1. Ben McClellan, BSN, RN
April11, 2014
Health Promotion Project #5
A project to meet partial requirements
For NRSG 520
Health Promotion Across the Lifespan
Southern Adventist University
School of Nursing
Teaching Nugget
2. Introduction of Patient
JM-Caucasian Male; DOB
Ht-6’3” Wt-275 lbs. BMI 34.4
Married, father of one
Employed by Life Care-Med Tech
College-Nursing program
Health Issues- obesity and HTN
Health promotion focus-Improve overall health
and decrease risks for other diseases
Increase exercise routine and healthy eating
habits
3. Healthy People 2020
Reaching high-quality, longer lives free from
disease, injury and early death
Promote quality of life, healthy growth and behaviors
Achieve and maintain a healthy BMI
Consume nutrient-dense foods
Limit intake of unhealthy foods
(Healthy People 2020, 2013)
4. Learning Theory
Health Promotion Model was proposed by Nola
Pender
Defines health as a positive dynamic state, not just
absence of disease
HPM focuses on three areas: individual
characteristics and experiences, behavior-specific
cognitions and affect and behavioral outcomes
The goal is health promoting behavior
Terms include- prior related behavior, personal
factors, perceived benefits, perceived barriers,
interpersonal and situational influences
(Health Promotion Model,
2012)
5. Change Theory
Transtheoretical Model of Behavior Change
Stages of Change: precontemplation,
contemplation, preparation, action, and
maintenance
TTM is useful in guiding treatment and
prevention
Pros vs. Cons
(The Transtheoretical Model, 2013)
6. Program Plan
PRECEDE-PROCEED Model by Green and Kreuter
Social Dx- Discuss importance of exercise and risk
factors of obesity
Epidemiological Dx- Acquire prevalence & severity of
health issues
Behavioral & Environmental Dx- Be informative on health
issues of group
Educational & Organizational Dx- Educating of
equipment use & proper body mechanics
Administration & Policy Dx- Local church gym and
surrounding property
(Green &
Kreuter, 2005)
7. Program Evaluation
PRECEDE-PROCEED Model by Green and Kreuter
Implementation- acquiring staff, materials, and
recruitment & advertising of class
Process Evaluation- Is the intervention being
conducted according to steps 2-5?
Impact Evaluation- has the program led to any effect
on the group?
Outcome Evaluation- evaluates the effect of the
program using Rapid Assessment of Physical Activity
test at the end of 6 months
(Simons-Morton, Mcleroy, &
Wendel, 2012)
8. Rapid Assessment of Physical
Activity
Rapid Assessment of Physical Activity
Physical Activities are activities where you move and increase your heart rate above its resting
rate, whether you do them for pleasure, work, or transportation.
The following questions ask about the amount and intensity of physical activity you usually do. The intensity of the
activity is related to the amount of energy you use to do these activities.
Examples of physical activity intensity levels:
Light activities
• your heart beats slightly faster than normal
• you can talk and sing
Moderate activities
• your heart beats faster than normal
• you can talk but not sing
Vigorous activities
• your heart rate increases a lot
• you can’t talk or your talking is broken up by large breaths
9. RAPA
How physically active are you? Check one answer on
each lineI rarely or never do any physical activities YES NO
I do some light or moderate physical activities, but not every week YES NO
I do some light physical activity every week YES NO
I do moderate physical activities every week, but less than 30
minutes a day or 5 days a week
YES NO
I do vigorous physical activities every week, but less than 20
minutes a day or 3 days a week
YES NO
I do 30 minutes or more a day of moderate physical activities, 5 or
more days a week
YES NO
I do 20 minutes or more a day of vigorous physical activities, 3 or
more days a week
YES NO
I do activities to increase muscle strength, such as lifting weights or
calisthenics, once a week or more
YES NO
I do activities to improve flexibility, such as stretching or yoga, once YES NO
10. RAPA Scoring instructions
RAPA 1: Aerobic
Score as sedentary- yes to question #1
Score as under-active- yes to question #2
Score as under-active regular-light activities- yes to question
#3
Score as under-active regular- yes to questions # 4 & 5
Score as active- yes to questions # 6 & 7
RAPA 2: Strength & Flexibility
I do activities to increase muscle strength, such as lifting
weights or calisthenics, once a week of more. (1pt)
I do activities to improve flexibility, such as stretching or
yoga, once a week or more (2pt)
Both (3pt)
None (0pt) (How physically active are
12. References
Green, L. W. & Kreuter, M. W. (2005). Health
Promotion and Planning: An educational And
Ecological Approach. (4th ed.). New York, NY:
McGraw Hill.
Health Promotion Model (2012). Nursing theories:
a companion to nursing theories and models.
Retrieved from
http://nursingplanet.com/health_promotion_model
.html
Health Promotion Research Center (2013).
Retrieved from
http://depts.washington.edu/hprc/rapa.
HealthyPeople.gov (2013). Retrieved from
http://www.healthypeople.gov/2020/topicsobjectives20
13. References
Simons-Morton, B., McLeroy, K. R., & Wendel, M.
L. (2012). Behavioral Theory in Health Promotion
Practice and Research. Burlington, MA: Jones &
Bartlett Learning.
