing and hearing about the volunteer’s experiences might be shocking to the students which could help in motivating them to change their views. This is because the brain pays more attention to information that causes an emotional response (Wolfe, 2010). Similar to this, Tyler and Cook (1984) established that media influence is ‘largely impersonal’ when trying to change the opinions of people. With this in mind speaking to the students face to face from a person who is around the same age, more of a personal connection can be made in contrast to a media campaign stating facts. As a result, it is more likely to motivate and help them make positive changes needed for their health.

Being a health care professional, it is important that the workshop is as effective as possible. Evaluating the impact of this intervention may be hard as there will be no easy way to know of the long-term effects it has on the students. A simple questionnaire could be given to them when the workshop finished to get an idea of how much they enjoyed the session and to see if they found it useful, giving an insight of how effective it was. These questionnaires could be anonymous, as this will give a greater chance of the answers being honest (Guerra-Lopez, 2007). The questions would be quantitative so data can be be easily interpreted and allow for changes to be made if similar interventions occur in the future.

To conclude, using the opportunities and resources available as a student nurse an intervention in the form of a workshop will be organised with the help from a school nurse to a group of year 10 students. This will involve hearing about the experiences from a volunteer with COPD and information being sent to the parents of those involved. This should be an effective form of health promotion for smoking prevalence in 15-year olds, and will be evaluated through a questionnaire at the end of the session.

References

1. Acheson, D (1988) Public Health in England. Report of the Committee of Inquiry into the Future Development of the Public Health Function. London, HMSO.
2. Action on Smoking and Health (2015) Young people and Smoking. Available at: http://ash.org.uk/download/young-people-and-smoking/ (Accessed: 22 March 2019)
3. Action on Smoking and Health (2018) Facts at a glance – key smoking statistics. Available at: http://ash.org.uk/download/facts-at-a-glance/ (Accessed: 23 March 2019)
4. Arday, D.R., Giovino, G.A., Schulman, J., Nelson, D.E., Mowery, P. and Samet, J.M., 1995. Cigarette smoking and self-reported health problems among US high school seniors, 1982–1989. American Journal of Health Promotion, 10(2), pp.111-116.
5. Barnett, M., 2005. Chronic obstructive pulmonary disease: a phenomenological study of patients’ experiences. Journal of clinical nursing, 14(7), pp.805-812.
6. Dappen, A., Schwartz, R.H. and O’Donnell, R., 1996. A survey of adolescent smoking patterns. J Am Board Fam Pract, 9(1), pp.7-13.
7. Department of Health (2018) Public Health Outcomes Framework for England 2016/19. London:DH
8. Evans, R.I., Rozelle, R.M., Mittelmark, M.B., Hansen, W.B., Bane, A.L. and Havis, J., 1978. Deterring the Onset of Smoking in Children: Knowledge of Immediate Physiological Effects and Coping with Peer Pressure, Media Pressure, and Parent Modelling 1. Journal of applied social psychology, 8(2), pp.126-135.
9. Guerra-Lopez, I. (2007) Evaluating Impact: Evaluation and Continual Improvement for Performance Improvement Practioners. HRD Press: Massachusetts.
10. Kipke, M. (ed.) (1999) Adolescent Development and the Biology of Puberty. Washington: National Academy Press.
11. Naidoo, J. and Wills, J. (2016) Foundations for Health Promotion. 4th edn. Edinburgh:Elsevier
12. National Health Service Health Education England (2015) What is public health? Available at: https://www.healthcareers.nhs.uk/node/1467 (Accessed: 20 March 2019)
13. Office for National Statistics (2016) Smoking inequalities in England. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/drugusealcoholandsmoking/adhocs/008181smokinginequalitiesinengland2016 (Accessed: 23 March 2019)
14. Otten, R., Engels, R.C., van de Ven, M.O. and Bricker, J.B., 2007. Parental smoking and adolescent smoking stages: the role of parents’ current and former smoking, and family structure. Journal of behavioral medicine, 30(2), pp.143-154.
15. Prochaska, J.O. and DiClemente, C.C. (1982) Trans-theoretical therapy – towards a more integrative model of change psychotherapy: Theory, Research and practice 19(3): 276-288
16. Public Health England (2018) All Our Health: about the framework. Available at: https://www.gov.uk/government/publications/all-our-health-about-the-framework/all-our-health-about-the-framework (Accessed: 21 March 2019)
17. Royal Collage of Nursing (2016) Nurses 4 public health. The value and contribution of nursing to public health in the UK: Final report Available at: https://www.rcn.org.uk/-/media/royal-college-of-nursing/documents/clinical-topics/public-health/nurses-4-public-health.pdf?la=en&hash=80035E1F63ECC5038D07F85E78E6802AEA5870FB (Accessed: 21 March 2019)
18. Royal Collage of Nursing (2019) Public Health. Available at: https://www.rcn.org.uk/clinical-topics/public-health (Accessed: 20 March 2019)
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22. U.S. Department of Health and Human Services.(2014) The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
23. Watson, S. Skinner, C. (ed.) (2004) Encyclopaedia of School Psychology. Kluwer Academic/Plenum Publishers: New York.
24. Wolfe, P., 2010. Brain matters: Translating research into classroom practice. ASCD.
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The purpose of this written assignment is to discuss health promotion with a patient and their family that suffers from the chronic condition type two diabetes mellitus. First, I will define and describe health promotion. Next, we will discuss type two diabetes mellitus, its disease process, symptoms, and possible treatments. Finally, I will discuss three ways I could promote the health of the patient and family dealing with type two diabetes.

