Victor Appau, Telana Fairchild, Bonnie Fitzgerald, Susan Hernandez, Abigail Mathews, Holly Shumard,...
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Stress, Diabetes and Hypertension Victor Appau, Telana Fairchild, Bonnie Fitzgerald, Susan Hernandez, Abigail Mathews, Holly Shumard, Sophie Stec, Reasmey Taing NP Students UMass - Worcester, Graduate School of Nursing N/NG 603A, Fall 2012
Victor Appau, Telana Fairchild, Bonnie Fitzgerald, Susan Hernandez, Abigail Mathews, Holly Shumard, Sophie Stec, Reasmey Taing NP Students UMass - Worcester,
Victor Appau, Telana Fairchild, Bonnie Fitzgerald, Susan
Hernandez, Abigail Mathews, Holly Shumard, Sophie Stec, Reasmey
Taing NP Students UMass - Worcester, Graduate School of Nursing
N/NG 603A, Fall 2012
Slide 3
Discuss each section as it relates to Healthy People 2020,
Health Determinants, and other sources Review our case study
patients The use of the 5 As model Poster session with 5 As model
applied to case study patients Video with Walter and use of MI
Community resources NP role HIPPA Dhalgren and Whitehead,
1991.
Slide 4
Work-place stress may develop as a result of work environment
Other Sources: o Unmanaged stress is a risk factor for multiple
chronic diseases o A combination of primary, secondary, and
tertiary methods are effective in stress management (USDHHS 2012).
(CDC, 2012). (Richardson and Rothstein, 2008).
Slide 5
Goals: o Reduce new cases of DM Target: Move from 8 new
cases/1,000 people to 7.2 new cases/1,000 people aged 18-84 o
Reduce DM death rate Target: Move from 73.1/100,000 deaths to
65.8/100,000 o Bi-annual HbA1c for adults with diabetes Target:
Move from 64.6% to 71.1% adults diagnosed with DM who have 2 HbA1c
in 12 months
Slide 6
Experience delays in getting care they need Less likely routine
screening and preventive care Not engage in fitness activities Use
tobacco Be overweight Have high blood pressure Experience symptoms
of psychological stress Receive less social-emotional support Have
lower employment rates
Slide 7
Goals: o Reduce number of adults with disabilities living in
congregate care residences Current: 57,462 Target: decrease to
31,604 o Increase participation in social, spiritual, recreational,
community, and civic activities to the degree that they wish o
Reduce delays in receiving primary care due to specific barriers,
and delays in obtaining assistive devices, service animals, and
technology services
Slide 8
A group of disorders affecting a persons ability to move and
maintain balance or posture Caused by abnormal development of the
brain or damage to the developing brain early in life Estimated
1/300 children in US have CP (CDC, 2012)
Slide 9
Skin breakdown Falls Social isolation Depression Decrease
independence Self-care Deficit Premature aging: o Extra Stress o
Organ system not to full capacity Pain: o Common sites o Chronic
and Acute (CDC, 2012) (NINDS, 2012)
Slide 10
No Standard Therapy We need more research on adults with CP.
Individual plan of care Interprofessional disease management
(NINDS, 2012)
Slide 11
Goals: o Increase cholesterol checks within the preceiding 5
years Estimated 74.6% US adults in 2008 Target: increase by 10%, to
82.1% o Reduce high total blood cholesterol levels 15.0% of adults
in the US fell into this category from 2005-2008 Target: Reduce
this statistic to 13.5%, a 10% reduction o Reduce the mean total
blood cholesterol levels The mean total blood cholesterol levels in
2005-2008 time period was 197.7 mg/dL Target: Decrease by 10%, mean
total blood cholesterol level 177.9 mg/dL
Slide 12
Goals: o Reduce adults with hypertension 29.9% of adults aged
18+ y/o had high blood pressure/hypertension in 200508 Target: 26.9
percent o Reduce adolescents with hypertension 3.5% of children and
adolescents aged 8 - 17 y/o had high blood pressure/ hypertension
in 200508 Target: 3.2 percent
Slide 13
43 y/o AA/NA male w/ hx of CP powered wheelchair Senior VP of
Finances o maybe when I have my nervous breakdown, I can get
workmen's comp o Concern for job security Runs late, HIGH stress
level Partner of 5 years & has a personal care assistant C/O:
Anxious, stressed, trouble sleeping EtOH- martini lunches &
nightly cognacs Gourmet Parisian diet *Yelled during
appointment*
Slide 14
54 y/o Italian female Divorced mother of 3 children, lives in
own mothers home New Assoc. VP of HR o Concern for job security
Social EtOH, smoker wicked bad temper Depressed, denies SI Low
self-esteem o Former Miss Teen MA *Overheard other pt exam*
Slide 15
Originally Developed US Department of Health and Human Services
Counseling smokers Adopted and supported USPTF Behavior change in
obese patients
http://www.uspreventiveservicestaskforce.org/3rduspstf/b
ehavior/behsum2.htm
http://www.uspreventiveservicestaskforce.org/3rduspstf/b
ehavior/behsum2.htm Recommended USPTF Clinicians to counsel tobacco
cessation http://www.uspreventiveservicestaskforce.org/uspstf09/to
bacco/tobaccors2.htm
http://www.uspreventiveservicestaskforce.org/uspstf09/to
bacco/tobaccors2.htm Evidence in support Jay et al. (2010).
