Heart Health - LPNI

February is Heart Month in America.  For Christians world-wide it serves as a reminder to care for the body that God has given us.  Research confirms that 80 per cent of all heart attacks and strokes could be prevented if individuals did five things: ate a healthier diet, increased physical activity, quit smoking, managed a healthier weight and controlled blood pressure, glucose and cholesterol.  Lifestyle choices play a large role in this endeavor.  However, changing harmful behavior is extremely difficult!  The parish nurse plays a vital role in helping members live a healthier life.

Psychologists have added a great deal of understanding regarding behavior change but little of that information reached practitioners on the front lines of the problems.  During the 1950s the polio epidemic was raging.  There was resistance to screening and rampant non-adherence to treatment.  Rosenstock developed the Health Belief Model to better understand the problem.   Unless individuals truly understand the connection between their harmful behavior and the health threat, the likelihood of their taking action is greatly diminished.  Sometimes a trigger may provide the teachable moment that breaks through the denial and stimulates action.  An elevated blood pressure or heart attack in a close relative or friend may serve as the trigger. Individuals may begin to connect the dots between their harmful behavior and the need to take action to reduce their own risk.

Bandura added another dimension to the discussion.  To be successful at behavior change the individual must posses a higher level of self-efficacy or confidence to actually be able to make the change.  If the change is too difficult failure ensues and leads down a path of  discouragement and despair.

Prochaska described five stages that individuals move through on the road to successful behavior change, individuals must possess a higher level of self-efficacy or confidence to actually be able to make the change.   Pre-contemplation (denial), contemplation (weighing the pros verses the cons), preparation (taking small baby steps at changing), action (changing) and maintenance (changed the behavior for at least 6 months).  Interestingly, Prochaska found that only 20 per cent of the population have enough motivation to make a needed change.  Yet, almost all of the lifestyle  prescriptions provided by well meaning healthcare providers target the 20 per cent already taking action.  What should be done with 80 percent of people mired in a non-action stage?

Most recently, Wansink found that success lies in helping people make small, simple changes that fit easily into everyday life, The best diet is the one that you don’t know you’re on.  In his book, Mindless Eating, he encourages individuals to set up their home for success.  Keep unhealthy foods out of the house or out of sight to give one time to think about their choice.  Satisfy a craving with a 100 calorie snack and never eat out of the larger bag.  Use a smaller dinner plate to increase the perception of fullness.

In my work, I encourage individuals to eat regular meals, reduce portions and add a palm size of nuts between meals if needed.  Blood glucose levels are stabilized, cravings are reduced and a healthier weight is maintained.  Finally, for those who don’t like to exercise, a short walk can be hugely beneficial.  Success builds self-efficacy which begets more confidence and greater      success.

Living a healthy life all of the time is unrealistic for most of us.  For all have sinned and fall short of the glory of God.  (Romans 3:23) However, parish nurses remain on the front lines of   behavior change when the teachable moment presents.  

So, whether you eat or drink, or whatever you do, do all to the glory of God.  (1 Corinthians 10:31)

Benjamin et al. (2017) Heart disease and stroke statistics—2017 update. Circulation, p. 207.

Rosenstock, I. (1960) What research in motivation suggests for public health. American Journal

     of Public Health, (295-302).

Bandura, A. (1997) Self-efficacy: The Exercise of Control. W. H. Freeman.

Prochaska, J. & Prochaska, M. (2016) Changing to Thrive. Hazelden Publishing.

Wansink, B. (2007) Mindless Eating: Why We Eat More than We Think. Bantam Dell.

Jennie E. Johnson, RN-BC, PhD

Parish Nurse Volunteer

Shepherd of the Hills, Rathdrum, Idaho

8895 West Riverview Drive

Coeur d’ Alene, ID 83814 USA