Closing Words

It was bittersweet to see this summer’s service learning project come to an end. Time spent with the consumers and staff at Piper Place has been an enlightening and encouraging experience. The group learned important information about disease processes and complications along with preventative techniques. The health promotion study was a great opportunity for the consumers to keep track of their own health factors. Although our implementations did not yield any statistically significant results, the targeted population, community, and I learned the importance of health promotion. More extensive study into individual cases and specific interventions is essential to improving health promotion. We learned that education is a needed priority within healthcare, especially for groups with learning disabilities or who are more prone to disease. I hope to see more effective interventions aimed at successful health promotion in future research.

               

Data Collection

My Last Day at Piper Place

Classes at Piper Place went very well. The consumers appreciated each session of new information and participated in every planned activity. The next step in the research study involved collecting post-implementation data. I manually measured blood pressures using a stethoscope and blood pressure cuff and weighed the consumers with an electronic scale. I collected hip and waist measurements and also calculated BMI and heart rate. Data also included a survey that each participant completed. A copy of it is pictured below:

Health Assessment Questionnaire

Name:  ____________________________________________________

Age: ____________

Sex: _____________

1. How do you describe your health in general?

_____ Excellent

___  _ Good

_____ Fair

_____ Poor

2. During a typical day does your health limit you in moderate activities, such as moving a table, using a vacuum cleaner, bowling, or playing golf?

_____ Yes, very limited

____   Yes, limited a little

      __ No, not limited at all

3. During a typical day does your health limit you in climbing several flights of stairs

_____ Yes, very limited

_____ Yes, limited a little

_____ No, not limited at all

4. Have you had any problems completing your regular activities during the past month due to your physical health?

_____ Yes

_____ No

5. Were you limited in the kind of work or other activities as a result of your physical health during the past month?

_____ Yes

_____ No

6. How often do you engage in aerobic exercise (walk or ride a bicyle > 30 minutes, run or jog >20 minutes)?

_____ Not At All

_____ At least one time per week

_____ At least two times per week

_____ At least three times per week

_____ More than three times per week

7. During the past month have you accomplished less than you would like due to emotional problems such as feeling anxious or depressed?

_____ Yes

_____ No

8. During the past month have you failed to complete activities as carefully as usual due to emotional problems such as feeling anxious or depressed?

_____ Yes

_____ No

9. During the past month, how much did pain interfere with your normal activities?

_____ Not At All

_____ Somewhat

_____ Moderately

_____ Much of the time

_____ All of the time

10. How often have you felt calm and peaceful during the past month?

_____ Not At All

_____ Somewhat

_____ Moderate amount of time

_____ Much of the time

_____ All of the time

11. How often did you have a lot of energy during the past month?

_____ Not At All

_____ Somewhat

_____ Moderate amount of time

_____ Much of the time

_____ All of the time

12. How often have you felt downhearted and blue during the past month?

_____ Not At All

_____ Somewhat

_____ Moderate amount of time

_____ Much of the time

_____ All of the time

13. During the past month, how much of the time has your physical or emotional health interfered with your social activities (like visiting with friends or relatives)?

_____ Not At All

_____ Somewhat

_____ Moderate amount of time

_____ Much of the time

_____ All of the time

14. How often do you feel that your life situation is putting you under too much stress?

_____ Always

_____ Most of the time

_____ Sometimes

_____ Rarely

 _____Never

15. How often do you have someone to talk to when you are feeling lonely, depressed, angry, or in need of help?

_____ Always

_____ Most of the time

_____ Sometimes

16. Do you currently smoke cigarettes, cigars, pipes or other tobacco?

_____ Every day

_____ Most days

_____ Some days

_____ Never smoked

_____ I quit

17. Do you currently use smokeless tobacco (e.g., dip snuff)?

_____ Every day

_____ Most days

_____ Some days

_____ Rarely

_____ Used, but quit

_____ Never used

18.How often do you eat high-fat food?

_____ Every day

_____ Most days

_____ Some days

_____ Rarely

19.How often do you have fruits or leafy vegetables?

_____ Every day

_____ Most days

_____ Some days

_____ Rarely

20.Do you have your regular meals on time?

