Basic Nursing: Chapter 27: Health Promotion

Who is Myers, Sweeny, and Witmer?

theorists defined wellness as "a way of life oriented toward optimal health and well-being in which body, mind, and spirit are integrated by the individual to live more fully within the human and natural community;includes lifestyles and habits as components of health and permits people who have been diagnosed with disease to be considered healthy

What does health promotion activities are useful to all individuals, whether well or sick, because?

they encourage optimal function

What are self-care programs?

typically cover nutrition, exercise, stress management, or disease prevention

What is a Pap Smear?

used to detect cellular changes in the cervix

For women, beginning at age 45 years, what choice do they have?

women at average risk for breast cancer should have the choice to start annual breast cancer screening with mammograms

What is wheel of health?

"spokes" of the health wheel represent the dimensions of health: emotional, intellectual, physical, spiritual, social/family, and occupational;level of wellness progresses from the center to the outer part of the wheel; center represents the least amount of wellness, and the outer part represents optimal wellness. If one area of an individual's life is not functioning at optimal level, life will not be as fulfilling as it could be.

What is tertiary prevention?

focuses on stopping the disease from progressing and returning the individual to the pre-illness phase. Rehabilitation is the main intervention during this level

Why should skin cancer screening be done?

-A general survey of the skin using the ABCD criteria is a useful approach for assessing for skin malignancy: Asymmetry, Border irregularity, Color variability, Diameter greater than 6 mm. -Rapidly changing lesions are also associated with an increased risk for cancer. -Any suspicious lesions should be biopsied

What are the lipid screening guidelines?

-Adults aged 20 years or older—Have a fasting lipid panel at least once every 5 years. If total cholesterol is 200 mg/dL or greater—or high-density lipoprotein is less than 40 mg/dL—then frequent monitoring is required. -Children aged 9 to 11 years—Universal screening is recommended, regardless of risk factors for cardiovascular disease -Children aged 2 to 8 years—Screening is recommended if a parent, grandparent, aunt/uncle, or sibling has a history of myocardial infarction, angina, stroke, coronary artery bypass graft/stent/angioplasty, or hyperlipidemia

When should cervical cancer screening begin?

-All women should begin cervical cancer screening at age 21. -Women between the ages of 21 and 29 should have a Pap test every 3 years. They should not be tested for human papillomavirus (HPV) unless it is needed after an abnormal Pap test result. -Women between the ages of 30 and 65 should have both a Pap test and an HPV test every 5 years. This is the preferred approach, but it is also okay to have a Pap test alone every 3 years. -Women older than age 65 who have had regular screenings with normal results should not be screened for cervical cancer. Women who have been diagnosed with cervical pre-cancer should continue to be screened

What are the four broad goals for the U.S. population set by the Healthy People 2020 initiative?

-Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. -Achieve health equity, eliminate disparities, and improve the health of all groups. -Create social and physical environments that promote good health for all. -Promote healthy development and healthy behaviors across every stage of life.

What are some health promotion program types?

-Disseminating Information -Changing Lifestyle and Behavior -Protecting the Environment -Assessing Wellness and Appraising Health Risk -Setting up Health Promotion Programs

What does the My Plate convey?

-Enjoy food but eat less. -Avoid oversized portions. -Make half of the plate fruits and vegetables. -Drink water instead of sugary drinks. -Switch to fat-free or low-fat (1%) milk. -Compare sodium in foods. -Make at least half your grains whole grains.

What are the guidelines for good health?

