Chapter

16

Health Promotion

Kozier & Erb's Fundamentals of Nursing, 8e Berman, Snyder, Kozier, Erb Copyright 2008 by Pearson Education, Inc.

Question 1
A nurse and a primary care provider inform a client that chemotherapy is recommended for the diagnosis of cancer. Which of the following nursing actions is most representative of the concept of holism? 1. 2. 3. 4. Offer to come to the client¶s home to provide needed physical care. Contact the client¶s spiritual adviser. Inquire how this will affect other aspects of the client¶s life. Provide the client with information about how to join a support group.
Copyright 2008 by Pearson Education, Inc.

Rationales 1
1. 2. 3. 4. Although arranging for home care may be appropriate, the nurse begins a holistic approach to care by examining, with the client, in what ways the illness influences the various segments of her life. Although facilitating spirituality, may be appropriate, the nurse begins a holistic approach to care by examining, with the client, in what ways the illness influences the various segments of her life. Correct. Holism implies consideration of all aspects of the client¶s life. The client is the best source of information regarding personal needs. Assessment should always precede intervention. Although offering coping resources may be appropriate the nurse begins a holistic approach to care by examining, with the client, in what ways the illness influences the various segments of her life.

Copyright 2008 by Pearson Education, Inc.

Question 2
While hospitalized a client is very worried about business activities. The client spends a great deal of time on the phone and with colleagues instead of resting. Which of the following principles of need therapy applies? 1. 2. 3. 4. His higher level need cannot be met unless the lower level physiologic need is met. His lower level physiologic needs are being deferred while higher needs are addressed. The higher need takes precedence and the lower need no longer must be met. It is necessary for someone else to meet his higher level needs so he can focus on the lower level need.

Copyright 2008 by Pearson Education, Inc.

The client obviously values the business more than physical health. a lower level need (rest) can be postponed until a higher level need (success. Incorrect. Copyright 2008 by Pearson Education. 2. Correct. safety) is met. Inc. It is very likely that no one else can meet that need for him and the lower need must still be met eventually. 4. Incorrect. . 3. When a person feels strongly enough. lifestyle.Rationales 2 1. Choices are often related to learned experiences. and values. Incorrect.

the weight returned along with extra pounds after each program. Perceived barriers to action Perceived self-efficacy Interpersonal influences Situational influences Copyright 2008 by Pearson Education.´ Although weight loss occurred while attending two previous programs that ³guaranteed´ weight loss. 4. Inc. I don¶t have the willpower.Question 3 A client who is 46 pounds overweight tells you. . 3. According to the Health Promotion Model. ³I was just born to be fat. 2. the nurse is most likely to focus on which of the following behavior-specific cognitions and affects variable for this client? 1.

Correct. Option 4 refers to the person¶s perception of the environment and how it assists or detracts from the healthy behavior. or attitudes of others. Inc. 3. 2. Option 1 is a person¶s perceptions about available time. Copyright 2008 by Pearson Education. beliefs. inconvenience. expense. and difficulty performing the activity. 4. . Perceived self-efficacy is the confidence the person has for achieving the desired outcome. Option 3 is the person¶s perceptions concerning the behaviors.Rationales 3 1.

The nurse assesses that the client¶s BP is below normal range and the apical pulse is 110. . Compensation Decompensation Self-regulation Equilibrium Copyright 2008 by Pearson Education. Inc. The nurse knows that the increase in the client¶s pulse illustrates which aspect of the client¶s homeostatic mechanism? 1. 3.Question 4 A client is admitted for heart failure. 2. 4.

Inc.Rationales 4 1. The compensatory mechanism of increasing the heart rate is the body¶s way of trying to balance an ineffective cardiac output since the BP has decreased. . 2. 3. 4. Equilibrium is balance through adaptation to the environment. Decompensation occurs when the compensatory mechanism is ineffective. Self-regulation refers to the homeostatic mechanisms that come into play automatically in the healthy person. Copyright 2008 by Pearson Education. Correct.

