Nursing Care of Healthy Populations: Health and Wellness, Health Promotion, Sleep and Spiritual Health

Health and Wellness

  • Health Definition:
    • A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity (WHO, 1947).
    • Aligns with the goals of nursing practice.

Key Concepts

  • Health Promotion: Activities/interventions that help patients maintain or enhance their current health levels.
  • Wellness: Educates individuals to care for themselves in a healthy way, improving control over their health.
  • Illness Prevention: Activities/interventions to protect individuals from actual or potential health threats, helping to avoid crises.
    • Primary Prevention: Precedes disease; focuses on health promotion (e.g., immunizations, physical fitness programs).
    • Secondary Prevention: Prevents complications or the worsening of existing conditions (e.g., preventing post-operative incisional infections).
    • Tertiary Prevention: Minimizes the effects of long-term disease or disability, aiming for rehabilitation to the highest possible level of functioning (though not pre-illness level).

Eight Dimensions of Wellness

  • Emotional
  • Spiritual
  • Intellectual
  • Physical
  • Environmental
  • Financial
  • Occupational (especially relevant for retired individuals)
  • Social

Maslow’s Hierarchy of Needs

  • Very important in nursing education and the NCLEX-RN exam.
  • Forms the basis of nursing care.
  • Priorities change based on different situations.
  • Emphasizes that each patient has unique needs.
  • Provides a framework for critical thinking, helping to determine:
    • What to do first.
    • Which patient to see first.

Models of Health and Illness

  • Different models change focus of nursing care
    • Health Belief Model: A person’s beliefs guide the nursing plan of care.
      • Individual perceptions of disease risk.
      • Individual perception of severity of illness.
      • Likelihood that a person will take preventative action.
    • Health Promotion Model: Health is a dynamic process influenced by:
      • Individual characteristics and experiences.
      • Behavior and knowledge.
      • Behavioral outcomes.
    • Holistic Health Model: Focuses on the promotion of optimal health.
      • Integrative health care utilizes the body's natural healing abilities and complementary/alternative interventions.

Influences on Health Beliefs and Practices

  • Internal Variables:
    • Developmental Stage: From childhood to older adulthood.
    • Intellectual Background: Cognitive ability influences the level of thought and understanding.
    • Perception of Functioning: Subjective data from the patient about how symptoms affect their quality of life.
    • Emotional Factors: Coping mechanisms, stress, and fear affect health beliefs and practices.
    • Spiritual Factors: Influence treatment choices, levels of hope, and comfort.
  • External Variables:
    • Family: Beliefs/practices are influenced by the family.
    • Socioeconomic Factors: Approval from family and friends affects health behavior; the ability to pay for treatments/medications influences choices.
    • Cultural Background: Values, beliefs, and customs influence health beliefs and practices.

Risk Factors

  • Definition:
    • A situation,
    • habit,
    • social or environmental condition,
    • physiological or psychological condition,
    • developmental or intellectual condition,
    • spiritual condition,
    • or other variable that increases vulnerability to illness or accident.
  • Nurses are responsible for identifying and modifying risk factors in all settings.
  • Risk factors often dictate the need for action.
    • Example: A high score on a postpartum depression scale indicates an increased risk of postpartum depression, necessitating a care plan to protect the person.
  • Types
    • Modified and Nonmodifiable
      • Genetic and Physiological
      • Age
      • Environment
      • Lifestyle
      • Nurses are most likely to change lifestyle risk factors.

Stages of Health Behavior Change

  • Pre-contemplation: The person is not interested and may be defensive.
  • Contemplation: The person is ambivalent but will accept information and is starting to realize that change is necessary.
  • Preparation: The person believes that change is necessary, and the nurse assists in developing a plan of action.
  • Action: The person is actively involved in the plan for change, though barriers may be present (approx. six months).
  • Maintenance: Changes are ideally integrated into the person’s lifestyle.
  • Patience is vital; avoid judgmental statements and provide factual information.

