This assignment is about how to plan and conduct a health promotion advice on an individual patient to improve patient’s quality of healthy life. In this essay, the author will first of all outline how the government policies, which are the National Service Framework (NSF) for Long-term Conditions and the NSF for Diabetes, were developed. The author will outline briefly all benefits are for her particular patient – Mr Smith (pseudonym name) in compliance with the NMC (2008) on confidentiality, is a 48 year-old taxi driver, who is newly diagnosed with type II diabetes mellitus (T2DM), married with two teenage children.
He frequently works during unsocial hours and has very unhealthy life style as he relies on fast-food from cafes for his meals. He is overweight with the Body Mass Index (BMI) of 30 and is finding it challenging to maintain a normal blood glucose level. He is also concerned that he may lose his job should he be commenced on insulin. His eldest son is to start university next year and the fees are expensive. The author will then give an analysis of risk factors that may predispose Mr Smith to develop T2DM.
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Additionally, the author of this essay will briefly overview a health promotion model which is Procheska and Diclemente’s model, follow by a description of the application of this model in facilitating behaviour change with Mr Smith, utilising communication skills and some health promotion interventions to help him improve his health. The author will also acknowledge some barriers which may be encountered to Mr Smith’s lifestyle change and discuss some ethical issues relating to health promotion. According to Mark et al (2005, p. ), health is defined as: “a state of well-being with physical, cultural, psychosocial, economic and spiritual attributes, not simply the absence of ill ness”. Therefore, putting medical or surgical intervention in saving lives and combating illness is not enough. In 2005, the Department of Health (DOH) updated and published the NSF for Long-term Conditions with the purposes are for the health and social bodies and their local partners to work together closely to plan and deliver services for all people with long-term conditions to make their lives better.
This NSF sets eleven quality requirements for the health and social care services to support those with long-term neurological conditions to improve their quality’s lives, to manage their symptoms and live as independently as possible (DOH, 2005). Moreover, much of this NSF guidance can also apply to people with other long-term conditions. This NSF also aims to build on proposed changes in NHS management and commissioning to bring about a structured and systematic approach to delivering treatment and care for people with long-term conditions (DOH, 2005).
Similarly, DOH recently updated the NSF for Diabetes with twelve new standard and key interventions which are necessary to raise the standards of diabetes care, in order to ensure that people with diabetes have the care that truly fits their needs, regardless of their age, gender, ethnic backgrounds and their social class (DOH, 2007). According to the NHS Choices, in the UK, diabetes affects approximately 2. 3 million people, and it is thought there are at least half a million more people who have the condition but are not aware of it. Subsequently, Mr Smith in this essay is one of them has been recently diagnosed with T2DM.
This condition is known formerly as non-insulin-dependent-diabetes, which occurs when the body produces too little insulin, but for some reason the insulin receptors are unable to respond to it, a phenomenon called insulin resistance (Marieb, 2007, p. 637). T2DM also have a profound impact on general well-being and lifestyle of the sufferers and their families. Significantly, Dr Hillson – the National Clinical Director for Diabetes declared that: “Every person with diabetes deserves the best possible care, no matter where, when or by whom that care is delivered” (DOH, 2008).
Leading on from this, the author’s patient – Mr Smith should be given the care and support by the health and social care bodies to improve his health status and meet his individual needs based on these policies’ aims. Firstly, the author of this essay would like to introduce her role as a health-care practitioner and the health promoter of Mr Smith. The author has a duty of care to support people in caring for themselves to improve and maintain their health whilst giving information and supports that relevant to a person’s needs (NMC, 2008).
Before giving health promotion advice, the author analyses the major risk factors that may predispose Mr Smith to develop T2DM. Using an evidence-based approach, according to Diabetes UK, being over 40 years old is one of the risk factors. He is also overweight with BMI of 30. Therefore, the more risk factors that applies to him, the greater chance of him developing. Concerning about his eating habit, i. e. eating fast-food and other fatty things at the cafes, this factor may itself contribute leading him becoming obese as he is already overweight (Diabetes UK, Causes and Risk factors).