´ ³There have been home break-ins with burglary in our neighborhood. is it time for my shot?´ ³I felt welcomed when I first joined the group and I look forward to the monthly meetings. ³Nurse. which statement characterizes the highest level of need? 1. my pain is severe . We are thinking of moving.´ Copyright 2008 by Pearson Education. . 4. .´ ³I¶m very proud of receiving the Employee of the Month award.Question 5 Using Maslow¶s framework. 2. . 3. Inc.

This is a safety and security need. 3. . This is a physiological need. 2. Correct.Rationales 5 1. 4. Inc. This is a self-esteem need. This is a love and belonging need. Copyright 2008 by Pearson Education.

Inc. .Assessing and Planning Health Care ‡ Enhanced when nurses understand: ± Individuality ± Holism ± Homeostasis ± Human needs Copyright 2008 by Pearson Education.

Individuality ‡ Each individual is a unique being ‡ Focus on total care and individualized care context ‡ Total care context considers all the principles that apply when taking care of any client ‡ Individualized care context means using the total care principles that apply to the person at this time Copyright 2008 by Pearson Education. Inc. .

Holism ‡ Concerned with the individual as a whole. not as an assembly of parts ‡ Strive to understand how one area of concern relates to the whole person ‡ Consider the relationship of individuals to the environment and to others Copyright 2008 by Pearson Education. Inc. .

Characteristics of Homeostatic Mechanisms ‡ ‡ ‡ ‡ Self-regulatory Compensatory Regulated by negative feedback systems Feedback mechanisms Copyright 2008 by Pearson Education. Inc. .

Inc.Theoretical Frameworks used in Individual Health Promotion ‡ Needs Theories ± Maslow ± Kalish ‡ Developmental Stage Theories Copyright 2008 by Pearson Education. .

.Maslow¶s Hierarchy of Needs Copyright 2008 by Pearson Education. Inc.

. and is objective Judges people correctly Has superior perception.Maslow¶s Characteristics of the Self-actualized Person ‡ ‡ ‡ ‡ ‡ Realistic. and philosophy Copyright 2008 by Pearson Education. sees life clearly. music. is more decisive Has clear notion of right and wrong Is usually accurate in predicting future events ‡ Understands art. Inc. politics.

. possesses a feeling of self control ‡ Is highly independent. courageous. personality is integrated ‡ Respects self. Inc. and willing to make mistakes ‡ Is open to new ideas ‡ Is self-confident and has self respect ‡ Has low degree of self-conflict. desires privacy Copyright 2008 by Pearson Education. does not need fame. spontaneous. listens to others carefully ‡ Is highly creative.Maslow¶s Characteristics of the Self-actualized Person ‡ Possesses humility. flexible.

Inc. loving. . and governed more by inner directives than by society ‡ Can make decisions contrary to popular opinion ‡ Is problem-centered rather than selfcentered ‡ Accepts the world for what it is Copyright 2008 by Pearson Education.Maslow¶s Characteristics of the Self-actualized Person ‡ Can appear remote and detached ‡ Is friendly.

Inc. .Healthy People 2010 ‡ Two major goals are: ± To increase quality and years of healthy life ± To eliminate health disparities Copyright 2008 by Pearson Education.

. Inc.Healthy People 2010 ‡ Organized around 28 focus areas to improve health ‡ Establishes a set of leading health indicators reflecting public health concerns ‡ Indicators will help develop action plans to improve the health of both individuals and communities ‡ Individual health closely linked to community health and reverse ‡ Vision is ³healthy people in healthy communities´ Copyright 2008 by Pearson Education.

Inc.Health Promotion and Health Protection/Illness Prevention The difference is the individual¶s motivation for behavior Copyright 2008 by Pearson Education. .

. Inc. positive approach to wellness ‡ Seeks to expand positive potential for health Copyright 2008 by Pearson Education.Health Promotion ‡ Not disease oriented ‡ Motivated by personal.

