• Internal Code :
  • Subject Code : CNA257
  • University : University of Tasmania
  • Subject Name : Nursing

Case Study: Leonie

Table of Contents

Introduction

Behavioural health risk factors

Physical inactivity

Obesity

Nutrition

Assessment tools

Interventions 

Discussion

Conclusion 

References

Introduction

In healthcare research and application, the historic focus has always been on individual or person-level factors that impact health outcomes with a less degree of interest in the potential determinants of health or disease. Blake, Narayanasamy, Batt, and Khunti (2019) defined effective health promotion as the process of enabling individuals to enhance control over and to improve their health. Moreover, Allen et al, (2017) mentioned that healthcare promotion should not be limited to a disease or infirmity; it should also focus on the mental, physical and social wellbeing of individuals.

In addition to this, behavioural studies are crucial for healthcare practitioners to understand the susceptibility of people toward certain risk factors and should form the basis of delivering effective healthcare. This report presents an analysis of Leonie's case study and discusses the behavioural risk factors associated with the same. The report also discusses possible interventions via the person-centred approach and analysis the obligation of registered nurses in respect of the chosen intervention.

Behavioural Health Risk Factors

According to the details provided in the case study, 3 health-related behavioural risk factors were assessed, namely, physical inactivity, obesity, and nutrition.

Physical inactivity

Leonie used to engage in physical activities like gardening and long walks. However, over the past 6 months, she has started to spend less time outdoors and more time in her house. She has even stopped driving and meeting with her friends. van der Ploeg and Hillsdon (2017) reported a direct relationship between physical activity and cardiorespiratory health, and on the other hand, physical inactivity is associated with high blood cholesterol, high blood pressure, overweight, and diabetes. Moreover, studies report that physically active people are less likely to develop heart diseases as compared to inactive individuals (Zelle, et al. 2017).

Obesity

According to the medical details of Leonie, aged 73 is 160 cm tall and weighs 105 kgs. This results in a Body Mass Index (BMI) of 41 which places her in the obese category. For her height, the ideal weight should have been between 47 and 63. Furthermore, the sisters of Leonie suggested that Leonie is not undertaking personal care and has gained approximately 6-10kg in the last 6 months. AIHW (2018) suggests that obesity can increase the risk of developing certain cancers, type 2 diabetes, and heart disease, and is a key health problem for older Australians.

Nutrition

Apart from physical inactivity and obesity, a lack of nutrition and proper diet is also a behavioural health risk factor that can adversely affect the health and wellbeing of Leonie. Her sisters mentioned that Leonie is not coping at home and needs more support to manage activities like self-care and cooking. They also reported that Leonie has been buying microwave meals for the last 6 months, rather than preparing fresh foods. Tek and Karacil-Ermumcu (2018) suggested that improper diets for elderly individuals are associated with chronic non-communicable diseases (NCD) including diabetes, hypertension, obesity and even some types of cancer.

Assessment Tools

In literature related to physical activity, assessment tools have been mainly used for 4 reasons, namely, to identify those at risk, tailor a physical activity intervention, baseline assessment and combination of baseline assessment and intervention. Dutton, Bauman, Dennis, Zwar, and Harris (2017) mentioned that General Practice Physical Activity Questionnaire (GPPAQ) is one of the most widely used assessment tools for physical activity. However, Fleig et al, (2016) suggested that despite is popularity; GPPAQ has low levels of validity and reliability. On the other hand, according to Chatterjee, Chapman, Brannan, and Varney (2017), GPPAQ itself is an easy tool to assess physical activity levels and can be used in a wide range of electronic systems, but its integration in routine practice is complex and time-consuming.

Concerning obesity, the use of comprehensive nutritional assessment tools is helpful in the detection and prevention of obesity. The Body Mass Index (BMI) is a relatively simple and widely accepted tool for obesity assessment. It is a mathematical formula based on weight and height which allocates a number to the relative risk for mortality and morbidity of an individual (Hobbs, Griffiths, Green, Jordan, Saunders and McKenna 2018). It is a tool of choice for researchers and is extensively used by health organizations, policymakers, and healthcare professionals. The only issue with this assessment tool is it might assess muscular individuals as obese.

