This Is For A Clinical Client - Drew Case Study - Nursing Assignment Help

Assignment Task

Case Notes
Drew lives with his wife who is particularly active and thinks he should engage in more physical activity. Hence his visit to the clinic. Drew has two children and one grandchild. He hasn’t done much regular exercise since before his kids were born and lacks confidence. He has a family history of cardiovascular disease, but his GP has run tests and isn’t that worried. 

Recommended Program

Strength
I’ve prescribed Drew20 minutes of body weight exercises each day. Then, when he can do 20 minutes non-stop, hehas to extend the session by 5 minutes and continue to do this every time he reaches the time limit without having to take a break1.So as to support Drew’s confidence and make sure he’s executing exercises correctly, I have him practice the movements for each exercise a couple of times before he starts a set2.

Conditioning
I’ve also designed a cardio circuit for Drew to address his family history. Drew struggles to get away from work some afternoons, so I’ve also designed an at-home program for him3. I’ve given Drew a diary to log the number of times he completes his program at home4. 
PLEASE NOTE:
This is for a CLINICAL client therefore the population group is DIFFERENT to the one you have for assessment 2 as you have a HEALTHY client. The recommended BCTs and stats in this example will be different to the ones you will use for assessment 2. The references used in this paper will be different to the ones you have for your assessment given it is a different population group. Do notreference French et al (2014) in your assessments.

Title
Introduction
Thanks for the opportunity to review your program, Michael. It seems like you’ve put a lot of thought into how to motivate Drew and get him exercising regularly. I’ve read your program and have a handful of suggestions based on current, highest-level evidence.
BCT Identification and Critique
In your current program, you have four behaviour change techniques (BCTs). In line with Michie et al.’s (2013), I have identified 8.7 Graded Tasks (1), 8.1 Behavioural Practice/Rehearsal (2), 2.3 Self-Monitoring of Behaviour (3), and 1.2 Problem Solving (4). Based on a meta-analysis of older adults by French et al. (2014), physical activity increases when behavioural practice/rehearsal (present, d = 0.14; not present, d = 0.38; z = 1.66, p<0.05) and self-monitoring of behaviour (present, d = 0.13; not present, d = 0.25; z = 2.00, p<0.05) are not included in programs. As such, I would suggest removing these. French et al. also showed that graded tasks had no effect on physical activity behaviour (present: d = 0.44; not present: d = 0.17; z = 1.20, ns), but it was effective for enhancing confidence (present, d = 0.65; not present, d = 0.31; z = 3.33, p<0.001), which is relevant for Drew. As such, I would retain this BCT. Finally, while problem solving has a positive effect on physical activity behaviour change (present: d = 0.27, not present: d = 0.15; z = 1.88, p<0.05), it has a negative effect of confidence (present: d = 0.27, not present: d = 0.44; z = 3.03, p<0.01). This might be effective later when Drew’s confidence is higher, but I suggest removing it for now.
Recommendations
Again drawing on French et al.’s work, 6.1 Demonstration of the Behaviour is the only BCT that is effective for physical activity behaviour change (present: d = 0.35, not present: d = 0.09; z = 4.24, p<0.001) without compromising self-efficacy (present: d = 0.41, not present: d = 0.33; z = 1.54, ns). I would recommend including this in both your strength and conditioning programs. As suggested, you can retain graded tasks for addressing Drew’s confidence, but you might like to add another BCT to the conditioning section for the same reasons. As work occasionally interrupts Drew’s intentions to exercise, you might consider using motivational interviewing (MI) techniques to explore his motivations and empower him to engage in exercise at time convenient to him. Motivational interviewing (included as part of 3.1 Social Support – Unspecified) has a large positive effect on confidence (present: d = 0.68, not present: d = 0.34; z = 5.05, p<0.001) without compromising physical activity behaviours (present: d = 0.22, not present: d = 0.17; z = 0.80, ns).
Conclusion 
In summary, I wanted to again acknowledge the effort you’re going to support Drew and the thoughtfulness of your program. Applying some of the suggestions above may help you realise your hopes for Drew and have a long-lasting effect on his exercise behaviour change. Good luck.

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