Dr. Green's guidelines for designing health promotion programs in ICU infection prevention

Green provides some clear guidelines to assist health education and promotion specialists in the identification and design of health promotion techniques for implementation in health promotion and disease prevention programs. Discuss how five of the guidelines presented by Dr. Green could assist you in the selection of an appropriate health promotion technique. Support your answer with appropriate examples.

The module gives really simple guidelines as to the how the process of health education promotion can work in today's world. Healthcare is a social industry and hence understanding the community structure and its needs is the primary concern. According to the directions given by Dr. Green, the following factors have to be considered before designing and implementing health promotion and disease prevention programs. Hence the process is structured by first identifying the needs of the community and then setting the goals (short-term and long-term) accordingly. Once this is done the following steps are completed in order to design and implement efficient health promotion and disease prevention programs: the settings of the community are examined (cultural, political, norms, etc.); the population characteristics and demographics are identified; the extent of change is calculated (individual vs. community); all the resources and capital available for the health promoter are identified and used in accordance with prior health promotion/disease prevention experiences within the community; a theory or model that best suits the promotion technique is then recognized and applied. Once these steps are covered, the health promoter then divides all functions across three different tiers; the primary, secondary and tertiary. In the following description, we present an example of how a health promoter can market the prevention of nosocomial infections in the ICU amongst the employees of a hospital. The example will show the entire process divided across the aforementioned three tiers (Green, Module 1a and b).

Primary

With regards to reducing nosocomial infections rates, in a recent study on the C-difficile infection impacting the state of patients in ICU, Muto and colleagues (2007) also concentrated on a number of sanitizing practices that could prove to be helpful in reducing nosocomial infection rates in ICU settings. They supported the use of these practices by also providing scientific and monitory proof of the success of these practices which proved to an efficient disease prevention marketing technique in the long run (Green, Module 1a and b). Even though they had little success initially, the subsequent tests and trials on helpful practices proved to be successful. They even highlighted the most appropriate ways to clean the rooms of the patients (Muto et al., 2007; Kollef, 2008). Some of the successful practices that were consequently adopted since the publication of the study included the following:

(1) The increased use of soap and water for hand sanitization to reduce transfer of bodily substances that might lead to infections,

(2) The utilization of frequent infection-control reviews and examinations to identify the loopholes or flaws in the sanitization processes for ICU, and (3) The decreased use of chemical sanitizers like ceftriaxone, clindamycin, and levofloxacin. Three other studies that supported these findings, namely, Muto et al. (2007), Gerding et al. (2008) and McMullen et al. (2007).

According to the study conducted by Muto and colleagues in 2007, the consistent use of the aforementioned practices and methods was very effective in reducing the infection rates for patients in ICU as the annual rates of infections dropped down to 3.0 in 2006 from an extreme high of 10.4 in the year 2000 (Muto et al., 2007). This proves that the primary prevention technique in disease prevention or health promotion can be best supported by practical or scientific proof (Green, Module 1a and b).

Secondary

In another recent research, Isakow and colleagues (2007) found that the use of probiotics can be a very successful option to control the GI tract within the ICU setting. They further support the use of probiotics due to the simple and easy management that it requires as well as the overall safety report it has and the low expenses and thus the prevention promotion techniques focused on these aspects when marketing its use in the hospitals (Isakow et al., 2007; Green, Module 1a and b). On the contrary, in a prior study, McFarland (2006) highlights that probiotics were successful in decreasing the RR of any and all antibiotic-associated diarrhea but practical result showed a differing outcome. McFarland (2006) found that only 13 out of a total of 25 studies (which is only 50%) have shown results where the ICU patients have had significantly successful results with the use of probiotics (McFarland, 2006). These variations in the results could have numerous factors behind it like the form of probiotics used, the sample chosen, the complementing antibiotic used, the overall dosage and administration, etc. This is why Isakow and colleagues agree that further studies are needed to determine the most effective preventive measures to decrease the infection of C. difficile-associated diarrhea within the ICU setting (Isakow et al., 2007; Kollef, 2008).