Nutrition assessment is performed by nurses and clinicians to gather the required information and to conduct a focused examination to determine the nutrition problem and its severity. The most used tool for nutrition assessment is the Subjective Global Assessment (SGA) which involves the relevant information of patients' medical history such as dietary intake change, weight loss, etc, and physical examination (Neto, van Vliet, de Jong, Jagar-Wittenaar and Navis 2018). SGA then classifies the subject as either nourished, moderately malnourished or severely malnourished. Du et al, (2017) described the limitation of SGA and suggested that it only classifies subject in 3 categories and fails to take biochemical values under consideration.

Interventions

To help Leonie, person-centred approach would be most useful as it is internationally recognized as the foundation for social care and modern health services. It is a component of the quality of care that works beyond the clinical quality of care and includes concepts like autonomy, support, and respect (Hakansson et al. 2019). It further emphasizes the need for healthcare services to be responsive to the needs of the individual and should strive to promote the rights of recipients. Person-centred approach is especially important for the elderly as it facilitates a wide range of support from multiple care providers and professionals.

Weight loss intervention through a person-centred approach would be helpful for Leonie as weight loss requires a considerable effort and change in the lifestyle of the patient. Moreover, while weight loss interventions will be helpful for Leonie, it is important to consider the preferences of Leonie and to include them in the goal-setting. This will increase the likelihood of intervention to help Leonie by providing a personalized intervention plan (Wahwiak 2017).

In addition to this, a client-centred counselling approach can be used to motivate Leonie towards physical activity. The major points of a client-centred counselling strategy include establishing rapport with the client, defining an agenda for discussion and understanding how ready the client is towards transforming her behaviour (Wild et al 2019). After that, the importance of physical activity is discussed and confidence is built into the client to make the change possible. It is important to respect the clients' freedom of choice throughout the process.

Discussion

Nurse practitioners (NPs) and nurses have a distinct opportunity to impact the obesity epidemic through weight-loss interventions. Through such interventions, nurses can act as role models for patients by educating them and their families on obesity-related illnesses, healthcare system and nutrition (Felizl, Brito and Rodrigues 2019). Nurses can closely work with patients and act as personalized counsellors by helping them in the identification of goals and in developing plans to achieve them. In addition to this, nurses can provide support to patients to form a safe, effective and personalized plan which is suitable to them. Hohol, Gilbert, and Johnston (2019) mentioned that nurses also know the risk that can arise from obesity and can educate the patients on the same and can explain how obesity can turn into heart diseases, diabetes, and even cancer.

On the other hand, nurses can also play an active role in motivating patients to engage in a more active lifestyle. Primary care and community care nurses are at the forefront of healthcare and their role has evolved to include chronic disease management, health coaching, and preventive care. Nurses can simply talk with patients regarding their activity levels to trigger awareness about personal health behaviour (den Ouden et al 2017). Moreover, nurses can draw on national education initiatives and discussions with patients to identify and address barriers, set achievable goals and monitor the achievement of patients. However, it is important to note that clinical judgement should always be utilized alongside recommendations and the activity goals should be realistic and gradual (Himmelferb, Commodore-Mensah and Hill 2016).

Conclusion

In conclusion, the report suggests that behavioural risk factors can help to control the underlying causes of poor health in the elderly. In the given case study of Leonie, the key behavioural health risk factors were identified as physical inactivity, obesity, and nutrition. Nurses can use comprehensive assessment tools like General Practice Physical Activity Questionnaire (GPPAQ), Body Mass Index and Subjective Global Assessment to gather relevant information about theses behavioural risk. Moreover, a person-centred intervention would be most helpful in addressing these behavioural risks. The intervention strategies mentioned in the report are weight loss and counselling. Lastly, in terms of the role of nurses in the abovementioned interventions, it can be said that nurses are distinctly positioned to positively affect the health of patients through such interventions by generating awareness and providing support to patients.

References

Allen, L., Williams, J., Townsend, N., Mikkelsen, B., Roberts, N., Foster, C. and Wickramasinghe, K. 2017. Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review. The Lancet Global Health, 5(3), pp.e277-e289.

