Critical Appraisal of Health Promotion Approaches and Nursing Skills

Introduction

The health promotion of service users or patients is required to empower and engage the individuals in adopting healthy behaviour for making changes which lower their risk of developing chronic diseases (Fertman and Allensworth, 2016). Thus, health promotion is essential for control and prevention of chronic illness among individuals to ensure them better health and well-being. In this presentation, health promotion approaches which allow people to develop informed healthcare choices are to be critically appraised. Moreover, the knowledge and skills required by the nurses for systematic health promotion are to be critically discussed.

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Biography of the Patient

  • NMC Code ensures keeping patient’s personal information confidential (NMC, 2018)
  • Clare is a 75-year-old African American female who has suffered traumatic brain injury and lives along at home

The NMC Code of Conduct instructs the nurses that no personal information of the patients without their prior consent is to be shared so that confidentiality and privacy is maintained (NMC, 2018). Thus, to inform the background of the patient, the pseudonym Clare is to be used to keep the identity of the patient confidential and private for ensuring their safety from any harm or abuse.

Clare is a 75-year-old African American female living alone in a small apartment in England. She is responsible to manage her daily errands such as cooking, washing and others. However each weekend, a caregiver assists her in cleaning her home and clothes. The caregiver is involved in supporting Clare in her chores after she faced a traumatic brain injury (TBI) most recently by slipping down on the wet bathroom floor. Clare is unemployed and depends on the supportive finances sent by her daughter who lives abroad for work purposes.

Identifying key health issue and risk

  • Poor physical and mental health
  • Traumatic brain injury
  • Depression, anxiety and obsessive compulsive disorder (OCD)

According to Tajima et al. (2018), physical health is referred to as the condition in which the fitness level of the body is considered and mentions lack of presence of any disease in the body. However, the study by Lundström et al. (2020) informs that mental health is referred to as the emotional and psychological well-being of the body.

In case of Clare, it is reported that she is suffering from traumatic brain injury as the physical health issue which has also contributed to make her develop mental health issue such as depression, anxiety and OCD as additional health concern.

Defining Traumatic Brain Injury (TBI)

The traumatic brain injury is referred to acquired injury in the brain that has occurred due to any sudden trauma leading to damage the brain. In the UK, the Trauma Audit and Research Network mention that since 2014 for the last 10 years a total of 49,594 patients are reported to have faced traumatic brain injury. However, among them, a total of 26,862 people (54%) were found to be above the age of 60 years who have suffered from TBI and needed medical attention (TARN, 2017). This indicates that elderly people in the UK are vulnerable to experience TBI.

Breakdown of patients

The UK Trauma Audit and Research Network inform that location of fall incident among the elderly are mostly within indoor compared to outdoors. This is evident as 60% of the falls among elderly of 70-79 years of age occurred indoors compared to only 39% of falls occurring outdoors among the elderly that leads to their traumatic brain injury (TARN, 2017). In case of Clare, it is seen that she also suffered TBI inside her home at the bathroom indicating that to prevent TBI and falls among the elderly effective preventive measures are to be maintained indoors compared to outdoors. This is because majority of falls among the elderly of 70-79 years of age have occurred indoors compared to outdoors.

location of age

Health impact of TBI

The traumatic brain injury (TBI) leads individuals to experience seizures in the early stages. This mainly occurs due to build up of hydrocephalus which is cerebrospinal fluid on the cerebral ventricles leads to create increased pressure on the nerves and tissues in the brain. It eventually leads to damage blood vessels of the brain causing presence of blood clots in the brain that makes the person experience headache (Carney et al. 2017). In case of severe TBI, it is seen that tear occurs on the meningitis layers surrounding the brain and may lead the person experience vertigo that causes dizziness after TBI among the affected individuals (Maas et al. 2017). These adverse effects are able to be experienced by Clare as a result of the fall making her experience severe health complications in managing balance.

