Running Head: HEALTH PROMOTION PAPER 1

Health Promotion Paper

Dana Courtney

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

Bon Secours Memorial College of Nursing

Gerontological Nursing (NUR 4113)

4/8/2018

“I have neither given nor received aid, other than acknowledged, on this assignment or test, nor

have I seen anyone else do so.”

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Introduction

The client that participated in this project is a 76 year old woman that is very aware of her

own health needs. She has no problems with communication, is very independent, and has family

support. She currently experiences changes that are part of the normal aging process, which

includes problems with her sleep.

Healthy People 2020 lists “Sleep Health” as one of its 2020 Topics and Objectives to aid

in improving health in all Americans. The goal is to “increase public knowledge of how adequate

sleep and treatment of sleep disorders improve health, productivity, wellness, quality of life, and

safety on roads and in the workplace” (Sleep health, 2018). Sleep is a major requirement for

development when younger. As you get older, sleep becomes more important in an individual’s

health maintenance, especially in individuals with chronic disorders or diseases (Sleep health,

2018).

Diagnosis

After I had completed the required assessment tools, I asked the client if there was

anything in regards to her health that she wanted to work on. She said she hadn’t been

experiencing pain like she had in the past, but she did want to have better sleep. I found the

Pittsburgh Sleep Quality Index assessment tool and we went through that together. Once I totaled

up her score, I was surprised by how high her score was. When we met the second time, I asked

if she would like to learn more about sleep health and hopefully improve her sleep, and we

decided to use that as the topic for her teaching plan.

The short-term outcomes that my client and I decided on were for her to be able to

“verbalize knowledge of a variety of techniques for sleep enhancement” and for her to “engage

in effective strategies to improve quality of sleep”. Our goal was for her to achieve both of these
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by March 1, 2018. This was appropriate for my client, as this allowed her to learn the

information provided and gave her time to implement this into her sleep routine. It also allowed

her time to ask me any questions she may have had about the information.

My client and I decided that her long-term goals or outcomes would be to “feel rested

after sleep” and “achieve age appropriate total sleep hours” by April 15, 2018. The time-frame

gave her about a month and a half to use these strategies and techniques from her short-term

outcome. We decided that she would retake the Pittsburgh Sleep Quality Index after April 15th

to see if her score changed any. I had planned to be the one to reassess, but she could do the

reassessment herself or have a family member do it. Her family can also help with this long-term

outcome through encouragement and support.

Plan

Based on the learning methods survey that my client completed, my client’s learning

method is kinesthetic learning. When it came to developing a plan for her, we had to really think

about the best way for her to learn about improved sleep. We decided that I would come back

with a few handouts that had some information and tips or tricks for improved sleeping and she

would write them out herself and try a few of them at night when she went to bed. Unfortunately,

before I could go back for my next visit, she ended up with a case of the shingles, so I had to

change the teaching plan a little. My client is technologically proficient, so I created a website

with the information I thought was pertinent for her case and sent it to her because I wanted to

make sure she could still receive the information, despite being sick.

Teaching

The teaching approach I used was more direct and geared towards my client as a learner.

I tried to give my client the opportunity to learn at her own pace and in a setting she was
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comfortable with. The teaching itself contained information about the benefits of sleep and the

effect that poor sleep health can have on your body, especially as you get older; the

recommended amount of sleep from the Centers for Disease Control and Prevention (CDC); how

sleep changes as you get older; and tips from Harvard Medical School for better sleep. My goal

was to provide this information to the client based on her desire to experience better sleep at

night.

The National Sleep Foundation (NSF) conducted a literature review that examined sleep

duration recommendations. The sleep duration recommendation for older adults (≥65 years) was

7 to 8 hours, which is considered by experts to be appropriate for health and well-being

(Hirshkowitz et al., 2015). Getting the recommended amount of sleep is ideal, but it is important

not to sleep too much more or less than the recommended amount as that may also affect

individual health. Short sleep (less than 6 hours) has been linked with several leading causes of

death including obesity, diabetes, hypertension, cardiovascular disease and cancer; and may also

impact both adaptive and innate immunity, which includes “antiviral immune responses with

consequences for infectious disease…” (Beydoun et al., 2017). “Prolonged lack of sleep can lead

to fatigue, irritability, decreased pain tolerance, increased corticosteroid and catecholamine

levels, and decreased ability to heal” (Radkte, Obermann, & Teymer, 2014).

