communication, wellness, competencies
Chapter 8 – Communication
Steps of the Communication Process (Berlo)
Stimulus initiates every interaction.
Sender / Source (Encoder)
Person or group that begins the message formation.
Encodes ideas, feelings, or data into a communicable form.
Message
The content or product generated by the sender.
Can be verbal, non-verbal, written, symbolic, or electronic.
Channels of Communication
Auditory (hearing, spoken words, sounds).
Visual (reading, observing, graphics, charts, body language).
Kinesthetic (touch, procedural demonstration, muscle memory cues).
Receiver (Decoder)
Interprets the message; assigns meaning based on personal variables.
Feedback loop begins here—receiver becomes the new sender.
Feedback (Confirmation)
Response that tells the original sender whether the message was understood.
Can be verbal ("I understand") or non-verbal (nod, action taken).
Components in the Process of Communication
Source ⟷ Message ⟷ Channel ⟷ Receiver.
Two simultaneous message types:
Verbal (words, language choice).
Non-verbal (tone, posture, facial expression, eye contact).
Interpersonal Variables
Education, culture, mood, knowledge level, past experiences.
Environment
Physical surroundings, noise level, temperature, privacy; strongly affects clarity and comfort.
Feedback completes the loop and ensures accuracy.
Forms of Communication
Verbal Communication
Relies on shared understanding of language.
Includes vocabulary, denotation, connotation, pacing, intonation, clarity.
Non-verbal Communication
Facial expressions, gestures, eye contact, touch.
Spatial issues (proxemics): intimate, personal, social, public distances.
Chronemics (time): punctuality, wait time perceptions.
Boundaries: role limits, professional vs. personal.
Body movements, posture, gait: convey confidence, fatigue, pain.
Appearance & grooming: often forms first impression.
Sounds: moaning, crying, gasping, sighing transmit need or emotion.
Communication Technologies
Electronic Communication
Encompasses any digital or telecommunication medium.
Social Media
Benefits: rapid updates, community outreach.
Risks: breaches of confidentiality, blurring of professional boundaries.
Guidelines: ANA and NCSBN provide best-practice standards.
E-mail / Text Messages
Quick, asynchronous; leave permanent record.
Health-care organizations implement encryption, secure servers.
HIPAA: rule still applies.
Telehealth & Telemedicine
Video visits, remote monitoring, telenursing.
Increases access; potential drawbacks: limited assessment cues, tech barriers.
Levels of Communication
Intrapersonal (Self-Talk)
Internal dialogue; influences self-esteem, preparedness.
Example: a nurse reassures herself before public speaking. (NCLEX-style Q#1 correct answer: Intrapersonal.)
Interpersonal
Between two or more people; goal = information exchange.
Includes client-nurse, nurse-physician, peer interactions.
Group Communication
Small-group: 3–10 persons, focused on tasks (e.g., care-plan meeting).
Organizational: large system-wide messages, policy rollouts.
Group Dynamics: cohesion, roles, norms, decision patterns.
Characteristics of Effective vs. Ineffective Groups
Group Identity: clear purpose & name fosters unity.
Cohesiveness: sense of belonging; poor cohesion → fragmentation.
Patterns of Interaction: open, respectful vs. hidden, hostile.
Decision Making: democratic, consensus vs. autocratic, unclear.
Responsibility: shared accountability vs. blame-shifting.
Leadership: facilitative vs. dominating or absent.
Power: equitable distribution vs. power struggles.
Factors Influencing Communication
Developmental Level: age, cognitive stage, language skill.
Sociocultural Differences: cultural norms, eye contact rules, idioms.
Roles & Responsibilities: title influences expectations (e.g., “doctor” vs. “student”).
Space & Territoriality: respecting personal zones prevents anxiety.
Physical, Mental, Emotional State: pain, fatigue, fear, psychosis impede clarity.
Values: deeply held beliefs filter perception.
Environment: noise, temperature, lighting, privacy.
SBAR: Standardized Hand-Off Communication
S: Situation
Identify self, unit, patient, brief issue ("I’m concerned the patient may arrest").
