CHAPTER 16

HEALTH PROMOTION
DR. WAJED HATAMLEH
NUR 211
LEARNING OUTCOME 1
Explain the relationship of individuality and holism to nursing practice.

Concepts for Lecture

1. Assessing and planning health care of the client is enhanced when
the nurse understands the concepts of individuality, holism,
homeostasis, and human needs.
2. To help clients attain, maintain, or regain an optimal level of health,
nurses need to understand clients as unique individuals who are
different from every other human being. Nurses need to focus on
both a total care context and an individualized care context. In the
total care context, nurses consider all the principles and areas that
apply when taking care of any client of that age and condition. In the
individualized context, nurses become acquainted with clients as
individuals, using the total care principles that apply to this person at
this time.
3. Nurses are concerned with the individual as a whole, complete, or
holistic person, not as an assembly of parts.
When applied in nursing, the concept of holism emphasizes that
nurses must keep the whole person in mind and strive to understand
how one area of concern relates to the whole person. Nurses must
also consider the relationship of the client to the environment and to
others.

LEARNING OUTCOME 2
List four main characteristics of homeostatic mechanisms.

Concepts for Lecture

1. Homeostasis is the tendency of the body to maintain a state of
balance or equilibrium while constantly changing. Homeostatic
mechanisms have four main characteristics:
• Self-regulation
• Compensatory
• Regulated by negative feedback systems
• May require several feedback mechanisms to correct only one
physiological imbalance

LEARNING OUTCOME 3
Identify theoretical frameworks used in individual health promotion.

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Concepts for Lecture

1. A variety of theoretical frameworks provide the nurse with a holistic
overview of health promotion. Two major theoretical frameworks
that nurses use in promoting health of an individual are needs
theories and developmental stage theories.
In needs theories, human needs are ranked on an ascending scale
according to how essential the needs are for survival. SUGGESTIONS FOR CLINICAL ACTIVITIES
Maslow (1970) ranked human needs on five levels in ascending • Have the students prioritize the nursing
diagnoses for their assigned clients using
order: physiological, safety and security, love and belonging, self- Maslow’s hierarchy of needs.
esteem, and self-actualization.
Human needs serve as a framework for assessing behaviors,
assigning priorities to desired outcomes, and planning nursing
interventions.
Developmental stage theories categorize a person’s behavior or
tasks into approximate age ranges or in terms that describe the
features of an age group.
These theories allow nurses to describe typical behaviors of an
individual within a certain age group, explain the significance of
those behaviors, predict behaviors that might occur in a given
situation, and provide a rationale to control behavioral
manifestations.

LEARNING OUTCOME 4
Identify Maslow’s characteristics of the self-actualized person.

Concepts for Lecture

1. The self-actualized person has the following characteristics
• Is realistic, sees life clearly, and is objective about his or her
observations
• Judges people correctly
• Has superior perception, is more decisive
• Has a clear notion of right and wrong
• Is usually accurate in predicting future events
• Understands art, music, politics, and philosophy
• Possesses humility, listens to others carefully
• Is dedicated to some work, task, duty, or vocation
• Is highly creative, flexible, spontaneous, courageous, and willing
to make mistakes
• Is open to new ideas
• Is self-confident and has self-respect
• Has a 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
• 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
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LEARNING OUTCOME 5
Describe the vision, mission and goals of Healthy People 2020 and the
development process for specific objectives to help improve the health of a
community.

Concepts for Lecture

1. Healthy People 2020 presents a comprehensive 10-year strategy for
promoting health and preventing illness, disability, and premature
death.
Its two major goals are to increase quality and years of healthy
life and to eliminate health disparities.
2. To support these goals, Healthy People 2020 is organized around 28
focus areas to improve health (see Box 16–2). It also establishes a
set of leading health indicators that reflect the major public health
concerns in the United States at the beginning of the 21st century
(see Box 16–3).
It is expected that these indicators will help develop action plans
to improve the health of both individuals and communities.
The foundation for Healthy People 2020 is the belief that
individual health is closely linked to community health and the
reverse; thus the vision for Healthy People 2020 is “Healthy People
in Healthy Communities.”
As a result, partnerships are important to improve individual and
community health. Businesses, local government, and civic,
professional, and religious organizations can all participate.

LEARNING OUTCOME 6
Differentiate health promotion from health protection or illness prevention.
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Concepts for Lecture

1. Considerable differences appear in the literature regarding the use of
the terms health promotion, health protection, and illness
prevention. The individual’s motivation for the behavior is the major

difference.
2. Health promotion is not disease oriented. It is motivated by a
personal, positive approach to wellness, and seeks to expand positive
health potential.
3. Health protection/illness prevention is illness or injury specific, is
motivated by avoidance of illness, and seeks to thwart the occurrence of
insults to health and well-being

LEARNING OUTCOME 7
Identify various types and sites of health promotion programs.