Slide 16
43 y/o AA/NA male w/ hx of CP powered wheelchair Runs late,
HIGH stress level Partner of 5 years & has a personal care
assistant C/O: Anxious, stressed, trouble sleeping EtOH- martini
lunches & nightly cognacs B/P: 165/110 FBS: 130 Total
Cholesterol: 354mg/dL HDL 20mg/dL LDL: 200mg/dL 54 y/o Italian
female Divorced mother of 3 children, lives in own mothers home New
Assoc. VP of HR o Concern for job security Social EtOH, smoker
wicked bad temper Depressed, denies SI B/P 120/80 FBS: 110 HbA1C:
6.3% Total Cholesterol: 115mg/dL
Slide 17
Transtheoretical Model: stages of change - o Pre-contemplation:
lacking intent to change, no interest in changing behavior,
resistance o Technique: explore the balance of changing vs not
changing; what's good and what's not good Readiness to change and
confidence in ability to change Motivational Interviewing:
Partnership between provider and patient Explore ambivalence Change
comes from patient Suggestion: Self-monitoring Keep a journal
Support and follow-up
Slide 18
Cerebral Palsy MA http://www.masscp.org/cpma/cpma_frameset. htm
Diabetes Center for Excellence http://www.umassmemorial.org/our-
care/diabetes-center-of-excellence Stress Reduction
http://umassmed.edu/content.aspx?id=41254
Slide 19
Definition: o Level of Education o License o Holistic and
preventative care o Culture relativism Massachusetts o Advanced
skills o Collaboration o Inside expertise o Practice guidelines
Mass.Gov.Health and Human Services. (2012).
http://www.mass.gov/eohhs/provider/licensing) Rosenthal, L. D.,
& Guerrasio, J. (2010). Acute care nurse practitioner as
hospitalist: role description. Critical Care Nurse, 21-26.
Slide 20
The purpose of 244 CMR 4.00 is to establish the conditions
under which registered nurses licensed by the Board of Registration
in Nursing may practice in an expanded role. 244 CMR 4.00 also
establishes principles of supervision, responsibility, and
discipline to which nurses practicing in the expanded role are
subject Responsible for own practice Employment of advanced skills
o Evaluation o Diagnoses o Treatment Mass.Gov.Health and Human
Services. (2012).
http://www.mass.gov/eohhs/provider/licensing)
Slide 21
Diagnosing, treating, evaluation Medical histories Physical
examinations Diagnostic studies Prevention and prescribing Primary
and specialty care services Acute and critical care settings
Surgeries and procedures Counseling and educating Rosenthal, L. D.,
& Guerrasio, J. (2010). Acute care nurse practitioner as
hospitalist: role description. Critical Care Nurse, 21-26.
Slide 22
Community clinics, health centers, urgent care centers Health
maintenance organizations (HMOs) Hospitals and hospital clinics
Nursing homes Physicians offices Public health departments Nurse
practitioner practices/ offices Rosenthal, L. D., & Guerrasio,
J. (2010). Acute care nurse practitioner as hospitalist: role
description. Critical Care Nurse, 21-26.
Slide 23
Increase access to health care programs o Stress management o
Nutritional counseling o Fitness programs o Smoking cessation o
Family counseling Rosenthal, L. D., & Guerrasio, J. (2010).
Acute care nurse practitioner as hospitalist: role description.
Critical Care Nurse, 21-26.
Slide 24
Audrey over heard Walters appointment Definition: o 1996 o
National standards o Protection of healthcare information Paper
Electronic o Organization required to develop polices and
procedures Failure to comply> penalties File complaint with OCR:
http://www.hhs.gov/ocr/privacy/hipaa/complaints/i ndex.html.
http://www.hhs.gov/ocr/privacy/hipaa/complaints/i ndex.html $1.5
million US Department of Health and Human Services. (2012).
HHS.gov
Slide 25
Best practice: o Ensure compliance o Physical and technical
safeguards o Risk assessment o IT audit o Breach notification plan
US Department of Health and Human Services. (2012).
HHS.gov/ocr/privcay
Slide 26
Inform Walter Discuss with Audrey o HIPPA law o Role Report to
HMO Mandatory training for ALL employees Designee
http://www.hhs.gov/ocr/privacy/ http://www.hhs.gov/ocr/privacy/ US
Department of Health and Human Services. (2012).
HHS.gov/ocr/privacy/
Slide 27
Slide 28
References Agency for Healthcare Research and Quality, National
Guideline Clearinghouse. (2008). Practice guideline for the
treatment of patients with acute stress disorder and posttraumatic
stress disorder. Retrieved from
http://guideline.gov/content.aspx?id=5954&search=acute+stress
Initiative by The Agency of Healthcare Research and Quality, The
National Guidelines Clearinghouse provides a database of evidence
based treatment guidelines addressing several health areas
(Overweight and obesity, Tobacco, Acute Stress). These guidelines
are useful in identifying and addressing the goals of behavior
change for Walter and Audrey. It also provides practitioners with
evidence based treatment resources to address Walter and Audrey's
problems such as smoking, stress and weight management. Agency for
Healthcare Research and Quality, National Guideline Clearinghouse.
(2011). Management of overweight and obesity in the adult.
Retrieved from http://guideline.gov/content.aspx?id=33134
Initiative by The Agency of Healthcare Research and Quality, The
National Guidelines Clearinghouse provides a database of evidence
based treatment guidelines addressing several health areas
(Overweight and obesity, Tobacco, Acute Stress). These guidelines
are useful in identifying and addressing the goals of behavior
change for Walter and Audrey. It also provides practitioners with
evidence based treatment resources to address Walter and Audrey's
problems such as smoking, stress and weight management. Agency for
Healthcare Research and Quality, National Guideline Clearinghouse.
