Selected Family Health Promotion Assessment and Initiative - Essay Example

? Selected Family Health Promotion Assessment and Initiative Nursing has a fundamental function to play in reorienting the healthcare system and adopting goals that match the contemporary society in pursuit of healthful living styles, healthy families, and healthy communities. Health can be regarded as a social phenomenon, a way of living that can be easily communicated within institutions such as the family. The McGill model of nursing that is grounded in the premise that behavior change is largely voluntary and that health promotion is highly likely to be successful if it is participatory. Health promotion impacts positively on health literacy centering on health related knowledge, attitudes, motivation, confidence; behavioral intentions; and, personal skills relating to healthy lifestyles. The central purpose of this paper is to examine the concepts of health and learning as outlined by the McGill model of Nursing. In light of family partnership, I visited a family three times in which I adequately familiarized with the family’s health goals and concerns, their present strengths, coping strategies, and resource utilization. Selected Family Health Promotion Assessment and Initiative Chapter 1: Introduction 1.1 Background and Aims Health promotion refers to the process of enabling individuals to exercise control over their health and its determinants. Health promotion seeks to create an environment that is essential for the making of informed choices. Health promotion approaches include early intervention and prevention such as primary health screening and surveillance; identification of opportunities to facilitate and support healthy lifestyles choices; understanding and application of the determinants of health encompassing aspects such as societal influences on the health of individuals (Allen & Warner, 2002). Effective health promotion requires gathering of enough information regarding the identified health issue. The underpinning issues in health promotion activities include individual beliefs, knowledge and attitudes centering on the health issue (Friedman, Bowden, & Jones, 2003). This factor in inspired by the manner in which an individual thinks, which renders him/her susceptible to developing the health problem. The McGill model of nursing, whose salient features encompass health, family, collaboration, and learning was developed by F. Moyra Allen. The McGill model of nursing can be praised for its fluidity, flexibility, and functionality. The model core focus centers on health promotion, especially within the family. The goal of the model is to bridge the gap evidenced by the absence of community resources that pursue the healthy development of families across their life span (Allen & Warner, 2002). Some of the assumptions of the model include every family has capabilities or health potential manifested by strengths, motivation, and resources that form the foundation of health promotion behavior, and the outcomes of health promotion hinges on competence in health behavior and enhanced health status. 1.2 Nature of the Home Visits The visit to David’s family was a referral made by a neighbor out of concern that the family was tackling various health issues. Since the visits are conducted at home, I had to decide the times that would be best to reach the target audiences, especially which the family members are likely to pay attention, act on the message, or find the messages more engaging. This situation meant that I must pay close attention to providing explanations for the initial phone call, and avail an opportunity for the family to accept or reject the visit. Prior to the introductory meeting with the family, I had to prepare adequately beforehand to ensure that the meeting was successful. I made the phone call to the family and requested a home visit and expressed my desire to meet up with the whole family. The family in question was a single family comprising of a father, David, and his two teenage daughters, Natalie and Millie. I came to learn later that the mother had passed away several years ago. The meeting took place in their home prominently after work hours so as to fit in with their schedule. When I arrived to the house, the door was ajar. Attempts to establish whether anyone was at home were initially unsuccessful. Afterwards, I heard a response and went in to find a man sitting in the living room, whom I later learnt to be the father. The living room was messy, and ashtrays filled with cigarette butts were scattered all over the place along with empty bottles of beer. In setting out to the family visits, I had certain questions in mind; what healthy families are like; how families pursue healthy living; signs of family adopting healthy practices, and the behaviors that children can learn to adopt healthy ways. The purpose of the visits was to foster health behaviors in individuals and families that will enhance their competency in dealing with life events and developing in a healthful fashion (Friedman, Bowden, & Jones, 2003). In my visits, I asked the family members what they thought the health issues within the family were, or the health issues that concerned the family. The meeting