Some of the other common infections in the ICU that also need further screening include the following:

• Pneumonia (Use of chest X-ray is important for screening)

• Ventilator-associated Pneumonia (VAP) (assessment and identification of bacterial spread is important for screening)

• Urinary tract infection (UTI) (regular utilization of prophylactic antibiotics is an important aspect of screening)

• Surgical Site Infections (SSI) (hand sanitization and proper incision technique is an important aspect of screening) (Kollef, 2008)

Tertiary

The application of these findings show that the clear determinant factor of the success of failure of infection-prevention techniques used in the hospitals is the adherence and obedience of the doctors and healthcare workers (Green, Module 1a and b). There is little evidence presented by the writer that supports this to be the determinant factor but there is enough evidence for the writer to conclude that the overall structure of infection control in the ICU will improve if and when the following aspects are controlled:

• Expenses and costs of the necessary equipment and procedures were decreased to manageable and affordable values, • There was an adequate and timely supply of the necessary capital or sources

• The scheduling and training of the doctor and nurses was more flexible and lenient so as to not get them overworked and exhausted

• Level of dissatisfaction amongst patients was decreased through conducting surveys and identifying what caused them discomfort

• The possibility of making mistakes with new procedures that discouraged higher levels of participation was controlled by backing and supporting all procedures with proper training, education and scientific proof of success.

• The disarray between the nurses and the doctors and the somewhat blame game was managed with proper delegation and distribution of responsibilities and decision making tasks

All these aspects were then included in the regular training session for the nurses and doctors within hospitals so as to ensure that they remain up-to-speed with the recent demands and needs of the patients and the community and were thus able to mobilize the community and its resources accordingly (Green, Module 1a and b).

2. Dr. Perko discusses the National Cancer Institute's Health Communication Wheel. Outline the basic components of this process and explain how this can be used to assist the health educator to develop effective health messages.

The health communication wheel and components discussed by Dr. Perko include the following aspects:

The diagram/wheel above was structured by me in view of the discussion conducted by Dr. Perko and it shows how and when each step should be completed. Below is a further discussion of these aspects.

Step 1: Review Background Information

- The increase in contact information using forms: the use of forms that have integral patient information i.e. personal contact information is an integral part for any communication in the short- and long-term (Perko, Module 4)

Step 2: Set Communication Objectives and Channels

- The provision of a 24-hour contact number for the healthcare provider and company is also an integral part of the communication wheel. The 24-hour helpline can be provided to the customers with the forms that they are required to fill out with their personal contacts (Perko, Module 4)

- The provision of a website and email address is also an integral part in the modern world where the use of internet is believed to be far more convenient and efficient as a means of communication (Perko, Module 4)

- The objective will be to primarily understand the problem that the customer is currently facing and recognizing strategies that can help resolve it.

Step 3: Target audience

- The target audience is recognized by the health promotion team e.g. all nosocomial infection prevention tactics will be promoted within the staff of the hospital as opposed to the end consumer (Perko, Module 4)

Step 4: Identify message

- It has to be recognized whether the message is for the health promotion tactics or the disease prevention tactics; this will then determine whether humor, theatrics, direct/indirect communication, etc. must be used (Perko, Module 4)

Step 5: Select Communication channels

- The most effective means of communication is recognized i.e. via telephone, email, marketing, direct face-to-face communication, focus groups, interviews, etc. (Perko, Module 4).

Step 6/7: Create messages/Develop promotion programs

- The messages and development programs are created and implemented with the help of professional marketing or advertising companies (Perko, Module 4)

Step 8: Implement communication strategies

- This is done primarily following the internal organizational structure of the hospital (discussed late in question 6 under health communication) (Perko, Module 4)

Step 9/10: Assess Effects/Feedback

- This is a long-term monitoring process of the management whereby statistical, qualitative and quantitative data and facts are collected to ensure the success or failure of a promotion strategy employed (Perko, Module 4)

3. Discuss three examples of health promotion techniques that can effectively achieve environmental change.

Ethical awareness towards the environment

The foundation of all ethical analysis, in all fields, is based around the ethical theories and principles that have been established and standardized over the years. This is so because these theories and principles form the guiding points from which the right method for a critical environmental decision can be obtained. It is important to note here that every ethical theory and principle is focused on foreseeing or suggesting a certain aspect of life which could vary from predicting the result of decision as well as the results of following certain rules upon one's social or health life. Nevertheless, all ethical theories and principles are useful in different scenarios only when they are structured around the attainment of common environmental aims.

