Introduction
Mr. Green is a 52 year old African-American male employed full-time as a managerial consultant. His job requires frequent travel, and he is on the road about three weeks of each month visiting clients around the country. During a typical work week, he spends most of his time sitting on airplanes, in cars, or at meetings. He also finds himself “rushing and stressed out a lot” because he’s worried about missing flights or being late for appointments. Much of the business he conducts is over meals – business lunches or dinners. Although, as he explains, he tries to make healthful choices from the menus, he feels like he’s often eating when he’s not hungry because he is so sedentary during the day. But he says that gaining weight is an “expected consequence of aging”, so he doesn’t worry about it too much. He smokes one pack of cigarettes a day.
He has been married for 26 years and has three teenage children. When he is home between business trips, he feels a lot of pressure to get things done around the house like repairs and bill paying. But he also wants to spend time with his children – attend their athletic events, for example – his wife, get to the gym, and see his poker buddies. He expresses a lot of frustration about there not being enough hours in the day and time between his business trips.
His wife has been very concerned about his schedule and stress level even when he is home. She asked him to get a physical, and the lab results included the following:
- B/P: 170/90
- Pulse: 85
- Fasting glucose: 120
- Total cholesterol levels: 260
- Triglycerides: 152
- HDL: 38
- LDL: 165
- BMI: 27
Mr. Green is annoyed because, even though his doctor is telling him he needs to take better care of himself, Mr. Green thinks these findings are just a normal part of aging and that there isn’t much he can do to change them. Plus, he can’t imagine how he could build lifestyle changes into his busy schedule.
Clinical problem
An examination of the patient reveals 4 potential problems that could develop into significant health risks later on in life, these consist of the following: Potential Health Problem #1: Frequent traveling around the country, on average the patient is on the road 3 weeks of each month visiting clients. Various studies into the effects of frequent travel reveal the propensity for these particular individuals to be more prone to airborne illnesses, fatigue and stressors which are caused by the hassle and effort required in traveling to multiple locations within a short period of time.
It has been shown that these negative symptoms are more likely to manifest themselves in individuals of poor health or advanced age which fits the profile of the client. Potential Health Problem #2: The patient is always feeling rushed and stressed due to worrying about being late for flights or appointments. Health risks associated with constant stress have been related to increased blood pressure, higher propensities for strokes, black outs due to sudden fatigue and variety of other potential health problems (Premature heart disease 2009).
The constant travelling that the client is undertaking on a monthly basis will have a lasting effect on his health in the long run if nothing is done to mitigate the constant resurgence of stress. Potential Health Problem #3: Most of the business the patient conducts is over meals, business lunches or dinners. From the point of view of a healthcare specialist the practice of eating meals while conducting business arrangements creates irregularities in normal rate of food consumption. It is recommended by a variety of studies that eating meals constantly at set times throughout the day helps to stabilize a body’s metabolism and prevent the possibility of ulcers due to infrequent eating habits.
Potential health problem #4: The patient states that he often eats when he is not hungry due to his sedentary lifestyle. The reason behind this is not just his sedentary lifestyle but rather his rate of consumption and the time in which he consumes food. It can be assumed that most business meetings conducted by the patient do not occur at a regular time interval; as such the patient eats food infrequently and probably eats multiple times in a single day due to the necessity of having to deal with multiple clients.
This skews the metabolic clock of the body along with the proper triggers in the brain related to the desire to eat as a result this causes people to eat even when they are not hungry which the client obviously shows. Potential Health Problem #4: The client states that he smokes one pack of cigarettes a day, the health risks associated with such a practice range from lung cancer, throat cancer, respiratory problems, and several future health risk which can and will kill the patient in the future. Based on the identified potential health problems this way paper will now examine the current health indicators of the patient and determine an appropriate plan to resolve the health problems before they get out of hand. The lab results after the patient’s physical examination reveals the following results which are quite worrying:
- B/P: 170/90
- Pulse: 85
- Fasting glucose: 120
- Total cholesterol levels: 260
- Triglycerides: 152
- HDL: 38
- LDL: 165
- BMI: 27
It has been established by numerous studies that blood pressure does increase with age however the current results of Mr. Green indicate an abnormally high blood pressure for a person within his age group. The lower figure in the results indicates the constant amount of pressure that exists within the arteries of Mr. Green while the higher figure is a temporary spike that occurs when the heart beats. The problem with high blood pressure is that it places undue strain on the heart which does cause damage over time on the rather sensitive inner linings of the various arteries resulting in the occurrence of heart attacks, strokes and various other problems (Premature heart disease 2009).
