Running head: HEALTH PROMOTION 1

Health Promotion

Lindsay Winston

Bon Secours Memorial College of Nursing

Gerontological Concepts and Issues NUR 4113

Ms. Krukiel

November 15, 2018

“I Pledge…”
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Introduction

Promoting a healthy life to all individuals is the priority from a nurse’s perspective. This

project presented the opportunity to explore the health needs for older adult clients and get a

better grasp on how to deliver appropriate care to the population. The client I performed my

health promotion project on was a 91-year-old white male, Mr. M. The client is a retired army

veteran and he currently lives at home by himself. However, he does have caregivers that are

present at his house 12 hours everyday. Mr. M informed me that he does not have many living

family members except for one niece that lives about two hours away. His health history consists

of two previous strokes and a documented transient ischemic attack. After assessing Mr. M and

interviewing him, there were obvious cognitive impairments noted related to his previous

vascular injuries. In addition, the client states that he has a history of falls, has trouble

remembering to go to the bathroom and depends on others for important things such as

remembering to bathe, fixing his meals and brushing his teeth. The client depends on assistive

devices to help him with ambulation like a wheel chair and a walker. At the conclusion of

completing a physical assessment, appropriate assessment tools and one-on-one interaction, I

was able to identify a priority need of risk for falls for Mr. M, which will be discussed

throughout the paper. The plan that will be discussed relates to Healthy People 2020 in very

significant ways. Healthy People 2020 focuses on improving the health, quality of life and

functioning of older adults (Healthy People 2020, 2018). According to Healthy People 2020,

falls are very prominent in older adults; in fact, they are the leading cause of injury in the older

adult population. Healthy People 2020 aims to decrease the number of falls in older adults by

addressing risk factors and educating clients and caregivers on how to prevent falls and improve

the quality of life for older adults, which was my goal for Mr. M (Healthy People 2020, 2018).
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Nursing Diagnosis

The diagnosis that was chosen for the client was: “At risk for Falls.” The diagnosis that

was considered is very appropriate and important for this client in many different aspects. Mr. M

exhibits multiple extrinsic and intrinsic risk factors for falling. Intrinsic risk factors that are

applicable for the client include: older age (being older than 65), history of previous falls,

cognitive impairment, poor gait and balance, sensory deficits, muscle weakness and chronic

conditions such as stroke and incontinence. In addition, extrinsic risk factors that were

objectively assessed were poor lighting in his house, obstacles or tripping hazards present and

lack of bathroom grab bars. Furthermore, the client lives alone and even though he has

caregivers there all throughout the day for assistance, the fact that he is home alone all night

makes him very vulnerable and at an increase risk to fall. After assessing the client and

considering all of the nursing diagnosis that were applicable for his condition, risk for falls was

the top priority and needed to be addressed immediately to prevent injury.

Multiple short-term outcomes were identified for the client to ensure the teaching was

effective and that interventions were going to be implemented to decrease Mr. M’s risk for falls.

The first outcome that was discussed for client focused on providing safety for the client,

therefore decreasing the chances of him falling and improving his overall health. The outcome

stated that the client and the caregivers will implement strategies to increase safety and prevent

falls in the home (Gulanick & Myers, 2017). The outcome was to be met one week after the

completion of teaching (10/22/18) which involved effective ways to promote safety and

eliminate extrinsic factors within the living environment. The outcome that was expressed was

met as evidenced by objective assessment of the floor being free from clutter, appropriate

lighting placed throughout the house, grab bars placed in the bathrooms and adequate space to
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ambulate with a wheel chair. In addition to implementing strategies to decrease external factors,

a second short-term goal focused on educating the client in the importance of utilizing assistance

when ambulating and transferring to eliminate the risk of falling. I expressed to the patient that

by the end of the teaching I wanted him to be able to recite to me the importance of asking for

help when ambulating and what the next steps would be if he did encounter a fall. At the end of

the teaching, the goal was met as the client stated that he will not transfer out of his wheel chair

without the assistance of one of his caregivers. Also, the client stated that in the event of a fall,

he will press the button on his life alert and call for help, which indicated the emphasis on safety

was effective.

Short-term goals are extremely important in order to evaluate the effectiveness of the

teaching and to implement immediate interventions to promote positive results. However, it is

just as important to identify long-term goals to make sure the interventions continued to be

followed and the client’s health is being benefited in a long-term manner. The ultimate long-term

goal for the client was: by the end of the year, the client will not sustain a fall (Gulanick &

Myers, 2017). Obviously, we do not want the client to endure a fall at any time, but if we set a

date for the end of the year, it will be a time to check in on the client’s status and re-evaluate if

any other interventions need to be made at that time to continue to avoid the risk for falling.

