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Running head: HEALTH PROMOTION

Health Promotion

Allison Brown

Tamera Krukiel

NUR 4113: Gerontological Concepts and Issues

Bon Secours Memorial College of Nursing

November 10, 2018

I pledge…
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Running head: HEALTH PROMOTION

Assessment

The client that was chosen for the health promotion project was a 74-year-old, white male. His

initials are J. C. He worked in the coal mines in Southwest Virginia for 30 years, where he retired with

some health issues. He suffers from a hearing impairment, vision impairment, and the most limiting is his

walking abilities. He tends to be unsteady on his feet, which causes him to have balance issues. This has

resulted in falls in the past and hospital visits. He is a hard worker that likes his independence, so getting

him to slow down can be a daily challenge. The client does daily tasks such as cleaning litter boxes,

trimming bushes, and cutting the grass, which he does on his own without any assistance.

This client’s mobility problems relate back to Healthy People 2020 and its objectives for elder

adults. One long term service is, “Reduce the rate of emergency department (ED) visits due to falls

among older adults” (Healthy People 2020, n.d.). The client has ended up in the ED due to falls that he

has had in the past, and Healthy People 2020 is trying to reduce these risks. One of the interventions that

also pertains to the client is, “Falls Prevention in Community-Dwelling Older Adults” (Healthy People

2020, n.d.). Healthy People 2020 is promoting interventions that can help reduce falls in people 65 years

and older, thus pertaining to the client that was interviewed.

Nursing Diagnosis

The nursing diagnosis that was chosen for the client was, risk for falls related to altered mobility

as evidence by the patient stumbling and shaking while walking. This nursing diagnosis was chosen

because this seems to be the most prevalent problem with the client due to his independence and fall

history. The client needs to be aware of what can happen to him if he is not careful or if he does not take

his time. Two short term goals were chosen for the patients. The first one is, the patient will request

assistance prior to ambulation 8/10 times within the next 24 hours by November 11, 2018. This outcome

will insure that the client is receiving the help he needs while ambulating, thus decreasing his risk of

falling. The second short term outcome that was chosen for this patient is, the patient will verbally
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Running head: HEALTH PROMOTION

acknowledge three needs for prevention of falls by the end of November 11, 2018. This is another way

that can potentially decrease the number of falls that the client experiences.

Long term outcomes were also discussed with the patient. One outcome was, patient will

experience zero falls in the next 6 months, ending in May 2019. We want the client to be able to learn

techniques that will reduce his falls. The other long-term goal that was chosen was, if patient does start to

fall within the next 6 months, he will verbalize two ways to make the fall less traumatic, resulting in less

injuries. This goal will help the client to experience less traumatic injuries and could prevent him from

potentially having to go to the hospital.

Interventions

I used the Fulmer SPICES: An Overall Assessment Tool for Older Adults (Greenberg, 2012)

which identified that the client had evidence of falls. Based off of this finding I also used the Fall Risk

Assessment for Older Adults: The Hendrich II Fall Risk Model to identify the clients risk of falls

(Hendrich, 2016). The client scored a 8, making him at high risk for falling. It was identified that the

client needed teaching and interventions put into place so that he would experience less falls. After

completing the Survey of Preferred Learning Methods, it was identified that the client learns best by

auditory methods and his secondary learning method was visual learner. A teaching plan was made using

these strategies so that the client could learn ways to prevent falls.

The client, his wife, and I sat down together to form a teaching plan. We watched a video on

Youtube that talked about 6 tips to help prevent falls. A poster with the information from the video was

created so that the client could hang it on his wall and refer to it if he had forgotten anything. A calendar

was also hung up beside the poster so that the client could keep track of any falls that he has during the 6-

month period.

One journal article that I looked at provided an incite of what all can contribute to falls (Sharif,

Al-Harbi, Al-Shihabi, Al-Daour, & Sharif, 2018). According to Sharif et al., (2018) falls can be

contributed to many factors including illness, sense of dizziness, loose carpets, throw rugs, vision

problems, shoes, and medications. A walk through was done throughout the house with the client and his
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Running head: HEALTH PROMOTION

wife to see if there were any potential hazards. Upon walking through the house, we found throw rugs,

slippery floors, the client’s shoes did not fit properly, nightlights were not used at night, and no rails were

provided anywhere throughout the house. The client also mentioned that he does not always wear his

glasses. Medications were also discussed to see if any of them were contributing to his falls.

