RUNNING HEAD: Health Promotion Project 1

Health Promotion Project

Kyle O. Henshaw

Professor Krukiel

Bon Secours Memorial College of Nursing

NUR 4113

August 30, 2017

Honor Code “I pledge..”

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Throughout this paper, I will be teaching, evaluating and discussing a Caucasian 84-year-

old female that currently lives in her home by herself. Overall, she is a fairly healthy woman

with only a few medical conditions. Her past medical history includes: afib, stroke, hypertension,

GERD, hyperlipidemia, hypothyroidism, and occasional dehydration. She ambulates without an

assistive device and only major surgery to this date is having a pacemaker put in. The patient is

alert and oriented x4 with a very supportive family that consists of two daughters who live

locally and a sister close by too. With her age and previous stroke, she may tend to forget things

easier now than when she was younger but overall, she is doing well. She is able to perform all

of her ADL’s by herself and even gets to the YMCA about 5x a week. Her diet includes of

mostly vegetables, which are her favorite food group, so she may be lacking in other areas for

proper nourishment.

Assessment

After the initial visit with my patient, I had to think what would be best to teach her based

on her needs. I explored speech therapy options, ways to improve memory to help her with

medications, paying bills, and making appointments. She also inquired about taking a driving

course for older adults to feel safe as well as reviewing the signs and symptoms of stroke again in

case she experiences another episode. Another important teaching need I find she may need help

with is fall prevention. She is creeping up in age and I noticed some potential hazards (ex: rugs,

flooring, etc) that could cause harm if she was not paying attention. Even though they were all

great options to teach and learn about, I am going to focus on her memory needs. By assisting with

her memory needs, I am able to incorporate and relate back to Healthy People 2020. My goal is to

give her the tools to improve her memory skills which allows her to stay on schedule with all of

her medications, bills and various appointments. Those tasks will allow her to live a healthier and
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longer life, improve the health of her and others around as well as just promoting health as a whole.

Healthy People 2020 focuses on the above and I believe I can accomplish that with my patient.

Nursing Diagnosis

The nursing diagnosis I chose for my patient is impaired memory related to decreased

cardiac output, neurological disturbances, and medications as evidence by inability to learn or

retain new skills or information, inability to recall recent or past events, and observed or reported

experience of forgetting. This diagnosis is best for this patient because of her occasional

confusion and forgetfulness. This can become a safety problem if she becomes forgetful and

does not take her medication at the right time. Some short-term goals for this patient includes:

patient able to maintain attention and respond appropriately to environmental cues within limits

of disease by the time I leave from teaching that day (6pm) and patient is oriented to time,

person, place, and self within limits of disease by the end of the day (6pm). These are short term

goals that are achievable within that timeframe. A long-term goal I came up with for her includes

that the patient uses techniques to promote retention and recall of information within 3 months. I

believe this timeline is long enough for her to practice the skills I teach her and will start to help

with her overall memory functioning. The family will be able to evaluate if her memory is

improving by questioning her, seeing if she is taking her medications, and asking her about

past/future events (like appointments or what she ate/did earlier in the week).

Teaching Plan

Once I was able to figure out her learning style, I was able to come up with a teaching

plan to help her develop her memory. Using the information, I gathered from the survey of

preferred learning method, I was able to understand that she learns best when she can actually

see it and then by completing what was shown to her. This learning style is great for what we
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were trying to accomplish. The patient, patient’s family, and I decided to engage in skills that did

both. I was able to explain and demonstrate the skill first and then I made her show and explain it

back to me. This allowed her to work on her short-term memory and comprehension skills. For

an example, I would show her how to play the card game War. I then would hand her the cards

and ask her to explain it to me. This allowed me to assess whether or not she comprehended what

I showed her and to see if she could remember enough information to provide adequate

directions on how to play the card game.

During the teaching sessions, I used a variety of tools to help her with her memory skills.

I used tools such as clustering, teaching and then doing, and finally making connections. This

relates back to the goals for the patient by becoming more aware of self and recalling

information within a certain time frame. The approach of clustering, I took a chunk of

information and taught her how to break it down into smaller, easier material. For an example, I

tried to get her to remember her daughter’s phone number in case of emergencies. Instead of

looking at all seven digits, I broke it down for her into a three digit and four-digit chunk. This

made it less overwhelming and easier to learn. This clustering tool became beneficial when I

incorporated the teaching and then doing skill. I was able to teach her a skill and made her then

do it. Finally, the last approach, making connections, helped her connect certain information with

forming a connection with it. For an example, she connected the color of her pills to what the

actual pill was. Luckily, she had an assortment of different colored pills which made it easier for

her to connect.