B: Background
Pertinent history, Code status, vitals, mental status, oxygen use, skin.
A: Assessment
Clinician’s conclusion ("likely septic", "unstable") or uncertainty.
R: Recommendation
Actions requested: transfer to ICU, see patient now, order tests (CXR, ABG, EKG, , ), clarify frequency of vitals.
Sets expectation: when to call again if no improvement.
Benefits
Creates concise, predictable flow.
Reduces omission errors during shift changes.
Encourages critical thinking (nurse must form an assessment/recommendation).
The Therapeutic Nurse–Patient Relationship
Purposeful, goal-directed; never spontaneous friendship.
Built on patient’s needs; nurse shares professional info, patient shares personal.
Unequal information sharing—nurse maintains confidentiality & boundaries.
Communication is primary tool to build rapport & trust.
Phases
Orientation
Introductions, roles clarified.
Contract/Agreement: goals, location, frequency, duration.
Working
Implement plan; encourage expression, teach, counsel, collaborate.
Termination
Evaluate goal attainment.
Summarize progress, plan for continuity, closure.
(NCLEX-style Q#3 correct answer: Orientation phase involves establishing the contract.)
Traits of a Therapeutic Relationship
Caring, person-centred, dynamic.
Time-limited; nurse accountable for outcomes.
Goals mutually set per patient priorities (SMART style).
Factors Promoting Effective Communication
Dispositional Traits (personal qualities)
Warmth & Friendliness.
Openness & Respect.
Empathy (vs. sympathy): "walk in their shoes" cognitively & affectively.
Honesty, Authenticity, Trustworthiness.
Caring Attitude.
Competence: sound clinical knowledge increases credibility.
Rapport Builders (environmental/interactional)
Clear Objectives: know why you are interacting.
Comfortable Environment: seating, lighting, minimal noise.
Privacy & Confidentiality assurances.
Patient- vs. Task-Focus: prioritize the person.
Observational Skills: note non-verbal cues, environment.
Optimal Pacing: match speed to patient condition & comprehension.
Communication Skills for Nurses
Conversation Skills
Control tone (calm, non-judgmental).
Be knowledgeable; misinformation erodes trust.
Flexibility: adapt to patient cues.
Clarity & Conciseness; avoid jargon & ambiguous words.
Truthfulness; do not promise what can’t be delivered.
Open-minded; avoid premature conclusions.
Utilize teachable moments.
Listening Skills
Sit at eye level; conveys presence.
Relaxed alert posture; minimize distractions.
Maintain appropriate eye contact; cultural sensitivity.
Stay attentive; do not rehearse your reply.
Note themes, recurring ideas.
Use therapeutic silence, touch, humor judiciously.
Interviewing Techniques
Open-Ended Questions: invite elaboration ("How have you been sleeping?").
Closed Questions: yes/no or specific ("Have you taken your meds today?").
Validating: confirm understanding ("So you take insulin twice daily, correct?").
Clarifying: seek more detail ("What do you mean by ‘dizzy’?").
Reflective: mirror back feelings ("You seem frustrated about the pain levels").
Sequencing: establish chronological order.
Directing: focus or redirect patient to vital topic.
(Quiz Q#4: Open-ended ≠ validating; validating questions confirm data.)
Assertiveness vs. Aggression
Assertive Nurse
Confident posture, steady eye contact.
Uses “I” statements ("I feel concerned when…").
Shares thoughts & emotions appropriately.
Works independently or collaboratively.
Stays calm under stress.
Requests assistance when needed.
Gives & accepts compliments.
Admits mistakes, owns responsibility.
Aggressive Behavior
Rights asserted in negative, violating manner.
Verbal: threats, condescension, angry tone.
Physical: pushing, blocking exit.
Goal: "win" regardless of others.
Damages relationships, teamwork, safety.
Blocks (Barriers) to Communication
Failure to perceive patient as human.
Failure to listen actively.
Non-therapeutic comments & questions:
Clichés ("Everything will be fine").
Closed questions limiting disclosure.
