Health Promotion and Maintenance of Health
Best Practices in Health Promotion for Elderly Persons with Type II Diabetes
Since the 60s, many societies have struggled with defining health as more than merely the absence of disease. Health was conceptualized by Dunn (1961) as a high level of wellness that emphasizes actualization. In 1974, the World Health Organization would define health as “a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity” (WHO 1974). This definition would capture the evolving idea that health should be more than the absence of illness. Since this definition, discussion and debate have continued to measure and assess health when looking at more than just morbidity and mortality. People above the age of 65 with chronic illnesses such as diabetes need to understand the nature of their diseases and be empowered to avoid smoking, obesity, and unhealthy diets (Tack et al., 2018). They also need to be encouraged to control blood glucose and to exercise. The above, accompanied by good health education and access to professional care, is part of health promotion for diabetes and some of the critical roles that are played by nurses.Health Promotion and Maintenance of Health
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As stated, most nurses understand health promotion to be part of their nursing role. However, according to Pham and Ziegert (2016), health promotion is usually viewed as health education. Health education is defined as the planned process that aims to achieve health and illness-related learning, and it is a significant part of an empowerment health promotion model. Health promotion, on the other hand, is a process that facilitates people to improve and enhance control over their health. It includes health education and different strategies to meet the environmental and social determinants of health. Environmental factors include all factors that affect health, be it directly or indirectly. Factors directly affecting health include a shortage of food and exposure to toxic materials. In contrast, those that affect it directly include a lack of access to exercise facilities, resulting in lower physical activity levels. A supportive environment is another given concept in health promotion and is described as a social, economic, physical, and political environment that supports health (Tack et al., 2018).
New treatments reduce the burden of mortality and morbidity of diabetes in adults above the age of sixty-five. Despite these advances, what remains essential is that diabetes and its complications can be delayed or prevented by the modification of risk factors (Fagherazzi and Ravaud 2019). In the spirit of health promotion, this research paper analyses nurses’ role in leading health promotion against diabetes mellitus in adults over the age of sixty-five.Health Promotion and Maintenance of Health
Literature Review
Elders with Type II Diabetes
For older individuals, research has shown that there are two distinct paths. The first path involves a sedentary lifestyle. This path is characterized by overweight and ultimately leads to the burden of type 2 diabetes. The second path is an active lifestyle that can prevent or, at the very least, delay this disease’s onset. Older adults, if equipped with some essential strategies, can beat the odds of acquiring diabetes. The landmark study known as the Diabetes Prevention Program (DPP) is known to have shown the importance of lifestyle approaches for this condition. The 2002 survey carried out by the National Institutes of Health (NIH) and subsequently published in The New England Journal of Medicine provides credence to the above approaches. The study was a randomized clinical trial involving 27 centers and over 3,200 participants over the age of 25. These individuals were at risk of developing type 2 diabetes. The study would evaluate the effects of intensive lifestyle modifications, including moderate physical exercise and healthy diets, standard care plus placebo, and usual care plus the drug metformin in the prevention and delaying type 2 diabetes. According to the study, people facing an increased risk of developing this disease could delay or prevent it by losing from between 5% to 7% of their body weight. This should be achieved through moderate physical activity and reduced caloric and fat intake. These interventions were measures of health promotion and can be facilitated by nurses. In the study, these interventions would work better for people above the age of 65 as they reduced their risk of developing diabetes by 71% (Diabetes Prevention Program Research Group 2019).
Health Promotion
Holistic interventions in health promotion, however, involve the entire person. In health promotion for diabetes patients, it will involve the integration of the patient’s body, mind, and spirit in the health promotion process. For example, it is the role of nurses to encourage patients to maintain positive attitudes and use spirituality, physical activity, music, art, and other tools to assist them in coping with their condition (Whitehead et al., 2017). With conditions such as diabetes that are non-communicable, there is evidence suggesting that healthy mindsets and lifestyles could positively impact how the patient deals with their diagnosis. The patient’s motivation to understand diabetes and seek help begins in their mind. Therefore, one of the main components of holistic health promotion involves being positioned to mentally grasp the relationship between the thought and the healing processes. Nurses participate in this process through interdisciplinary relationships with counselors and therapists who will ease the process of getting over the initial shock of diagnosis and making a choice to seek education and make the required lifestyle changes.Health Promotion and Maintenance of Health
Once the decision to seek education and engage in behavior change has been reached, nurses have reported the next step to be the use of behavior change and health coaching. This intervention will also have an interdisciplinary component as a nutritionist will be consulted to offer direction on the patient’s diet. In contrast, a physical therapist will offer advice on an exercise regime that fits a particular patient. As the patient begins the recommended diet and physical exercises, the nurse is to embark on reinforcing information provided by the other specialists while embarking on interventions of their own. They will offer guidance on preparing the foods as directed by the nutritionist, getting support from members of the family and signs and symptoms of hyperglycemia and hypoglycemia that the patient should expect (Whitehead et al., 2017).
