Running head: HEALTH PROMOTION PROJECT 1

Health Promotion Project

Brandee M. King

Tamara Krukiel, RN, MSN, ANP-BC, PMHNP-BC

Bon Secours Memorial College of Nursing

Gerontological Concepts NUR 4113

March 27, 2018

“I Pledge”
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Health Promotion Project

For my health promotion project, I chose to interview my grandmother who is a 72-year-old female. She

lives alone in her home and is in good overall health. The client reports concern with difficulty falling asleep and

staying asleep and frequently has to take an herbal supplement, Melatonin, to go to sleep. The client reports no

other major health problems that may be affecting her sleep patterns but does admit to staying up late at night

watching television and using the internet. Healthy People 2020 has an objective to “increase the proportion of

adults who get sufficient sleep” (Healthy People 2020, 2018). This is an important topic to address with the client

because adequate sleep is important in many aspects. 25 percent of U.S. adults report insufficient sleep rest at

least 15 days out of every 30 days. The right amount of sleep is important and necessary to fight off infection,

support metabolism of sugar to prevent diabetes and to work safely and effectively (Healthy People 2020, 2018).

This is especially important for the adult population because their overall health and wellness is impaired as they

age. The Centers for Disease Control and Prevention (CDC) estimates that adults age 61-64 years of age need

between seven and nine hours of sleep each night and adults 65 years and older need between seven and eight

hours of sleep each night (CDC, 2018).

Nursing Diagnosis

For the nursing diagnosis of this client, I chose: Disturbed sleep patterns related to

inability to fall asleep as evidenced by patient reporting short nights of sleep where she awakes

remaining fatigued. Based on the client’s medical history, and this being a concern I chose to

address this topic because she is primarily independent and in good health with no other

concerns. The client reported that having trouble sleeping was a “nuisance” in her life because

she wanted to sleep, her body just would not allow her. This is important to the client because

sleep plays a major role in overall wellness and can have a profound impact on mental health and

wellness.

One short term outcome that was established with the client was the client would be in

bed by 9PM each night without having to use Melatonin to fall asleep. The time established for
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bed time was determined by meeting the client’s goals as far as what time she would like to be

up each morning. The client stated that she likes to be around 4-5AM because that has been her

routine for many years. I discussed with the client that the use of Melatonin is not discouraged

however it should not be primarily used as a sleep aide on a daily basis.

A long-term outcome for the client was the client would have more vigorous activity

during the afternoon and evening hours and would avoid caffeinated beverages after 4PM. I

provided education for the client on activities she could do in the afternoon or evening that may

promote a better sense of falling asleep such as walking around her neighborhood, avoiding late

afternoon naps and having more activities that involved exercise. The client previously stated

that she liked to watch television or play on the internet before going to bed and this was

discouraged as it could be a reason the client has a problem falling asleep. I discussed with the

client that she could make activity charts for which she checked off afternoon or evening activity

and she could keep track if her sleep was improving. I also recommended setting a timer on her

television so that it cut off at a certain time each night and when the television cut off, that could

be her limit on both television and internet.

Teaching

The teaching plan identified with the client was developed by addressing specific concerns of

the client and identifying interventions that would work for the client and would promote

success. The client was in agreement with the teaching plan and verbalized understanding. The

content of the teaching was designed based off of the educational status and functional ability of

the client. The client graduated high school and had some college experience so was mentally

capable of learning the teaching and stated she felt comfortable with the teaching approach being

utilized. One tip offered by the Modern Medicine Network that was utilized in the development
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of teaching the client was “take a few minutes to talk and problem-solve before starting to teach.

Ask the patient about experience in a given area. Find out what’s worked or what hasn’t worked

in the past” (Modern Medicine Network, 2018). The client was able to offer insight as to what

might be helpful specifically for her, and she was also able to better examine herself and what

strategies she thought might fit better for her lifestyle.

According to evidenced based practice the best approach to teach the older adult client is to

offer education to the client and the family in order to encourage support and additional help

from family members. An article, written by Cabrera, also suggested that a helpful approach for

the adult client is to promote active participation in support groups. This approach is particularly

appealing to the older adult because it establishes a sense of belonging and hearing advice and

teaching from other members of the same group ensures a trusting relationship between

members. Cabrera, also identified that it is important to assess the anxiety level and coping

ability of the client because this can affect the client’s readiness to learn (Cabrera, 2018).

