UNIVERSITY OF PLYMOUTH
FACULTY OF HEALTH AND SOCIAL WORK
Module NUR 261Public Health / Health Promotion Adult Nursing 20 Credits at Level 2 September 2006 Cohort |
ASSESSMENT OF COURSEWORK
Aim: The aim of this assignment is to allow you an opportunity to examine public health and health promotion concepts relevant to adult nursing practice.
STUDENT NAME: Alan P Jack
STUDENT ID: 001255
PERSONAL TUTOR/MODULE SPECIFIC TUTOR: Kim Young
SUBMISSION DATE: 2 June 2008
TEACHING BASE: The Knowledge Spa, Truro, Cornwall.
WORD COUNT: words
Module Leader
Margaret Wade
Lecturer (Nursing)
Faculty of Health & Social Work
The Knowledge Spa
Royal Cornwall Hospital
Treliske
Truro
Cornwall TR1 3HD
01872 256466 / 256450
mwade@plymouth.ac.uk
Table of Contents
Section | Page number |
Front Page | 1 |
Table of Contents | 2 |
Statement of Confidentiality | 3 |
| Assignment Guidelines | 4 |
| Scenario | 10 |
| Assignment | 11 |
| References | 12 |
Reading List | 13 |
Definitive Module Record NUR 261 |
Statement of Confidentiality
20 credits: Level 2
Aim: The aim of this assignment is to allow you an opportunity to examine public health and health promotion concepts relevant to adult nursing practice.
Assessment Mode: A 2,500 word essay in which you will explore ONE of the scenarios introduced in the module analysing specific public health and health promotion issues.
Assessment Criteria: You will be required to:
explain how the particular health need has been identified using demographic and epidemiological data to support your discussion
apply health promotion theory to explore possible health promoting activities
identify possible evaluation methods to demonstrate the effectiveness of health promotion interventions
Assignment profile
Section | Content | Suggested word limit (approximate) |
Introduction | Identify the scenario and outline the particular aspects you will be exploring | 250 |
Main body of essay | Explore the following:
| 500 1,000 500 |
Conclusion | Provide a summary of your work. Include implications for practice, with recommendations if appropriate. | 250 |
Please ensure anonymity is maintained throughout your assignment in accordance with ‘Assess’ documentation in your programme handbook.
Please refer your programme student handbook for information on the University of Plymouth’s marking criteria, referencing and correct presentation.
Word Limit: 2,500 words (+/- 10%). Work in excess of the word count will not be read or marked.
Assignment hand in date (theory): 2 June 2008
Provisional Results: 1st July 2008
Scenario Outline
Jack Ford is 72 years old and has lived in and around Welbourne all his life. He has been married and divorced twice, but at present lives alone in a flat in the social housing development. Jack has had a variety of occupations over the course of his life, including farm labourer, factory worker and mechanic. He has smoked, both cigarettes and a pipe for most of his adult life.
Jack ford has recently been gaining weight significantly and is classified as obese. He has presented at the GP surgery with symptoms of type 2 Diabetes.
What public health and health promotion issue would you want to consider?
The World Health Organisation defines Diabetes as "... a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces" (World Health Organisation on-line 2008a). It goes on to suggest that it accounts for 5% of global deaths annually and that 80% of diabetic are inhabitants of low or moderate income countries. The Organisation elsewhere differentiates between type one diabetes, where insufficient insulin to support life is excrete, type two, where inappropriate somatic responses to insulin production and Impaired Glucose Tollerance and impaired fasting glycaemia where blood glucose is raised but to below that which would be indicate a diabetic diagnosis.
There are several types of Diabetes. Historically, Diabetes Mellitus tended to be classified by depending on insulin administration or the lack of it. In more recent times, it is accepted the disease is more complex. Type 1 Diabetes refers to
Type 2 refers to where insulin is produce which
This has previously been referred to as Non-Insulin Dependent Diabetes Mellitus as well as Maturity Onset Diabetes Mellitus. The latter name has been challenged as the number of individuals under 16 is now significantly
Because the symptoms of Diabetes Mellitus type 2, individuals may be going undetected. On a global scale, this could include
In the United Kingdom, the "missing Million" is the subject of some debate. This, until now, could have included Jack.