Maintaining ethical standards in the healthcare planning and decision making structure is a complex process especially when environmental concerns are also simultaneously tackled (Eddy, Module 5). Nonetheless, hospitals tend to consider only the macro aspects when doing so. They do not inspect the needs of the environment at the micro level and hence many of them don't use the resources for 'green' equipment. This has implications on the patients as well as their own performance as there is a decline in quality, perceptions and also outcomes in reduced employee retention (Maly and Anderson, 2008). Adair and Thomas (2004) assert that top management is not aware of changes in healthcare team characteristics of the hospital they have chosen when the ethical standards are not met, which gravely hinders in creating ethically sound health promotion and disease prevention processes (Adair and Thomas, 2004; also see Eddy, Module 5).

Services

The service of good healthcare is essential to the society due to two major causes; reprieve from diseases and improved healthcare facilities for humans. Nonetheless, the healthcare system has been undergoing some extreme difficulties from the very beginning of the 1990s. Speedy progress towards a technique of controlled healthcare and incorporated delivery systems has led the healthcare suppliers to identify the existence of a contest and competitive surge. It's possible to only subsist in this competitive environment when the healthcare provided is beyond the customer's demands and expectations. To be able to provide economical and environmentally friendly healthcare to the clients, the hospitals have to study the major facets of service quality. Hence the recognition of 'green' service quality provision is one aspect that can not only help the hospital improve its overall services structure but also simultaneously decrease the overall competition because of their environmental friendly approach (Eddy, Module 5).

Advertising

Healthcare has been observed in many ways in the elements of traditional healthcare research. Quality can be as the ability to reach the wanted goals by fair means only. If we view it from the different perspective the increase in environmental awareness when providing healthcare services can lead to increases in patronage, long-term profitability and competitive advantage (Eddy, Module 5).

The secrets to success within this structure are:

1. Marketing: to employ a way to market both straight to companies and simultaneously use the services of autonomous insurance advisers and stockbrokers to promote that the hospitals use environmental friendly tools and exercise ethical standards that help sustain the environmental structure. It will then be essential to develop tactics that establish brand recognition among more recognized and penetrated insurance plans available (Eddy, Module 5).

2. Product quality: The help supplied by medical insurers could prove to be top-notch when establishing strong penetration within the domain of 'green' companies. The value added connection with the hospitals' employees and its provider service systems will make sure that they are able to attain and sustain client satisfaction over a period of time. To retain client satisfaction, the following tactics could be employed:

I. Reduce consumer erosion by controlling the overall rate and speed of growth

II. Counter competitive insurance plans by consistently monitoring and/or refining the market expansion strategies and use of media services to promote the 'environmentally friendly' stance (Eddy, Module 5)

4. Discuss the Health Risk Assessment (HRA) process and explain how HRA's can be used both as a health promotion technique and as a data collection instrument.

The quality of service is the most significant variable correlated to all healthcare structures whether these structures are for the hospitals, elderly care, child care, etc. (Mills, 2005). The casual association between these two variables is such that if the overall quality of service improves on the basis of healthcare provider's ability, technological advancements, products' use, etc.; the overall impact on the healthcare structure will be immensely constructive and the risks will simultaneously decrease as well (Fitzhugh, Module 5b). Some of the factors that should be considered when assessing causality between these two variables can include: risk evaluations, behavioral changes, evolution of diets, psychological consistencies, social encouragement structure like family assistance, financial aid, etc. (Mills, 2005).

The diagram below shows how the quality of healthcare service influences the health risk assessment structures. The factors directly influenced by the former (services) variable are represented in the green circles i.e. they have a casual association with the former variable and the circles with the green outline are the ones who share a compounding relation with the former variable. The orange circles represent the variables that share a casual relationship with the latter (risk) variable and a compounding relationship with the former variable. The circle in the orange outline shares a compounding association with both the former (risk) and the latter (services) variable.