"Why" / "How" questions that feel accusatory.
Probing or prying beyond necessity.
Leading questions pushing an answer.
Giving unsolicited advice ("If I were you …").
Judgmental comments ("That’s irresponsible").
Changing subject abruptly.
False assurance ("Don’t worry" without basis).
Gossip, rumors; erode trust.
Disruptive interpersonal behavior (incivility, bullying).
Disruptive Interpersonal Behavior & Workplace Violence
Incivility: rude or discourteous actions (eye-rolling, sarcasm).
Horizontal/Lateral Violence: peer-to-peer hostility, bullying.
Organizational Responses: zero-tolerance policies, reporting systems, training, counseling.
Verbally & Physically Aggressive Patients
Behaviors: yelling, threats, assault.
Nurse response: remain professional, assert boundaries, ensure safety, engage leadership and security, debrief.
Practice Questions Recap
Q1: Reassuring self → Intrapersonal.
Q2: "Touch means the same to all" → False.
Q3: Orientation phase activity → Contract established.
Q4: Open-ended questions validate? → False; validating questions do.
Real-World Relevance & Ethical Considerations
Clear communication decreases medical errors (e.g., SBAR adoption linked to reduction in sentinel events).
Electronic messaging must balance efficiency with patient privacy (HIPAA compliance; audit trails).
Cultural humility & sensitivity combat implicit bias, improve outcomes for diverse populations.
Addressing disruptive behaviors enhances staff retention and patient safety.
Integration With Previous Learning
Builds on foundational communication theories (Berlo, Peplau).
Reinforces therapeutic use of self from earlier psychosocial nursing modules.
Links to legal/ethical content: confidentiality, informed consent require accurate communication.
Supports QSEN competencies: patient-centered care, teamwork, safety, informatics.
Module 1 – Health, Wellness, Illness & SBAR
Health
Definition (WHO):
“A dynamic state of physical, mental, emotional, spiritual, and social well-being—not merely the absence of disease.”
Key Characteristics
Holistic perspective → multidimensional (body, mind, spirit, social context).
Highly subjective → each person defines health differently based on values, experiences, culture.
Influencing (Determinant) Factors
Genetics / hereditary predispositions.
Lifestyle behaviours (nutrition, exercise, substance use, sleep hygiene).
Environment (physical surroundings, pollutants, housing, climate).
Socio-economic status (income, education, employment, insurance).
Access to health-care services (geographic availability, affordability, acceptability).
Interaction among factors is dynamic; improvements or declines in one dimension shift the overall health state.
Wellness
Definition: A pro-active, self-directed, evolving process of becoming aware of and making choices toward a healthy, fulfilling life.
Six (+2) Common Dimensions
Physical – Balanced nutrition, regular exercise, restorative sleep, preventive screening.
Emotional – Stress management, resilience, coping strategies, emotional intelligence.
Intellectual – Lifelong learning, curiosity, critical thinking, creativity.
Social – Healthy relationships, effective communication, community involvement, belonging.
Spiritual – Meaning, values, purpose, connection to something greater than self.
Occupational – Work satisfaction, work-life balance, professional growth.
Environmental – Safe surroundings, sustainable practices, minimal exposure to hazards.
Nurse’s Role
Model and promote healthy lifestyles.
Educate clients on self-care, risk reduction, and preventive strategies.
Facilitate goal-setting; encourage personal responsibility and empowerment.
Health Promotion & Prevention
Three Classic Levels
Primary Prevention – Interventions before illness occurs.
Vaccinations, dietary education, smoking cessation programs, safety legislation (seat belts).
Secondary Prevention – Early detection & prompt intervention.
Screening tests (mammography, BP checks), focused assessments, treating asymptomatic disease early.
Tertiary Prevention – Minimise complications of chronic illness and rehabilitate.
Cardiac rehabilitation, physical therapy, medication adherence programs, support groups.
Ethical / Practical Significance
Cost-effective to invest upstream (primary) rather than downstream (tertiary).
Requires inter-professional collaboration and community resources.