-Get 30 or more minutes of physical activity most days of the week. -Do strength-building exercises at least twice per week. -Avoid all tobacco use and frequent exposure to secondhand smoke. -Alcohol is not recommended, but if you drink alcohol, limit to one to two drinks in a day. -Get adequate rest, at least 7 to 8 hours of sleep daily for best health. -Eat a nutritious breakfast daily for optimal physical and mental performance. -Choose whole-grain breads and cereals, at least three or more servings/per day. -Eat at least five servings of fruits and vegetables daily. -Limit high-fat meats, whole milk, and butter. Vegetable oils are healthier than oils from animals. -Nuts, such as almonds, contain healthy fats and protect against heart disease. Legumes prevent carbohydrate cravings, prevent metabolic syndrome, provide protein and energy, protect against cancer, and are a source of calcium and other vitamins and minerals. -Maintain a healthy weight by eating well and participating in regular, moderate-intensity physical activity. -Develop effective coping skills and maintain a happy, hopeful outlook. -Maintain good social support and frequent contact with family and friends. -Participate regularly in a faith community or other group that provides meaning, direction, and support in your life. -Be safety conscious; wear safety belts in the car and helmets when biking. -Remain in a monogamous relationship, or always use condoms, or abstain. -Get regular exams, including age/gender-recommended preventive exams.

What are the Health Promotion Models?

-Pender's Health Promotion -Wheel of Wellness -Trans-theoretical Model of Change

Identifying a patient's locus of control is of practical importance for several reasons, why?

-People who feel powerless about preventing illness are least likely to engage in health promotion activities. -People who respond to direction from respected authorities often prefer a health promotion program that is supervised by a healthcare provider. -Clients who feel in charge of their own health are the easiest to motivate toward positive change.

An effective way for you to promote health and wellness to your patients is to be a role model and engage in healthy behaviors yourself. What are some examples?

-Strive to maintain a healthy BMI. Patients are more apt to listen to your counseling about the importance of a normal BMI if you are a good role model. -Do not smoke. -Limit alcohol consumption. -Exercise or engage in other stress-relieving activities such as yoga/meditation. -Eat a well-balanced diet. -Get enough sleep/rest. -Maintain a healthy work/life balance. -Practice preventive medicine (e.g., keep current with health appointments and screenings, annual physicals, dental appointments, and eye exams).

What should be done with telephone counseling?

-When using telephone counseling, set goals and map out the strategy for change just as you would in face-to-face counseling. -Let the client know how and when you can be reached if questions arise. -If you are using the telephone for follow-up counseling, it is best to schedule a time to speak. Having an appointment helps keep the patient accountable to the expected behavior and to reinforce the information.

What is included in the history and physical examination?

-health history -physical examination -laboratory studies -disease-specific studies

What are some things about cigarette smoking?

-percentage of middle and high school students who reported smoking cigarettes in the past month was 7.4% and 25.3%, respectively -electronic cigarettes are the most commonly used products among middle (5.3%) and high school (16%) students -Overall, the percentage of high school students and adults who reported using tobacco products remained stable at 20% to 23%, after declining from 36% in the previous decade. -Men were more likely to be current cigarette smokers than women (24% compared with 18%) -southern United States contains the highest percentage of tobacco users -Smoking as few as three cigarettes/day can increase the risk for cardiovascular disease and increase the risk of infections (pneumonia, active tuberculosis)

What can health education provide?

-self-care strategies, caregiver concerns, or how to be an effective healthcare consumer -Programs may consist of lectures, printed material, billboards, or posters. For example, the accompanying Self-Care box, Teaching Clients How to Prevent Upper Respiratory Infections, might be reproduced and posted in the lounge, restrooms, or locker areas of a worksite during cold and flu season to decrease absenteeism. -Nurses can teach clients how to be effective healthcare consumers, how to interact with healthcare providers, and how to maneuver through the healthcare system.

How is life stress reviewed?

-stressful life change events -daily stresses -hardiness

What are some examples of health behaviors?

-teen pregnancy -abuse of alcohol and illicit drugs -tobacco use -obesity -sedentary lifestyle

What are some common descriptions of health?

-world health organization -jean watson -betty neuman -myers, sweeney, and witmer -synthesis

What are the first 2 assumptions of the health promotion model which the concern is interpersonal environment?

1. Health professionals constitute a part of the interpersonal environment, which exerts influence on persons throughout their life span. 2. Self-initiated reconfiguration of person-environment interactive patterns is essential to behavior change.

What should be taken into consideration when you decide which screening tests to offer to their patients?