For this particular client, she did not require many teaching aids. Based off of the clients

desire I provided educational websites that showed the importance of sleep specifically related to

the older adult. I used the CDC website and utilized resources previously researched by the

client. The client had a strong willingness to learn and did not require any help with reading or

writing as the client is proficient in that area. The client stated that she had the financial

resources to support a change in her lifestyle behaviors if needed however, she did not want to

spend a large portion of money due to her skepticism around removing Melatonin from her

current ritual.
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Measurable Outcomes

Short-term goals were partially achieved. The client stated that she was able to be in bed

each night by 9PM but she admitted to continuing to use Melatonin each night. The client stated

that she was reluctant to not use the Melatonin because it was a habit for her and she had become

reliant on the medication to help her sleep. The short-term outcome was measured by the client

writing down on a piece of paper each night the time she was in bed. I was able to easily identify

and confirm that the client was in bed each night by 9PM and the client felt a sense of

accomplishment by being able to prove she completed the task. The client also stated that she did

feel better and felt like she was sleeping more soundly when she went to bed by 9PM.

After discussing an individualized plan for long-term outcomes with the client, it was

decided that she would enroll in the local YMCA around her house. We would sit down together

and figure out different classes she could do through the YMCA or find activities she could do

while at the gym to promote fatigue later in the evenings. The client also verbalized that she was

going to only drink coffee in the mornings and she would avoid it late in the evening. Together

with the client we set a timer on her television that would automatically cut her television off at

8PM. This would give the client plenty of time to wind down and get in bed by her 9PM goal.

Evaluation

Most of the client outcomes identified were related to primary prevention. The CDC

defines primary prevention as “intervening before health effects occur, through measures such as

vaccinations, altering risky behaviors (poor eating habits, tobacco use), and banning substances

known to be associated with a disease or health condition” (CDC, 2018). By promoting vigorous

activity to promote fatigue in the evenings and altering the daily activities that could affect sleep,
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primary prevention is identified by eliminating the various risk factors. The client responded to

the teaching very well. The client stated that the teaching plan “seemed silly” at first but at that

last visit was grateful for the teaching. The client demonstrated that she was very responsive to

the teaching and was open to trying new techniques. The client did seem hesitant when asked to

not use her Melatonin easily because as stated, “it makes me sleep better and I would rather not

take the risk of not sleeping when I have such a hard time staying asleep on my own”. This was

also a limitation as the client was heavily dependent on the Melatonin and her skepticism to

discontinue the medication was a barrier in teaching. I don’t think that I would do anything

differently with this client but I could provide more research and evidenced based practice to

support why the lifestyle behavior change was important. I think providing evidence that

sleeping difficulty is common in the aging process and that many adults suffer from sleep

disturbances, the client would be more inclined to adapt the strict sleeping strategies.

Summary

After completing the health promotion project, I developed different feelings towards the

aging population. Prior to taking a Gerontology course or completing the health promotion

project, I did not like older adults and I felt like they were very challenging to take care of

because they were total care. I chose to utilize my grandmother to complete the health promotion

project and I enjoyed getting to spend more time with her while influencing her to take better

care of herself to promote healthy aging. I never would have considered myself a teacher prior to

nursing school but I have come to learn that a major aspect of being a nurse is also being an

educator. I really enjoyed teaching my grandmother and I enjoyed only having to focus on her at

one time. I feel like I am able to make a difference in her life and better take care of her because

of the career I am pursuing and she enjoys learning from me as well because of our relation. I
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enjoyed being a teacher for this project and I was better able to understand the importance of

education in the older adult population.

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References

Cabrera, G.M., & Kornusky, J.M. (2018). Insomnia in older persons. CINAHL Nursing Guide

Centers for Disease Control and Prevention: How much sleep do I need? (n.d). Retrieved March

27, 2018, from https://www.cdc.gov/sleep/about_sleep/how_much_sleep.html

Healthy People 2020: Sleep health objectives (n.d). Retrieved March 27, 2018, from

https://www.healthypeople.gov/2020/topics-objectives/topic/sleep-health/objectives

Modern Medicine Network: Tips for teaching the elderly (n.d.). Retrieved March 28, 2018, from

http://www.modernmedicine.com/modern-medicine/content/tips-teaching-elderly