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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?

3. Offer to come to the client’s home to provide


needed physical care.
4. Contact the client’s spiritual adviser.
5. Inquire how this will affect other aspects of the
client’s life.
6. Provide the client with information about how to
join a support group.
Copyright 2008 by Pearson Education, Inc.
Rationales 1
• 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?

3. His higher level need cannot be met unless the lower


level physiologic need is met.
4. His lower level physiologic needs are being deferred while
higher needs are addressed.
5. The higher need takes precedence and the lower need no
longer must be met.
6. 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.


Rationales 2
• Incorrect.
• Correct. Choices are often related to
learned experiences, lifestyle, and
values. The client obviously values the
business more than physical health.
When a person feels strongly enough, a
lower level need (rest) can be postponed
until a higher level need (success, safety)
is met. It is very likely that no one else
can meet that need for him and the
lower need must still be met eventually.
• Incorrect.
Copyright 2008 by Pearson Education, Inc.
• Incorrect.
Question 3
A client who is 46 pounds overweight tells you, “I was just
born to be fat. I don’t have the willpower.” Although
weight loss occurred while attending two previous
programs that “guaranteed” weight loss, the weight
returned along with extra pounds after each program.
According to the Health Promotion Model, the nurse is
most likely to focus on which of the following behavior-
specific cognitions and affects variable for this client?

4. Perceived barriers to action


5. Perceived self-efficacy
6. Interpersonal influences
7. Situational influences

Copyright 2008 by Pearson Education, Inc.


Rationales 3
• Option 1 is a person’s perceptions about
available time, inconvenience, expense,
and difficulty performing the activity.
• Correct. Perceived self-efficacy is the
confidence the person has for achieving
the desired outcome.
• Option 3 is the person’s perceptions
concerning the behaviors, beliefs, or
attitudes of others.
• Option 4 refers to the person’s
perception of the environment and how it
assists or detracts from the healthy
behavior.
Copyright 2008 by Pearson Education, Inc.
Question 4
A client is admitted for heart failure. The
nurse assesses that the client’s BP is
below normal range and the apical pulse
is 110. The nurse knows that the
increase in the client’s pulse illustrates
which aspect of the client’s homeostatic
mechanism?

3. Compensation
4. Decompensation
5. Self-regulation
6. Equilibrium
Copyright 2008 by Pearson Education, Inc.
Rationales 4
• Correct. 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.
• Decompensation occurs when the
compensatory mechanism is ineffective.
• Self-regulation refers to the homeostatic
mechanisms that come into play
automatically in the healthy person.
• Equilibrium is balance through
adaptation to the environment.
Copyright 2008 by Pearson Education, Inc.
Question 5
Using Maslow’s framework, which statement
characterizes the highest level of need?

3. “Nurse, my pain is severe . . . is it time for my


shot?”
4. “I felt welcomed when I first joined the group
and I look forward to the monthly meetings.”
5. “I’m very proud of receiving the Employee of
the Month award.”
6. “There have been home break-ins with burglary
in our neighborhood. We are thinking of
moving.”

Copyright 2008 by Pearson Education, Inc.


Rationales 5
• This is a physiological need.
• This is a love and belonging need.
• Correct. This is a self-esteem
need.
• This is a safety and security 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, Inc.


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.


Theoretical Frameworks used
in Individual Health Promotion
• Needs Theories
– Maslow
– Kalish
• Developmental Stage Theories

Copyright 2008 by Pearson Education, Inc.


Maslow’s
Hierarchy of Needs
Self
actualization

Self-esteem

Love and belonging

Safety and security

Physiologic

Copyright 2008 by Pearson Education, Inc.


Maslow’s Characteristics of
the Self-actualized Person
• Realistic, sees life clearly, and is
objective
• Judges people correctly
• Has superior perception, is more
decisive
• Has clear notion of right and wrong
• Is usually accurate in predicting
future events
• Understands art, music, politics, and
Copyright 2008 by Pearson Education, Inc.
Maslow’s Characteristics of the
Self-actualized Person
• Possesses humility, listens to others
carefully
• Is highly creative, flexible, spontaneous,
courageous, and willing to make mistakes
• Is open to new ideas
• Is self-confident and has self respect
• Has low degree of self-conflict; personality
is integrated
• Respects self, does not need fame,
possesses a feeling of self control
• Is highly independent, desires privacy
Copyright 2008 by Pearson Education, Inc.
Maslow’s Characteristics of the
Self-actualized Person
• Can appear remote and detached
• Is friendly, loving, and governed
more by inner directives than by
society
• Can make decisions contrary to
popular opinion
• Is problem-centered rather than self-
centered
• Accepts the world for what it is
Copyright 2008 by Pearson Education, 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 “healthy 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.


