Introduction
The topic of this paper is focused on health promotion and disease prevention in healthcare. More specifically, it is centered on smoking cessation and the nursing process which is utilized in determining a nursing diagnosis and a plan of care for the client. The most significant finding on this assessment was the client reported smoking one pack of cigarettes per day for over 46 years. Although client reported no problems with her respiratory system, she did admit that a moderate amount of activity made her short of breath. The following information was taken from the Health and Cultural History.
Assessment
The client (LW) presented as a married, 60-year old Afro-American female who appeared well-groomed with a calm pleasant affect. She stated she was in good health and reported no accidents or serious injuries and one hospitalization throughout her life for the birth of her daughter. Although client denied any history of respiratory diseases, she admitted to smoking one pack of cigarettes per day and confirmed that she has been smoking for over 46 years. She expressed concern about this subject and admitted that she would like to quit smoking.
The client does not work and stated her daily activities included cooking, cleaning, watching television, shopping with her friends, and talking on the computer with her daughter and grandchildren who live out of state. The client revealed that she is happily married, has lived wither her husband for over 35 years, and has never experienced any violence from him. The client expressed that she has a supportive social network including her husband, daughter, grandchildren, friends and neighbors.
The client is currently in the Generativity vs. Stagnation stage of her growth and development, according to Erik Erikson’s 7th stage of development. This development stage encompasses whether an individual has lived a valuable life or have contributed to the leadership and teaching of the younger generation. This developmental stage begins about 40 years of age and lasts until age 65 (Treas p. 164). The client has accomplished the goal of this stage as evidenced by her close relationships with her family, friends and the contentment she displayed while speaking about them.
The client explained that she considered her race and ethnic origin to be Afro-American. The client reported her religion was Baptist and she believed it played an integral role during illness and times of grief. She revealed she has requested visits from clergy members and utilized prayer as a coping skill or remedy for dealing with health issues. She stated that her family does not have a problem displaying emotional distress because it was natural and explained that she personally expressed grief by crying, loss of appetite, and acceptance.
Nursing Diagnosis
The definition of a wellness nursing diagnosis would be when a client is not presently ill but would like to improve their health to a better level, however, both elements need to be in place to be considered a wellness diagnosis (Treas p. 60). The assessment revealed that the patient has no medically diagnosed problems and commented that she would like to quit smoking. The nursing diagnosis chosen for this client was Readiness for enhanced health management r/t smoking cessation as evidenced by expressing a desire to quit smoking.
Outcomes
Outcomes are planned and measured goals of treatment for the client. They must have three components including (1) patient must be able to accomplish the goals, (2) the goals need to be quantifiable, and (3) the goals must be reasonable. The following outcomes have been set for the client: (1) Patient will review and discuss at least three smoking cessation techniques within the next week. (2) Patient will set a date to quit smoking within the next month.
Nursing Interventions
Nursing interventions are the activities that nurses implement to help clients attain their outcomes (Treas p. 102). The first nursing intervention for Outcome 1 would be for the nurse to advise the client to quit smoking. The rationale for this intervention inferred that the best way to decrease tobacco-related death and improve the client’s well-being would be to inspire clients to quit smoking (Hyun et al., 2013). The second intervention would be for the nurse to inform the patient about the health hazards of smoking and benefits of quitting. According to the Centers for Disease Control and Prevention (CDC), the rationale for this intervention would be to educate the client about the negative physical consequences associated with smoking and how the client’s health status could be improved by quitting (CDC, Health Effects of Cigarette Smoking, 2017). The third intervention would be for the nurse to educate the patient regarding medication options available and used to stop or reduce smoking. The rationale for this intervention would be to reduce withdrawal symptoms of nicotine associated with smoking reduction and cessation (Reid et al., 2016). The fourth intervention for Outcome 1 would be for the nurse to encourage the patient to attend counseling. The rationale for this intervention would be that by combining medication with therapy optimizes the client’s chances to stop smoking (Reid et al., 2016).
For Outcome 2, the first intervention would be for the nurse to help the client formulate a specific quit plan. The rationale for this intervention would be that when a client has prepared a plan of action their chances of cessation are increased (Smokefree.gov, Tools & Tips). The second intervention would be for the nurse to provide the client with toll-free phone numbers for smoking cessation. According to the American Journal of Public Health, approximately 13 percent of smokers reach their goal of quitting because of the easy access and usefulness of smoking quit lines (Asvat et al., 2014). The third intervention would be to provide the client with a smoking cessation website. The rationale for this intervention would be that providing support and resources for smoking cessation increases quit rates (Smokefree.gov, Tools & Tips). The fourth intervention would be for the nurse to download a Free Quit Guide Mobile App on the client’s phone. The rationale for this intervention would be the same as the third intervention in that higher rates of smoking cessation are attained when clients are provided with resources and support (Smokefree.gov, Tools & Tips).
Conclusion
Despite a steady decline of tobacco usage in North America since the mid-sixties, it continues to be the number one reason of avoidable sickness and mortality (Asvat et al., 2014).
According to the Oncology Nursing Forum, when smokers where given nursing interventions their probability of quitting was elevated by more than 49% in comparison to smokers who did not receive any advice (Hyun et al., 2013).
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