Running Head: HEALTH PROMOTION PAPER

Health Promotion Paper

Lillian Facka

Tamera Krukiel, RN, MSN, ANP-BC, PMHNP-BC

Bon Secours Memorial College of Nursing

Gerontological Nursing (NUR 4113)

4/13/2018

“I have neither given nor received aid, other than acknowledged, on this assignment or test, nor

have I seen anyone else do so.”

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Introduction

The client that participated in this health promotion project is a 78 year old female. She

possesses an acute awareness regarding her physical, emotional, and mental health. There are no

impairments to her communication, activities of daily living, or mobility. The client lives

independently in Charleston, South Carolina with family living close to her senior living

community. Currently, she experiences hyperlipidemia, hypertension, and changes in her

circadian rhythm that interrupt her normal sleeping pattern.

Healthy People 2020 recognizes that sleep disturbances affect 25% of the United States

population. Sleep is a part of human healing; lack of sleep disturbs daily temperament, which

may place a burden on interpersonal relationships (U.S. Department of Health and Human

Services, 2018). The endocrine, metabolic, and neurological functions of the body are all

impacted by sleep duration; chronic short sleep can lead to heart disease, high blood pressure,

obesity, and diabetes.

Diagnosis

During our second visit, after completing the assessments, the patient and I discussed

what aspect of her health she feels that she needs the most guidance on. Based on the data we

recorded, she manages her medications well and possesses the ability to verbalize her health

promotion techniques, such as good nutrition and physical activity. However, her sleep habits

have become random, resulting in chronic short sleep. Assessing this data, we decided to this

indicated further testing using the Pittsburgh Sleep Quality Index (PSQI). The client goes to

sleep as 12:00am, wakes up by 3:00am, and gets a total of six hours of sleep. The PSQI score we

obtained was a Global 9, indicating she is a poor sleeper.

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Coming to the conclusion that better sleep leads to better health outcomes, we

collaborated on short and long term goals. Short term, we discussed a teach back method: I

would teach the her useful techniques during this visit and the following visit she will repeat

them back to me. Long term, we planned to establish a bedtime routine that best suits her

lifestyle.

Plan

Prior to our third follow up visit, the participant and I discussed what her personal goal of

this project was. She stated to feel well rested by the end of this assignment, 4/5/2018. Delving

further into her desire for better sleep, I have learned that sleep significantly impacts her

memory. Tsapanou et al., (2017) states that there is a strong association between sleep and

memory, further detailing that positive sleep habits lead to better memory retention. After the

desired positive outcome date, we decided to re-evaluated the clients sleep by using the PSQI.

We planned on ridding her bedroom of televisions, bright light, and distracting noises.

Encouraging a warm bath for bed was also an addition to the plan.

Teaching

Teaching consisted of self-reported data with the use of conversation and recording hours

of sleep using a sleep diary. In addition, given the client likes to read, I provided her with some

handouts regarding sleep for the geriatric population. These handouts encouraged physical

activity during the day and a restful sleeping environment for positive sleep hygiene.

The participant enjoys having access to the internet and frequently uses sources such as

the CDC, FDA, and NIH for education. In addition to the handouts, I also used weblinks for the

participant to read when her schedule permits.

Outcomes
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During our third meeting, the client and I discussed her goals. She was able to meet her

short term goal fully, verbalizing positive sleeping techniques back to me. She was also able to

meet her long term goal. We both expressed a large amount of excitement, knowing that this was

a difficult task to complete alone.

Over FaceTime, she showed me her bedroom. No television was present, the window

blinds were covered with heavy blankets, and she purchased a white noise machine. In addition

to the bedroom, the participant verbalized that she takes a warm bath every night as her to

routine to destress from the day. The PSQI re-assessment proved that these techniques were

successful as evidenced by a new score of 3.

Evaluation

Speaking with the participant on the third visit, she was able to complete the short term

goal. Her long term goal, creating a positive sleep routine, was also verbalized to me. She stated

she has removed the television from her room, placed heavy blankets over the windows to

darken her bedroom, purchased a white noise machine, and takes a warm bath before bed. The

second PSQI scale resulted in a score of 3, a significant decrease in the previous score of 9. The

client now goes to sleep at 10:00pm, wakes at 6:00am and feels well rested receiving eight hours

of sleep.

The teaching that took place was primary prevention, given that the participant does not

wish to visit a sleep clinic or have any diagnosed sleep disorders, which would lead to secondary

and tertiary prevention.

The participants hearing has decreased as a normal part of aging, so communication took

place via FaceTime and text message. She responded well to the form of data collection, given
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that she was about to visualize the researcher and take notes during our conversation. The

limitation faced is the inability to visit the client personally due to distance.
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References

Adjei, N. K., & Brand, T. (2018). Investigating the associations between productive housework

activities, sleep hours and self-reported health among elderly men and women in western

industrialised countries. BMC Public Health, 181-10. doi:10.1186/s12889-017-4979-z

Brandão, G. S., Camelier, F. R., Sampaio, A. C., Brandão, G. S., Silva, A. S., Gomes, G. F., & ...