For this project, I used a website as my teaching aid, which was appropriate given our

situation. My client’s education level might have had an impact on learning, but I tried to use

words that I knew she would understand and keep the information simple. She does get frustrated

with herself sometimes, because she wasn’t always the greatest student in school and didn’t

receive a lot of support at home either. Her socioeconomic status did not have an impact on her

learning because she wasn’t required to purchase anything in order to learn the material. She
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could very easily access the information with technology she already had, such as her phone or

iPad. I did my best to include her preferred learning methods with the teaching aids, which is

why I included the “Tips and Tricks” section. That would allow her to actually try a few different

things to see if they improved her sleep and she could make a list or write them down if so

desired.

Outcomes

Both of the short-term outcomes were achieved on February 26th. The client’s short-term

outcomes were measured by self-reporting, which meant that she was able to call me and

verbalize techniques that she could use in order to improve her sleep quality. She also expressed

that she knew most of these techniques, but was going to use a few of them each night to help

her. She called me on February 26 to report these achievements to me, which was about a week

after I had sent her the website.

In order to help the client follow up on her long-term goals, I plan to communicate with

her at the end of each week and ask about her sleep quality from that week. I will also ask if she

has tried any new sleep improvement tips and whether she liked that particular tip or not. She is

able to refer back to the website as needed and ask me questions at any point in time. After April

15th, I will re-do the Pittsburgh Sleep Quality Index to see if there has been any improvement in

her sleep quality over the last two months.

Evaluation

The short-term and the long-term nursing outcomes were related to primary prevention,

as this was focused more on health promotion and our intention was promote sleep. I provided

education on preventative measures that will hopefully help to keep health problems from
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developing in the future. Since she doesn’t have a disease or illness related to her sleep, the

outcomes would not be considered secondary or tertiary prevention.

I felt that the client responded well to the teaching. One of the major limitations was that

I wasn’t able to be there when she received the information. We were able to communicate via

text message, but I always worry that meanings will be misconstrued when communicating via

text. One of the more effective parts of the teaching I provided is that she is able to access the

information anytime she has a device, such as her phone, laptop, or tablet with her. She could

even share it with her friends if she so chooses to. She did use the information I shared with her

and has said that her sleep has improved over the span of three nights as a result, which was good

because she had problems with her sleep for most of February.

Summary

The role of nurse-teacher was very odd for me, since this client has usually been the one

teaching me or caring for me over the years. In the last few years, I have started taking the role of

nurse more often when with this client, especially when it comes to her health. It was nice to be

able to be the nurse-teacher providing health promotion teaching, rather than fulfilling the nurse-

teacher role at a doctor’s office or after a health problem.

I already knew that she was very self-aware of her health and kept up with all of her

doctor’s appointments. When I sent her this information about sleep health, I was slightly

surprised to learn that she knew all of them but one, which was to not watch the clock. We both

were able to learn something new through this. I also learned that providing care for older

patients requires a lot more work than I thought. I thought that I would be doing health

promotion for pain rather than sleep, but I should not have assumed that I knew what the client

needed.
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References

Basics about sleep. (2017, May 4). Retrieved from

https://www.cdc.gov/sleep/about_sleep/index.html

Beydoun, H. A., Beydoun, M. A., Chen, X., Chang, J. J., Gamaldo, A. A., Eid, S. M., &

Zonderman, A. B. (2017). Sex and age differences in the associations between sleep

behaviors and all-cause mortality in older adults: Results from the National Health and

Nutrition Examination Surveys. Sleep Medicine, 36, 141–151.

http://doi.org/10.1016/j.sleep.2017.05.006

Colten, H. R., & Altevogt, B. M. (2006). Sleep disorders and sleep deprivation: An unmet public

health problem. Washington, DC: Institute of Medicine.

Get enough sleep. (2018, March 20). Retrieved from

https://healthfinder.gov/HealthTopics/Category/everyday-healthy-living/mental-health-

and-relationship/get-enough-sleep#the-basics_1

Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., DonCarlos, L., … Adams

Hillard, P. J. (2015). National Sleep Foundation’s sleep time duration recommendations:

Methodology and results summary. Sleep Health: Journal of the National Sleep

Foundation, 1(1), 40 - 43.

Radtke, K., Obermann, K., & Teymer, L. (2014). Nursing knowledge of physiological and

psychological outcomes related to patient sleep deprivation in the acute care setting.

MEDSURG Nursing, 23(3), 178-184.

Sleep health. (2018, April 6). Retrieved from https://www.healthypeople.gov/2020/topics-

objectives/topic/sleep-health
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Twelve simple steps to improve your sleep. (2007, December 18). Retrieved from

http://healthysleep.med.harvard.edu/healthy/getting/overcoming/tips