Health Promotion and Nursing Intervention for Enhancing Well-being

Introduction

Health promotion can be defined as the pathway in which the holistic wellbeing of people are promoted (Aaron, 2014). The concept of health promotion is not only associated with prompting physical health and wellbeing but also it is associated with promoting the psychological, emotional and spiritual wellbeing (Campos et al. 2016). This assignment will discuss the health promotion as well as healthcare policies that impact the lifespan of the patient in the given scenario. Then this assignment will SMART goal and nursing intervention in relation to improve health and wellbeing of Cedric. These SMART goals and intervention will present the care and support to the behavioural, physical and psychological needs of Cedric. This assignment will also discuss the effective communication strategy in terms of recognising and responding to health needs of Cedric thereby promoting his health and wellbeing.

The case study:

Cedric a 75year old man has been having more frequent hospital admissions due to the progressive worsening of his COPD [Chronic Obstructive pulmonary Illness] and want to be cared for at home.

The World Health organisation (WHO) 2021 states that COPD is one of the third leading cause of death in the world and has resulted in the death of more 3.23 million people world-wide as of 2019, and it is mostly diagnosed in middle aged individuals from ages 40 and above. COPD affect both women and men, but more common in men, and more women tend to die more from this disease each year (COPD Working Group, 2012). COPD is caused by any one of several factors among which include smoking and air pollution, which damage the airways and makes breathing difficult (Qureshi et al., 2014).

Health promotion and healthcare policies:

A health promotion is not only associated with providing the compassionate medical and nursing care to services users in hospital and community setting but also enables health and nursing professionals to conduct an effectives and systematic health promotion structure to support the holistic needs of each patient. In the case study, effective health promotion strategies are developed for meeting the holistic needs of Cedric. These health promotion strategies ad tier impacts on the lifespan of Cedric are as follows:

Health promotion strategies for Cedric:

For Cedric four SMART health promotion interventions are set up for providing the compassionate care ad improving lifespan of Cedric. These SMART goals are follows:

Intervention 1: to promote health and wellbeing by improving his breathing condition in Cedric in relation to comply with the NHS and health care policies:

This intervention is about to provides the best possible medical and nursing care to Cedric to promote his holistic wellbeing (physical, emotional, psychological and spiritual wellbeing). In line with promoting holistic wellbeing in Cedric, nurses will comply with all the NHS guidelines and health and social care regulation in terms of improving the care delivery.

Intervention 2: To provide useful health education to Ceric regarding self-management of COPD at home by attending the pulmonary rehabilitation program

This intervention is about to educate Cedric regarding the techniques and methods that he can use at homes for improving his breathing conditions. Under this SMART goal, nurses will motivate Cedric to join pulmonary rehabilitation program under which Cedric will be advised regarding the ways in which he can improve his breathing condition. Under this program Cedric will be educated regarding changing his dietary intake, lifestyle, exercise routine and medication regimen which are important for improving his breathing condition.

Intervention 3: to maintain effective and transparent communication with Cedric to track the usefulness of ongoing management and monitoring of health complications

The objective of this SMART goal is to conduct an effective and transparent communication with Cedric to track the usefulness of the ongoing management and motoring process of any health deterioration of complication. The achievement of this goal, will enable nurses to make early recognition and respond to the possible health deterioration in Cedric thereby provide him with the immediate nursing care.

Intervention 4: to improve the self-dependence in Cedric by reducing his Daughter’s burden to look after him:

Under this goal, nurses will develop self-management skill , decision making and problem solving skill in Cedric which will enhance his self-dependence in this way, nurses can reduces the mental and physical burden of Cedric ‘s daughter regarding looking after him. Under this goal, nurses will work along wit the local social care agencies to provide best possible support to Cedric and his daughter to reduce the mental stress on Tracy to take burden of his father.

Impacts on the above-mentioned health promotion goals on lifespan of Cedric:

Health promotion gives people the opportunity to have control over their health and wellbeing, with the aim to empower them to improve the quality of their health (Kemppainen et al., 2012). Abovementioned health promotion strategies will be implemented into practices in Cedric’s case study to promote his health and wellbeing. Under NICE (2021), health and nursing professionals must have the competence to use right health promotion strategies to improve health condition of a COPD patient. In which context Campos et al. (2016) mentioned that, while complying with health ad social care regulation for health promotion nurses must ensure that they have the necessary skills and professional knowledge that are required to meet the professional standard in healthcare context.

