Running head: SENIOR HEALTH PROMOTION PROJECT

Senior Health Promotion Project

Dahlia Rose
Gerontology
NUR 4113
Bon Secours Memorial College of Nursing
4/17/16

SENIOR HEALTH PROMOTION PROJECT

Ms. Rose is a very pleasant, well-nourished, 79-year-old Caucasian female in no apparent

distress. She is single and resides alone in a rural home. She is overweight, with a BMI of 28.3,
and she smokes about 12 cigarettes per day. She describes her overall health as good and states
that she tries to exercise regularly and eat well to maintain her health. She has a past medical
history of thyroid cancer related to smoking and subsequentially had a thyroidectomy and is now
maintained on Levothyroxine. She reports only gastrointestinal problems at the current time to
include incontinence, decreased peristalsis and internal hemorrhoids as determined by
colonoscopy. She also reports skin problems of excessive dryness and eczema. She wears glasses
but does not require the use of hearing aids or dentures. No gait problems were noted, she denies
any recent falls, and she does not require the use of assistive devices for ambulation. She states
that her greatest concern related to her health is her difficulty with sleeping which is what we
mutually determined would be the area of opportunity for teaching.
According to Healthy People 2020, poor sleep is a common problem with 25 percent of
U. S. adults reporting insufficient sleep or rest at least 15 out of every 30 days. Sleep is a critical
determinant of health and well-being, much like nutrition and physical activity. Adequate sleep is
necessary to fight off infection, support the metabolism of sugar, brain performance, and allow
for efficiency and safety at work. Untreated sleep disorders could increase the risk of health
disparities such as heart disease, high blood pressure, obesity and diabetes. Among the older
adult population, untreated sleep disorders could decrease quality of life and contribute to
functional limitations and loss of independence. (Healthy People 2020, n.d.)
Sleep is very essential to Ms. Rose and she informed me that if she does not sleep well
she is often forgetful of words and does not feel as energized in the day. In order to assess her
sleep quality, I utilized the Pittsburgh Sleep Quality Index (PSQI) assessment tool. She reported

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that she typically goes to bed around 10:30 pm, sleeps about 6-7 hours a night and it takes her
about 45 minutes to fall asleep on average. The greatest factors affecting her sleep quality
include having to go to the bathroom frequently during the night, bad dreams and being too hot.
She has tried taking over the counter sleep aids, such as melatonin, Benadryl or Valium to help
her fall asleep. She also has tried eating lighter at night, not drinking water after 7 pm, and
drinking a glass of cold milk with little changes in her sleep patterns. I calculated her responses
and her total PQSI score was 9, which is indicative of a poor sleeper.
Based on the information obtained in her health interview and the PSQI assessment tool,
I determined that sleep was a problem that warranted teaching. The diagnosis that correlates with
this health concern is: Disturbed Sleep Pattern related to incontinence, bad dreams and being too
hot as evidenced by dissatisfaction with sleep and a PQSI score of 9. The desired short term
outcomes are that she will report improvement in her sleep pattern and she will be able to
verbalize ways to improve sleep quality in 4 weeks as measured by PQSI and sleep diary. Her
long term outcome is that she will attain a reduction in distress and an increased sense of wellbeing in 8 weeks as measured by sleep diary and PQSI. These specific outcomes are related to all
levels of prevention. By incorporating interventions to promote sleep, this can help prevent
further nights of disturbed sleep and also maintain restful nights. Therefore, this addresses
primary and tertiary prevention. Additionally, we will be utilizing the PQSI screening/assessment
tool to measure her progress which addresses secondary prevention as well.
Teaching sessions were performed via teleconference on the 15 and 17 of April, since the
client lived over 8 hours away, and they vwere focused on ways to improve her overall sleep
quality. Some suggestions that were made included performing light activity during the day and
stopping before bedtime which would help increase her energy during the day and promote sleep

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at night (Doenges, Moorhouse, & Murr, 2014). She was encouraged to discontinue smoking, or
decrease the amount she smokes daily, as nicotine can also interfere with sleep (Schutte-Rodin,
Broch, Buyesse, Dorsey & Sateia, 2008). Bedtime comfort regimens were discussed to include a
warm bath, a glass of warm milk, or small amount of wine or brandy at bedtime which would
promote relaxation and milk enhances the synthesis of serotonin which is a neurotransmitter that
helps the client fall asleep faster and sleep longer. She was instructed to limit the use of OTC
sleep aids, Benadryl or Valium that she has at home unless absolutely necessary. Lastly, she was
advised to contact her primary care provider if incontinence continues to be the primary reason
she is unable to sleep. (Doenges, Moorhouse, & Murr, 2014) This information was discussed
with her verbally and a few written handouts were also provided with additional modalities to
reinforce teaching.
The teaching sessions went well and she was very receptive of the information provided.
She verbalized that she would try to incorporate more modalities to help her sleep such as
performing light exercises, drinking warm milk before bed, taking sleep aids only when needed
and that she would consult her doctor if necessary. She did not however, like the idea of quitting
or reducing her smoking. Unfortunately, the short term and long term goals were not met because
there was not enough time to gauge her progress. If I could have done differently, I would have
allotted more time to work on this project so that I could accurately gauge the effectiveness of
my teaching. Regardless, I am confident that the teaching was beneficial and she is sure in what
she needs to do to improve her overall sleep quality. We will continue to move forward to make
sure that her goals are met. She will monitor her sleep patterns over the course of 4-8 weeks via a
sleep diary and she will make any changes as necessary. I will also continue to check in on her
progress via teleconference and perform the PQSI assessment tool at 4 and 8 weeks to determine

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the progress she has made and if any additional interventions and/or teaching needs to be
performed.
In conclusion, I found that this assignment helped me to be more comfortable with the
nursing process of assessment, diagnosis, planning, interventions and evaluation. It required me
to focus on each of those steps to create and enhance the nurse-client relationship. It also
highlighted the importance of teaching in attaining optimum patient outcomes. Additionally, it
emphasized the importance of therapeutic communication and collaboration to promote trust and
understanding with my client. Overall, this was a good experience and I am even more eager to
begin my journey as a nurse and I look forward to many more exciting experiences to come.

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References
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2014). Nursing care plans guidelines for
individualizing client care across the lifespan. Philadelphia, PA: F. A. Davis Company.
Healthy People 2020. (n.d.) Sleep health. Retrieved from
https://www.healthypeople.gov/2020/topics-objectives/topic/sleep-health
Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C., & Sateia, M. (2008). Clinical guidance for
the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep
Medicine, 4(5), 487-504.
Whalley, M. (2016). Sleep problems & insomnia. Psychology Tools. Retrieved from
http://psychology.tools/sleep-and-insomnia.html