A Case Study of Change: Obesity

A Case Study of Change corpulencyObesity in primary disturbance has become an increasingly putting surface hassle. Like any other medical fix overweight and heavy tolerants should pick up access to appropriate treatment and cargon utilize a delicate, reasonableness and non-judgemental approach. Weight loss in primary c ar is of use up for the purposes of improving a persons smell of heart. During the study the author will verbalism the prevalence of obesity using the geographical trust region with a cosmos of 158,000 (Office of guinea pig Statistics (ONS) 2007) in comparison with the t proclaim centre found exercise where the author works as a trainee nurse practitioner. The utilize has a mixed socioeconomic, predominately (95.53%) White British population of 15, 186 (Annual Public vigorousness Report 2008). Local authority with in which the author works has been graded as 49th most deprived out of the 354 local government activity in England in 2007 in the In dex of Multiple Deprivation 2007 (IMD 2007). Although obesity is increasing at the a deal rate in all hearty classes, the prevalence of obesity is higher in refuse socio-economic groups, particularly in women (Henderson and Gregory 2002).The National Institute for Health and clinical Excellence (NICE) developed guidelines on identifying and treating obesity in 2006 following on from the Scottish Intercollegiate Guidelines electronic network (SIGN 1996), this in turn along with Primary cope service poser 2007 has lead to Health Care Professionals feel at offices to come along the reason knowledge, contribute and implement a service to deliver coordinated obesity precaution enabling unhurrieds to compound their eating and activity habits and spark weighty unmarrieds to put down weight, maintain weight recur and increase physical fitness in accordance with the White paper (2004). It is in any case thought that additional training in demeanoral counselling maybe vital when assessing a patients readiness to accept transplant (Drummond 2000). Individuals who are not emotionally erect to tackle the issue of modus vivendi convinces are more likely to fail. relations with obesity in the form setting bed be achieved by setting up specific lifestyle clinics dedicated to offering nourishment and advice to patients who wish to lose weight or maintain a fitter lifestyle flavour specifically at demeanor falsify. This clinic can control alongside or in conjunction with existing chronic distemper and routine Health check clinics with self referral or healthcare professional referal. By financial aiding the patient look at how unhealthy conducts can be an gene of their lifestyle and daily choices (see table 1) it is possible to kindle ways in which to revision in a mutually concur plan of care.Awareness and knowledge of what change is necessary and why, are thoroughgoing first steps in enabling change to occur. Motivation is an of th e essence(p) part of nearly everything we do. Regular reviews can endure motivation and change behaviour with with(predicate) and through incentives and penalties. Personal factors, such as individuals self motivation, endeavour and desire to alter their appearance and health are alike important. lay and objectives can influence how much quite a little want to change save their priorities and commitments may alike obstruct their ability to change.Change to clinical practice can only be successful if the reasons for introducing the change are catch, congenial with current practice and ideas and the puzzle out is planned carefully in draw near (Davis1999). Change theories share common factors. To ascertain behavioural change, according to these theories, patients bespeak the desire to view as a change, have the ability to hazard the change, suppose that they will have a better flavour of life if they make the change, believe that the change is right for them, and di scover how and when to make changes.Obesity solicitude gets an integrated approach involving a multi-disciplinary squad of Healthcare Professionals. ordinary Practice is an ideal starting betoken to influence and teach management strategies. Healthcare professionals need better training and access to management programmes that entangle dietary advice, physical activity and behavioural change if they are to initiate the policy effectively. For the programme to succeed the patient necessitate to be the commutation component. Obesity does not lend itself to the classical medical exercise where the condition is diagnosed, treatment prescribed and because the professional responsible for the outcome. It is ultimately the patient who is in control over their decision to proceed and succeed. Weight lose/maintenance is not easy for obese/overweight patients, many of whom have already tried and failed in controlling their weight. It is the role of the primary care team to support a nd encourage weight management and lifestyle change. In an attempt to achieve these changes in behaviour management are vital. have and physical activity are human behaviours which can be limited even though they are predisposed by a intricate set of factors. If in practice the overweight/obese patient was place and advised of the fact, they simply wouldnt care. Consultation with the patient and establishing if they recognise they have a weight problem using a sensitive and respectful way is the first essential step to change. It is then possible to produce a plan of action involving providing information and eliciting the patients views about(predicate) their weight as well as details about their weight history and any front attempts at weight loss. The early stages of consultation are about create a rapport with the patient through active listening. Communications skills are essential to implement a behavioural approach effectively (NICE 2007). Professionals should excessiv ely have the ability to express consideration, build self-belief and provide clear, structured and relevant information.Raising the issue of lifestyle changes can be extremely awkward to talk about as the patient may feel uncomfortable and they may feel responsible. This could have a negative effect on the patient-professional relationship (Drummond 2000). As a professional it can be hold that we have a duty of care to discuss the importance of a behavioural approach in managing obesity and its practical application in helping overweight patients achieve and maintain behavioural changes. Pearson 2003 suggests that linking weight to a current health concern is often an appropriate way to salute weight management issues. Advice should be individualised to condition and patient.By providing the patient with the appropriate information to help them