1. Different agencies and groups generate different guidelines for type and frequency of screening. For example, the American Cancer Society has different Pap screening recommendations than does the U.S. Preventive Services Task Force; the American Congress of Obstetricians and Gynecologists may have yet another recommendation. 2. Most evidence-based guidelines make use of cost-benefit analysis to arrive at their recommendations. 3. Various third-party payors have different policies regarding the type and frequency of screening for which they will reimburse. 4. Guidelines and recommendations change often.

What are the 3 ways information can be disseminated?

1. Individual level—Teaching a client how to modify his personal dietary intake 2. Group level—Classes offered at the local hospital, prenatal education programs, and work-site programs 3. Community level—A billboard that presents the dangers of smoking, health blogs on the Internet, and health fairs Changing Lifestyle and Behavior These are group-level programs that provide information and offer support for activities such as weight loss, smoking cessation, exercise, nutrition, and stress management. Some include a maintenance program to help sustain the change.

What are health indicators?

1. Physical activity 2. Strength training 3. Not smoking 4. Alcohol use 5. Adequate rest 6. Breakfast daily 7. Whole grains 8. Fruits and vegetables 9. Fats, cholesterol 10. Nuts and legumes 11. Healthy weight 12. Mental health 13. Social support 14. Community 15. Safety 16. Safer sex 17. Regular exams

What are the levels of protection?

1. Primary prevention 2. Secondary prevention 3. Tertiary prevention

Pender and Murdaugh summarized the health promotion process as a series of 9 steps that involve the client and the nurse. What are they?

1. Review and summarize data from assessment. 2. Reinforce the client's strengths and abilities. 3. Identify health goals and related behavioral change options. 4. Identify behavioral or health outcomes that will indicate that the plan has been successful from the client's perspective. 5. Develop a behavior change plan based on the client's preferences, on the stages of change, and on "state-of-the-science" knowledge about effective interventions. 6. Reiterate benefits of change and identify incentives for change from the client's perspective. 7. Address environmental and interpersonal facilitators and barriers to behavior change. 8. Determine a time frame for implementation. 9. Commit to behavior-change goals, and structure the support needed to accomplish them.

What are the 5 assumptions of the health promotion model which are characteristics of people, whom the theorist assumes?

1. Seek to create conditions of living through which they can express their unique human health potential. 2. Have the capacity for reflective self-awareness, including assessment of their own competencies. 3. Value growth in directions viewed as positive and attempt to achieve a personally acceptable balance between change and stability. 4. Seek to actively regulate their own behavior. 5. Interact with the environment in all their bio-psychosocial complexity, progressively transforming the environment and being transformed over time. Pender's model has been used extensively in several disciplines in research and professional practice focused on health promotion. As a nurse, you should find Pender's focus applicable to your work.

What are the 3 general characteristics of the hardy person?

1. control: belief in the ability to control the experience 2. commitment: feeling deeply involved in the activity producing stress 3. challenge: ability to view the change as a challenge to grow

What happens on work-sites?

health clinics within large companies may be contracted to provide specific health promotion programs, such as smoking cessation, stress management, weight reduction, and fitness training. Employers have found that health programs decrease work-related injuries and sick leave

What are the most common sites for health promotion programs?

health facilities, work-sites and schools

For example, a patient hospitalized for a total hip replacement would receive the following. What does primary prevention strategies focus on?

help her after she returns home, for example, limiting her salt intake and eating a balanced diet that is low in fat and refined sugar

For example, a patient hospitalized for a total hip replacement would receive the following. What does Tertiary prevention strategies focus on?

helping her recover from surgery, preventing complications of surgery, and, later on, helping her regain her strength and learn to walk again

What is Pender's Health Promotion Model?

identifies three groups of variables that affect health promotion: (1) individual characteristics and experiences, (2) behavior-specific cognition's and affect, and (3) behavioral outcome

What is synthesis?

Applying aspects of these reflections on health

Why should colon caner screening be done?

Both men and women should have a fecal occult blood test using a multiple stool take-home test every year beginning at age 50 and a screening colonoscopy based on risk factors. If there is a strong family history of colorectal cancer or polyps, screening should begin at an earlier age and be conducted more frequently

What is assessing wellness and appraising health risk?