Health–Illness Continuum
Conceptual Model: Health is a spectrum rather than a binary state.
Individuals continually move back and forth on the continuum due to life events, acute illness, chronic management, lifestyle changes.
Clinical Implication: Assess where the patient is today, not just diagnose the disease; set goals to shift toward wellness.
Cultural & Individual Perspectives
Health beliefs, practices, and meanings vary across cultures, religions, age groups, and personal experiences.
Cultural competence = Respect, awareness, and skills to deliver patient-centred care across cultural boundaries.
Ask open-ended questions about traditional remedies, dietary rules, decision-making hierarchy.
Avoid stereotyping; focus on individualized assessment.
SBAR – Structured Communication Tool
Acronym: Situation, Background, Assessment, Recommendation.
Purpose
Deliver critical information clearly, concisely, and predictably.
Standardise communication → reduce variability, prevent omissions.
Enhance patient safety, especially during hand-offs, rapid response calls, inter-disciplinary consults.
Supports improvement in continuity of care, clinical reasoning, and team trust.
S – Situation (What is happening NOW?)
Identify self, role, location.
Identify patient (name, age, admission reason).
State the immediate problem/concern.
Example Script:
“Hi, this is Emma, a nurse on 4W. I’m calling about Mr. John Smith, a 72-year-old admitted for CHF. He’s now short of breath; O₂ saturation dropped to 88\% on 4 L NC.”
B – Background (WHY is the patient here? What led up to now?)
Pertinent medical history (diagnoses, allergies, comorbidities).
Recent vital signs, lab values, imaging, or therapy response.
Current medications, IV fluids, treatments.
Example:
“Admitted 2 days ago for acute CHF exacerbation. Hx: HTN, CAD, CKD. On IV Lasix; last BNP . Earlier, stable on room air.”
A – Assessment (WHAT do you think is going on?)
Synthesis of objective & subjective data.
Compare to baseline; indicate severity/trend.
State clinical impression.
Example:
“I believe he’s experiencing worsening fluid overload. +2 pedal edema, new bilateral diminished lung sounds.”
R – Recommendation (WHAT do you want?)
Clear, direct request: treatment, orders, consult, transfer.
Provide time frame or urgency.
Example:
“Please evaluate him now. Consider increasing his diuretic or ordering a CXR. Requesting respiratory therapy consult.”
SBAR Tips & Best Practices
Prepare: review chart, latest labs, vitals → anticipate questions.
Be concise but complete → focus on clinically relevant data.
Practise active listening; read-back or clarify unclear orders.
Document: who, what, when, planned actions.
Use SBAR for all hand-offs (shift change, ER → floor, floor → ICU, discharge calls to PCP/LTC facility).
Continuity of Care & SBAR Impact
Bridges shifts, units, and disciplines; “connects the dots.”
Reduces duplication and wasted resources through accurate, consistent information transfer.
Builds inter-professional trust; shows preparedness and patient knowledge.
Critical for safe transitions (high-risk times for error).
Communication Failures – Patient Safety Consequences
Leading root cause of sentinel events & medical errors.
Decreasing miscommunication could directly increase patient safety and quality.
Research/educational goal: develop knowledge representation → ontology-driven tools to teach clinicians how to avoid miscommunication.
Care Coordination
Deliberate organisation & communication about patient-care activities among ≥2 healthcare team members (including patient).
Aims: appropriate, continuous, cost-effective care tailored to individual needs.
Sub-domains
Case Management – Aligns services/resources for quality & cost-effective outcomes.
Transition Management – Ensures safe, seamless movement across settings/providers/community.
Overlaps with SBAR by emphasising structured information sharing.
Integrative Connections & Exam Reminders
Health, wellness, prevention, and SBAR are intertwined: promoting wellness (primary prevention) reduces SBAR “crisis” calls; SBAR skill supports tertiary care by mitigating complications.
Cultural competence always overlays assessments (S & B) and recommendations (R) → interventions must be culturally appropriate.
Ethical obligation: non-maleficence (avoid harm) demands effective communication; beneficence promotes health & wellness education.