The study by Brander et al. (2016) mention that traumatic brain injury which may cause localised damage to the brain is responsible to trigger symptoms of obsessive compulsive disorder as an impact of the condition. This may occur immediately or months later after perceiving the trauma in the brain. In addition, the study by Randall et al. (2017) informed that TBI experienced by a person also show symptoms of stress and depression. However, it is unclear about the factors responsible for rise of OCD and whether psychosocial stress out of injury leads to depression among people with TBI. The deteriorated mental health impact mentioned as a result of TBI is evident from the case of Clare where she also shows symptoms of depression, stress and OCD after experiencing TBI.

Causes of TBI

The causes of TBI include collision with objects, accident, assaults and falls (Pöttker et al. 2017). In case of Clare, it is seen that she experienced fall at the bathroom which led her to experienced traumatic brain injury (TBI). As commented by Kannus et al. (2020), elderly people experience complex health issues and often is unable to keep adequate balance of the body. This is because with older age the nervous tissues as well the muscles in the body in the body are weakened making them prone to experience injury out of fall. It indicates that the old age may have contributed to lack of managing adequate balance of the body by Clare. This, in turn, has led her to slip down on the bathroom floor as she was unable to control standing and maintain enhanced grip while slipping to prevent fall.

Needs Assessment

The needs assessment is referred to the systematic process of reviewing hindrances in health faced by patients for identifying and addressing the needs of the patients to ensure them enhanced health condition (Harrison et al. 2017).

The needs assessment of Clare is executed by the nurses through organisation of an interviewing where effective and detailed interaction with her is developed to understand her key needs and demands regarding health after TBI to be fulfilled to ensure her well-being.

The needs assessment of Clare informs that she requires a slip-free indoor environment so that occurrence of such falls that leads to brain injury can be prevented in future.

Moreover, Clare needs physical support to manage her everyday chores as TBI has made her physical weak out of experiencing dizziness in managing her everyday work.

She reported to need mental health assistance to cope with OCD, depression and stress which has presently affected her emotional and psychological health in an adverse way making her feel mentally weak to lead her life.

Skills and knowledge required by nurses for executing health promotion and health intervention to enhance health of individuals

  • Communication Skill:

    The nurses required to have effective communication skill for promoting the health of the patients or individual. This is because through effective communication the nurses can determine the care needs of the patients. Moreover, effective communication skills allow the nurses to share adequate information regarding care with the patient to encourage them in making sharing decision toward developing an enhanced care plan (Baek et al. 2018). The presence of effective communication skill leads nurses to gather care ideas from their colleagues and experts in determining potential intervention for enhanced patient outcomes (Song and Lee, 2016). As argued by Mohamed and Fashafsheh (2019), hindered communication skill of the nurses makes them unable to show compassion and understand key needs of the patients regarding their care. This leads nurses to execute problematic healthcare intervention that is not satisfactory for the patients which in turn contribute to hindered patient outcome. Thus, presence of effective communication skill among the nurses would help them understand key needs of Clare and accordingly provide her potential intervention to promote her health ensuring positive outcome for Clare.

  • Team working:

    The presence of team working skill and knowledge is essential for nurses to promote health of patients and offer them effective intervention. This is because through team working nurses are able to collaborate with experts from multi-disciplinary team that allows them to share expertise in delivering enhanced care to the patients (Morris, 2016).

  • Information sharing:

    The nurses are required to have adequate knowledge for sharing information to execute enhanced health promotion and intervention of care for the patients. This is because sharing care information by nurses to the patients helps the service users to provide informed consent and show compliance in care to be delivered by the nurses, in turn, allowing the nurses to achieve enhanced patient outcome (Inoue and Tsuru, 2016).

Overview of Intervention

Clare is to be provided person-centred care as intervention so that specific intervention that is centred around to meet her specific needs is able to be provided by the nurses and healthcare professionals.

