1. health and fitness

Building skills in health promotion and chronic
disease prevention for the
DNP prepared nurse practitioner:
A multigenerational case-based approach
Gail Johnson, DNP, APRN; Basia Belza, PhD, RN, FAAN;
Christine Hoyle, DNP, APRN
University of Washington
DNP Role in Health Promotion—Disease Prevention
Essential Skills
• Analyze epidemiological, biostatistical,
environmental data
• Apply evidence-based approaches to individual
and population health
• Risk assessment
• Risk reduction
• Screening
The Challenge
• To teach DNP students new skills that they can
apply in a practical way to real life situations
• To develop a creative approach to teaching in
a large class of 90 students
• To keep interaction meaningful among
students in a 50% online, 50% in person
course
Multigenerational Family Case Components
• Family case includes 4 generations
• Illustrates individual risk factors, family
connections, community dynamics
• Multiethnic
• Health profile developed
for each family member
Charles
Charles is a 79 yo male, retired, former
maintenance worker, married to Betty for 56
years. 2 children; one died accidental death age
22. Son Rob lives in same city. 3 grandchildren
and 2 great grandchildren. Charles has wellcontrolled HTN and DM type 2.
Charles’ Health Profile
Diet: Wife cooks. Tries to eat a low fat, low cholesterol diet, likes fruits but doesn’t eat
a lot of vegetables, coffee 2 cups a day. Struggles with his weight.
Elimination: No concerns
Sleep: Sleeps 8-9 hours a night
Habits: Former smoker, drinks occ. beer, exercises with evening walk with dog around
the block.
Meds: Lisinopril 20 mg a day, Metformin 1000 mg twice daily
Allergies: NKDA
Patient Profile: Lives with wife in their own home, 3 grandchildren, 2 great
grandchildren. Supports include wife and son.
ROS: HTN past 5 years, well controlled on medication, DM type 2, dx’d 4 years ago,
initially diet controlled, on metformin past 2 years.
Family Hx:
• Mother: HTN, died age 85 from stroke
• Father: unknown
Luis
• Luis is a 3 year-old mixed Caucasian/ Hispanic
male, daughter of Chris and Maria. Luis lives
with his parents and sister. His father works in
construction. His mother stays home. Luis was
last seen 2 months ago in the emergency
room for stitches when he cut his forehead in
a fall from the porch. He has a history of
asthma and eczema, well controlled currently.
Luis’ Health Profile
Diet: Eats all table food, especially likes tortillas, cheese, fruits, not vegetables. Drinks
whole milk - 8 ounces with each meal. Drinks soda on weekends, some candy, no gum.
Elimination: Recently completed toilet training for bowel, dry during day and most
nights; night wetting about once a week. Mom not concerned.
Sleep: Sleeps through night. Naps most days for an hour in afternoon.
Safety: Mom has Ipecac and gate for stairs, no cupboard locks or outlet protectors.
Mom states Luis is very active and she can't be watching him every minute due to
infant; states he "has to learn things the hard way."
Development: Dresses and feeds self. Can follow simple directions and likes to be a
"helper". Parents have no concerns, but wonder about his speech. Describe him as an
active, happy, loving little boy. Language- Mom states he babbles and sometimes says
words that she can understand like "milk", "potty", "go", and "baby". Can follow her
directions and she thinks he understands and hears well. Often points to what he
wants. Spanish and English are used in the home.
Patient Profile: Family lives in Seatac, low to middle class neighborhood, renting
home; many children in neighborhood. Luis plays well with others most of the time.
Cared for by Mom at home. Watches TV 3-4 hours every day.
Immunizations: Hep B x 3, DtaP x 2, IPV x 2, Hib x 2, MMR at 12 mos.
Family Hx: mother--asthma, allergic rhinitis, grandfather--HTN
Assignment #1 Risk Assessment
• Choose a Family Member
• Identify health risks based on population data
for age group
• Identify additional risks based on PMH,
personal habits, FH
• Identify health promotion goals
• What is a strategy for risk assessment to use in
Primary Care setting? Pros and Cons?
Assignment #2 Risk Reduction
• Revisit your patient from Assignment #1
• Identify a risk reduction strategy for this
patient to be used in a Primary Care setting
• Review evidence behind this strategy.
• What are the shortcomings to this approach?
• What are the recommended vaccines for this
patient?
Assignment #3 Screening
• Choose a screening guideline to review
– Sensitivity, specificity, predictive value?
– Characteristics of disease, test and population
screened?
– Sources of bias in screening?
– Differences in guidelines for this test?
• Recommend evidence based
screening guidelines for a chosen
family member
Assignment #4—Population Health
• Explore the health indicators of the community of
SeaTac in which fictional family lives
• Choose one indicator related to one family member
and explore in depth
• Plan a health promotion approach to address this
indicator from a community perspective
– Frame with a Health Promotion Theory
– Consider strategies for risk assessment, reduction,
screening
– Consider behavior change, health
education/communication approach
– Consider a specific population approach
Evaluation
• Graded participation in online case discussion
• Peer and faculty feedback to online postings
• Course evaluation
Next Steps
• Consider further integration of case in DNP
core curriculum—e.g. Health Policy and
Politics; Social Determinants of Health;
Program Evaluation and Quality Improvement
• Build on the case in second and third year
clinical course assignments related to
advanced health assessment, disease
management and pharmacology
Summary
• Real world application of concepts of risk
assessment, risk reduction and screening
helps advanced practice nursing students
develop the necessary skills for future
practice.
• The multigenerational case approach can
easily be adapted to other cultures,
communities and health professions.