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Clinical problem
Based on the WHO CDC standard for body weight in proportion to height, the patient, Ms. Jones, is classified as overweight and possibly suffering from the effects of slight muscle degeneration due to her sedentary lifestyle and diet. Based on the case data apparently Ms. Jones does not engage in any physically strenuous activity, neglects to maintain a proper diet and does not exercise regularly. Based on the study of Dunton et al on the national average BMI in the U.S., women at 30 to 39 years of age should have a BMI of 26.4, the current BMI of Ms. Jones is 29 (Dunton et al., 2009).
This shows that the current health status of the patient is not ideal and needs to be rectified to prevent the possibility of weight related problems from occurring or an increase in weight as time passes. It is also apparent the patient is suffering from the effects of yo-yo dieting; the case data has shown that the patient was ten pounds lighter before at a weight of 148 pounds however over the course of two months gained the weight back when she supposedly stopped dieting.
The characteristics of yo-yo dieting often involves a cyclical process where the dieter losses a certain amount of weight, stops, gains the weight back and starts the process all over again to lose weight. Unfortunately the weight that is lost is most often water and muscle mass instead of fat and as result each cycle of the process causes a gradual deterioration of total muscle mass which causes weight to be gained back faster during the next phase of the dieting cycle. The patients diet consists of fast food which often contains high amounts of fat, cholesterol, sugar and high fructose corn syrup which contributes to weight gained when not coupled with regular exercise.
Due to the nature of the patients job which is sedentary in nature along with the responsibility of taking care of two children the result is a body which has lost muscle mass, gained an inordinate amount of weight in fat and is at risk for weight related problems such as diabetes, necrosis of the liver or blocked arteries which can lead to strokes or possibly a heart attack. The plan of action in this particular case is to change the dietary and sedentary lifestyle choice of the patient to lower her BMI, gain muscle mass and ensure that her weight stabilizes at an appropriate level for her height (Guedes et al., 2010).
Strengths and competencies
In the case of the patient the best motivator and support system would be her own children. Due to her life as a single mother and the apparent devotion she has for her children, the patient would be more willing to change her lifestyle should her children encourage her and motivate towards this particular decision. As such it would be recommended that the process of entering into a healthier lifestyle should be entered into by all members of the family in order to help foster an environment that is conducive to lifestyle change.
At the present 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 disorders such as high blood pressure and diabetes (Guedes et al., 2010).
Patients 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). Based on the case data, Ms. Jones shows that she is guilty about not being able to see her children during the day and as a result spends all her free time during evenings with them. This situation presents itself as an opportunity to create two health goals for the patient namely personal and family oriented goals.
Personal oriented goals for the patient will focus on reducing her BMI, preventing herself from regressing into yoyo dieting and building up muscle mass while family oriented goals focus on changing the family diet towards healthier options while at the same time including forms of physical activity to compliment the patients personal goals. Such goals are realistically plausible due to several factors: the first is the fact that the patient wishes to spend more time with her children.
The case notes have showed that the patient regrets not being able to spend more time with her children due to her job as a result this behavioral attribute of wanting to spend more time with her children could be used as an influencing factor to drive a certain degree of behavioral change. The patient comes home every day from work and spends all her time with her children, as such, this time could be used in physical activity with her children such as a light form of sports (i.e. badminton).
This particular form of physical activity would help with the patients inherent desire to be closer to her children while at the same time would help to slowly increase the amount of physical activity the patient does in a single day without it being too strenuous. This activity is rather easy to do; the patient would be more than willing and has the added benefit of fulfilling the personal goal of lowering her BMI through exercise which would help her gain muscle mass. Changing diets presents itself as the most challenging goal yet this is also plausible. In the case notes the patient shows that the reason why she picks fast foods is due to their convenience, as such it can also be said that should alternative healthier means be available the patient would choose them.
Grocery stores have various sections where readymade salad dressings, salads and healthy roasted items are available. By switching to buying from groceries rather than fast food establishments the customer is able to control the type of food that her family eats and the amount of fats and calories that go into it. This meets the goal of changing the diet of her family while at the same time helps to resolve the issue of yoyo dieting. 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 of fast food eaten. The greater the amount of physical activity with her children along with a lower amount of fast food eaten per week equates into a better physical status for the patient.
