Chapter 3

Health Promotion and Risk Factor Management Care Plans

This chapter is a new addition to Nursing Care Plans: Diagnoses, Interventions and Outcomes. It was written to address the challenges of working with patients who are seeking to increase their level of well-being. Typical nursing care plans focus on sick care, helping patients manage their medical illnesses. In these disease-focused care plans, nurses assume the more active role, with patients as the recipients of care. Thus this new chapter is unique in that it showcases patients who are actively engaged in health-seeking behaviors. The public is beginning to realize that almost half of all premature deaths in the United States are caused by lifestyle-related problems: unhealthy foods, overweight and obesity, tobacco smoking, poorly managed stress, sleep deficit, and sedentary lifestyle, to name a few. Nurses have always done an excellent job educating patients about health and disease; however, research is clear that education, though necessary, is not sufficient for making needed lifestyle changes. Making changes to one’s lifestyle is very complex. Helping a patient adopt new health behaviors requires attention to multifaceted, evidence-based strategies known to facilitate successful behavior change. These strategies include a combination of methods to enhance awareness of risk factors, increase motivation for change, set realistic goals, focus on tailoring the regimen, incorporate self-monitoring, enhance self-efficacy, provide skills in problem-solving, include social support and rewards, and address relapse prevention. Nurses are well-positioned to guide patients who are actively seeking to improve their health habits and environment to achieve their optimal level of health and wellness. These care plans demonstrate the important partnership nurses have with patients in assisting them to develop the knowledge and skills needed for making healthy lifestyle decisions and enacting healthy behaviors.

 Health-Seeking Behaviors

= Independent  = Collaborative

 For additional care plans and an Online Care Plan Constructor, go to http://evolve.elsevier.com/Gulanick/.

Definition: Active seeking (by a person in stable health) of ways to alter personal health habits and/or the environment in order to move toward a higher level of health

Health promotion activities include a wide range of topics such as smoking cessation; stress management; weight loss; proper diet for prevention of coronary artery disease, cancer, osteoporosis, and others diseases; exercise promotion; prenatal instruction; safe sex practices to prevent sexually transmitted infections; protective helmets to prevent head trauma; and practices to reduce risks for diabetes, stroke, and other diseases.

Patients of all ages may be involved in improving health habits. Social cognitive theory identifies factors (e.g., behavior, cognition and other personal factors, the environment) that influence how and to what extent people are able to change old behaviors and adopt new ones. Psychosocial factors such as stress and anxiety regarding perceived risk for disease, along with social support for engaging in the health-promoting behaviors, must be considered. The action plan must be tailored to fit with the patient’s values and belief systems. Opportunities for self-monitoring and receiving feedback enhance the behavior change process.

The setting in which health promotion activities occur may range from the privacy of someone’s home, group activities (e.g., weight maintenance groups or health clubs) or even the work setting (especially targeted programs for hypertension management and weight reduction). This care plan gives a general overview of health-seeking behaviors.

 Readiness for Engaging in a Regular Physical Activity Program

The 2008 Physical Activity Guidelines for Americans provides an evidence-based prescription for assisting individuals with improving their health through regular physical activity. Based on the Aerobics Center Longitudinal Study, recommendations include both aerobic and muscle-strengthening activities in the following doses: at least 150 minutes per week of moderate aerobic physical activity to obtain general health benefits and muscle-strengthening activities using major muscle groups on 2 or more days per week. Additional health benefits can be achieved in a dose-response fashion, either by increasing the intensity to vigorous activity or by increasing the duration of moderate activity to 300 minutes per week. Health benefits can be achieved in intermittent episodes of even 10 minutes of moderate physical activity. Health benefits are attainable by individuals of all ages, even those with chronic medical problems. Stressful and busy lifestyles, socioeconomic factors, physical constraints, and lack of motivation are all barriers that can contribute to low physical activity. Nursing objectives are to educate patients on the importance of adopting an active lifestyle and to assist patients in finding ways to personalize the recommended exercise prescription.

 Readiness for Enhanced Immunization Status

Definition: A pattern of conforming to local, national, and/or international standards of immunization to prevent infectious disease(s) that is sufficient to protect a person, family, or community and can be strengthened

Every year, approximately 50,000 adults in the United States die from diseases that could have been prevented by vaccines. Influenza and pneumonia are the fifth leading cause of death in older adults in the United States. Immunizations are one of the safest, most cost-effective public health measures available to patients to preserve their health. Although many adults do support immunization programs for their children, they are often less informed about the many health benefits of vaccines as adults. The Centers for Disease Control and Prevention (CDC) recommendations clearly identify who is at risk for various diseases and who should be immunized to protect against them.

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