08 Oct This week we will be learning about: Step 1 To co
This week we will be learning about: Step 1 To complete this discussion, you will be logging into The Neighborhood. The Neighborhood is a virtual community that enables you to achieve a deep understanding of total patient care. The Neighborhood’s stories, activities, and case studies on more than 40 characters provide a 360°-view of a client’s life. The Neighborhood will enhance the skills you use daily in the nursing profession.Click on Accessing and Using The Neighborhood for directions to enter the virtual community.Select the link watch the video for further instruction on The NeighborhoodClick on “Neighborhood” to access the neighborhood simulation and to navigate to and read the following Neighborhood episode:Helen Martin, Season 1 Episode 1-15: Helen is a woman in her late 40s who is overweight and struggling to lose weight. She has gallstones, which are causing her pain, an anxiety disorder, and her family situation is not supportive.Step 2 As you go through The Neighborhood episode for Helen Martin, map out her health situation using the Health Promotion model (revised) on page 40 of Health Promotion in Nursing Practice. Pay particular attention to the interpersonal and situational influences on her health.Describe the concept of health promotion and changing behaviors into healthy lifestyle changes. In your explanation, include the following items:Discuss Helen’s interpersonal and situational influences and how they affect her healthy behavior.Do you think Helen is committed to the plan?The Health Promotion Model assessment can help nurses develop counseling strategies for clients to recognize negative behavior and change it into healthy behavior. How would you help Helen make this change?Cite any sources in APA format. HELEN MARTINHelen Martin is a 48-year-old White female who is married to Gil. They have been married for 18 years. Helen has a daughter (Tracie) from a previous marriage, and she has two teenage children with Gil (Anthony and Kristina). She has been relatively happy in this marriage. Her primary frustration with Gil is that he always wants to take care of everybody and has a hard time saying no. She thinks he is generous to a fault. Helen has never gotten along well with Gil’s adult son, Mark, or Gil’s mother, Mary. For all the years they have been married, Mary has referred to Helen as a “gringa,” which really annoys her. Helen often feels frustrated when Gil and his mother speak to each other in Spanish, because nobody else in the family can understand them.Helen works as a teller at a bank. Although she finds her job monotonous, she appreciates the steady income. Helen is overweight and has tried to lose weight most of her adult life. She frequently diets and, in fact, has lost a great deal of weight in the past, but she just can’t seem to keep it off. She blames menopause for her most recent weight gain.Helen experiences indigestion following a few meals this week. She takes an antacid, believing the problem is just heartburn. She also experiences hot flashes.Gil tells Helen that his mother wants to move in and that they should make room for her. Helen is furious with this decision for several reasons: Gil did not first consult with her, they don’t have room for her, they cannot afford another person in the house, and Helen has never gotten along well with her mother-in-law.Helen continues to have indigestion following meals; it does not occur following all meals, just sometimes. The discomfort is usually located in the upper right side of her abdomen, and sometimes it is quite painful. The pain can last for up to a couple of hours and then it subsides. Occasionally, she feels nauseous as well. To top it off, Helen experiences several episodes of hot flashes.Helen is not happy about Mary moving into the house. Her two daughters are angry and fighting because they have to share a bedroom to accommodate their grandmother. Helen thinks that this is very unfair to both the girls. Additionally, she overhears Gil and Mary talking to each other in Spanish. They know darn well that nobody else in the family speaks Spanish. She thinks that Mary does this intentionally so that she can talk to Gil in a way Helen can’t understand.Helen continues to experience pain and indigestion after meals. In fact, the symptoms have become more frequent. She decides to make an appointment to see her physician about the symptoms.Helen has not slept well this week. She has had a hard time falling asleep because she worries about everything: the kids, money, problems at work, and recent problems on the national level that affect the country. Oftentimes, she gets up and paces about the house, trying to turn her mind off. About the time she falls asleep, she is awakened by Mary, who is watching TV in the den during the middle of the night. She asks Mary to keep the volume down so that she won’t disturb the family. Helen also wakes at times because of hot flashes and night sweats.Helen sees her family physician, Dr. Rowe, this week for indigestion. Based on Helen’s symptoms, Dr. Rowe suspects that Helen has cholelithiasis and orders an ultrasound scan of the abdomen. The ultrasound confirms the presence of gallstones. The physician tells Helen that she has two options: (1) conservative therapy that would involve dietary modification (a low-fat diet and a reduced-calorie diet to promote weight loss); or (2) surgery to remove her gallbladder. Helen decides to try dietary modification. Dr. Rowe refers her to the Neighborhood Patient Education Center for more information. She is encouraged to use over-the-counter