Likely test focus: apply SBAR in scenario-based questions; identify level of prevention in given examples; plot patient along continuum; discuss social determinant impacts.
Blended Competencies, Clinical Reasoning & Person-Centered Nursing (Comprehensive Notes)
ANA Definitions of Nursing
Overarching Mandate: Nursing involves the provision of a caring relationship that actively facilitates health and healing in all settings.
Holistic Attention
Considers the complete range of human experiences and responses to both health and illness.
Integrates the patient’s physical setting (home, community, hospital) and social environment (family, culture, socioeconomic status).
Data-to-Meaning Integration
Merges objective assessment findings with the subjective experience of individuals, families, or groups.
Respects personal narratives as valid clinical data.
Scientific Application
Employs judgment and critical thinking to translate scientific knowledge into accurate diagnoses and effective treatments.
Requires continuous appraisal of evidence and patient response.
Knowledge Advancement
Nurses are expected to engage in scholarly inquiry to expand professional knowledge.
Participation ranges from bedside quality-improvement projects to formal research studies.
Societal Influence
Actively shapes social and public policy geared toward social justice and equitable health care.
Advocates for vulnerable populations and addresses determinants of health.
Safety & Quality Assurance
Commits to safe, high-quality, evidence-based practice.
Employs standard protocols, continuous competency assessment, and outcome monitoring.
Thoughtful Person-Centered Practice
Key Elements
The Person: Recognized as a unique, autonomous partner in care.
The Professional Nurse: Blends science, art, ethics, and reflective self-awareness.
Reflective Practice → Personal Learning: Continuous self-evaluation fosters growth.
Clinical Reasoning & Judgment: Integrates data, experience, and patient preferences.
Person-Centered Nursing Process (ADPIE) guides all actions.
Response to Individual Need: Tailors interventions to real-time patient circumstances.
Components of Thoughtful Practice (Diagram-Based Synthesis)
Reflective Practice: Foundation for life-long learning.
The Nurse’s Core
Personal Attributes (open-mindedness, responsibility, motivation, leadership, courage).
Knowledge Base (theoretical, empirical, experiential).
Clinical Experience (situational know-how).
Blended Competencies (see detailed section below).
QSEN Competencies: Patient-centered care, teamwork, evidence-based practice, quality improvement, safety, informatics.
Patient-Centered Nursing Process: .
Clinical Reasoning: Bridges assessment findings and action.
Ten Guiding Principles of Person-Centered Care
Every team member is a caregiver.
Care is anchored in continuous healing relationships.
Customization honors individual needs, values, and choices.
Knowledge flows freely among patients and all caregivers.
Care is delivered in an environment of comfort, peace, and support.
Families & friends are integral to the care team.
Patient safety is an overt, visible priority.
Transparency is the default—no hidden information.
Collaboration focuses on the patient’s goals and best interests.
The patient remains the primary source of control for all decisions.
The Professional Nurse
Personal Attributes
Open-minded, values human dignity, self-aware.
Accepts personal responsibility and strives for excellence.
Exhibits leadership and possesses the bravery to question unsafe systems.
Knowledge Base
Draws on a broad repository of nursing science, related disciplines, and best evidence.
Translates theoretical concepts into clinical action.
Blended Competencies
1. Cognitive
Critical thinking: deliberate, outcome-oriented reasoning.
Clarifies purpose, evaluates adequacy of knowledge, anticipates potential pitfalls.
Utilizes resources; critiques decisions to refine future thinking.
2. Technical
Mastery of equipment, procedures, and emerging technologies.
Commitment to simulation, deliberate practice, and skill validation.
3. Interpersonal
Promotes human dignity and respect.
Establishes therapeutic, caring relationships.
Appreciates the mutual reward of nurse-patient exchange.
4. Ethical/Legal
Operates within legal scope & professional standards.
Recognizes and acts on moral obligations; owns strengths & limitations.
Example (Question #1): Seeking resources for a homeless patient with a diabetic foot ulcer = Ethical/Legal skill.
