It is anticipated that the initial discussion post should be in the range of 650-700 words. Substantive content is imperative for all posts. All discussion prompt elements for the topic must be addressed. Please proofread your response carefully for grammar and spelling. All posts should be supported by a minimum of one scholarly resource, ideally within the last 5 years. Journals and websites must be cited appropriately. Citations and references must adhere to APA format.
Review the health maintenance guidelines presented in this week’s lecture material.
Post a discussion on your observations about review of these guidelines with a patient that you and your preceptor have seen in clinic.
Include in the discussion:
- The patient’s age, gender and applicable health maintenance guideline
- The preceptor’s approach to the topic of the health maintenance guidelines
- The patient’s response to or questions about health maintenance guidelines
- An overview of the health promotion model, or change model, that you would utilize to frame your discussion with a patient about health maintenance guidelines applicable for their age, gender, and health status
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.
1) As a certified Family Nurse Practitioner, I have been working in a Wellness clinic for the past 3 years and I see patient everyday who are mostly 65 years and older. In my clinic rotation now, it is solely for psychiatric services.
Instead I would like to share what I do in the Wellness Clinic. Health promotion and disease prevention is one of the important approaches to focus because of high incidence of chronic diseases and functional impairments among the geriatrics. Health promotion strategies have three basic targets: to maintain and increase functional capacity, to maintain or improve self-care and encouraging social interaction. These contribute to a longer, independent and being self-sufficient. Evidence also shows that participating in activities is vital for healthy aging. (Golinowska, Groot et. Al 2016)
The patient’s age, gender and applicable health maintenance guideline 65 years and older
- Healthy lifestyle- encourage patient to practice healthy lifestyle and increase physical activity. The American Heart Association and American College of Sport Medicine provides recommends different type of activity for these population. It has four classification: balance, flexibility, muscle strengthening and aerobic
- Screen for Alcohol dependence/abuse. Specific questioning regarding frequency and quantity of alcohol use. If positive, proceed to asking CAGE questioning.
- Immunization- Td or Tdap every 10 years; Influenza vaccine, Pneumococcal vaccine; Herpes Zoster Vaccine
- Screening colon cancer- Prostate cancer screening which should be based on patients discussion; Colorectal cancer screening; breast cancer screening; Lung cancer screening 55 to 74 years with a history of at least 30 pack-years of smoking (current smokers or those who discontinued smoking within 15 years
- Blood pressure screening
- Lipid screening
- Abdominal Aortic aneurysm- ultrasound abdomen in men ages 65 to 75 who have ever smoked; one-time screening with who have a first-degree relative who required AAA repair or died from AAA rupture; screening to women who have a strong family history of either AAA repair or death due to AAA rupture, depends on patient’s decision.
- Screening for diabetes
- Functional assessment- activities of Daily living
- Cognitive Assessment- in patients with memory complaints, either self-expressed, or noted by a caregiver or clinician.
- Depression Screening
- Osteoporosis- women 65 years of and older and men who have either manifestations of low bone mass
- Vision Screening
- Screening for hearing loss
- Screening for Vitamin D deficiency
- Screening for Fall
- Screening incontinence
- Medication Use
- Home safety evaluation
- Advance Directive and health care proxy
The patient’s response to or questions about health maintenance guidelines
All my patients are responsive to the health maintenance guidelines that we do every year for Annual Wellness Visit and they are proactive and look forward to this yearly wellness visit.
