Health Promotion

1. What is Health?

• Health: Overall state of well-being.

• Illness: Personal experience of feeling unwell.

• Disease: Specific pathological condition.

2. Health Promotion
Improving health and preventing illness.

• Healthy eating

• Exercise

• Immunizations

• Stress management

• Regular screenings

• Avoiding tobacco and excessive alcohol

• Adequate sleep

3. Health Promotion Across the Lifespan

• Major Life Stages:

  1. Infancy

  2. Early childhood

  3. Middle childhood

  4. Adolescence

  5. Young adulthood

  6. Middle adulthood

  7. Older adulthood

4. Determinants of Health
Factors influencing health:

• Genetics/Biology: Inherited traits

• Environment: Housing, pollution, safety

• Lifestyle/Behavior: Diet, exercise, smoking

• Healthcare Access: Quality and availability - social

• Socioeconomic Factors: Income, education, employment - social

• Social Support: Family, friends, community

• Culture: Health beliefs and practices - social

• Education: Health literacy - social

5. Prevention
Three Levels:

• Primary: Prevents disease (e.g., vaccines, healthy diet)

• Secondary: Early disease detection (e.g., screenings)

• Tertiary: Manage existing disease (e.g., rehabilitation)

6. Wellness
An active choice process for better health across dimensions:

• Physical

• Emotional

• Social

• Intellectual

• Spiritual

• Environmental

• Occupational

Quick Recall for Prevention:

• 1° = STOP (Prevent before it starts)

• 2° = SCREEN (Detect early)

• 3° = SUPPORT (Manage and prevent complications)

Development: the pattern of movement or change that begins at conception and continues through the human life span (until death).

 Traditional Approach: emphasizes extensive change from birth to adolescence, little to no change in adulthood, and decline in old age(growth stops at adolescence)

Life Span Approach: Growth happens throughout life(changes).

• Menopause

• Frontal lobe

• Dementia

• Arthritis

Life expectancy - 79 years

Female longer - Body Comp, hormones, X chromosome.

Growth: quantifiable change in structure

• Childhood: growth measured regularly

• Adulthood: assess systems undergoing change

•Many factors impact and influence

Rate of development varies - all depends on factors and influences.

• Cephalocaudal: head to toe

• Proximodistal: midline to periphery

  • In to out

• Differentiation: simple to complex; general to specific

  • Embryo and starts to grow.

• Development involves growth, maintenance, and regulation of loss.

• Development is a co-construction of biology, culture, and the individual.

• Development is lifelong and multidimensional: biological, cognitive, and socioemotional dimensions.

Conceptions of Age

• Chronological age: # of years alive

• Biological age: age in terms of ones health

• Psychological age: adaptive capacities compared to others of the same age

• Social Age - connected with others better support group - live longer.

Biological: changes in an individual’s physical nature

• physical changes

Cognitive: changes in thought, intelligence, and language

• might learn diff language

• Health literacy

• Mental changes

Socioemotional: changes in relationships with other people, changes in emotions, and changes in personality.

• relationships

• All emotions

• How you handle it

• Interactions - how u interact with people(patients with attitudes)

Five Theoretical Orientations to Development 

Psychoanalytic 

Cognitive 

Behavioral and Social Cognitive

Ethological

Gilligan - Personal relationships. Empathy, responsibility, avoiding harm, emotions. Should be present everywhere. Relationships with patients is important no matter what. CAREGIVER TOO!

Erikson’s - highlights 8 psychological conflicts. Applied psych, but all nursing settings. Relate to time period. Worse and better option. Def pediatric nurse! Accomplishment vs conflict. Want them to accomplish goals.

Piaget - gain knowledge through world around them. Cognitive skills and logic.

Stage 1: Sensory motor (birth to 2)

Stage 2: Pre operation (2-7)

Stage 3:Concrete operational (7-11)

Stage 4: Formal operational(11-older)

Vygotsky - Social interaction. Outpatient

Kholberg - 6 stages (what’s right and wrong) Rules - reward system. Top - gain morals.

Theory - Roadmap. Guidance, blueprint. Promotion healthy habits for patients.