QSEN Competencies (Quality & Safety Education for Nurses)
Patient-Centered Care.
Teamwork & Collaboration.
Evidence-Based Practice.
Quality Improvement.
Safety.
Informatics.
Clinical Reasoning & Decision Making
Purpose: Purposeful, informed, outcome-focused thinking addressing patient problems.
Guided by professional standards, policies, ethics, and law.
Driven by patient/family/community needs & preferences.
Integrates nursing process, problem-solving methods, and the scientific method.
Continual focus on safety, quality, reevaluation, and self-correction.
Early inclusion of patients, families, and stakeholders in decisions.
Employs logic, intuition, creativity; leverages strengths while mitigating human error potential.
Problem-Solving Approaches
Trial & Error: Sequential testing of available options until success.
Scientific Method: Ordered seven-step process (ask, hypothesize, test, analyze, conclude, implement, evaluate).
Intuitive: Immediate grasp based on deep tacit knowledge—hallmark of expert nurses.
Creative Thinking: Generates novel solutions when conventional approaches fail.
Clinical Judgment Models
Tanner Model
Noticing – perceptual grasp of salient cues.
Interpreting – meaning-making to frame a response.
Responding – execution of chosen action.
Reflecting – real-time and post-hoc evaluation of impact.
Nursing Process Model (ADPIE)
Assessing: Systematic data collection.
Diagnosing: Identify strengths, actual/potential problems.
Planning: Set individualized goals/outcomes; choose interventions.
Implementing: Execute plan; document.
Evaluating: Determine effectiveness; modify plan as required.
NCLEX-style Example (#2): Analyzing data to find patient strengths post-CVA = Diagnosing stage.
Clinical Reasoning Phases & Outcomes (ADPIE Lens)
Assessing → Detect cues (signs, symptoms, risks).
Diagnosing → Analyze data; create differential list.
Planning → Predict complications, prioritize, choose actions.
Implementing → Act, monitor, adjust in real time.
Evaluating → Reflect, repeat cycle as necessary.
Clinical Judgment Outcomes
Recognize priority needs, risks, deviations, education gaps.
Determine desired outcomes, possible adverse reactions, and surveillance strategies.
Allocate most qualified professionals and monitoring plans.
Characteristics of the Nursing Process
Systematic: Ordered, logical progression of steps.
Dynamic: Steps overlap and interact continuously (Question #3 answer “Dynamic”).
Interpersonal: Places human relationship at the center.
Outcome-Oriented: Collaborative goal-setting with patients.
Universally Applicable: Usable across specialties and settings.
Benefits of the Nursing Process
For Patients
Scientifically grounded, individualized holistic care.
Promotes continuity and coordinated, cost-efficient interventions.
For Nurses
Fosters inter-professional collaboration.
Professional satisfaction and measurable impact.
Drives personal and career growth.
Concept Mapping (Instructional Strategy)
Steps:
Collect all patient problems and concerns.
Connect/Analyze relationships among items.
Create a visual diagram.
Integrate core concepts (nursing process, holism, safety, advocacy).
Validated True/False Item (#4): Concept mapping indeed involves identifying, graphically displaying, and linking key concepts (True).
Reflective Practice
Reflection-in-Action: Real-time “thinking on your feet.”
Reflection-on-Action: Post-event analysis to extract lessons.
Reflection-for-Action: Prospective contemplation to adapt future practice.
Supports professional growth, enhanced clinical reasoning, and quality improvement.
Health, Wellness, and Health Disparities
Concepts of Health and Wellness
World Health Organization (WHO) definition: Health is a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.
Population health is tracked globally by two chief indicators:
– frequency or incidence of a disease.
– number of deaths produced by a disease.
Personal perception of health is subjective and shaped by:
Individual values and beliefs.
Family traditions and expectations.
Cultural norms and practices.
Community / societal messages and resources.
Definitions of Health States
Wellness – an active, ongoing process of creating and maintaining optimum health; requires conscious lifestyle choices that promote physical, mental, and emotional well-being.
