NUR230 Health and Wellness

Robert Louis Stevenson on health

"It is not a matter of holding good cards; it's playing a poor hand well."

Hippocrates

(~400 BCE) scientific approach to resolving illness; health as equilibrium btn mind, body; incorporation of social, environmental, mental, and physical factors for treatment of whole person

20th Century

-2 world wars: medical model emphasized treatment of infectious disease (typhoid, TB, GC) -Scientific, economic, and sociopolitical forces propelled health care reform Healthy mother and infant programs Stock market crash, Great Depression New Deal & Social Security Act Universal health care in Canada Post WWII: new drugs, diagnostic methods, treatment regimes: e.g. penicillin, vaccines, surgical procedures ↑ Morbidity/mortality related to lifestyle, e.g. CV disease r/t smoking, obesity, sedentary lifestyle Escalating health care costs Health-For -All Goal (U.S. 1990; now HP 2020)

Health: mind-body-spirit connection

-Balance: unity and integration of body, mind, soul, and spirit -Imbalance -> illness/disease -Ability to adapt and respond to changes in the internal and external environment to achieve balance and maintain homeostasis or equilibrium -Quality of life

Internal environment factors

-Biophysical: genetic makeup, sex, age, and developmental level all significantly influence a person's health. -Psychological: emotional factors influencing mind-body interactions and self-concept. -Cognitive: include lifestyle choices and spiritual and religious beliefs, e.g., poor dietary choices; high risk activities without corresponding protection

external environment factors

-Events, influences, & responses influencing health , e.g., air, water, light, cleanliness, sanitation, safety of community, politics & public policy; zip code -Standards of living. Reflecting occupation, income, and education. -Family and cultural beliefs. Patterns of daily living and lifestyle to offspring( children). -Social support networks. Family, friends, or confidant (best friend); job satisfaction

21st Century

-Health care cost containment -Demographics: aging "boomers," increased life expectancy -Increasing population of under/uninsured -Health disparities among minorities, aggregate groups -Expanding professional opportunities for health promotion, especially by nurses, e.g. nurse managed health centers; NPs; nursing & health related research -Affordable Care Act (2010)

Health Promotion

-Highly prioritized responsibility for nurses to the public -Integral to nursing practice and essential in helping to define nursing as a profession -Reflected in nursing's metaparadigm, which helps in understanding the meaning of and categories of knowledge for nursing

Hx of Health Promotion

-Little understood about anatomy or physiology of the body -Illness and healing attributed to supernatural or spiritual forces -Knowledge & use of health and technology interwoven with values, attitudes, and ideology of society

Assumptions (Beliefs) of Health Promotion in Nursing Practice

-People are self-directed (autonomous; abstract and critical thinkers), and their health behaviors have long-lasting effects -Environment (internal and external) influences quality of health and of life -People capable of learning, adapting, and changing -Biopsychosocial beings who communicate and interact with others to enhance health

concepts of metaparadigm

-Person (recipient of nursing care: patient, family, group, community, population) -Health (processes and determinants of wellness, illness, disease) -Environment (internal, external to Person) -Nursing (goals, roles, interventions)

Florence Nightingale 1820-1910

-care for the sick and the well: influenced health reform, health policy, and statistics -Lobbied to improve housing, sanitation, nutrition, physical fitness and recreation -Health as a continuum

Health Promotion (2nd definition)

-fosters physical and emotional well-being so people can increase their length and quality of life -process of empowering people to make healthy lifestyle choices and motivating them to improve their self-care

Health Promotion (WHO, 1986)

...enabling people to live healthy lifestyles by building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services

Medicare:

65 & older; people with disabilities on SS, clients with end-stage renal disease

Canada health Act (1984):

Accountability to public Accessibility of HC Comprehensive services Universality Portability

Egypt: (hx)

Disease prevention through personal hygiene and sanitation Stringent regulations re cleanliness, food, drink, exercise, & sexual relations

care for the sick and the well: influenced health reform, health policy, and statistics Lobbied to improve housing, sanitation, nutrition, physical fitness and recreation Health as a continuum

Florence Nightingale

Rome (hx)

Health Promotion exercise, massage, and therapeutic baths Luxurious indulgence versus purposeful health promotion; dependent on who they conquered and what they knew about health; strong focus on public health: sanitation, street cleaning, construction, ventilation, heating, etc.

World Health Organization 1948

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

ANA (2010)

Health is an experience that is often expressed in terms of wellness and illness, and may occur in the presence or absence of illness or injury.