Health is core concept

•Epidemiology: study of health and disease from a societal perspective

Health viewed as dichotomy

• High-level wellness vs depletion of health.

• Wellness is the positive end of continuum.

• Adaptation is the negative end of continuum.

Current views of health: Emphasis placed on quality of life. Nutrition.

Models of Health (Clinical, Role Performance, Adaptive)

• being free from signs and sympotms of Disease.(Clinical)

• Can they perform their roles? (Role)

• Adjust positively to society(Adaptive)

•Eudaimonistic Model

• Optimal health

  • Physcial, psychological, social, spiritual.

•Wellness-Illness Continuum

• Positive health

•High-Level Wellness

• Low level - ill

• High - healthy.

Disease

• failure of adaptive mechanisms.

• Results in Functional structural disturbances

• Multifactoral approach increases chance of successful intervention.

Ilness:

• Subjective çeperince of individual and physical manifestation of Disease.

• Mismatch en needs and resources to meet the needs.

• When u start needing help.

Disease vs Illness- disease has no symptoms. Illness has symptoms but can’t see underlying disease. Both - symptoms and detection.

Disaprity - differences in how you treat them according to race,etc.

Primary Prevention:

• Precedes disease/dysfunction

• Interventions—health protection

• Health promotion (e.g., education)

• Vaccines are primary prevention interventions

• Focus: maintain/improve general individual, family, community health

• Health protection – reducing threats to health

• Health promotion – encouraging lifestyle change to move toward health

Six Stages change: Transtheoretic model of change

• Pre-contemplative—not considering change

• Contemplative—aware but not considering change soon

• Preparation—planning to change

• Action—has begun to make behavioral change (recent)

• Maintenance—continued commitment to behavior (long term)

• Relapse—reverted to old behavior

Secondary Prevention:

• Focus on early detection

• Earlier treatment results in more favorable outcomes

• Limit disabilities from disease

• Screening falls under secondary prevention

  • Individuals

  • Populations

Examples: Colon cancer screening, Pap tests

Tertiary Pervention

• Focus on restoration and rehabilitation

• Minimize long term complications of disease

• Restore function; prevent further injury/disease

Examples:

• Cardiac rehab after myocardial infarction (MI)

• ROM to maintain mobility after cerebrovascular accident (CVA)

Nursing Roles

Advocate – directly assists persons to obtain services needed

• Care manager – assists individuals to obtain care - coordinates care

• Consultant – specialize skills and knowledge

• Deliverer of services – provides direct care

• Educator – promotes patient literacy

• Healer – helps individuals integrate and balance

• Researcher—evidence-based practice

• Evidence - Research, clinical experience, patient preference.

Improving prospects for health

• Population diversity

  • İncreased diversity

  • Changes in age distributation

  • Health promotion

Shifting Problems

Moving toward solutions

Developmental milestones:

Reflexes: built in reactions to stimuli: automatic and inborn.

Imp: Language, social, movement, speaking - future development.

Gross Motor: Large muscle activities.

The development of posture:

• Posture - a dynamic process linked with sensory information in the skin, joints and muscles, which tell us where we are in space.

  • Learning to walk

  • Occurs about the time of their first birthday

 Development in the second year

• Toddlers become more skilled and mobile

By 13-18 months, toddler can pull a toy or climb stairs.

By 18-24 months, toddlers can walk quickly, balance on feet, kicking.

Language development

• A form of communication - whether spoken, written, or sign. Based on system of symbols. Consists of words used by a community and the rules for varying and combining them.

• Infinite Generativity: the ability to produce an endless number of meaningful sentences using a finite set of words and rules.

Emotional development:

Feeling or affect that occurs then a person is in a state of interaction that is important to him or her : wellbeing.

Biological and environmental influences:

• Certain brain regions play a role in emotions.

• Relationships and culture provide diversity in emotional experiences.

Pragmatic approach - practical approach. (Needles)

• often challenged by political opposition or community (moral condemnation).

Social Determinants of health: access to health, socioeconomic, education.

Factors affecting someone’s ability to attain good health.

Harm reduction - Reducing behavior - addressing damaging behaviors of vulnerable populations.

