Acute Elderly Care within inpatients utilizing Health Belief Model

Conceptualization of health has occurred over time, leading to the need of a more holistic approach to health; The World Health Organization (1946) definition of “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (Stanhope & Lancaster, 2011). With this definition in mind, the profession of nursing needs to look at a holistic approach to care; meaning that care is provided to an individual with a condition not the just the condition (Frisch, 2010). Advocacy in nursing requires one to engage others within their profession and outside of it to bring awareness to the inequity and inequality within health care (Canadian Nursing Association, 2020). “Economic and social imbalances [within Canada] produce inequalities of opportunities, differential life chances, and different social consumption patterns”; these “social and economic inequalities are related to health status and the utilization of health care services” (Bolarisa & Bolaria, 2009, p. 167, 178). If one was to look at an acute care setting providing care to a senior population, a nurse might identify this population to be high risk for adverse outcomes. This blog will explore how these outcomes can be prevented through utilization of the Health Belief Model.

Health Belief Model

The Health Belief Model (HBM) is one of the oldest models but is still widely recognized (Glanz & Bishop, 2010). It was originally developed in 1950s to assist in understanding why or why not people utilized public health services and has evolved to address more current concerns regarding prevention and detection (Glanz & Bishop, 2010). “The HBM theorizes that people's beliefs about whether they are at risk for a disease or health problem, and their perceptions of the benefits of taking action to avoid it, influence their readiness to take action” (Glanz & Bishop, 2010). The key beliefs of this model are: 1) Perceived susceptibility, 2) Perceived severity, 3) Perceived benefits, 4) Perceived Barriers (Simpson, 2015). In addition to these four beliefs, this model includes cues to actions and self- efficacy (Simpson, 2015). As Glanz and Bishop (2010) stated “The HBM has been applied most often for health concerns that are prevention-related and asymptomatic”.

Acute Care of the Elderly

When it comes to the patient population over 65 years of age, they become more vulnerable to adverse outcomes while being hospitalized. “Special considerations should be taken for the care of elders in the hospital, especially those with advanced age, baseline cognitive impairment, functional limitations, or frailty (Sanon, 2020). Senior friendly care should have a focus on achieving best possible outcomes for the elderly (Regional Geriatric Program of Toronto, 2020).

Hazards of Hospitalization to Elderly

As stated by Sanon (2020) “the most common hazards of hospitalization older adults are faced with during the period of an acute hospital stay, including functional decline, delirium, malnutrition, medication side effects, hospital-acquired infections, pressure ulcers, and the use of physical and pharmacologic restraints”. The two most common are likely functional decline and delirium.

• Functional decline can be defined as “a new loss of independence in self-care capabilities and is typically associated with deterioration in mobility and in the performance of activities of daily living” (Senior Friendly Hospitals, 2014). It is noted that “30-60% of older people experience functional decline when acutely hospitalized” (Senior Friendly Hospitals, 2014).

• Sanon (2020) defined delirium as “an acute, fluctuating syndrome associated with altered attention, awareness, and cognition, often due to an underlying medical condition”. The prevalence of delirium extremely common with one third of hospitalize seniors acquiring delirium (Sanon, 2020).

Health Belief Model and OSMH

Working at Orillia Soldiers’ Memorial Hospital (OSMH) has allowed myself to participate in bringing senior friendly care to acute medicine with an integrated approach. Health promotion and policy development requires policy makers to be aware of their decisions and accept responsibility (Stanhope & Lancaster, 2011). The table outlines the HBM requirements as well as OSMH beliefs.

Moving Forward

By implementing the HBM at all levels within the organization, OSMH is shifting model of care for medical and rehabilitation to integrated model will improve the health outcomes for patients on this unit. The below graphic illustrates the HBM applied to the intuitional and interpersonal levels.

The below graphic illustrates one way the HBM is applied through two levels of influence, interpersonal and intrapersonal.

As can be seen from the graphics by starting at the institutional level and working down the levels to intrapersonal level, health outcomes for the senior population can be influenced to result in the better outcomes. By having strong policies, procedures and protocols to address senior friendly concerns such a delirium and functional decline allows he organization to have a senior friendly focus. These guide care from the time of first interaction to time of discharge as standardized approach and expectations. With having these policy and procedures, educational resources can be developed to support the interpersonal level in having the knowledge necessary to imply the standardized approach to senior care. With the interpersonal level having this knowledge, they can feel confident in education the patient and family. With all levels being informed on importance and prevention strategies, the outcomes are improved for this vulnerable population.

References

Bolaria, S., & Bolaria, R. (2009). Inequality, food security, food banks,and health. In Bolaria, S.

& Dickinson, H. (ed.), Health Illness and Health Care in Canada (pp.167-182). Toronto:

Nelson

Canadian Nurses Association. (2020). Policy & Advocacy. Retrieved from https://www.cna-aiic.ca/en/policy-advocacy.

Frisch, N., (2010). The challenges of holistic nursing practice. In McIntyre, M. & McDonald, C.

(3rd ed.) Realities of Canadian nursing: Professional, practice, and power issues (pp.

223-237). Philadelphia: Lippincott Williams & Wilkins.

Glanz, K., & Bishop, D. B. (2010). The role of behavioral science theory in development and implementation of public health interventions. Annual review of public health, 31, 399–418. https://doi.org/10.1146/annurev.publhealth.012809.103604

Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July, 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April, 1948.

Regional Geriatric Program of Toronto. (2020). The Senior Friendly Care Framework. Retrieved from https://www.rgptoronto.ca/wp-content/uploads/2018/02/The-Senior-Friendly-Care-Framework-11x17-Handout.pdf

Sanon M. (2020) Hazards of Hospitalization. In: Chun A. (eds) Geriatric Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-19625-7_33

Senior Friendly Hospitals. (2014). Functional Decline. Retrieved from http://seniorfriendlyhospitals.ca/toolkit/processes-care/functional-decline

Simpson, V. (2015, Mar). Models and Theories to Support Health Behaviour Intervention and Program Planning. Retrieved from https://extension.purdue.edu/extmedia/HHS/HHS-792-W.pdf

Stanhope, M., & Lancaster. J. (2011). Community Health Nursing in Canada (2nd Canadian ed.).

Toronto: Mosby Elsevier