This could have many implication as individuals may not have any idea that, as they have no symptoms, that they are do not have the disease and so do not feel that they need to alter any
Pre-diabetis, also referred to Metabolic Syndrome and formally called Glucose Intolerance in now the subject of much research.
Diabetes Insidus is a condition which is not related to insulin production and is
The symptoms with which Jack could be presenting numerous. These could include the passing of large volumes of undiluted urine (polyuria) and an excessive thirst (polydipsia) (Marib and Hoehn, 2007). Both these symptoms are caused by hyperglycaemia in that the excessive glucose in the blood has an osmotic effect on the kidney tubule inhibiting them reabsorbing water that thus causes vast quantities of urine which then results in reduced circulating volume causing dehydration which activates the hypothalamic thirst centres causing polydipsia. As the large ammounts of glucose can not enter cells as insulin is not fascilitating this, the lack of energy causes hunger (polyphagia). The NHS Direct Website (2008) mentions also that tiredness, and less commonly genital itching, frequent Thrush infections and blurred vision
Jack exhibits a number of demographic and lifestyle factors which may affect his disease experience. Smoking tabacco can result in vascular compromiseation can compund the changes which are caused by Diabetes Mellitus
| The aim of this assignment is to allow you an opportunity to examine public health and health promotion concepts relevant to adult nursing practice. | |||||||||||
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| Intro: Identify the scenario and outline the particular aspects you will be exploring (250 words) | This discussion will based upon a scenario involving Jack Ford,72, who presents to his General Practioner with the symptoms of diabetes (see appedix 1). Jack has several demographic and lifestyle factors which will affect his disease experience, some of which are changable and some which are not. A discussion of the types of diabetes will be followed by an investigation into some of the demographic and epidemiological factors that are pertinent to diabetes and Jack's situation. The focus of this discussion will be to explore how the risk factor of obesity can impact upon the development of this disease and how its reduction of weight can significantly improve the health and lifestyle of of an individual who finds themselves in this situation. | ||||||||||
| Three degrees of helath promotion have been identified. Primary health promotion pertains to that which is undertaken to prevention of the commencement of health consequense occuring. This is exemplified as health eating campagnes in schools which can help to decrease the onset of diabetes (). Secondary health promotional activity aims to prevent any adverse health consequence from deteriating further. This would include teaching foot care techniques to newly diagnosed diabetics. Tertiary health promotion is concerned with | |||||||||||
| DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) is a national education program taylored for individuals with Diabetes type 2. Being primarily pioloted by 15 English Primary Care Trusts (PCTs) from 2004 and is now being tested via a 1000 subject randomised control trial in selected English and Scotish PCTs. Taking its lead from the National Institute for Health and Clinicle Excelence guidance | |||||||||||
| Jack is affected by several National Service frameworks. These include those for Elderly People, Body Mass index (BMI), the calcuation of weight divided by height squared, has been widely used as an indicator of obsesity, normal weight and under weight. It is one of the factors that is included in several nutritional scores. It can provide a basic analogue of whether any weight management activities need to be implicated. However, it is limited in that it does not take into account any risk factors. Moreover, there is now much research which brings into question the validity of BMI. Waist measurement is now bieing mooted as a more reliable predictor of risk with regard to weight. The NMC (2008) call for Registrants to be non-judgemental in the Code for asdfasfsadfs. However, much has been written about prejoritive attitudes of Nurses and other health care professionals. If | |||||||||||
| The NMC (2008) call for Registrants to be non-judgemental in the Code for asdfasfsadfs. However, much has been written about prejoritive attitudes of Nurses and other health care professionals | |||||||||||
Diabetes Mellitus- 09:39
Rising Incidence of Type 2 Diabetes in Children in the U.K....
