Running head: HEALTH PROMOTION PROJECT 1

Health Promotion Project

Jennifer Pierce

NUR 4113: Gerontological Concepts and Issues

April 2, 2018

Honor pledge statement: I have neither given nor received aid on this assignment, nor have I
seen anyone else do so
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Assessment

In March 2018, over the course of four visits and multiple phone calls, a health

promotion project was completed with an older adult client. The client is a 73 year-old

Caucasian female in overall good health. The client suffers from no chronic diseases and has no

significant past medical history. The client is of normal weight and appears to engage in a

healthy lifestyle that includes a well-balanced diet, no smoking and moderate alcohol

consumption. The client lives independently with her husband and enjoys an active social life

with friends. The client has six grandchildren nearby and is active in their caretaking.

Although the client has been able to maintain a healthy weight as she ages, she is concerned

about losing muscle strength and the subsequent potential for falls. Thus, a teaching plan for the

client was developed to provide education about muscle-strengthening activities.

Exercise supports the overall Healthy People 2020 goal to improve the health, function,

and quality of life for older adults. Exercise, including muscle-strengthening activities, most

notably relates to the following Healthy People 2020 older adult objectives: 1) reduce the

proportion of older adults who have moderate to severe functional limitations; 2) increase the

proportion of older adults with reduced physical or cognitive function who engage in light,

moderate, or vigorous leisure-time physical activities; and 3) reduce the rate of emergency

department visits due to falls among older adults (Healthy People, 2018). The teaching plan also

relates to the U.S. Preventive Services Task Force recommendation that community-dwelling

adults age 65 and older engage in regular exercise to prevent falls (U.S. Preventive Services Task

Force, 2018).

Nursing Diagnosis
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The nursing diagnosis for the client is readiness for engaging in a regular physical

activity program related to client’s concern about muscle wasting as evidenced by client

expressing willingness to begin a regular physical activity program (Gulanick & Myers, 2014).

The client stated that her primary health promotion need as she ages is to maintain her physical

independence. The client noted that she has watched her peers and her sister become weaker as

they age and that she is starting to see how this connects to their increasing physical limitations.

For example, the client observed her sister being unable to rise from the floor after playing with a

grandchild. She noted that her sister simply did not have the muscle strength to push herself up

from the floor. The client is fully engaged in her role of grandmother and appears worried that

she may find herself in a situation similar to her sister if she does not begin muscle-strengthening

activities.

Additionally, the client also has plans to age in place with her husband, assuming they

both maintain their physical mobility. The client understands that a fall could cause serious

injury and adversely impact her ability to stay in her home. Given her current level of

independence and mobility, the client is motivated to take the steps necessary to maintain her

current quality of life.

The health promotion project was conducted in March, 2018. Four in-person visits with the

client took place as follows:

▪ March 3, 2018 – initial meeting and discussion of project, exploration of health

promotion interests

▪ March 9, 2018 – assessment tools completed and initial, collaborative development of

teaching plan
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▪ March 17, 2018 – Review and discussion of teaching plan, teaching activities, evaluation

of short-term objective

▪ March 31, 2018 – Final visit with client, evaluation of long-term outcomes, and follow-

up planning

In between visits, phone calls with the client were conducted to review the teaching plan, clarify

information and provide encouragement in achieving outcomes.

The short-term outcome for this teaching plan was that the client will verbalize accurate

information about benefits of increasing physical activity and strategies to develop a personal

program of increased lifestyle activity (Gulanick & Myers, 2014). The outcome was measured

by having the client restate what was learned during the teaching and engage in discussion and

related Q/A about the topic. The timeframe for accomplishing this outcome was March 17,

2018.

The long-term outcome for this teaching plan was that the client performs muscle-

strengthening exercise on at least two days per week. The outcome was measured by having the

client complete an activity log and self-report on her exercise. The timeframe for accomplishing

this outcome was March 31, 2018. During the final visit with the client, strategies to continue

meeting this objective were discussed, including the use of the activity log and identifying a

support person to provide accountability.

Teaching Plan

The teaching plan was mutually developed with the client during the first two weeks of

the project. During the first two client visits, the client’s goals and expectations were discussed.

Additionally, strategies for success and potential barriers to change were identified. For

example, setting small, realistic goals was deemed crucial to success. As a result, the teaching
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plan called for only ten minutes of exercise twice a week in the beginning. Also, the client is

well-educated, likes to read and as a former nurse, expects a program that incorporates evidence

based practice. As such, the teaching plan utilized material from the Growing Stronger: Strength

Training for Older Adults program, which was developed by the Centers for Disease Control

(CDC) and Tufts University (2002). The Growing Stronger program also appealed to the client

because it provided substance as well as comprehensive resources, including activity logs, in one

document. The client stated that with previous attempts at regular exercise she felt overwhelmed

by all the information on the Internet and not knowing where to start.