In the journal article Working Memory Load-Dependent Brain Response Predicts

Behavioral Training Gains in Older Adults, the authors stated that “working memory training

studies have shown that some older adults are able to increase their working memory
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performance through training” (Heinzel, et al., 2014, p. 1224). This journal article enforced that I

could still help my patient to improve their overall memory functioning. Even though she is

suffering from a stroke and old age, there is still room to enhance her memory skills.

I used two teaching aids that helped when trying to get my patient to focus on her

memory skills. I used the survey of preferred learning to get a general understanding on which

learning method was best for her. Then I used the mini-mental exam to evaluate where she was

at baseline. This gave me a better understanding on how to focus my teaching for the period I

had planned with her. I also took into consideration her education level, medical history, and

home routine/schedule. I adapted to her home schedule like when she works outs and eats in

order to have her full attention. This strategy worked out and I would recommend this strategy in

the future for teaching her anything. This made her comfortable and focused on the task versus

worrying about what she needs to get done.

The first short term goal I came up with was very easy for her to achieve. I wanted her to

become alert and oriented times four by the end of my time with her on that first day. She

achieved that with flying colors. I soon learned that her memory of herself and being in the

moment is great, it is just her memory on recent events or how to accomplish a new skill is the

issue. I measured this first short-term goal by asking her the date, time, where she was at and her

name. She answered all the questions correctly so I knew she was oriented times four. The other

short-term goal I measured was if she can maintain attention and respond appropriately.

Measuring this was more subjective than objective which made it much more difficult to assess.

This goal was partially met. At times, she was able to stay on task but at other times she found it

very difficult to. With all of the commotion from her family coming in and out along with the

cats running around just made it difficult for her to stay on task. Some of her answers did not
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correspond with the questions that I asked so that is when I knew she was not paying attention or

did not fully understand the question. To follow up on the long-term goal, I need the family to

check in on her to make sure that she can remember some of her recent and future events. For an

example, if she started a new medication, I would like to know if she knows what that

medication is and what it is for. If she can tell them when to take it, that is when I know my

teaching has been working. The family should also try to use some of the tools I taught her daily.

This will allow her to continue to adapt her memory skills and not lose what we gained for the

past few visits.

Evaluation

I found that discharge teaching or even teaching alone can be a very hard process for any

individual. My initial reaction was that I did not think we were even going to make it past the

first day or task. I had a feeling that it was going to be difficult but I had no idea how difficult it

actually was. The nurse teacher role is not for everyone. I found it to be challenging in how to

present the information so that it made sense to my patient. I can only imagine trying to do that

for multiple patients who all have different learning styles. Kudos to the people who can

teach/discharge in a timely fashion. I learned how to become patient and teach in multiple

approaches. Taking care of and helping an 84-year-old woman was not easy and we did not go as

fast as I thought we would have. I learned how to break things down and simplify the directions.

I had to learn how to present the information so she could understand it and also use layman

terms instead of the medical terms because she had no idea. I did not want to confuse her any

more than what she was already, I also did not want her to get down on herself before we even

started.
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References

Heinzel, S., Lorenz, R. C., Brockhaus, W., Wustenberg, T., Kathmann, N., Heinz, A., & Rapp, M. A. (2014).

Working Memory Load-Dependent Brain Response Predicts Behavioral Training Gains in Older

Adults. Journal of Neuroscience, 34(4), 1224-1233. doi:10.1523/jneurosci.2463-13.2014

Speros, C. I., (Sept. 30, 2014) "More than Words: Promoting Health Literacy in Older Adults" OJIN: The

Online Journal of Issues in Nursing Vol. 14, No. 3, Manuscript 5.

Teaching older adults. (n.d.). Retrieved August 28, 2017, from http://www.euromedinfo.eu/teaching-

older-adults.html/

Touhy, T. A., Jett, K. F., Ebersole, P., & Hess, P. A. (2012). Ebersole & Hess toward healthy aging: human

needs & nursing response. St. Louis, MO: Elsevier/Mosby.