Group Community Health Promotion

Introduction

A stroke is an interruption of the blood supply to any part of the brain. It is sometimes called a “brain attack”. A stroke happens when blood flow to a part of the brain is interrupted because a blood vessel in the brain is blocked or bursts open. If blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage. There are two major types of stroke: ischemic stroke and hemorrhagic stroke. Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot. Hemorrhagic strokes, on the other hand, occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain (Hoch, 2010).

Stroke is the third leading cause of death in the United States. People of all ages and backgrounds can have a stroke. In 2006, 137,000 people in the United States died of stroke, accounting for nearly 1 in every 17 deaths. Only heart disease and cancer killed more people. Someone in the United States has a stroke every 40 seconds. Every three or four minutes, someone dies of stroke. It is the third leading cause of death for both men and women. In 2006, out of every 10 deaths due to stroke were in women. Every year, about 795,000 people in the United States have a stroke. About 610,000 of these are first or new strokes. About 185,000 people who survive a stroke go on to have another. Ischemic strokes, which occur when blood clots block the blood vessels to the brain, are the most common type of stroke, representing about 85% of all strokes. In 2009, stroke cost the United States $68.9 billion. This total includes the cost of health care services, medications, and missed days of work. Stroke is a leading cause of serious long-term disability (CDC, 2010).

Stroke is among the five leading causes of death for people of all races and ethnicities. But the risk of having a stroke varies. Compared to whites, African Americans are at nearly twice the risk of having a first stroke. Hispanic Americans’ risk falls between the two. Moreover, African Americans and Hispanics are more likely to die following a stroke than are whites (Lloyd-Jones, et al., 2009).

Although stroke can happen to anyone, certain risk factors can increase chances of a stroke. However, studies show that up to 80% of strokes can be prevented by working with a healthcare professional to reduce personal risk. It is important to manage personal risk and know how to recognize and respond to stroke signs and symptoms (National Stroke Association, 2011). With this in mind, the goals of the Power to End Stroke campaign are: (1) to create a “movement” around the serious health disparity issue of a stroke in African Americans and to drive the message that stroke is largely preventable; (2) to increase awareness of high blood pressure and diabetes as risk factors; and (3) to promote adherence to primary and secondary prevention guidelines.

Review of Literature

The Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention created the Prevention Research Centers (PRCs) Cardiovascular Health Intervention Research and Translation Network (CHIRTN) in 2005 to develop partnerships and create a research agenda that addresses cardiovascular health promotion. Six participating universities with expertise in heart disease and stroke prevention research collaborate with their PRC partner communities and other partners to (a) conduct demonstration research projects and (b) identify gaps in knowledge and make recommendations for future research to address those gaps. The report described the structure and current efforts of the CHIRTN. The goal of their efforts is to promote cardiovascular health for Americans, particularly underserved, at-risk populations (Farris, et al., 2008).

National Stroke Association’s Stroke Prevention Advisory Board, an elite group of the nation’s leading experts on stroke prevention, established the first Stroke Prevention Guidelines. They were published in a 1999 issue of Journal of the American Medical Association (JAMA) and have been updated to reflect current medical standards. Stroke Prevention Guidelines include: (1) know blood pressure, (2) identify atrial fibrillation, (3) stop smoking, (4) control alcohol use, (5) know cholesterol level, (6) control diabetes, (7) manage exercise/diet, (8) treat circulation problems, and (9) transient ischemic attack (National Stroke Association, 2011).

High blood pressure is a major stroke risk factor if left untreated. Have blood pressure checked yearly by a doctor or at health fairs, a local pharmacy or supermarket or with an automatic blood pressure machine. Atrial fibrillation is an abnormal heartbeat that can increase stroke risk by 50%. Atrial fibrillation can cause blood to pool in the heart and may form a clot and cause a stroke. Smoking doubles the risk of stroke. It damages blood vessel walls, speeds up artery clogging, raises blood pressure and makes the heart work harder. Alcohol use has been linked to stroke in many studies. Most doctors recommend not drinking or drinking only in moderation – no more than two drinks each day. Cholesterol is a fatty substance in blood that is made by the body. It also comes in food. High cholesterol levels can clog arteries and cause a stroke. Many people with diabetes have health problems that are also stroke risk factors. Excess weight strains the circulatory system. Exercise five times a week. Maintain a diet low in calories, salt, saturated and trans fat and cholesterol. Eat five servings of fruits and vegetables daily. Fatty deposits can block arteries carrying blood to the brain and lead to stroke. Other problems such as sickle cell disease or severe anemia should be treated. A transient ischemic attack (TIA) is a temporary episode of stroke-like symptoms that can last a few minutes to 24 hours but usually causes no permanent damage or disability. TIA and stroke symptoms are the same. Recognizing and treating a TIA can reduce stroke risk. Up to 40% of people who experience a TIA may have a stroke (National Stroke Association, 2011).