Quality of Healthcare Service

Health Risk Assessment

Behavioural Changes

Capability of Staff

Staff

Motivation

Risk Evaluations

Packages provided to Workforce

Social Structure and Consistency

Long-term Job security and consistency

Psychological consistencies

Counseling

Convinced by prior research, many counseling sessions given in the school will also emphasize upon the positive presence of parental support and guidance. Furthermore, it will offer different opportunities for depressed students to interact with their parents in specialized or normal settings to discuss their problems and for parents to openly and effectively communicate with their family members. Parents, through these interactions, will become more aware of what type of depression afflicts their child, the nature of the disorder and the ways through which parents can be of help in the remedial process of the child in order to increase their academic performance (Kramlinger, 2002). The timeline for this will not be restricted and the mechanism needed for this will be the presence and input of a professional counselor.

Therapeutic help for the entire family

Another way of dealing with a student's decreased student achievement is arranging a family therapy session where a professional therapist talks to the parents of the student along with the student suffering from academic depression or lowered performance at the same time. Varying needs and circumstances may cause the therapist to see other family members as well, such as siblings, grandparents, other members in the immediate family or even friends (Reinecke and Davison, 2002).

Such kind of therapy will aim to help build upon the different relationships in the family as problems, issues and concerns are discussed and resolved candidly under the advice of an independent and professional counselor or therapist. A high level of emphasis will be laid on communicating effectively that, in the future, will assist the family in understanding other family members and their needs in a better way. As different emotional concerns and experiences will be discussed, parents may find themselves better able to solve the academic or depression-related problems of their children without the therapy (Reinecke and Davison, 2002). Again, the timeline for this will not be restricted and the mechanism needed for this will be the presence and input of a professional counselor (Simons, Module 2).

However, it is important to note here that it is not always easy trying to convince some people to undertake a family therapy as they may not want to discuss their problems or they may be afraid of being blamed about something and may not share such a level of understanding and trust with the parents, as may be required for an open and candid discussion in front of a third person. Other inhibitions may include the fear of confiding in somebody, confusion about one's problems or fear of being labeled (Reinecke and Davison, 2002). Hence, it will be an important for the counselor to also be trained in the art of persuasion so as to encourage participation. Another important persuasive tactic could be to provide the family with long-term motivations to partake in the family therapy e.g. career advice, private sessions, confidentiality, peripheral professional financial/social advice, etc. (Simons, Module 2).

Health communication

"Directing" is by far the most close-structured format of the health communication as the leaders always give specific instructions, the followers or team members have only specific tasks to fill from which they cannot deviate. The biggest con for this format is that the communication s always top-down and one way. The pro, however, is that it allows the company to work under a very clear-cut structure and there is rarely any confusion with regards to workload and liability. This format is very common in traditional or family businesses where the overall format is very rigid and the head of the family who is also the head of the company has all the control and rarely ever seeks to modernize with time (Hersey and Blanchard, 1969a; b).

In "Coaching," the biggest difference from the "directing" format is that the team members or followers have the liberty to share their ideas and compulsions with the leader and other members which make the communication model a lot more effective and useful as the communication runs both ways. The pro-here is that everyone feels like they are a part of the organization and the job satisfaction levels are high, the con is that mostly the suggestions taken in by the employees are not applied which can be taken very negatively in the long-run. This format is usually present in the transitional companies i.e. The companies that are running family businesses but are moving towards modification with modern techniques (Hersey and Blanchard, 1969a; b).

In "Supporting," the overall task of the leader is based around delegation of tasks ad regular monitoring while the team members control what they each contribute. This is the format that is most commonly present globally. The pro-here is that all team members are highly sufficient and informed about their tasks, which takes the pressure off of the leader. In "Delegating," most of the control lies with the team members. which is why the biggest pro-here is the high level of job satisfaction amongst employees, and the leader is only involved in the overall decision making when the team members feels its necessary. However, the con here is big as the surrendering of overall control from the leader to the team members can result in high personality clashes, diversion from primary objectives, creation of personal objectives, etc. (Hersey and Blanchard, 1969a; b).

