CHAPTER 16: HEALTH PROMOTION  HOMEOSTASIS- tendency of the

body to maintain a state of balance

HEALTH PROMOTION – a way thinking while continually changing
that revolves around a philosophy of
wholeness, wellness and well-being. PHYSIOLOGICAL HOMEOSTASIS

INDIVIDUAL HEALTH  Homeostasis mechanisms have 4

Dimensions of individuality include: main characteristics
1. Self-regulation
 Persons total character -homeostatic mechanisms
encompasses: come into play automatically
-behaviors, emotional state, in the healthy person
attitudes, values, motives, abilities, 2. Compensatory
habits and appearances - homeostatic mechanisms
 Persons self-identity counteract the conditions
encompasses: abnormal for the person
-perception of self as a separate and 3. Tend to regulated by
distinct entity alone and in negative feedback
interaction with others 4. May require several
 Persons perception encompass: feedback mechanisms to
-the way the person interprets the correct only one
environment or situation physiological imbalance
-directly affecting how he she  Homeostasis occurs within the
thinks,feels,and acts in a given physiological system
situation  SYSTEM
CONCEPT OF INDIVIDUALITY - A set of interacting
-To help clients attain, maintain or regain identifiable parts or
and optimal level of health nurses need to components
understand clients as an individual  BOUNDARY
- A real or imaginary line
-When providing care nurses need to that differentiates one
focus on the client both a… system from another
 2 General types of systems
 Total care context 1. Closed system
-considers all the principle and areas -not exchange energy,
that apply when taking care of any matter, information with
client of that age and condition environment
 Individualized care context - receives no input
-using total care principles that apply -gives no output
to this person at this time 2. Open system
- Energy matter and
CONCEPT OF HOLISM
information move into
-emphasizes that nurses must keep the
and out of the system
whole person in mind and strive to
through the systems
understand how one area of concern
boundary.
relates to whole person
- All living systems
CONCEPT OF HOMEOSTASIS  An open system depends on the
quality and quantity of its
 INTRODUCED BY: Cannon  INPUT
-to describe the relative constancy of -information, material or
the internal pressure of the energy that enters the
body system
 EQUILIBRIUM- balance  THROUGHPUT
 -processed to a way useful to
the system
 FEEDBACK
-some of the output of the
system is returned to the
system as an input
-enables system to regulate
itself by redirecting the output
back into the system
 NEGATIVE FEEDBACK
-Inhibits change
 POSITIVE FEEDBACK
-Stimulates change
PSYCHOLOGICAL HOMEOSTASIS
- a state of mental well-being
-need for love, security, and self-esteem,
which must be met to maintain
psychological homeostasis
-when not met, certain coping mechanisms
are activated to protect the person and
provide psychological homeostasis.
-acquired or learned through the
experience of living and interacting with
others
 prerequisites for a person to
develop psychological
homeostasis can be summarized
as follows:
 stable physical
environment in which the
person feels safe and secure
 stable psychological
environment from infancy
onward, so that feelings of
trust and love develop.
 A social environment that
includes adults who are
healthy role models
 A life experience that
provides satisfactions
ASSESING THE HEALTH OF
INDIVIDUALS
 COMPONENTS
-health history
-physical examination
-physical fitness assessment
-lifestyle assessment
-health risk appraisal
-health beliefs review
-life stress review
APPLYING THEORETICAL
FRAMEWORKS
 Two major theoretical frameworks
that nurses use in promoting the
health of the individual:
1. NEED THEORIES
-human needs are ranked on an
ascending scale according to how
essential the needs are for survival
-Most renowned need theorist:
ABRAHAM MASLOW
KALISH HIERARCHY
NEEDS
STIMULATION NEEDS,
includes sex, activity,
exploration, manipulation,
and novelty
CHARACTERISTICS OF BASIC NEEDS
 People meet their own needs
relative to their own priorities
 Although basic needs generally must
be met, some needs can be
deferred.
 Failure to meet needs results in one
or more homeostatic imbalances,
which can eventually result in illness.
 A need can make itself felt by either
external or internal stimuli.
 A person who perceives a need can
respond in several ways to meet
it.
 Needs are interrelated
2.DEVELOPMENTAL STAGE THEORIES
- Categorize a person’s behaviors or tasks
into approximate age ranges or in terms that
describe the features of an age group
DEFINING HEALTH PROMOTION
 Edelman and Mandle (2010) state
that “PREVENTION, in a narrow
sense, means avoiding the
development of disease in the
 future, and, in the broader sense,
consists of all interventions to limit
progression of a disease”
 Leavell and Clark (1965) defined
three levels of prevention:
1. Primary prevention
PURPOSE: to decrease the risk
or exposure to disease
-health promotion
-protection against spec. health
problems
2. Secondary prevention
GOAL: -identify individuals in an
early stage of a disease process
-to limit future disability
-early identification of health