The person-centred care approach intervention would include the following:

  • Slip-free bathroom (Alshammari et al. 2018)
  • Support in executing daily chores
  • Home visits

Exposure and Response Prevention (ERP) therapy for managing OCD (Blakey et al. 2019)

Cognitive Behaviour Therapy for managing depression and stress (Andersen et al. 2016)

In order to manage a slip-free bathroom for Clare, installation of non-slip floor mats are required. This is because nonslip floor mats are going to create an uneven floor in which the person cannot slip even if the floor remains wet (Alshammari et al. 2018). Moreover, mops are to be present for removing any water spills on the floor that could create slippery texture for Clare to fall.

The support for daily chores is to be provided to Clare for promoting her health as intervention because out of dizziness she may be able manage her household work which could even create chances of fall among them.

The home visit by nurses is required to ensure screening and monitoring of Clare’s health. This is because it would make sure whether or not she is taking adequate medication and following strategies to overcome the symptoms and adverse health impact of TBI.

The Exposure and Response Prevention (ERP) therapy is the approach in which the therapist encourages the individuals suffering from OCD to face their fears and avoid obsessive thoughts to be built up by neutralising them through compulsions (Blakey et al. 2019). Since TBI has led Clare to face OCD, therefore ERP is to be used for managing her condition.

The Cognitive Behaviour Therapy (CBT) is short-term technique in which the behaviour and attitudes of individuals are altered by focusing on to change the cognitive processing of the individuals (Andersen et al. 2016). Thus, CBT would be used as health intervention for Clare to promote her health. This is because through CBT she can be realised of the negative thoughts which are contributing to her depression to be changed by consulting and talking with the therapist.

Approaches for intervention- Empowerment approach

The empowerment approach for health promotion has the key aim to make individuals or patients gather enhanced control over their decisions and actions in managing their health.

Aim:

To increase Clare’s ability in self-management of symptoms of TBI and mental health condition

Objective:

  • To empower Clare to use non-slip floor mats in the bathroom and maintain balance during slips
  • To empower Clare to involve in meditation and yoga for ensuring enhanced mental health condition

Process:

The nurses are to share information regarding self-management of TBI and mental health issues to Clare for empowering her to take actions in promoting her health.

Criticism of approach

The criticism with implication of empowerment approach in promoting health of Clare is as follows:

  • Failure of Clare to make rationale choices regarding her care management
  • Inadequate knowledge and skill of Clare for self-management of TBI and OCD
  • Lack of adequate resources present for Clare to support her empowerment in taking self-management action for enhancing her mental and physical health

Evaluation

The evaluation in healthcare intervention is referred to assessment of the extent to which implemented intervention is effective to accomplish care goals for the patients to enhance their health and create well-being (Otay et al. 2017).

The intervention for Clare is to be evaluated through the following techniques:

  • Feedback

    : The feedback from the patients regarding the provided care intervention helps the nurses to assess the extent to which it is effective for offering them satisfactory care and the changes to be made as per mentioned comments by the patients regarding the intervention (Dukhanin et al. 2018). Thus, to evaluate the efficiency of the current healthcare intervention for Clare, feedback from her regarding it is to be gathered. This is because the feedback can be analysed to understand to what extent it is effective and further additional services to be provided for providing create satisfactory care.

  • Monitoring Health:

    Clare’s health is to be monitored in continuous manner before and after the intervention. The results of her health condition before and after the health intervention is to be compared to determine the success of the provided care for enhancing health of the patient.

Conclusion

The above discussion informs that Clare is suffering from traumatic brain injury (TBI) which has also led her to experience obsessive compulsive disorder (OCD), depression and stress as additional health condition. The health intervention to be made for promoting health of Clare includes instalment of non-slip floor mat in bathroom, ERP therapy for OCD and CBT therapy for managing depression and stress. The skills and knowledge required by nurses for health promotion and health intervention include team working, communication and information sharing skills.

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References

  • tarn 2017, Major Trauma In Older People, Available at: https://www.tarn.ac.uk/content/downloads/3793/Major%20Trauma%20in%20Older%20People%202017.pdf [Accessed on: 8th June 2020]
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  • NMC 2018, NMC Code of Conduct, Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on: 8th June 2020]
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