(2012). Tobacco treatment. Retrieved from
http://guideline.gov/content.aspx?id=36845 Initiative by The Agency
of Healthcare Research and Quality, The National Guidelines
Clearinghouse provides a database of evidence based treatment
guidelines addressing several health areas (Overweight and obesity,
Tobacco, Acute Stress). These guidelines are useful in identifying
and addressing the goals of behavior change for Walter and Audrey.
It also provides practitioners with evidence based treatment
resources to address Walter and Audrey's problems such as smoking,
stress and weight management.
Slide 29
American Diabetes Association (ADA). (n.d.). Stress. Retrieved
from
http://www.diabetes.org/livingwith-diabetes/complications/stress.html
American Diabetes Association is a web based site that pertains to
the prevention, treatment, and cure for diabetes. Their objective
is to help those who are affected by diabetes and provide them with
valid information for their understanding of the disease. This site
is a reputable and highly quoted site for those in the diabetic
world. There are guidelines for treatment and research to support
the data at this site. For our purposes this site aids in our
understanding of diabetes, how it relates to patients, and
information for us as providers in diagnosing and treating
patients. We are able to link why stress might have an effect on
developing or worsen the symptoms of diabetes. American Heart
Association. (2011, November). Target Heart Rates. Retrieved from
http://www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/Target-Heart-
Rates_UCM_434341_Article.jsp American Heart Association is well
known association that focuses on cardiovascular health in relation
to heart disease and stroke. This association provides the medical
field with standards of care for cardiovascular disease and stroke.
They are a well trusted association among medical professionals,
lets face it they provide the education and approval certification
for practitioners to give CPR, ACLS, etc. For this particular
information gained was to aid us in prescribing exercise
prescriptions to our two case study patients and give them the
information for understanding target heart rates and how to
calculate heart rates. American Heart Association. (2012, April).
About high blood pressure. Retrieved from
http://www.heart.org/heartorg/conditions/highbloodpressure/high-blood-pressure-or-
hypertension_ucm_002020_subhomepage.jsp The American Heart
Association is a non-profit organization that advocates for the
United States public through cardiovascular research, education,
community programs through fund-raising which support continued
growth. It gives a clear, organized breakdown of information and
current research for the general public. The reference also gives
further information on risk factors and prevention for
patients.
Slide 30
American Heart Association. (2012). What your cholesterol
levels mean. Retrieved from
http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/What-Your-Cholesterol-Levels-
Mean_UCM_305562_Article.jsp American Heart Association is well
known association that focuses on cardiovascular health in relation
to heart disease and stroke. This association provides the medical
field with standards of care for cardiovascular disease and stroke.
They are a well trusted association among medical professionals,
lets face it they provide the education and approval certification
for practitioners to give CPR, ACLS, etc. This particular website
found on their site was to aid us in describing cholesterol levels
to patients and what is means if they high. Also, gives the
providers insight about knowing when their patients are at risk for
development of certain diseases. American Society of Hypertension.
(2010). La presin arterial y su salud. Blood Pressure Health.
Retrieved from
http://www.ash-us.org/documents/BloodPressureHealthSpanish.pdf The
ASH produced an informational booklet through which
Spanish-speaking patients can learn basic concepts of blood
pressure, information about high blood pressure, and how to lower
and control high blood pressure. The document underlines clear
methods and guidelines as well as provide an interactive diary with
outlined questions for provider follow- up. The resource also
provides illustrations and photos for further visual learning
methods. Barter, P.J. (2011). The causes and consequences of low
levels of high density lipoproteins in patients with diabetes.
Diabetes and Metabolism Journal, 35, 101-106. doi:
10.4093/dmj.2011.35.2.101 This review summarizes the relationship
between pre-diabetes or diabetes and low HDL levels, low HDL levels
with high triglyceride levels, HDL as a compound and pancreatic
beta cells, and HDL levels with insulin resistance. The review
illustrates how the progression of diabetes can be stopped or
reversed through increasing and managing HDL levels. The document
also describes the effect of niacin and other forms of
pharmaceutical treatment to increase HDL levels. This is a reliable
review of data analysis for the provider. Centers for Disease
Control and Prevention. (2011). Physical Activity. Retrieved from
http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html
According to the CDC, adults need 150 minutes of moderate intensity
cardiovascular exercise per week to achieve cardiovascular
benefits. This recommendation allows patients to break their
minutes into manageable segments of at least 10 minutes in
duration. Patients working at moderate intensity should be able to
talk during their workout, but not sing.
Slide 31
Centers for Disease Control and Prevention. (2012). Cerebral
Palsy (CP). Retrieved from http://www.cdc.gov/NCBDDD/cp/facts.html
The Centers for Disease Control and Prevention (CDC) is a
government agency focusing on public health. The topic of cerebral
palsy is addressed on the CDC website. The website provides
background information about the disease, including basic facts,
statistics, information about screening and diagnosis, and links to
research and articles. This resource was a place for me to access
general background information about CP and the health problems
people with CP face. Centers for Disease Control and Prevention.