.Health Protection/Illness Prevention ‡ Illness or injury specific ‡ Motivated by avoidance of illness ‡ Seeks to thwart the occurrence of insults to health and well-being Copyright 2008 by Pearson Education. Inc.

. Inc.Types of Health Promotion Programs ‡ Health promotion ‡ Specific protection ‡ Screening for early detection of disease Copyright 2008 by Pearson Education.

Sites of Health Promotion Programs ‡ Various settings for programs: ± In home ± Community ± Schools ± Health care organizations ± Worksites Copyright 2008 by Pearson Education. . Inc.

.Health Promotion Model (HPM) Link to HPM Figure ‡ Competence or approach-oriented model ‡ Motivational source for behavior changes based on individual¶s subjective value of the change Copyright 2008 by Pearson Education. Inc.

Variables of HPM ‡ Individual characteristics and experiences ± Prior related behaviors ± Personal factors ‡ Behavior-specific cognitions and affect ± ± ± ± ± ± Perceived benefits of action Perceived barriers to action Perceived self-efficacy Activity-related affect Interpersonal factors Situational influences Copyright 2008 by Pearson Education. Inc. .

. Inc.Variables of HPM ‡ Commitment to a plan of action ‡ Immediate competing demands and preferences ‡ Behavioral outcome Copyright 2008 by Pearson Education.

Stages of Health Behavior Change Copyright 2008 by Pearson Education. Inc. .

Inc.Stages of Health Behavior Change Link to Stages Diagram ‡ Precontemplation ‡ Contemplation ‡ Preparation ‡ Action ‡ Maintenance ‡ Termination Copyright 2008 by Pearson Education. .

Inc.Nurse¶s Role in Health Promotion ‡ ‡ ‡ ‡ ‡ Model healthy lifestyle Facilitate client involvement Teach self-care strategies Assist clients to increase levels of health Educate clients to be effective health care consumers Copyright 2008 by Pearson Education. .

Nurse¶s Role in Health Promotion ‡ Assist clients to develop and choose health-promoting options ‡ Guide development of effective problemsolving and decision-making ‡ Reinforce clients¶ personal and family health-promoting behaviors ‡ Advocate in the community for changes that promote a healthy environment Copyright 2008 by Pearson Education. Inc. .

.Assessment of Health ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ ‡ Health history Physical examination Physical fitness assessment Lifestyle assessment Spiritual health assessment Social support system review Health risk assessment Health beliefs review Life-stress review Copyright 2008 by Pearson Education. Inc.

desires. . Inc.Developing Health Promotion Plans ‡ Based on health needs. and priorities of the client ‡ Client decides on: ± Goals ± Activities or interventions to achieve these goals ± Frequency and duration of activities ± Method of evaluation Copyright 2008 by Pearson Education.

Implementing Health Promotion Plans ‡ Emphasis on self responsibility ‡ Nursing interventions include: ± Supporting ± Counseling ± Facilitating ± Teaching ± Consulting ± Enhancing the behavior change ± Modeling Copyright 2008 by Pearson Education. . Inc.

Evaluating Health Promotion Plans ‡ Ongoing ‡ Collaborative effort ‡ Client actions may include: ± Continue the plan ± Reorder priorities ± Change strategies ± Revise the contract Copyright 2008 by Pearson Education. Inc. .

Inquire how this will affect other aspects of the client¶s life. 4. 2. Which of the following nursing actions is most representative of the concept of holism? 1. . Contact the client¶s spiritual adviser. 3. Provide the client with information about how to join a support group. Copyright 2008 by Pearson Education. Inc. Offer to come to the client¶s home to provide needed physical care.Question 1 A nurse and a primary care provider inform a client that chemotherapy is recommended for the diagnosis of cancer.