problems
- prompt intervention to alleviate
health problems
3. Tertiary prevention
FOCUSES: restoration and
rehabilitation
GOAL: returning the individual to
an optimal level of functioning
HEALTH PROMOTION as behavior
motivated by the desire to increase well-
being and actualize human health potential
DISEASE PREVENTION OR HEALTH
PROTECTION as behavior motivated by a
desire to actively avoid illness, detect it
early, or maintain functioning within the
constraints of illness
SITES FOR HEALTH PROMOTION
ACTIVITIES
Health promotion programs exist in many
settings. Programs and activities may be
offered to individuals and families in the
home or in the community setting and at
schools, hospitals, or worksites.
-individuals may feel more comfortable
having a nurse, diet counselor, or fitness
expert come to their home for teaching and
follow-up on individual needs. not cost
effective for most individuals.
-group approach, find it more motivating,
HEALTH PROMOTION MODEL
competence- or approach-oriented model in
which the motivational source for behavior
change is based on the individual’s
subjective value of the change—that is, how
the client perceives the benefits of changing
the given health behavior
BEHAVIOR SPECIFIC COGNITIONS AND
AFFECT
 Perceived benefits of action
- Prior positive experience-
motivational factor.
 Perceived barriers to action
- decreasing the individual’s
commitment to a plan of action
 Perceived self-efficacy
- serious doubts, decrease their
efforts and give up
- strong sense of efficacy, exert
greater effort to master problems or
challenges
 Activity-related affect
- positive affect, repeated
- negative affect , avoided.
 Interpersonal influences
- concerning the behaviors, beliefs,
or attitudes of others
 Situational influences
- direct and indirect
- more apt to perform health
promotion behaviors - comfortable in
the environment
COMMITMENT TO A PLAN OFACTION
 TWO PROCESSES:
1. Commitment
2. Identifying specific strategies
for carrying out and
reinforcing the behaviors
 commitment alone -“good
intentions” - not actual performance
IMMEDIATE COMPETING DEMANDS
AND PREFERENCES
 Competing demands
 - low level of control
 Competing preferences
- high level of control
- depends on the individual’s ability
to be self-regulating
BEHAVIORAL OUTCOME
- directed toward attaining positive health
outcomes for the client.
- result in improved health, enhanced
functional ability, and better quality of life
STAGES OF HEALTH BEHAVIOR
CHANGE
The Transtheoretical Model (TTM)
1. PRECONTEMPLATION STAGE
- Not think about changing (next 6
months)
- uninformed or underinformed about
the consequences
- tend to avoid reading, talking, or
thinking about their high-risk
behaviors
2. CONTEMPLATION STAGE
- acknowledges having a problem
- considers changing
- Actively gathers information
- verbalizes plans to change
- may not be ready to commit to
action
3. PREPARATION STAGE
- intends to take action in the
immediate future
- may have already started making
small behavioral changes
- makes the final specific plans to
accomplish the change.
4. ACTION STAGE
- person actively implements-
interrupt previous health risk
behaviors and adopt new ones
- requires greatest commitment of
time and energy.
5. MAINTENANCE STAGE
- strives to prevent relapse-
integrating newly adopted behaviors
into his or her lifestyle
- no longer experiences temptation
- 6 months to 5 years
6. TERMINATION STAGE
- ultimate goal
- individual has complete confidence
- problem is no longer a temptation
or threat
THE NURSE’S ROLE IN HEALTH
PROMOTION
A variety of programs can be used for
the promotion of health
 Information dissemination
- most basic type of health
promotion program
- use of a variety of media
- consider factors such as cultural
factors and different age groups
-Knowing the best place and method
to distribute information- increase
the effectiveness
 Health risk appraisals and
wellness assessment programs
- explain to individuals the risk
factors
- motivate them to reduce specific
risks and develop positive health
habits
 Lifestyle and behavior change
programs
- require participation of the
individual
- geared toward enhancing the
quality of life and extending the life
span
 Environmental control programs
- response to the continuing
increase of contaminants
 Health promotion activities
- involve collaborative relationships
with both clients and primary care
providers.
THE NURSING PROCESS AND HEALTH
PROMOTION
NURSING MANAGEMENT
 ASSESING
COMPONENTS
1. Health History and Physical
Examination
- detecting any existing problems
- age of the individual must be
considered
2. Physical Fitness Assessment
- assesses several components
of the body’s physical
functioning: muscle endurance,
 flexibility, body composition, and
cardiorespiratory endurance
3. Lifestyle Assessment
- personal lifestyle and habits of
the client as they affect health
- The goals of lifestyle
assessment tools are to
provide the following: 1 .An
opportunity for clients to assess
the impact of their present
lifestyle on their health
2. A basis for decisions related to
desired behavior and lifestyle
changes
4. Spiritual Health Assessment
- ability to develop one’s inner
nature to its fullest potential
5. Social Support Systems
