Consider a community-based program for young people that encourages health-related behavior changes, increasing fruit and vegetable intake and engaging in activity. EB: This program for overweight and obese young people helped implement behavior and lifestyle changes that were associated with significant reductions in self-reported weight and Body Mass Index Z-score (standard deviation), without compromising growth in height (Stubbs et al, 2012).

 Support religious affiliation and positive school climates for adolescents, particularly for lesbian, gay, and bisexual youths in the community. EB: Although religious climate was also associated with health behaviors among heterosexual youths, it was more strongly associated with the health behaviors of lesbian, gay, and bisexual youths. Among LGB youths, a supportive religious climate was significantly associated with fewer alcohol abuse symptoms and fewer sexual partners (Hatzenbuehler, Pachankis, & Wolff, 2012).

 Assess homeless elderly veterans in the community for suicidal behavior and make appropriate referrals. EB: This study documented the increased prevalence of suicidal behavior in homeless elderly veterans (Schinka et al, 2012).

 Provide community-dwelling older women with psychoeducation about aging skills and behaviors and cognitive function that includes group discussion. EB: This new comprehensive educational group intervention reduces negative emotional reactions toward cognitive functioning. It can potentially contribute the well-being of an important and large group of older adults (Hoogenhout et al, 2012).

• Provide information about the pervasiveness and deadly consequence of HBV for Asians in the United States. EB: Asians in San Francisco are disproportionately affected by chronic hepatitis B virus (HBV) infection and its fatal consequences. This information was most likely to drive clients to seek education and testing (Shiau et al, 2012).

• The above interventions may be adapted for Home Care and Client/Family Teaching.

• Provide support for establishment of a community garden. EB: In this study, community garden participants consumed fruits and vegetables 5.7 times per day. Community gardeners met national recommendations to consume fruits and vegetables at least 5 times per day, compared with 37% of home gardeners and 24% of non-gardeners (Litt et al, 2011).

• Encourage visitation of children when family members are in intensive care. Visitation of children should be supported to facilitate expression of feelings associated with major health changes in family members (Knutsson et al, 2008).

 Refer parents of critically ill children to an intervention program such as COPE, a theory-based intervention program. EBN: Research findings indicate that this program reduces short- and long-term stress, anxiety, and post-traumatic stress disorder symptoms often experienced by parents with critically ill children (Peek & Melnyk, 2010).

• Use visualization and distraction during chest physiotherapy for children with cystic fibrosis. Although chest physiotherapy is central to the management of cystic fibrosis (CF), adherence among children is problematic. Visualization and distraction may improve compliance (Williams et al, 2007).

 Assess for signs of depression resulting from illness-associated changes and make appropriate referrals. EBN: Depression may be a consequence of aging. Assessments of the spouse’s perception as well as of the client’s factual situation may identify risk factors that are leading to a depressed state (Franzen-Dahlin, 2008).

• Use open-ended questions in screening for depression in the elderly (Magnil, Gunnarsson, & Björkelund, 2011).

• Support activities that promote usefulness of older adults. EB: Older adults with persistently low perceived usefulness or feelings of uselessness may be a vulnerable group with increased risk for poor health outcomes in later life (Gruenewald et al, 2009; Rozanova, Keating, & Eales, 2012).

 Encourage social support. EBN: In this study, social support demonstrated a positive relation with perceived well-being in older adults (Kiefer, 2011).

• Monitor the client for agitation associated with health problems. Support family caring for elders with agitation. EB: The findings in this study suggest that some symptoms, such as agitation/aggression and irritability/lability, may affect the caregivers significantly, although the symptoms’ frequency and severity are low (Matsumoto et al, 2007).

• Assess for the influence of cultural beliefs, norms, and values on the client’s ability to modify health behavior. CEB: What the client considers normal and abnormal health behavior may be based on cultural perceptions (Leininger & McFarland, 2002; Richardson, 2004; Van Bruggen, 2008).

• Assess the role of fatalism on the client’s ability to modify health behavior. EB: Fatalistic perspectives, which involve the belief that you cannot control your own fate, may influence health behaviors in some cultures. EB: Fatalism has been identified as a dominant belief among Latinos and is believed to act as a barrier to cancer prevention (Espinosa de los Monteros & Gallo, 2011). Some African American women experience a fatalistic attitude about breast cancer (McQueen et al, 2011).

• Encourage spirituality as a source of support for coping. CEB: Many African Americans and Latinos identify spirituality, religiousness, prayer, and church-based approaches as coping resources (Giger et al, 2008).

• Negotiate with the client regarding the aspects of health behavior that will need to be modified. CEB: Give-and-take with the client will lead to culturally congruent care (Leininger & McFarland, 2002).

• The above interventions may be adapted for home care use.

• Take the client’s perspective into consideration, and use a holistic approach in assessing and responding to client planning for the future. EBN: Clients with newly diagnosed diabetes do not want to become their illness (Johansson, Dahlberg, & Ekebergh, 2009).