allowed the members to talk freely as possible. Establishing rapport was critical in order to make all parties comfortable during the meeting. David informed me that he had recently been diagnosed with diabetes and was on medication. Natalie and Millie, who appeared withdrawn at first, informed me that they were “healthy”. The teenage girls were obese, attributable, in part, to their lifestyle of consuming junk food and no regular physical exercise. The conversations during the visits explored and clarified the family's health goals and concerns, their current strengths, coping strategies, and resource utilization (Friedman, Bowden, & Jones, 2003). The first meeting was tense probably due to uncertainty about my mission. The father kept smoking the whole time I was there, and the habit was taking a toll on his overall health. Tobacco has no safe levels of consumption and second-hand smoke bear the potential to harm non-smokers exposed to it. Hence, the father was exposing the daughters to unhealthy environment. If unabated, the habits bore the potential of high health and social costs to the family. 1.3 Content of the Home Visits Health Focus This centered on the inquiry into the nature of health and the family’s focus on the health aspects. The main tasks encompassed exploring activities such as coping, accommodating, and adaptive behaviors inspired by daily life occurrences, and the development of capacity-building behaviors that reinforce the family/individual in altering and modifying their approach to life situations in search of optimum functioning (Friedman, Bowden, & Jones, 2003). Family System This factor is grounded in the premise that health behaviors are learned and anchored within a family/social system of interaction and influence. The success of the home visits hinged on viewing the family members via a family filter. The adoption of healthy behaviors cannot be isolated and form part of a broader pattern of behavior in the family group. Perspective on Learning According to social cognitive learning theory, human behavior, which is learnt through observation, embodies a constant interaction between the cognitive, behavioral, and environmental components. Individuals possess the capacity to learn through observation. Hence, the family may select and incorporate behaviors that match their own ways and bear outcomes that are valuable to them. Building a rapport with the family availed prime conditions of health-promoting interactions as outlined by social learning theory. 1.4 Discussion The first visit provided an opportunity to enquire what the family wanted to achieve, especially in enhancing its quality of life. The visit also provided a platform to identify the health and other issues that significantly influence the outcome that the family seeks. The subsequent visits were very helpful as they molded therapeutic conversations contributing to the understanding and expression of the meaning of common and distinct experiences. During my second visit, I had a private session with Natalie and Millie in which they expressed the desire to gain knowledge on sexual and reproductive health. The conversation revealed that the family faced monumental challenges, especially on how to take action and overcome their unhealthy way of life (Friedman, Bowden, & Jones, 2003). There was a need to fill key knowledge gaps on reproductive and sexual health problems among the youth. Natalie confessed to me privately that she had engaged in unprotected sexual intercourse. This placed her at an enhanced risk of sexually transmitted infections, including HIV, or involvement in unintended early pregnancy. Thus, it was necessary to enhance contraceptive knowledge and overcoming barriers associated with adolescent reproductive health such as incorrect or inadequate information on sexual and reproductive health or fear that confidentiality will be violated. Natalie was deterred from using contraception due to fear that her father will find out, concerns regarding side effects and fear of violence from the partners. In preparation for each visit, I developed a timeline detailing all the key activities and tasks that ought to be accomplished in the visit, the subject to carry out the activities and tasks, and the time that I expect each activity to start and finish. The family visits availed opportunities to observe how the father provided care and support to his daughters. The visits to the family provided me with an opportunity to gain insights via direct observation and inquiry into the nature of the father’s engagement with the children, inclusive of his views, concerns, and questions; the families’ general physical and mental health, and cultural values that can impact on the father’s role and engagement with the children. The identification of the goals and objectives of the family promotion project aided the target group to understand what the project was all about and what it sought to achieve (Allen & Warner, 2002). This is informed by the family’s ability to engage in shaping the direction of their life by developing choices and patterning their lifestyle in light of their goals and circumstances. Family members should alter their life situation in order to function at maximum capacity and satisfaction