NUR 211

Chapter16
Health Promotion
Dr. Wajed Hatamleh
 Learning Outcomes

1. Explain the relationship of individuality

and holism to nursing practice.
2. List four main characteristics of
homeostatic mechanisms.
3. Identify theoretical frameworks used in
individual health promotion.
4. Identify Maslow’s characteristics of the
self-actualized person.
 Learning Outcomes (cont'd)

5. Describe the vision, mission, and goals of

Healthy People 2020 and the development
process for specific objectives to help
improve the health of a community.
6. Differentiate health promotion from health
protection or illness prevention.
7. Identify various types and sites of health
promotion programs.
 Learning Outcomes

8. Discuss the Health Promotion Model.

9. Explain the stages of health behavior
change.
10.Discuss the nurse’s role in health
promotion.
11.Describe components of health
assessment that pertain to health
promotion.
 Learning Outcomes (cont'd)

12.Discuss nursing diagnosing, planning,

implementing, and evaluating as they
relate to health promotion.
Assessing and Planning Health
Care
• Enhanced when nurses understand:
– Individuality
– Holism
– Homeostasis
– Human needs
 Concept of Individuality

• Each individual is a unique being

• Focus on total care and individualized care
context
• Total care context considers all the
principles that apply when taking care of
any client
Concept of Individuality (cont'd)

• Individualized care context means using

the total care principles that apply to the
person at this time
 Holism

• Concerned with the individual as a whole,

not as an assembly of parts
• Strive to understand how one area of
concern relates to the whole person
• Consider the relationship of individuals to
the environment and to others
• Interventions are directed toward restoring
overall harmony
 Physiological Homeostasis

• Homeostasis is the tendency of the body

to maintain a state of balance or
equilibrium while constantly changing.
Homeostatic mechanisms have four main
characteristics:
• Self-regulatory
• Compensatory
 Psychological Homeostasis

• Emotional or psychological balance or a

state of mental well-being
• A stable physical environment in which the
person feels safe and secure
• A stable psychological environment where
feelings of trust and love are developed
Psychological Homeostasis (cont'd)

• A social environment includes adults who

are healthy role models
• A life experiences the provides
satisfactions
Applying Theoretical Frameworks

A variety of theoretical frameworks provide

the nurse with a holistic overview of health
promotion.
– Needs Theories : Maslow
– Developmental Stage Theories
Figure 16-3 Maslow’s needs.
From Psychology of Human Behavior, 5th ed., by R. A. Kalish, © 1983. Wadsworth, a part of Cengage Learning, Inc.
Reproduced by permission, www.cengage.com/permissions.
 Needs Theories

• Maslow’s five levels of human needs

– Physiological needs
– Safety and security needs
– Love and belonging needs
– Self-esteem needs
– Self-actualization
 Needs Theories
• Developmental stage theories
– Describe typical behaviors within a certain age
group
– Explain the significance of those behaviors
– Predict behaviors that might occur in a given
situation
– Provide rationale to control behavioral
manifestations
– Can be used in parental and client education,
counseling, and anticipatory guidance
 Healthy People 2020

• Belief that individual health is closely

linked to community health and the
reverse
• Partnerships are important to improve
individual and community health
– Business, local government, and civic,
professional, and religious organizations can
all participate
 Box 16-2
Healthy
People
2020
Framework
 Defining Health Promotion

• Three levels of prevention

– Primary focuses on health promotion,
protection against specific health problems
– Secondary focuses on early identification of
health problems, prompt intervention to
alleviate health problems
– Tertiary focuses on restoration and
rehabilitation with the goal of returning the
individual to an optimal level of functioning
 Defining Health Promotion

• Health promotion is behavior motivated by

the desire to increase well-being and
actualize human health potential
• Disease prevention or health protection is
behavior motivated by a desire to actively
avoid illness, detect it early or maintain
functioning with the constraints of illness
Sites for Health Promotion Activities

• Various settings for programs:

– In home
– Community setting
– Schools
– Hospitals
– Worksites
• Identify one health promotion behavior that
you have attempted to change or would
like to change.
• For example, has the student
attempted to change this behavior before?
If so, what happened and how might this
prior attempt at behavior change influence
this attempt to change the behavior?
Health Promotion Model (HPM)

• Competence or approach-oriented model

• Motivational source for behavior changes
based on individual’s subjective value of
the change
 Variables of HPM

• Individual characteristics and experiences

– Personal factors
– Prior related behaviors
 Variables of HPM (cont'd)

• Behavior-specific cognitions and affect

– Perceived benefits of action
– Perceived barriers to action
– Perceived self-efficacy
– Activity-related affect
– Interpersonal influences
– Situational influences
 Variables of HPM (cont'd)

• Commitment to a plan of action

• Immediate competing demands and
preferences
• Behavioral outcome
Figure 16-4 The Health Promotion Model (Revised).
From Health Promotion in Nursing Practice, 6th ed. (p. 45), by N. J. Pender, C. L. Murdaugh, and M. A. Parsons, 2011,
Upper Saddle River, NJ: Prentice Hall. Reprinted with permission.
Figure 16-5 The stages of change are rarely linear. It is
more common for people to recycle several times through
the stages. The person who takes action and has a
relapse (recycles through some or all of the stages again)
is more apt to be successful the next time than the
individual who never takes action.
Diagram based on content from Changing for Good, by J.
O. Prochaska, J. C. Norcross, and C. C. DiClemente,
1994. Copyright by J. O. Prochaska, J. C. Norcross, and
C. C. DiClemente. Reprinted by permission of
HarperCollins Publishers Inc.; and “The Transtheoretical
Model and Stages of Change” by J. O. Prochaska, C. A.
Redding, and K. E. Evers, in Health Behaviors and Health
Education: Theory, Research, and Practice, 3rd ed.,
2009, by K. Glanz, B. K. Rimer, and F. M. Lewis (Eds.).
Copyright © 2009 by Jossey-Bass. Reproduced with
permission from John Wiley & Sons, Inc.
Nurse’s Role in Health Promotion

• Model healthy lifestyle

• Facilitate client involvement
• Teach self-care strategies
• Assist individuals, families, and
communities to increase levels of health
• Educate clients to be effective health care
consumers
Nurse’s Role in Health Promotion
• Assist clients, families, and communities to
develop and choose health-promoting
options
• Guide development in effective problem
solving and decision making
• Reinforce clients’ personal and family health-
promoting behaviors
• Advocate in the community for changes that
promote a healthy environment
 Assessment of Health

• Health history
• Physical examination
• Physical fitness assessment
• Lifestyle assessment
• Spiritual health assessment
 Assessment of Health (cont'd)

• Social support system review

• Health risk assessment
• Health beliefs review
• Life-stress review
 Diagnosing

• Wellness diagnoses can be applied at all

levels of prevention
• Useful for healthy clients who require
teaching for health promotion, disease
prevention, and personal growth
• Provides a clear focus for planning
interventions without indicating a problem
exists
 Planning

• Based on needs, desires, and priorities of

the client
• Client decides on:
– Goals
– Activities or interventions to achieve these
goals
– Frequency and duration of activities
– Method of evaluation
Implementing Health Promotion
Plans
• Involve both the nurse and the client
• Nursing interventions include:
– Review and summarize data from assessment
– Reinforce strengths and competencies
– Identify health goals
– Identify behavioral outcomes
– Develop a behavior-change plan
– Reiterate benefits of change
Implementing Health Promotion
Plans (cont'd)
• Nursing interventions include:
– Address environmental and interpersonal
facilitators and barriers
– Determine a time frame
– Formalize commitment
– Implementing Health Promotion Plans
– Exploring available resources
– Implementing
Implementing Health Promotion
Plans (cont'd)
• Nursing interventions include:
– Providing and facilitating support
– Individual counseling sessions
– Telephone or computer counseling
– Group support
– Facilitating social support
– Providing health education
– Enhancing behavior changes
– Modeling
 Evaluating

• Ongoing
• Client actions may include:
– Continue the plan
– Reorder priorities
– Change strategies
– Revise the contract
• Collaborative effort