A wellness assessment tends to focus on the healthy behaviors. It supports positive change to improve health. A health risk appraisal identifies risky behaviors that promote disease. These tools are available on the Internet, in magazines, and at fitness centers.

Why should breast cancer screening be done?

All women should be familiar with how their breasts normally look and feel and report any changes to a healthcare provider right away. Although research does not show a clear benefit for physical breast exams done by either a health professional or by patients for breast cancer screening, women should be encouraged to discuss the risks and benefits of breast self-examination (BSE) and clinical breast exam with their healthcare provider

What is included in health history?

Ask the client about family history of health disorders and cause of death of family members. Keep in mind that the accuracy of reporting is higher for relatives without, rather than those affected by, a given disease. Gather the history directly from the client. As always, provide privacy and comfort while conducting the history and exam.

What does a physical fitness assessment include?

Cardio-respiratory fitness is reflected in the ability to perform large-muscle, moderate- to high-intensity exercise for prolonged periods of time. There are many different modes of testing, such as field tests (walking or running), treadmills, stationary bicycles, and step testing. Results depend on age and gender. Muscular fitness refers to both muscle strength and endurance. Muscle strength is a measure of the amount of weight a muscle (or group of muscles) can move at one time. Muscle endurance refers to the ability of a muscle to perform repeated movements. Flexibility is the ability to move a joint through its range of motion. The most common assessment is to evaluate low back and hip (trunk) flexion.

What is individual counseling?

Contracting-Counseling may include writing a contract detailing the client's expected behaviors. Print out the contract and have the client sign it to reinforce his commitment. Suggest that the client post the plan in a location where he will see it often so that it serves as a frequent reminder. Reinforcing- During counseling sessions, remember to reinforce health-promoting behaviors that have already been established. For example, the client who uses tobacco may eat a balanced diet; reinforce the healthy habit to boost self-esteem. Stress to the client that you believe the client can succeed in making the desired behavior change.

What is protecting the environment?

Environmental control programs promote health by focusing on air and water quality, toxic waste, healthy homes and communities, infrastructure and surveillance, and global environmental health.

What kind of lifestyle changes should be implemented?

For healthy living, adults and teens must choose a lifestyle without tobacco and recreational drugs and with little alcohol. Getting enough sleep and managing stress are also important. In general, adults need 6 to 9 hours of sleep a night. Children need more sleep. Inadequate sleep is linked to weight gain and obesity.

What happens in schools?

Health learning can begin at an early age, and nurses and teachers can regularly reinforce healthy behaviors and redirect unhealthy behaviors. Schools provide a setting that allows for continued exposure to information. Interventions may be directed at general health promotion issues, such as physical activity, or they may focus on specific health risks, such as tobacco and alcohol use. School nurses work closely with teachers and parents to provide health promotion services in the schools.

What happens if exist occurs during or at the end of the maintenance period of the transtheoretical model of change?

If the exit occurs during or at the end of the maintenance period, the behavioral change is successful. If the exit occurs before the end of the maintenance period, relapse will occur, and the individual will return to the previous lifestyle.

What is included in the disease-specific studies?

In clients with known cardiac or pulmonary disease, additional disease-specific studies may be performed ; electrocardiogram, carotid ultrasound, or pulmonary function tests

Why should testicular cancer screening be done?

In spite of the low prevalence of testicular cancer, men should be aware that a lump in the testicle or a feeling of heaviness or swelling in the scrotum could be a sign of testicular cancer and should report these findings to their healthcare provider immediately

Describe teen pregnancy, a health behavior.

Pregnant teenagers are less likely to receive early prenatal care. They are more likely to drop out of school and to live in poverty than are older pregnant women. The birth rate for teenagers aged 15 to 19 years dropped 9% from 2013, to 24.2%, a historic low for the United States.

What is the nurse's role in health promotion?

Primarily is to motivate clients and facilitate change. Clients are independently responsible for most of their health promotion activities. You may need to help them identify goals, but it is essential that the goals be the clients', not yours.

What is included in the laboratory studies?

Recommended lab work depends on the history and exam findings. For most adult clients, a screening lab consists of a complete blood count, comprehensive metabolic panel (also known as a chem 20 panel), lipid panel, thyroid function panel, and urinalysis

What can exercise do?

