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Nursing Care Plans: Nursing Diagnosis and Intervention, 5/e
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Health-Seeking Behaviors:
Health Promotion; Lifestyle Management; Health Education; Patient Education
Sheri Martucci, RN, MS
Meg Gulanick, RN, PhD

NANDA: The state in which a patient in stable health is actively seeking 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; exercise promotion; prenatal instruction; safe sex practices to prevent sexually transmitted diseases; protective helmets to prevent head trauma and other practices to reduce risks for diabetes, stroke, and others.

Patients of all ages may be involved in improving health habits, though younger patients often more aggressively approach risk factor reduction in areas where research has documented beneficial effects. Less research has been conducted with the elderly population, though patients of any age should be encouraged to adopt a healthy lifestyle to improve their quality of life. Age is also a consideration in designing specific interventions such as exercise. Elderly patients require a longer warm-up period when initiating exercise, and their target heart rate may be lower.

Social cognitive theory identifies factors (behavior, cognition and other personal factors, and 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. Finally, the action plan must be tailored to fit with the patient's values and belief systems.

The setting in which health promotion activities occurs may range from the privacy of one's home, group activities such as 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 and then focuses on one specific type--smoking cessation.

Related Factors

Defining Characteristics

Expected Outcomes


GENERAL

Ongoing Assessment

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Determine cultural influences on health teaching.
Certain ethnic and religious groups hold unique beliefs and health practices that must be considered when designing educational plans.
(i) Question patient regarding previous experiences and health teaching.
Adults bring many life experiences to learning sessions. Often patients have previously tried unsuccessfully to engage in a specific health practice. Reasons for difficulties need to be explored.
(i) Assess patient's individual perceptions of health problems.
According to models such as the Health Belief Model, the patient's perceived susceptibility to and perceived seriousness and threat of disease affect health-seeking behaviors.
(i) Determine at what stage of change the patient is currently.
The Transtheoretical Model emphasizes that interventions for change should be matched with the stage of change at which patients are situated. For example, if the patient is only "contemplating" starting an exercise program, efforts may be directed to emphasizing the positive aspects of exercise; whereas if the patient is in the "preparation" or "action" stages, more specific directions regarding exercise (e.g., places to exercise, equipment, target heart rate, warm-up activities, and others) can be addressed.
(i) Identify priority of learning need within the overall plan of care.
Patients learn material most important to them.
(i) Identify any misconceptions regarding material to be taught.
(i) Assess patient's confidence in his or her ability to perform desired behavior.
According to the self-efficacy theory, positive conviction that one can successfully execute a behavior is correlated with performance and successful outcome.
(i) Identify patient's specific strengths and competencies.
Every patient brings unique strengths to the health planning task (i.e., motivation, knowledge, social support).
(i) Identify health goals and areas for improvement.
Systematically reviewing areas for potential change can assist patients in making informed choices.
(i) Identify possible barriers to change (i.e., lack of motivation, interpersonal support, skills, knowledge, or resources).
If the patient is aware of possible barriers and has formulated plans for dealing with them should they arise, successful behavioral change is more likely to occur. For example, if trying to engage in more exercise, shopping malls can be substituted for outdoor activity during periods of inclement weather.