(2012). Selected Preventative Screening Recommendations. Retrieved
from
http://www.cdc.gov/nccdphp/dnpao/hwi/resources/preventative_screening.htm
Centers for Disease Control and Prevention outlines recommended
preventative health screenings and intervals for adults, as
established by U.S. Preventive Services Task Force (USPSTF). The
list serves as a tool to identify potential valuable screening,
with the risks and benefits to be weighed and individualized based
on patient needs. Center for Mindfulness in Medicine, Health Care,
and Society. (n.d.). Stress Reduction Program. University of
Massachusetts Medical School. Retrieved from
http://www.umassmed.edu/Content.aspx?id=41254 Center for
Mindfulness in Medicine, Health Care, and Society is part of the
University of Massachusetts Medical Department. At the center, they
aid clients through an eight week Stress Reduction Program
developed in 1979 by Dr. Jon Kabat-Zinn. Due to Dr. Kabat-Zinn
evidence based research and studies in stress reduction, the
program seem trustworthy and applicable. Other professionals have
adapted his techniques imbedded in this program to help with
several different patients and for many different reasons and it
seems successful based on the research and testimonies. For our
purposes this provided us with a program we could inform providers
about in order to get their patients involved. Both Audrey and
Walter could benefit from stress reduction. Chobanian, A.V.,
Bakris, G.L., Black, H.R., Cushman, W.C., Green, L.A., Izzo, J.
L.,... Materson, B.J. (2003). The seventh report of the joint
national committee on prevention, detection, evaluation, and
treatment of high blood pressure. The Journal of the American
Medical Association, 289, 2560-2571. The Seventh Report of the
Joint National Committee (JNC 7) is an excellent reference and
guide for the treatment of hypertension. The guide contains
recommendations that are based on evidence from a rigorous
systematic reviews and synthesis of the published medical
literature. The purpose of JNC report is to provide an
evidence-based approach to prevention and management of
hypertension.
Slide 32
Dagogo-Jack, S., Egbuonu, N., Edeoga, C. (2009). Principles and
practice of nonpharmacological interventions to reduce
cardiometabolic risk. Medical Principle Practice, 2010(19),
167-175. doi:10.1159/000285280 This article reviews landmark
studies that demonstrate the principles of nonpharmacological
approaches to the reduction of the components of the metabolic
syndrome, including pre-diabetes, prehypertension and dyslipidemia.
Lifestyle interventions have been shown to ameliorate and prevent
the progression of individual components of the metabolic syndrome.
Dahlgren, G. and Whitehead, M. (1991). Policies and strategies to
promote social equity in health. Stockholm Institute for Future
Studies Department of Veteran Affairs. (n.d.). [Chart for pulse
rates per minute defined by age groups for moderate activity and
vigorous activity]. MOVE! Retrieved from
http://www.move.va.gov/download/NewHandouts/PhysicalActivity/P09_HowToTakeYourHeartRate.pdf
Department of Veteran Affairs is another US government association
that is provided and held to standards of our government. The
validity of the source is based on the fact it is a government
association and this particular information is from the MOVE
program from the NCP. This particular information came from a
handout they are providing to their client as part of the MOVE
program. This was great source for the table provided and giving
informative, simple instruction on how to check your pulse for
patient or providers to use as a tool for educating patients.
Fessler, M.B., Massing, M.W., Spruell, B., Jaramillo, R., Draper,
D., Madenspacher, J.H., Zeldin, D.Z. (2009). Novel relationship of
serum cholesterol with asthma and wheeze in the United States.
Journal of Allergy and Clinical Immunology, 124(5), 967-974. doi:
10.1016/j.jaci.2009.08.005 This data analysis utilizes the Centers
for Disease Control and Prevention 2006 survey National Health and
Nutrition Examination Survey provided by the CDC National Center
for Health Statistics. The study describes an inverse relationship
of serum total cholesterol and non-high density lipoproteins with
asthma and/or clinical wheeze, with a strong relationship
specifically with the Mexican-American population.
Slide 33
Fitday. (n.d.). How to Calculate Your Serum Cholesterol Level.
Retrieved from http://www.fitday.com/fitness-
articles/nutrition/fats/how-to-calculate-your-serum-cholesterol-level.html
This is simply an online journal for those try to lose weight and
help keep a record of progress. After exhausting all the well-known
sites for an exact equation for calculating the total cholesterol I
had to use what I could find and this site gave insight. However,
the are no listing of references or dates to know the validity of
this site, but seems these days AHA, CDC, etc. use a lipid panel
for testing and there is no need for this calculation anymore. If
anything this would be a good website to tell patients about that
is free of cost to help them track their healthy lives. Frost, S.
(2011, June 25). Exercise Plan for Busy Moms. Livingstrong.com.
Retrieved from
http://www.livestrong.com/article/478805-exercise-plan-for-busy-moms/?utm_source=RELARTICLES_R1
Livestrong is the website that Lance Armstrong is a founder. They
claim to post only information that is expert based and reviewed.
This particular article is from 2011 and was reviewed at that time.
LiveStrong used other sources and allowed experts to write articles
that are then reviewed by peers increasing the level of confidence
in the information found on this site. This website, having used it
previously for Walter, is useful and knowledgeable about exercise
for all different people. With Audrey we face the issue of her
being a busy mom. This particular article referenced four other
sites for busy moms and how they can find a way to fit exercise in
their busy schedule. Hart, Jacqueline A. (2003, June 3). High blood
pressure (hypertension) guide. Penn Cardiac Care. Penn Medicine.
Retrieved from
http://www.pennmedicine.org/health_info/hbp/index.html These
University of Pennsylvania Medical School resources give accurate
and detailed information on hypertension, symptomology, and
information on the DASH diet to which patients can refer. These two
references highlight the importance of blood pressure monitoring
and severity of the condition. It supports blood pressure screening
and lifestyle changes that the patient can further read in detail.