Disease – a medically identified pathologic change in body structure or function. Usually diagnosed via objective measures (labs, imaging, assessment).
Illness – the subjective experience of living with a disease; describes how the disease affects the person’s level of functioning and quality of life.
Classifications of Illness
Acute Illness
Rapid onset of signs/symptoms, relatively short duration.
Often self-limiting or resolved with minimal long-term impact.
Examples: appendicitis, pneumonia (→ Answer to Question #1), infectious diarrhea, common cold.
Chronic Illness
Slow, often insidious onset; may include periods of remission (symptom minimization) and exacerbation (flare-ups).
Causes irreversible alterations; produces permanent change in anatomy, physiology, or both.
Requires long-term management, education, and support.
Examples: diabetes mellitus, rheumatoid arthritis, osteoporosis.
Stages of Illness Behavior (Suchman’s Model)
– recognition of physical change; triggers decision-making.
– individual validates illness, self-care, or seeks professional help (Question #2 context – the coughing, febrile client is here).
– acceptance of professional diagnosis, reliance on others for care, decisions, or support.
– relinquishes dependent role, resumes normal activities or new baseline.
Health Equity and Disparities
Health Equity – the attainment of the highest level of health for all people; involves removing obstacles (poverty, discrimination, lack of access) so everyone can reach full health potential.
Health Disparity – a health difference closely linked to (race, ethnicity, income, geography, disability, etc.).
Social Determinants of Health (SDOH) – conditions in which people are born, grow, live, work, play, worship, and age. Influence:
Health outcomes.
Functioning capacity.
Quality of life and risks.
Diversity, Inclusion, and Equity (D, I & E)
Institutional / Structural Racism – systemic policies or practices that create differential access to goods, services, and opportunities by race.
Implicit (Unconscious) Bias – attitudes/stereotypes that affect understanding, actions, and decisions unconsciously.
Diversity – representation and welcoming of varied race, religion, nationality, culture, age, sexual orientation, gender identity.
Inclusion – creating environments where everyone feels valued, respected, and has a sense of belonging and purpose.
Equity – ensuring fair access to the resources, opportunities, and conditions needed to thrive.
Vulnerable Populations – groups at greater risk for poor health outcomes (e.g., homeless, migrant workers, LGBTQ+, elderly living alone).
Factors Affecting Health and Illness
Basic Human Needs – unmet needs (food, water, safety, etc.) create higher disease vulnerability.
Human Dimensions – holistic view (see next section).
Self-Concept – mental image or perception of one’s strengths, weaknesses, appearance, and emotions; influences compliance, motivation, and coping.
Risk Factors – variables increasing probability of illness/injury.
The Human Dimensions of Health
Physical Dimension – genetics, age, developmental stage, race, gender.
Emotional Dimension – mind–body interactions; effect of emotional states on physical health and vice versa.
Intellectual Dimension – cognitive abilities, education, past experiences; affect health literacy & choices.
Environmental Dimension – housing quality, sanitation, climate, pollution (air, water, food).
Sociocultural Dimension – economic status, lifestyle, family, cultural values; e.g., keeping in touch with neighbors to foster community (→ sociocultural, not emotional – Answer to Question #3).
Spiritual Dimension – beliefs, values, purpose, and ways these inform health decisions.
Risk Factors for Illness & Injury
Modifiable – can be changed or controlled (smoking, diet, exercise, stress level, seat-belt use).
Non-modifiable – cannot be changed (age, genetics, family history).
Six major categories:
Age
Genetic Factors
Physiologic Factors (e.g., pregnancy, obesity, hypertension)
Health Habits
Lifestyle (occupation, recreation, substance use)
Environment (living conditions, pollution, violence)
Health Promotion & Illness Prevention Levels
Primary Prevention – before disease occurs; protect against or reduce risk.
Examples: immunizations, accident-prevention education, family-planning counseling, safe-water campaigns.
Secondary Prevention – early detection & prompt intervention to halt or slow disease.
Examples: screenings (blood pressure at mall – Answer to Question #4), mammograms, Pap smears, vision/hearing tests, growth/development checks.
