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Mrs A had smoked since she was a teenager, around fourteen years old, both her parents had also smoked as she was growing up. Parental influence could have played a role on Mrs A lifestyle choices due to observing and watching her parents as she grew up. “Parent cigarette smoking has been identified as a significant risk factor for adolescent cigarette smoking” (Bauman, Carver & Gleiter, 2001 as cited by Ashley et al, 2008). It is also suggested that girls are more likely to start smoking due the influence of their parents smoking than boys, showing greater correlation with the mother smoking, (Ashley et al, 2008). The results gathered from Peterson et al, (2006) study suggest that an individual is more probable to smoke at an earlier age if both parents smoke. There is a significant pattern noted between the influence an individual’s parents smoking can have on the risk of the individual beginning. As stated previously, Mrs A smoked from being around fourteen years old. At this point, fourteen was the age in which people normally left school and began to get jobs and work. Smoking was also a huge part of socialising and social interaction. McRobbie, H. & Myers, K. (2011), states that social pressure can be a huge influential factors on lifestyle choices, as people conform to their peers. Also smoking was viewed as a choice not a dependency by society. Karelina, K. & DeVries, A.C., (2011), states that the “social environment” an individual is based in can have a crucial impact and influence on their health. Ash (2016), states that around the nineteen sixties that total number of women that smoked had hit it’s greatest, around forty five in every one hundred women smoked. Mrs A felt very isolated when she was an impatient in hospital.The visiting hours in which friends and family could attend were only for two hours a day in the evening. Mrs A had also been married and lived with her husband for over fifty years and she felt lost and lonely without her husband being with her. They did everything together from cooking and cleaning, to days out and socialising. Mrs A adhered to a very strict routine throughout her week and did not like to be inside or in one specific place. This had a negative effect on Mrs A’s health as she felt trapped and state that she felt like she was ‘in a prison’. Age UK (2017), state that an individual feeling lonely can be linked to a decline or worsening of a person’s health. Mushtaq, R. (2014), also states again that “loneliness” can have a massive effect on the deterioration of an individual’s health and this issue must be tackled in order to prevent further deterioration on a individual’s wellbeing both physically and mentally. There are also many factors that affect an individuals lifestyle choices on a community level. These revolve around things such as the support available, the media and policies and procedures that may affect an individuals choices. Throughout the decades, the media has played a huge role in the health of individuals. This is included from advertisements, campaigns and television shows. Lifestyle choices that can have a huge negative impact on health, have been made to be seen as fashionable or promoted. Action on Smoking and Health (2018), states that are still issues surrounding the way smoking is portrayed by the media which causes worry. However, over the years this has become less prominent and advertisements have been banned promoting certain products and campaigns release to support people to make the healthier choice. This also includes smoking, drinking, exercise and healthy eating. Examples of these include campaigns such as Stoptober, Health Harms and Change4Life. Also, many new policies and procedures have been brought into to help tackle choices that can have a negative impact on an individuals health such as smoking and alcohol. Progression has been made steadily over the years to assist in preventing smoking including tobacco no longer being able to be advertised, increases in taxes and a lot of places becoming “smoke-free” zones, (Peretti-Watel, Halfen, Gremy, 2007). Greger, M. (2016), states that the rising of tax is something that could be seen to make a positive impact on individuals suffering from chronic diseases. Action on Smoking and Health (2018), states that many laws were brought into effect surrounding advertising smoking and tobacco related products. These laws ended with a complete ban on any type of advertisement relating to tobacco and for packs to become debranded in order to appear less appealing to people. The main policy included within this were The Tobacco Advertising And Promotion Act 2002, which then led to further reductions in promotions leaving almost every form of advertising from tobacco companies illegal. Wright, J (2011), states that it was in the early twenty first century that warnings surrounding an individual’s health were placed on packets and the ban of smoking in public places was implemented in 2007.The push for support and services to becoming more available and apparent to individuals has only began in recent years. The support and services that are available now, were not available to patients before which can play a role in impacting their lifestyle choices which affect health. The push for people to stop excess drinking, smoking and eating unhealthy were not addressed as widely as they are now. The help relevant to Mrs A would involve care such as COPD