make informed decisions about their health behaviour is part of the professional role. By individualising programmes to see/support pati ents in changing their lifestyle for good can give them the incentive to lose some weight or prevent further weight gain. at that place is always the risk at this point that the patient will throw away the change process altogether.Behaviour change theory examines the difference mingled with sits of behaviour and theories of change (Darnton 2008). Models of behaviour identify us with specific behaviours, by pointing out the underlying factors which influence them. By contrast, theories of change illustrate behaviour change over time. The theories are complementary to each other intellect both is essential in order to improve successful advances in behaviour change.Numerous models can be incorporated together to assist in taste the reasons for our behaviour and how they interrelate but also help us work out the relationships between the reasons to allow us to opine the behavioural outcomes. Tim Jackson writes models reveal factors where policy can work (Jackson 2005).Models fu ndamentally recommend a feature menu for policy makers to choose from do no one model the perfect model but gift the policy maker choice and flexibility to use several antithetical models.Social-psychologist Kurt Lewins Change Theory (1951) involves group work to change habitual behaviours, using an unfreezing, restructure, refreezing guide in which habitual behaviours (attitudes, value and behaviours) are studied by the group and reorganised, before universe reintegrated back into everyday routines (Coghlan and Brannick, 2003 Coghlan and Claus, 2005 Lewin, 1951). Lewins work on change has provided the basis for many later advances in change theories (Lewin 1951). Lewins change theory will be the basic model for the proposed change in practice.Lewins early research entailed changing the patterns of diet in America and is because particularly relevant to issues, such as obesity, that we face today. Lewin concluded that we are likely to modify our own behaviour when we participat e in problem analysis and solution and more likely to carry out decisions we helped to make (Lewin 1951).Unfreezing is a reflective process that involves un victimizeing without removing own uniqueness and laborious re reading and restructuring of thoughts, awareness, beliefs and way of persuasion. In the planning process of change this critical starting point for change can be overlooked. Three pre-conditions simultaneously need to be satisfied for current patterns of behaviour to unfreeze. Firstly disconfirming information which involves disproving a theory. Secondly Lewin (1951) suggested creating guilt or survival anxiety, getting patients to accept behaviour is incorrect but this destructs self-esteem and individualism. The third pre-condition was that disconfirming information could also create what he termed learning anxiety. This creates a sense of weakness, a depression that change cant be initiated due to being unable to learn quickly enough to enable a move into a cru de situation and adapting inadequately often looks more acceptable than risking failure in the learning process. Overcoming learning anxiety is probably the hardest and most critical element in unfreezing.Unfreezing is the most significant and complicated part of any change process, and also the most difficult to achieve as self-esteem and identity securely control people. Yet achieving this is not the end but a gateway to the next levelLewins (1951) next stage, restructuring, also had three elements opening with reorganising thinking. He called this cognitive redefinition and it is at the heart of much of todays systemic thinking (Senge 1990).Albert Einstein quoted the significant problems we have cannot be solved at the same level of thinking with which we created them. It is therefore essential to meet and communicate with others to look at the same problem in different ways. Lewin (1951) then suggested managed learning. impersonation or identification is the simplest way of lea rning in this situation. Learning by copying those we respect and trust. This process is very evident today in standard setting and peer-based learning. Lewin (1951) suggested learning in this way to be shallow and superficial seen as an easy selection in a difficult situation as it is a case of doing what has been advised without really understanding the implications of why it is being done. Kurt Lewin (1951) therefore favoured a different means of learning that he called scanning. This meant seeking alternative sources of information including reading, travel and conversation with people from different backgrounds in order to obtain an accurate understanding of your own situation and adapt accordingly. The problem he saw with peer approaches was that if nonentity had research a subject in detail data was incomplete. And if the sensitive behaviour isnt correct for the behaviour and understanding of the learner then it becomes disconfirming.The final element of Lewins model (19 51) is refreezing making things stick. What he found was that working with gatekeepers, collectively, through scanning rather than identification creates change that sticks and becomes eventually refrozen into the current norm. Lewin offers a basis for change within an ever changing environment.Health sentiment Model Janz and Becker 1984 was influenced by Kurt Lewins theories (1951) which state that perceptions of reality, rather than objective reality, influence behaviour. For an obese patient to perceive the personal effects their weight has on their lifestyle they need to be able to admit they have a weight problem.The stages of change model Prochaska and Diclemente 1984 describes change as a process, broken down into a series of stages through which individuals progress, dependent on the degree of interest in the sought after outcome of the individual. The concept of change is that the patient considers the consequences of actions for changing behaviour, what their desired ou tcome is and which results in a contract to make change. Changing habits happens gradually and often people will need to go through stages of the hertz many times before they achieve lasting change. Gottlieb 2004 suggested that the stages of change model conceived that everyone is on a journey of change, beginning with limited knowledge and progressing through numerous stages to achieve change.Societal models are also important to those develop policies and change as often it is necessary to work on the background factors limiting behavioural options directly. Enabling change is not just about changing a persons perception of these material factors (e.g. cost). The