Illness

  • Definition: A state in which a person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired.
  • Types:
    • Acute Illness:
      • Severe, with an abrupt onset of intense symptoms.
      • Reversible, with a relatively short duration.
    • Chronic Illness:
      • Persistent (beyond 6 months).
      • Irreversible.
      • Affects functioning in one or more body systems.

Illness Behavior

  • Definition: How a patient:
    • behaves or acts to monitor their bodies,
    • defines and interprets their symptoms,
    • takes action,
    • uses health care resources in the event of an illness.
  • Influenced by the person's beliefs and values related to health and illness.
  • Illness behavior causes changes affecting the person and family members:
    • Behavioral/Emotional Changes: Irritability, anger, depression, and despair.
    • Body Image: Anxiety, depression, withdrawal.
    • Self-Concept: Poor self-image if no longer able to fulfill roles and responsibilities.
    • Family Role Responsibilities: Other family members may have to assume new responsibilities, which is a major stressor for patients and families.
    • Family Dynamics: Changes produce stress, and the nurse plays a supportive role in the holistic care of the patient.

Nurses CARE For People

  • Caring is a universal phenomenon influencing how people think, feel, and behave in relation to one another.
  • It is the essence of excellent nursing practice and the core of nursing.
  • All nursing actions are based on the fundamental commitment by the nurse to care for people (holistically) and the population as a whole.
  • Caring for people should focus on the uniqueness of each person; care should be humanistic and holistic.
  • Caring facilitates a nurse’s ability to know a person, allowing the nurse to recognize a person’s problems and find and implement individualized solutions.

Caring – A Moral Imperative Ethic of Care

  • Presence: "Being there" through body language, eye contact, voice tone, listening, and a positive open attitude (a nurse can be face to face with a patient WITHOUT being present!).
  • Touch: Comfort patients that are afraid, embarrassed, or uncomfortable with gentle caring touch as non-verbal communication (ensure that your touch is welcome and culturally appropriate).
  • Listening: Active listening is nonjudgmental and accepting, allowing a patient to reach out to another human being and tell his story (try not to get distracted by other tasks).
  • Knowing Your Patient: May occur over time; avoid assumptions!
  • Spiritual Care: Assist the patient in using spiritual resources; caring forges a spiritual connection between nurse and patient.
  • Relief of Pain and Suffering: Beyond pain medication, provide comfort, dignity, and respect in the face of human suffering (may encompass interventions listed above).
  • Family Care: Allow active participation of the family in care; holistic care of the patient includes recognizing and addressing the needs of family members.

Nursing Diagnosis r/t Health Promotion

  • Writing a Health Promotion-Based Diagnosis
    • A health promotion diagnosis is described using a two-part statement.
    • How to write a Health Promotion-Based Diagnosis (2-Part)
      • Health Promotion (Diagnostic Label) + Signs & Symptoms (Defining Characteristics)
      • [Diagnostic Label] + "as evidenced by" + [Defining Characteristics]
    • Health Promotion-Based Diagnosis Examples:
      • Readiness for Enhanced Chestfeeding as evidenced by the patient stating their desire to exclusively
        breastfeed and requesting information on how to achieve this.
      • Readiness for Enhanced Coping as evidenced by the patient expressing a desire to enhance social
        support and spiritual resources.

Sleep – A Basic Human Need

  • Proper rest and sleep are as important to health as good nutrition and adequate exercise.
  • Without proper amounts of rest and sleep, the ability to concentrate, make judgments, and participate in daily activities decreases, and irritability increases.
  • Patients require individualized approaches based on their personal habits, patterns of sleep, and the particular problem influencing sleep.

Physiology of Sleep

  • Circadian rhythm.
  • Sleep regulation.
  • Regulated by a sequence of physiological states integrated by central nervous system (CNS) activity.
    • Hypothalamus.
    • Reticular activating system (RAS).
    • Homeostatic process.
  • Stages of sleep.
    • Nonrapid eye movement (NREM).
    • Rapid eye movement (REM).
  • Sleep cycle.
    • Pre-sleep period: First 10-30 minutes.
    • Three stages of NREM and REM sleep: 90-110 minutes.
  • The number of sleep cycles depends on the total amount of time that the person spends sleeping.