Based upon these findings there were interventions done to make the house a safer environment.

The client was hard of hearing, so some things had to be repeated multiple times. The client’s education

level and socioeconomic level had no impact on his learning. We went through the house and pulled up

all of the throw rugs, we put hand railings up in the bathrooms and by the stairs, bought nightlights and

put them up throughout the house, bought new shoes that fit the client, and even bought house slippers

with grips on the bottoms so he would not fall on the slippery floors. All these interventions have been

shown to reduce the number of falls in the elderly. We also taught the client how he can lower himself to

the floor or by sliding down a chair or the wall incase he was to start falling, so that he wouldn’t sustain

serious injuries.

The short-term outcomes were achieved because the client requested assistance prior to

ambulation 8/10 times within the next 24 hours by November 11, 2018 and he was also able to verbally

acknowledge three needs for prevention of falls by the end of November 11, 2018. These are huge steps

for the client in order to meet his long-term goals. The first short term goal was measured because the

client was calling for assistance before ambulating. He did this 8 out of 10 times by November 11, 2018.

The second short term goal was measured by using verbalization to acknowledge why prevention of falls

is important by November 11, 2018.

There were numerous teaching strategies put into place that was used for helping the client with

his long-term goal. One of the strategies that was used was watching a Youtube video on how to prevent

falls. Another was using a poster to keep track of things that had been taught to the client and his wife. If

he forgot ways to prevent falls or ways to prevent serious injuries from occurring, then he could go and

refer to the poster. There was also a calendar hanging up beside the poster so that the client could mark

off each month he didn’t have a fall or keep track if he did fall and the injuries he sustained. Another way
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Running head: HEALTH PROMOTION

that I could make sure that the long term-goals were being followed through with is to call the patient and

his wife to follow up on the teaching plan with him.

Evaluation

The outcomes that were identified for this client were a mixture of primary and secondary

prevention. Primary would happen before a fall occurred, while secondary prevention would be used to

prevent serious injuries incase a fall were to happen. The client responded well to the teaching that was

provided. I could tell that the client was very interested in learning ways to prevent himself from falling,

which made it a lot easier for him to learn the information that I was teaching to him. The client stated

things such as, “It is easier to learn when things are written down”, “I will use these strategies to help

reduce my incidence of falls”, and “I wish I started using these strategies a while ago”. Since the client is

so willing to learn, I think he is going to do great and continue to implement these strategies for a long

time. I think that more family could have been involved in the teaching. If something were to happen to

his wife or son, then someone else in the family would need to be responsible for helping him with these

things and to make sure he continued to follow his plan. I would also cut teaching sessions shorter.

Maybe try to do 30 minutes sessions at a time, instead of an hour or two.

I was glad to be able to have this experience in teaching the client on how to prevent falls. As

nurses, we will be providing our clients with education on a daily basis, so I think this assignment was a

great way to help us get use to education patients. It makes me feel good that we were able to identify

certain things within the home that can b easily fixed that might prevent the client from serious injuries in

the past. I learned that we have to be very patient with patients, especially elderly patients because they

can not take as much teaching in one sitting like middle aged adults. Overall. I think this project was a

good learning experience.

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Running head: HEALTH PROMOTION

References

Healthy People 2020. (n.d.). Retrieved September 15, 2018, from https://www.healthypeople.gov/

Hendrich, A. (2016). Fall Risk Assessment for Older Adults: The Hendrich II Fall Risk Model. Retrieved

September 15, 2018, from https://consultgeri.org/try-this/general-assessment/issue-8.pdf

Greenberg, S. (2012). Fulmer SPICES: An Overall Assessment Tool for Older Adults (KATZ). Retrieved

October 4, 2018, from https://consultgeri.org/try-this/general-assessment/issue-1.pdf

Gulanick, M., & Myers, J. L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes.

Philadelphia, PA: Elsevier/Mosby.

Sharif, S. I., Al-Harbi, A. B., Al-Shihabi, A. M., Al-Daour, D. S., & Sharif, R. S. (2018). Falls in the

elderly: Assessment of prevalence and risk factors. Pharmacy Practice, 16(3), 1206.

doi:10.18549/pharmpract.2018.03.1206