Hart, Jacqueline A. (2004, March 29). High blood pressure is
silent. Penn Cardiac Care. Penn Medicine. Retrieved from
http://www.pennmedicine.org/health_info/hbp/hbp_step5.html These
University of Pennsylvania Medical School resources give accurate
and detailed information on hypertension, symptomology, and
information on the DASH diet to which patients can refer. These two
references highlight the importance of blood pressure monitoring
and severity of the condition. It supports blood pressure screening
and lifestyle changes that the patient can further read in
detail.
Slide 34
Health Indicators Warehouse. (2008). Smoking cessation success
(percent). Retrieved from
http://www.healthindicators.gov/Indicators/Smokingcessationsuccess-6monthsto1yearago
(adults18yearsandolder)_1555/Profile/Data The Health Indicators
Warehouse, as cited by Healthy People 2020, provides a resource of
current national statistics on smoking cessation adjusted by a
variety of indices (age range, sex, etc.). Healthy People 2020.
(2012). Disability and Health. Retrieved from
http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=9
Healthy People 2020 covers the topic of Disability and Health in
order to explore the disparity of health care among people with
disabilities. The report aims to promote the health and well-being
of this population. This report was useful in looking at disability
in relation to goals for Walters care. Healthy People 2020. (2012).
Heart Disease and Stroke. Retrieved from
http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=21
Healthy People 2020 covers the topic of cardiovascular disease. The
webpage served to provide basic info on cardiovascular disease and
its risk factors. Heisler, M., Resnicow, K. (2008). Helping
patients make and sustain healthy changes: a brief introduction to
motivational interview in clinical diabetes care. Clinical
Diabetes, 26(4). Retrieved from http://diabetes.niddk.nih.gov This
article focused on a major aspect of using Motivational
Interviewing (MI) to help patients undertake and sustain the
necessary behaviors to manage their conditions. MI requires
practice and considerable training. Improving our ability as health
care providers to listen, to understand and empathize with the
patients struggles during difficult lifestyle changes. Working with
the collaboration of the patients is the underlying philosophy.
Horsman, M., Suto, M., Dudgeon, B., Harris, S. (2010). Aging with
cerebral palsy: Psychosocial issues. Age and Aging. 39, 294-299.
doi: 10.1093/ageing/afq018 This article described a narrative
review of nine prior studies which aimed to address the
psychosocial issues challenging adults with CP. McMaster
Universitys Guidelines for Critical Review was used to evaluate
both quantitative and qualitative studies. This article was useful
in identifying areas of need for psychosocial support in an aging
patient with CP. The discussion included the detrimental influence
of physiological impairments on the psychosocial taxing effects of
the disease.
Slide 35
Isometric Exercises. (n.d.). Isometric Exercises- History and
Benefits. Retrieved from: http://www.isometricexercises.net This is
a commercial based website used to get more information about
isometrics Dr. Rimmer mentioned in his article. Due to having to
make a prescription exercise plan for Walter I need examples of
Isometric exercise and an idea if he could perform these exercises.
The website was helpful and gave insight; however, confidence in
the site is low due to lack of explanation of references used and
dates the data are pulled. Based on the other sites found during
searching this one was the easiest to follow and gave the most
information for this project. Jay, M., Gillespie, C., Shlair, S.,
Sherman, S., Kalet, A. (2010). Physician's use of the 5as in
counseling obese patients: is the quality of counseling associated
with patients' motivation and intention to lose weight. BMC Health
Services Research,10, 159. Retrieved from
http://www.biomedcentral.com/1472-6963/10/159 Jay, M et al.
explained the quality of physicians use of the 5as model of
behavior change in counseling and investigated the relationship or
associations between the quality of counseling and patients
enthusiasm to lose weight. The results of this research were
pertinent to Audrey and Walters cases because it was found that
physicians use of the 5as model was associated with higher
likelihood of patients desire to lose weight, eat healthy and
exercise. This study provided us with a recent evidence based
corroboration of the effectiveness of the 5as model being used to
affect behavior change in Audrey and Walter. Kodama, S., Tanaka,
S., Saito, K., Shu, M., Sone, Y., Onitake, F.,... Sone, H. (2007).
Effect of aerobic exercise training on serum levels of high-density
lipoprotein cholesterol: a meta-analysis. Archives of Internal
Medicine, 167(10), 999-1008. doi:10.1001/archinte.167.10.999 This
is the meta-analysis describing the relationship of exercise
amount, exercise intensity, and cholesterol levels. The article
outlines criteria for increasing HDL with lifestyle changes and
exercise through increased intensity and duration more than the
national recommendations.
Slide 36
Lind, B.K., Lafferty, W.E., Tyree, P.T., Diehr, P.K. (2010).
The Journal of Alternative and Complementary Medicine. 16(4),
411-417. The authors research the insurance expenditures of
patients who use CAM versus those using only conventional medicine.
This study indicated that patients using CAM have higher outpatient
expenditure, but this expenditure is off-set by costly impatient
imaging studies of non-CAM patients. The research suggests there is
a cost benefit for insurance companies to cover CAM modalities in
order to reduce expenditure per patient. Matthews, K.A., Katholi,
C.R., McCreath, H., Whooley, M.A., Williams, D.R., Zhu, S.,
Markovitz, J.H. (2004, July, 6). Blood pressure reactivity to
psychological stress predicts hypertension in the CARDIA study.