• Assist the client to adapt to his/her diagnosis and to live with the disease. EBN: Despite being diagnosed with diabetes, clients still want to continue the same life and be the same persons as before, although they now carry a disease (Johansson, Dahlberg, & Ekebergh, 2009).

 Refer the client to a counselor or therapist for follow-up care. Initiate community referrals as needed (e.g., grief counseling, self-help groups). EBN: Families need assistance and support in coping with health change and caregiving (Honea et al, 2008).

• Refer to care plan for Powerlessness.

• Assess family/caregivers for coping and teaching/learning styles. CEB: The degree of optimism and pessimism influences the coping and health outcomes of caregivers of clients with Parkinson’s disease (Lyons et al, 2004).

• Foster communication between the client/family and medical staff. EBN: Family members of individuals undergoing cardiopulmonary resuscitation expressed a need to be involved and present or informed at all times during the process (Wagner, 2004). EB: Psychotherapeutic interventions should not only address the clients’ problems but also the support-givers’ questions, needs, and psychosocial burdens (Frick et al, 2005).

• Educate and prepare families regarding the appearance of the client and the environment before initial exposure. EBN: Families indicated that knowing what to expect was helpful (Clukey, 2008).

• Help the client to enjoy a sense of “wellness.” Provide support for progress and support enjoyment of the physical, emotional, spiritual, and social aspects of life. EBN: Nurses provide information and support to facilitate the individual in his/her progress toward a achieving a sense of wellness and recognizing that healing will take time (White et al, 2012).

• Teach a client and his or her family relaxation techniques (controlled breathing, guided imagery) and help them practice. EBN: Guided imagery with relaxation may be an easy-to-use self-management intervention to improve the quality of life of older adults with osteoarthritis (Baird & Sands, 2006).

• Allow the client to proceed at own pace in learning; provide time for return demonstrations (e.g., self-injection of insulin). CEB: Use clear and distinct language free of medical jargon and meaningless values (Wagner, 2004).

• If long-term deficits are expected, inform the family as soon as possible. CEB: An honest assessment shared by the nurse of a particular situation is important to the family’s sense of what is expected of them in adapting to a health care change (Weiss & Chen, 2002).

• Provide clients with information on how to access and evaluate available health information via the Internet. Client access to health information and personal health records is becoming increasingly important in today’s health care society. MedlinePlus, NIH Senior Health, and ClinicalTrials.gov are designed to get medical information directly into the hands of clients (Koonce et al, 2007).

• Assess the client’s perception of health. EB: Perceived ill health in older clients is associated with lower self-care ability and sense of control (Söderhamn, Bachrach-Lindström, & Ek, 2008). Older clients with diabetes or metabolic syndrome often underestimate their cardiovascular risk (Martell-Claros et al, 2011).

• Assist client to identify both life- and health-related goals. EB: Older individuals endorse health goals and disease management that are congruent with their life goals (Morrow et al, 2008).

• Provide information that supports informed decision-making. EBN: Encouraging independence and enhancing social networks can enhance client autonomy (Rosland, Heisler, & Choi, 2010).

• Discuss with the client and support person realistic goal-setting for changes in health maintenance. EBN: The Modified Caregiver Strain Index can be given to family members of older adults to help determine the level of stress/burden and the consequences for the caregiver’s overall health. Often the caregiver is an older adult as well. The index can act as a guide to select interventions that will help the older adult but also reduce caregiver strain and improve the lives of both (Onega, 2008; Wolff et al, 2010).

• Educate the client about the symptoms of life-threatening illness, such as myocardial infarction (MI), and the need for timeliness in seeking care. EBN: Women, especially those of advanced age, wait longer before seeking treatment for signs and symptoms of acute MI (Higginson, 2008).

• Assess influence of cultural beliefs, norms, and values on the client’s ability to modify health behavior. EB: Awareness of the cultural importance of family and social relationships, symbolic and social meanings of food, and the spiritual dimensions of disease are key in encouraging self-management of disease (Sowattanangoon, Kotchabhakdi, & Petrie, 2011).

• Assess the effect of fatalism on the client’s ability to modify health behavior. EB: Fatalistic beliefs about cancer may hamper screening and delay help-seeking for symptoms (Beeken, Simon, & von Wagner, 2011).

• Assess for use of and reasons for not using health services. EBN: Compared with Caucasians, women of color had later initiation of prenatal care and fewer prenatal visits overall (Park, Vincent, & Hastings-Tolsma, 2007). Language and cultural barriers were identified as barriers to utilization of mental health services for Latino children (Lopez, Bergren, & Painter, 2008).

• Clarify culturally related health beliefs and practices. EBN: Language, culture, and ethnicity influence the choice of a health care provider and participation in health management strategies (Hjelm, Berntorp, & Apelqvist, 2012). Use of trained medical interpreters and familiarity with folk illness beliefs treatments positively affects the client’s health outcomes (Brotanek, Seeley, & Flores, 2008).