and adopt value health behaviors. The development of a plan for the family required formulation of a broad range of intervention options, educating the family on the significance of the proposed plan, and discussing the health promotion in the context of the family’s perception. The assessment of the family wellbeing required observation of the interactions between the family members, noting indications of aspects such as level of anxiety, irritability, or depression; inquiring about stress or conflict within the family; inquire about the parent’s physical and mental health inclusive of information such as present substance abuse, and stress. I also enquired about the family’s sources of support, whether personal, financial, or community, as well as other environmental stressors, inclusive of poverty and family violence. Some of the factors that I considered included access to knowledge and information, financial sufficiency, network of family, neighbors and friends, access to community services, and sense of family efficacy (Friedman, Bowden, & Jones, 2003). Based on the supportive milieu, I highlight the centrality of the family in the health promoting process by recognizing the family as the primary source of information essential to the situation and the direction that the engagement was taking. Striking a shared orientation to content between the family and I was critical to establishing a collaborative relationship that is essential to tackling the health situations (Allen & Warner, 2002). The collaboration, which was built over the three visits, featured episodes of assessment, planning, implementation, and evaluation. The health work moved through cycles of exploring, experimenting, and valuing in the client’s views/opinions, feedback, and outcomes. Chapter 2: Assessment 2.1 Vision Setting Assessment centers on placing the distinct concerns of the individual/family within a broader context in order to develop an overall profile of the health situation (events, behavior, knowledge, attitudes) on which both the nurse and family are encountering (Allen & Warner, 2002). During the first meeting, we were able to identify more sharply on the critical realities of the situation. This gave us an opportunity (nurse and family) to plan action that is practical and relevant to the situation. Environmental factors such as physical, social, and economic factors can be modified to support behavior, health, and quality of life. Amid the conversation, I noticed that the relationship between the father and his daughters was sometimes difficult and strained. Natalie and Millie felt that their father spent little time with them, obviously owing to his drinking problem. The father was oblivious of the fact that he significantly shapes the behaviors and choices of his daughters, and may have been the cause of the teenagers taking up to drinking. Parental health-related behaviors can influence adolescent well-being in diverse ways including availing positive (or negative) role models and contributing to healthy or unhealthy physical and social environments. Parental habits can also significantly shape adolescent health behaviors by enhancing easy access to destructive habits such as smoking and drinking (cigarettes or alcohol). On the positive side, parents can contribute to enhancing access to healthy foods. Most adolescents adapt effectively to parenting in circumstances when they have a supportive and encouraging environment. Developing and maintaining a healthy, safe environment for the adolescents is a critical step towards promoting health and addressing health issues. As a result, I highlighted certain parenting strengths and availed anticipatory guidance aids to build confidence and competence of the father. My prominent task was to develop strategies for guaranteeing a healthy living environment for the wellbeing and health of the family members (Gottlieb & Feeley, 2005). Thus, there was a need for David to quit or slow down on drinking and smoking and assert himself as an excellent role model to the daughters. In fact, the father should develop a close parent-adolescent relationship, by adopting excellent parental skills guided by effective parenting styles. Towards this goal, the family agreed to engage in shared family activities. The father accepted to step and provide positive parent role modeling to impact positively on his daughters’ health and development. Research findings indicate that teens who have positive relationships with their parents are often less likely to engage in diverse risk behaviors such as smoking and drinking. Similarly, the teens are less likely report symptoms of depression and are high likely to report enhanced levels of perceived well-being. 