The content of the teaching was taken from the Growing Stronger book provided by the

CDC. Growing Stronger is a 12-week program comprised of Part 1 (weeks 1-2), Part 2 (weeks

3-6) and Part 3 (weeks 7-12). The four exercises from Part 1 were included in the teaching plan.

These exercises included a warm-up, squats, wall push-ups, toe stands, and finger marching.

Teaching activities were conducted during the third client visit on March 17, 2018.

The teaching approach utilized was informal, to include discussion, demonstration and practice

by the client. The teaching was organized as follows:

▪ Benefits of strength training – building strength, maintaining bone density, improving

balance, coordination and mobility, reducing the risk of falling, and maintaining

independence in performing activities of daily life

▪ Personal goal setting – completion of goal setting worksheets from book, scheduling

time for exercise, and identification of potential barriers as well as strategies for success

▪ Exercises – review of Part 1exercises, including review of visual aids and instructions

from book, demonstration, and repeated practice

▪ Next steps – completing activity logs, plan for follow-up visit, Q/A
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Between March 17, 2017 and March 31, 2018, multiple phone calls with the client took place.

The purpose of the calls was to provide the client with support and encouragement, review the

client’s progress in completing the scheduled exercises and provide information if the client had

any questions.

Research provides evidence about the benefits of physical exercise and strength training

for older adults in terms of maintaining mobility, supporting healthy aging and preventing falls.

For example, researchers at Penn State College of Medicine (Kraschnewski, Scianamma, Poger,

et al., 2016) found that older adults who do strength training activities at least twice a week had a

greater mortality benefit than those who did not. According to a recent Harvard Medical School

report, muscle disuse, not aging alone, is a leading cause of sarcopenia or gradual decrease in

muscle tissue. Without interventions like strength training, the average 70 year old will have lost

25% of their muscle mass and another 25% by age 90.

According to data compiled by the National Council on Aging (NCOA), falls are the

leading cause of fatal and non-fatal injuries among older adults. Falls can cause many older

adults to lose their independence and require long-term nursing care. To address this growing

healthcare problem, NCOA has established the National Falls Prevention Resource Center to

promote evidence-based falls prevention programs. Included in many of these programs is an

emphasis on helping older adults be physically active and maintain their mobility. Strength

training is one such strategy that is promoted. Also, as noted previously, the U.S. Preventive

Services Task Force recommends regular exercise for adults age 65 and older to prevent falls

(U.S. Preventive Services Task Force, 2018).

Teaching Aids
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The teaching aids and techniques used were appropriate based on the client’s high level

of education, motivating factors, and preferred learning style. Teaching tools and techniques

included:

▪ Growing Stronger book – though lengthy, the book is easy to read and includes goal-

setting worksheets, illustrations and step-by-step instructions for each exercise, and 12

weeks of activity logs. This was an appropriate resource given the client’s cerebral

nature and secondary preference for visual learning.

▪ Demonstration and practice – Each exercise was demonstrated for the client and then the

client practiced the exercise until she felt comfortable with the motions. This was an

appropriate teaching technique given the fact that the client’s preferred learning method

is kinesthetic.

▪ Phone calls – phone calls to check-in with the client helped provide accountability and

motivation for the client to complete her exercises. This was an appropriate technique

because the client had noted that she is more likely to exercise if there is some type of

accountability in place.

▪ Coaching – the teaching was conducted by assuming the role of coach or informal

personal trainer, as opposed to presenting information in a didactic manner. This was an

appropriate technique considering the client’s level of independence and autonomy.

The short-term outcome for this teaching plan was achieved on the third client visit. The

short-term outcome was that the client would verbalize accurate information about benefits of

increasing physical activity and strategies to develop a personal program of increased lifestyle

activity (Gulanick & Myers, 2014). The outcome was measured by having the client restate
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what was learned during the teaching and engage in discussion and related Q/A about the topic.

The accuracy of the client’s knowledge was informally assessed to be accurate.

The long-term outcome for this teaching plan was that the client performs muscle-

strengthening exercise on at least two days per week. This long-term outcome was achieved by

the fourth and final client visit. To measure the outcome, the client provided activity logs and

self-report that she had completed exercises two times per week during the past two weeks. The

long-term goal to finish the Growing Stronger 12-week program was established with the client.