Studies, including those supported by the Agency for Healthcare Research and Quality, show that some people are more at risk for stroke than others. Chronic health conditions such as high blood pressure and diabetes can increase the risk, as well as lifestyle choices such as smoking cigarettes, being overweight, or drinking excessively. Men, African Americans, and people with a family history of stroke have a higher risk as well. If you have already had a stroke or a transient ischemic attack, you are at highest risk. Prevention is the best medicine (AHRQ, 2008).

Major clinical studies that evaluate prevention strategies for heart disease and stroke fail to consider a participant’s ethnicity, a factor that can more than double the rate of death in some groups, according to research led by St. Michael’s Dr. Joel Ray. The study, published online in the Quarterly Journal of Medicine, reviewed 45 major clinical trials on prevention strategies. Researchers found that only 1 in 4 studies reported on the ethnicity of participants (St. Michael’s Hospital, 2011).

In Florida, black young adults are hospitalized for stroke at a rate three times higher than their white and Hispanic peers, a new study by the University of South Florida (2009) researchers’ reports. The study was presented at the American Heart Association’s Council on Epidemiology and Prevention Annual Conference. Disparities in stroke outcomes between black and white patients have been widely reported for years. While overall death rates for stroke are down, blacks bear a disproportionate burden of disease, disability and death from strokes, according to the lead author Elizabeth Barnett Pathak, PhD.

Conceptual Framework

In spite of significant advances in treatment, stroke remains a devastating disease. Treating stroke is costly, and, is the major cause for referral to long-term care facilities. The good news, however, is that stroke is preventable. Lifestyle changes such as stopping smoking, increasing physical activity and eating a healthy diet can significantly reduce the number of those who are at risk of stroke. In addition, interventions such as blood pressure-lowering medications, antiplatelet or anticoagulant drugs – “blood thinners” – or surgery (carotid endarterectomy) can reduce the number of strokes by half among high risk individuals. Health promotion practices are changing the distribution of risk factors in the population by modifying knowledge, the environmental support and policies that prevent the development of risk factors. Health promotion encourages people to follow a healthy lifestyle and to take control of their health. Preventing stroke will require a multifaceted approach that goes beyond a specific focus on cardiovascular disease, diabetes or transient ischemic attack. A growing body of evidence suggests that the most effective prevention strategies are those that actively engage the communities they are intended to serve. Current trends in health promotion research and practice support a collaborative approach to disease prevention, that include population-based awareness and educational strategies designed to: inform the public about stroke risk factors, motivate individuals with modifiable risk factors to address them, and convince individuals without behavioral risk factors to avoid them. Best practices in health promotion are those sets of processes and activities that are consistent with health promotion values/goals/ethics, theories/beliefs, evidence, and understanding of the environment, and most likely to achieve health promotion goals in a given situation. In health promotion, the definition of health is broad and holistic. It goes beyond the absence of disease. It is multilevel and considers the health of individuals, organizations and communities, and to achieve its goals and objectives requires work with other sectors beyond health (Mitchell & Schwenger, 2004).

Nola Pender’s Health Promotion Model (HPM) is an attempt to depict the multifaceted natures of persons interacting with the environment as they pursue health. The model’s assumptions reflect the behavioral science perspective and emphasize the active role of the patient in managing health behaviors by modifying the environmental context. HPM has a competence- or approach-oriented focus. Health promotion is motivated by the desire to enhance well-being and to actualize human potential. Pender asserts that complex biopsychosocial processes motivate individuals to engage in behaviors directed toward the enhancement of health. The Health Promoting Lifestyle Profile, derived from the model, often serves as the operational definition for health-promoting behaviors. This model has implications for application by emphasizing the importance of the individual assessment of factors believed to influence health behavior changes (Alligood & Tomey, 2010).