Therapeutic Interventions

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Clearly define the specific behavior to be changed.
The more precisely defined the behavior is, the greater the chance of success.
(i) Guide the patient in setting realistic goals.
Goals that are too global, such as "lose 30 lbs," are difficult to achieve and can foster feelings of failure. Shorter range goals such as "losing 5 lbs in a month" may be more achievable and therefore reinforcing.
(i) Promote positive expectations for success.
Patients with stronger self-efficacy to perform a behavior are much more likely to engage in it.
(i) Assist patient in developing a self-contract.
Contracts help to clarify the goal and enhance the patient's control over the behavior, creating a sense of independence, competence, and autonomy.
(i) Assist in developing a time frame for implementation.
Changes need to be made over a period to allow new behaviors to be learned well, integrated into one's lifestyle, and stabilized.
(i) Allow periodic evaluation, feedback, and revision of health plan as necessary.
This provides a systematic approach for movement of patient toward higher levels of health and promotes adherence to plan. Appropriately timed feedback is critical to successful behavior change.
(i) Reward positive efforts and achievement.
Rewards may consist of verbal praise, monetary rewards, special privileges (earlier office appointment, free parking), or telephone calls.
(i) Inform patient of appropriate resources in the community; use referrals and agencies that enhance the learning of specific behaviors.
(i) Implement the use of modeling to assist patients.
Observing the behavior of others who have successfully achieved similar goals helps exemplify the exact behaviors that should be developed to reach the goal. Use of videotapes with people performing the desired behavior have been quite effective.
(i) Provide a comprehensive approach to health promotion by giving attention to environmental, social, and cultural constraints.
The various health promotion models emphasize that focusing only on behavior change is doomed to failure without simultaneous efforts to alter the environment and collective behavior.
(i) Use a variety of teaching methods.
Learning is enhanced when various approaches reinforce the material that is being taught.
(i) Prepare for lapses and relapses.
Relapse prevention needs to be addressed early in the treatment plan.
(i) Encourage participation of family or significant others in proposed changes.
This may enhance overall adaptation to change.

SPECIFIC PATIENT BEHAVIORS FOR SMOKING CESSATION

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Determine that the patient is interested in quitting smoking.
The health care provider should validate the importance of quitting smoking so the patient is clear about the goal.
(i) Choose an approach to quitting most suitable for the specific patient, as in the following:
(1) cold turkey--abrupt cessation from one's addictive level of smoking;
(2) tapering--one smokes fewer cigarettes each day until down to none;
(3) postponing--one postpones the time to start smoking by a predetermined number of hours each day eventually leading to no cigarettes;
(4) joining a smoking cessation program;
(5) pharmacological aids--nicotine patches, gum;
(6) acupuncture, hypnosis.

Different approaches appeal to different individuals.
(i) Formally set a date to quit smoking, either verbally or by contract.
This reinforces the intent and behavior to be changed.
(i) Avoid temptation or situations associated with the pleasurable aspects of smoking. Suggest the following:
(1) instead of smoking after meals, brush teeth or go for a walk;
(2) instead of smoking while driving, take public transportation;
(3) avoid having a cocktail before dinner if it is associated with smoking;
(4) limit social activities or situations to those where smoking is prohibited;
(5) if in a social situation where others smoke, try to associate with the nonsmokers present;
(6) develop a clean, fresh, nonsmoking environment at work.
(i) Find new activities to make smoking difficult, impossible or unnecessary (e.g., swimming, jogging, tennis, handball, racquetball, aerobics, biking).
(i) Maintain clean taste in mouth by brushing teeth often and using mouthwash.
(i) Do things that require the use of the hands (e.g., crossword puzzles, needlework, gardening, writing letters).
(i) Keep oral substitutes handy: carrots, pickles, sunflower seeds, sugarless gum, celery, apples, and others.
Oral gratification helps reduce the urge to smoke. Low-calorie foods should be chosen because ex-smokers burn fewer calories, and 25% may experience a weight gain when they stop smoking.
(i) Learn relaxation techniques to reduce urge: make self limp, visualize a soothing, pleasing situation.
Breathing exercises help release tension and overcome the urge to smoke.
(i) Seek social support.
Commitment to remain a nonsmoker can be made easier by talking with friends and family.
(i) Mark progress and reward self for not smoking. Each week, month, or more, plan a special celebration and periodically write down reasons one is glad for quitting and post them.
(i) Instruct patient that relapses can occur. If they do, recognize the problem, review reasons for quitting, anticipate triggers, and learn how to avoid them.
(i) Pursue various coping skills to alleviate further problems and re-sign a contract to remain an ex-smoker.
It is difficult to remain an ex-smoker. A slip means that a small setback has occurred; it does not mean that the patient will start smoking again. Despite strong resolve to quit, patients often find themselves in situations that may encourage relapse. Being prepared to recognize these and offering other options or sources of assistance enhances the patient's ability to cope and minimizes relapses.

Education/Continuity of Care

Actions/Interventions
Key:
(i) independent
(c) collaborative
(i) Provide instruction as described in interventions above.
(i) Explore community resources.
(c) Refer patient to self-help groups as appropriate.

NIC

Self-Modification Assistance; Health Education; Patient Contracting; Smoking Cessation

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