[PDF] Diabetes: State of the Nations 2006
NLH - Diabetes - Incidence and prevalence of diabetes
[PDF] NHS Diabetes
ScienceDirect - The Lancet : The rising incidence of childhood ...
[PDF] Improving Diabetes Services: The NSF Four Years On
Lifestyle Interventions to Prevent Diabetes [February 2006; 144-5]
Prevalence and Incidence of Diabetes - WrongDiagnosis.com
Cancer incidence and mortality in patients with insulin-treated ...
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| It goes onto discuss three other phenomena. Type 1 diabetes (formerly known as insulin-dependent) in which the beta cells in the islets of langerhans cell in the pancreas fails to produce the insulin which is essential for survival. The onset of this type of diabetes was more prevelant in childhood or adolesence but this pattern is now changing.
Although not at a level that would constitute diabetes, individuals with Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) demonstrate elevated blood glucose levels which seems to place them at higher risk of developing both cardiovascular disease as well as diabetes. | |||||||||||
This discussion will based upon a scenario involving Jack Ford,72, who presents to his General Practioner with the symptoms of diabetes (see appedix 1). Jack has several demographic and lifestyle factors which will affect his disease experience, some of which are changable and some which are not. A discussion of the types of diabetes will be followed by an investigation into some of the demographic and epidemiological factors that are pertinent to diabetes and Jack's situation. The focus of this discussion will be to explore how the risk factor of obesity can impact upon the development of this disease and how the reduction of weight can significantly improve the health and lifestyle of of an individual who finds themselves in this situation from a public health prespective. Research will involve the types of helath promotional services available at both a micro and macro level. This will be followed by an evaluation of these.
It must be noted that jack is a smoker. This could have an impact on his disease experience as nicotine has an
poor
fat and diet...
dietietic
locus of controlThe World Health Organization (World Health Organisation on line (2008), defines diabetes as:
"Diabetes mellitus is a chronic disease caused by inherited and/or acquired deficiency in production of insulin by the pancreas, or by the ineffectiveness of the insulin produced. Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves."
It goes onto describe four phenomena namely type one Diabetes mellitus where little or no insulin is produce, type two which results from the body's maladaptive response to the action of insulin and Impaired Glucose Tollerence and Impaired Fasting Glycaemia where elevated blood glucose levels which seem to place them at higher risk of developing both cardiovascular disease as well as diabetes.
It is significant that the incidnece of diabetes type two is increasing.
There are seveveral significant dimension to this increase.
The overal global incidence has increased.
The disease in now presenting at a younger age.
This seems to be varying directly with the increase in obesity.
diabetetes fat relationship....
Randomised control tries have ini
Randomised controlled trials have shown that (diabetes prevention research group, 2002 Lindström et al, 2003). The diabetes prevention programme found that weight loss of between 5% and 7% of total body weight accompanied with moderate physical activity of half an hour five times per week proved to be almost doubly effective as the use of the glucose lowering medication namely Metformin (diabetes prevention research group, 2002).
From a global incidence, Wild et al (2004) have projected that dabetic incidence could more than double from its 2000 level of 171 million to that of 366 million by the year 2030. As the United kingdom as a whole,
c
This discussion will based upon a scenario involving Jack Ford,72, who presents to his General Practitioner with the symptoms of diabetes (see appendix 1). Jack has several demographic and lifestyle factors which will affect his disease experience, some of which are changeable and some which are not. A discussion of the types of diabetes will be followed by an investigation into some of the demographic and epidemiological factors that are pertinent to diabetes and Jack's situation. The focus of this discussion will be to explore how the risk factor of obesity can impact upon the development of this disease and how its reduction of weight can significantly improve the health and lifestyle of of an individual who finds themselves in this situation.
