New_Health_Promotion

The aim of this assignment is to discuss the importance of health promotion strategies in relation to the care of a patient with enduring mental illness. This assignment is focusing on an elderly patient in his eighties who is being treated for schizophrenia using the medication clozapine and a health promotion strategy. This assignment will also be discussing the patient’s diabetes and smoking health promotion strategies to bring a more holistic approach. For the sake of confidentiality, the patients name will be changed to Ross to comply with the Nursing and Midwifery Council guidelines on patient confidentiality (NMC, 2004). Ross has been using the mental health services since the early fifties and has been an in-patient for the past twenty two years. Ross was diagnosed with having paranoid-schizophrenia on his first admission and has been re-admitted several times since. He has become very institutionalised and dependent on staff and medication because of his regular periods in hospital. Ross is a very inpatient man which makes it difficult to get him to co-operate with any nursing interventions. He has also been a smoker from an early age and gets irrational when he doesn’t have access to cigarettes. Ross was married for forty years before his wife passed away, leaving their only child as his next of kin. Before discussing Ross’s health it is necessary to understand what health education and health promotion is and why it is important for the patient. Health promotion has been defined as "the process of enabling people to increase control over, and to improve, their health to an optimal level" (department of health, 2001). Optimal health is defined as a balance of physical, emotional, social, spiritual and mental health; which in many patients will mean a change in there lifestyle. Lifestyle change can be facilitated through a combination of three factors, which are to enhance awareness, change in behaviour and create enviroments that support good health practices (Spencer P, 2002). Enhancing awareness will have the greatest impact of the three factors in producing a lasting change in this particular patient because he is an intelligent man who is worried about his general health. Health education is similar to health promotion, however the difference is that health education is teaching people about illnesses and health promotion is encouraging them to use their knowledge to take better care of themselves. As Ross is currently on a hospital ward, it is an ideal opportunity to educate and encourage him to take control of his health. In accordance with health promotion, it may be necessary to take medication, which recently Ross has been refusing. Ross is taking many different types of medication as he suffers from a variety of health problems including diabetes, heart complaints, motion sickness, irritable bowel syndrome and schizophrenia. Ross is currently taking clozapine, which is not usually prescribed to elderly patients because of a lack of research in to the effects it may have on the age group. Due to this lack of research, the patient was started on a lower dosage rather than the dosage used in younger adults (BNF, 2004). However, after three days the multi disciplinary team (MDT) were satisfied that there were no adverse affects from the drug and it was prescribed at the normal dosage. Ross is also prescribed Metformin, Lisinopril, Fybrogel, kwells and lactoulose for his other health complaints. As Ross was an inpatient it was very difficult to convince him to comply with his medication, therefore it was necessary for a health promotion strategy to be put in place. In order for the strategy to be effective, the patient’s beliefs needed to be taken into account. This was done through using the Health Care Belief model. This model involves the exploration of the health beliefs of a patient. The health professional then provides information that is personally relevant to the patient, and explores with the patient the possibility of lifestyle changes or treatment. Becker and Maiman (1975) combined a number of patient beliefs into a health belief model and then sorted them further into four groups. Group one includes the patient’s interest in health matters, which may correlate with personality, class and social group. In relation to the patient, this means that the kind of intervention he wants will depend on what fellow patients are provided with, regardless of whether or not he actually needs the same treatment. Group two finds out how vulnerable the patient feels to a particular disease and how severe he feels the threat to be. This threat could appear larger than it is due to outside influences, for example family misinforming them or knowledge of someone having the disease. Group three discusses the patient's estimate of the benefits of treatment versus the costs, risks or inconvenience. In this case the patient finds anything that isn’t done immediately an inconvenience therefore he does not like giving his consent for blood samples as he does not see immediate results. Due to Ross being an institutionalised patient the cost of these interventions will not be an issue to him. The final group talks about the factors that prompt the patient to take action, such as developing alarming symptoms, advice from family and friends, or reports in the media. This last group looks at why the patient has requested the help, and who, if anyone has advised the patient to seek help. This model can be summarised as the patient's ideas, concerns and expectations. Patients given support with the management of long-term illnesses can live healthy and happy lives. Educating patients about their condition allows them more involvement in their treatment and greater control over their lives. Involving the patient in his own care can reduce the severity of symptoms and improve confidence, resourcefulness and self-sufficency. Because there are many aspects of Ross’s health that can be improved, it was necessary to put many different health care strategies into affect. These included strategies for the diabetes, medication, smoking and methods on how to make sure he was coping mentally and physically. The strategy that was felt to be the most important was medication. This was also considered to be the best way to get Ross to comply with the health care staff. As Ross can decide for himself, the nursing staff felt it was vital for Ross to know what the consequences could be if he refused to comply. The first step to letting Ross decide was to educate him about what the medication he was going to take was, how and why he would be taking it, and what the medication was actually doing to improve his health. Before nursing staff begun educating him, they asked him to reveal any knowledge he had about his medication. It transpired that his daughter had been giving him false information which was leading to his resentful attitude towards the medication. It was necessary to ensure the patient knew that the information he had been given about the medication was incorrect (DOH, 1997). Once this had been achieved it was possible to correctly inform him, which increases the chance of him complying with his medications in the future. As Ross is taking clozapine, it is also necessary to take