Health Equity: highest level of health for all people - eliminate disparities

• Common obstacles to health care:

  • Race, ethnicity, age, etc.

• Absense of disease does not automatically equate to good health.

Vulnerable pop - Elderly, homeless, minority groups, rural communities, immigrants, refugees.

Culture: Languages, customs, beliefs, arts, knowledge.

Values: Belief about the worth of something, influence behavior and thinking.

Value orientation: Values learned and share through socialization. Reflect “personality type” of particular society.

Cultural and linguistic competency:

• ability to be respective and responsive to needs of a diverse population.

  • Cultural and linguistical services - major element in eliminating disparities.

Immigrants and Refugees

• Immigrants: include and foreign born residents

  • Decline in economic stability and social support.

  • Cultural and language barriers

Unauthorized immigrants: persons who entered country without legal status or stayed beyond limits.

Refugee: immigrant who is unwillling or unable to return to country of origin.

• additional trauma due to violence brutality.

Folk Healing and Nursing:

• Folk healing practices: Reflect beliefs, values, treatment of cultural group. Unlicensed: lay midwives, herbalists, spiritualist.

• Nurses must avoid ethnocentrism

  • Viewing other ways as inferior or unnatural.

Holistic approach:

• Patient and family centered care.

Arab:

• Three major waves: late 1800s to 1960s

  • Lebanese, Syrians, Egyptians

    • Religions: Christianity, Judaism, Islam

• Health concerns:

  • Adult onset diabetes

  • Coronary artery disease

  • Role of acculturation

    • Merging their culture with ours.

  • Mental health

  • Teenage smoking

Barriers to care

Selected health-related cultural aspects

Asian Americans:

• Many countries/cultures

  • Chinese, Koreans, Filipinos

    • Model minority

• value education

Health concerns and care issues

• hesitancy to seek early diagnosis/screening

• Higher rate tuberculosis

• Mental health problems due to adjustment issues

• Lower rate of obesity, hypertension

• HIV

• HEP B

• Liver disease

Selected health related cultural aspects

Barriers to care

Hawaiians and Pacific Islanders:

• Strong body of knowledge is lacking

• Higher rates of obesity, smoking and ETOH

• Leading cause of death: cancer, heart, CVA, DM, accidents

• Needs education and healthy diet.

• Holistic perspective

Latino:

• focusing on primary prevention and encouraged screenings.

• STD

• Free clinics

• Largest ethnic group

• Education would help them,

• Stomach cancer

Black/ African Americans:

• Clincs

• Holistic approach - they r centered ard religion

• Church imp

• Lack of insurance

• Home remedies

• Education on trust

Native Americans:

• Counsling services

• Strokes

• Suicide

• Cancer

• CVA

• Education

LGBTQ:

• Stigma, discrimination, lack of access to

• Bullying, drug use

• Educating people

• Mental health services

• Money

Poverty and Homeless:

• Complex persistent and growing problems

• Significant negative impact to healthcare access

• Mental illness, violence/injury, poor access to care.

NIH - Infectious disease

• aids, infant morality, cancer, diabetes.

Equity - custom tools that identify and address inequality.

Inequality - Unequal access to opportunities.

Equality - both get ladders - not equal opportunity

Justice - equal opportunities

Affordable care act - Focus on vulnerable pop.

• coverage, control, cost

  • Reduce number of uninsured people.

Health indicator - provide info identifying what could happy - infant mortality rate = maternal health and health access.

• rise opioid deaths

• Market place - Obama care

Safety - kids, elderly,smoking sensation, CV - stroke. (79)

• decease infant mortality rate.

• Heart disease

Health disparities and health care disparities:

• Health = difference in health outcomes

• Healthcare = difference between groups regard to access, medical treatment, insurance coverage, quality of care, subsets of pop.

Florence - sanitation

Lilian - train nurses - settlement - train family too

Nursing - errors occurring because of the work environment

• afraid to ask quesrtions

• Short staffed

• Lack of equipment

IOM - now national academy for medicine

Hygiene incorporated into most religions

• During Middle Ages widespread epidemic disease - leoparsy, etc.

  • Food supply - life span

  • Transportation enhances food distribution

  • Technological advances improved food production

    • Sewers

CDC - control - interventions

Prevention - incorporation of prevention merged with med.