analgesics for pain.Helen goes to the Patient Education Center and receives dietary counseling from a nurse educator. She is taught about low-fat food options and is given sample menus and cooking techniques to minimize fat. Helen is very motivated to go on this diet to avoid the pain, and she looks forward to losing some weight.Helen agrees to Mary’s request to prepare dinner three times a week. Helen shares with Mary what she learned at the Patient Education Center, with an expectation that the meals Mary cooks will be prepared based on this dietary plan. She becomes angry when she finds that Mary essentially ignores her requests and is frustrated because the rest of the family members comment on how good dinner is when Grandma cooks. She believes that Mary is intentionally sabotaging her dietary efforts.Helen comes home one day after work this week and is unable to find anything because Mary has rearranged the entire kitchen. Helen feels angry and invaded. Mary defends her actions by claiming that Helen’s kitchen was very disorganized and that she is just trying to help the entire family.Helen becomes frustrated when she finds that Mary continues to rearrange things in the house and clean things that were already clean. Helen also notices that Mary is often unaware that the dishes she washes and puts away are still dirty, so Helen ends up rewashing dishes.She has given up fighting with Mary over the dinner menu and has decided to take Gil’s advice and limit fat intake at other meals, eating only small portions when Mary cooks.Helen is angry when she learns that Mary and Gil have given Kristina permission to use the car. She does not feel that it is appropriate for Mary and Gil to make such decisions without her input. But, at this point, if she were to put a stop to it, she would end up looking like the “bad guy.” Helen is so frustrated with this that she eats a large, fatty meal and ends up having 2 hours of indigestion, pain, and nausea as a result. She also has trouble sleeping that night. She blames Gil and Mary for the pain and loss of sleep.Helen panics when Anthony fails to bring Kristina home after a school function. She tries to call Kristina’s cell phone, but it is turned off. She becomes frantic and is sure that somebody has abducted Kristina. Helen gets in the car and drives to the school to see if she can find her daughter. On the way to school, she becomes increasingly anxious and begins to experience shortness of breath and tightness in her chest and throat. The closer she gets to the school, the worse the symptoms become. Helen’s symptoms reach the point at which her heart is pounding in her chest and she feels like she is suffocating; she breaks out in a cold sweat. Helen pulls over to the side of the road and begins to cry. She tells herself to calm down and that everything surely will be all right. After a few minutes, Helen composes herself and continues driving to the school. When she gets to the school, she finds that the college fair is over and nearly everybody has left. When she gets back home, she finds Kristina there watching TV. Helen screams at her and wants to know where she was and why she didn’t answer her phone. She tells Kristina that she almost had a heart attack and that her gallbladder acted up because of this situation.Helen goes to the Neighborhood High School open house with Gil to meet Kristina and Anthony’s teachers. They are very complimentary about both of their children. One teacher who has taught both of them says they are really quite different from each other. Kristina is very outgoing and bubbly, and Anthony is very quiet and studious. Helen remarks that her daughter is quite the socialite.Helen overhears Gil and Mary speaking to each other in Spanish again; for some reason this is really getting on her nerves. Why can’t they speak so that others in the family can understand?Helen is worried about Kristina when she fails to come home by 1 a.m. following a school dance. She attempts to text and call Kristina’s cell phone, but it is turned off. She paces the house and alternately worries that Kristina has been in a wreck or that she is up to no good with her date. She feels a subtle tightness in her chest and slight shortness of breath, which she attributes to her gallbladder problems. When Kristina comes home, Helen grounds her for staying out an hour past her curfew and warns her that if she turns off her cell phone and can’t be reached in the future, she may lose her cell phone privileges. When Kristina protests, she reminds her who pays her phone bill each month. Helen feels frustrated because Tracie and Anthony never behaved in this way.Helen overhears Gil and Mary speaking to each other in Spanish – AGAIN. When she mentions to Gil that she does not like it and it makes her feel left out, he tells her this is how they communicated with one another when he was growing up and it really is no big deal.Tracie tells her mother about the foil in Anthony’s room and tells her the house looks awful with the foil, especially when the afternoon sun is shining on it. Helen agrees it does not look very good, but then again, she hates the pinkish color their next door neighbors used to paint their house, and the people who live across the street have weeds growing in their front yard. She hopes the neighbors complain so she can tell them what she thinks of their homes.Helen begins to experience indigestion and pain again. She knows that she has not stuck with her low-fat diet very well. She is hopeful that the symptoms will subside with better eating habits. HELENS Journal entryWhat is Gil thinking? I guess he