Circulation, 110(1),74- 78. doi:10.1161/01.CIR.0000133415.37578.E4
This article is found in the Circulation Journal. The study is
based on a large sample size of participants enrolled in the CARDIA
Study. The research for this article was to show if there is a
relationship between stress and hypertension. We do have to keep in
mind that this is an article with many strengths and weaknesses. As
mentioned before the sample size was very large and included both
black and white men and women from 18 years of age to 30. The
researchers followed the participants over a thirteen year period
using standardize measurements and protocols. Even though, they had
a large sample size there were lost follow up with some of the
participants. Also, in one particular measurement of blood pressure
to a stressor used in the study only one blood pressure measurement
was used instead of taking an average. Their review of literature
was very weak; more sources would have added more support to their
theory. There is also no conclusive details on the nature of the
association of stress to blood pressure found during the study and
there is a need for more research. For our purposes, we used to
show that yet there is no understanding and great data to represent
a direct relationship of stress to hypertension; we learn again
that stressors do increase blood pressure measurements done on a
wide, multiple range of individuals. Mayo Clinic Staff at the Mayo
Foundation for Medical Education and Research (MFMER). (2010,
August 5). Stress and high blood pressure: What's the connection?
Retrieved from
http://www.mayoclinic.com/health/stress-and-high-blood-pressure/HI00092
Mayo Foundation for Medical Education and Research is part of the
Mayo Clinic Network. Their goal as a network is to provide the best
patient care by using information from research to educate and
practice. They receive funding and do their own research using
their patient population and their clinical staff. There may be
slight bias in their studies; however, they base their outcomes on
patients are first. For the particular data provided for this
information was a website based on seven references, one of which
was the AHA and citation within the last six years. For our
purposes, they provided studies that aided in our understanding
about stress and high blood pressure.
Slide 37
Mayo Clinic Staff at Mayo Foundation for Medical Education and
Research (MFMER). (2010, December 8). Exercise: When to check with
your doctor first. Retrieved from
http://www.mayoclinic.com/health/exercise/SM00059 Mayo Foundation
for Medical Education and Research is part of the Mayo Clinic
Network. Their goal as a network is to provide the best patient
care by using information from research to educate and practice.
They receive funding and do their own research using their patient
population and their clinical staff. There may be slight bias in
their studies; however, they base their outcomes on patients are
first. For the particular data provided for this information was a
web site based on three references, two which are reputable sources
(CDC and ACMS) within the last two years. However, one reference
used was a expert opinion from someone in the clinical staff. For
our purposes, this information aided us in developing information
to give to patients so they know when they should consult with
their provider before exercising. As providers and gave us
information on which patient population we should evaluate before
allowing them to do exercising. Mayo Clinic. (2007). Fitness: Tool:
Target heart rate calculator. Retrieved from
http://ww.mayoclinic.com/health/target-heart-rate/SM00083 Mayo
Foundation for Medical Education and Research is part of the Mayo
Clinic Network. Their goal as a network is to provide the best
patient care by using information from research to educate and
practice. They receive funding and do their own research using
their patient population and their clinical staff. There may be
slight bias in their studies; however, they base their outcomes on
patients are first. For the particular website it is simply a tool
providers or patients can use to calculate target heart rates in a
simple, easy way. This tool is based on the CDC and adapted by
MFMER in 2007. CDC is a reliable source that the MFMER recognizes
as giving factual information and created this tool based on their
standardization of care for patients. Michigan Quality Improvement
Consortium. (2004). Communication Guidelines to Promote Behavior
Change. Retrieved from
http://www.mqic.org/pdf/Communication_Guidelines_to_Promote_Health_Behavior_Change_176076_7.pdf
The Michigan Quality Improvement Consortium is a resource for
clinical practice guidelines based on current research evidence.
This communication guideline is pertinent to Walter and Audrey's
cases because it underscores motivational interviewing and patient
centered behavior change which we implemented to effect behavior
change in Audrey and Walter.
Slide 38
Mortensen, A.M. (2011, July 22). Desk Exercises for Stress
Relief and Health. Livestrong.com. Retrieved from
http://www.livestrong.com/article/499013-desk-exercises-for-stress-relief-and-health/.
Livestrong is the website that Lance Armstrong is a founder. They
claim to post only information that is expert based and reviewed.
This particular article is from 2011 and was reviewed at that time.
LiveStrong used other sources and allowed experts to write articles
that are then reviewed by peers increasing the level of confidence
in the information found on this site. This website gave a lot of
information for those with busy work schedules. Using more than one
of them was to strengthen each other, providing the same
information from two different authors and two different reviewers.
As mentioned, with Audrey we face the issue of her being a busy
mom. This particular article referenced three other sites and how
they can find a way to fit exercise in their busy schedule even at
the office desk. Mosca, L., Appel, L.J., Benjamin, E. J., Berra,
K., Chandra-Strobos, N., Fabunmi, R.P., Grady, D. (2004). Evidence
based guidelines for cardiovascular disease prevention in women.
Journal of the American College of Cardiology, 43, 900-921.
National Center for Health Statistics. Center for Disease Control
and Prevention. (2011). NHANES Survey 2009-2010. National Health
and Nutrition Examination Survey. Retrieved from
http://www.cdc.gov/nchs/nhanes/nhanes2009-2010/nhanes09_10.htm This
journal article articulates a data analysis of the Centers for
Disease Control and Prevention 2009 survey National Health and
Nutrition Examination Survey provided by the CDC National Center
for Health Statistics. The National Health and Nutrition
Examination Survey (NHANES) is a program of studies designed to
assess the health and nutritional status of adults and children in
the United States. The survey is unique in that it combines
interviews and physical examinations (CDC, 2012). The data analysis
revealed a correlation of low HDL cholesterol levels and major
depression in women, and illustrated a correlation of high LDL
cholesterol levels and major depression in men. National Institutes
of Health. (2011, August). Relaxation Techniques for Health: An
Introduction. National Center for Complementary and Alternative
Medicine. Retrieved from
http://nccam.nih.gov/health/stress/relaxation.htm The National
Institutes of Health is a part of the US Department of Health and
Human Services. This is our nations agency for research in the
medical field. The website gives links to its research and
development and sets standards based on congressional decisions and
policy. For these reasons, the NIH is a very renowned website and
highly trustworthy to all of those involved in the medical world.
