Frenn, Marilyn

Lee, Helena

English

epublications@Marquette

Marquette Universitye-Publications@MarquetteNursing Faculty Research and Publications Nursing, College of1-1-1992Health Maintenance, AlteredMarilyn FrennMarquette University, marilyn.frenn@marquette.eduHelena LeePublished version. "Health Maintenance, Altered," in Nursing Diagnosis in Clinical Practice: Guides forCare Planning. Eds. Kathy V. Gettrust and Paula D. Brabec. Albany: NY: Delmar Publishers, 1992:276-284. Publisher link. © 1992 Delmar Learning, a part of Cengage Learning, Inc . Used withpermission.A state in which an individual is unable to identify, manage, and/or seek out help to maintain health (NANDA, 1990, p. 78). Marilyn Frenn, R.N., Ph.D. Helena Lee, R.N., M.S.N . . . . . . . . . . . . . . DEFINING CHARACTERISTICS Age-related preventive measures not taken Expressed health concerns Limited adaptive behaviors to internaV environmental changes Regular and unmitigated exposure to health hazards: Abuse Ageism CONTRIBUTING FACTORS Pathophysiological Crime Pollution Poverty Racism Sexism Regular practice of behaviors that: Increase risk of illness Limit optimal function Limit recovery from illness or disability Responses to illness or disability that inhibit health behaviors, e.g., fatigue, impaired mobility, inability to concentrate, pain, perceptual deficits Psychosociobehavioral ENVIRONMENTAL Cultural barriers to use of health care system Health advice incongruent with beliefs (cultural, health, religious) Lack of environmental resources: 276 Acceptable and affordable health care Equipment Finances HEALTH MAINTENANCE, ALTERED 277 Food Health care providers/systems that promote health Health resources---e.g., food nutrients not labeled, healthy foods expensive or hot available, lack of safe place to exercise Housing Transportation Limited social support for health: Dysfunctional family system Lack of meaningful and supportive relationships Peer modeling and support of unhealthy behaviors Public or workplace policies that do not promote health Societal support of unhealthy products and behaviors INDIVIDUAL Depression Dysfunctional grieving llliteracy Lack of information regarding: Age-appropriate screening and self-care Community resources Health hazards Health promotion services Personal health status Lack of personal requisites: Goals or purpose Motivation Perceived control over health Perceived responsibility for health behaviors Previous health-promoting life-style Self-efficacy Lack of skills in: Communication Individual coping Learning Stress management Time management Perceived barriers outweigh benefits Spiritual distress Unachieved developmental tasks 278 SECTION TWO EXPECTED OUTCOMES Client will be able to pursue chosen health-seeking behaviors. Participation in monitoring of baseline patterns and changes in health is reported. Required h~alth maintenance services are accessible. Client will state a realistic plan for pursuing health behaviors within limitations. Responses to illness or disability are controlled as much as possible. INTERVENTIONS Universal Assess current practice of age-appropriate health maintenance. (Base age-appropriate health maintenance schedules accord-ing to most recent Center for Disease Control (CDC), National Screening Council, and other national association guidelines, e.g., American Heart Association). General guidelines are as follows: YOUNG ADULTS (20-39 YEARS) Assess need for health education/counseling: Creating a healthy environment Disease-prevention measures Exercise Nutrition and weight management Parenting skills Safety Stress management Substance use Dental hygiene: every 6-12 months Immunizations: Tetanus--every 10 years Rubella for women with zero antibodies-once \ ; RATIONALE Assessment reinforces the need for ongoing practice and provides data for specific teaching or referral. INTERVENTIONS Screenings: Blood cholesterol-once; rescreen if high-risk client-every 4 years Complete physical-every 5--6 years Skin and other cancer screening---every 3 years Substance use screening-every 5--6 years Male: Testicular self exam---every month Female: Breast self exam---every month Pap smear---every 1-3 years Mammography-baseline (once) High-risk young adults: Females with breast cancer or immediate family history-mammography every year History of abnormal Pap smears, multiple partners, or early age of first intercourse-Pap smear every year Family history of colorectal cancer-stool guiac, digital exam, sigmoidoscopy every year Exposure to tuberculosis-PPD once (chest x-ray for pre-vious positive PPD reading) HEALTH MAINTENANCE, ALTERED 279 RATIONALE Assessment reinforces the need for ongoing practice and provides data for specific teaching or referral. 280 SECTION TWO INTERVENTIONS MIDDLE AGED ADULT (40-59 YEARS) Continue previous assessment and add the following: Assess need for health education/counseling: Adjustment to grandparent-hood Caring for aged loved ones Empty nest syndrome Midlife changes Preparing for retirement Immunizations for those with chronic illness: Influenza-every year Pneumoccocal-every year Screening: Blood pressure-every :>-5 years Schiotz tonometry (for . glaucoma)-every:>-5 years Sigmoidoscopy-every 4 years after age 50 Stool guiac-every year after age 50 Female: Mammography-every year OLDER ADULT (60-74) Continue previous assessment and add the following: Assess need for health educa-tion/counseling: Age-related changes Bowel and bladder function Nutrition and weight management I RATIONALE Assessment reinforces the need for ongoing practice and provides data for specific teaching orJreferral. r INTERVENTIONS Sleep pattern