The Concept of Health and Along with the Preventive Paradigm - Research Paper Example

?Topic:  Vitamin D Deficiency: Developing, implementing and evaluating a research-based intervention I. Problem: Compliance with National Practice Guideline X Summary of the problem Health care system is burdened in the recent times and the public health issue with the middle-aged and elderly is reaching new heights, attracting the need for timely and appropriate interventions in the health care management practices of chronic diseases like CVD, NIDDM and obesity among others. Adults and elderly over the age of 30 years are found to be at an increased risk of Cardio-Vascular Diseases (CVD) which are in turn related to NIDDM and obesity. Obesity is a chronic disease and is becoming a public health issue, with high body-mass index (BMI) >30 leading to NIDDM and CVD. The issue is aggravated with low levels of vitamin D. National Institute of Health (NIH) and the International Osteoporosis Foundation (IOF) guidelines recommend that a 800 to 1000 IU daily supplement of vitamin D to maintain >30 nmg/L levels and this needs appropriate interventions as the need of the hour as practitioners and health care providers need to enhance their knowledge base on the harmful effects of vitamin D deficiency. II. Relevance to nursing and the value of the project to the advancement of nursing knowledge Patient concordance can be improved by effectively equipping the practitioners with relevant knowledge on the need for maintaining appropriate vitamin D levels. Lee (2001) observes that at least 50 percent of chronic diseases can be prevented, and health promotion is a major concern in preventing these all-cause diseases. Health promotion is defined as “combination of health education and related organizational, economic, and environmental supports for behaviour change of individuals” (Green and Kreuter, 1991, Lee, 2001) in which health education is the primary concern. Health education focuses on health behaviour which is central to health promotion and is found to affect at multiple levels through personal and interpersonal health behaviours (Lee, 2001). Health of an individual is perceived more as an additive process due to the influences of environment, physical and psychological factors as viewed by Nightingale. Further, health is not just the absence of disease but a multi-dimensional concept that is more relevant to the 21st century health concern. It is also the major concern regards nursing, apart from the other three nursing metaparadigms: person, environment and nursing. Being a self-standing concept in the field of nursing, health is promoted as a holistic process for adapting oneself to social, psychological and biological changes through goal-driven behaviour to implement the four health models described by Edelman and Mandle (2004): clinical, role performance, adaptive and eudaimonistic models (Lippincott and Lippincott, 2008). Health promotion enhances the concept of health and along with preventive paradigm, forms the basis for health belief model (HBM) and further, Pender’s health promotion (PHP) model. Many of the other models of nursing and health care are based on these two models. As nurses engage in complex functions like health education, assist, supervise or carry out medical treatments suggested by physicians, their role in health promotion becomes is crucial and is based primarily on PHP model. Nurses play a crucial role in “the process of enabling people to increase control over and improve their health” (WHO, 1984, p5; Mackey, 2002, p4). III. Intervention: Analysis of Institution Unit X’s adherence to National Practice Guideline X within the past 6 months Describe selected intervention. Education training program as an effective intervention program is suggested for a target audience which includes practitioners, nurses, and other providers of health care. The nursing process is similar to the education process and involves the four stages: assessment, planning, implementation and evaluation. PHP model focuses on four related aspects of intervention: inputs, outputs, activities and outcomes. PHP model, although forms the basis for the new model, it is still lacking in a holistic approach to include families and communities. This intervention, although, based on PHP model for health promotion, would be helpful in addressing the gap in effective intervention through training the nurses, health care providers and practitioners to efficiently support and implement further interventions to the elderly with high risk of vitamin D deficiency. Thus, PHP colluded with HBM would be an ideal mix to base the intervention program (Ripollone, 2011). The intervention program will need to be clear, consistent, adequate, logical, holistic or complex, distinguishing, convergent, pragmatic, and utilitarian with a wider scope and significance. This ensures that the prevention and promotion of chronic health diseases is also focused on during intervention (Ripollone, 2011). The intervention is aimed at increasing compliant behaviour of the patient and the health care provided by the nurses, etc. compliant behaviour can include adhering to strict medication prescribed or even avoiding some or all of the unhealthy practices that may inhibit the patient’s roadmap to a healthy living (Lannon, 2011). HBM extended by PHP can be used effectively for health promotion as it is seen that the role of patient’s in healthcare decisions has progressed to a cognitive-motivational concordance involving the patient’s self-care behavior and commitment to their self-care under the close collaboration with healthcare practitioner’s recommendations (Kyngas, Duffy, & Kroll, 2000). However, practitioners often times become engrossed with staying caught up with professional tasks such as seeing patients and dictating notes that meeting current guidelines based on research go unmet. Thus, educational methodologies like the proposed intervention through training program for practitioners, healthcare providers, etc.; about vitamin D deficiencies are needed to improve their knowledge base of the deficiency and in turn reiterate needed education to their patients on causes, prevention and control of diseases due to vitamin D deficiency. IV. Purpose: Identify areas for change in nursing practice of Institution Unit X Kramm, Gangnon, Jones, Linzer, & Hansen (2010) reported that practitioners were half as likely to test vitamin D levels in patients with vitamin D deficiency symptoms due to their busy schedules and lack of knowledge of current research guidelines and that only approximately one-third of elderly individuals