2.2 Priority Setting and Problem Definition The interactions with Natalie and Millie revealed that the adolescents engage in behaviors that jeopardize their present and future state of health. This was worrying as almost two thirds of premature deaths, and close to one-third of the total disease burden in adults is mainly associated with conditions and behaviors whose onset is the youth. Some of the dominant health issues that affected Natalie and Millie included risk to early pregnancy, HIV, harmful use of alcohol and tobacco, poor mental health, and risks to physical violence. During the assessment, I was sensitive to the stressors and strains experienced by the family, whether financial, physical, or emotional. The father’s smoking exposed the daughters to inhale second hand smoke, which enhanced the risk of developing health problems such as bronchitis, pneumonia, and lung diseases, as well as enhanced asthma attacks. Moreover, Natalie and Millie were at an enhanced risk of developing the habit themselves. Similarly, David’s alcohol abuse at home meant that the teenagers could readily access alcohol and probably become addicted to alcohol. Access to alcohol in the home is often linked to teen drinking, besides been linked to family experiences such as family violence. Educational and organizational diagnosis involved identification of the predisposing, enabling, and reinforcing factors that act as supports or barriers to modifying the behaviors. The assessment involved identification, description, and prioritization of health issues that the family faced. The Behavioral diagnosis highlighted behavioral and non behavioral causes (personal and environmental factors) that contributed to some of the health problems that the family faced. For instance, David’s uncontrolled alcohol intake placed him at enhanced risk to developing diabetic complications. The effectiveness of interventions laid depended on the quality of the assessment. The assessment provided a platform to comprehend the family situation based on aspects such as the family system (single parent family), patterns of interaction and key relationships, whereby I recognized the strenuous relationship within the family (Allen & Warner, 2002). Furthermore, the assessment provided a platform to explore the functions, as well as the roles of each family member. It was also essential to look into the family’s learning and developmental styles in relation to health and wellbeing, as well as the nature and quantity of resources accessible to the family, plus the various financial and social supports that the family can access. The behavioral and environmental diagnosis involved identification of risk factors or risk conditions that the intervention sought to influence. This was achieved through the ranking of the personal and environmental factors in terms of how they influence the outcomes sought. The behavioral and environmental diagnosis involved identification of the behavior and lifestyles and/or environmental factors that ought to be altered to influence the highlighted health issues. There was a need to explore the predisposing factors to the unhealthy lifestyles such as poor knowledge, attitudes, values, and beliefs concerning healthy living. The assessment explored a number of issues, which include promoting of physical activity, promoting accessibility and consumption of a balanced diet, and promoting mental health and wellbeing. Other issues explored included promoting sexual and reproductive health, minimizing tobacco-related harm, minimizing harm from alcohol and related drugs. Despite the initial fears of not striking a comfortable and open relationship with the family, I was successful in entering into a negotiation with the family, whereby sharing, testing out, and validating information was evident throughout the process (Friedman, Bowden & Jones, 2003). The plan facilitated developmental, and growth seeking behaviors guided by realistic goals. This incorporated institution of certain strategies to be mobilized in order for the family to attain full capacity for health that is meaningful to them. In the interactions, we were able to clarify concerns and goals guided by the learning style and using provocative or rhetorical questions that invite discussion. My main role was to establish linkages and raise awareness. The family, on the other hand, bore the task of clarifying concerns, highlighting preferences and resources, displaying strengths, making decisions regarding alternatives, noting outcomes, testing new behavior, and noting outcomes. The observations and assessments made on my first visit were critical to the formulation of goals of the health promotion project. My first goal detailed raising awareness to the family on the impacts of unhealthy eating habits such as consumption of junk food, a favorite to the family, in an effort to promote healthier choices. Secondly, I wanted to raise an understanding on the gains of regular physical exercise. Similarly, it was critical to raise awareness on the benefits of smoking less or promote quitting smoking altogether. My fourth goal detailed enhancing awareness on the benefits of health checks and urging the family to visit the doctor for regular checkups as I had learnt that the family rarely visits the doctor, unless sick. One of my objectives was to ensure that, by the end of my home visits, the family members will be walking for 30 minutes on most days of the week. Secondly, the family members resolved that each will undertake a health check at least twice a year. Similarly, by the end of the engagement, I expected the father to be smoking less, and all family members to learn about the advantages of eating a healthy diet. I also targeted that the family should be knowledgeable and