Vision and hearing acuity Coping with chronic illness Coping with loss Fall prevention Home care options in caring for other(s) Options for developing and maintaining activity, relationships, and societal contributions Screenings: Blood pressure-every year Complete physical exam-every year Depression and suicide-every visit OLD OLD ADULT (75 YEARS AND OVER) Continue previous assessment and add the following: Assess need for health education/counseling: Community resources for home maintenance Immunizations: In£luenza-every year Pneumoccocal-every year Death and dying: Long-term care/supportive living options Reminiscence Develop written health maintenance contract that is specific, time-dated, rewardable, and evaluated. I HEALTH MAINTENANCE, ALTERED 281 RATIONALE Assessment reinforces the need for ongoing practice and provides data for specific teaching or referral. Contract enables effective performance and evaluation. 282 SECTION TWO INTERVENTIONS RATIONALE Incorporate age-appropriate A busy staff is more likely to use a health mainte-health maintenance schedules nance schedule which has been included in the into standardized/computerized plan of care. care plan. Plan individual health promo- Plans that incorporate symptom management tion activities considering ~e more likely to be effective. responses to illness or disability. \ Provide health maintenance Preventive health actions aid overall recovery services that client/family are and maintenance. unable to accomplish. Reinforce age-appropriate Health information changes and accuracy are health maintenance. needed regarding specific risks, appropriate screening, and self-care activities. Review existing health care The complexity and change in health care sys-resources. tems may prevent usage of existing resources. Work with health care systems, Major barriers to health maintenance are societal employers, and policy makers to in origin. create healthy public policy. Work with professional organi- Organized nursing effort can produce positive zations to reduce environmental change. threats to health, e.g., poverty, pollution, crime, and abuse. Inpatient Collaborate with other Those who practice health promotion may disciplines in creating an be more effective role models. Organized institutional health promotion approaches to health promotion enable access program for staff and clients. to services in a cost-effective manner and main-tain relationships with health care providers after discharge. Send written materials home Eighty percent of those who begin life-style and set up referrals for health change return to previous life-style behaviors. maintenance prior to discharge. Follow-up care can aid in maintaining changed behaviors. r HEALTH MAINTENANCE, ALTERED 283 INTERVENTIONS RATIONALE Community Health/ Home Care Continue previous health main- Continuity of care fosters health outcomes. tenance programs in the home as needed. Develop consumer health Cost-effective health maintenance and referral advocacy programs. can be accomplished by trained volunteers. Develop programs that can be Services provided where people work, learn, offered to employers and others and play may improve access and utilization. seeking to provide health main-tenance services. Develop specific screening and Those at risk will have health services available risk-reduction programs based to them. on national and regional health goals. Distribute health information Misinformation may result from lack of updates to health providers and knowledge or changes in health information. consumer groups. Provide advocacy services for Underserved groups are at high risk for health groups with limited access to problems. health maintenance services. Provide health screening and Convenience may enhance utilization by those referral services at regular at high risk for health problems. intervals. Reevaluate need for individual Services can be provided to those most in need. and group health maintenance programs as client/family skills are acquired. l 284 SECTION TWO Albert, M. (1987). Health screening to promote health for the elderly. Nurse Practitioner, 12 (5), 42-58. American Nurses' Association. (1980). A Social Policy Statement. Kansas City, MO: ANA. * Frenn, M., Borgeson, D., Lee, H, & Simandl, G. (1989). Lifestyle changes in a cardiac rehabilitation program: The client perspective. Journal of Cardiovascular Nursing, 3 (2),43-55. * Haan, M., Kaplan, GA., & Camacho, T (1987). Poverty and health: Prospective evidence from the Alameda County study. American Jc;Jurnal of Epidemiology, 125, 989-998. Houldin, A.D., Saltstein, S.w, & Ganley, Khl. (1987). Nursing diagnoses for wellness: Supporting strengths. Philadelphia: Lippincott. Lindberg, S.c. (1987). Adult preventive health screening: 1987 update. Nurse Practitioner, 12, 19-41. Maglacas, A.M. (1988). Health for all: Nursing's role. Nursing Outlook, 36 (2), 66-71. North American Nursing Diagnosis Association. (1990). Taxonomy I (Rev. 1990). St. Louis: • NANDA. Office of Disease Prevention and Health Promotion, Department of Health Education and Human Services, (1990). Healthy people 2000. Washington D.c.: Government Printing Office. * Stuifbergen, A.K, Becker, HA., Ingalsbe, K, & Sands, D. (1990). Perceptions of health among adults with disabilities. Health Values, 14 (2), 19-26. * Wierenga, M.E., Browning, J.M., & Mahn, J.L. (1990). A descriptive study of how clients make life-style changes. The Diabetes Educator, 16 (6), 469-473. 

Health Maintenance, Altered

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Health Maintenance, Altered

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