_____ Every day

___  _ Most days

_____ Some days

_____ Rarely

21. Have any of these family members been diagnosed with type II diabetes or heart disease

(Circle all that apply)

_____ Mother

_____ Father

_____ Siblings (brother and/or sisters)

_____ Grandparents

22. How long ago did you see a physician or other healthcare provider?

_____ Within the past 6 months

_____ Within the past year

_____ Between 1 and 3 years ago

_____ Longer than 3 years

23. When was your last physical exam?

_____ Within the past 6 months

_____ Within the past year

_____ Between 1 and 3 years ago

_____ Longer than 3 years

24. When did you last see a dentist?

_____ Within the past 6 months

__    _ Within the past year

_____ Between 1 and 3 years ago

_____ Longer than 3 years

25. Did you receive a flu vaccine this past year?

_____ YES

_____ NO

                It is definitely more of a challenge to work with a group with mental disorders. Many people would talk while getting blood pressure checked which caused me to have to re-measure and switch arms. Excessive clothing oftentimes became a barrier. My most difficult encounter existed with the surveys.  Some consumers were illiterate while others could not focus on the questions as a result of cognitive impairments. In most cases, I administered the questionnaires orally. There will still others who did not understand what I was asking, and I reframed the questions to be easier to comprehend. Although I confronted a few problems during data collection at Piper Place, I thoroughly enjoyed my experience. I relished in the opportunity to reach out to this population who really needs more focused attention. I am ecstatic to be involved in research that will add to the modest amount of literature about health promotion interventions for people with psychiatric disorders. After organizing all the data for Gary Milligan, he is now inputting all the information for analysis. As a result of the six promotion courses, we hope that the groups’ vital signs improve as well as their overall perception of good health. Mr. Milligan plans to write about his findings at Piper Place, and he hopes to publish in significant periodicals such as the Journal of Psychosocial Nursing and Health Services. I will keep you updated about the results!

               



Day 6- You Are What You Eat!

For the last course at Piper Place, we taught the consumers about healthy diet and nutrition. Alabama has the highest rates of diabetes in the South due to bad eating habits and lack of exercise. We first discussed the benefits of eating right such as lowered blood pressure, cholesterol, and depression. Next we broke down the components of food. Calories are the units of measurement that indicate the energy value of food, and too many calories turn into fat. Carbohydrates are another energy component effecting diet.

                Decisions…Decisions…The food choices we make have the greatest effect on obesity and other health factors. However, it can be difficult for the mentally ill community to make nutritious decisions. Many consumers do not have jobs or family assistance which contributes to low income. Nutritious foods generally cost more than unhealthy foods, so the quick alternative is fast food. Cognitive impairments also prohibit this population from driving, so they may be unable to go to the grocery store and are forced to eat what is given in their boarding home. To combat these barriers, we taught the group how to make better decisions in their own living environments. Simple preventative measures include exercise, eating smaller portions, and drinking water. We should trade bad carbohydrates like Twinkies for good carbohydrates such as vegetables. These floods slowly enter the bloodstream, while bad carbs overload the body and quickly convert to fat. If we have to eat fast food, the grilled option is a healthier choice.

                Finally, the consumers participated in an activity involving the U.S. government’s new dietary guidelines. MyPlate illustrates the five food groups that are the building blocks for a healthy diet using a familiar image—a place setting for a meal. Each consumer was given a plate that we divided into the 5 food groups. Using crayons and colored pencils, the group drew different fruits, vegetables, grains, protein, and dairy products on their plates. This activity was an effective teaching tool. We were sure to help the consumers choose healthy foods for each plate section. They could also take the plate home as a constant reminder.

Follow the link below to learn more about the new MyPlate Initiative

MyPlate.gov

               

Day 5- Talking To Your Doctor

        It can be hard for some of us to communicate our symptoms and needs when we visit the doctor. We may feel nervous and forget or fear the treatment and doctor’s advice. These emotions may even affect our health or vital signs and is called “white coat syndrome.” If this occurrence can happen to cognitively healthy people, I am certain that the mentally ill community has the same difficulties with their healthcare providers. For this reason, we discussed doctor communication at the 5^th study course. A good relationship with your doctor can result in better return care.  We told the consumers to stay involved in their care and ask questions about treatments and medications. The main point of the class involved preparation for the doctor’s visit. Due to cognitive impairments, the group needs to take extra steps to be sure they are effectively communicating with their doctor. Psychiatric disorders include a variety of symptoms and methods of care, so clients should provide the necessary information.  These important tips can even help mentally stable people come better prepared for their healthcare visit:

1.       Write down all the questions you’d like to ask.

2.       Make and bring a list of symptoms. You might want to research your condition at the library or on the Internet.

3.       Bring a list of all the medicines you take.

4.       Arrive early

5.       Bring your medical records/insurance details.

6.       Bring someone with you. A companion also could help you relax, remind you of questions you forgot to ask, and help you remember what the doctor said.