Review
- fosters successful coping
-promotes satisfying and
effective living
- allows the nurse and client to
discuss and evaluate the
adequacy of the client’s support
system together and, if
necessary, plan options for
enhancing the support system
6. Health Risk Assessment
- Assessment and educational
tool
- indicates a client’s risk for
disease or injury
-Includes a summary of the
person’s health risks and lifestyle
behaviors with educational
suggestions on how to reduce
the risk.
- as a means to begin a health
promotion and risk reduction
program
- helpful for assessing individual
and group health risks.
7. Health Beliefs Review
- need to be clarified
- Locus of control is a
measurable concept that can be
used to predict which people are
most likely to change their
behavior
8. Life-Stress Review
 VALIDATING ASSESMENT DATA
- nurse and client- review, validate,
and summarize the information
-nurse, verbally reviews the current
practices and attitudes of the client
-client, validation, increase
awareness of the need to change
The nurse and client need to
consider the following:
• Any existing health problems
• The client’s perceived degree of
control over health status
• Key health beliefs
• Level of physical fitness and
nutritional status
• Illnesses for which the client is at
risk • Current positive health
practices
• Spirituality
• Sources of life stress and ability to
handle stress
• Social support systems
• Information needed to enhance
health care practices
• Client strengths
 DIAGNOSING
- health promotion domain,the
awareness of well-being or normality
of function and the strategies used
to maintain control of and enhance
that well-being or normality of
function”
-preceded by the modifier “readiness
for enhanced.
- provide a clear focus for planning
interventions without indicating that
a problem exists
 PLANNING
- Health promotion plans, according
to the needs, desires, and priorities
of the client
- client decides- health promotion
goals, the activities or
interventions to achieve those
goals, frequency and duration of
the activities, and the method of
evaluation
-nurse, provides information,
emphasizes the importance, and
reviews the client’s goals and plans
to make sure they are realistic,
measurable, and acceptable to the
client
 STEPS IN PLANNING
1. Review and summarize data
from assessment
 -nurse shares summary of data
collected
2. Reinforce strengths and
competencies of the client
-areas-doing well-need further
development
3. Identify health goals and
related behavior-change
options
-client selects top priority
4. Identify behavioral or health
outcomes.
- specific behavioral changes -
needed to bring about the
desired outcome.
5. Develop a behavior-change
plan
-selecting behavioral options that
are most appealing and that they
are most willing to try
6. Reiterate benefits of change
-positive benefit-need to be
reiterated
-he health-related and non–
health-related benefits -central
motivating factors.
7. Address environmental and
interpersonal facilitators and
barriers to change
-Environmental and interpersonal
factors that support positive
change should be used to
reinforce the client’s efforts to
change lifestyle
8. Determine a time frame for
implementation
-Appropriate knowledge and
skills can be developed before a
new behavior is implemented.
The time frame may be several
weeks or months.
-can offer encouragement to
achieve long-term objectives
9. Formalize commitment to
behavior-change plan
-usually verbal
-formal, written behavioral
contract is being used to
motivate the client to follow
through with selected
actions
 EXPLORING AVAILABLE
SOURCES
-essential aspect of planning is
identifying support resources
available to the client. (fitness
program at a local gymnasium, or
educational programs)
 IMPLEMENTING
-“doing” part of behavior change
 PROVIDING AND FACILITATING
SUPPORT
-vital component of lifestyle change
is ongoing support that focuses on
the desired behavior change and is
provided in a nonjudgmental
manner.
 INDIVIDUAL COUNSELING
SESSIONS
 TELEPHONE OR INTERNET
COUNSELING
-efficient for the busy client who may
not have the time for in-person
sessions
 GROUP SUPPORT
-learn the experiences of others in
changing behavior
 FACILITATING SOCIAL SUPPORT
-such as family and friends, can
facilitate or impede the efforts
directed toward health promotion
and prevention
 PROVIDING HEALTH EDUCATION
 ENHANCING BEHAVIORAL
CHANGE
 MODELING
-Through observing a model, the
client acquires ideas for behavior
and coping strategies that can be
used with specific problems.
 EVALUATING
-ongoing basis, both during the
attainment of short-term goals and
after the completion of long-term
goals.
-client may decide to continue with
the plan, reorder priorities, change
strategies, or revise the health
promotion-prevention contract
CHAPTER 17: HEALTH,WELLNESS AND
ILLNESS

CONCEPT OF HEALTH, WELLNESS AND

WELL BEING

HEALTH

-defined in terms of the presence or absence of

disease.

 FLORENCE NIGHTINGALE
-state of being well and using every
power the individual possesses to the
fullest extent.
 WHO
-a state of complete physical, mental,
and social well-being, and not merely
the absence of disease or infirmity.”
 TALCOTT PARSONS