Independent practice - free market system

• chose your provider, prevention has gained importance, declining physicians working in private practice.

Advanced practice nurse:

• Serve as primary care providers

• Multidisciplinary collaborative approach

• Specialty and hospital roles increasing

Primary care and prevention.

Local level - first line of access

• direct services to public

State - second line of access

• policy,planning,program coordination

Federal - third line access

• assume overall responsibility for health protection of citizens

• Determines health policy.

Red Cross - disaster, blood drives, BLS, volunteer

Medicare - 2nd largest

• insurance, disability,federal dollars - state, low income, no discrimination for health before insurance

• Medicare - federal insurance, covers cost for ppl over 65, good for diagnosed in stage renal disease, ALS, recurring signs and and symptoms.

• Medicade - low income,amount of money physician would get, preexisting conditions discrimination, poverty guideline

First - elementary and secondary schools

Nurses role - advocate

The Therapeutic Relationship:

• Trust

• Safe space

• Listening to patient

• Pace

• Milieu - context of setting

• Nurse to coworker

• Nurse to patient

• Values: principles, attitudes, beliefs,guide actions.

Values:

• Active: physically acts out.

• Cognitive: Beliefs - what they think - verbal - intellectual.

Seven steps: 1-3 -cognitive, 4-5 - emotions, 6-7 - behavior changes

• Choosing freely

• Choosing from alternatives

• Choosing after careful consideration

• Cherishing values

• Pubic affirmation

• Acting choice

• Repeating pattern

Self concept - mental picture of urself

• evolves through life

• Limits, goals

Self esteem

• Learned from experience

• Feel abt urself

Can affect ur judgement and attitude abt yourself.

Self awareness:

• listening to oneself: thoughts, reactions, impulses

• Listening and learning from others

• Insight into one’s role in the story

Components of self:

• The public self

• Semi public self

  • Patient is unaware - they think it’s okay, but nurse knows smth else.

• Private self

  • No revealed to others.

• Inner self

  • Unconscious not known to the individual.

Listening to oneself

• Attention to emotions, thoughts, memories, reactions.

Listening to and learning from others

• Feedback

Indenting the individual’s values

Use reflection to restate the value

Shared thoughts and relationships - communication is the foundation.

• FAMILY CENTERED as well

Electronic Communication

• increasingly communication is electronic.

• Electronic applications for healthcare

• Expanded access to care

• Research demonstrated equal efficacy as face to face

• Expected to become more ubiquitous

Communication function and process

• Care functions of communications:

  • Obtain and send messages: retain info

  • Use info new conclusions, revisit, past, anticipate future

  • Begin and modify physiology process

  • Influence others and events

• Process(four components)

  • Inputs - taking in information

  • Output - further information exchange

  • Feedback - monitoring system for communication can be positive or negative

  • Feedback loop - dynamic nature of communications

  • Situational context - physical, psychosocial, cultural dimensions

Verbal and nonverbal

• Verbal

  • Words are symbols for ideas

  • Includes sign language, touch language

  • Challenges

  • Communication

  • Functions

• Nonverbal

  • Messages not spoken or written

  • Facial expressions eye or body movement gestures.

  • Particularly vulnerable to misunderstanding

  • Culturally and situationally bond

  • Great power to transmit into thoughts, feelings, etc.

  • Nonverbal messages from both patient and nurse

    • Doesn’t reflect senders conscious thought.

• Metacommunication

  • Staff meeting

  • Group huddle

  • Group meeting

  • Reading in between the lines

• Effective communication steps

  • Firmly starting case

    • Need argument content and met communication

  • Clarifying the message

    • Need complete message

  • Seeking feedback

• Listening - actively focusing on message

  • Nonverbal cues - influenced by culture/situation

  • Reciprocity

• Flexibility - balance control

  • Rules of appropriate communication

• Silence - can be therapeutic

  • Lack of interest vs reflection

  • Conveying support

• Humor

  • Positive - relives tension, climate sharing

  • Negative - blocks communication, inflicts, emotional pain

• Touch

• Space between communicators

  • Varies according to type, setting, culture

  • Proxemics - use of space between communicators

  • Understanding space enhances communication congruency.