Specifically, the next set of exercises in the 12-week series was reviewed and then demonstrated

and practiced by the client. During this final session, strategies were identified and discussed to

maintain the client’s motivation to continue strength training activities in the future. The

following strategies appeared to be most realistic in terms of supporting the client:

▪ Continued use of the activity logs provided by Growing Stronger

▪ Sharing personal goals with a friend who can provide support and accountability

▪ Making exercise “appointments” by scheduling time on the calendar as if it were a

doctor’s appointment or meeting that cannot be missed

Evaluation

The nursing outcomes were related to primary prevention. Specifically, the outcomes

were related to preventing injury (falls) or disease (sarcopenia) before it occurs. Additionally,

the outcomes were related to promoting overall good health and improved quality of life by

promoting/maintaining mobility.

The teaching was effective because we focused on a small number of realistic and

achievable goals. For example, choosing four simple exercises that could be completed in less

than 10 minutes ensured that the client did not feel overwhelmed right out of the gate. The client
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stated “This has been helpful in terms of giving me a jump start to get me going…” The

teaching also was effective we because we met multiple times and worked collaboratively to

develop the teaching plan. Also, the teaching plan was based on the client’s preferred learning

methods so we focused on the kinesthetics and physically doing the exercises together.

The limitations of the teaching were evidenced in several ways. First, I have no formal

training in exercise physiology, physical therapy or any related topic. At times, the client would

ask questions that I could not answer because of this lack of knowledge. For example, she had

questions about specific muscles that were left unanswered. Limitations also were evidenced in

terms of the follow-up plan. Although the client stated the desire to continue with the exercise

program, she acknowledged that she might not do it on her own. In fact, she said, “I know I have

to do these exercises but it’s always been hard for me to maintain any kind of long-term exercise

program on my own. I think the accountability is what I really need. I might have to invest in a

personal trainer.” The fact that the client recognized this about herself was a good outcome but

whether or not she acts on it remains to be seen.

The most effective way to revise the teaching strategies would be to conduct the teaching

over a longer period of time. For example, if I could have met with the client weekly for eight

weeks then she would have had more time to develop her exercise habits. Also, I would have

been able to provide the accountability that she needs until she feels motivated on her own to

continue with the program. A second strategy also would have been to recruit a second

participant for the program. For example, if the client and a friend participated in the teaching

together then they would be able to support each other with the long-term follow-up.

I enjoyed my role of nurse-teacher working with a healthy older adult in the community.

It was refreshing to spend time with an older adult who has no chronic diseases, no physical
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limitations and good motivation for staying healthy. This experience lies in stark contrast to my

experience as a PCT caring for elderly, hospitalized patients. The most significant thing I

learned from this project is that healthy aging is largely about self-care and lifestyle. Although

genetics play a role, maintaining a healthy weight, eating a healthy diet, and staying active are

likely just as important in terms of having a good quality of life as we age. This fact highlights

the importance of primary prevention for older adults. As the health care system prepares for the

silver tsunami, more emphasis needs to be placed on helping baby boomers get and/or stay

healthy and active.

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References

Centers for Disease Control and Prevention (2002). Growing stronger: Strength training for

older adults. Retrieved from

https://www.cdc.gov/physicalactivity/downloads/growing_stronger.pdf

Gulanick & Myers (2014). Nursing Care Plans: Diagnoses, Interventions, and Outcomes (8th

ed.). Philadelphia, PA: Elsevier Mosby

Harvard Medical School (2015). Strength and power training for older adults. Harvard Health

Publishing. Retrieved from https://www.health.harvard.edu/exercise-and-

fitness/strength-and-power-training-a-guide-for-older-adults

Healthy People 2020 (2018). Older adults. Retrieved from

https://www.healthypeople.gov/2020/topics-objectives/topic/older-adults

Kraschnewski, J., Scianamma, C. Poger, J., Rovniak, L., Lehman, E., Cooper, A., Ballentine, N.,

& Ciccolo, J. (2016). Is strength training associated with mortality benefits? A 15 year

cohort study of U.S. older adults. Preventive Medicine, 87. Doi:

10.1016/j/ypmed.2016.02.038

National Council on Aging (2015). Falls Free: 2015 National falls prevention action plan.

Retrieved from https://www.ncoa.org/wp-content/uploads/FallsActionPlan_2015-

FINAL.pdf

U.S. Preventive Services Task Force. Falls Prevention in Older Adults: Counseling and

Preventive Medication. Retrieved from

https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/fal

ls-prevention-in-older-adults-counseling-and-preventive-medication