When the year comes to an end, the client and the caregivers can follow-up with the progress

they have made towards identifying and avoiding Mr. M’s risks for falls. Therefore, identifying

positive and negative strategies that were utilized and encouraging to continue to implement the

positive strategies that were used to promote well-being in Mr. M’s health. Combining both

short-term and long term goals in the plan of care for Mr. M is an effective way to ensure the

best quality of life for the client.

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Teaching Plan

Throughout this project, performing appropriate health and physical assessments was

imperative in order to identify what the greatest priority of teaching was for the client. However,

once that aspect was established, it was essential to interview the client to determine factors that

may affect learning or even implementing the teaching presented. The content of the teaching

presented consisted of information specific to client and the relationship with the risk for falling.

First, I thought it would be effective to present facts about falling to the client. In some cases,

individuals can display a naïve attitude regarding the facts about falling and not understand the

impact they have. Therefore, important facts about falling and how they affect individuals on a

daily bases were presented, so the client would have a better understanding and perspective on

their significance. Next, I made sure to explain intrinsic and extrinsic risk factors that put the

client at an increased risk for falling; thus he could understand what risk factors he obtains.

Furthermore, information was included on why it is so important to prevent falls. This section of

teaching included information regarding injuries that can result from falls and the long-term

affect they can have. Finally, important information was included on how to prevent falls. This

portion of the teaching consisted of crucial information such as talking to your doctor to evaluate

your risk for falling, the importance of range of motion activities, the importance of having your

vision checked and a step-by-step section on how to make your home safer. Since the client

proved to be a visual learner, the teaching tool utilized was a PowerPoint that was printed and

physically given to the client. In addition, there was a visual aid at the end of the presentation

that provided “do’s” and “don’ts” when trying to prevent falls.

According to the CDC (2017), one out of five falls results in a serious injury. This is a

significant statistic and indicates that is crucial to identify individuals who are at risk for falls and
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provide adequate teaching to decrease the number of falls; thus decreasing serious injuries

related to falling. In a journal presented by Ungar et al. (2013), the authors state identifying risk

factors is imperative when planning preventative measures to avoid falls. In Mr. M’s case, he

portrays a multitude of risk factors indicating that he will require multiple different aspects of

teaching to fully inform form him of appropriate preventative measures. Furthermore, the journal

that was considered states that the Guidelines of the American Geriatric Society suggest

interventions regarding falls should include modifications to environmental hazards, use of

assistive device and re-evaluation of drug therapy (Ungar et al., 2013). Overall, the authors

recommend an initial assessment, followed by a comprehensive identification of risk factors will

allow an appropriate diagnosis of the etiology of the fall therefore implementing appropriate

interventions to decrease the occurrence of falls (Ungar et al., 2013).

As stated above, the teaching aid used was a PowerPoint presentation that was printed

and given to the client. A visual aid was also utilized to emphasize the importance of what to do

and what to avoid when trying to prevent falls. When presenting the teaching points, it was

important to consider and factors that may affect learning. After completing the Survey of

Preferred Learning, Mr. M displayed that he is most receptive to visual teaching aids. In

addition, the client did not have any hearing or sight impairments, which allowed me to perform

the teaching effectively. However, one teaching barrier that I encountered was that the client

currently suffers from mild dementia. Therefore, his short-term memory is poor and his attention

span may be shortened. When implementing the teaching it was important to teach in brief

sessions, avoiding jargon and big bulks of information. Also, providing a hard copy of the

PowerPoint was helpful in teaching to this client needs and allowing him to have resources to

refer to. Another aspect to consider when performing teaching for this client was the other
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healthcare members that were involved in the teaching process and care of Mr. M. It was

essential to include the caregivers in the teaching so that they can provide additional emphasis on

the teaching in the future and also be included in the interventions that are planning to be

implemented. Despite the cognitive impairments that the clients exhibited, he portrayed an

eagerness to learn and the caregivers obtain enthusiasm to participate as well.

