Rationale: Left untreated – 52.3% lifetime risk for fracture Many women do not engage in...
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Osteoporosis The Silent Killer Osteoporosis affects millions of people in the United States. This presentation will review a study in which computer based interventions will be examined to explore behavior change in relation to increasing calcium and vitamin D intake. Rationale: • Left untreated – 52.3% lifetime risk for fracture • Many women do not engage in prevention behaviors • Exercise, diet, and medication are usually recommended for prevention • Prevention could increase quality of life for many patients and reduce health care expenditures
Rationale: Left untreated – 52.3% lifetime risk for fracture Many women do not engage in prevention behaviors Exercise, diet, and medication are usually
Rationale: Left untreated 52.3% lifetime risk for fracture Many
women do not engage in prevention behaviors Exercise, diet, and
medication are usually recommended for prevention Prevention could
increase quality of life for many patients and reduce health care
expenditures
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(Smeltzer, Bare, Hinkle & Cheever, 2010) 10 million
Americans have osteoporosis 33.6 million Americans have osteopenia
Fractures potentially result in acute and chronic pain,
disfigurement, failure to return to normal functional status, and
increased mortality rate (Ryan, Maierle, Csuka, Thomson &
Szabo, 2013)
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The Integrated Theory of Health Behavior Change suggests that
health behavior change can be enhanced by fostering knowledge and
beliefs, increasing self-regulation skills and abilities, and
enhancing social facilitation (Ryan, 2009, p. 161). Polly Ryan,
PhD, RN, CNS-BC Kathleen J. Sawin, PhD, CPNP-PC, FAAN University of
Wisconsin
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Randomized Controlled Trial Intervention: Computer-based
information about calcium, vitamin D, diet, and osteoporosis
Results: Statistically significant differences in the intervention
group versus the control group in calcium intake from food and
supplements. No difference in vitamin D intake. (Ryan, Maierle,
Csuka, Thomson & Szabo, 2013)
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Scenario: 51 year old woman who is not taking any vitamins or
supplements, not eating the recommended amounts of calcium or
vitamin D, and has a low bone density DXA score. This patient is
asking for information about things she can do to prevent fractures
and further bone density loss. 1.Identify (variables in the
situation) Knowledge deficit Age Possible vitamin deficiency Low
bone density scores Woman Diet 2. Relate (or put the variables
together to form propositions) Primary Proposition: Patient is
curious about things she can do to prevent or reverse bone loss.
Possible Assumptions: Patient is unaware that behavior change can
prevent or reverse bone loss. Possible Confounding Variables: Lack
of education or advice about diet, exercise, or supplements. 3.
Understand (the importance of the prepositions, assumptions, and
confounding variables) Proposition: If patient does not change her
behaviors she is at risk for further bone density loss and
subsequently fractures. Significance of Assumptions: If the patient
is unaware of behavior changes she is at increased risk to lose
more bone density and have fractures. Possible Confounding
Variables: If patient does not believe that changes in diet,
exercise, or supplements will reduce future bone loss and risk for
fractures she will not change her behavior.
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4. Explain (the significance of the situation to those involved
based on their individual KSVME) Proposition: In terms the patient
can understand explain how modifications in diet, exercise, and
taking supplements can reduce bone density loss and the risk of
fractures. Assumptions: Explain that bone density loss can be
modified and the risk of fractures reduced. Confounding Variables:
Assess what the patient currently knows about risk factors for
osteoporosis and modify messages to fill in gaps in knowledge. 5.
Predict (what will happen in this situation if one or more
variables are not changed) Proposition: If bone density loss is not
addressed the patient may have a debilitating fracture leading to
loss of independence and possibly loss of life. Assumptions: If the
patient modifies her diet, exercise regimen, and starts supplements
as recommended she will stop or reverse bone density loss.
Confounding Variables: If the patient is willing to make changes in
her habits she will reduce her risk of fractures and bone density
loss. 6. Influence (someone to change one or more variables in
order to achieve a desired outcome or prevent an undesirable one)
Proposition: Help the patient make meaningful changes in her diet,
exercise regimen, and supplements. Assumptions: Ensure patient
understands the behavior modifications that are being addressed, if
not modify teaching. Confounding Variables: If the patient is
unwilling to make changes, explore her reluctance to better
understand what is motivating her.
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Design programs to increase knowledge and beliefs in health
change behaviors using technology including handheld devices.
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Nurses can help to identify patients at risk and help to
implement prevention strategies.