An overview of the health promotion model, or change model, that you would utilize to frame your discussion with a patient about health maintenance guidelines applicable for their age, gender, and health
I chose the Health belief Model to promote health and to prevent disease. This model emphasizes the key factors that influences health behaviors as individuals perceived threat to the disease, the consequences of getting the disease, the positive advantage of taking into action, the possible hindrance to action, exposure to factors that warrant an action and confidence in the ability to succeed. It suggest that most patient are almost certainly to take preventive actions if they see the risk of and ill effects of the getting the disease. (Laranjo 2016)
Laranjo, L. (2016). Health Belief Model. Health Belief Model – an overview | ScienceDirect Topics. https://www.sciencedirect.com/topics/medicine-and-dentistry/health-belief-model.
rural health, rural health. (2021). The Health Belief Model – Rural Health Promotion and Disease Prevention Toolkit. https://www.ruralhealthinfo.org/toolkits/health-promotion/2/theories-and-models/health-belief.
Heflin, M. T. (2021, June 4). UpToDate. https://www.uptodate.com/contents/geriatric-health….
Golinowska, S., Groot, W., Baji, P. et al. Health promotion targeting older people. BMC Health Serv Res 16, 345 (2016). https://doi.org/10.1186/s12913-016-1514-3
The patient is a 19-year-old white female.
According to Sutter Health (2019), the recommended screening and health maintenance guidelines for a person her age should receive the following:
- Wellness Check: blood pressure check, healthy weight, assess overall health.
- Screening Tests: HIV, Hepatitis C, obesity, and blood pressure.
- Immunizations: Influenza, Varicella, HPV, MMR, Tdap.
- Women’s health: Chlamydia and Gonorrhea, Cervical cancer screening (pap test every 3 years starting at age 21), and pregnancy screening.
- Discussion Topics: Alcohol use, tobacco use including vaping and smokeless tobacco, depression, diabetes, domestic violence, unhealth drug use, prevention of STDs, and prevention of skin cancer.
- Individualized/Patient-Provider Shared Decisions: Meningococcal B Vaccine, HPV Vaccine.
The only areas my preceptor approached were screening questions about sexual health and pregnancy, since the patient is taking antidepressant medications, alcohol and tobacco use, and domestic abuse. We did not perform blood pressure testing, weight, immunizations, or other women’s health issues. The only topics that were relevant to the patient were the ones that were addressed. The patient is being seen for depression and anxiety so questions about her depression were approached and she does have a history of an unhealthy relationship with her parents, so the topic of domestic and family violence was visited.
The patient was open to answering any and all questions. My preceptor did a great job of explaining the types of questions she would be asking and the reason behind them. Once the client understood that the questions were relevant to her care and her medication regimen, she was happy to give all answers.
According to Nursing Theory (2020), the Pender health promotion model helps to define health as a positive dynamic state rather than simply the absence of disease. I would like to use this model with this patient because at only 19 years old, she is otherwise healthy. She just needs to perceive her overall health as “good” and work towards keeping herself healthy, which she likes to do by working out at the gym. Since her physical well-being is being taken care of, she could now work on her mental health well-being. The Pender health promotion model makes four assumptions: Individuals seek to actively regulate their own behavior, individuals, in all their biopsychosocial complexity, interact with the environment, progressively transforming the environment as well as being transformed over time, health professionals, such as nurses, constitute a part of the interpersonal environment, which exerts influence on people through their lifespan, and self-initiated reconfiguration of the person-environment interactive patterns is essential to changing behavior (Nursing Theory, 2020).
Basically, I would use this model to help the patient do some self-reflecting and mediation exercises and apply the same principals as she does when she has the discipline to go to the gym 4-5 times per week. I would draw on her own self-care ability and have her focus that energy on her mental health well-being.
Pender’s Health Promotion Theory. (2020). Nursing Theory. Accessed June 15, 2021. https://nursing-theory.org/theories-and-models/pen…
Health promotion is an integral aspect of healthcare, a process that involves the involvement of the public in their health. It is carried out through the use of social and environmental factors that can affect their well-being. It also influences individuals to take control of their health (World Health Organization, 2016).