In Mr. Green’s case he did state that he was under a constant amount of stress which would result in a higher indicated BP result. The unique aspect of BP is that it changes to an extent depending on external factors, such as stress, influencing results. While stress could be indicated as a factor other results such as a fasting glucose level of 120, a total cholesterol level of 260, a BMI of 27 and an HDL of 38 all indicate that Mr. Green is suffering from poor eating habits which has resulting in undue pressure being placed on his body due to the excess accumulation of fat as a result of a lack of sufficient exercise.
As indicated by the problem profile the patient is often sedentary and lethargic and rarely engages in physical activities that would help improve his weight. Another indicated problem is the fact that the patient believes in the notion that the reason his body is the way it is right now is due to age instead of the lifestyle he lives. The desired change for this particular patient involves changing his mentality regarding what is the result of age and what is the result of unhealthy habits. As such this paper will seek to enact a plant to establish a sufficient level of change in Mr. Green in order for him to live a healthier life.
Strengths and competencies
The current motivator for the patient comes in the form of his desire to spend more time with his child and with his wife. Various studies into reforming health habits have shown that support systems in the form of family and friends have been proven to be effective in encouraging true and lasting change in an individual’s approach towards a healthy lifestyle (Pender et al. 2011). As such the best support system that could be put into place for the patient would have to be his own family.
At the present time the patient is classified under the “lack of physical conditioning” and “lack of practice for physical exercise” stage of change as described by Guedes et al in their study involving sedentary individuals with high blood pressure.
This particular stage is marked as “at risk” due to the potential for developing weight related problems such as heart attacks, strokes and diabetes (Guedes et al., 2010). The reason why the patient fits this particular description is simple, his lethargic life style obviously does not result in any significant physical activity, his BMI and cholesterol levels indicate that he is eating far too much than what he needs and finally his mentality regarding his health related problems are far from being rational in a medical sense.
Patient’s health goals and outcomes
To help the patient attain a better state of health realistic goals must be set within a designed framework to help guide the patient and create a framework which they can adhere to (Trembaly et al., 2010). For Mr. Green this involves the following goals to be achieved: insert periods of physical activity into his daily scheduled, adjust his eating habits to conform to a set schedule, change his meeting styles to avoid having to eat while discussing business deals and attempt to reduce the amount of stress or strain in his life by allowing at least one day of rest in between travelling across the various regions in the country (Pender et al. 2011).
Such goals are realistic when taking into account the fact that employing a period of rest and physical activity (walking, going to the gym etc.) can be easily achieved by an individual should they schedule such opportunities as part of a daily routine. The problem with Mr. Green is that his current lifestyle has become so habitual that inspite of his desire for change his own mentality is preventing him from realizing that there is way in which it can be achieved.
The measurable outcome of such goals and how to measure them comes in the form of the amount of physical activity done on a weekly basis and a reduction in the amount food eaten while on trips. An examination of the patient’s BP, HDL, BMI and HDL levels will also be done over the period of six months to monitor if he is following the prescribed recommended actions. It is expected that the greater amount of physical activity and reduction in nonessential food eating would help to mitigate the lethargic lifestyle of Mr. Green and enable him to engage in more activities with his wife and children (Pender et al., 2011).
Nursing interventions for behavior change
In this particular case Tremblay et al explains how people tend to be so set in their behavioral paths that changing the way in they think about their lifestyle is the first and most important step in helping them achieve a healthier lifestyle. The fact is humans in general are creatures of habit and despite the overwhelming need to change certain habits most people do not want to. Based on this the action plan for this paper will consist of the following:
- Change the assumptions of Mr. Green regarding there not being enough time to do anything.
