The World Health Organization(WHO) defines health promotion as “the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being (World Health Organization, 2013).
What health promotion means to my nursing practice is ensuring that all my patients are treated with a holistic perspective. Not only are their physical needs met but they are mentally and socially able to effectively go back into the community with the appropriate resources to help them prosper. Nurses play a huge role in illness prevention and health promotion. We, as nurses assume the role of ambassadors of wellness. I believe that nurses play just as an important role in caring for the well as they do in caring for the sick. Caring for the well can actual be more important than caring for the sick because prevention is key. If we can preserve wellness, we reduce the number of times a person needs to enter the health-care system, thus reducing costs. To facilitate that process, we must provide people with appropriate information. Nurses have a key role in providing that information in the form of health teaching.
An example was when I was caring for one of my patients who was awaiting long term care. She was in with a diagnosis of failure to cope. She did not have many physical needs that needed to be met except assistance with ADL’s and medications. However, she stated to me numerous times how she was lonely and how her family was not able to come visit her often. She was in need of therapeutic communication. She had felt very lonely being trapped in a closed environment such as the hospital for such a long time. Not only was it important for me to meet her physical needs she was in desperate need for her social well-being. I would set a certain amount of time in my day aside to ensure I had time to interact with her throughout my shifts. Being
confined and isolated in the hospital can become very lonely thus, is it vital to ensure adequate communication aside from disease related communication is provided to patients.
One client for whom I have cared for was a 74 year old female who presented with a primary diagnosis of right hip fracture. She had secondary diagnoses of emphysema, asthma and hypertension. The surgery she had performed was right monopolan. She was transferred to the unit after initially arriving at emergency with a fractured hip. She had previously experienced a fall which resulted to her injury.
Psychological needs include oxygen, food, water, a sense of security, sense of self esteem, to learn to be able to give and receive love, affection and feel a sense of belonging. The patient was very independent and lived on her own in a single storey house prior to her fall. I wanted to discuss with the patient how this injury makes her feel in regards to her independence. She was quite upset about the possible fact she might not be able to return to her lifestyle prior to her surgery. I explained to her the many resources she will have available in the community if she wanted to continue to reside alone such as CCAC. I discussed with her they will be able to come to her house if she required assistance with ADL’s following her discharge from the hospital. By addressing her concerns about her illness she portrayed a sigh of relief and became more comfortable about her recovery process.
A patient can begin to feel very lonely once they are admitted to the hospital because it is a very confined space with many strangers that can make some patients uncomfortable. I ensured that I tried to spend enough time with the patient to ensure she was not feeling anxious or alone. I also instructed her to include her family and friends in her recovery. I discussed with her that going on walks with her family when they come to visit, taking a walk to the sunroom in a more interactive environment would make her feel happier and not just a patient in the hospital.
Cultural and spiritual aspects in a individuals life can have a huge aspect in their recovery. I discussed with her what she believed in. She explained
to me that she was a Jehovah witness. She also explained to me that she did not want any blood products due to her beliefs. She told me she was quiet religious and how that helped her a lot throughout her life. I advised her to continue with her routine even while at the hospital and how that would help with her recovery.
Physical needs were also met, with routine meals throughout the day. She was on a full adult diet. Many times the patient was hungry between meals, which is when I would offer her toast, or a sandwich from the kitchen. She was very good with diet, she understood when she was full and when she needed more. She explained to me that she ate a very well-balanced diet at home consisting of fruits, vegetables and protein. She was 160.02 centimeters with a healthy weight of 58.967 kilograms. She was also an active individual, always wanting to try to get up to go to washroom, or going for walks to the sunroom or just around the unit. Her lab results showed that her white blood cells were high at 17.2 which was most likely due to her surgery. Her hemoglobin was slightly low at 105 and similarly her hematocrit at 0.33 for which she was taking ferrous gluconate twice a day. Due to her surgery and her age she was also taking routine calcium and vitamin D tablets. She also had a history of hypertension which was well managed at 122/65 with lopressor (Metoprolol) and cozaar (Losartan potassium). She was also taking a multivitamin (Centrum) for overall nutrients and vitamins. Due to her lab results her potassium was slightly low at 3.0 therefore Apo-K was ordered once daily. The client was having adequate elimination and however, she stated she was not having routine bowel movements although she was taking Colace (Docusate sodium). I explained to her that this was most likely due to her decrease in activity since her surgery. I explained to her once she was able to ambulate more often that they should go back to how they were prior to her injury. I also used this as an opportunity to educate her on how to manage her hypertension through diet. I explained to her how it was important to avoid foods high in salt and fat in order to reduce and maintain her blood pressure. I encouraged her to increase her fluid intake so we could disconnect her from her IV fluids. She was an active participant in her physiotherapy and was quite motivated to ambulate and recover so she could return home.
One obvious wellness diagnosis for this patient was risk of injury from fall related to mobility impairment, compromised musculoskeletal and post-op hip surgery manifested by use of assistive devices, age >65, difficulty ambulating, and weakness in extremities (Ackley & Ladwig, 2008, p. 344).
A second diagnosis is acute pain related to surgical incision on right hip manifested by facial grimace, guarding behavior and verbal report of pain felt in right hip (Perry & Potter, 2010).
A third is risk of infection related to post operative incision on right hip manifested by incision line, open wound and a dressing (Ackley & Ladwig, 2008).
Another diagnosis is activity intolerance related to generalized weakness, right hip surgery manifested by verbal report of pain & weakness, imbalance between oxygen supply and demand portrayed by need for oxygen (Ackley & Ladwig, 2008).
Lastly, a diagnosis of readiness for enhanced self-care related to independence in maintaining life, health, personal development and well-being manifested by verbal desire to return home, desire for independence, well-balanced meals, increase in fluid intake and active participation in physiotherapy (Ackley & Ladwig, 2008).
Ackley, B.J., & Ladwig, G.B. (2008). Nursing diagnosis handbook: An evidence-based guide to
planning care (8th ed.). St. Louis: Mosby Elsevier.
Perry, A. G. & Potter, P. A. (2010). Clinical nursing skills and techniques (7th ed.). St. Louis: Mosby. World Health Organization. (2013). Ottawa charter for health promotion. Retrieved from: http://www.who.int/healthpromotion/conferences/previous/ottawa/en/