Health promotion:
Is the process of enabling people to increase control over and to improve their health
It encompassess health, wellness, disease and illness
Determinants of health:
Broad range of personal, social, economic and environmental factors that determine individual and population health
The main determinants of health include:
Income and social status
Employment and working conditions
Education and literacy
Childhood experiences
Physical environments
Social supports and coping skills
Healthy behaviors
Access to health services
Biology and genetic endowment
Gender
Culture
Race / racism
Population health:
Means health outcomes of a defined group along with the distribution of health outcomes within the group
Levels of prevention:
Primordial:
Before risk factor
Aimed at affecting health before at risk lifestyle behaviors are adopted
Reflects policy level intervention
Examples: healthy eating school based programs, creating bike/walking paths, reduction of sodium in food
Primary:
Interventions / education
The goal is to intervene before the disease process occurs
The focus is to maintain/improve general individual, family and community healthy
Example: administering immunizations
Secondary:
Screening
Focuses on early detection
Example: pap tests
Tertiary:
Focuses on restoration and rehabilitation
Minimize long term sequelae of disease
Restore function; prevent further injury / disease
Example: cardiac rehab about MI
Approaches to health over time:
Medical:
Traditional approach
Health equated with quality of medicine and number of acute care hospitals
Very expensive system
Behavioral approach:
Lalonde
Epp report and ottawa charter
Places responsibility for health on individuals
Social marketing and health education campaigns (anti-smoking campaigns)
Socio Environmental approach:
Social context of health
Social determinants of health
Looks beyond the individual
Recognizes the complexity of health
Lalonde report:
A new perspective on the health of canadians
Response to 3 crises:
Growth in expenditures did not match gains in life expectancy
Sick care expenditures created budget problems
Medicine not successful at curing chronic conditions
Recognized dynamic nature of health
4 key areas:
Human biology
Environment
Lifestyle
Health care organization
Started focusing on lifestyle
Decreasing behavioral risk factors for chronic disease
Entire population rather than individual
Recognized value of research
The epp report:
Achieving health for all: a framework for health promotion
Identified 3 major challenges not met by current health care practice and policies
Disadvantaged groups have lower life expectancy, poorer health, higher disability
Preventable disease continues to harm health of canadians
Chronic diseases/lack of community support
Achieving health for all (epp report):
Three health challenges:
Reducing inequalities
Increasing prevention
Enhancing coping
Three health promotion mechanism:
Self care
Mutual aid
Healthy environments
Three implementation strategies:
Fostering public participation
Strengthening community health services
Coordinating healthy public policy
The ottawa charter:
Identified 5 strategies to achieve health for all by the year 2000:
Strengthen community action
Build health public policy
Create supportive environments
Develop personal skills
Reorient health services
Milestone document in that it places responsibility for health on society as a whole
Enable people to increase control
Key concept: empowerment
Identified prerequisites for health (peace, shelter, income, food)
Viewed health as dynamic and positive having both social and individual dimensions
Health promotion and disease prevention:
Health promotion:
Directed towards increasing the level of well-being
Disease prevention:
Action to avoid illness and disease
Health disparities:
Differences in health status among different population groups
Health inequities:
Differences in health between population groups-defined in social, economic, demographic terms that are unfair and avoidable
Common avoidable and unacceptable disparities:
Lack of health insurance and high healthcare costs
Language barriers
Lack of transportation
Provider-patient communication
Biased clinical decision making
Patient’s mistrust and refusal
Social justice:
Social justice is the equitable, or fair, distribution of society’s benefits, responsibilities and their consequences
It focuses on the relative position of social advantage of one individual or social group in relation to others in society as well as on the root causes of inequalities and what can be done to eliminate them
Major social determinants generating health inequalities in canada:
Income
Housing
Food insecurity
Equality:
The assumption is that everyone benefits from the same supports
This is equal treatment
Equity:
Everyone gets the supports they need
This is the concept of affirmative action
Justice:
The causes of the inequity was addressed
The systemic barrier has been removed
(everyone can see the game without help)
How can nurses provide care to vulnerable populations:
Be comfortable with diversity
Understand client’s beliefs, values, practices
Be aware of barriers
Communication and caring practices
Advocate on behalf of your clients
Not judge or evaluate beliefs in terms of nurse’s own culture
Check your privilege
Strength based nursing
An approach to care - promotes empowerment, self-efficacy and hope
The nurse focuses on inner and outer strengths
Fosters the capacity for health and innate mechanisms of healing
Based on 8 core values:
Health and healthing
Uniqueness
Holism and embodiment
Subjective reality and created meaning
Person and environment are integral
Self-determination
Learning, timing and readiness
Collaborative partnership
Reality inquiry:
Complex interplay of human life, the world and nursing practice
Aimed toward patient-well being, nurse well-being and system well-being
Essential components:
Relational consciousness
Inquiry as a form of action
Five Cs:
Compassionate
Curious
Committed
Competence
Corresponding to ‘what is’
Health belief model:
Developed to explain individual decisions for health screening opportunities
Designed to explain health behavior and health behavior change
Focuses on individual
Framework for motivating people
Negative consequences are the prime motivator
Health promotion model:
Focus is on optimizing wellness versus avoiding disease
Social cognitive theory:
Emphasizes the influence of efficacy beliefs on health behavior
Self-efficacy: individual’s belief in their ability to influence own health
Includes roles of reinforcement and observational learning
Modeling:
Parents model behavior for their child
Success depends on:
Motivation
Client involvement
Identify pre contemplative stage
Social support networks
Obstacles depend on:
Values
Beliefs
Life stressors
Goals
Previous experiences