The Transtheoretical Model of Behavior Change
(n.d.). Retrieved from
http://www.umbc.edu/psyc/habits/content/the_mo
del/.
Notas del editor
Hello, my name is Ben McClellan and this is my teaching nugget for health promotions across the lifespan project #5
JM is a 43yom, that is married with a teenage daughter. He works full-time at Garden Plaza, night shift, for life care. He also is currently enrolled at CSCC in the nursing program. He is morbidly obese which increases his risk for DM, CAD, HTN, CVA, certain CAs, and OA. He wishes to lose the excess weight he has gained over the past 10 years, thereby decreasing his risk for the previously mentioned illnesses. He also wishes to see his daughter walk down the aisle and knows that the road he has been going down will only lead to an early death. He plans to increase his current exercise routine and change his eating habits to achieve this goal.
Objectives:NWS-8:Increase the proportion of adults who are at a healthy weight.NWS-9:Decrease the proportion of adults who are obese.Interventions & ResourcesSimply-Color, variety, and freshness Start slow-make changes that will last Every change made to improve diet mattersNutrient dense foods include whole grains of bread or pasta, fruits, vegetables, low fat or fat free milk or milk products- cheese or yogurt, and lean meats and other protein sources- nutsUnhealthy foods are those with saturated fats and trans fats, cholesterol, added sugars, salt and alcohol- candy, sodas, chips, fast foods are just a few examples of foods to avoid.
HPM notes that every person has unique personal characteristics and experiences that affect their actionsPrior related behavior- JM was raised to eat/eating healthy food, get plenty of exercise, rest and to drink water instead of sodas.Personal factors- JM is strong willed to lose weight once he sets his mind to it.Perceived barrier- school, work, time, money, and weatherInterpersonal infl.-family and friends provide a support system for JMSituational infl.-family get together, holidays, or super bowel partiesCompeting demands-time with family, work, and schoolThese experiences of JM, positive or negative, can motivate him to change his way of living.Health promoting behavior should result in improved health, enhanced functional ability and better quality of life
TTM is an integrative, biopsychosocial model that conceptualizes the process of intentional behavior change. It consists of 5 stages-precontemplation, contemplation, preparation, action, and maintenance.TTM allows for JM to make changes, either regression or progress from precontemplation to action in just a few weeks.It is important to teach patients the pros of losing weight-the changes should be individualized to each individual. This will enable the patient to progress forward. Relapses can happen when temptations are greater than the patients will to change.Experiential processes- consciousness raising, dramatic relief, environmental reevaluation, self-reevaluation, social liberationBehavioral Processes- reinforcement management, helping relationships, counter conditioning, stimulus control, self-liberationWhen this all started JM was in the preparation stage- he was ready to change and knew the pros outweighed the cons. He decided to start walking daily and to increase his diet to nutrient dense foods to help reach his goal of a BMI<30.
The PRECEDE-PROCEED model stands for predisposing, reinforcing, enabling constructs in educational diagnosis and evaluation. It consists of 5 phases: 1 social diagnosis, 2 epidemiological diagnosis, 3 behavioral and environmental diagnosis, 4 educational and organizational diagnosis, 5 administration and policy diagnosis
The staff was gathered from the church and local college nursing students by the me the leader. We posted flyers in mailboxes around town and by word of mouth. The class was offered free of charge to encourage participation.Using the RAPA at the beginning of the program, the leader as able to make changes along the way for those individuals who needed more assistance than others. The RAPA allows for the group to come together in different activity levels based on their previous activity level prior to the class. Short-term goals, weigh-ins, labs-HDL, LDL, glucose levels were measured at weeks end with a decrease noted glucose and weights in 75% of group participants. At the end of the 6 month period LDL and HDL labs were drawn and showed a 15% improvement in 80% of the group participants. The inactive group showed the largest improvement. Throughout the program each individual was allowed to go at their own pace with personal coaching and encouragement with each phase. Exit interviews were conducted to assess individuals overall health. 90% expressed an increase in their activity level and being comfortable enough on machines in which they could use on their own. Their confidence was much higher at the end of 6 months. They said they have not had to go to their PCP as often with the improved blood work since starting the fitness program. They have told others about their success, which in return has led to interest of other parties in living a healthier lifestyle.
Light activity-walking leisurely, stretching, vacuuming, or light yard workModerate activity-fast walking, aerobic class, strength training, or swimming gentlyVigorous activity-stair machine, jogging or running, tennis, racquetball, or badminton
Here is a questionnaire of the RAPA that was used at the beginning and end of the 6 month program
This is how the group was graded based on the answers they gave in the questionnaire
Barriers overcame in the program were lack of knowledge with exercise machines, proper stretching and food and beverages choices The staff was always available during and after the class for words of encouragementThe group was encouraged to give themselves rewards when they met their goals for the week- small vacation to a favorite place to hike or relax..no food rewards though.Down loading apps that keep track of calories is a great way to monitor intake.Prayer is the key however. Keeping God first allows us to conquer any goal or task.
Here are the references. I hope you learned a lot and enjoyed my presentation. Have a good day!