The study covers the areas of health promoting interventions for the case of noncompliant patient under strict low salt diet and smoking prevention. The nursing intervention suited for the task is through health teaching and fostering of the patient’s compliance in adhering to the medical advice for the betterment of health. The health promotion intervention used in this study is guided by the model of Prochaska & DiClemente’s Stages of Change.
The study provides an analysis of the proposed health-teaching plan according to this transtheoretical model in order to provide basis for its validity and applicability towards the patient’s needs. Introduction The study applies the theoretical model of Prochaska & DiClemente in the context of transtheoretical model, which provides an integrative framework for comprehending and acquiring significant rationale for human international behavioral change.
The model has significantly been used for health risk and health protective behavioral assessments, and its emphasis has been centered mainly on initiation and cessation of addictive behaviors (William and Heather, 1998 p. 3). With the case of the patient being in line with hypertension prevention and low salt diet, the transtheoretical model determines the best possible nursing intervention to facilitate and foster patient compliance through the understanding of health promotion.
The model has been chosen and applied as the standard basis of the teaching plan’s evaluation since its focus relies mainly on behavioral change, which is considered essential and crucial for the patient’s adherence to the care plan established. In the study, the main discussion revolves in the evaluation of a health promoting teaching plan focusing on noncompliant client for law salt diet and reduction to possible elimination of smoking habit utilized by the client.
In addition, the study uses the theoretical frameworks of Prochaska & DiClemente in the context of transtheoretical model to further explain the quality of teaching plan administered to the patient. Discussion Patient Information The patient is currently 26 year old female with history of hypertension and a smoker. The assessed past medical history includes illness incidences of seizure disorder, emphasized muscular dystrophy. Meanwhile, the history of medical procedures that have been utilized by the patient are knee surgery, tonsillectomy, Shoulder Replacement, Appendectomy.
Lastly, the hereditary illness of the patient obtained through family history analysis is cardiac disease, which manifests the condition of hypertension. The patient is reluctant in participating in any nursing intervention administered to her, such as salt restrictions and withdrawal from smoking habit. She is manifesting noncompliance towards these health promoting tasks due to her subjective inappreciation for her condition. As verbalized by the patient, she stated that she thinks she has to die from something any way so she cannot see giving up salt or stop smoking.
With this, the possible nursing inferences involve the patient’s reluctance in health care participation especially in terms of health promoting tasks; hence, the health promotion should center on the changing the patient’s perception towards the need to promote her condition. Pathophysiology of Patient’s Condition Nursing Diagnosis: Noncompliance to low salt diet and smoking preventive measures as manifested by behavior indicative of failure to comply The data available for the patient lies mainly in the aspect of objective assessment of medical history.
Meanwhile, in the subjective portion of assessment, the patient indicates reluctant behavior indicative of noncompliance to health promoting tasks and actions provided by the nurse. The patient has a manifesting condition of hypertension and with the history of possible hereditary cardiac anomalies. The purpose of low salt diet and smoking are very much entailed to the physiological explanation of the patient’s condition. Salt in the body promotes fluid shifting through the alteration of blood solutes in the body.
Salt intake has a consistent and direct effect on blood pressure due to its promotion of vasoconstriction and adrenal stimulation for producing adenocoricotropic hormone, which alters fluid balance in the body. The high intake of salt causes increase in circulating fluid volume in the blood, which consequently increase arterial pressure exerted in vascular walls. The presence of inappropriate sodium: renin ratio (increased sodium and decreased rennin secretion) causes the failure on sodium suppression and further accumulation of sodium.
Renin is in charge of fluid secretion, which regulates the excretion of sodium in the blood; however, with the decreased content of this hormone, sodium accumulates and increases its levels in the blood (Beevers, et. al. 2007 p. 3). Therefore, fluid accumulates in the cellular cavities, cells engage into increased fluid retention causing cellular swelling, and the tends to store calcium ions, which causes smooth muscle vasoconstriction, causing the clogging of arterial diameter; hence, inducing increased in blood pressure (Beevers, et. al. 2007 p.
3). On the other hand, smoking instills the chemical component nicotine in the arteries through gas exchange in the respiratory tract. This promotes clogging in respiratory arterioles and the passing of nicotine substance in the blood circulation. The Nicotine substance is the main component providing detrimental effects in both cardiopulmonary circulation through stimulation of nicotinic receptors of sympathetic and parasympathetic ganglia, neuromuscular junction innervating skeletal muscles and the central nervous system pathways (Barile, 2004 p.
148). This physiological interaction promotes vasoconstriction in the cardio-pulmonary region, which contributes in the hypertensive condition of the patient. Hence, in this physiological context, the need of the patient for further health promotion in accordance to salt limitation and smoking restrictions are essential in order to prevent further complications and improve the circulatory and pulmonary function of the patient. Prochaska & DiClemente’s Stages of Change Model
The transtheoretical model of Prochaska & DiClemente provides the concept of dynamic and motivational component of change process over time. The model consists of meaningful steps consisting of specific tasks required to obtain successful, sustained and appropriate behavioral change (William and Heather, 1998 p. 4). The key concept in the model of Prochaska & DiClemente is to facilitate the initiation and progression of behavioral change through motivation and actual behavioral modeling.
Movement through the stages revolves in a cyclical manner wherein changing individuals move back and forth in these stages until the goal of change is met (Marcus & Forsyth, 2003 p. 12). Within the context of this theory, there are five sequential stages that can be identified, namely: precontemplation stage, contemplation stage, preparation stage, action stage, and lastly, maintenance stage (William and Heather, 1998 p. 4). The pre-contemplation stage considers the ignorance of the patient in the physical occurrence or nature of the existing problem; hence, promoting noncompliant behaviors (William and Heather, 1998 p.
4). The next stage of change involves the patient’s changing concept of change and the start of realizing the need to shift the inactive status to an active state of change, but does not yet engage to the action towards change itself (Marcus & Forsyth, 2003 p. 12). The contemplation stage creates the atmosphere of serious thinking and problem consideration from the part of the patient, which includes decision making and evaluation of the advantages and disadvantages of the proposed care intervention for the patient (William and Heather, 1998 p.
4). The preparation stage represents resolution of the decision-making task and a commitment to a change plan to be implemented in a specific time frame agreed by both patient and care facilitator (William and Heather, 1998 p. 4). In this stage, the nurse and the patient sets up a contract or plan for attaining the targeted change outcome. In this scenario, the nurse incorporates the patient in the planning purposes in order to foster independence on health care management.
In addition, through this, the nurse obtains the perceived necessities of the patient, which can further improve the applicability and effectiveness of the plans made (Marcus & Forsyth, 2003 p. 12). During the action stage, the plan for behavioral change is implemented wherein the nurse monitors the patient’s adherence, initiative to change, coping skills, and the progressive results of behavioral change (William and Heather, 1998 p. 4). This can be considered as the implementation stage wherein the nurse considers and monitors the patient’s adherence and compliance to the set health care interventions.
Lastly, the maintenance changes wherein the patient and the nurse try to establish the continuity of behavioral change and the maintenance of the change that has been implicated by the intervention (William and Heather, 1998 p. 4). In this phase, the nurse evaluates the changes made through the applied nursing interventions against the initial assessments obtained by the health care provider. The nurse encourages further development and the sense of health self-care management in the patient herself (Marcus & Forsyth, 2003 p. 12).