• Effective communication essential to quality care.

Proxemics

• use of space will vary with setting and culture

• Nurses must be sensitive to special zones esp if caring for persons across cultures

ZONES OF SPACE - common to North America

• intimate space - 18 inches

• Social consultive space - 9ft -12

• Personal - 4 ft

• Public space - football field - 12 ft and beyond

Health literacy:

• capacity to read, comprehend, and folllow through on health information

• Key factors to consider

• Fifth or six grade level is the goal

• Avoid complex terms

• Simplify sentences

Rapport - harmony and affinity between people.

Trust me- reliance on another person based on sense of safety, honesty, reliability.

• Do what they said

• Examine behaviors

Empathy - understand others feelings

Goal direction - meet need or wellbeing

Ethics - behavior affects others, actions involve choices that may be judged by standards of right and wrong.

Nurse: respect individual rights, support person’s family.

HIPPA - health insurance portability and accountability act.

Ethics in communicating

• goals must be agreeable to patient

  • Patient(not nurse) chooses care alternatives

  • Decision making is per patient’s value system.

• Nurse responsible to help patient set goals

  • Examines values.

• Focusing on inidivudial

  • Person, not nurse, focus on interaction

• Helping person to clarify content/meaning

  • Prompt further description/data

  • Goal: to help person describe problem and solve together

• Reflection

  • Selective paraphrasing or repetition

  • Goal - emphasize their goal?

• Constructive confrontation

  • Indentifies behavior

  • Helps person examine meanings/consequences.

• Clarify patient’s preferred nouns/pronouns

  • Promotes clear thinking/communication.

• Motivational interviewing:

  • Engaging - address, issues, establish trust

  • Focus - narrowing focus to area of change

  • Evoking - eliciting motivation for change

  • Planning - developing steps to create change

• Barriers to effective communication

  • Anxiety

    • Alters perception, distorts reality

  • Attitudes

    • Bias/stereotypes

  • Gaps between the nurse and individual

    • Sex, age, ethnicity, language

  • Resistance

    • Behavior to reduce anxiety(avoidance, anger)

      • Goal: identify, and understand behavior

Transference and counter transference

• Reacting to another as if the person is someone from the past.

Sensory barriers

• use other senses: obtain specialized assistance

Failure to address concerns/needs

• setting

Relationship stages:

• Orientation

• Working phase

• Termination phase

  • These stages can also occur in brief interactions

  • Feasible for 15-minute family interactions

Clear communication, structured interview, focus on them.

Applied ethics:

• moral philosophy is underlying to discipline

• Discovering or proposing right vs wrong

• What ought I do

Moral Philosophy

• formulating theories or framework to guide action

• Uses moral theory to propose/implement action

• Seeks to arrive at good actions, avoid harmful actions

Values theories: result from philosophical inquiry about good action

• discriptive theories - SEEM TO VALUE

  • Concerned what humans seem to value

  • Send on observation

• Normative theories - SHOULD VALUE

  • perceptive properties what people ought to value

  • Concerned with ensuring good actions

• Good action that provide the least harm

• Adherence to duties

Feminist ethics - human beings are inseparable from their relationships with others.

Prof resposibilities:

• accountability to patients/society

• Provding upmost care

• Following rules

• Hippa

• Mandated reporter

• Explain to patient for consent

Giving patients information

Assessment - key component

• nursing process

  • Assessment

  • Diagnosis

  • Planning

  • Implementation

  • Evaluation

Health belief:

• predict behaviors

Resource

• cdc

• Medline plus

• Healthy people 2030

Environmental - area you live in- lack of stores

Age - fulfill development tasks

Functional - individual performance of tasks

Cultural - influences health patterns

• eating habits

Health expression

• observable a person’s bio, spiritual, physical habits manifest daily.

Subjective - patient says

Objective - data I’m collecting

Comprehensive family assessment:

• family health status: functional, potentially dysfunctional.

• Role model: collaborate with family, provide information, decision - making, problem solving, liaison for services.

• System - boundaries control system

• Behaviors - member responses influence patterns

• Values - provide means for interpreting events.