Day 4- Exercise

                I have been an athlete since I could walk, so this topic was my favorite to teach. I am passionate about physical fitness and knew this kind of enthusiasm was necessary to connect with the consumers. The daily anxieties and hardships regarding their mental conditions oftentimes places exercise at the bottom of the list of priorities. Research shows, however, that physical activity is even more beneficial to the psychiatric client. Exercise stimulates cognitive function and improves mental capacity, mood, and energy. It also maintains a healthy weight to combat the weight gain associated with many psychiatric medications such as antipsychotics and antidepressants. The benefits of getting active are widespread and include reducing disease related risk factors and increasing immunity.

                We also taught the group some useful information about the types and different components of exercise. Stretching is an important part of a workout, and it is also essential to vary the activity to include muscular endurance and aerobic conditioning. Many mentally ill consumers think it’s impossible to obtain physical fitness, so we offered some great tips to get started:

1.       30-60 minutes of moderate-vigorous exercise most days of the week is recommended.

2.       Talk to your doctor about what you can and can’t do based on your diagnosis.

3.       Choose activities you enjoy. I like to listen to my favorite music while I run.

4.       Recruit a partner for support and encouragement. You will get into conversations and 30 minutes of walking will fly by.

5.       Set realistic goals and listen to your body.

            To reiterate a positive attitude toward exercise, I finished the class with a little physical activity of my own. I played some always-loved Michael Jackson and got the consumers up and on their feet! Together we completed body squats, arm circles, calf raises, and high knees. The group enjoyed the movements and were glad to find out they were capable of physical activity.

Day 3- Diabetes

     The 411 on diabetes was the topic of the third course at Piper Place. We discussed the anatomy and physiology behind the disease, beginning with the function of insulin. We cleared up some misunderstandings that diabetes is not contagious like most illnesses and is not directly caused by eating too much sugar. The power point presentation was the greatest help because the consumers needed a visual depiction of these hard-to-grasp concepts. Big words such as hyperglycemia were easier to understand when assisted by brightly colored pictures. I quickly learned that these types of aids must be considered and utilized when educating the mentally ill client.

Below is an example of a slide used to effectively teach the warning signs of hypoglycemia:

                In addition to the signs and treatment regarding high and low blood sugar, we extensively discussed the complications of diabetes and what the consumers should be on the lookout for if they have this illness. When left untreated or improperly managed, diabetes can lead to stroke, heart disease, and hypertension. The kidneys are also affected by high blood sugar.  Neuropathy can be caused by diabetes, so patients should take special care of their eyes and feet. The consumers learned a lot about this prevalent illness. We hoped to help those with the disease take better care of themselves as well as prevent people from developing diabetes.

Day 2- Stress Management

              The next session at Piper Place focused on a topic that almost all consumers encounter when coping with and managing their psychiatric disorders. Stress is common to many mentally stable people, so I couldn’t imagine what challenges the seriously mentally ill community must face. That exact point began the stress management course—“Everyone has stress, and you’re not alone.” We then educated the consumers about the physiological aspects of stress, informing them that stress is not always negative. Exercise and puzzle games are some good examples of stress. The group mentioned that bad examples of stress in their lives include job loss, financial woes, and coping with the reactions of other people and family.

                In order to keep the consumers thinking and engaged, we ask lots of questions. This dialogue also allows us to see what the group already knows as well as correct any misconceptions they may have. The participants were very aware of the physical signs of stress such as increased heart rate, perspiration, aches, and pains. A harder concept to grasp was the difference between external and internal stress. An illness or relationship difficulty classify as external stressors while personal beliefs and guilt are causes of internal stress. Coping mechanisms ended the day’s class with great examples from us as well as the consumers. Talking and breathing techniques were top choices for stress management, and some people even preferred to go to a secluded place for a good scream. The group was surprised to find out we had a great activity planned to help relieve their tension and anxiety—DIY stress balls! We assisted the consumers with stuffing Play-Doh into balloons. This simple hands-on experiment was a hit! (not to mention, messy) The activity was an excellent ending to a discussion that for this group, was quite straining.

Day 1- Heart Disease Prevention

At this point in my addition as researcher to the Piper Place study, Mr. Milligan had already completed phase 1 of the project—collecting pre-implementation data. He collected heart rate, blood pressure, waist and hip circumference, weight, and height to determine body mass index and waist-hip ratio. These measurements are clinically indicative of overall health and obesity. He also administered a questionnaire to accompany the physical aspects of health as well as to measure the consumers’ perspective of his or her own health. My later post should include a copy of this survey.