able to identify what recommended portions of fruits and vegetables are essential to meet the suggested dietary intake. Chapter 3: Implementation During my preparations, I knew that collaboration with the family carried every opportunity of success in my health promotion endeavor. All along, I was accommodative by tolerating the initial confusion, and appreciating efforts made by the family in the health promotion (Friedman, Bowden, & Jones, 2003). The implementation encompassed the institution of an informal and welcoming physical and social setting; engagement and participation, and provision of opportunities to ingrain problem solving skills such as observing, collecting information, weighing evidence, brainstorming options, planning, and evaluating the outcomes. This also encompasses the acquisition of skills central to the situation at hand such as physical care of the diabetic father. In order to strike collaboration with the family, we agreed to strike a partnership in assessment, implementation, and evaluation of the plan shaped by the outcomes and the family’s responses to these outcomes (Allen & Warner, 2002). This aided in building on the client’s strengths and capacities accompanied by elements such as goals, motivation, knowledge and skills, and social support. Some of the key messages that I employed to promote positive behavioral change include healthy food translates to healthier people, regular exercises will help make one strong and healthy, having a regular medical checkup can stop one from getting sick, quitting smoking and controlling the alcohol intake is one of the best things that the David can do for himself, as well as for his kids, and enhanced health makes stronger families. The development of growth seeking activities encompassed aspects such as setting realistic goals for development in line with the present circumstances; mobilizing resources and potentials within the family and from the entire social context; changing behavior and adopting lifestyle choices that enable functioning at maximum capacity; connecting health achievement with life goals, and assuming duty for personal/family development (Gottlieb & Feeley, 2005). My core task revolved around assisting the family to build on their potential for problem-solving and goal achievement via active participation and personal discovery (Friedman, Bowden, & Jones, 2003). The intervention featured activities such as goal setting and self monitoring, the development of social support for physical activity, structured problem solving, and the prevention of a relapse. The effectiveness of the intervention depended on behavior change and the social support strategies. It was evident that the greatest health gains to be attained lay in encouraging even small increases in physical activity. The family could attain health benefits from accumulating, on most days of the week, 30 minutes or more of moderate intensity physical activity. The planned sessions played a critical role in changing knowledge, attitudes, self efficacy, and individual capacity to be physically active. During my first visit, efforts to establish a favorable interactive environment were constrained by the brevity of the relationship that I had with the family. The uneasiness evident in my first visit complicated the process of negotiation and collaboration, especially in the creation of an ideal environment rich in support, care, expertise, and safety. Nevertheless, this did not last long as we grew fond of each other and the conversations became more open. This was critical since the outcome of health promotion rests solely on the collaboration of the patient. In addition to the father’s illness, collaboration was also constrained by an apparent emotional distress, and the authoritative perception that I was an outsider and had no reason to meddle in the family affairs, leave alone make home visits. The accomplishments in this stage set the stage for additional health work that was needed such as convincing the father to join an alcohol support group in the path toward rehabilitation. Fathers are central to their children’s health and development. Thus, it was necessary that David sets the pace of behavioral change and exercises regularly. In fact, studies indicate that adolescents whose parents exercise regularly are themselves likely to adopt the same. I equipped David with diabetes management skills such as keeping to a schedule, eating a balanced diet, coordinate meals and medication. I also advised him to implement an exercise plan (preferably the entire family), adopt an exercise schedule, stay hydrated, and to check blood sugar regularly. It was also essential that he quit drinking and smoking, or to at least slow down as smoking is an independent risk factor for diabetes and may enhance the risk of complications. Smoking can heighten the risk of developing complications such as circulatory problems, stroke, and heart disease. It was also essential that he managed his alcohol intake by drinking alcohol with food and not drinking more than two drinks of alcohol in a day. Chapter 3: Evaluation 3.1 Process Evaluation There are three levels of evaluation for health promotion; process, impact, and outcome. Process evaluation explores all