Concepts for Lecture

1. Health promotion programs are found in many settings. They may be
offered to individuals and families in the home or in the community
setting and at schools, hospitals, or worksites.
The type of program depends on the current concerns and the
expertise of the sponsoring department or group.
For example, the local health department may offer a town-wide
immunization program, the fire department may disseminate fire
prevention information, and the police may offer a bicycle safety
program for children, or a safe-driving campaign for young adults.
Programs offered by health care organizations initially began
with a specific focus on prevention such as infection control or fire
prevention and gradually expanded to include issues related to
employee health and lifestyle such as smoking cessation and
exercise. Increasingly, hospitals have offered a variety of these
programs to the community.
School health promotion programs may serve as a foundation
for children of all ages to gain basic knowledge about personal
hygiene and issues in the health science providing a cost-effective
and convenient setting for health-focused programs. The school
nurse may teach programs about basic nutrition, dental care, activity
and play, drug and alcohol abuse, for example. Classroom teachers
may include health-related topics in their lesson plans.
Worksite programs for health promotion have developed out of
the need for businesses to control the rising cost of health care and
employee absenteeism. Worksite programs may include health
promotion programs that affect all employees such as air quality
standards for the office or plant; programs aimed at specific
populations, such as accident prevention for the machine worker;
screening programs such as blood pressure screening; or health
enhancement programs, such as fitness information and relaxation
techniques.

LEARNING OUTCOME 8
Discuss the Health Promotion Model.
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Concepts for Lecture

1. The Health Promotion Model (revised) (HPM) is a competence or
approach-oriented model in which the motivational source for
behavior change is based on the individual’s subjective value of the
change—that is, how the client perceives the benefits of changing
the given health behavior (see Figure 16–4).
2. There are a number of variables in this model: individual
characteristics and experiences, behavior-specific cognitions and
affect, commitment to a plan of action, immediate competing
demands and preferences, and behavioral outcomes.
Individual characteristics and experiences include personal
SUGGESTIONS FOR CLINICAL ACTIVITIES
factors and prior related experiences. Some personal factors,
• Have the students discuss the pros and cons of
categorized as biological, psychological, and sociocultural, can be fear as a motivating factor for behavior
changed and others cannot. Nursing intervention usually focuses on change.
factors that can be modified; however, it can be just as important to
focus on factors that cannot be changed, such as family history.
Prior health-related behavior includes previous experience,
knowledge, and skill in health-promoting behavior. Individuals who
made a habit of previous health-promoting behaviors and received a
positive benefit as a result will engage in future health-promoting
behaviors in contrast to those persons with a history of barriers to
achieving the behavior.
Behavior-specific cognitions and affect include a set of variables
that is of major motivational significance for acquiring and
maintaining health-promoting behaviors that can be modified
through nursing interventions. These variables include perceived
benefits of action, perceived barriers to action, perceived self-
efficacy, activity-related affect, interpersonal influences, and
situational influences.
Commitment to action includes specifying strategies for
carrying out and reinforcing the behavior.
Immediate competing demands and preferences can interfere
with carrying out the plan to change behavior. A competing demand
is a behavior over which an individual has a low level of control.
Not responding to this demand may cause a more negative outcome
than not performing the health-promoting behavior.
Competing preferences are behaviors over which an individual
has a high level of control; however, this control depends on the
individual’s ability to be self-regulating or to not “give in.”
The health-promoting behavior is the outcome of the HPM and
is directed toward obtaining positive health outcomes for the client.

LEARNING OUTCOME 9
Discuss the nurse’s role in health promotion.

Concepts for Lecture

1. The nurse’s role in health promotion includes:
• Model healthy lifestyle behaviors and attitudes.
• Facilitate client involvement in the assessment, implementation,
and evaluation of health goals.
• Teach clients self-care strategies to enhance fitness, improve
nutrition, manage stress, and enhance relationships.
• Assist clients, families, and communities to increase their levels of
health.
• Educate clients to be effective health care consumers.
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• Assist clients, families, and communities to develop and choose

health-promoting options.
• Guide clients’ development in 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.

LEARNING OUTCOME 10
Describe components of health assessment that pertain to health promotion.

Concepts for Lecture

1. Plans for health promotion are based on a thorough assessment of
the individual’s health status.
Components of this assessment are the health history and
physical examination, physical fitness, lifestyle, spiritual health,
social support system, and health risk assessments, health beliefs
review, and life-stress review.

LEARNING OUTCOME 11
Discuss nursing diagnosis, planning, implementing, and evaluating as they
relate to health promotion.

Concepts for Lecture

1. Health promotion plans need to be developed according to the needs,
desires, and priorities of the client. The client decides on goals,
activities, or interventions to achieve these goals, the frequency and
duration of the activities, and the method of evaluation. Another
essential aspect of planning is identifying support resources
available to the client.
2. Implementing is the “doing” part of the behavior change. Self-
responsibility is emphasized. Nursing interventions may include
supporting, counseling, facilitating, teaching, consulting, enhancing
the behavior change, and modeling (see Figure 16–6).
3. Evaluating takes place on an ongoing basis, both during the
attainment of short-term goals and after the completion of long-term
goals.
During evaluation, the client may decide to continue with the
plan, reorder priorities, change strategies, or revise the health
protection/health promotion contract. Evaluation of the plan is a
collaborative effort between the nurse and the client.
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