The Nurse can play a good role in promoting good health in Cedric’s Case by, following the guidelines stated in the National institute for health and Clinical Excellence. for the care of patients with COPD. The NICE (2021) identifies various Nursing interventions that can be used to promote the health and wellbeing of patients with COPD.

Intervention 1: to promote health and wellbeing by improving his breathing condition in Cedric in relation to comply with the NHS and health care policies:

Under this intervention nurses would use pharmacological and non-pharmacological process in improving the breathing condition of Cedric. Under pharmacological process, nurses would comply with the medicine regulations and NHS principles to ensure that there is effective use of right medicine in case of Cedric and there is no risk of medication errors. The Medication that are used for Cedric to prevent COPD exacerbations consist of inhaled Bronchodilator’s and oral medications. Bronchodilators can be short acting or long-acting bronchodilators (Kankaanranta et al., 2015). Long-acting bronchodilators is usually recommended for most patients with COPD because It helps to reduce the risk of exacerbation by improving the flow of air in and out of the lungs and reducing the amount of air that are trapped in the lungs during an exacerbation of COPD (Aaron, 2014). Other medicines that can be used with the bronchodilators include oral Methylxanthines, oral Phosphodiesterase-4 inhibitors and inhaled Corticosteroids (Santos et al., 2015).

National institute for health and Clinical Excellence (2021) have reviewed the evidence for inhaled therapies in COPD and have concluded that, the combination of long-acting muscarinic antagonists and long-acting beta2 agonists and inhaled Corticosteroids (LAMA+LABA+ ICS) provides the greatest benefit to overall quality of life for patient with COPD. Example of LMA + LABA + ICS are Fluticasone Furoate + Umeclidinium + Vilanterol (NICE 2021). In case of Cedric nurses must ensure that they provides the right dose of bronchodilators to Cedric as per the recommendation of the pulmonologist. After administering the medicine to Cedric, nurses must check whether there is any kid of side effects of medicines (Esteban et al. 2016). Any health deterioration after the medication to Cedric will be immediate reported to the pulmonologist and care manager for provide Cedric with the immediate clinical support.

The non-pharmacological intervention for improving breathing condition in Cedric involves proving advice on effective dietary and lifestyle changes that are needed for reducing the risk of COPD exacerbation (Gloeckl et al. 2018).

Nurse will also support Cedric by provide him information about pneumococcal and influenza vaccinations because this is in line with national guidance and be Referred to the Community Respiratory Specialist team or Home Oxygen Service and Review (HOSAR) for proper assessment and appropriate initiation of oxygen therapy if needed (NICE 2021).

The Nurse should consider Cedric response to his medication and note any potential side effects. The Bronchodilators selected for Cedric should be based on his ability to use the inhalers. Cedric should be trained using easy and clear communication on how to use the inhaled Bronchodilators and should be shown short video found on U-tube on how to use Bronchodilators.

Intervention 2: To provide useful health education to Ceric regarding self-management of COPD at home by attending the pulmonary rehabilitation program

Pulmonary rehabilitation is a special kind of program that is individually tailored to care for patients with COPD and other respiratory impairment (Gloeckl et al., 2018). There are different types of Pulmonary Rehabilitation that can be used to improve breathing pattern in COPD patients, for example we have Inspiratory muscle training, Diaphragmatic breathing, and Pursed lip breathing. For this case study, Cedric will be encouraged to use the Pursed lip breathing.

Pursed lip breathing (PLB) is a kind of Pulmonary rehabilitation that is known to be very cost-effective for therapeutic intervention, and helps to improves shortness of breath, physical performance ability, and the overall quality of life in patients with COPD (Yang et al., 2020). Pursed lip breathing helps to slow expiration, prevents the collapse of small airways, and control the rate and depth of respiration. Additionally, NICE (2021), also state that Pursed lip breathing is a cost-effective intervention for stable and post exacerbation COPD patients, and long term follow up has shown a reduction in hospital admissions, and mortality rate.

The nurse should communicate clearly to Cedric on how to perform Pursed lip breathing, these should include practical demonstration so that Cedric can understand the process. The nurse should also get feedback from Cedric to ensure he fully understand the process.