It is also the largest fund providing agency to research and
development leading to state of the art and the most up to date
research projects. For our purposes this site gave us the opposite
response to the flight or fight, which as we learned is how the
body relaxes and decrease blood pressure and decreases the release
of hormones that affect glucose levels in our body.
Slide 39
National Institute of Neurological Disorders and Stroke.
(2012). Cerebral Palsy: Hope Through Research. Retrieved from:
http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm#211453104
National Institute of Neurological Disorders and Stroke (NINDS) is
a subset of the National Institutes of Health. NINDS aims to to
reduce the burden of neurological disease. NINDS dedicates a
Disorders page to CP. The webpage offers background information
about the disease, as well as risk factors, treatment options,
management, and research. The information on the NINDS website was
used to generate nursing diagnoses for Walter and to supply general
information about the treatment for adults with CP. Prochaska, J.,
Velicer, W., Rossi, J., Goldstein, M., Marcus, B., Rakowski, W.,
Rossi, S. (1994). Stages of change and decisional balance for 12
problem behavior. Health Psychology, 13(1), 39-46. This article was
used for further exploration in the Transtheoretical Model of
Change in order to write the script for Walters Motivational
Interview and Stages of Change video. Richardson, K. M., Rothstein,
H. R. (2008). Effects of Occupational Stress Management
Intervention Programs: A Meta-Analysis. Journal of Occupational
Health Psychology, 13 (1), 69-93. A meta-analysis exploring the
effectiveness of occupational stress management interventions
represented 55 types of interventions and included 2,847 studies.
The studies were then coded as cognitive behavioral, relaxation,
organizational, multimodal, and alternative. Psychological outcomes
were measure in most studies, versus physiological outcomes. The
most commonly used intervention was relaxation technique. The
authors used a selection process for inclusion of studies,
requiring randomization of subjects, as control group, employed
subjects, studies published in English after 1975, and exclusion of
subjects diagnosed with major psychiatric disorders. Most
interventions ranged from 8-12 weeks, and many were self-taught via
audio tapes. Cognitive-behavioral interventions had the greatest
outcomes, while relaxation was the most utilized intervention. Its
worth noting that combining many stress reducing techniques in an
intervention will reduce positive outcomes. Research indicated that
two techniques per intervention produce the best outcomes.
Understanding the effectiveness of occupational stress management
will enable the provider to create an evidence-based intervention,
like to improve patient outcomes.
Slide 40
Rimmer, J.H. (2012). Resistance Training for Persons with
Physical Disabilities. National Center on Health, Physical
Activity, and Disability. Retrieved from
http://www.ncpad.org/94/699/Resistance~Training~for~Persons~with~Physical~Disabilities
The National Center on Health, Physical Activity, and Disability is
known for thirteen years of work with disabled clients keeping them
on track with health and fitness. Dr. J.H. Rimmer is 25 year
veteran working on health promotions with those who are disabled.
He is well-known in his field through publishing in many resources
and his position in two federal organizations. Due to his long time
in the field of study and peer-reviewed publications this document
has some validity to it. He is the only author and there are no
statements of when or if reviewed so there could be some biasness
from him. From the details; however, the description and the
knowledge used gives confidence that the article holds truth.
Walter has CP and due to this he has found it difficult to stay in
shape, so this article gives insight to things specifically for CP
clients. Roger, V. L., Go, A. S., Lloyd-Jones, D. M., Benjamin,
E.J., Berry, J. D., Borden, W.B., Turner, M. B. (2012). Heart
disease and stroke statistics-2012 update: a report from the
american heart association. Circulation, 125, 2-220. doi:
10.1161/CIR.0b013e31825e7519 This report gives current and thorough
statistical information for individual prevalence of hypertension,
coronary artery disease, heart failure, and other cardiovascular
diseases in each state as well as the United States as a whole. The
report also provides mortality and morbidity rates for the United
States. The document provides information on risk assessment as
well as nutritional data in regard to cardiovascular diseases
providing a complete resource of information for a provider or
researcher. Sandmaier, M. (2005 December). Your guide to a healthy
heart. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, National
Institutes of Health. National Heart, Lung, and Blood Institute,
NIH Publication No. 06-5269. Retrieved from
http://www.nhlbi.nih.gov/health/public/heart/other/your_guide/healthyheart.pdf
The National Institutes of Health is a part of the US Department of
Health and Human Services. This is our nations agency for research
in the medical field. The website gives links to its research and
development and sets standards based on congressional decisions and
policy. For these reasons, the NIH is a very renowned website and
highly trustworthy to all of those involved in the medical world.
It is also the largest fund providing agency to research and
development leading to state of the art and the most up to date
research projects. For our purposes this site has lead us to the
discovery of many articles to provide us with information on
stress, hypertension and diabetes. Along with that, the site gives
us insight of future research.