Project Plan

A multidisciplinary group will be organized to be led by nurse practitioners (NPs). An office will be established in the target site that will be responsible in handling all the communications, conferences, records and other business related issues. Community partnership will be initiated with the local hospitals, medical clinics, laboratories, pharmacies, and other establishments/ organizations that would make possible impact with the goals and objectives of the study. Patients’ referral sources will be the hospitals, medical clinics, board and care, assisted living facilities and other establishments/organizations in the target site. For the purpose of this study, there will be patient’s selection process. Initial screening will be done in the office according to the general information received from the referral source. The evaluating nurse will do the final screening at the patient’s home. A data gathering tool previously designed will be used that will be the basis of patient’s selection for the inclusion in the study and also the basis for the plan of care. The evaluating nurse will communicate with the NP for the initial order before leaving the patient’s home and would involve the patient or the responsible party in formulating the initial plan of care. Interdisciplinary conferences would follow the patient’s admission to the program that will tackle modifications in the initial plan of care if needed and other related issues. Periodic review of the study design will be conducted routinely during interdisciplinary conferences. This will ensure the quality of service and adherence to the study design. Composite of the multidisciplinary group are the NPs, skilled nurse, social worker, dietitian, physical therapist, occupational therapist, speech therapist and volunteers. Each will have distinct functions related to their field of specialty. Ethical and legal issues relating to this study will be addressed accordingly. Consent and permits to enroll prospective patients in the program will be prepared and utilized. Patients will be appropriately informed of their rights and responsibilities. HIPAA and privacy will be observed. Monitoring tools will be created and these will reflect patients’ clinical course while in the program. The program will entail direct patient care at home and that includes skilled observation and assessment, monitoring, health teachings and medication management among others. Referral to other health care agencies will be considered as deemed necessary. Every health care provider and patient interaction will be properly documented. Each participant of the program will be covered with a patient’s chart.

Inclusion criteria for the study are: African-American, hypertensive, diabetic, obese, smoker, and physically inactive. Target site must be an underserved area, e.g. Compton, CA.

Conclusion

Stroke as the third leading cause of death and a leading cause of serious long-term disability in the United States significantly impacts the country’s economy as well (CDC, 2010). For this reason the group focuses their attention on its health promotion and disease prevention. Adopting Nola Pender’s Health Promotion Model (HPM) the group came up with a project plan to promote stroke prevention motivated by the desire to enhance well-being and to actualize human potential (Alligood & Tomey, 2010). Health care providers and the prospective patients through individualized plan of care are given the choice to have the skilled intervention conducted either at home or in outpatient settings. The group came up with the algorithm of the project operations. Indeed, the members of the group are in one accord that this project has the potential to resolve significant issues related to stroke prevention and definitely would contribute to the advancement of primary care nursing practice.

 

 

 

 

 

 

 

 

 

 

 

Figure 1. Conceptual Framework: Power to End Stroke Campaign

 

 

Environment

 

 

 

Person

 

 

 

 

 

 

 

Nursing

 

 

Health

 

 

 

 

 

 

Power to End Stroke Campaign

 

 

Health Promotion Strategies

 

 

 

 

Well-Being

 

 

 

 

 

 

 

 

 

Figure 2. Algorithm of the Project Operations

Patient

 

 

 

 

Referral Source

 

 

 

Intake Coordinator

 

 

Initial Screening

 

 

 

Selection Process

SN Evaluation

At Home

 

 

 

Final Screening

 

 

 

Care Plan

 

 

 

 

Not Homebound

Homebound

 

 

 

Health Education Center

Intervention at home

Intervention at home

 

 

 

Periodic Assessment/Evaluation

 

 

 

Needs further intervention

Goals met

 

 

Discharged

 

References

AHRQ. (2008, February). Agency for Healthcare and Quality. Retrieved from

 

http://www.ahrq.gov

 

Alligood, M. R., & Tomey, A. M. (2010). Nursing theorists and their work, (7th ed).

 

Maryland Heights, Missouri: Mosby Elsevier.

 

CDC. (2010, January 28). Centers for Disease Control and Prevention. Retrieved

 

from http://www.cdc.gov

 

Farris, R. P., Pearson, T., Fogg, T., Bryant, L., Peters, K., Keyserling, T., et al. (2008). Building

 

capacity for heart disease and stroke prevention research: the cardiovascular health

 

intervention research and translation network. Health Promot Pract, 9(3), 220-227.

 

Hoch, D. B. (2010, June 15). National Center for Biotechnology Information. Retrieved

 

http://www.ncbi.nlm.nih.gov

 

Lloyd-Jones, D., Adams, R., Carnethon, M., De Simone, G., Ferguson, T. B., Flegal, K., et al.

 

(2009). Heart Disease and Stroke Statistics – 2009 Update. A Report from the American

 

Heart Association Statistics Committee and Stroke Statistics Subcomittee. Circulation,

 

119:e21-e181.

 

Mitchell, D., & Schwenger, S. (2004). Prescribing Prevention: Health Promotion and Stroke

 

Prevention. Toronto, Ontario: Ontario Prevention Clearinghouse.

 

National Stroke Association. (2011). National Stroke Association. Retrieved

 

From http://www.stroke.org

 

St. Michael’s Hospital. (2011, March 17). Science Daily. Retrieved from

 

http://www.sciencedaily.com

 

University of South Florida Health. (2009, March 13). Science Daily. Retrieved from

 

http://www.sciencedaily.com