1 Lifestyle risk factor
Chad is a patient that faces health problems as a result of social determinants. The poverty experienced by Chad in terms of material and well being has led to the development of risk factors such as excessive alcohol consumption, smoking, isolation, poor nutrition, inactivity and low self-esteem. Chad is also exposed to asthma due to adverse housing conditions. Chad experiences a high level of depression and stress even in adulthood courtesy of childhood financial and social inability (Webber et al., 2013).
2 The transtheoretical model of behaviour change Stage and Motivational Interviewing
According to Fawcett & Rabinowitz, 2020 economic disparity, loss of personal worth, and lack of social connection make patients similar to Chad vulnerable to health problems. The underprivileged patients believe they cannot control life, feel insignificant due to comparisons and resign to substance abuse to escape the harshness of reality. Chad needs to be prepared for the change to ensure the health recommendation prevails. Chad may be in ambivalence and therefore may not receive a change warmly. In provoking Chad to adopt a healthy lifestyle, a nurse needs to inform him of the limitations of the lifestyle he leads. Chad may be unaware that condemning his life to smoke and drinking worsens his health by exposing him to cancer and liver cirrhosis. Once Chad knows the negative consequences of his lifestyle, he could consider adopting a healthier lifestyle, although changing may seem difficult. Before influencing ultimate change, I would advise Chad to smoke at least smoke once in a day and drink once in a week to prepare him for change (Lamorte, 2019).
According to Cherry, 2019, giving a patient ample time to prepare for change helps to make the final action a success. After preparing Chad to quit smoking and drinking, measures to curb him from assessing the substance should be implemented. When Chad decides to change his lifestyle, adherence to counselling meetings and instilling confidence in his abilities may lower the temptations to return to the former life. The counselling sessions need to convince Chad of a good and happier life despite the challenges in life.
A primary nurse needs to communicate with Chad in a way that he will realize his personal goals and abilities apart from offering therapeutic assistance. The nurse should avoid being judgmental and listen carefully to the difficulties experienced by Chad (Vallis et al., 2013). The nurse should relate to the experience of Chad the low-income level, poor house conditions, transportation problems and why they triggered him to substance use to make him open and comfortable. When Chad feels understood and appreciated, he will not resist medical care. The nurse also needs to enhance the strength and confidence of Chad. For instance, making Chad believe that he is strong to have survived in the harsh environment to adulthood may boost his inner power (Biglow, 2012). The nurse should employ a collaborative strategy in decision making with Chad, respecting his beliefs and evoke inner feelings to change (Hall et al., 2012).
Nurse: Hi Chad, I am Emerson, the general practitioner nurse. I highly appreciate your effort and courage to share with us your problems. How are you?
Chad: I am fine.
Nurse: Could you kindly tell me about your life?
Chad: I was born in a poor single family. My mother was the breadwinner in our family, and she spent a crucial part of the day on her work. I hardly had time with her due to her tight work schedule and spent my time watching television and my grandmother.
Nurse: That is not easy. I cannot imagine myself living without the company of my parents.
Chad: Exactly. It was an unbearable and painful experience. I experienced transport difficulties since there were no close bus routes, and our house was poorly ventilated, causing me to acquire asthma. Furthermore, I often went to school hungry, which made me a poor performer in school.
Nurse: You must be strong, indeed. It is rare to encounter patients with your guts.
Chad: Thank you. I never anticipated such a compliment. I failed to join campus due to the complicated nature of application forms, financial inability and poor grades. Currently, I work partly in a manufacturing company with a minimum wage. To cope with the stress, I regularly drink and smoke.
Nurse: I completely understand how you must have been pushed to turn to substance abuse. Can you tell me your concern about drinking and smoking?
Chad: I sometimes feel when I drink and smoke too much I use a lot of money that I would develop myself or help my mother. I also think alcohol provides more comfort and makes me forget all the troubles I have.
Nurse: Are you aware that turning to drugs provides a temporal and illusion of happiness? Drugs also make you susceptible to cancer and cirrhosis.
Chad: I think I now believe so. The reason why I indulge in excessive drinking is that alcohol fades away in enlightening my life after a while. Therefore, I deceive myself that taking more and more will keep me happier.
Nurse: What do you think about taking up a religious life? Or finding a new cause in motivating other unprivileged children?
Chad: My mother seems to find some fulfilment I faith despite the struggle she goes undergoes. I will try to dedicate my life to serving God. I would not like any child to go through what I have experience either. I prefer to try change so that my child or any other may not suffer as I have. But I find it difficult to stop taking alcohol and smoking.
Nurse: Certainly, you will have reasons to implement change. Have you tried reducing the number of cigarette or bottle of alcohol you take daily?
Chad: I never thought of that. Instead of stopping immediately, I could set a limit like smoking once a day and take one alcohol bottle a week. I think I can slowly manage to overcome my addiction.
Nurse: Wow! Your desire moves me. Taking drugs and alcohol exposes you to diseases such as cancer and liver cirrhosis. Do you think you can resist temptations to return to substance abuse?
Chad: I do not entirely believe I can. I am likely to fall to temptations due to my friends or at the slightest provocation of my childhood memories.
Nurse: What do you think about joining a rehabilitation centre in the community?
Chad: If you could point out to one where I can freely air my concerns and feel appreciated, I would not hesitate to go. I would not like to return to my miserable life.
When a nurse carefully listens to a patient and makes deductions by provoking him to change, an efficient and productive medical approach can be administered. In this case, prompting Chad to desist from alcohol and smoking deliberately will yield a positive outcome. Chad will realize the health complications he is bound to suffer if he persists with his behaviour. Empowering Chad to believe he has control in life and that poverty is not a final sentence to unhappiness can help him adopt a healthier lifestyle (Mandy & Heeyoung, 2013). Positive feedback from Chad will be attained if he feels understood, and when we picture ourselves in his situation. Likewise, a nurse should be non-judgmental when addressing patients issues. Engaging Chad in decision making could also help influence behavioural change. Nurses should not take up an authoritative position and think patients are insufficient in making sound decisions.
Biglow, M. (2012, October 1). Applying motivational interviewing strategies and techniques to psychiatric pharmacy practice | Mental health clinician | Allen press. Allen Press. https://meridian.allenpress.com/mhc/article/2/4/91/21580/Applying-motivational-interviewing-strategies-and
Cherry, K. (2019, November 17). The 6 stages of behavior change. Verywell Mind. https://www.verywellmind.com/the-stages-of-change-2794868
Fawcett, S., & Rabinowitz, P. (2020). Chapter 17. Analyzing community problems and solutions | Section 5. Addressing social determinants of health and development | Main section | Community tool box. Community Tool Box. https://ctb.ku.edu/en/table-of-contents/analyze/analyze-community-problems-and-solutions/social-determinants-of-health/main
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Webber, J., Miller, C., White, C., & Edward, M. (2013, June 13). Social Determinants of Health [Video]. YouTube. https://www.youtube.com/watch?v=_11xLlwKgWc