aspects of the process of delivering a program and highlights evaluating health promoting actions and documenting reach and capacity of the home visits to yield the desired health action (Allen & Warner, 2002). During the evaluation, I looked at the family’s responses to both the plan, as well as the outcomes of the plan, and then amended the plan as necessary. This point involved gathering evidence on family responses and outcomes, although I was not necessarily interested in assigning value. The evaluation was both independent and collaborative, whereby we evaluated the tentative linkages between the activities undertaken and the outcomes. This provided a window for sufficient prominence on the process of learning and availed opportunities to identify factors that impacted on the process. The evaluation of the health promotion sought to assess whether the visits and the accompanying activities had met their objectives (Friedman, Bowden, & Jones, 2003). This was essential in giving one a sense of achievement and aid one to work out means of enhancing the outcomes of the next visit. In the evaluation, I employed qualitative evaluation by looking at how well an activity was delivered and received based on the family members’ expressed thoughts and opinions, how the family members have been engaged with the activities and tasks, and how they felt carrying out the activities, and what they thought could have been done better. 3.2 Impact evaluation Impact evaluation explores the immediate effect that health promotion programs have on the family such as health literacy, adoption of healthy lifestyles, and creation of healthy environments (Allen & Warner, 2002). Health promotion programs possess a broad range of immediate effects on individuals and on social and physical settings. The Impact evaluation was guided by impact indicators that we had established earlier specifying the change expected (Friedman, Bowden, & Jones, 2003). The impact evaluation revealed that the family had an enhanced health knowledge, skills, and motivation, and had undertaken modifications to their health actions and behavior. With regard to the family settings, the family had managed to create a physical environment that promotes health and minimizes exposure to health risks. Outcome evaluation pursues the endpoint of interventions outlined as outcomes such as enhanced quality of life. It is no doubt that the health promotion activities led to an enhanced quality of life and decreased disability. In a considerable way, the interventions propelled social relationships reinforced by parental monitoring and family interactions, which played a significant role in modifying or changing the attitudes (Allen & Warner, 2002). The health promotion activities have led to enhanced healthy lifestyles manifested by David giving up smoking and the family adopting healthy eating, and engaging in physical exercises regularly. Having regular health checks has also been crucial in aiding the family to avert medical crisis. Since I made three visits to the family, the end of one visit meant the planning for the next. Each home visit encompassed three phases; preparation, conducting the visit, and a post-visit evaluation. Through evaluation, I was able to validate the health work process as per the outcomes in the situation and their satisfaction with the outcomes. Engagement with the family was critical to establishing a relationship with the contact family and central to the success of the project. Close collaboration with the family from the beginning has been critical in ensuring that the family members take on the healthy behavioral changes that I had been attempting to achieve. The family’s functioning style was remarkable in that the family perceived the health issues as situations to be dealt with as part of family life. The family showed initiative and close collaboration, especially during the visits. The family also actively participated in defining situations, goals, and expectations. Being part of the process has ensured that benefits derived from the health promotion effort last longer than the project’s short-term objectives. The maintenance of close collaboration with the family guaranteed that I remained informed and updated about the progress. The information shared during the collaboration was treated with utmost confidentiality. Conclusion The project’s goal was to enhance awareness of the risk factors for health issues that the family faced. This has been attained through facilitating the family to attain awareness of and access to healthcare services and programs (Friedman, Bowden, & Jones, 2003). The visits to the family were largely successful in raising awareness on the risk factors to the health issues afflicting the family and availed information and encouragement to minimize their risk and pursue a healthier lifestyle. References Allen, M. & Warner, M. (2002). A developmental model of health and nursing. Journal of Family Nursing, 8 (2), 96-135. Friedman, M., Bowden, V., & Jones, E. (2003). Family nursing: Research, theory and practice (5th ed.). Stamford, CT: Appleton & Lange. Gottlieb, L., & Feeley, N. (2005). The collaborative partnership approach to care: A delicate balance. Toronto, Canada: Elsevier. Read More