Discussion Questions-Behavioral Change
Assignment questions
Have you had the experience of assisting a patient with a behavioral change or provided some type of educational information to a patient in your psych clinical yet this semester? If not in clinical, what about within your current work clinical environment?
What types of education or ideas can you provide to parents of pediatric patients for improving their nutritional habits and general lifestyle habits?Discussion Questions-Behavioral Change
What populations are most at risk for nutritional deficiencies?
What is your role as the FNP in providing nutritional counseling? Who could you collaborate with if needed? Who should you refer a newly diagnosed diabetic patient to?
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What are two benefits of exercise for patients with osteoarthritis, RA, or arthritis? Why is it so important to individualize the exercise plan for each patient?
What are some stress management techniques that would be helpful to use as an FNP in your daily practice for patients who have a stress imbalance?Discussion Questions-Behavioral Change
Why do you feel (in your own words) it is important to address a patients stressors during their appointment?
What are some stress management techniques that you feel you could benefit from as a working student from the lecture?
Discussion Questions
- I have indeed had the experience of assisting a patient with behavioral change in my psychiatry clinical this semester. The opportunity presented itself when a patient with posttraumatic stress disorder (PTSD) who underwent his first psychiatric interview in the clinic the previous week was seen by the therapist. The patient was put on both pharmacotherapy and psychotherapy. The latter was to be in the form of cognitive behavioral therapy or CBT to engineer cognitive remodelling in the patient (Corey, 2017). It was therefore during the first CBT session for this patient that I got the opportunity to assist the therapist with educating the patient on changing their thoughts to help change their behavior. The experience was very educative and enabled me to sharpen both my affective and psychomotor skills as a future advanced practice registered nurse (APRN). I got to apply what I had learnt in theory in practice with regard to taking the patient through the steps of changing their thought process to be able to change their behavior. In this case, the patient needed to avoid thoughts about past misfortunes and replace them with positive thoughts. In the end, this would influence a change in their behavior such as avoiding public social places. This was a survivor of a terrorist attack and has always evaded being present in public places as much as he can. The CBT session was an eye-opener for me in assisting patients with psychiatric problems that require help with behavioral change. It is my intention to grasp any other similar future opportunity so that I can perfect my therapy skills with patients suffering from mental health problems.
- There are several types of education and ideas that I can give to parents of child patients with regard to dietary and general lifestyle habits. To begin with, it will be important for them to understand that childhood obesity is a big public health problem in the United States in particular and the world at large. In the US alone, it is estimated that one in three children aged 2-19 years are either overweight or obese (Wolstein et al., 2015). For this reason, it would be desirable for the parents of those child patents to understand the link between obesity and nutritional intake. To better illustrate this, I will use the proven fact that obesity disproportionately affects children in families of low socioeconomic status (Kornet-van der Aa et al., 2017). I will educate the parents to understand that it is the dietary choices and nutritional intake of these poor populations that largely contribute to the obesity epidemic among poor populations. Because low income families cannot afford healthy foods, they resort to buying for their children cheap high-calorie snacks and beverages as well as fast food that have very low nutritional value apart from the calories. When combined with many hours of watching television daily as well as lack of physical exercise, this results in the development of overweight and obesity. I will advise these parents to avoid the cheap but less nutritious foods and try as much as they can to prepare for their children fresh foods with ample fruits and vegetables.
I will also educate the parents of the child patients about the role of the other factors that must be present with poor nutrition for obesity to develop in a child. These are a sedentary lifestyle such as watching many hours of television and the child not engaging in any sporting activities. This way, the parents will know that they need to encourage their children to watch less of television and engage more in physical activities. Finally, I will let the parents know the cost and seriousness of overweight and obesity in terms of comorbid conditions such as type II diabetes mellitus, hypertension, arthritis, and heart cardiovascular complications such as myocardial infarction. Knowing this will hopefully inspire them to teach their children to practice healthy lifestyle habits for a longer life. It is known that obesity significantly reduces the life expectancy of the person suffering from it (Abdelaal et al., 2017). Discussion Questions-Behavioral Change
- According to Bruins et al. (2018), the populations most at risk for nutritional deficiencies are critically ill persons, older adults, women of childbearing age who are either pregnant or lactating, children, adolescents, obese persons, as well as infants and toddlers. Critically ill patients usually have no ability to meet their nutritional needs by themselves. For this reason, they are dependent upon the decisions of others to meet those needs. Another factor that makes them more prone to nutritional deficiencies is that they cannot orally ingest solid or liquid food. That means they can only be fed through a nasogastric tube of parenterally. These methods of alternative feeding have their own challenges and deficiencies when it comes to meeting the nutritional requirements of a critically ill patient. One particular challenge is that the liquid foods/ nutritional supplements that go into the patient must be decided by an expert. Older adults on their part have a gastrointestinal tract and digestive system that has considerably reduced efficiency in terms of absorption and other factors. For this reason, they may not get the maximum benefit from the food they ingest and end up suffering nutritional deficiency. To complicate matters, older adults almost invariably suffer from various chronic diseases that affect their nutritional status. An example is the neurocognitive disorder Alzheimer’s disease which makes the person forgetful about meals.
