The promotion of health remains to be at the core of nursing practice. In any procedure demonstrated by the nurse, the principle is always to provide the best care that would promote health and wellness for the patient. In a research conducted by Hilton on the role of the acute nurse practitioner in the development of an in-patient palliative care program, she states that one of the acute nurse practitioner competencies is the ability of the nurse to “provide for the promotion of health and protection from disease by assessing for risks associated with care of complex acute, critical, and chronically-ill patients” (2008). This role is not limited to palliative care cases only, but also extends to the entire population of patients. Especially in the community or public health settings, health promotion is advocated by the community or public health nurse in order to prevent any occurrence, complication, or aggravation of disease/illness. Besides health promotion, prevention and cure are also vital in the practice of the nursing profession.
This care plan is aimed at emphasizing the importance of an active lifestyle by applying certain Range-of-Motion exercises in day-to-day living. An active lifestyle not only prevents high blood pressure, but reduces stress and promotes overall health as well. Active ROM exercises may be done for both ambulatory and non-ambulatory individuals depending upon the exercise demonstrated. ROM exercises are done in order to promote the circulation of blood in the human body, as well as to stimulate the body to release endorphins—or “happy hormones”—which are important to relieve stress and maintain body functioning.
Moreover, the general objective of this care plan is to promote health, in a span of 3 hours, by endorsing to health care professionals the techniques that will prevent individuals from having hypertension. Specifically, after 2 hours, the lecturer should be able to discuss and demonstrate active ROM exercises, which can be implemented on a daily basis. After 1 hour, the lecturer would then evaluate the teachings by conducting a written exam and a return demonstration of the procedure.
The target audience of this health promotion plan is the nurses, who work in the same nursing home. The location, where the presentation for this plan would be held, is the nursing home setting. Additionally, there will be around 3-5 nurses, who will participate in this presentation.
In the acute care setting, nurses are not only responsible for promoting health in an effective, but also in an efficient manner; time is of value in this area of nursing. Since acute singularly means “having a sudden onset, sharp rise, and short course” (Merriam-Webster, 2013), being able to perform appropriate procedures in a time-limited setup is a necessity for nurses. Acute care involves immediate attention and planning. Before these steps, however, the acute care nurse practitioner should be able to assess which health problems are to be prioritized. Prioritization of health problems is necessary in order to avoid further complications that may possibly lead to death.
The Centers for Disease Control and Prevention reports that “67 million American adults (31%) have high blood pressure” (Center for Disease Control and Prevention, 2013). This means that one in every three American adults is hypertensive. CDC also mentioned that the indication of hypertension in adults is a systole of 140 mmHg or higher and a diastole of 90 mmHg or higher (Center for Disease Control and Prevention, 2013). High blood pressure is also related to certain heart diseases, such as congestive heart failure. The American Heart Association confirmed that “74% of Americans with congestive heart failure have blood pressure over 140/90” (2012).
In lieu with the nursin responsibility of caring for the hypertensive or potentially hypertensive client, guides are established by the National Institute of Health, as to the risk factors of such a disease. These would include old age, race/ethnicity, overweight/obesity, gender, unhealthy lifestyle habits, and other risk factors such as stress, pre-hypertension, and a family history of hypertension (National Heart, Lung, and Blood Institute, 2012). According to the NIH, the elderly are prone to high blood pressure. This is particularly because ageing patients eventually experience atrophy or loss of elasticity of certain vessels and heart muscles required for pumping blood into the human body system. Their hearts compensate by contracting more forcefully for proper circulation. Other predisposing risk factors, or risk factors that cannot be changed, would include ethnicity, gender, and family history. The NIH says hypertension is “more common in African American adults than in Caucasian or Hispanic American adults”, but notes the following regarding gender as a risk factor:
Men and women are equally likely to develop HBP during their lifetimes. However, before age 45, men are more likely to have HBP than women. After age 65, the condition is more likely to affect women than men. (National Heart, Lung, and Blood Institute, 2012)
On the other hand, some risk factors may be modifiable, like obesity and lifestyle. Obese or overweight people should maintain a good range of blood pressure readings by consistently participating in exercises and choosing the proper diet for their age and condition. Changing lifestyle habits by eating less sodium, drinking less alcohol, getting enough potassium, stimulating physical activity, and avoiding smoking are also recommended by the NIH (National Heart, Lung, and Blood Institute, 2012).