                Now that the pre-experiment data has been collected, it was time to teach some classes!  On my first day at Piper Place we taught about the prevention of heart disease. Risk factors for this illness include genetics, male gender, obesity, tobacco and alcohol use, and diabetes. We also talked about the variables that affect heart disease such as cholesterol, and the difference between “bad” (low-density lipoprotein) and “good” (high-density lipoprotein) cholesterol. A majority of the consumers smoke cigarettes, so it was very important to address this issue. Smoking increases blood pressure and the risk for heart attacks and decreases HDL’s. These factors can also lead to heart disease. The session ended with preventative measures such as healthy eating and exercise.

                Communicating with a group of people diagnosed with psychiatric disorders poses a few difficult, but fun challenges. The consumers are very inquisitive. We could barely speak two sentences before a question was asked. Got to love the involvement! Questions would often be unrelated to the topic, however, so the session required much redirection. When speaking, we had to use simple sentences and analogies that were easier for the group to understand. For example, “heart disease is an illness where your heart is sick. The heart pumps one gallon of blood every minute which looks like one gallon of milk from the grocery store.” Visual aids such as heart models and power point presentation helped the consumers better comprehend the information while giving them some hands-on activities. Although the communication barriers were tough, I enjoyed having to tailor my words “on the spot.” They were eager to learn, and I did my best to help them grasp the information.

Info On Mental Illness

The consumers at Piper Place have been diagnosed with a wide variety of psychiatric disorders. I gained substantial knowledge about these illnesses during second semester’s psychiatric nursing class as well as clinical. Here I will shed light on some of the disorders I witnessed and encountered.

Anxiety Disorder

                When a person cannot use constructive coping measures to combat normal levels of anxiety, higher levels can result to cause behavioral changes in the client that are often persistent and disabling. The various anxiety disorders include panic and obsessive compulsive disorders, phobias, and posttraumatic stress disorder. Patients with anxiety disorders behave in ways that endanger themselves and others while others are so fearful of social or specific contact that they may never even leave home.

Below is a clip featuring a woman living with Panic Disorder:

Bipolar Disorder

                This mood disorder is characterized by recurrent episodes of depression and mania that usually emerge in late adolescence or early adulthood. The client experiencing bipolar disorder may exhibit bizarre, paranoid, and psychotic behavior during manic episodes. These incidences alternate with depressive episodes in which the client appears to lack energy and interest, personal hygiene, and concentration. Treatment of bipolar is focused on keeping the patient healthy and free from harm. Mood stabilizers such as Lithium and Valproic Acid are used as well as benzodiazepines and antidepressants.

In this video, famous actor Maurice Benard talks about his struggles with Bipolar Disorder:

Introduction

Welcome to a study in health promotion! I am Lauren Cage, a third semester nursing student at University of Alabama-Birmingham. I would love to share my experience with the UAB Honors Program, for whom I had to implement a Service-Learning project. I was blessed with the opportunity to become involved in a significant research study, and this blog follows my journey through this project development.

But Wait, What’s Service Learning?

The UAB School of Nursing has an Honors Program that comprises a select group of students. The three-semester sequence allows students to engage with other faculty and the community to eventually take part in a service-learning project. Students link up with a community partner in their personal field of interest to assist with the specific needs of the organization and surrounding community. The result is a successful learning experience in which the students as well as faculty explore the significant issues impacting the world of healthcare.

My Partner and Project

Last semester, I completed Psychiatric clinical rotations at Piper Place, a community day center for those with serious mental illness. Piper Place is located in Bessemer, Alabama and provides an interactive program for consumers to come and enjoy time away from home. They can communicate with others that share the same experience as well as talk to professionals about their circumstance. The day center is a positive environment in which I enjoyed every visit. I participated with the consumers in activities such as Bingo and cookie decorating. The fun was still educational, however, as our clinical group led important sessions on nutrition, communication, and other healthy topics. When my semester came to a quick end, I immediately knew my time at Piper Place was not up yet.

I wanted to reach out to this population even more! The psychiatric patient has life difficulties that encompass the emotional, physical, and mental aspects of well-being. A mental illness not only takes a toll on the brain, but also affects the body and spirit. I was focused on teaching the consumers at Piper Place how to better take care of themselves. To my surprise, someone beat me to the pitch! Gary Milligan, a BSN graduate of Birmingham-Southern College and MSN graduate of UAB, recently began a research study with the consumers. I am honored to be on his team of researchers as he implements the experiment. The study focuses on the effects of health promotion on people with serious mental illness, right up my alley! The research involves taking vital signs of consumers. We will then teach six courses on various health-related topics, and finally retake the vital signs. The hypothesis is that consumers will have better health outcomes as well as an improved overall view of their health as a result of health promotion teachings. My blog will further explain our research methods and the weekly classes.