Functions of Sleep

  • A time of restoration, memory consolidation, and preparation for the next period of wakefulness.
  • Restores biological processes.
  • Protein synthesis and cell division for the renewal of tissues occurs.
  • Dreams
    • Occur in NREM and REM sleep.
    • Important for learning, memory, and adaptation to stress.

Physical Illness

  • Physical illness can cause pain, physical discomfort, anxiety, depression, and sleep disturbances:
    • Respiratory disease.
    • Heart disease, hypertension.
    • Nocturia.
    • Restless leg syndrome (RLS).
    • Gastrointestinal disorders.

Sleep: Healthy People 2030 Priority

  • 67.5% of adults get enough sleep - goal is to increase that percentage to prevent health problems.
  • Health risks associated with inadequate sleep:
    • Obesity.
    • Diabetes.
    • Heart disease.
    • Cancer.
    • Dementia.

Nursing Knowledge Base: Sleep and Rest

  • Rest contributes to:
    • Mental relaxation.
    • Freedom from anxiety.
    • State of mental, physical, and spiritual activity.
  • Bed rest does NOT guarantee that a patient will feel rested!

Normal Sleep Requirements and Patterns

  • The average daily amount of sleep needed, by age, is:
    • Newborns (up to 3 months old): 14 to 17 hours.
    • Infants (4 to 12 months old): 12 to 16 hours, including naptime.
    • Young children (1 to 5 years old): 10 to 14 hours, including naptime.
    • School-aged children (6 to 12 years old): 9 to 12 hours.
    • Teenagers (13 to 18 years old): 8 to 10 hours.
    • Adults (18 years and up): 7 to 9 hours.

Factors Influencing Sleep

  • Drugs and substances.
  • Lifestyle.
  • Usual sleep patterns.
  • Emotional stress.
  • Environment.
  • Exercise and fatigue.
  • Food and caloric intake.

Sleep History Questions to ask patients

  • Description of sleeping problems.
  • Usual sleep pattern.
  • Physical and psychological illness.
  • Current life events.
  • Emotional and mental status.
  • Bedtime routines.
  • Bedtime environment.
  • Behaviors of sleep deprivation.

Health Promotion Activities Related to Sleep

  • Environmental controls.
  • Promoting bedtime routines.
  • Promoting safety.
  • Promoting comfort.
  • Promoting activity.
  • Stress reduction.
  • Bedtime snacks.
  • Pharmacological approaches.

Sleep Deprivation

  • Common symptoms include:
    • Daytime sleepiness.
    • Fatigue.
    • Irritability.
    • Trouble thinking, focusing, and remembering.
    • Headaches.
    • Slowed reaction times.

Health Risks Associated with Inadequate Sleep

  • Obesity
  • Diabetes
  • Heart disease
  • Cancer
  • Dementia
  • There is a U-shaped association between sleep duration and health outcomes: individuals with short (<5 h/d) or long (\geq9 h/d) sleep duration showed a higher risk for metabolic syndrome than those with normal sleep duration (7-8 h/d).