Women who are either pregnant or breastfeeding are not only meeting their own body’s nutritional needs, but also those of the newborn. For this reason alone, women who are either not socioeconomically capable or are busy professionally may find themselves unable to meet the nutritional needs of both. Infants, toddlers, children, and adolescents on their part are going through developmental stages of rapid growth that require foods of high nutritive value. That means they can easily face nutritional deficiency if they get into situations in which food is either scarce or low in nutritional content. And the last group of people at risk of nutritional deficiencies are persons who are obese. Overweight and obesity as a medical condition is not produced by overabundance of food. Rather, it is caused by poor choices regarding the food that one eats. Particularly, its development is encouraged by the consumption of foods rich in calories and almost nothing else. Because obese individuals do not take enough fruits and vegetables in their diet, therefore, they are likely to suffer nutritional deficiencies. Obese persons have been found to suffer from deficiencies of especially micronutrients and ions such as ascorbate, B complex, fat-soluble vitamins, magnesium, and calcium. According to McKay et al. (2020), the deficiency of these factors is associated with an increase in the body mass index or BMI. Discussion Questions-Behavioral Change
- The role of the Family Nurse Practitioner (FNP) in providing nutritional counseling is limited to health promotion. The FNP advises and educates the patient on the importance of regularly eating a balanced diet and how this is important in preventing disease. However, the FNP is not a nutrition expert and cannot delve into the details of specific nutritional requirements for the patients. In performing this task of nutritional counseling, the nurse practitioner needs op practice close interprofessional collaboration. When required, she will need to collaborate with nutritionists and dieticians ho can then give the patient expert nutritional details and guidance. In the case of a newly diagnosed diabetic patient, the FNP should refer them to a registered dietician for nutritional guidance and meal planning.
- Two benefits of exercise for those with rheumatoid arthritis, osteoarthritis, or arthritis are (i) that exercise strengthens the musculature surrounding joints thereby making them more stable and resistant of additional wear and tear; and (ii) that exercise augments flexibility of the joint as well as strength thereby increasing the range of movement and lowering the joint pain caused by difficulty in movement (Arthritis Foundation, n.d.). It is important to individualize the exercise plans for different patients suffering from all the forms of arthritis because the extent of disability is different for each patient. That means before coming up with an exercise plan for every individual patient with arthritis, a thorough assessment must first be performed to ascertain the extent of the condition as well as the extent to which the patient can endure and tolerate physical activity safely. In a nutshell, therefore, one exercise plan cannot work for two arthritis patients as there is no one-size-fits-all solution.
- For those patients who have a stress imbalance, some of the stress management techniques that would be helpful and that the FNP may advise are regular physical activity in terms of isotonic and resistance exercise, time set aside for leisure and relaxation, eating a regular balanced diet with enough fresh fruits and vegetables, and having enough rest and sleep to rejuvenate after a stressful day. Exercise improves blood flow to the whole body including the brain. This makes neurotransmission more efficient and therefore stimulates activity in the reward pathways such as the dopaminergic mesolimbic pathway. Activity of the dopaminergic neurons in this area of the brain produces a feeling of pleasure and reduces stress (Stahl, 2013). A proper diet that is balanced ensures that the body gets all the nutrients that it requires to function correctly. This plays a part in the reduction of stress as the lack of micronutrients and important ions is bound to interfere with biochemical and metabolic reactions that prevent the brain from being susceptible to stress. Last but not least, having enough rest/ sleep as well as leisure time ensures that the body is rejuvenated and refreshed to take on the next day-to-day challenges. Discussion Questions-Behavioral Change
- I feel it is important to address a patient’s stressors during their appointment because (i) stress will make the patient not concentrate on the session, (ii) stress will make the patient not understand properly the medical advice given during the appointment, and (iii) stress will interfere with the adherence of the patient to treatment schedules and therapeutic recommendations.
- Personally as a working student from lecture, some of the stress management techniques I feel I could benefit from are (i) some form of physical exercise such as aerobics, (ii) enough rest and sleep, and (iii) socializing with family and friends.
References
Abdelaal, M., le Roux, C.W., & Docherty, N.G. (2017). Morbidity and mortality associated with obesity. Annals of Translational Medicine, 5(7), 1-12. http://dx.doi.org/10.21037/atm.2017.03.107
Arthritis Foundation (n.d.). Benefits of exercise for osteoarthritis. https://www.arthritis.org/health-wellness/healthy-living/physical-activity/getting-started/benefits-of-exercise-for-osteoarthritis
Bruins, M.J., Bird, J.K., Aebischer, C.P., & Eggersdorfer, M. (2018). Considerations for secondary prevention of nutritional deficiencies in high-risk groups in high-income countries. Nutrients, 10(1), 47-61. http://dx.doi.org/10.3390/nu10010047
Corey, G. (2017). Theory and practice of counseling and psychotherapy, 10th ed. Cengage Learning.
Kornet-van der Aa, D.A., Altenburg, T.M., van Randeraad-van der Zee, C.H. & Chinapaw, M.J.M. (2017). The effectiveness and promising strategies of obesity prevention and treatment programmes among adolescents from disadvantaged backgrounds: A systematic review. Obesity Reviews, 18(5). https://doi.org/10.1111/obr.12519
McKay, J., Ho, S., Jane, M., & Pal, S. (2020). Overweight and obese Australian adults and micronutrient deficiency. BMC Nutrition, 6(12). https://doi.org/10.1186/s40795-020-00336-9
Stahl, S.M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications, 4th ed. Cambridge University Press.
Wolstein, J., Babey, S.H., Diamant, A.L. (2015). Obesity in California. UCLA Center for Health Policy Research. https://healthpolicy.ucla.edu/publications/Documents/PDF/2015/obesityreport-jun2015.pdf
Discussion Questions-Behavioral Change