isn’t thinking. Why would he think I would be okay with him inviting his mother to move in with us?!. He always bends over backwards to help everyone, but he knows how much I struggle to get along with Mary. She’s the problem. It’s not me. Doesn’t he realize that? I have enough stress in my life without him adding to it. The house is crowded already. It’s not fair for the girls to have to share a room. They need their privacy. They are going to resent their grandmother for this. What if the girls get mad at me? What if Mary turns the girls against me?How are we going to afford this? We need to save up for college and pay off our debts, not take care of another person who should be able to take care of herself. I feel bad that she lost her husband, I really do, but it is not my fault that she didn’t manage her money properly. I shouldn’t have to pay for her living expenses too. I need to work more hours, but I don’t want to be away from the house and the kids anymore than I already am. If Gil would pick up some overtime it would help, but that darn back of his is making things difficult. And of course he hurt it again while helping Mary. If he’d done it at work, everything would be fine, but NO, he has to do it moving his mother’s stuff. Doesn’t she know he has a bad back?Why is it so hard to sleep at 3am? I don’t know…. Maybe hot flashes, maybe heartburn, MAYBE MARY KEEPING THE TV ON VERY LOUD!Saw the dietician today. How am I going to do this?. I’ve tried to eat right and lose weight, but I just can’t. And now, Mary is doing more and more of the cooking. She makes things as high in fat as she possibly can, just to annoy me and to make Gil happy.OK, let’s think of the list:Fresh fruits and vegetables – that’s doable.Whole grains – everyone else likes the white stuff, so that will be hard.Lean meat, poultry and fish -Chorizo is out. There’s nothing low-fat about pork sausage No one here likes any fish except fish sticks. (I don’t think that’s what they mean by fish.)Low-fat dairy products – we use 2% milk. I’ll try to switch to 1% without telling anyone.Fried foods (I love anything fried)Highly processed foods – I always need things to save time. (Mary, of course, makes everything from scratch.)Fatty red meat… If I tell this to Mary she’ll go buy a freezer full and make it every night just to spite me.What if my diet makes everyone else unhappy and they stop eating? What if they revolt against me and want Mary to do all the cooking? What if I can’t lose any weight? 40Part 1 • The Human Quest for Health The Health Promotion ModelThe health promotion model (HPM) proposes a framework for integrating nursing and behavioral science perspectives with factors that predict health behaviors. The model provides a way to explore biopsychosocial processes that motivate individuals to engage in behaviors that enhance health and well-being. The original HPM described the potential of seven cognitive–perceptual factors andfive modifying factors to predict health behaviors. Cognitive–perceptual factors include importance of health, perceived control of health, definition of health, perceived health status, perceived self-efficacy, perceived benefits, and perceived barriers. Modifying factors include demographic and biological characteristics, interpersonal influences, situational influences, and behavioral factors. The HPM is a competence-or approach-oriented model, as it does not include“fear” or “threat” as a source of motivation for health behavior. Although immediate threats to health have been shown to motivate action, threats in the distant future lack the same motivational strength. The HPM is applicable to any health behavior in which threat is not proposed as a major source of motivation.THEORETICAL BASIS FOR THE HEALTH PROMOTION MODELThe HPM describes the multidimensional nature of persons interacting with their inter-personal and physical environments as they pursue health. The HPM integrates con-structs from expectancy-value theory and social cognitive theory within a holistic nursing perspective.THE HEALTH PROMOTION MODEL (REVISED) The revised HPM (Pender, 1996) is shown in Figure 2–4. Three new concepts were incor-porated into the original model: activity-related affect, commitment to a plan of action, and immediate competing demands and preferences.Individual Characteristics and ExperiencesIndividual characteristics and experiences include personal factors and prior related behavior. Personal characteristics and experiences affect subsequent actions. Their influence depends on the target behavior being considered.PRIOR RELATED BEHAVIOR. Research indicates that often the best predictor of behavior is the frequency of the behavior in the past. Prior behavior has both direct and indirect effects on the likelihood of engaging in health-promoting behaviors. The direct effect may be due to habit formation, which predisposes one to engage in the behavior auto-matically with little attention to the details of its execution. Habit strength accrues each time the behavior occurs and is strengthened by concentrated, repetitive practice. Prior behavior is expected to indirectly influence health-promoting behaviorthrough perceptions of self-efficacy, benefits, barriers, and activity-related affect. Bandura refers to anticipated benefits as “outcome expectations.” If short-term benefits are experienced early in the course of behavior change, the behavior is more likely to be repeated. Barriers to a given behavior are experienced and stored in memory as “hur-dles” to overcome to be able to engage successfully in the behavior.
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