Regular physical activity each week, sustained for months and years, can produce long-term health benefits including a lower risk for heart disease, stroke, type 2 diabetes, hypertension, high cholesterol, metabolic syndrome, certain types of cancer, and depression. Regular physical activity also prevents weight gain; improves cardiorespiratory and muscular fitness; prevents falls by increasing muscle tone, strength and balance, and promotes better memory and cognition in older adults

Prochaska and DiClemente model identified 6 stages of change: What are they?

Stage 1: In the precontemplation stage there is no intention to change behavior in the foreseeable future, because patients are unaware or underaware of their problems. They do not yet contemplate change. Stage 2: Contemplation—Patients are seriously thinking about overcoming a problem but have not yet made a commitment to take action. Stage 3: Preparation—Individuals are intending to take action in the next month and are reporting some small behavioral changes ("baby steps"). Stage 4: Action—The plan is implemented; this requires considerable commitment of time and energy. Stage 5: Maintenance—Individuals are working to prevent relapse and they grow increasingly more confident that the change can be sustained. Stage 6: The termination stage completes the maintenance. Persons who enter into the termination stage have changed the behavior and are not in danger of relapse.

Why should prostate cancer screening be done?

The U.S. Preventive Services Task Force (USPSTF) recommends against routine prostate-specific antigen (PSA)-based screening for prostate cancer but understands that some patients may request testing. PSA screening should be done only if it includes shared decision making that enables an informed choice by patients. However, healthcare professionals may consider offering the PSA and digital rectal exam (DRE) yearly to men age 50 years and older at risk for prostate cancer and with at least a 10-year life expectancy. If there are risk factors, testing should begin at age 40 to 45 years

What is included in the physical examination?

The level of detail of the physical examination depends on the health history. At a minimum, the exam should include vital signs, weight, body mass index (BMI) or waist circumference, auscultation and palpation of the chest and abdomen, inspection of the skin, and palpation of peripheral pulses.

Describe abuse of alcohol and illicit drugs, a health behavior.

The risk of disease, injuries, and intentional death (suicide and homicide) increases with substance abuse.

What is changing lifestyle and behavior?

These are group-level programs that provide information and offer support for activities such as weight loss, smoking cessation, exercise, nutrition, and stress management. Some include a maintenance program to help sustain the change.

What is disseminating information?

To recognize a problem and understand the options for change, people need information

What is a nutritional assessment?

a key component of an overall wellness assessment; Assessment involves an evaluation of typical eating patterns correlated with physical examination findings and BMI. Body composition is important in identifying health risks. The usual methods for determining body fat composition clinically are by measuring height, weight, circumferences, and skinfolds

What is hardiness?

a quality in which an individual experiences high levels of stress yet does not fall ill

What is primary prevention?

activities are designed to prevent or slow the onset of disease. Examples include eating healthy foods, exercising, wearing sunscreen, obeying seat belt laws, and keeping up with immunizations

What activities does lifestyle include?

activities that promote optimal living, such as taking responsibility for one's health, physical activity, nutrition, interpersonal relations, spiritual growth and stress management

What is counseling?

an interpersonal communication process that helps a client to identify problems and make changes. In the context of health promotion, counseling promotes personal growth and helps clients change their lifestyle; may be formal or informal, one-to-one or a small-group discussion, face-to-face or offered via telephone or online; Each meeting with a client is a potential counseling session

What is health promotion model based on?

based on seven assumptions that reflect both nursing and behavioral science perspectives

What is a health promotion diagnosis?

clinical judgement about a individual's family's group's or community's motivation and desire to increase well being and to actualize health potential

What does health promotion mean?

finding ways to help individuals develop a state of physical, spiritual, and mental well-being

What is World Health Organization?

defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

Health protection is motivated by?

desire to avoid illness

Health promotion is motivated by?

desire to increase well-being

What is the disadvantage of telephone counseling?

does not allow you to detect nonverbal communication

What happens in a health facility?

each interaction between patient and healthcare provider is an opportunity for health promotion. Unfortunately, most interactions focus on the disease process and compliance with treatments. You will need to make a conscious effort to help clients focus on behaviors that prevent illness and promote health.