Camelier, A. A. (2018). Association of sleep quality with excessive daytime somnolence

and quality of life of elderlies of community. Multidisciplinary Respiratory Medicine,

131. doi:10.1186/s40248-018-0120-0

Brandão, G. S., Gomes, G. F., Brandão, G. S., Sampaio, A. C., Donner, C. F., Oliveira, L. F., &

Camelier, A. A. (2018). Home exercise improves the quality of sleep and daytime

sleepiness of elderlies: a randomized controlled trial. Multidisciplinary Respiratory

Medicine, 131-9. doi:10.1186/s40248-017-0114-3

Tsapanou, A., Gu, Y., O'shea, D., Yannakoulia, M., Kosmidis, M., Dardiotis, E., & ... Scarmeas,

N. (2017). Sleep quality and duration in relation to memory in the elderly: Initial results

from the Hellenic Longitudinal Investigation of Aging and Diet. Neurobiology Of

Learning & Memory, 141217-225. doi:10.1016/j.nlm.2017.04.011

U.S. Department of Health and Human Services. (2018, April 10). Sleep Health. Retrieved April

10, 2018, from https://www.healthypeople.gov/2020/topics-objectives/topic/sleep-health

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HEALTH PROMOTION AND TEACHING NEEDS: based upon your discussions with the client
and the information found above, identify…
Topic(s) that the client would like to/ needs to learn about:
The client would like to learn about developing positive sleep habits that result in longer REM
sleep.
How do these topics relate to Healthy People 2020 and/or USPSTF:
Healthy People 2020 states that poor sleep may lead to neurological, endocrine, and immune
dysfunction. It is important for this client to learn positive sleep techniques in order to maintain
their good health.
Variables which may impact the client’s learning and how this can affect your teaching plan
(SYNTHESIZE & remember to discuss these in your paper):
Economic: Client is retired, works part-time at Costco. During her shift, she is able to learn about
new products and demonstrate them to the public. This enables her to interact with new people and
cultivate friendships within the community.

Cognitive: Her short term memory is impacted by lack of sleep.

Hearing/sight impairments: Client wears glasses and is hard of hearing.

Sensory-motor capabilities or deficits: The client has no sensory-motor deficits. She has full range of
motion.

Education Level: The client possesses and bachelor’s degree in business management and master’s
degree in psychology.

Family System/Support: Matriarch, she is a mother of four, grandmother of four, and great-
grandmother of three. She has family in Charleston, SC with her, family in Richmond,VA and
family in Alton, IL.

Significant variables identified above (communication, space, social organization, environmental control,
biological): Short term memory impairment.

NURSING DIAGNOSIS:
Nursing diagnosis for the client that addresses their health promotion learning needs, including “related
to” and “as evidenced by”. You also may use “at risk for” nursing diagnosis.
At risk for poor short-term memory retention related to poor sleep habits as evidenced by
decreased short-term memory recall.
Desired Measurable Short-term Outcome(s) – with time frame and method for evaluating outcomes:
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Participant will be taught three healthy sleep habits during the second visit; participant will teach
back these methods to the researcher on the second visit, 4/5/2018.

Desired Measurable Long-term Outcome(s) – with time frame and method for client to evaluate
outcomes:
Participant will remove distracting elements from room and darken windows by 4/5/2018.
Survey of Preferred Learning Method(s) *

DIRECTIONS: Read the following statements. If the statement is mostly true for you, then circle the
letter that follows the statement.

1. Once I’ve done something, then I’ve got it…………………………………….…K

2. I must look directly at the speaker to understand him or her……………………..V
3. My handwriting is quite good…………………………………………………….K
4. I can spell words out loud better than when I have to write them down…………A
5. If someone asks me to spell a word, I have to write it down to answer…………..V
6. I would rather listen to tapes then view slides……………………………………A
7. I remember a lecture better than what I read……………………………………..A
8. I understand material better if I read out loud……………………………...……..A
9. I am often the last person to notice that something has been added to a room…...A
10. I learn better if I see and hear the material at the same time………………….V&A
11. I often need to ask people to repeat what has just been said……………………...V
12. Sometimes in a lecture I tune out even when I am really trying to pay attention...V
13. I use my hands a great deal when I speak………………………………………...K
14. I can tell if I’m doing a new physical skill right by the way it feels……………...K
15. I would rather demonstrate how to do something than explain it………………...K
16. I have trouble remembering unless I write things down……………………...V&K
17. A page full of print is too much for me to read…………………………………...A
18. The easiest way(s) for me to learn something is to:
1. Read it……………………………………………………………………V
2. Hear it…………………………………………………………………….A
3. Try it………………………………………………………………………K
4. Write it in my own words………………………………………………...K
5. Explain it to someone……………………………………………………..A
6. Draw a picture or diagram of it…………………………………………...K

TOTAL EACH OF THE LETTERS YOU CIRCLED: V’s __5__ A’s _1___ K’s _7___
V’s indicate visual method; A’s indicate auditory method; K’s indicate kinesthetic method. Add up the
number of A’s, K’s, and V’s. The highest total indicates your preferred learning method.
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*Adaptation of the Swassing-Barbe Modality Index

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