Tertiary Prevention – after diagnosis; reduce disability, restore or maximize functioning.
Examples: teaching diabetic foot care, cardiac rehabilitation, physical therapy post-stroke, referral to cancer support group.
Models of Health and Illness
Health Belief Model (HBM) – Rosenstock (1974)
Explores what people perceive to be true about health.
Health-related action depends on:
Perceived Susceptibility – belief about personal risk of a disease.
Perceived Seriousness – belief regarding the severity and potential consequences.
Perceived Benefits – belief that recommended action will reduce risk or severity.
Modifying Variables – demographic (age, gender), sociopsychological (peer pressure), structural (knowledge, prior contact).
Health Promotion Model (HPM) – Pender / Murdaugh
Emphasizes interaction with environment while pursuing health.
Predictive factors:
Personal characteristics (biologic, psychological, sociocultural).
Behavior-specific knowledge & beliefs (perceived benefits/barriers, self-efficacy).
Outcome – health-promoting behavior leading to positive health throughout lifespan.
Revised HPM adds:
Activity-Related Affect – feelings before, during, after behavior.
Commitment to a Plan of Action.
Immediate Competing Demands & Preferences – alternative behaviors.
Health–Illness Continuum – Travis
Visual scale with death ↔ high-level wellness on opposite ends.
Health is dynamic, constantly changing with internal & external influences.
Individuals move back and forth daily.
(Question #5 – the correct model for changing states.)
Agent–Host–Environment (Epidemiologic Triangle) – Leavell & Clark
Disease result of interaction among:
Agent – factor that must be present (pathogen, toxin, stress).
Host – susceptible organism.
Environment – external conditions allowing or inhibiting disease transmission.
Useful for infectious diseases; limited for chronic/noninfectious conditions.
Stages of Change Model (Transtheoretical Model) – Prochaska & DiClemente
Applied to counseling for injury prevention, addiction, weight control.
Five dynamic stages:
Pre-contemplation – no intention to change.
Contemplation – aware of need, thinking of change.
Determination (Preparation) – commitment to act.
Action – implementing plan.
Maintenance (sometimes added) – sustaining new behavior, preventing relapse.
Ethical, Philosophical & Practical Implications
Commitment to social justice demands nurses address health disparities and advocate for vulnerable populations.
Recognizing implicit bias is essential to provide equitable care.
Holistic nursing requires assessment of all human dimensions; interventions targeting only the physical dimension may fail.
Chronic illness management underscores the need for patient education, self-management support, and long-term relationships.
Prevention levels guide resource allocation: investing in primary prevention saves long-term tertiary costs.
Embedded Practice Questions (NCLEX-Style) – Quick Recap
Q1: Acute vs. chronic illness – .
Q2: Stages of illness behavior – determining the correct stage clarifies nursing role; client self-medicating is Stage 2 (Sick Role).
Q3: Recognize human dimensions – community contact is sociocultural, not emotional.
Q4: Secondary prevention – blood pressure screening represents early detection.
Q5: Continuum model sees health as constantly changing, extremes and .
Connections to Previous/Foundation Concepts
Maslow’s Hierarchy aligns with basic human needs affecting health.
Epidemiology principles underpin Agent–Host–Environment model.
Nursing Process parallels Stages of Change: assessment (pre-contemplation/contemplation), planning (determination), implementation (action), evaluation (maintenance/relapse).
Real-World Relevance
Rising chronic disease prevalence heightens importance of secondary & tertiary interventions.
COVID-19 illustrated intersection of SDOH, structural racism, and health disparities.
Community health initiatives (e.g., BP kiosks in malls) are cost-effective strategies for population-level secondary prevention.
Key Take-Home Messages
Health is multidimensional, dynamic, and deeply influenced by context.
Prevention occurs on a continuum (primary → tertiary); early action saves lives and resources.
Equity is achieved not by equal distribution but by fair distribution of opportunities.
Behavior change is staged; understanding client readiness increases nursing effectiveness.
Holistic assessment across all human dimensions guides comprehensive nursing care.