This discussion will based upon a scenario involving Jack Ford,72, who presents to his General Practitioner with the symptoms of diabetes (see appendix 1). Jack has several demographic and lifestyle factors which will affect his disease experience, some of which are changeable and some which are not. A discussion of the types of diabetes will be followed by an investigation into some of the demographic and epidemiological factors that are pertinent to diabetes and Jack's situation. The focus of this discussion will be to explore how the risk factor of obesity can impact upon the development of this disease and how the reduction of weight can significantly improve the health and lifestyle of of an individual who finds themselves in this situation from a public health perspective. Research will involve the types of health promotional services available at both a micro and macro level. This will be followed by an evaluation of these
The World Health Organisation defines Diabetes as "... a chronic disease that occurs when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces" (World Health Organisation on-line 2008a). It goes on to suggest that it accounts for 5% of global deaths annually and that 80% of diabetic are inhabitants of low or moderate income countries. The Organisation elsewhere differentiates between type one diabetes, where insufficient insulin to support life is excrete, type two, where inappropriate somatic responses to insulin production and Impaired Glucose Tolerance and impaired fasting glycaemia where blood glucose is raised but to below that which would be indicate a diabetic diagnosis.
The symptoms with which Jack could be presenting numerous. These could include the passing of large volumes of undiluted urine (polyuria) and an excessive thirst (polydipsia) (Marib and Hoehn, 2007). Both these symptoms are caused by hyperglycaemia in that the excessive glucose in the blood has an osmotic effect on the kidney tubule inhibiting them reabsorbing water that thus causes vast quantities of urine which then results in reduced circulating volume causing dehydration which activates the hypothalamic thirst centres causing polydipsia. As the large amounts of glucose can not enter cells as insulin is not facilitating this, the lack of energy causes hunger (polyphagia). The NHS Direct Website (2008) mentions also that tiredness, and less commonly genital itching, frequent Thrush infections and blurred vision
Body Mass index (BMI), the calculation of weight divided by height squared, has been widely used as an indicator of obesity, normal weight and under weight. It is one of the factors that is included in several nutritional scores. It can provide a basic analogue of whether any weight management activities need to be implicated. However, it is limited in that it does not take into account any risk factors. Moreover, there is now much research which brings into question the validity of BMI. Waist measurement is now being mooted as a more reliable predictor of risk with regard to weight.
The Diabetes Prevention Research Group (2002) and the Finnish Diabetes Prevention Study (Lindström et al, 2003) carried out randomised controlled trials which have indicated that diabetes can be delayed or even prevented with moderate increases in physical activity and improvements in diet. The former showed that found that weight loss of between 5% and 7% of total body weight accompanied with moderate physical activity of half an hour five times per week proved to be almost doubly effective as the use of the glucose lowering medication namely Metformin. The latter compared an intervention group against an interventions group but only of 40 to 64 year olds where as the former investigated subject of 25 years and older. More research may bring forth some more answers, especially if it were longitudinal in nature.
Three degrees of health promotion have been identified. Primary health promotion pertains to that which is undertaken to prevention of the commencement of health consequence occurring. This is exemplified as health eating campagnes in schools which can help to decrease the onset of diabetes (). Secondary health promotional activity aims to prevent any adverse health consequence from deteriorating further. This would include teaching foot care techniques to newly diagnosed diabetics. Tertiary health promotion is concerned with
DESMOND (Diabetes Education and Self-Management for Ongoing and Newly Diagnosed) is a national education program tailored for individuals with Diabetes type 2. Being primarily piloted by 15 English Primary Care Trusts (PCTs) from 2004 and is now being tested via a 1000 subject randomised control trial in selected English and Scottish PCTs.
Taking its lead from the National Institute for Health and Clinical Excellence guidance on diabetes,
DESMOND is a form of secondary health promotion in that the individuals have already been diagnosed so the emphasis is on preventing the
Prior to 2003 when the diabetes National service framework and the National Institute for health and clinical excellence published their guidance on diabetes, there was no benchmark by which education schemes could be validated. Desmond Caulfield's all
By its very design, Desmond has been tailored to meet the standards laid in out in these policies.
Has progressed to developing pathways of care for individuals for the whole of their disease journey.
