support. When I asked John the reasons why he smoked, he voiced that his habit is done
mainly through boredom and addiction. Although John suffers no chronic breathing
problem, he can become quite breathless on exertion.
Eating and Drinking
John cooks and shops for himself with the support of staff. His diet contains food high in
saturated fat such as fried foods which have a negative impact on his weight. John
receives all benefits entitled to him and his finances are managed well by staff. Therefore
a more balanced diet is affordable. Supermarkets are located close so are easily
accessible. When I asked John about his diet he was not aware of foods that could have
an adverse effect on his health and has always eaten similar foods. John is teetotal
through choice as he said that alcohol had never been of interest to him.
Eliminating
John has no problems with elimination and is doubly continent.
Personal Cleansing
John is able to wash and cleanse himself, although prefers showers before bed as opposed
to showers in the morning. Sometimes John needs encouragement to maintain his
hygiene and wear clean clothes each day. John wears dentures and capable of maintaining
oral hygiene using sterident to soak his dentures each night and mouthwash each
morning.
Controlling Body Temperature
The house John lives in is central heated throughout with the radiator in his room being
adjustable to his own preference. John chooses his own clothes and is capable of
dressing appropriately according to weather conditions.
Mobilising
John mobilises without the use of aides. John openly states that he will not walk long
distances as he feels this makes him more breathless. John does not participate in much
activity during the week and recommended moderate exercise of 30 minutes per day is
not carried out.
Working and Playing
John is involved in a gardening activity one day a week which is organised by social
services. He expressed that he looks forward to Thursdays as this is the allocated day for
the activity. He participates well with whilst there and expressed that he has made some
good friends from the group. When I asked John about his social life he voiced that he
would to have more constructive ways to spend his time as he feels he does not go out
enough.
Expressing Sexuality
John has had no known sexual partners, therefore staff have never felt the need to educate
him on safe sex and John has never raided this as an issue. Testicular examinations have
been carried out in the past by male members of staff with John’s consent. The reasons
for this examination have been explained to John and he understands the reasons and
importance for this.
Sleeping
John sleeps well through the night after retiring at about 11pm. John would quite happily
stay in bed through the day. However, after encouragement from staff he rises before
midday. He expressed that the reasons for this behaviour is because he does not have
anything to look forward to most days.
Dying
Since there was no obvious risk of death in the near future, I felt it was inappropriate to
speak to John about this to avoid unnecessary anxiety.
Concept of Need
After referring to the findings of my health needs assessment, I decided to select
‘smoking’ and ‘diet’. After discussing the outcome of the assessment with John and care
staff we agreed that that the health needs identified are good areas of Johns Health in
need of health promotion, in order for John to make informed choices about his own
health. (Bradshaw, 1972 cited in Naidoo and wills, 2000; Ewles and Simnett, 1999)
identified the following concept of need:
Normative: Need defined by an expert/professional
Felt: Individual identifies what they want
Expressed: What an individual says they need i.e. a felt need turned into a request or demand
Comparative: Comparison between similar groups of patients
Using this concept of need as a tool, I have recognised that the health need ‘smoking’ is a
felt need as John identified this himself and ‘diet’ is a comparative need as his body mass
index indicates a healthy weight for John would be three stones lighter than his current
weight.
Action Plan
Smoking
After talking to John it became clear that he would like to quit smoking as felt it was
detrimental to his health. I have set a goal for this health need which is to provide John
with information so that he could make an informed decision and also to provide him
with any support he may require. This goal is both achievable and measurable by whether
John gives up smoking. As my placement is for only seven weeks, I won’t be there to see
whether John gives up smoking permanently, although Johns Key worker has advised
that she is happy to act on information provided by myself in order to give John the
necessary support required in his determination to give up. I informed John that I would
obtain some information on his behalf about the different support networks and free
advice available. I arranged a consultation with the Roy Castle smoking cessation which
is located only yards from where he lives. It was also felt by John that his inactive social
calendar reflects on the amount he smokes per day. Therefore I felt it was necessary to
channel his time into more productive activities. After discussing interests with John it
became apparent that he enjoyed reading. He mainly read at home in his room, although I
suggested that regular visits to the local library might encourage his interest as well as
reducing the urge the smoke as the library has a no smoking policy in place.