As a registered nurse, the author of this essay also has a duty of care to help people to understand about their health (NMC, 2008). Mr Smith has already told the author his health concern at the outpatient clinic. Health promotion advice is chosen to help him to improve his health. The term health promotion is defined as: “any event, process or activity that facilitates the protection or improvement of the health status of individuals, groups, communities or populations.
The objective is to prolong life and to improve quality of life, that is to prevent or reduce the effects of impaired physical and / or mental health in those individuals who are directly (e. g. patients) or indirectly (e. g. carers) affected. Health promotion includes both environmental and behavioural interventions” (Marks et al, 2005, p. 393). Because people’s health behaviour or lifestyles have been regarded as the cause of disease, therefore the main focus of health promotion is behaviour change.
Using a health promotion model can be helpful as it help the health promoter think theoretically (Naidoo and Wills, 2000). Following the model also help the health promoter to prioritize the more or less desirable interventions applied for patient. There are several models, such as: Caplan and Holland (1990), Tannahill (1996), Prochaska and DiClemente (1984)… (Naidoo and Wills, 2000). Nevertheless, the author is using the Prochaska and DiClemente (1984) – the Transtheoretical model to plan and conduct the health promotion advice to encourage Mr Smith to change his current health behaviour.
The model identified six stages that a person can go through during the behaviour change’s process. It takes a holistic approach based on people’s readiness to change. It provides a cycle framework for a wide range of interventions by health promoter ( Ewles and Simnett, 2003). According to Ashworth and Doherty (Practice Nursing Journal, 1997), different patients have different needs depending on the stage of change they are in. Therefore, the role of the practice nurse is matching what the patient does and saying what the person’s stage is in order to put in appropriate interventions.
The first stage of the change cycle is known as Precontemplation. At this stage, people are not considering changing, becoming unaware of the risks of lifestyle’s behaviour or having no motivation to change, but people may progress to the next stage, which is referred to as Contemplation. However, if Mr Smith was at the Precontemplation stage, the health promoter would give him more information related to his condition, explain to him more about the risk factors and causes for raising his awareness. The author thinks that Mr Smith has reached this Contemplation stage.
As based on model theory, at this stage, people are aware of problem and benefits of change. They are thinking about tackling it but have not made any action plans yet (Perkins et al, 1999). However, they may experience some ambivalence, therefore they may seek information to help them make decision to change (Naido and Wills, 2000). As the health promoter role, the author would do Mr Smith’s initial assessment to find out how much information he knows about this condition, such as: what T2DM is, what symptoms are, causes and risk factors, complications and how to treat it.
The author would also check Mr Smith’s health records to arrange for further health check. Moreover, the author would ask him whether he smokes, or does any exercise, what types of food he eats… to gather information, so that she could make an action plans for him to change the behaviour. As good communication is an essential element to succeed in health promotion (Ewles and Simnett, 2003), the author would now try to help Mr Smith to express his worries, feelings, concerns…so that these could be identified for further action using partnership communication skills with respect.
The reason that communication plays a vital role in health promotion is enabling people to think for themselves about health dilemmas and choices, and supporting them in decision making (Katz et al, 2000). The author is using different forms of communication when talking to Mr Smith. From speech related to non-verbal behaviour, form eye-to-eye and facial expression to changes in body position are for establishment a good relationship with him, to persuade him of decision making (Katz et al, 2003).
As a good communicator, the author would have to empathise, not to judge but rather to listen, thereby fostering a trusting relationship. To evidence-based of changing is possible, the author would then give him an example of Kim Wood who has changed her health behaviour to improve her life after been diagnosed with T2DM (Diabetes UK website, My stories). After Mr Smith has perceived all the given information, he then reaches to ready to change decision. This stage is called Preparing to change (Naidoo and Wills, 2003).
He now decides to change the particular habit concerned seriously, which is changing his diet. He has also understood that if he could control his diabetes through healthier diet, managing weight loss and keeping more active, he would not need to take insulin injections which would cause him lose his job if he has to be on insulin therapy. The author would now make an action plan for him which should be realistic, supported by the health promoter, achievable goal and some rewards for encouragement for Mr Smith’s success.