Health Promotion
• Not disease oriented
• Motivated by personal, positive
approach to wellness
• Seeks to expand positive potential
for health

Copyright 2008 by Pearson Education, Inc.


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.


Types of Health Promotion
Programs
• Health promotion
• Specific protection
• Screening for early detection of
disease

Copyright 2008 by Pearson Education, Inc.


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.


Variables of HPM
• Commitment to a plan of action
• Immediate competing demands and
preferences
• Behavioral outcome

Copyright 2008 by Pearson Education, Inc.


Stages of Health
Behavior Change

Copyright 2008 by Pearson Education, 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, Inc.


Nurse’s Role in
Health Promotion
• Assist clients to develop and choose
health-promoting options
• Guide development of effective
problem-solving 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.


Developing Health
Promotion Plans
• Based on health needs, desires, 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, Inc.


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.


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?

3. Offer to come to the client’s home to provide


needed physical care.
4. Contact the client’s spiritual adviser.
5. Inquire how this will affect other aspects of the
client’s life.
6. Provide the client with information about how to
join a support group.
Copyright 2008 by Pearson Education, Inc.
Rationales 1
• 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?

3. His higher level need cannot be met unless the lower


level physiologic need is met.
4. His lower level physiologic needs are being deferred while
higher needs are addressed.
5. The higher need takes precedence and the lower need no
longer must be met.
6. 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.


Rationales 2
• Incorrect.
• Correct. Choices are often related to
learned experiences, lifestyle, and
values. The client obviously values the
business more than physical health.
When a person feels strongly enough, a
lower level need (rest) can be postponed
until a higher level need (success, safety)
is met. It is very likely that no one else
can meet that need for him and the
lower need must still be met eventually.
• Incorrect.
Copyright 2008 by Pearson Education, Inc.
• Incorrect.
Question 3
A client who is 46 pounds overweight tells you, “I was just
born to be fat. I don’t have the willpower.” Although
weight loss occurred while attending two previous
programs that “guaranteed” weight loss, the weight
returned along with extra pounds after each program.
According to the Health Promotion Model, the nurse is
most likely to focus on which of the following behavior-
specific cognitions and affects variable for this client?

4. Perceived barriers to action


5. Perceived self-efficacy
6. Interpersonal influences
7. Situational influences

Copyright 2008 by Pearson Education, Inc.


Rationales 3
• Option 1 is a person’s perceptions about
available time, inconvenience, expense,
and difficulty performing the activity.
• Correct. Perceived self-efficacy is the
confidence the person has for achieving
the desired outcome.
• Option 3 is the person’s perceptions
concerning the behaviors, beliefs, or
attitudes of others.
• Option 4 refers to the person’s
perception of the environment and how it
assists or detracts from the healthy
behavior.
Copyright 2008 by Pearson Education, Inc.
Question 4
A client is admitted for heart failure. The
nurse assesses that the client’s BP is
below normal range and the apical pulse
is 110. The nurse knows that the
increase in the client’s pulse illustrates
which aspect of the client’s homeostatic
mechanism?

3. Compensation
4. Decompensation
5. Self-regulation
6. Equilibrium
Copyright 2008 by Pearson Education, Inc.
Rationales 4
• Correct. 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.
• Decompensation occurs when the
compensatory mechanism is ineffective.
• Self-regulation refers to the homeostatic
mechanisms that come into play
automatically in the healthy person.
• Equilibrium is balance through
adaptation to the environment.
Copyright 2008 by Pearson Education, Inc.
Question 5
Using Maslow’s framework, which statement
characterizes the highest level of need?

3. “Nurse, my pain is severe . . . is it time for my


shot?”
4. “I felt welcomed when I first joined the group
and I look forward to the monthly meetings.”
5. “I’m very proud of receiving the Employee of
the Month award.”
6. “There have been home break-ins with burglary
in our neighborhood. We are thinking of
moving.”

Copyright 2008 by Pearson Education, Inc.


Rationales 5
• This is a physiological need.
• This is a love and belonging need.
• Correct. This is a self-esteem
need.
• This is a safety and security need.

Copyright 2008 by Pearson Education, Inc.