DESMOND's education groups are based on Leventhal's common sense theory,where
the dual process theory,
and the social learning theory which
on of the advantages of DESMOND is that it is very client focused, tailoring its imput to the individual concerned. At the very heart of the orgnaisation are both healthcare professionals as well as individuals with diabetes thus integrating scientific knowledge base with clincial experience and the lived experience of those with the disease.
Conversely,
Desmond is an example of secondary prevention in that the aim of the intervention is a the emphasis is on the
However,
Desmond is an example
Both secondary and cursory attention encompassed within the Desmond ideology in that
The secondary prevention
The secondary preventive ethos is that of aiming to prevent the progression of diabetic process
Prevention of the progression of the disease process or of her unwonted state through early detection when this favourably affects outcome
The cursory element
The cursory prevent the development of his concerns with the prevention of avoidable complications of panic irreversible, manifest disease or prevention of the the occurrence of an illness or other unwonted phenomenon
Downey, beginning with a programme before diabetes
Beginning with a programme primarily for individuals who had just been diagnosed with diabetes, Desmond progressed
Has progressed to developing pathways of care for individuals for the whole of their disease journey. Although this
The NMC (2008) call for Registrants to be non-judgemental in the Code for asdfasfsadfs. However, much has been written about pejorative attitudes of Nurses and other health care professionals
The NMC (2008) call for Registrants to be non-judgemental in the Code for asdfasfsadfs. However, much has been written about prejoritive attitudes of Nurses and other health care professionals
There are several types of Diabetes. Historically, Diabetes Mellitus tended to be classified by depending on insulin administration or the lack of it. In more recent times, it is accepted the disease is more complex. Type 1 Diabetes refers to
Type 2 refers to where insulin is produce which
This has previously been referred to as Non-Insulin Dependent Diabetes Mellitus as well as Maturity Onset Diabetes Mellitus. The latter name has been challenged as the number of individuals under 16 is now significantly
Jack exhibits a number of demographic and lifestyle factors which may affect his disease experience. Smoking tobacco can result in vascular compromisation can compound the changes which are caused by Diabetes Mellitus
Wordings
References
http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=128§ionId=10 Lindström, J., Louheranta, A., Mannelin, M., Rastas, M., Salminen, V., Eriksson, J., et al. (2003). The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care, 26(12), 3230–3236 http://care.diabetesjournals.org/cgi/content/full/26/12/3230 Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of Type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346(6), 393–403. Department of Health (2004) Choosing Health: making healthier choices easier. Leddy Kun, S. (2006) http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1238902 Ewles, L. and Simnett, I. (2004) Health promotion: a practical guide. 5e. Oxford: Balliere Tindall http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/print.html http://scholar.google.co.uk/scholar?hl=en&lr=&cluster=3564791000148442555 http://scholar.google.co.uk/scholar?hl=en&lr=&cluster=2449456301460039406 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2258400 http://www.aihw.gov.au/publications/health/ah96/ah96-x04.htmlWorld Health Organisation [on-line] (2008)a. Programes and Projects: Diabetes. http://www.who.int/diabetes/en/ visted 24th April 2008 World Health Organisation [on-line] (2008)b. Diabetes Action On-line. http://www.who.int/diabetesactiononline/diabetes/en/ visited 5th May 2008 http://www.framinghamheartstudy.org/index.html framingham http://www.framinghamheartstudy.org/index.html Fenn, P. (2007) Assessment and managment of abdominal obesity in patient with type 2 diabetes. Nusing Standard 21, 25, 37-44
Fenn, P. (2007) Assessment and managment of abdominal obesity in patient with type 2 diabetes. Nusing Standard 21, 25, 37-44Brown, I., Stide, C., Psarou, A., Brewins, L., Thompson, J. (2007) Management of obesity in primary care: nurse's practice, belief and attitudes. Journal of Advanced Nursing 59 (4), 329-342 Marieb E. N. and Hoehn, K. (2007) Human Anatomy and Physiology: Pearson International Editional Edition. 7e. San Francisco: Benjamin Cummings