• Provide culturally targeted education and health care services. EB: A culturally sensitive diabetes education program produced improvement in HbA_1c, fasting plasma glucose, cholesterol/HDL ratio, and HDL in Hispanic clients (Metghalchi et al, 2008). Hispanic individuals with diabetes who participated in a lifestyle awareness program reported a sense of empowerment and increased self-efficacy (McCloskey & Flenniken, 2011).

• The interventions described previously may be adapted for home care use.

 Provide nurse-led case management. EBN: Individualized, systematic, and guideline-based nurse case management promotes cardiovascular risk reduction in home-based, primary care, and community settings (Berra, 2011). A home care service model utilizing nurse-led case management facilitates access to services and resources and has a positive impact on the client’s functional ability (Morales-Asencio et al, 2008).

• Include a health-promotion focus for the client with disabilities, with the goals of reducing secondary conditions (e.g., obesity, hypertension, pressure sores), maintaining functional independence, providing opportunities for leisure and enjoyment, and enhancing overall quality of life. EB: Individuals living with physical disabilities or cognitive impairment receive fewer preventive services and have higher rates of chronic illness (Reichard, Stolzle, & Fox, 2011). Community-based physical activity and educational programs provide fitness and psychosocial benefits for individuals with intellectual (Heller et al, 2011) or developmental (Bazzano et al, 2009) disabilities.

• Encourage a regular routine for health-related behaviors. EBN: Individuals who establish a regular routine for exercise are more likely to be compliant over time than those who use an ad hoc approach to exercise (Hines, Seng, & Messer, 2007).

• Provide support and individual training for caregivers before the client is discharged from the hospital. EBN: Caregivers are very interested in receiving instruction and hands-on practice of procedures they would need to perform at home. They report increased confidence in their ability to provide such care and to help their loved ones manage symptoms at home (Hendrix et al, 2009).

• Assist client to develop confidence in ability to manage the health condition. EB: Self-management education targeted at self-efficacy improves physiological outcomes, enhances coping techniques, and reduces health care use (Labrecque et al, 2011).

• Consider a written contract with the client to follow the agreed-upon health care regimen. Written agreements reinforce the verbal agreement and serve as a reference. EB: Written agreement between health care providers and clients may promote adherence (Bosch-Capblanch et al, 2007).

• Using self-care management precepts, instruct the client about possible situations to which he or she may need to respond; include the use of role playing. Instruct in generating hypotheses from available evidence rather than solely from experience. EBN: Interventions that focus on increasing self-awareness of cues relative to health increase the client’s ability to recognize and respond to changes in symptoms and health status (Hernandez, Hume, & Roger, 2008).

• Provide the family with website addresses where information can be obtained from the Internet. (Most libraries have Internet access with printing capabilities.) EB: Internet/video-delivered interventions are successful in increasing physical activity and fruit and vegetable intake in adolescents (Mauriello et al, 2010). Online information gathering can promote client engagement in health maintenance and care (Iverson, Howard, & Penney, 2008).

 Develop collaborative multidisciplinary partnerships. EBN: Multidisciplinary and multifactorial interventions are likely to be more effective in achieving desired outcomes (Norlund, Ropponen, & Alexanderson, 2009).

• Tailor both the information provided and the method of delivery of information to the specific client and/or family. EBN: Client-centered educational interventions that focus on individualization have a positive impact on the client’s sense of well-being and optimism that therapy will be effective (Radwin, Cabral, & Wilkes, 2009).

• Obtain or design educational material that is appropriate for the client; use pictures if possible. EB: The use of materials tailored to the individual has a strong effect on dietary behavior (Enwald & Huotari, 2010) and physical activity (Wanner et al, 2009).

• Teach the client about the symptoms associated with discontinuation of medications, such as a selective serotonin reuptake inhibitor (SSRI). EB: Educate client about SSRI discontinuation syndrome, which may include lightheadedness, dizziness, headaches, GI disturbances, diaphoresis, lethargy, vivid dreams, and flu-like symptoms. A 3- to 4-week graded dosage tapering is encouraged with short-acting SSRIs to avoid this syndrome (Hosenbocus & Chahal, 2011).

• Explain nonthreatening aspects before introducing more anxiety-producing information regarding possible side effects of the disease or medical regimen. EBN: Anxiety may interfere with concentration and the ability to understand and remember (Lachman & Agrigoroaei, 2012).

• Treat tobacco use as a chronic problem. Tailor the smoking cessation program to the individual. Consider mixed groups of current and past smokers. EB: Flexible smoking cessation programs that are tailored to the individual’s culture and life situation and offer support to a range of smokers are perceived by participants as both beneficial and valued (Ritchie, Schulz, & Bryce, 2007).