a weekly blood sample. In order to achieve this, further educating on the reasoning behind this was necessary. Ross was very apprehensive about being prescribed clozapine because he found it a great inconvenience with no immediate effects. Nursing staff educated Ross by giving him small pieces of information at a time so as to not confuse him. This worked well because the patient wanted to be involved his own care. However he did become verbally and physically aggressive if he felt he was being pushed into anything he did not like or did not want to continue with the treatment. Ultimately, the educating strategy worked as Ross regularly complied with the medication and giving blood samples. As he was on a large number of medications, which also included a liquid, it took a longer period of time for nursing staff to administer his medication, this often resulted in Ross becoming impatient and angry. Nursing staff decided that the best way to reinforce compliancy is to be firm with him and remind him why the medication is necessary for his health. On occasions the nursing team would offer Ross a cigarette or a cup of tea in exchange for his compliance. However, this method could cause problems because he may expect it every time or other patients will see what is happening and expect the same treatment. The second health care strategy dealt with how to monitor Ross’s diabetes and how best to keep his blood sugar level under control. This strategy had to take into account his diet and fluid intake, when to take his blood pressure and blood sugar levels, reducing cholesterol and setting up a program to help him stop smoking. Standard three of the National Service Framework for diabetes (NSF) states that all children, young people and adults with diabetes will receive a service which encourages partnership in decision making, supports them in managing their diabetes and helps them to adopt and maintain a healthy lifestyle (DOH, 2001). This will be reflected in an agreed and shared care plan in an appropriate format and language. Parents and carers should be fully engaged in this process where staff feel it is appropriate. Ross is a type two diabetic. In many cases, type two diabetes can be controlled by lifestyle changes alone. A healthy diet is essential for people with this type of diabetes. This is the same as the normal, balanced diet that is recommended for good health, for example, low in saturated fat, sugar and salt and high in fibre, vegetables and fruit. Carbohydrates should be distributed evenly throughout the day in order to prevent high blood sugar levels after a meal. As a result of this it is very important that staff manage his diet to try and stabilise and maintain his blood glucose level. To maintain Ross’s health and well being, nursing staff have to regularly monitor his blood sugar level. As Ross is inpatient and short tempered, it is often very difficult to collect a sample of his blood. Staff decided that the best method of increasing his agreement with blood glucose tests was to educate him and reinforce the necessity of the tests, just as they had done with his medication. This was only attempted once the patient had been sufficiently educated about his medication and was complying with the nursing team, so as not to overwhelm him with information. Educating Ross about his blood glucose was very difficult because this information is complicated and difficult to understand. It took a long period of time but eventually his consent was obtained and he allowed the staff to take his blood. This worked for a short period but Ross would often refuse consent to staff who were either new or staff that were not persistent enough with him. To counter this, only certain members of staff were allowed to carry out the blood glucose testing. This greatly improved the regularity of blood glucose testing and therefore had a positive effect on his health. The final health care strategy that was put in place was aimed at helping Ross to give up smoking. This is necessary as smoking has many detrimental effects on the body, which makes giving up an important step towards maintaining optimal health. To help someone give up smoking it is important to understand why they smoke. For example, it may help them deal with stressful or unpleasant situations, reduce boredom, anxiety or depression, increase confidence in social situations or it may just help them unwind and relax. Once the reasoning behind smoking has been identified, it is possible to plan a way of breaking the patient’s smoking cycle (DOH, 1999). The nursing staff felt they had educated the patient enough, so they decided that the best way to encourage Ross to stop smoking was to gently persuade him to stop. It is important not to pressure a patient about giving up smoking as it will do more harm than good. It is likely to make them feel stressed or under pressure, which will in turn have them reaching for another cigarette. It is important to talk to Ross about smoking and ask him to think about his habit, the dangers of smoking and the benefits of giving up. Smokers say support from those closest to them often helps them to find the strength and courage to give up. It is possible that if you try to manipulate a patient, or put emotional pressure on them, it may make it harder for them to give up. An effective way of encouraging them to cut down is to ask them not to smoke at certain times or places, for example during meal times or in the car. However, ensure it is done in a courteous and non-judgemental manner. Gradually, small changes in the choices people make can lead to huge improvements in not only their own health, but also those around them. However, changes need to be based on choices, not direction. Unfortunatly, Ross refused to give up smoking because he became very agitated and stressed without cigarettes. The nursing staff also faced a problem as he refused to take his medication and eat his meals when he could not have a cigarette. This consequently affected his schizophrenia and blood sugar levels. Often the only way to get the patient to cooperate with his meals and medication was to allow him a cigarette. For this reason the health promotion stratagy failed to get the patient to give up smoking all together but did succeed in lowering the amount of cigarettes Ross smoked in a day. Overall, the patient responded well to these health promotion stratagies. However, as Ross is an inpatient man, it took a lot of time, patients and persuasion from the nursing staff. An additional problem was that he only trusted a few members of staff and these members were not always available. Improvements to these health promotions could have been to further involve his daughter in his care. This would have been beneficial as it would have increased the number of people Ross trusted involved in his care and reduced the strain on the nursing staff. Educating Ross was an effective health promotion stragegy as he is an intelligent man who was able to understand the benefits to his health. These health promotion strategies set out the aims and methods so that all members of the multi diciplinary team can work together and not be manipulated by the patient. Therfore play a vital role in achiving and maintaining a patients optimal health.