Family health promotion could be defined as a process that empowers a family to take control of their health through education by focusing on the physical, emotional, biological, and spiritual elements of the family members as a unit, with the family nurse also playing a vital role (Kaakinen et al., 2018). Type 2 diabetes mellitus is a chronic metabolic condition that affects the person body’s ability to effectively use the hormone insulin. Insulin is needed to metabolize the body’s essential fuel source that is known as glucose or sugar. The hormone insulin is made in the pancreas and is then secreted into the bloodstream, where it acts like a key to open the door to the cells of the body, to allow glucose to enter the cells in order to be used for energy. When someone has type two diabetes their body either does not make enough insulin to control blood sugar or their body cannot adequately or effectively use the insulin that is produced by their pancreas, which results in there being too much glucose in the bloodstream. Type two diabetes is usually adult onset but can affect a person of any age and is usually linked to obesity. There are several risk factors such as: weight, inactivity, family history, age, and race or ethnicity. It usually comes on gradually, so it often goes unnoticed for years. There are several symptoms such as: fatigue, blurred vision, slow healing wounds, unintended weight loss, frequent infections, and darkened skin to the neck and armpits. The three most common symptoms are increased thirst, increased hunger, and increased urination. Leaving diabetes untreated could lead to several complications such as kidney, eye, and nerve damage. Prevention is key and can be possible with diet and lifestyle changes. If a person is diagnosed, they may be able to control the condition with diet changes, increased activity, weight loss, and certain medications. Type 2 diabetes has been classified as one of the most challenging chronic conditions to control (Carpenter et al., 2019).

Health Promotion and Utilizing the Family of the Diabetic Patient

Families can play a pivotal role in a patient’s care and treatment of any chronic condition. Therefore, patients with type two diabetes mellitus need the support of their families in order to perform self-care and prevent complications (Luthfa & Ardian, 2019). Family empowerment is a strategy where the nurse collaborates with the family and provides information, strategies, and encouragement to help the family facilitate lifestyle changes (Kaakinen et al., 2018). The use of commendation could be used to empower the family to help enable them to view the issue in order to move towards the solution (Kaakinen et al., 2018). With the solution being diet and lifestyle changes, along with symptom management. I believe that including the family in the plan of care will increase the likelihood of its success. As the nurse, I would involve the whole family in the preparation of the plan of care, provide diet teaching, and provide instruction on modifiable lifestyle changes (Kaakinen et al., 2018). I would also include frequent follow-up visits to monitor for success, in which I believe will facilitate lasting results for the whole family.

Health Promotion and Educating the Diabetic Patient and Family

Knowledge is an important aspect regarding the influence of family involvement on diabetes self‐management (Bennich et al., 2019). The use of education is a key component of health promotion. However, prior to educating a patient it is essential that the family health nurse first assess their knowledge base and then gage their readiness to learn new information. After my assessment was completed, I would provide them with written educational material that they could review and then keep as a reference. Next, I would verbally deliver the information and be available to answer any questions they may have on the material that I shared. I would ensure that the material would include the description of type two diabetes mellitus, its disease process, symptoms, risk factors, complications, and possible treatments.

Health Promotion and Family Nutrition

Family nutrition is currently an intricate aspect of family health promotion and health protection (Kaakinen et al., 2018). The family nurse’s role in family nutrition is to assess the quality of nutrition being served, provide guidance, instruct, and support changes made by both the patient and their family (Kaakinen et al., 2018). Healthy eating habits can aid in the prevention and management of diabetes. I believe that involving the entire family in meal preparation and nutrition education will increase the likelihood of success with diet adherence and facilitate lasting lifestyle changes.

In conclusion, health promotion is critical for not only the newly diagnosed patient with diabetes but also their family. First, I defined and described health promotion. Next, we discussed type two diabetes mellitus, its disease process, symptoms, and treatments. Finally, we discussed three ways I could promote the health of the patient and family dealing with type two diabetes. I hope you found this written assignment both informative and enjoyable.

References

1. Kaakinen, J. R., Coehlo, D. P., Steele, R., & Robinson, M. (2018). Family health care nursing: Theory, practice, and research (6th ed.). F.A. Davis Company.
2. Luthfa, I., & Ardian, I. (2019). Effects of family empowerment on increasing family support in patients with type-2 Diabetes Mellitus. Nurse Media Journal of Nursing, 9(1), 58. https://doi.org/10.14710/nmjn.v9i1.22501
3. Bennich, B. B., Munch, L., Overgaard, D., Konradsen, H., Knop, F. K., Røder, M., Vilsbøll, T., & Egerod, I. (2019). Experience of family function, family involvement, and self‐management in adult patients with type 2 diabetes: A thematic analysis. Journal of Advanced Nursing, 76(2), 621-631. https://doi.org/10.1111/jan.14256
4. Carpenter, R., DiChiacchio, T., & Barker, K. (2019). Interventions for self-management of type 2 diabetes: An integrative review. International Journal of Nursing Sciences, 6(1), 70-91. https://doi.org/10.1016/j.ijnss.2018.12.002