The overall use of technology advancements within the health communication model can only be helpful as healthcare leaders can use the advanced technology to gather better and more detailed data on market trends and situations that form the basis of their overall structure. Hence, once the data quality improves the overall services and provision of consumer and global needs would be more efficiently fulfilled. The ethical concern here however is that mostly data collection on such a large expanse can lead to privacy and confidentiality issues along with the issues of copyright which the hospital must protect itself against by following ethical means of data collection. If the overall ethical issues are handled correctly, then the overall application of the health communication leadership style will prove to be far more versatile than any other style as it will allow the leaders the liberty to not only choose their management structure but also allow them to modify it when the need arises or the situation demands it (Hersey and Blanchard, 1969a; b; 1977).

Nutrition

The educational policymakers acknowledge that educational institutions have an important part to place in fostering the wellness of their pupils, in deterring adolescent obesity and in dealing with issues that are related to weak diets and lack of adequate physical activity among the students (USDHSS, 1996; Agron et al., 2010). The policy of increased physical activity and proper diet structures thus could incorporate:

1- Diet recommendations and guidelines for all the food present in the institution

2- The objective of providing diet-based information, exercise and other such activities (Simons, Module 2)

3- Assertion that the district's policies for reimbursable lunch not be less constraint than federal policies

4- An outline for gauging the application of well-being regulations (Agron et al., 2010).

Inadequate nutritional or dietary strategies along with training materials may be partly to blame for the knowledge deficit about proper nutrition and exercise, as many families find it challenging to engage in a learning process that lacks creativity and originality (Forshaw, 2009). Because perceptions, attitudes, and habits formed during the preschool years and the culture thereof, school nurses and educators must try innovative instructional strategies of health and wellness education approaches to point the young children as well as their family toward a healthy lifestyle. Hence, adequate planning, instruction, and evaluation are vital in creatively seeking to educate the young children and their families about nutrition and exercise primarily from the school nurses and therapists (Perkins, 2009).

Proper nutrition and adequate physical activity are vital for the growth and development of the children and for the establishment of a healthy lifestyle that prevents future obesity (USDHHS, 1996). The teenage school years present optimal times to not only help establish healthy lifestyle patterns for the child and her family but also to influence family meal planning in the home (USDHHS, 1996). The training materials given by the nurses to the family will thus need to be evaluated by assessing the knowledge, attitudes and behaviors of the children and their parents initially regarding fundamental concepts of health and wellness (Simons, Module 2).

7. Discuss the role and rationale for using creativity, theatrics and humor when selecting health promotion techniques

The healthcare marketing has gone through noteworthy transformations during the last decade. The overall industry in general has witnessed monumental consolidation. The consolidation has happened mainly for hospitals to stay lucrative despite major boosts in healthcare expenses. One other way the industry has worked with or tackled the increasing expenses continues to be elevated adoption from the realm of managed or handled care promotion techniques that incorporate humor. Managed or handled care was particularly designed in an effort to provide a foundation base of healthcare insurance programs and keep the overall expenses within the limits required (Potuck, Module 3a) and once this started using humor in its promotion techniques the overall impact was such that the healthcare insurance programs became more accessible to the lay man. This is perhaps the biggest advantage that they healthcare has had since the inclusion of humor in its promotion as the lay man is able to understand the message being transferred and the biggest pro-here is that it does not cost the hospital any additional finances to include humor in the promotion (Potuck, Module, 3a).

Irrespective of how the healthcare industry domain has transformed and attempted to consider the adaptation of humor strategies that helped tackled significant boosts in promotion, it is still an alarming fact that more and more Americans do not have health. In fact, most of the Americans that have healthcare insurance have experienced their insurance plan treatment or program minimize in services in the long run (Potuck, Module, 3a).

The diffusion and penetration of theatrics within the promotion of health differs from the use of humor based on the kind of tool used and the ways that these tools are used. The theatrics penetration and diffusion is perhaps most prevalent within the promotional techniques today due to the overall presence of numerous medical serials that add drama to the normal medical processes (Potuck, Module, 3b). Numerous clinical structures are also more efficiently depicted with the implementation of theatrics as opposed to humor.

8. Discuss 3 health promotion techniques that health teachers / educators can use to help design and implement effective intervention strategies.