Slide 41
Shelby, J., McCance, K.L. (2004). Understanding
Pathophysiology. S.E. Huether, K.L. McCance (Eds.). St. Louis,
Missouri: Mosby. This is a text book from undergraduate nursing
studies. The text book is about the pathophysiology of the human
body. In this particular chapter the author is describing what
stress is, how your body reacts to stress, the benefits and risk
and how this relates to disease. The reference was very useful to
aide in describing stress in relation to why it affects the body
and understanding how it may lead to hypertension and diabetes. The
information is highly reliable because it purpose is to provide
facts so that health care professional will understand the
pathophysiology of the human body. Due to its being a text book,
the information is reliable and bias is minimal to obsolete. This
text book helped us be able to understand and explain how stress is
related to increase blood pressure and increase glucose levels.
Being able to explain this will help support our other resources in
describing the link of stress to hypertension and diabetes. Slaman,
J., Roebroeck, M., van Meeteren, J., van der Slot, W.,
Reinders-Messelink, H., Lindeman, E., van den Berg-Emons, R.
(2010). Learn 2 Move 16-24: effectiveness of an intervention to
stimulate physical activity and improve physical fitness of
adolescents and young adults with spastic cerebral palsy: a
randomized controlled trial. BMC Pediatrics, 10(79), 1-8. This
article described a randomized, controlled study, designed to
evaluate the effectiveness of intervention to increase physical
activity and improve fitness in adolescents and young adults with
spastic CP. While the results of this trial have not yet been
published, the article offered explanation and research detailing
the reason for methods used and design of the interventions to
stimulate physical activity and fitness in people with CP. Tedders,
S. H., Fokong, K. D., McKenzie, L. E., Wesley, C., Yu, L.,Zhang, L.
(2011). Low cholesterol is associated with depression among US
household population. Journal ofAffective Disorders, 135,
115-121.doi:10.1016/j.jad.2011.06.045 This study compares HDL and
LDL levels among men and women with the propensity toward major
depressive disorder. The findings illustrate clinically significant
differences between men and women. Thorpe, D. (2009). The role of
fitness in health and disease: status of adults with cerebral
palsy. Developmental Medicine and Child Neurology, 51(4),
52-58.doi: 10.1111/j.1469-8749.2009.03433.x This article reviewed
quantitative research on physical activity and fitness and its
relationship to health in adults with CP. The author identified a
need for greater research on this topic and aimed the article at
presenting possibilities for future research. United States
Department of Health and Human Services. (2012). Healthy People
2020 Topics and Objectives: Heart Disease and Stroke Washington,
D.C. Retrieved from
http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=21
This is a comprehensive report on the objectives and goals of the
Department of Health and Human Services as they pertain to the
cardiovascular health of the American population. The report is
based on extensive health statistics describing the current state
of health of the American people and provides measurable goals for
which to strive. The report also outlines means to obtain these
goals, including tips on behavior modification and methods for
patient motivation.
Slide 42
United States Department of Health and Human Services, National
Institutes of Health, National Heart, Lung, and Blood Institute.
(2002). Third report of the National Cholesterol Education Program
(NCEP) expert panel on detection, evaluation, and treatment of high
blood cholesterol in adults (adult treatment panel III), final
report (NIH Publication No. 02-5215). Retrieved
fromhttp://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf
This report is the result of the NCEP panels expert research on the
management of dyslipidemia. It gives a basic description of lipids
and primary targets of LDL, HDL, and total cholesterol management.
It presents methods of assessing and predicting an individuals risk
of adverse cardiovascular events based on current disease states
and the presence of certain risk factors. The report also outlines
guidelines for detection and evaluation of dyslipidemia and,
finally, guidelines for treating dyslipidemia through both
therapeutic lifestyle changes and drug therapy. United States
Department of Health and Human Services, National Diabetes
Education Program: A joint program of the National Institute of
Health and the Center for Disease Control and Prevention. (2003).
Small steps big rewards prevent type 2 diabetes. NIH Publication
No. 03-5334 Retrieved from http://www.ndep.nih.gov This program
designed to help health care providers and with the collaboration
of the patients with the key components of and effective diabetes
prevention regimen in the GAME plan: Goals, Accountability,
Monitoring, and Effectiveness. This prevention is obtained through
a lifestyle of activity and nutrition. van der Slot, W.,
Nieuwenhuijsen, C., van den Berg-Emons, R., Bergen, M., Hilberink,
S., Stam, H., Roebroeck, M. (2012). Chronic pain, fatigue, and
depressive symptoms in adults with spastic bilateral cerebral
palsy. Developmental Medicine and Child Neurology, 54, 836-842.
doi: 10.1111/j.1469-8749.2012.04371.x This article describes a
study aiming to examine the co-occurrence of chronic pain, fatigue
and depression in adults with spastic CP. Adults with CP were
interviewed and self-report instruments were used for data
collection and quantification of symptoms. This article clarified
the link between pain, fatigue, and depression, and pointed towards
the needs of adults with CP in addressing these issues. The article
also addressed a gap in the literature regarding the clinical
effects of these symptoms and identified a need for preventative
measures and interventions. Wang, D. (2011, May 26). ROM Exercises
for the Wheelchair Bound. Livestrong.com. Retrieved from
http://www.livestrong.com/article/338602-rom-exercises-for-the-wheelchair-bound
LiveStrong is the website that Lance Armstrong is a founder. They
claim to post only information that is expert based and reviewed.
This particular article is from 2011 and was reviewed at that time.
This website offered the most informative information for helping a
patient in a wheelchair exercise. Again, this is focused for
Walter, having CP and being confined to a wheelchair is his excuse
for not being physical. However, this website seemed to relate very
well to clients who are wheelchair-bound and sensitive to their
needs. Dr. Rimmers article gave a general idea about how people
with CP could exercise but lacked specific exercise. Needing an
exercise plan for Walter, I referred to LiveStrong for assistance
with some good examples of exercise he can begin using daily.