The patient’s age, gender and applicable health maintenance guideline:
My 64-year- old male patient has several chronic comorbidities, which include diabetes, Hypertension, hyperlipidemia, congestive heart failure, and chronic kidney disease. The electronic medical record (EMR) system where I’m working flags the patient’s chart, listing the quality measures for that patient. It alerts past due or current health promotion indicators. Mr. T is non-compliant with his treatment regimen. He does not take his medications as prescribed and does not follow his dietary restrictions. While perusing his chart, several health maintenance indicators were not met. Some of the measures that were not up-to-standard were the lipid panel, and prostate cancer screening (NCCDPHP, n.d.). Although the patient is not 65-years-old, he qualifies for the pneumoccocal vaccine related to his risk factors.
Mr T’s Health Maintenance/Promotion reflected as follow: Up to date on immunizations, flu (10/2020), pneumonia (1/2020 & 11/20). Colonoscopy up to date (5/2014) – normal repeat in 10 years. Diabetic foot exam (2/2021). Dilated eye exam (3/2021). Last hgba1c 6.8 (3/2021) Diet- Diabetic. He occasionally exercises by walking.
Domestic Abuse Screening – negative
Alcohol/Nicotine/Drug Use: Denies – “Never drinker, never smoker, never used drugs”
Depression Screening: Denies SI/AH/VH, feeling lonely, sad, or thoughts of self-harm. Patient reports happy with life; sleep 6-8 hourse per day; appetite good, do cross/word puzzles daily, and visits senior center weekly to dance. Also stated bo guns in home.
The preceptor’s approach to the topic of the health maintenance guidelines
The health maintenance guidelines were discussed between my preceptor and I. However, the patient was not adhering to his treatment regimen. The preceptor explained the various tests and measures that were implimented to evaluate the patient. He also educated the patient on the importance of healthy lifestyle choices to manage his current health status.
The patient’s response to or questions about health maintenance guidelines
Although the patient is vaccinated for COVID-19, the patient is not comfortable leaving his home for labs or vaccinations, but would make an appointment if he has any problems or worsening symptoms.
An overview of the health promotion model, or change model, that you would utilize to frame your discussion with a patient about health maintenance guidelines applicable for their age, gender, and health status
Nursing theorist, Nola J. Pender believes, “A individual needs to change how he thinks before he can change how he behaves” (Murdaugh, Parsons, & Pender, 2019).
Health-promoting behavior is the desired behavioral outcome, which makes it the endpoint in the Health Promotion Model. Pender’s model spotlights on three zones: individual attributes and encounters, conduct-specific cognitions and affect, and behavioral results. These practices should result in improved health, upgraded functional ability, and improved quality of life and personal personal satisfaction at all phases of development.
Pender’s health promotion model (HPM) is one of the widely used models to plan for and change unhealthy behaviors and promote health (Khodaveisi et al., 2017). Utilizing the model and working cooperatively with the patient, the practitioner can help the individual in changing practices to accomplish a healthy lifestyle (Murdaugh, Parsons, & Pender, 2019). Changes in lifestyle can influence the health of a community, and can be used with other planning or behavioral models.
As healthcare providers, we must also understand that health promotion is a community affair. The environment in which people live and work can affect their perception of how well they can manage their health. This is why it is important that health care professionals are trained to interact with, educate, and empower individuals.
National Center for Chronic Disease Prevention and Health Promotion (n.d.). Promoting health for adults. Centers for Disease Prevention and Control.https://www.cdc.gov/chronicdisease/resources/publi…
Khodaveisi, M., Omidi, A., (2017). The Effect of Pender’s Health Promotion Model in Improving the Nutritional Behavior of Overweight and Obese Women. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC53852…
Kumar, S. & Preetha, G.S. (2012). Health Promotion: An Effective Tool for Global Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC33268…
Murdaugh, C. L., Parsons, M. A., & Pender, N. J. (2019). Health promotion in nursing practice (8th ed.). New York, New York: Pearson.
World Health Organization. (2016). What is health promotion? World Health Organization.https://www.who.int/features/qa/health-promotion/e…