What is the wellness focus in acute care?

educate patients about both health and disease

What are health beliefs?

embedded in one's culture and personal experiences; culture influences beliefs and practices affecting wellness and disease prevention

What does excessive alcohol do?

increases the risk of harmful health conditions, such as injuries (motor vehicle crashes, falls, drowning), violence, alcohol poisoning, and risky sexual behavior. Over time, excessive alcohol use can lead to the development of chronic diseases; estimated third leading cause of preventable deaths in the United States

What does cigarette smoking increase?

increases the risk of lung cancer, tuberculosis, heart disease, emphysema, and other diseases

What is secondary prevention?

involves screening activities and education for detecting illnesses in the early stages. Examples are breast self-examination, testicular exams, regular physical examinations, blood pressure and diabetes screenings, and tuberculosis skin tests

What is telephone counseling?

may be used as a primary counseling approach or as follow-up; clients with hectic schedules may find it easier to arrange than to schedule a face-to-face interaction.

For example, a patient hospitalized for a total hip replacement would receive the following. What does secondary prevention strategies focus on?

may have been used previously, for example, to screen for osteoporosis that leads to bone fragility and fractures

What is transtheorectical model of change?

may serve to alter unhealthy behaviors. Health promotion and protection involve either changing the individual's response to the illness-producing stimuli or changing the environment so that the person will be less likely to encounter illness-producing stimuli

What are care education programs?

may teach caregivers how to perform nursing tasks or prevent injuries, or they may provide a list of community resources for respite care

What is marijuana?

most commonly used illicit drug in the United States

Who is Betty Neuman?

nurse theorist describes health as an expression of living energy available to an individual; the energy is displayed as a continuum, with high energy (wellness) at one end and low energy (illness) at the opposite end

Who is Jean Watson?

nursing theorist proposed that health consists of three elements: (1) a high level of overall physical, mental, and social functioning; (2) a general adaptive-maintenance level of daily functioning; and (3) the absence of illness (or the presence of efforts that lead to its absence);refers to health as being a state of mind, the perception of the individual

What does group support provide?

opportunity to meet people experiencing the same difficulties and perhaps to find a role model

What is an important predictor of health risks?

pattern of body fat distribution; People with fat stored around the trunk and abdominal area have a higher incidence of metabolic syndrome, hypertension, hyperlipidemia, heart disease, type 2 diabetes, and premature death than do those who have the fat stored in the extremities

What do health promotion programs help?

person advance toward optimal health

What do community and public health nurses focus on what?

problems contributing to disease, such as poor housing conditions, sanitation, and nutrition; poverty and substance abuse

What is health promotion?

process of equipping people to have control over, and to improve, physical, emotional, and social health

What is a health risk appraisal (HRA)?

questionnaire that evaluates risk for disease based on current demographic data, lifestyle, and health behaviors

What is My Plate?

quick, simple reminder to people to be more mindful of the foods they eat; a picture of a plate that is divided into 4 sections: fruits, vegetables, grains and proteins

What is lifestyle?

refers to the manner in which a person conducts his life; physically, emotionally, spiritually and mentality

What increases with obesity?

risk of heart disease, diabetes, and stroke

Health screening activities are?

secondary prevention activities designed to diagnose specific diseases at an early stage so that treatment can begin before the disease can spread or become debilitating

Why should dental health screening be done?

should have regular dental checkups to detect early signs of oral health problems such as tooth decay, gingivitis (gum disease), and oral cancers

What is a role model?

teaches by example, demonstrating the behaviors and/or attitudes to be learned. Models provide inspiration and strategies for health promotion behavior.

It is helpful to know whether health outcomes are a result of actions the person takes, actions of powerful others, or chance. What does locus of control measure?

the person's perception of the extent of control from each source; person rates her level of agreement with statements such as, " I am in control of my health," "No matter what I do, if I am going to get sick, I will get sick" and "regarding my health, I can only do what my doctor tells me to do."

What does exercise reduce?

the risk of disease and enhances mental and physical health