Australian Institute of Health and Welfare (AIHW). 2018. Older Australia at a glance. Retrieved from https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance/contents/healthy-ageing/behavioural-risk-factors

Blake, H., Narayanasamy, M., Batt, M.E. and Khunti, K. 2019. Effectiveness of lifestyle health promotion interventions for nurses: Protocol for a systematic review.

Chatterjee, R., Chapman, T., Brannan, M.G. and Varney, J. 2017. GPs’ knowledge, use, and confidence in national physical activity and health guidelines and tools: a questionnaire-based survey of general practice in England. Br J Gen Pract, 67(663), pp.e668-e675.

denOuden, M., Kuk, N.O., Zwakhalen, S.M., Bleijlevens, M.H., Meijers, J.M. and Hamers, J.P. 2017. The role of nursing staff in the activities of daily living or nursing home residents. Geriatric Nursing, 38(3), pp.225-230.

Du, H., Liu, B., Xie, Y., Liu, J., Wei, Y., Hu, H., Luo, B. and Li, Z. 2017.Comparison of different methods for nutrition assessment in patients with tumours. Oncology Letters, 14(1), pp.165-170.

Dutton, S.N., Bauman, A., Dennis, S.M., Zwar, N. and Harris, M.F. 2017. Resourcing an evolution of roles in general practice: a study to determine the validity and reliability of tools to assist nurses and patients to assess physical activity. Australian Journal of Primary Health, 22(6), pp.505-509.

Fleig, L., Warner, L.M., Gholami, M., Kritikou, M., Vigilanza, A., Schwarzer, R., Brandi, M.L. and Ntzani, E. 2016. Who benefits from a single-arm online intervention to improve physical activity? A longitudinal pilot study. European Health Psychologist, 18(S), p.934.

Håkansson, J.E., Holmström, I.K., Kumlin, T., Kaminsky, E., Skoglund, K., Höglander, J., Sundler, A.J., Condén, E. and Summer, M.M. 2019. " Samesame or different?" A review of

reviews of person-centred and patient-centred care. Patient Education and Counselling, 102(1), pp.3-11.

Himmelfarb, C.R.D., Commodore-Mensah, Y. and Hill, M.N. 2016. Expanding the role of nurses to improve hypertension care and control globally. Annals of Global Health, 82(2), pp.243-253.

Hobbs, M., Griffiths, C., Green, M. A., Jordan, H., Saunders, J., & McKenna, J. (2018). Neighbourhood typologies and associations with body mass index and obesity: A cross-sectional study. Preventive Medicine, 111, 351-357.

Hohol, A., Gilbert, J. and Johnston, M. 2019. Chronic obesity. In Chronic Care Nursing: a Framework for Practice (pp. 243-258). Cambridge University Press.

Hohol, A., Gilbert, J. and Johnston, M. 2019.Chronic obesity. In Chronic Care Nursing: a Framework for Practice (pp. 243-258). Cambridge University Press.

Neto, A.G., van Vliet, I.M.Y., de Jong, M.F.C., Jager-Wittenaar, H. and Navis, G.J. 2018.Predictive validity of malnutrition screening (must) vs nutritional assessment (PG-SGA). Clinical Nutrition, 37, pp.S105-S106.

Tek, N.A. and Karaçil-Ermumcu, M.Ş. 2018. Determinants of health-related quality of life in home-dwelling elderly population: Appetite and nutritional status. The Journal of Nutrition, Health & Aging, 22(8), pp.996-1002.

van der Ploeg, H.P. and Hillsdon, M. 2017. Is sedentary behaviour just physical inactivity by another name?. International Journal of Behavioral Nutrition and Physical Activity, 14(1), p.142.

Wahowiak, L. 2017. Stigma, bias against people with obesity can harm health: Person-centered approach recommended.

Wild, B., Heider, D., Schellberg, D., Böhlen, F., Schöttker, B., Muhlack, D.C., König, H.H. and Slaets, J. 2019. Caring for the elderly: A person-centred segmentation approach for exploring the association between health care needs, mental health care use, and costs in Germany. PloS One, 14(12).

Zelle, D.M., Klaassen, G., Van Adrichem, E., Bakker, S.J., Corpeleijn, E. and Navis, G. 2017. Physical inactivity: a risk factor and target for intervention in renal care. Nature Reviews Nephrology, 13(3), p.152.

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