The most effective way to measure blood pressure would involve using a stethoscope and a sphygmomanometer. According to the CDC, normal blood pressure is 120/80 mmHg or less, pre-hypertension ranges from 120 to139 mmHg systole and from 80 to 89 mmHg diastole, and hypertension is 140/90 mmHg or higher (Center for Disease Control and Prevention, 2013). These values are applicable for the adult patients and may vary according to the patient’s age and weight.
In applying the principle of health promotion, however, nursing intervention should be done before the occurrence of the disease. Once hypertension is already present and it is treated, the treatment would not be called “health promotion.” Instead, it will fall under the “health treatment” or “health restoration” variety.
As proposed in this health promotion plan, Range-of-Motion Exercises must be done daily to promote proper circulation of blood. A study by Tseng and company concludes that “a simple nurse-led range-of-motion exercise programme can generate positive effects in enhancing physical and psychological function of bedridden older people with stroke” (Tseng, Chen, Wu, Lin, 2007). Stephens also suggests a brief, comprehensive procedure for the ROM Exercises or the exercises emphasized on stretches and joint mobilization (Stephens, 2010). The Brookside Associates have also come up with a guide to specific ROM exercises that can be used daily. In their website, they stated the types of body movement, which included flexion, extension, hyperextension, abduction, adduction, rotation, circumduction, supination, and pronation (Brookside Associates, 2007). In addition, the association has developed the following guidelines in performing the exercise, which can be found on their web-site as well:
Plan when range of motion exercises should be done. Plan whether exercises will be passive, active-assistive, or active. Involve the patient in planning the program of exercises and other activities because he/she will be more apt to do the exxercises voluntarily. (Brookside Associates, 2007)
After doing so, the patient’s respiratory and heart rates are expected to rise during the course of the exercise. The Brookside Associates’ website goes further and suggests the following about the ROM exercises:
Range-of-motion exercises should be done at least twice a day. During the bath is one appropriate time. The warm bath water relaxes the muscles and decreases spasticity of the joints. Also, during the bath, areas are exposed so that the joints can be both moved and observed. Another appropriate time might be before bedtime. The joints of helpless or immobile patients should be exercised once every eight hours to prevent contracture from occurring. (2007)
Caution should, however, be observed in the patients, who have heart and respiratory diseases. Too much stress and strenuous exercise may exacerbate such conditions. The procedure is also contraindicated for patients with connective tissue disorders, as it may cause pain and aggravation of the illness. The nurse must always keep in mind the benefits, as well as the risks, of the exercise.
Finally, the website by Brookside Associates concludes the range-of-motion exercise procedure, stating:
Encourage the immobile patient to participate as fully as possible so that he feels involved in the process. Always explain to the patient what you are about to do and enlist his cooperation. To avoid strain, remember to maintain your own proper body mechanics as you carry out the exercises for the patient. The overall nursing goal is to promote the maximum degree of mobility for the patient who cannot engage in the normal activities of daily living and prevent or reduce the effects of immobility. Performing range of motion exercises can often save the patient a lengthy rehabilitation. (2007)
In implementing this care plan, nurses and health care professionals in general should consider the capacities of the patient. If the patient is physically limited or may not be able to perform some exercises comfortably, care should be provided, so as to avoid injury or trauma. It is also important to gain the patient’s cooperation. In order to do so, the nurse must explain to the patient the benefits of such procedure in an effective manner and emphasize its benefits on the patient’s short-term, as well as long-term, health.
High blood pressure may be a long-term or chronic sickness. Care is, therefore, essential in order to minimize risks that would lead to high blood pressure. Besides minimizing risks, maintaining an active lifestyle is also important. Prevention of the disease and promotion of health will only be effective, once practiced consistently in everyday life. Inability to sustain healthy practices would defeat the purpose of staying healthy. As it is understood in this paper, high blood pressure can lead to many serious complications. Preventing high blood pressure, therefore, would result to preventing its complications and to ensuring longevity and quality of life. Once an individual suffers from hypertension, he/she would not be able to support his/her usual diet or perform strenuous/stressful activities. This is the reason, why promotion of health and prevention of the disease is important. Once acquired, hypertension can greatly affect and change the individual’s health status and lifestyle practices.
There are several other practices that could promote health and, at the same time, reduce the morbidity of hypertension. The goal behind these practices is to sustain and maintain health for the patient using short term goals. These short term goals may seem trivial at first yet; however, in the long run, it will serve as a preparation for the time, when the body is no longer able to function as actively as it had been, when it was younger.