When following up with the client a week after teaching was performed, the first short-

term outcome was completely met. The desired short-term outcome was measured by an

objective assessment of safety measures that were implemented within the client’s house. Upon

following up with the client, I observed the implementation of safety strategies such as: the floor

being free from clutter, appropriate lighting throughout the house, grab bars placed in the

bathrooms and adequate space to ambulate with a wheel chair or walker. Additionally, the

second short-term goal was achieved at the completion of the teaching. This goal was measured

by asking the client to perform the teach-back method at the conclusion of the teaching

indicating that he understands the importance of asking for assistance when ambulating and how

it can effectively decrease the risk for falls. Regarding the long-term goal, there is a significant

plan in place to follow-up and evaluate if the long-term goal was met. In this case, including the

client’s caregivers was imperative. The caregivers will be responsible for making sure the

client’s short-term goals are continuing to be followed. If the specific actions are constantly

being followed, Mr. M should not suffer from any falls. However, if a fall does occur, the

caregivers were informed of how important it is to re-evaluate the client’s health status and home

status to prevent more falls in the future. In conclusion, the teaching plan implemented included

all parties involved in the care of Mr. M to ensure safety and improve the quality of care being

implemented.
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Evaluation

The nursing outcomes that were specific for the client identified in the project related to

primary prevention because they focus on decreasing the occurrence of falls. Overall, I believe

the teaching provided was very effective. The client was engaged with each meeting that we had

and seemed intrigued in learning ways to improve his well-being. However, throughout the

teaching process, limitations did exist. One of the biggest limitations was the fact that the client

suffers from mild dementia. It was challenging being able to teach to his needs and displaying

patience when he did not fully understand the teaching the first time. Also, when I returned for

follow-up visits, the client struggled with remembering the information that was presented in

previous sessions, so it was important to review the material to ensure I was being effective. The

most effective way to provide the information to the client was by handouts, so that he could

refer and review them on his own time. The client made statements such as: “I understand that I

will ask for help when I need move from my wheel chair to my bed”, which indicated that the

teaching was effective. The client also asked questions like: “Will I need to stay in my wheel

chair all the time now, or can I still use my walker for exercise when I feel up to it?” Questions

like these indicated that the client was experiencing fear of losing certain activities of daily

living. In this case, I reassured him, that was not the case and we reviewed how he could still

ambulate with the walker, but in a safe way. Also, the client was very thankful for the time I was

taking from my day to educate him on this topic as evidenced by statements such as: “Thank you

so much for taking the time to help me and my health.” At the final meeting, I felt confident with

the information I had implemented into the plan of teaching and believe it was very effective for

the client and his condition.

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At the conclusion of this project, if there is anything I could have done differently, it

would have been the ability to have a few more visits with the client. I visited with the client on

four different occasions and three of them included teaching. Due to the client’s cognitive

impairment, the teaching could have possibly been more effective if I could have reviewed it a

few more times. Despite the memory loss, the client received handouts of the information for his

own review and the caregivers implemented teaching sessions, which ensured Mr. M was

educated on the specific topic. As I have stated throughout this paper, I learned a lot from this

health promotion project. In my opinion, at the conclusion of the project I have a better

understanding of the older population and how to approach an effective way to teach them. With

the tools that were provided, I felt very confident in my ability to adequately assess my client and

determine what the priority teaching topic would be. Then, with the help of websites such as the

CDC, Healthy People 2020 and scholarly journals, I educated myself on the topic of falls and

effectively educated the client. Overall, this project presented opportunities to perform

appropriate assessments, identify risk factors, formulate an appropriate diagnosis with

measurable outcomes and develop an adequate teaching method. It was a great learning

experience for not only the client involved, but for me as a student as well.

Conclusion

Health promotion in all individuals is the motto I live by as a nursing student. When

performing nursing care, I aim to improve the quality of all of my patient’s lives regardless of

their age. This project allowed me to focus specifically on the older population, which presented

a whole new learning experience. I was able to work through challenges such as memory

impairment and still provide a positive, effective learning experience for the client. Not only was
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I able to connect with the client in a very special way, but I was able to critically think, which

will ultimately improve the care I can provide to individuals in the healthcare setting.
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References

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes.

St. Louis, MO: Mosby, an imprint of Elsevier.

Older Adults. (n.d.). Retrieved November 19, 2018, from

https://www.healthypeople.gov/2020/topics-objectives/topic/older-adults

Risk for Falls. (2017). Retrieved November 14, 2018, from

https://www.cdc.gov/steadi/pdf/STEADI-FactSheet-RiskFactors-508.pdf

Ungar, A., Rafanelli, M., Iacomelli, I., Brunetti, M. A., Ceccofiglio, A., Tesi, F., & Marchionni,

N. (2013). Fall prevention in the elderly. Clinical cases in mineral and bone metabolism:

The official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and

Skeletal Diseases, 10(2), 91-5. Retrieved from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3797008/