were knowledgeable of vitamin D and its effects on the body (Oudshoorn, Hartholt, Van Leeuwen, Colin, Van Der Velde, & Van Der Cammen, 2011). Hence, there is a need for effective intervention to educate the practitioners of health care to the elderly in health promotion and prevention of chronic diseases. The intervention training program will include the four stages of nursing/ education process: assessment, planning, implementation and evaluation and each of the stages will be compliant to the standard intervention practices required of intervention standards in nursing. The intervention includes a framework, precede-proceed model and marketing of the intervention approach (Ivanov and Blue, 2008). V. Targeted/desired Outcomes (must include measurable criteria): Five key action areas are the focus of the intervention: Building Healthy Public Policy, Create Supportive Environments, Strengthen Community Action, Develop Personal Skills and Reorientation of Health Services. And the intervention is aimed at addressing defined, measureable and modifiable health risks for the elderly, to evolve proactive health care programs targeted at individuals and communities using multiple strategies that are evidence-based and clinically proven. The intervention is also aimed at integration, collaboration and empowerment of service delivery, individuals and communities as they take increased responsibility of their health while monitoring and measuring the effectiveness of the program for continuous improvement (Ontario, 2006). As there is increased risk of chronic diseases like CVD, NIDDM and obesity due to vitamin D deficiency, the intervention is aimed to help identify the risk factors of the target population, determining appropriate disease prevention and health promotion activities, identify suitable intervention programs available and identifying gaps that need to be addressed through patient-specific prevention and promotion programs. The proposed intervention for nurses aims at identifying the level of knowledge of nurses of the affects of vitamin D deficiency on the patient’s health, health promoting behaviours of the patients and communities, patient’s psycho-social self-efficacy for active participation, ability of nurses in goal-setting and goal-achievement by planning appropriate intervention programs that are complaint with National Institute of Health (NIH) and the International Osteoporosis Foundation (IOF) guidelines or more specifically with HBM and PHP models. Assessment- Assessment of nurse’s knowledge on usefulness of vitamin D in preventing and promoting health, assessing two dimensions of autonomy: preferences for medical decision-making (6-item scale) and information-seeking (8-item scale) (Ende, Kazis, Ash & Moskowitz, 1989). Self-initiated health behaviours that serve to maintain or enhance level of wellness, self-actualization, or wellness, based upon the Health Promoting Model (Pender, 1982). Includes both health-protecting (preventive) behaviours that decrease risk for illness and health-promoting behaviours that sustain or increase well-being, self-actualization, and personal fulfilment (Walker, Sechrist, & Pender, 1987). Planning- An intervention training program for practitioners to evaluate their level of preparedness for health promotion. Implementation- Theoretical framework based on concepts related to health promotion for elderly to prevent diseases and promote healthy lifestyle is implemented through presentation. This also includes assessment of knowledge of nurses prior to the intervention and measuring the intervention effectiveness through a series of answers to questions on a likert scale. Measurement- Measure self-efficacy about one’s abilities to perform specific health promoting behaviours. Measures levels of physical activity among persons with physical disabilities. Questions relate to types and frequency of physical activity, activity, interest in exercise, and disability (Becker, Stuifbergen, Oh & Hall, 1993). Also, measure both internal and external barriers that are perceived as obstacles to health promoting behaviours in general (Becker, Stuifbergen, Sands, 1991). Include constructs of self-efficacy, social support, and perceived barriers to exercise. Adapted version adds 11 items about household and child or elder care activities in an attempt to be more sensitive to activity patterns in women. Conclusion- The proposed intervention for teaching practitioners of the importance of maintaining sufficient vitamin D levels in patients is charted by review of the models with the gaps addressed. Suitable course of action is also discussed for the nursing education process that implements four stages: assessment, planning, implementing and evaluating success of the intervention. The intervention itself is based on Health Belief Model (HBM) and Pender’s Health Promotion (PHP) model for nursing and draws on other relevant models to chalk out the short-term and long-term outcomes in assessing the capability of nurses in identifying risk factors in patients due to vitamin D deficiency and health behaviours of elderly, identifying gaps in health care, plan a theoretical framework for new interventions to address these gaps in the existing knowledge of cognitive-motivational concordance, implement the proposed framework for health promotion and evaluate the success and effectiveness of the proposed health promotion plan for future improvements. References- (Please note: sources in red need to be completed as I am unable to trace the files on my pc. Regret the inconvenience). Green and Kreuter. 1991. Ivanov, L and Blue, C. 2008. Principles of Health Promotion. Public Health Nursing: Policies, Politics & Practice. Delmar. Kramm, Gangnon, Jones, Linzer, & Hansen. 2010. Kyngas, Duffy & Kroll. 2000. Lannon, L. S. 2011. Using a health promotion model to enhance medication compliance. Available: http://findarticles.com/p/articles/mi_hb6374/is_n3_v29/ai_n28688918/pg_7/?tag=content;col1. Accessed on 14th October 2011. Lee, E. 2001. Health promotion for the chronic patients. Seoul National University College of Nursing, 2(2). Lippincott, W & Lippincott, W. 2010. Theoretical Basis of Community Health Nursing. Wolters Kluwer Health. Mackey, K. J. A. 2002. Using a Health Belief Model In Teaching Preventive Health Care Principles To Israeli RNs. University of Massachusetts Lowell, CITA Conference. Ontario. 2006. Guide to Health Promotion and Disease Prevention. Family Health Teams. Oudshoorn, Hartholt, Van Leeuwen, Colin, Van Der Velde, & Van Der Cammen. 2011. Ripollone, M. J. Health Promotion Theory: A Critique With a Focus on Use in Adolescents. Read More