Nursing interventions for behavior change
In their study on the physiological and health implications of a sedentary lifestyle, 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. Based on the work of Tremblay et al, this paper will create actions steps on the basis on first changing how the patient thinks of her life and then will move on to actually accomplishing the tasks needed in order to attain a healthier lifestyle. The actions steps of the patient are as follows:
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Address the issue of time management for physical activity
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Have a daily physical activity routine of at least 40 minutes in order to build up muscle mass
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Switch to a healthier approach to eating
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Reduce BMI to 26
Research done by Tremblay et al and Sekendiz et al involving a similar method of behavioral change shows a distinct improvement in the long term health improvement of sedentary women (Sekendiz et al., 2010). 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 patients condition is to instill awareness that they do have the time and that it is readily available to them.
Once they are aware that they have the time the gradual implementation of moderate daily physical activity can begin (playing badminton with her children) in order to encourage a gradual push towards improving her physical condition. It is during this gradual change that the patient is introduced to healthier eating methods which are just as convenient as fast food in order to encourage the customer to buy healthier options. Finally the base goal of reach a BMI of 26 is set once all the other goals are met and the patient is already undergoing the process on her own.
Incentives and barriers to change
The primary motivator in the life of the patient is the desire to be there for her children. The fact is if her current lifestyle were to continue then the result would give her a body that is obese, unhealthy and potentially suffering from any number of weight related illnesses that could have been prevented with the proper diet and exercise. For the patient, being with her two children is one of the highlights of her day and as such being there for them is one of her primary goals and responsibilities in life. It must be noted that the case notes indicate that the patient is a single mother with no spouse and only a single relative nearby.
As such should the mother die there would only her sister left to take care of the children. It must also be noted that due to her intense desire to be with her children it is likely that the patient will continue on with the particular lifestyle choice that she has chosen. Incentives for the patient to change her lifestyle choices involve being able to enjoy a greater amount of time with her children. As mentioned earlier, the patient regrets not being able to be with her children enough, the physical activities that come with joint family exercise sessions (i.e. playing badminton) would to foster a closer relationship between the mother and her children which would make the patient happier.
Long term incentives for changing her lifestyle choices involve being able to feel better due to a distinct loss of weight, being able to fit into clothes that she was not able to wear before and finally a distinct rise in the level of her self-esteem due to the improvement in her physical appearance. The obstacles facing these goals are threefold: convenience, force of habit and time; due to the convenience of fast food over cooking, the patient regularly chooses to buy such items instead of cooking a balanced home cooked meal.
Force of habit has prevented the patient from attempting activities outside of home and work resulting in static habit that will be hard to break. Finally the perception of time causes individuals to think that between going to work and taking care of a household there is realistically no time in order to push through with other health conscious activities.
Realistic time frame
In terms of the amount of time needed to complete and instill this particular set of new behavioral characteristics a time frame of roughly 2 years will be needed accomplish this. This particular time frame reasonable because it gives allowances for the possibility of a temporary relapse while allowing the patient to gradually go back to the prescribed pattern of behavior to improve her health. 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 her routine (playing badminton) and then slowly over the next few months shifting her diet from fast food to healthier options.. Setting up a time frame of less than one year creates too much of a psychological burden on the patient that they might wind up giving up on their goal due to the feeling of being pressured. What is needed in such cases is to allow for periods of gradual transition while at the same time knowing that the patient is sure to miss a few days of exercise or will buy fast food now and then.
Maintenance strategies
The true challenge in changing behavior is maintaining it over a lifetime; in the case of Ms. Jones the best possible way on encouraging the proper healthy behavior is to have her kids encourage her to live a healthy lifestyle. By encouraging the kids at an early age to engage in outdoor physical activities this would in turn encourage the patient to continue maintaining her healthy behavior in order to interact with her children which apparently is very important to her. In essence the long term plan of ensuring the health of the patient is to help facilitate and encourage any and all outdoor joint activity with her children which would help to increase her level of physical activity resulting in a more active and healthier lifestyle.
References
Dunton, G. F., Berrigan, D. D., Ballard-Barbash, R. R., Graubard, B. B., & Atienza, A. A. (2009). Joint associations of physical activity and sedentary behaviors with body mass index: results from a time use survey of US adults. International Journal of Obesity, 33(12), 1427-1436. 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.
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.
Sekendiz, B., Cug, M., & Korkusuz, F. (2010). Effects of swiss ball core strength training on endurance, flexibility and balance in sedentary. Journal of Strength & Conditioning Research (Lippincott Williams & Wilkins), 24(11), 3032-3040. Web.
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