2. . Holism implies consideration of all aspects of the client¶s life. in what ways the illness influences the various segments of her life. the nurse begins a holistic approach to care by examining. Although facilitating spirituality.Rationales 1 1. The client is the best source of information regarding personal needs. with the client. 4. Inc. in what ways the illness influences the various segments of her life. with the client. Assessment should always precede intervention. in what ways the illness influences the various segments of her life. the nurse begins a holistic approach to care by examining. Although arranging for home care may be appropriate. Copyright 2008 by Pearson Education. with the client. Although offering coping resources may be appropriate the nurse begins a holistic approach to care by examining. may be appropriate. 3. Correct.

4. Inc. 2. The client spends a great deal of time on the phone and with colleagues instead of resting. His higher level need cannot be met unless the lower level physiologic need is met. The higher need takes precedence and the lower need no longer must be met. Which of the following principles of need therapy applies? 1. 3. . Copyright 2008 by Pearson Education. His lower level physiologic needs are being deferred while higher needs are addressed. It is necessary for someone else to meet his higher level needs so he can focus on the lower level need.Question 2 While hospitalized a client is very worried about business activities.

When a person feels strongly enough. and values. 4. Copyright 2008 by Pearson Education. 3. lifestyle. The client obviously values the business more than physical health. a lower level need (rest) can be postponed until a higher level need (success. Incorrect. Inc. It is very likely that no one else can meet that need for him and the lower need must still be met eventually. Incorrect. safety) is met. Correct. 2. . Choices are often related to learned experiences. Incorrect.Rationales 2 1.

Perceived barriers to action Perceived self-efficacy Interpersonal influences Situational influences Copyright 2008 by Pearson Education. the nurse is most likely to focus on which of the following behavior-specific cognitions and affects variable for this client? 1. . 2. 4. 3.´ Although weight loss occurred while attending two previous programs that ³guaranteed´ weight loss. According to the Health Promotion Model. I don¶t have the willpower. the weight returned along with extra pounds after each program.Question 3 A client who is 46 pounds overweight tells you. ³I was just born to be fat. Inc.

or attitudes of others.Rationales 3 1. 2. expense. Option 3 is the person¶s perceptions concerning the behaviors. beliefs. Perceived self-efficacy is the confidence the person has for achieving the desired outcome. 3. Copyright 2008 by Pearson Education. Correct. Option 4 refers to the person¶s perception of the environment and how it assists or detracts from the healthy behavior. inconvenience. . 4. Inc. and difficulty performing the activity. Option 1 is a person¶s perceptions about available time.

. The nurse assesses that the client¶s BP is below normal range and the apical pulse is 110. Inc. 3.Question 4 A client is admitted for heart failure. 4. Compensation Decompensation Self-regulation Equilibrium Copyright 2008 by Pearson Education. The nurse knows that the increase in the client¶s pulse illustrates which aspect of the client¶s homeostatic mechanism? 1. 2.

Equilibrium is balance through adaptation to the environment. The compensatory mechanism of increasing the heart rate is the body¶s way of trying to balance an ineffective cardiac output since the BP has decreased. 2.Rationales 4 1. Inc. Decompensation occurs when the compensatory mechanism is ineffective. Correct. 3. Self-regulation refers to the homeostatic mechanisms that come into play automatically in the healthy person. Copyright 2008 by Pearson Education. . 4.

2. . 3.Question 5 Using Maslow¶s framework. ³Nurse. is it time for my shot?´ ³I felt welcomed when I first joined the group and I look forward to the monthly meetings.´ ³I¶m very proud of receiving the Employee of the Month award. 4. .´ Copyright 2008 by Pearson Education. my pain is severe . We are thinking of moving. . which statement characterizes the highest level of need? 1.´ ³There have been home break-ins with burglary in our neighborhood. Inc.

Correct. Copyright 2008 by Pearson Education. 3. This is a self-esteem need. This is a safety and security need. . 2. This is a love and belonging need. 4. Inc. This is a physiological need.Rationales 5 1.

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