Diet
After calculating Johns Body Mass Index (BMI) I found that John was classified as obese
with a BMI of 30.18. After discussing John’s weight with himself and his carer, a goal
was set for John to reach a targeted weight of 13 stones which is 2 stones lighter than his
original weight. I felt that this was achievable providing John acts on the advice I provide
throughout my placement. This is also measurable by weighing John on regular
occasions. I accessed information from ‘Eat well’ which is a campaign set up by the Food
Standards Agency; this is a government department which provides information
regarding nutrition and healthy eating (). This provided
a base for my action plan for John to diet but also to have the recommended daily intake
of essential nutrients which are needed to maintain healthy eating. After devising a diet
to suit John, we looked into healthy food choices and used simple learning techniques to
describe the differences between grilling as opposed to frying. This meant that John could
eat some of his favourite food although I promoted the need to prepare and cook things in
a different, healthier way. I accompanied him to the supermarket where he took an active
role in distinguishing healthier food options to substitute his initial food choices. After
highlighting issues relating to food and diet, I explained to John that his goal would be
more achievable if he carried out 30 minutes of moderate exercises per day. John voiced
that he would like to become a member of the local gym as he felt that this would
contribute to weight loss and also stimulate his life and be a potential hobby. After
discussing with John and his carers, we arranged convenient days and times in order for
John to become a regular member of the gym. Firstly, I contacted the gym and arranged
an induction which was free of charge. During the induction a qualified trainer
recommended what equipment was best for John to use, taking his learning disability into
account. This induction also allowed me to carry out a risk assessment and it was decided
that John must be closely supervised at all times in order to keep him safe from harm.
Conclusion
On reflection I found that I achieved my objectives by highlighting the key factors in
promoting John’s health which involved looking at him as an individual and his specific
circumstances. The strengths surrounding this health promotion are that John has
participated well and has took a keen interest in the health needs identified. Judging by
his ambitions I am confident that John will continue with the support of staff who have
agreed to go on with this particular action. Unfortunately due to the short space of time
within this setting, I can only presume that the information and health promotion I have
supplied will be a success. In promoting health awareness I was taking a holistic
viewpoint of the client and as such believe I was acting in his best interests. I referred to
relevant sources and gained up to date information with relation to these areas of health
promotion. I did have concerns arising from promoting giving up smoking when I
myself smoke. However I was simply providing John with the information so he could
then make an informed decision. In relation to diet and exercise I was weary about
encouraging a man who is reasonably unfit to make such drastic changes in his day to day
life. Although I was working with John himself and under his consent, I also had the
support of Johns care team and project manager.
I was astonished by the conscious effort made by John himself to obtain the outcomes set
as I appreciate how difficult it must be for someone who has smoked most of their life to
not only attempt to give up but to also introduce healthy eating an exercise at the same
time. On the other hand John has expressed enjoyment of his new activities as it provides
stimulation in John’s day to day life and described by himself as ‘something to look
forward to’. This exercise has increased my knowledge and understanding of the nurse’s
role in promoting health. I have come to understand that working in collaboration with
the client themselves and retrieving the relevant information are key factors in a
successful outcome. I believe the skills that I have developed will assist me throughout
my nursing career in determining health needs and providing holistic support whilst
promoting them.
References
Bunton, R and McDonald, G. (1992) Health Promotion: Disciplines and Diversity. London, Routledge.
Johnson, J. (1993) Progressive Relaxation and the Sleep of Older Men and Women. Journal of Community Nursing. Vol:10 (1) pg: 31
Naidoo, J and Wills, J. (1998) Health Promotion: Foundations for Practice. 5th Edition. London, Balliere Tindall.
Newton, C. (1991) Roper, Logan and Tierney: Model in Action. Hounslow. Palgrave McMillan.
Nursing and Midwifery Council. (2002), Code of Professional Conduct. London. NMC
Scientific Advisory Committee On Nutrition (SACN). www,Sacn.gov.uk