• Changes - affect whole family.

Healthy families

• Communication

• Trusting

• Setting boundaries

• Nurturing

Family risk factor

• lifestyle (overeating, drug dependency, malnourished, smoking)

• Biological (genetics)

• Environmental (stress, pollution)

• Social, psychological, cultural, spiritual(crowding, isolation)

• Health care system (overuse, lack of access)

• Families can assist individuals to reduce risk

• Nutrition, smoking, excises, ETOH, stress affect 7 of 10 leading causes of death.

Epidemiology uses mortality and morbidity as indirect evidence of health.

• family lifestyle stages associated with specific risk factors.

Gordon(2020); 11 functional health patterns

Systems approach with emphasis on developmental stages and risk factors

Evaluation of dysfunctional patterns in families

Risk factors predict potential dysfunction

Nursing process

• Family assessment: history, interview, roles, risks

• İnterventions

Family resilience:

• strategies for prevention during challenges

• Crises may reveal strengths and useful abilities

• Strong relationships, shared values, collaboration faster resilience

• Risks for disruption - dissolution associated

  • Substance or ETOH abuse, destructive behaviors

  • Violence or abuse threatens integrity of family

• Healthy people 2030 addresses bullying

• Family connectiveness vs violence `

Couple family - intervention as aimed at integrating sound health practices and heal its into couple’s lifestyle.

Childbearing family - interventions to support child rearing

Family with toddlers/preschool children.

Family with adolescents - time of identity crisis and adjustment

Young adults - health promoting actives

Middle Aged activities - empty nest syndrome is common

Family with older adults - challenges: safe/comfortable home, adjust to loss of spouse, preparing for end of life.

Nursing plan

• planning

• Implementation

• Evaluation

Community health nursing

Combines nursing practice and public health

• promote the health of populations

• Not limited to particular individual of group

Nurses supply educational information to at risk communities

Develop health oriented skills, attitudes, and related behavioral changes

Nurses develop essential relationships to promote community health missions

Nurse’s role: independent, dependent functions.

Observation data

• windshield survey - use of senses to determine community experiences

• Measurement data - population statistics, morbidity, mortality rates, US census statistics, epidemiological, and environmental data.

• Interview Data - key informants: key community leaders, community residents can provide important info, health agency personal.

Health perception - health management pattern

• health promotion and disease prevention practices.

Nutritional metabolic pattern - availability of food stores and/or subsidized food programs. Well-being indicators.

Elimination pattern - physical; air quality, humidity, inasccesible health care, exposure to pollutants.

Activity - excersie pattern - physical activities/ recreational options within communities

Sleep-rest-pattern

Reliability - same result

Extra nutrients - pregnant (folic acid), the older adult, exclusively breast fed baby.

Food safety - discarding food, seperating food, no cross contamination, hand washing.

Leading cause death: heart disease, CVA, stroke, DM 1

• type 2 - life style

  • Low carbs

Zinc, calcium - tissues repair

Oscow - calcium with vitamin D

Complimentary Therapies:

• massage

• Meditation

• Yoga

• Acupuncture

Complimentary therapy - non-mainstream practice that uses CAM in conjunction with allopathic traditional medicine.

• acupuncture to lessen side effects of treatment

• Alternative therapy - non-mainstream practice that uses CAM to substitute for standard medicine

  • Ex: herbs vs chemotherapy for cancer.

NCCIH

No discrimination.

Ayurvedic medicine

• evolved over thousands of years

• Minerals, herbs, metals

• Mind - body harmony

Traditional Chinese Harmony

• herbs, CAM treatments, acupuncture

• Yin and yan life forces

• Organs via earth,metal,fire,earth,wood

Healing touch, raki

First day of last menstrual period + 7 - 3 months

Feb 10 2026 feb 17

Presumptive - subjectively experienced.

BUBBLE HER

B - breasts

U - uterus

B - bladder

B - bowles

L - lochia (discharge)

E - episiotomy (scapula to cut down)

H - homans (walking ard)

E - emotion

R - rogam (RH factor)

Teratogen - environmental agents that causes spontaneous abortions.

• alc. - FAS

• Drugs

• Smoking

• Insufficient food