Use of IT Mechanisms

"Information technology (IT) has the potential to improve the quality, safety, and efficiency of health care. Diffusion of IT in health care is generally low (varying, however, with the application and setting) but surveys indicate that providers plan to increase their investments. Drivers of investment in IT include the promise of quality and efficiency gains. Barriers include the cost and complexity of IT implementation, which often necessitates significant work process and cultural changes. Certain characteristics of the health care market -- including payment policies that reward volume rather than quality, and a fragmented delivery system -- can also pose barriers to IT adoption. Given IT's potential, both the private and public sectors have engaged in numerous efforts to promote its use within and across health care settings. Additional steps could include financial incentives (e.g., payment policy or loans) and expanded efforts to standardize records formats, nomenclature, and communication protocols to enhance interoperability. However, any policy to stimulate further investment must be carefully considered because of the possibility of unintended consequences" (Medpac, 2004).

By offering fresh IT techniques and methods for healthcare providers and the healthcare services recipients to willingly access and utilize all relevant health data, IT increases the probability of improved healthcare value, protection, efficiency and competence. On the other hand, comparatively a small number of healthcare providers have completely implemented the modern IT structures and techniques. This minimal level of penetration of IT techniques in healthcare is partially a result of the intricate IT investment structures that expand beyond mere adaptation of technology but require alterations in the established work structures and increased responsibility for the healthcare staff working in the healthcare institutions (Medpac, 2004; Graham et al., 2010).

Promotion techniques

In some cases, the following aspects have been implemented to encourage increased IT investment in the healthcare structure:

- Alterations to the payment strategies and procedures, or simplifying them

- Constructing and institution of grants and funds, as well as

- Adopt necessary changes to implement specified technological structures and techniques (Medpac, 2004; Graham et al., 2010)

Implementation of IT training

Currently, the pattern is such that the healthcare structures and institutions usually utilize far less IT adaptation models than any of the other industries in the world. However, numerous studies have conducted surveys that illustrate that healthcare service providers are escalating their investments in the IT sector by initiating better education of IT amongst the employees. The amount of IT and the categories of IT structured or arranged contrast by locations as well as the structure of the institution. The frequency of IT in any situation mainly replicates the advantages and strong points of the motivators and de-motivators to investment in the IT structure. For many healthcare service providers and institutions, superiority and practice developments are the main drivers to adoption of IT structures. For many other industries the primary motivation for It investment is monetary gain and increased production efficiency which is why we see most IT structures have that element predominate all the obvious benefits. Nevertheless, the expenditure and the intricacy of IT performance, counting the essential managerial and workflow re-modeling requirements, create substantial barriers, as does doubt concerning the constancy and efficiency of the input of the IT industry in all other spheres but especially the healthcare domain (Medpac, 2004; Graham et al., 2010).

Promotion techniques

There have been numerous efforts made by both the private as well as the public investors and sectors in order to encourage IT investments across the healthcare industry as well as healthcare service providers (Medpac, 2004; Graham et al., 2010). Some of the recent healthcare promotion efforts seen to encourage investment include the following:

- Improving, designing and encouraging industry-wide principles and regulations for investment and implementation;

- Providing financial support for any and all research activities aimed to study the influence that IT has on healthcare value and quality;

- Giving the necessary motivations to increase interest in IT and IT investment;

- Offering the service of financial grants to the investors; as well as

- Designing the necessary policies and strategies that will enhance the accessibility and transference of knowledge amid, between and across service providers, recipients and investors (Medpac, 2004; Graham et al., 2010)

Communication between healthcare investors, recipients and providers

"Any policy to stimulate further investment must be carefully considered because of possible unintended consequences -- such as implementation failures due to organizations' inability to make the necessary cultural changes" (Medpac, 2004).

The aim for all healthcare providers is simply this: providing top-notch and high- quality healthcare services. For this purpose, it is necessary that the healthcare providers, investors and recipients see eye-to-eye on the intricate and integral issues by gathering all relevant information from different authentic sources. Once, the overall structure provides a common ground for both healthcare providers, the result will include the following aspects (Medpac, 2004; Graham et al., 2010):

- Increased capability of the healthcare providers

- Easier access for healthcare providers and recipients to the relevant knowledge databases

- Recognition of right to exercise and demand enhanced care

- Improved communication between patient and doctor

- Improved knowledge of the patients enables them to better take care of themselves and their medical condition

- Improved efficiency and quality of healthcare (Medpac, 2004; Graham et al., 2010).