Running head: SENIOR HEALTH PROMOTION PROJECT 1

Senior Health Promotion Project

Erika Swinson

April 21, 2017

Bon Secours Memorial College of Nursing

NUR 4113

Honor Code: I pledge

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Senior Health Promotion Project

The client that I chose to do my senior health promotion project on was my Grandmother.

The client is a 75-year-old female that lives in a house with her husband, located in a suburban

area. The client can speak, read, write, and understand English and so not translator was needed

for my assessment or teaching. The client has hearing loss in both ears but she does wears

hearing aids. She is also near and far sighted but wears corrective lenses for those issues. The

client still drives and has no transportation issues. The client is in overall good health but has

recently been dealing with some urge incontinence issues and her doctor recently started her on a

medication for it. I asked if she had tried bladder training to try and manage her incontinence

before starting her medication and she had not, but she wanted to learn about it. So, the topic we

choose was had to do with bladder training which included pelvic floor exercises and keeping a

diary. This teaching topic relates to the overall goal of Healthy People 2020 because it will help

her maintain her functional independence which improves her health and quality of life.

The nursing diagnosis that I chose for my grandmother was: health seeking behaviors

related to new condition (urge incontinence), as evidence by her desire to seek a higher level of

wellness. I chose this nursing diagnosis because the client already knew that she suffered from

urge incontinence and she wanted to learn about how she could better manage it herself so that

she could have more control over her health and body functions. This is important to the client

because she will be more comfortable going out in public to places and wont have to worry

about needing a bathroom right around the corner because she will have more control. The short-

term outcome that was set for the client was: the client will have less than 3 episodes of

incontinence a week related to the feeling of urgency noted in her diary by the time we met on

4/16/17. This short-term outcome was chosen because the client and I both felt that she would be
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able to reach that goal if she made sure to keep track of everything in her diary and did

everything else that was included in the teaching. The long-term outcome that was set for the

client was: the client will have retrained her bladder within 15 weeks of starting her bladder

training which was started on 3/21/17 she will keep track of everything in her diary to make sure

by the end of the 15 weeks she is regularly not having any periods of incontinence. This long-

term outcome was chosen because it takes 3 months to fully alter bladder function.

The teaching plan was developed by me simply asking my grandma how she wanted the

teaching information provided to her. I gave her the options of having documents emailed to her,

printed out, or if she would rather watch a video to learn about it. She told me that she would

prefer her teaching provided on paper that way she could look back at it when she needed to or

hang it up in her bathroom to help remind her to keep track of everything in the diary. I looked

through the internet to find documents that I thought would be the most helpful to her. We

discussed what was on the teaching documents and I got her to repeat it back to me to make sure

she understood everything. I provided her with 2 brief documents that talk all about bladder

retaining, how to do it, tips and fluid intake. I also provided her with a document that told her

what pelvic floor exercises are and how to do them. After going over those documents I provided

her with a Urinary Diary which had the time of day listed hourly with boxes that would be

checked with check marks next to the time when she urinated in the toilet, had a leaking

accident, noted the reason for the accident, and the type and amount of fluid she drank up to the

point of when she had an accident or used the toilet. On that same sheet, it also had a place where

she noted the number of pads she used in the 24-hour period and a spot where she could add any

additional information that would be relevant such as her type and dose of medication she was on

for the incontinence. I chose these teaching aids because I felt they would be the best way for her
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to learn considering all the various factors that could affect her learning such as her hearing

issues, vision issues, and her mild confusion if she doesnt hear you correctly, that way she

always had these sheets to refer back to if she had any confusion, In an article by Shamliyan,

Wyman, & Kane (2012) it was noted that there was a high level of evidence that suggests that

pelvic floor muscle training combined with bladder training increases the continence rate and

improves urinary incontinence.

The short-term outcome was achieved by the client the week before our meeting on

4/16/17. This outcome was measured by looking back at the clients urinary diary to see when

she had periods of leaking and what caused that leaking when she did have it. To help the client

follow-up on her long-term goal the client will continue to keep a urinary diary to monitor her

progress until she has reached the 15-week mark of the training. The client will continue to try

her best to only use the bathroom at the times we had chosen if she cant she will use some of the

urge suppression techniques noted in the teaching documents. If she can stop the urge the she

will continue to follow the schedule, if not she needs to wait at 5 minutes and then go to the

bathroom, after she needs to re-establish the schedule. Once she can fully reach her goal without

any breakthrough urination from the scheduled times she will gradually increase the time

between emptying her bladder by 15 minute intervals each time she reaches the goal throughout

the 15 weeks. She will stop this once she reaches a schedule that has her voiding every 3-4 hours.

If the client reaches this 3-4 hour between urination period then she has retrained her bladder,

she will be able to know if she reached the goal by looking at her urinary diary. The nursing

outcomes chosen were realted to tertiary prevention because we are helping her to manage her

chronic health problem.

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I believe that my teaching has been effective so far to the client. The client seems to be

responding well to the teaching and adhering to all parts so that she can reach her goal. When we

met on 4/16/17 she said to me I cannot believe I never tried any of this before, its really

seeming to help me so far. A limitation of my teaching would be that I am not there to make

sure that she is doing everything so I cant know if what she puts down in the dairy is 100%

accurate, but, she is my grandmother so I dont believe she would lead me in the wrong

direction. If I could do anything differently it would be to start the project earlier so that I could

see more progress in how effective the teaching was. I could revise the teaching strategy by

getting her to consult her physician to see what he has tried as far as teaching with her on that

topic. My feelings and reactions regarding the role of being the nurse teacher are that I was

surprised to learn that my grandmother was suffering from incontinence issues and I was

surprised to learn how easy it is to locate good teaching materials for clients of all ages and

levels of learning. I feel that this project made me more aware of how many different health

problems and medications are actually a reality for many older adults that I would typically

consider to be healthy adults.

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References

Bladder Training. (n.d.). Retrieved March 20, 2017, from

https://www.ucsfhealth.org/education/bladder_training/

Gulanick, M., & Myers, J. L. (2014). Nursing care plans: nursing diagnosis and intervention (8th

ed.). St. Louis, MO: Elsevier Mosby.

PATIENT INFORMATION Bladder Retraining [PDF]. (2012, June 1). Standford Primary Care

clinics.

Pelvic Muscle Exercises. (n.d.). Retrieved March 20, 2017, from

https://www.ucsfhealth.org/education/pelvic_muscle_exercises/index.html

Shamliyan, T., Wyman, J., & Kane, R. L. (2012). Nonsurgical treatments for urinary

incontinence in adult women: diagnosis and comparative effectiveness. Retrieved April

21, 2017, from https://www.ncbi.nlm.nih.gov/books/NBK92960/?report=classic

Touhy, T. A., & Jett, K. F. (2016). Ebersole & Hess' toward healthy aging: human needs &

nursing response. St. Louis, MOI: Elsevier.

Urinary Diary [PDF]. (n.d.). The Regents of The University of California.