- Establish a set daily time schedule for eating to stabilize his metabolism, discourage eating during meetings to reduce the amount of unwanted food in the system.
- Finally, place at least one day of rest in between travels in order to get his system to properly adjust resulting in a reduction of stress.
Tremblay et al posits that one of the primary reasons as to why patients do not get enough exercise is due to issues with time management (Trembaly et al., 2010). They believe that there is not enough time or they would not be able to accomplish the task within the time given. It is due to this that the first step in improving the patient’s condition is to instill awareness that they do have the time and that it is readily available to them (Pender et al., 2011).
In the case problem itself Mr. Green states numerous times how he feels that there is not enough time in his schedule in order to accommodate such activities. It is due to assumptions such as this that health problems continue to escalate beyond their original insignificant selves. In such cases where patients are made fully aware that they do have the time the gradual implementation of moderate daily physical activity can begin alongside that of changing their eating habits.
Incentives and barriers to change
In this case the primary motivation for the patient would be to be able to engage in more activities with his wife, children and friends by living a healthier and more productive lifestyle. The case problem implies that the patient is current frustrated over how he feels he has too little time for his family and friends. By reordering his life by the indicated guidelines the patient will find that he does have enough extra time left over in his daily schedule and that it was only his mind that was preventing him from doing so (Pender et al., 2011). Another motivator, although not implied in the problem statement, is the desire to live longer.
The results given to Mr. Green from the doctor indicate that should he not attempt to change his current mannerisms in any way it is highly possible that he might suffer irreversible health consequences later on in life. The main barrier to change in this particular case is the very mentality of the patient. Mr. Green categorizes his current health problems as being the result of age rather than the result of his unhealthy lifestyle. In order to actually remedy his current health prognosis he has to come to terms with the fact that age is not reason why he is the way he is right now. On the other hand should he not come to terms with his own unhealthy habits as being the cause of his bad checkup results it is likely that any health plan created to help Mr. Green is doomed to fail.
Realistic time frame
In terms of the amount of time needed to complete and instill this particular set of new behavioral characteristics for Mr. Green a time frame of roughly 2 years will be needed accomplish this. This time frame was decided upon due to the account of John Fuchs, a person who recovered from the end result of several years of health mismanagement which resulted in high blood pressure and several health problems (Fuchs, 2002).To reach the goal of being able to achieve a healthy lifestyle, incremental time frames are needed in order to help the patient adjust. The first few months are for the patient to gradually get used to adding daily exercise into his routine then afterwards comes the period of slowing weaning the patient off of his unhealthy eating habits.
Maintenance strategies
The true challenge in changing behavior is maintaining it over a lifetime; in the case of Mr. Green this involves maintaining his new healthy lifestyle despite having no supervision during his various trips around the country. In order to ensure that there is a method of keeping Mr. Green in line so to speak one method would be to utilize Mr. Green’s wife as an observer. Her role would be to monitor the changes that Mr. Green would be going through over the next two years and would ensure that he sticks to his new lifestyle choice.
References
Fuchs, J. (2002). I Turned Back the Clock. Natural Health, 32(8), 55. Web.
Guedes, N., Lopes, M., Moreira, R., Cavalcante, T., & De Araujo, T. (2010). Prevalence of Sedentary Lifestyle in Individuals With High Blood Pressure. International Journal of Nursing Terminologies & Classifications, 21(2), 50-56. Web.
Pender, N. J., Murdaugh, C. L., & Parsons, M. (2011). Health promotion in nursing practice, sixth edition. New Jersey: Prentice Hall.
Premature heart disease. (2009). Harvard Men’s Health Watch, 14(4), 4. Web.
Tremblay, M., Colley, R., Saunders, T., Healy, G., & Owen, N. (2010). Physiological and health implications of a sedentary lifestyle. Applied Physiology, Nutrition & Metabolism, 35(6), 725-740. Web.