Main Determinants of Health model (Dahlgren and Whitehead 1991) needs to be incorporated into obesity management and is a good Societal model. The model shows the individuals behaviour as one element, infra four other tiers of influencing factors including social and economic factors, cultural factors, environmental f actors and also the services that are available locally.Since Lewins field theory (1951), theoretical approaches to change have recommended developing theory through practice. Piloting and evaluation, followed by reckon learning back in, are the final stages in a process of disturbance development which can be characterised as learning through doing. Guidance on policy development needs to be clear however, it must also be flexible to different frameworks. valuation of any policy is undoubtedly important. Obesity as we have seen is measured in many different ways. Evaluations should measure change in the intended behaviour among the consultation group, as well as the effect on the observe influencing factors. Process evaluation concentrates on how a program is put into practice rather than the outcome. It asks how services are delivered, differences between the intended population and the population served, how programmes are accessed and managed. It aims to provide an explanatio n of how or why proposed outcomes of the project were (or were not) met. development from process evaluations can be used to decide future action, looking at whether a program should be abandon and a new plan of action devised , revise the current program (or components of it) to improve delivery, or how best to deliver it. This type of evaluation may also provide understanding about a programmes cultural, socio-political, legal and economic contexts that affect executionImpact evaluation measures overall achievements it is interested with the direct result of a program when it is finished. It should include a way of measuring unintended effects of a program, as well as the individuals targeted by the programme.Outcome Evaluation measures program goals and is concerned with longer term benefits of the program among the targeted population, and by how much. supervise of outcome is useful and necessary to determine whether outcomes were achieved within a condition timescale (Healt h Promotion, 2002), whereas evaluation attributes the changes observed to the interpellation testedThe models and theories used to underpin the intervention may then be reassessed in the framework of the target behaviour, and understanding of the behaviour itself assist in progression to the closing phase of the speech rhythm in which learning from the evaluation is fed back into the policy process. As part of the evaluation process, the appropriateness of the behavioural models used in the intervention should be assessed. Evaluation findings should update the development of the intervention itself and future interventions in similar policy areas.Audit is a technique that can be used to monitor then maintain or improve the quality of care and services provided. It is the method used to assess, evaluate and improve the care of patients in a systematic way, to enhance their health and quality of life (Irvine 1991)Structural visits are undertaken in relation to what resources there are available, suitableness and access to the clinics, access to continued support either 11, self-help, buddying up with others, web based support or group and also the staff available to run the clinic looking at skill mix.Process scrutinises taper on what was done to a patient, where clinical protocols and guidelines followed and did they work in practice. The audit may look at how an individual or the team operate, looking at waiting times from referral, patient recall for review, management plans, translate keeping, communication between the patient and staff.Outcome audits relate to the impact of the team or services provided on the patient. This could be achieved through patient happiness questionnaires provided at the start of the intervention, part way through and on attain target. Has there been an impact on their lifestyle and if so was this a positivistic experience or has it had a negative effect on their lives.Clinical audit gives valuable insight into how effe ctive a service is being provided by systematically collecting and analysing data on current practice. This allows the lifestyle team to become involved in assessing the effectiveness of their interventions. Clinical audit can help identify areas of behaviour and management which meet required standards, identify area which could be improved, promote changes in problem areas, improve quality of patient care, develop Healthcare Professional skills, give focal point for the most effective use of resources and evaluating how successfully changes have been implemented.Audit is also an important part of clinical governance, there to encourage the continual monitor and improvement of healthcare services. When designing an audit many factors need to be considered (see table 2)A fixed date of 6 months would be hold from the start for the collection of data and interpretation of the results initially but then audit would continue as long as needed to provide information to continue improvin g the service.Cost effectiveness also needs to be evaluated. Cost-effective analysis compares the cost-benefit ratio for one intervention against an alternative intervention. Benefits maybe expressed as patient-orientated health outcomes such as quality of life.The economic impact of lifestyle change maybe assessed in price of direct be, indirect costs and intangible costs. Direct costs boot out from the use of health care resources and if the direct cost of providing treatment is lower than the direct cost of disorder, the treatment is cost-saving for the health care system.Indirect costs look at the cost of illness to the thriftiness. The broader costs to society and the economy from weight problems already cost the wider economy in the region of 16 billion, and is set to rise to 50 billion per year by 2050 if leave unchecked (Department of Health 2009).Intangible costs are monetary values attached to the physical or psychological effects of illness, such as joint and back pa in, breath littleness, varicose veins and gallbladder problems. Obesity is estimated to cost the National Health Service approximately 4.2 billion (Department of Health 2009). Simple activities like getting around can be problematic for an obese individual (Drummond 2000). Quality of life for an obese person is thought to be less than optimal and this can lead to psychological problems. Intangible costs of illness maybe compared with the intangible costs of treatment, such as surgery.