Recommendations
Research has shown that type 2 diabetes patients have better outcomes when cared for by a multidisciplinary team. The main ambition of any health promotion program therefore should be to increase collaboration between patients and healthcare professionals, between program managers, healthcare centres and community stakeholders (Subrata and Phuphaibul 2019). Nurse leaders should therefore take the mantle when it comes to the development of these interdisciplinary taskforces to ensure that the patient has all relevant medical options on how to promote their health after their diagnosis.Health Promotion and Maintenance of Health
Patient education is also ranked as among the most effective best practices. As stated earlier in this response, patient education is key in ensuring that patients diagnosed with this form of diabetes understand how the disease is affecting them and how to improve their health and quality of life. This will ensure that the patient plays an active role in their health promotion and that they do not succumb to the pressure of the necessary life changes. Patient education also prevents diabetes patients from getting depression. People Suffering from Diabetes are twice or three times more likely to have depression than people free of the disease. Only about 50% of people with diabetes and have depression get diagnosed with the condition and get treatment (Ely et al., 2017). Treatment, however, is often very useful as it includes both therapy and medication. Educating patients on the same will ensure they seek immediate help if the symptoms display themselves. These symptom include feelings of sadness and emptiness, loss of interest in activities that one enjoyed engaging in, loss of appetite or overeating, sleeping too much or suffering from insomnia, problems with concentration and decision making, fatigue, irritability, and in extreme cases, thoughts of death or suicide. If signs of depression are detected, nurses are positioned to ensure that the patients get in touch with a psychiatrist for immediate intervention. It is recommended that this education be encapsulated in training on palliative care for patients with type 2 diabetes and therefore also involve caregivers.
According to Abd Elgaphar and Abd El‐Gafar (2017), telenursing is also an intervention that nurses have successfully offered to patients with diabetes as part of a holistic approach to health promotion. Studies have shown that the use of telenursing for following up with patients can have positive effects on both HbA1C and metabolism control and can improve both in twelve weeks. Studies have also shown that follow-ups over the telephone can improve the control of the Glycemic index and the process of self-care in patients with this form of diabetes. This was seen to be a function of the increased role that the patient takes on in taking care of themselves, patients discovering a new form of relation, and increases in their training and contact with healthcare provides. Telenursing should, therefore, be recommended and programmed as part of health plans for patients with type 2 diabetes.Health Promotion and Maintenance of Health
Limitations
The most significant barrier to the implementation of the above best practice program relates to the challenges that people above the age of 65 may have that will hinder them from pertaining to the recommended physical exercise (Fagherazzi and Ravaud 2019). As this response has stated, these include medications, cardiac issues, and joint health and may make it difficult to achieve both short-term and long-term goals with the participants. This can be overcome by ensuring that participants selected for the study are physically fit to undertake the recommended 30 minutes of daily exercise.
Another limitation that this program may face will relate to developing different diets for all the participants. While it is easier to design an exercise regimen that fits all participants, different participants will have different dietary needs and restrictions. As far as benefits are concerned, nurses working in such a project will get hands-on, evidence-based experience in diabetes prevention and management. Patients that participate in nurse-led holistic programs such as the above will have their risk of developing the disease, and its complications significantly reduced.
Interdisciplinary Aspect
For the development and implementation of the above program, an interdisciplinary team will be essential. Nurse leaders would spearhead the intervention program and get support from nurses. Psychiatrists will be on board to assess and treat symptoms of depression after assisting the patient in coming to grasp with their diagnosis. Nutritionists will be consulted in the development of individualized nutrition plans. Physical therapists will be consulted in the development of exercise prescriptions. Such projects are typically both funded and overseen by the board of directors of the specific healthcare installation carrying out. The benefits of including the above stakeholders are clear cut. Type 2 diabetes health promotion programs seek to offer the best recommendations to participants to get the best results. The health facility will benefit from gaining knowledge on evidence-based practice and improved patient outcomes. Nurses who will be at the front line will get the experience and prowess. The participants will benefit from improved health outcomes and a reduced risk of developing diabetes.Health Promotion and Maintenance of Health
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Summary
The above plan is a health promotion and health maintained plan aimed at reducing the risk of type 2 diabetes among the elderly. The program is based on evidence-based outcomes such as weight loss, physical exercise, and healthy eating to reduce said risk. The program is to be developed and run by nurses in coordination with other stakeholders ranging from a board of directors to nutritionists and physical therapists. If successful, this program will not only provide an evidence-based approach to reducing the risk of the disease, thereby improving patient outcomes, but it will reduce the burden of the disease on patients, health facilities, and the national health expenditure.
References
Abd Elgaphar, S. M., & Abd El‐Gafar, S. I. (2017). Effect of tele-nursing (phone-based follow-ups) on self-efficacy, healthy lifestyle, and glycemic control in diabetic patients. J Nurs Health Sci., 6(3), 67-76.
Ely, E. K., Gruss, S. M., Luman, E. T., Gregg, E. W., Ali, M. K., Nhim, K., … & Albright, A. L. (2017). A national effort to prevent type 2 diabetes: participant-level evaluation of CDC’s National Diabetes Prevention Program. Diabetes care, 40(10), 1331-1341. doi: 10.2337/dc16-2099.
Fagherazzi, G., & Ravaud, P. (2019). Digital diabetes: Perspectives for diabetes prevention, management and research. Diabetes & metabolism, 45(4), 322-329. doi: 10.1016/j.diabet.2018.08.012.
Pham, L., & Ziegert, K. (2016). Ways of promoting health to patients with diabetes and chronic kidney disease from a nursing perspective in Vietnam: A phenomenographic study. International journal of qualitative studies on health and well-being, 11(1), 30722.
Subrata, S. A., & Phuphaibul, R. (2019). A nursing metaparadigm perspective of diabetic foot ulcer care. British Journal of Nursing, 28(6), S38-S50.
Tack, C. J., Lancee, G. J., Heeren, B., Engelen, L. J., Hendriks, S., Zimmerman, L., … & van de Belt, T. H. (2018). Glucose control, disease burden, and educational gaps in people with type 1 diabetes: exploratory study of an integrated mobile diabetes app. JMIR diabetes, 3(4), e17. Health Promotion and Maintenance of Health