It might be unrealistic to expect individuals to change their lifestyles simply after a short time. Therefore, the action plan is a long-term process. To have a healthy balanced diet, the author would use the NICE clinical guideline 66, updated 2008 to give advice on diet for him, which is: “Encourage high-fibre, low-glycaemic-index sources of carbohydrate in the diet, such as fruit, vegetables, wholegrains and pulses; include low-fat dairy, products and oily fish; and control the intake of foods containing saturated and trans fatty acids” (NICE, 2008).
Increasing physical activity is other aspect of lifestyle modification that can be required for effective weight loss (NICE, 2008). The author would also recommend Mr Smith doing walking exercise as based in her research, it is said that: “Walking is an excellent exercise of moderate intensity for people with diabetes and over time till contribute to weight loss and weight control” (Holt, British Journal of Community Nursing, 2006, p. 379). The plan has been made simple, clear and consistent to achieve an effectiveness behaviour change (Marks et al, 2005).
On the other hand, the author would arrange for Mr Smith to have other health checked, i. e. eyes, heart, kidneys, feet…from other health professionals to prevent further complications of diabetes (Diabetes UK, Complications). He now moves on the next step of the cycle called Action stage. This is when Mr Smith should need to put the plan into action. In supporting him to monitor the changes, the author would empower him to keep a dietary diary, identify any barriers maintaining the change, checking his weight weekly and record it to recognise the weight loss for rewarding himself of success.
This would encourage Mr Smith to move on. The author would still need to support him at this stage, advice him to come and see her if any unforeseen problems arise. The next stage of this cycle is called Maintenance. This is now new behaviour beginning to become a new habit. However, for some people, maintaining it could be difficult and the person may return to the old behaviour, which is called Relapse (Naidoo and Wills, 2000). Therefore, the author would continue to support Mr Smith to maintain this new achieve behaviour.
However, if he relapsed, the author would help him to return to the Contemplation stage rather than Precontemplation of the cycle, and carry on the same process until he achieves the safer lifestyle. As progressing through the behaviour change cycle, Mr Smith may encounter some barriers which identified by the author. He may feel embarrassed and uncertain about how other people would react if knowing his illness condition (Diabetic UK website, Coping with diabetes). So, the author would also advise him that by letting others know can mean that he receives more support, especially from family and friends.
He may also suffer from emotions due to coping with diabetes. He could be anxious, lack of confident… Meanwhile, the author could give him some reassurance from time to time, or introduce Mr Smith to a local support group for him to build confidence to cope more. He could also get lots of encouragement form other association group, i. e. Care Support Events, Diabetes UK… to hear how others cope in similar situation. Additionally, he could feel isolated from his peers from the cafes, but to overcome this barrier, he could bring his healthy-diet meals to the cafe and joining them there during breaks.
Throughout the health promotion interventions, the author would always use health empowerment method to help Mr Smith making decision, so that he can understand more of what he is doing and take more control himself. However, it could bring an adverse effect as according to Tones (1998): “It will be argued that the empowerment strategy helps to resolve an important dilemma in health promotion – the need on the one hand to prevent disease and safeguard the public health, while on the other hand respecting individual freedom of choice, including the freedom to adopt an “unhealthy” lifestyle” (Cited in Kendall, 1998, p. 7). Not only that, the author also applies some key ethical principles in her health promotion job with Mr Smith. She respects patient’s autonomy, giving him choice to determine his change process. Helping him to change into healthier lifestyle, all advice given by the author are evidence-based to maintain non-malefience and beneficence. She also gives him an equal opportunity to discuss and create empowerment when giving health promotion based on principle of justice (Katz et al, 2000). In conclusion, overall the essay, the author has given the discussion on the reasons of development of government policies.
She has also analysed the risk factor that may predispose Mr Smith to develop T2DM. Using the Stage of Change model, the health promoter has put in some interventions to help him changing his behaviour, utilising her communication skills with some ethical issues relating to health promotion. She has also highlighted some barriers that Mr Smith may encounter specifically. Addtionally, the author has always used evidence-based advice to maintain good practice and up-to-date knowledge to complete her role as a health promoter.