American Nurses Association (1980)

Health is...a dynamic state of being in which the developmental and behavioral potential of an individual is realized to the fullest extent possible

World Health Organization (WHO) 1986

Health is...a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities

Approaches to Health Maintenance

Health promotion Health protection Disease and injury prevention

- health reformer; care of the vulnerable children, the poor, immigrants, the sick; school nursing -introduction of health insurance via Metropolitan Life -Visiting Nurse Service of New York

Lillian Wald

U.S. Health Care Reform

Medicare and Medicaid Affordable Care Act Office of Disease Prevention and Health Promotion Expanding roles for nurses

Jewish people (hx)

Mosaic Code—organized system for food preparation, hygiene, quarantine of those believed to have a communicable disease

ANA 2010

Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.

5 Major Health Determinant Categories HP 2020

Policy making Social factors Health services Individual behavior Biology and genetics

Nurse's Role

Promote health, protect health, maintain health, prevent illness in ways that are planned, evidence-based, and holistic in perspective

ANA (2015) Code of Ethics provision 5

The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, to preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.

ANA (2015) Code of Ethics provision 2

The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population.

What is health promotion?

The process of enabling people to increase control over, and to improve, their health (WHO, 1986) a planned combination of educational, political, regulatory, community and organizational supports for actions and conditions of living that contribute to the health of individuals, groups, or communities

Abrevation for World health organization

WHO

Health (present)

Wellness and quality of life

History of H & W: Early Greece (name gods also)

Worship of gods and goddesses signifying importance of health, exercise, hygiene, and nutrition Apollo - god of health Asclepius - god of healing Hygeia - goddess of health, hygiene, cleanliness Panacea - goddess of cures and panaceas; restored health

What is illness?

a personal state in which the individual's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished.

Wellness (extended definition)

a state of optimal well-being oriented toward maximizing an individual's potential; a life-long process of moving towards enhancing one's physical, intellectual, emotional, social, spiritual, and environmental well-being

Health (Past)

absence of disease

Wellness

active,optimal health

What is disease?

an alteration in body functions resulting in a change or reduction of capacities or shortening of the normal life span.

Health

an ideal state of physical and mental wellbeing: something to strive for but never fully attained

Overarching themes of HP:

any endeavor directed at enhancing the quality of health and wellbeing of individuals, families, groups, communities, and/or nations through strategies involving supportive environments, coordination of resources, and respect for personal choice and values

Pasteur

bacteria killed thru heat -> milk pasteurization

Belonging

being part of a whole

What is your attitude toward health?

can-do passive defeatist fate

Lister:

cleanliness and sterilization in surger

Early-America

colonization with survival of fittest against nature; sparse populations

China (hx)

emphasis on health as harmony between yin and yang, principle of contradictory but complementary opposites Yin - femaleness, neg energy, destruction, moon, completion, cold, darkness, death Yang - maleness, pos energy, the sun, creation, heat, light, heaven, dominance

What environmental factors influence health?

external and internal environment

Disease & Injury Prevention

focused on strategies that reduce the risk of disease or injury, identify risk factors, or detect and manage disease in its early, most treatable stages

Nightingale:

fresh air, light, nutrition, sanitation, fitness, recreation for well and sick people

Dunn (1980):

functioning to one's maximum potential while maintaining balance and a purposeful direction in the environment

metaparadigm

global perspective of nursing:

Becoming:

growing and developing

Semmelweis

handwashing as means to prevent infection

Middle Ages

health promotion stalled; focus on health came through religious institutions, with emphasis on purity of the soul & suppression of science; illness perceived as divine punishment for sin

Crusades:

healthy warriors needed to fight holy wars; concern for health re-emerged

Acute illness

is typically characterized by severe symptoms of relatively short duration.

Chronic illness

lasts for an extended period, usually 6 months or longer, and sometimes duration of a person's life; can be acquired or congenital

Befitting

making choices to benefit oneself for the future

Publicly funded health care

medicare, medicaid, Canada health act

paradigm

pattern or model; perspective

Marie & Pierre Curie

radium

Epidemiology

re'ship of disease, environment, individual, and community

Renaissance

return to science Des Cartes - separation of mind from body (contrary to Hippocratic holistic view of health & illness) Responsibility of society for public health and welfare

Maslow's Hierarchy of Needs

self actualization esteem needs belongingness and love needs safety needs psychological needs

Medicaid:

share of payment by state to healthcare agencies for poor, medically needy, aged, disabled, with their dependent children and families

Koch:

specific infectious diseases (anthrax, TB, vibrio cholera)

etiology

the cause of disease

Being: (dunn cont'd)

what makes a person separate and individual

Roentgen:

x-rays