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Promoting Weight Loss and Nutrition.
Transcript of Promoting Weight Loss and Nutrition.
Empowerment and Motivation
PROMOTING WEIGHT REDUCTION
Aims and Objectives
Primary, secondary and tertiary Health Promotion
The RCN believes in ‘going upstream’
Good communication skills and building therapeutic relationships
Nurses are ideally situated in healthcare
Nurses are obliged to educate (NMC 2008)
Promote patient lead Health Promotion
: Can be defined as the distribution of different health states amongst a particular population where various bio-psychosocial factors may affect specific conditions or diseases (Valinis 1999).
Last (2001) similarly suggests these ideas. However, additionally; it is explained that it also involves discovering health prevention and promotion measures which can work effectively in providing solutions to different health problems.
We chose this range of people as we felt the information available to people who are "overweight", may not be being actively promoted to them. They may be perceived as "average" due to the ever rising levels of obese and morbidly obese people.
This has been experienced by all of us on clinical placements where nurses may just categorise patients as an average BMI on scales such as Waterlow, MUST and WASSP.
The most well known definition of health comes from the World Health Organisation (WHO) (2013), who state "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."
WHO (2013) defines health promotion as, "The process of enabling people to increase control over, and to improve, their health."
CYCLE OF CHANGE MODEL
(Scriven 2010 adapted from Prochaska and DiClemente 1984)
Support Self Effiicacy
Roll with Resistance (Dart 2011).
What is it?
By definition " a client centered, semi-directive method of engaging intrinsic motivation to change behavior by helping clients explore and resolve ambivalence"
F R A M E S
Responsibility is on the patient
Menu of change options
Empathetic style of communication
Britt et al 2004
Long & short term detrimental effects...
Eat 5 portions of fruit and/or vegetables a day
of individuals are overweight
(BMI = 25-30)
of adults are obese (BMI = 30+)
"non judgemental attitude"
Strengths of using BMI
1) Its not expensive
2) easy to calculate
Many times BMI is criticized by the media and public as its main flaw is not being able to distinguish between FAT and MUSCLE.
It is over emphasised by the media by using an A list celebrity such as Brad Pitt who has a BMI that is technically obese?
Nurses need to reassure their patients that they also use a clinical judgement when completing assessments.
THE HEALTH BELIEF MODEL (HBM)
(Rosenstock 1974, cited in Rutter and Quine 2005)
Cues to action
Thinking about change
Ready to change
Maintaining 'safer' lifestyle
Not interested in changing 'risky' lifestyle
Body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify overweight and obesity in adults.
BMI= weight / height² (kg/m2).
STRENGTHS and WEAKNESSES of the CYCLE of CHANGE MODEL
Individuals may not be able to vision or see their goal as it is difficult for health professionals to give a time frame.
Difficult for health professionals to determine when people are ready to undergo change.
(West 2005, Hubley and Copeman 2008 and Naidoo and Wills 2009)
Easy for nurses to incorporate in their practice, as the models of health promotion can be applied to the nursing process, which is: assess, plan, implement, evaluate and reassess.
Acknowledges change can be a long and daunting process.
Can be applied in any context or health promotion areas.
(Linsely et al 2011)
Social support mechanisms and peer support
Specific population groups are at a greater risk of becoming overweight or obese. These groups tend to be the socially deprived groups in society which include:
Low income groups
Low education levels
Ethnic minority groups
(Ewles 2005 and Worsley 2008)
Internal locus of control:
A person believes their behaviour is caused primarily by their their own personal decisions and efforts (Cardwell and Flanagan 2008, p.164).
...if someone believes that they have a choice about whether or not they promote their own health through healthy eating they are more likely to try and eat healthily (Gottwald and Goodman-Brown 2012, p.94-95).
External locus of control:
A person believes their behaviour is caused primarily by fate, luck or circumstances (Cardwell and Flanagan 2008, p.164).
... someone who has an external locus of control is less likely to try change to change their diet for healthy one as they may believe this will have no effect (Gottwald and Goodman-Brown 2012, p.95).
The WHO's definition of health is more comprehensive as it considers mental and social influences on health and so is more holistic approach in defining health.
"Any combination of health education and related organizational, political and economic intervention designed to facilitate behavioural and environmental adaptations which will improve or protect health." (Anderson 1983 cited in Bunton et al. 2005)
Key components of health promotion:
To adjust health services and their resources towards the promotion of health
Seek current health promotion in nursing practice, and find effective ways to implement health promotion strategies
Prevention rather than cure
Peer support and peer learning needs to be promoted
Slimming World, Weight Watchers
Family and friends
Charitable organizations such as Self Help UK
Patient support/education groups such as Education Programmes for Patients (EPP Cymru).
Nutritional habits are often learned from family and friends
Encouraging the whole family to make change is often very effective, for example going on walks together and all eating a balanced diet together
Weaknesses of using BMI
2) Boundaries of categories can be changed and are different in different countries
"Health is defined and measured as the absence of disease and the presence of high levels of function" (Scriven 2010).
Strengths and Weaknesses of HBM.
Low self esteem
(Vaca Durr 2012)
It is argued that the model doesn't take in some factors such as outcome expectancy in order to predict health behavior e.g. whether the patient truly acknowledges or feels that they will be healthier as a result of their new behavior.
