Health Promotion - What Are Preventing Behaviours and Why Are They Important - Essay Example

Roper, Logan and Tierney say "Practitioners and patients should implement care that reduces health risks and encourage healthy behaviours as part of the implementation stage in the nursing process, these require the nurse to engage in preventing behaviours." 1. WHAT ARE PREVENTING BEHAVIOURS 2. WHY ARE THEY IMPORTANT 3. WHO SAYS THEY ARE IMPORTANT 4. HOW CAN YOU ENGAGE IN PREVENTING BEHAVIOURS IN THE IMPLIMENTATION STAGE 5. WHAT ARE THE BENEFITS 6. WHAT ARE LIMITATIONS Introduction According to Roper, Logan, and Tierney model, nursing is a biopsychosocial way where in practice, the nurses are supposed to take measures that help patients to find their own way of adapting to the necessary changes. If existing health behaviour is deviation from normal, this adaptation will need change of behaviour. Nursing delivered in a holistic manner is a form of nursing that help patients find suitable ways of adapting would definitely take into account the patients' emotions and thoughts very seriously. It also implies consideration of personalities of the patients, their life courses, and their autonomy and choices (Mooney and O'Brien, 2006). What are the preventive behaviours Health promotion is an important accepted aim of nursing practice and is often considered in practice equivalent to disease prevention or health maintenance. When clients follow primary preventive measures in the prepathogenesis period, they promote healthy behaviour in order to achieve specific protection from the disease. However, usually a nurse engaged in providing care to an ill individual would be able to promote preventive behaviour at the secondary level following the pathogenesis (Byrne et al., 2005). Therefore behavioural actions taken to promote health, protect health, and prevent disease are known as preventive behaviours. General Preventive Health Behaviours (GPHB) Checklist consists of twenty-nine items which were selected to represent a range of behaviours thought to be relevant to a British population (Ingledew and Brunning, 1999). Why are they important Health has been defined biomedically as absence of disease. If health promotion and specific protections are used as measures of primary prevention, they conform to this definition. If people are to be enabled to increase control over and improve their health, individual strategies must be incorporated in the nursing care plan (Whitehead, 2008). A resource model of health behaviour suggests that they are multidimensional, and preventive health behaviours may be positive and avoidant. Moreover, different health and social resources are associated with different health behaviours, and therefore, nursing strategies to promote wellbeing of the people often need to focus on educating clients practice new and healthy behaviours or change unhealthy behaviours (de Rijk et al., 2007). It is clear that it is a nursing practice directed to behavioural attributes of the clients with the goal to prevent disease and hence health promotion to achieve a greater level of health. This means the assessment process would need to include factors that influence the choice of behaviour of the patients, and modification of them would need different promotional strategies for them to be successful (Lippke and Ziegelmann, 2006). Who says they are important There is a considerable evidence of agreement regarding the positive influence of preventive behaviour on health. The WHO process of health promotion (Allen, 1995), Kulbok's resource model of health behaviour (Laffrey and Kulbok, 1999), Laffrey in her notion of health behaviour choices (Laffrey and Pollock, 1990), and Pender in his definition of health promotion (Pender, 1990) state that preventive behaviours are important. Both Department of Health and NMC standards recommend that they are important (DOH, 2003). How can you engage in preventive behaviours in the implementation stage Didactic, cognitive interventions may be used to transmit information about the disease process or the treatment regimen. Often a behaviour change requires educating the patient about the regimen, such as how to follow a low-fat diet or initiate an exercise programme. The underlying aim may be to increase the person's knowledge in the expectation that behaviour change will follow. However, the association between knowledge and behavior is small. Educational interventions alone have not yielded positive results (Benson and Latter, 1998). Various models of behavior change have guided studies investigating determinants of adherence or evaluating strategies to improve adherence. More recently, cognitive-motivational models have focused on beliefs, intentions, and self-efficacy, and most recently, readiness to change. Intervention strategies used today have arisen from research based on these models of behavior change, which have been predominantly based on social cognitive theory. Social cognitive theory, formerly known as social learning theory, is based on an underlying assumption that behavior, the environment, and cognition function as interacting determinants with a bidirectional influence on each other (Nieuwenhuijsen et al., 2006). In the implementation phase, the nurse must take into consideration self-efficacy. Self-efficacy is defined as a person's perceived capacity for exerting control over his or her motivation, cognition, behavior, and environmental demands. It is concerned not with a person's skills, but with the person's judgments of what he or she can do with those skills. Self-efficacy is behavior specific, that is, a person's self-efficacy for exercise may be different from self-efficacy for maintaining a healthy diet. There are four sources of efficacy: (1) mastery experience-the most powerful source comes from achievement of a series of sub-goals; (2) modeling or vicarious learning-observing another perform a task; (3) physiologic cues-making inferences from autonomic arousal or other symptoms; and (4) verbal or social persuasion-convincing others they possess the capability to achieve their goal (Keller and Allan, 2001). Benefits The benefit of such an approach is mainly promotion of self-care, and the nurses must approach health promotion from that angle. Self-care is a lay responsibility, but nursing profession may extend help to enhance the individual positive behaviour. All of these have scientific, religious, philosophical, and cultural dimensions, and thus the care provided by the nurses accomplishes the goal of achieving the change of health belief and behaviour both. Since there is no question that self-care practices promote healthy lifestyles and prevent onset of disease, these are definitely beneficial (Berry, 2004). Limitations It