http://www.eatlas.idf.org/Diabetes_Atlas___Executive_Summary_download/#EN
http://www.eatlas.idf.org/Obesity_and_type_2_diabetes/
http://content.nejm.org/cgi/content/full/346/6/393Downie, R., Tannahill, C. and Tannahill, A. (1996) Health promotion: models and Values. Oxford Oxford medical publications 
Integrative Health Promotion: Conceptual Bases for Nursing Practice, Second Edition. Boston : Jones and BartlettGreen, L. (1977) Education and measurement: some dilemmas for health education. American Journal of Public Health 67: 155-162 Backett, K., Davison, C. and Mullen, K. (1994) Lay evauaiton of health and healthy lifestyles evidence from three studies. British Journal of General Practice 44, 277-280 Davis, M.J., Heller, S., Skinner, T. C., Campbell, M. J., Carey, M. E., Cradock, S., Dallosso, H. M., Daly, H., Doherty, Y., Eaton, S., Fox, C., Oliver, L., Rantell, K., Rayman, G. and Khunti, K. (2008) Effectivents of the diabetes education and self managment or ongoing and newly diagnosed (DESMOND) programme for people with newly diagnosed type 2 diabetes: cluster randomised controlled trial. British Medical Journal 336(7642): 491–495.
Obesity: in statistics
People are getting fatter almost everywhere in the world. The World Health Organization predicts there will be 2.3 billion overweight adults in the world by 2015 and more than 700 million of them will be obese.
Figures for 2005 show 1.6 billion adults were overweight and 400 million were obese.
Obesity is a modern problem - statistics for it did not even exist 50 years ago.
The increase of convenience foods, labour-saving devices, motorised transport and more sedentary jobs means people are getting fatter.
The body mass index (BMI) is the most commonly-used way of classifying overweight and obesity in adult populations and individuals.
BMI is defined as a person's weight in kilograms divided by the square of their height in meters (kg/m2).
Each BMI figure is classified within a range, eg 18-25 is ideal and over 30 is reckoned to be obese.
According to a survey of bodyshapes conducted in the UK in 1951, a woman's average waist size was 70cm (27.5in). A 3-D survey carried out by SizeUK in 2004 found the average woman had a waist measurement of 86cm (34in) and a BMI of 24.4, just inside the ideal range.
There was no comparative data for men in 1951, but the SizeUK survey showed the average man in 2004 had a waist of 94cm (37in) and a BMI of 25.2, technically just outside the ideal range.
But obesity is not just a problem for adults - the spread of obesity among children is also alarming experts.
At least 20 million children under the age of 5 years were overweight globally in 2005, according to the WHO.
Measuring children, aged 5 to 14 years, who are overweight or obese is challenging because there is not a standard definition of childhood obesity applied worldwide. Figures for children in England are shown here.
Childhood obesity is a big problem in the United States. The following graph shows the trend in a number of countries around the world.
Experts are worried that the increase in obesity will lead to more health problems as people who are overweight have a higher risk of heart disease, Type II diabetes and other diseases including some cancers.
As most data sources do not distinguish between Type I and II diabetes in adults, it is not possible to present the data separately. The map below shows the prevalence of diabetes throughout the world in 2007.
Even if the prevalence of obesity remains stable until 2030, the American Diabetes Association, says that the number of people with diabetes will more than double.
It says the increase may be "considerably higher" than this if, as expected, the prevalence of obesity continues to rise around the world.
The link between obesity and type 2 diabetes
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* (2) IOTF. Childhood Obesity - The New Crisis in Public Health. International Obesity Task Force, London, 2003.
* (3) American Diabetes Association. Type 2 diabetes in children and adolescents. Diabetes Care 2000; 3:381-389.
* (4) Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346:393-403.
* (5) WHO/FAO. Diet, Nutrition and the Prevention of Chronic Diseases. Technical Report Series no. 916. WHO, Geneva, 2003. (www.who.int/hpr/NPH/docs/who_fao_expert_report.pdf)
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