Emphasis is solely on the individuals perception and understandings, the model fails to acknowledge any socio-economical influences on people's behaviour.
Does not take into account social norms or peer influences on perception. (Jansz and Becker 1994, Melnyn 1988).
Makes reasonable predictions e.g. small threats or sacrifices can have big long term rewards.
Even-though the HBM was not constructed to specify particular intervention strategies, it has been able to aid nurses to understand varying client behaviors and help correct them by altering their belief system (William 2011).
To understand the concept of health promotion and its relation to nursing practice.
To understand the importance of promoting weight reduction and nutrition.
To demonstrate the use of the health promotion models in practice.
Take into account the ethical considerations when providing health promotion.
Provide an overview of available resources clients can gain access to.
By Lauren Chatwin, Alix Crothers, Camilla Edwards, Chris Roberts and Adam Skinner
Relevant Legislation and Frameworks
Change4Life Wales (2013)
All Wales obesity pathway (WAG 2010)
Obesity, guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children (NIHCE 2010)
Creating an Active Wales (WAG 2009)
Framework for Action Nutrition (NPHS Wales 2005)
Food and Well Being,
Reducing inequalities through a nutrition strategy for Wales (Food Standards Agency Wales and WAG 2003)
Food and Fitness - Promoting Healthy Eating and Physical Activity for Children and Young People in Wales. 5 Year Implementation Plan (WAG 2006)
25.6 - Overweight
30.8 - Obese
17.9 - Underweight
5 A Day
30 Minutes of Exercise
5 Times a week
Cut Down Fat Intake
Walk for Health
National Exercise Referral Scheme
(Welsh Government 2012)
1.4 Billion adults are overweight, approximately 500,000,000 are obese.
37% classified as overweight
25% classified as obese
(Health and Social Information Center 2013)
high need to achieve
the feeling of always being under pressure.
degree of drive and ambition
degree of past and present competitive, aggressive and hostile feelings
degree of time-urgency.
(Cardwell and Flanagan 2008)
being patient, relaxed and easy going and therefore less vulnerable to stress.
we need to do something now
Aims and Targets
WEIGHT IS NOT SYNONYMOUS TO HEALTH
HUMAN RIGHTS ACT
(Berridge & Liddle 2010, DoH 2001, Nursing Times 2009, Piper 2009 and WAG 2008)
BMI = 28
History of depression
GP with chest tightness and feeling generally unwell
ECG- ischaemia- Acute Chest Pain Clinic.
Cannot be 'bothered to cook'
Regularly snacks and eats takeaways
He has never had regular BP or cholesterol check
(Gottwald and Goodman-Brown 2012)
Locus of Control
Empowerment involves collaboration and working together, and deciding on goals and action plans, and therefore it is necessary that health promotion activities engage the individual, so that they are enabled to empower themselves .
(Gottwald and Goodman-Brown 2012)
Assumptions that may be made about patients:
This person ought to change.
This person wants to change.
It is the right time for this person to change.
If this person decides not to change, this intervention has failed.
A tough approach is always best.
For this person, health is a prime motivator.
I'm the expert. This person must follow my advice.
(Scriven 2010, p.195)
Seligman 1980 (cited in Niven 2001, p.132) proposed that depressed people have learned helplessness from experiences and believe themselves unable to influence and control events... Over a period of time they have felt themselves to have no control their circumstances, they have perceived themselves to have 'no way out'. Thus, even when presented with 'an escape route', they do not take it but 'crawl into themselves' and give up trying.
(Green and Tones 2010 and Ustun and Jakob 2005)
(Dougherty and Lister 2011)
(Public Health Wales 2011)
The importance of exploring this health behavior and promoting health is high on the agenda as it is estimated that it approximately costs the NHS over £5 Billion a year to treat the impacts and consequences of being overweight or obese in the UK.
(Department of Health 2013)
(Romero-Corral et al 2008 and Stephenson 2013)
(Rollnick and Millner 2007, Leifer and Hartson 2004, and Polan and Taylor 2003)
(Scriven and Hodgins 2012)
(Green and Tones 2010)
(Green and Tones 2010)
(Scriven and Hodgins 2012)
(Bandura 1977, NMC 2008, Green and Tones 2010, Gottwald and Goodman-Brown 2012 and Change4Life Wales 2013)
(WHO 2009 & NMC 2008)
(DoH 2001, Health Development Agency 2005, NHS Choices 2013, WAG 2008 & Weight Watchers 2013 & WHO 2001)
(Health Magazine 2013)
Evidence Based Practice
Consider clinical judgement when calculating BMI
Have an understanding of the various Health Promotion Models available for nurses
Treat each patient as an individual
Health promotion as a means of prevention rather than cure
All nurses must support and promote the health, wellbeing, rights and dignity of people, groups, communities and populations.
1) It does not distinguish between fat or muscle tissue
(Welsh Government 2011)
(Welsh Government 2012)
(NMC 2008, Office of the United Nations High Commissioner of Human Rights and World Health Organisation 2008)
(NMC 2008 and Green and Tones 2010)
(Public health wales 2011)