should be noted that all these models tend to rely on a model of a person as a rational decision maker, subject to motivational forces but essentially making decisions and following them through. Once again, the roles of emotions and of situational variables are relatively underplayed, and hence while implementing these, there is always a chance of failure and it would need continuous reinforcement. There is also a role of nurse-patient therapeutic relationship in success of these programmes, which may have individual variability, and hence the efficacy may vary depending on the personal health beliefs of the nurses (Ogden and Hills, 2008). Roper, Logan and Tierney says when practitioners evaluate care as part of the evaluation stage in the nursing process, they should use the BASE LINES to establish if there has been any degree of movement away or towards the goal. HOW IS THIS DONE WHY IS THIS DONE WHO SAYS IT IS IMPORTANT BENIFITS LIMITATIONS Evaluation is the sixth phase of nursing process that follows implementation of the care plan. In that sense, this part of the nursing process judges the effectiveness of the nursing care to see whether that has been able to meet client goals from the point of view of the client behavioural responses. Although this may appear simple, this actually is tedious in the sense that it involves a thorough, systematic review of the effectiveness of the interventions and assessment of client goal achievement through some skills that include knowledge of standards of care, usual and normal client responses, conceptual models, theories of nursing and ability to monitor the effectiveness of nursing interventions, and awareness of findings from the research (Wimbush and Watson, 2006). It is important that as goal is determined jointly by the nurse and the client, critical assessment of goal attainment is also done jointly by the client and the nurse. The purpose of nursing care is to help the patient actual health problem, prevention of recurrence, and health maintenance. It is indicative that all these need evaluation of goals. The nurse is responsible to match client behaviour with the response specified in the goal. Therefore, initial baseline assessment of data is important which will indicate the comparison standard to determine a shift or a drift. These baseline data from initial assessment can be used by the nurse to identify the different facets of the presenting problem in order to establish the goal. This baseline data may also be used to evaluate objectively the attainment of goals. This is done by examining the goal statement to identify the desired patient/client response; assessing the client physically, behaviourally, experimentally, and psychologically for the presence of the intended behaviour; comparing the established outcome criteria with behaviour or response; and by judging the degree of agreement between the set goals and baseline (Kloseck, 2007). The baseline data are collected from a skillful nursing assessment, which may include a clinical examination through inspection, palpation, percussion, and auscultation. There are certain assessment instruments that also collect data. Client's laboratory tests are also important sources of baseline data. Secondary data may be available from family members or other caregivers. It is important to record patient's behavioural responses at baseline, and all information must be documented to have a better comparison in a future time within the care span (Spertus et al., 2001). A goal specifies the response or behaviour that indicates resolution of the problem of the client leading to a healthy state. This is usually a summary statement regarding what is to be accomplished as a result of the nursing care. Therefore, each problem indicated by the nursing assessment at baseline and recorded in the care plan will have a goal with a time-frame for evaluation. The baseline data serve as comparative standards, since goals are based on those, and meeting the goals would indicate success of the intervention and progress of the patient, and the reverse would be true for deterioration. Baseline data serve as standards against which nursing process evaluation occurs. Once the goals are evaluated, revision of the care plan can be done against those. Unmet and partially met goals require the repetition of the nursing process sequence, mainly in order to redefine the priorities in care (Spertus et al., 2001). Department of Health in their document Benchmarks for promoting health states that one of the indicators for best practice is to have a person-centred care plan that addresses needs and includes goals, outcomes, and actions (DOH, 2003). Baseline goal assessment is beneficial in planning a care, revising a care plan, discontinuation of a care plan, and modification of care plan as the case may be. These are determined by partially met, unmet, or met goals. These become significant when the initial plan might turn out to be inappropriate, where nursing may fail to incorporate important data in the baseline assessment, hence goals were wrong (Whitehead, 2004). Although baseline assessment is an important tool for achievement of goals out of nursing care, this does not incorporate the space for judgmental errors on the part of a nurse to determine the baseline. Moreover, this system needs followup of each step of the nursing process, which may be difficult. Detailed documentation is necessary to determine achievement of goals. In many cases when the patients have complex problems, behavioural goals would depend on patient health beliefs, where there is a fair chance of overlooking or misjudging some criterion. Thus when some goal is not met, it needs the entire nursing process to be repeated. Moreover, much of the goal determination depend on nurse's personal skills, which may assign different level of care, making the whole process erroneous needing an entirely different set of goals (Elliott et al., 2001). Reference List Allen, K., (1995). WHO defined health promotion as "the process of enabling people to increase control over and improve their health". Health Educ Q; 22(2): 157-8. Benson, A and Latter, S., (1998). Implementing health promoting nursing: the integration of interpersonal skills and health promotion. J Adv Nurs; 27(1): 100-7. Berry, D., (2004). An Emerging Model of Behavior Change in Women Maintaining Weight Loss. Nurs Sci Q; 17: 242 - 252. Byrne, M., Walsh, J., and Murphy, AW., (2005). Secondary prevention of coronary heart disease: patient beliefs and health-related behaviour. J Psychosom Res; 58(5): 403-15. de Rijk, A., van Raak, A., and van der Made, J., (2007). A New Theoretical Model for Cooperation in Public Health Settings: The RDIC Model. 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