Sleep Case Study: ADPIE

  • Assessment
    • Mr. Murphy says that it’s probably taking him about an hour to get to sleep.
    • On whether he awakens during the night, Mr. Murphy replies, “Are you kidding? No one can sleep around here; something is always going on.”
    • Mr. Murphy estimates he got about 4 hours of sleep the night before. He estimates it as nearly the worst night of sleep he has ever had.
    • At home, Mr. Murphy usually slept from about 10:00 p.m. to 6:30 a.m.
    • He says he rarely had trouble getting to sleep, and his wife says that listening to music helped him relax.
    • Mr. Murphy says that he is having some pain from the osteoarthritis, and he is having trouble changing position and getting comfortable.
    • Mr. Murphy yawns frequently and shifts position in his wheelchair frequently.
  • Diagnosis
    • Examples of nursing diagnoses for patients related to sleep:
      • Inadequate Sleep
      • Fatigue
      • Impaired Sleep
      • Reduced Fatigue
      • Sleep Deprivation
  • Plan
    • Goal Statements:
      • Within 1 week, Mr. Murphy will have fewer than two self-reported awakenings during the night.
      • Within 1 week, Mr. Murphy will report being able to fall asleep within 30 minutes of going to bed.
      • Within 1 week, Mr. Murphy will sleep an average of 7 hours a night.
  • Intervention
    • Environmental controls – Anna will provide a calm, quiet environment in the evening.
    • Promoting comfort – Anna will assist Mr. Murphy with repositioning for comfort.
    • Establishing periods of rest and sleep – Anna will assist Mr. Murphy to establish a sleep schedule.
    • Promoting safety – Anna will remove environmental hazards from sleep area.
    • Stress reduction – Anna will assist Mr. Murphy to remain calm (offer relaxing music before bed).
    • Controlling physiological disturbances – Anna will assist Mr. Murphy to the bathroom prior to bedtime.
    • Pharmacological approaches - Anna will offer pain medication before bedtime.
  • Evaluation
    • After 1 week, Mr. Murphy is falling asleep within 30 minutes of going to bed; he gets up two to three times a night, and he estimates that he gets 6 hours of sleep a night.
    • After 1 week, Anna notes Mr. Murphy is more alert, awake, and talkative during her visits.
    • Goals partially met.

FYI: Harness the Power of Your SLEEP

  • S – Stay on a schedule
  • L – Light – assure you have a dark room to sleep in
  • E – Environment is conducive to sleep, temperature, comfort, turn off electronics an hour before sleep.
  • E – Eat, drink, and think – do not eat a heavy meal prior to bed, drink alcohol before bed, or think about/watch the news.
  • P – Professional support if needed (WONDER weight management program).

Spiritual Health

  • An awareness of one's inner self and a sense of connection to a higher being, nature, or some purpose greater than oneself.
  • Includes personal beliefs that help a person maintain hope and get through difficult situations.
  • The human spirit is powerful, and spirituality has different meanings for different people.
  • Nurses need to be aware of their own spirituality to provide appropriate and relevant spiritual care to others.

Scientific Knowledge Base

  • An individual's intrinsic spirit seems to be an important factor in healing.
  • Healing often takes place because of believing.
  • Spirituality has a positive impact on the ability to cope with anxiety, stress, and depression.
  • A person's inner beliefs and convictions are powerful resources for healing.

Spiritual Health

  • Spiritual health represents a balance.
  • Spiritual health matures with increasing awareness of meaning, purpose, and life values.
  • Spiritual beliefs change as patients grow and develop.

Spiritual Assessment – Community-Based

  • Connectedness
  • Life satisfaction
  • Culture
  • Fellowship and community
  • Ritual and practice
  • Vocation

Potential Nursing Diagnosis Related to Spirituality

  • Risk for Spiritual Distress
  • Spiritual Distress
  • Defective Spiritual Distress
  • Hopelessness
  • Decreased Spiritual Distress

Caring for Yourself!!

  • Eat a nutritious diet.
  • Get adequate sleep.
  • Engage in exercise and relaxation activities.
  • Establish a good work-family balance.
  • Engage in regular non-work activities.
  • Develop coping skills.
  • Allowing personal time for grieving.
  • Focus on spiritual health.
  • Find a mentor/support network.

Healthy People 2030 Health Behaviors

  • Child and Adolescent Development
  • Drug and Alcohol Use
  • Emergency Preparedness
  • Family Planning
  • Health Communication
  • Injury Prevention
  • Nutrition and Healthy Eating
  • Physical Activity
  • Preventive Care
  • Safe Food Handling
  • Sleep
  • Tobacco Use
  • Vaccination
  • Violence Prevention