nursing and help to stop smoking. Attar-Zadeh, D. (2016), states that an individual living with COPD first intervention regarding their treatment plan should be to stop smoking. It is also essential with treatment for COPD, that the individual is correctly educated and equipped by the healthcare services to manage their condition. Zakrisson, A. and Hägglund, D. (2010), states that COPD nurses are beneficial to patients, however a way in which they believe this could be improved is to set out further “guidelines” surrounding the education that needs to be received by the patient suffering with COPD. There are many different types of clinical interventions that can be carried out in order to assist individuals with COPD, including the prescribing of oxygen, cognitive behavioural therapy and regular exercise. Ford, S., (2018), states that cognitive behavioural therapy, also known as CBT was shown to make a positive impact on patients anxiety who were suffering from COPD. It was emphasised how these should be “incorporated into routine care pathways”. Also having regular structured contact with COPD nurses and other parts of the multidisciplinary team can have a greater impact on the health of an individual suffering from COPD. Alongside many different therapies and products involved in helping with quitting smoking. This includes over the counter products and prescription products such as patches, inhalers, chewing gum and different therapies and support groups. NHS UK (2018), state that an individual’s chances of quitting are multiplied by four when help is accepted from the NHS. The National Health Service allows people to seek help through personal appointments, online and by telephone. This makes the services available to people of all ages including Mrs A as technology has advanced but not all people have understood this well and it still keeps simple and easy contact methods. The Health Belief model is set up on the belief that individuals are logical in the way they think and perceive things, and will choose the right option to maintain and strengthen their health dependant upon certain principles. These include being able to perceive the negative impact on their health, believing that in undertaking the task their will be a positive outcome and the belief that they have the commitment and are able to undertake the task required, (Changing Works, 2018). The lifestyle factors of Mrs A can be reflected on relating to the health belief model. This is due to Mrs A still smoking over sixty years, regardless of the education she has found out over time and the serious health complication she has had throughout her life including a stroke, hypertension, COPD and a hemorrhage. She has had many health issues as consequence of the negative choices that she has made that has impact her health, regardless of this she has still continued to smoke. There are many influences that have affected Mrs A and her choices such as her family as both parents smoked, her personality, the workplace she had worked in and then became a housewife after having children and many more. There is also the issue of self belief in her own abilities to stop smoking. Mrs A also suggested that her feelings towards smoking was that the damage was already done and felt like stopping now would not affect her lifestyle. This suggests that her actions do not already meet the principles of the health belief model. However, this could improve her engagement with treatment and has shown to do so through her recent admission as with the help of nicotine replacement therapy and the support of peers she has managed to stop smoking for several months. Nurse intervention and leaflets have helped increase Mrs A knowledge and through being able to stop there has been difference in the distance Mrs A can walk and her issue surrounding feeling breathless. Dhariwal, J. et al (2014), states that in patients with COPD stopping smoking is essential as early as possible, however it can still have a huge impacts on symptoms at stages further down the line with COPD. Kara, M., (2007), states the Roper, Logan and Tierney model is a good assessment and guidelines for the treatment of an individual suffering from COPD. In conclusion to this study it shows that lifestyles factors can have a large impact on an individual’s health, however there are also many other factors that can affect an individuals health. Lifestyle factors can include many things which are not always just personal to an individual this includes social groups, community, workplaces and government and healthcare intervention. The impact these lifestyle factors have varies for each individual due to personal differences and the treatment plans required and that are effective differs for each person. Person centered care has a huge impact on an individual’s health as treatments will only be effective if they suit the individual and meet their needs. Also, it shows that over the decades things that are socially acceptable and promoted have changed and laws have been put into place to help tackle these habits. However, in light of Mrs A the media and social groups played a huge role on her health. Each individual perceives good health differently which can affect their belief of how bad their health may possibly be. Mrs A was content with her health and believed she had good health for her age which influences her decisions towards her lifestyle choices.

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