Nurse should communicate with Cedric regarding how to use inhalers correctly to get the maximum usefulness of bronchodilators Kankaanranta et al. (2014). Nurses would also make transparent communication on the changes that Cedric needs to make in his diet, regular lifestyle, medication and exercise. Nurses would make clear communication with Cedric regarding making him understand the aerobic exercise that are prescribed by pulmonologists

Nurses can also use Ask-Tell-Ask method of communication, which will assist nurse to track the usefulness of the ongoing treatment and determines the health issues of Cedric. Ask-Tell-Ask method could be helpful in case of Cedric to ask question regarding how he feels after receiving treatment and tell him the strategies or techniques that he can use to improve his self-management skill in improving his breathing condition (Gloeckl et al. 2018). Then nurses would again ask Cedric regarding any health issue he experiences such as breathing difficulties or any side effect of medicines.

Managing daily activities is also very Essential because research shows that Low level of physical activity is the major cause of mortality in patients with COPD (Esteban et al.,2016). The Daily activities should be paced throughout the day for Cedric and support devices like walking aids should be used when the level of energy decreases.

Intervention 3: to maintain effective and transparent communication with Cedric to track the usefulness of ongoing management and monitoring of health complications

The nurse should be alert to any cognitive and behavioural changes in Cedric, such as confusion, agitation, and loneliness. Cedric has express feelings of loneliness for not been able to maintain contact with friends and other family members, which is due to difficulty attending to day-to-day activities.

Nurses, must maintain clear and concise communication with Cedric regarding his current oxygen saturating level, breathing condition and lung condition (Kankaanranta et al. 2014). Under NICE (2021), health care professions must communicate clearly with patients regarding their health status and ongoing treatment. In this context, nurses must make regular check of oxygen saturation, breathing rate and lung capacity of Cedric to communicate his current health condition, medications and ongoing treatment. Nurses will also provide clear information to Cedric regarding how he can use pulse oxymeter at home to self-check his oxygen saturation level and pulse rate.

Intervention 4: to improve the self-dependence in Cedric by reducing his Daughter’s burden to look after him:

COPD has shown to have a profound effect not only on the patient, but also on their families and careers. The reason is because, most COPD patients depend on their families and careers for practical assistance like providing personal care, taking medications, shopping, housework, and cooking (Elkington et al., 2005). Further the needs of COPD patients differ from patient to patient, some patients can maintain a certain level of independence, while other patients completely depend on family members and careers for Support. Most times, Family members and careers are not aware of the practical and emotional difficulties they would experience when providing care for a COPD Patient (Elkington et al., 2005).

Barnett (2005) points out how patient inactivity because of COPD deprive family members from participating in social activities. Robinson (2005) starts how the effects of COPD has affected families physically and emotionally because of friction in family relationships. Some patients also described how been overlying dependent on families and careers has proven problematic. Therefore, providing practical support for Family members and Careers looking after a patient with COPD is very crucial because it serves as a lifeline, as well as contributes to the overall well-being of the patient with COPD (Balducci et al., 2008).

Therefore, it is very important that Tracey is given support in caring for Cedric, since she is currently struggling with depression, and has her own family to take care for.

Communication is very important, because it strengthen the Nurse and patients relationship, it’s more than just sending and receiving of information, it involves the expressions of emotions and feelings (Wittenberg et al., 2018). Therefore, the Nurse should take into consideration the feelings and emotions of Cedric and Tracy, by giving them the opportunity to express their feelings and concerns. Here nurse communicate with Tracy and Cedric regarding understanding their needs for living a healthy life. In this context, nurses will use empathetic communicating for Cedric to provide him with psychological, emotional and spiritual support thereby promoting his self-management skill (Elkington et al., 2005). On the other hand, nurses will use concise and practices communication with Tracy regarding advising her about how she can provide her father the best support in meeting Cedric’s life needs. Moreover nurses must use the transparent information delivery system with Cedric and Tracy to inform them regarding the health condition of Cedric and the usefulness of the ongoing treatment.

Conclusion

Exacerbation of COPD can be triggered by various factors. The SMART goal is to work closely with Cedric, with the aim to reduce episodes of acute exacerbation of COPD and the need for readmissions, Cedric should continue to follow his medication regime as prescribe and Pulmonary rehabilitation exercise, adopt a healthy diet or nutrition, connect with friends and family, and maintain a positive attitude.

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