Chapter 6

Health and Wellness

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 Healthy People Documents

 Healthy People: The Surgeon General’s Report

on Health Promotion and Disease Prevention,
1979
 Healthy People 2000: National Health Promotion
and Disease Prevention Objectives
 Healthy People 2010
 Healthy People 2020

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 Healthy People Documents (Cont.)

 Healthy People 2020 Goals

 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 quality of life, healthy development, and
healthy behaviors across all life stages

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 Case Study

 Jack is a 59-year-old man with a history of type

2 diabetes, hypertension, and obesity. He is
married and works 50 to 60 hours per week in a
computer technology position.
 His wife works the same number of hours,
although she tends to travel more with her job
and sometimes works the night shift.
 As a result, both Jack and his wife have a hard
time fitting exercise into their daily routine, and
they often eat in restaurants.
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 Definition of Health

 A state of complete physical, mental, and social

well-being, not merely the absence of disease or
infirmity (WHO, 1947)
 A state of being that people define in relation to
their own values, personality, and lifestyle

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 Models of Health and Illness

 A model is a theoretical way of understanding a

concept or idea
 Health beliefs
 Health behaviors
 Positive
 Negative

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 Health Belief Model

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 Health Promotion Model

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 Models of Health and Illness (Cont.)

 Maslow’s Hierarchy of
Needs
 Used to understand
the interrelationships
of basic human needs
 Holistic Health Model
 Attempts to create
conditions that
promote optimal health

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 Case Study (Cont.)

 Jack comes to the clinic today for routine follow-

up for his diabetes. Jack’s laboratory data reveal
that his blood glucose level is consistently
running high. His blood pressure is on the high
side of normal.
 Sally, the diabetes nurse educator, is working
with Jack for the second time. Sally knows she
wants to find a way to get Jack’s blood glucose
levels down to avoid the long-term complications
of diabetes.

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 Variables Influencing Health
and Health Beliefs and Practices
 Variables influence how a person thinks and
acts.
 Health beliefs can negatively or positively
influence health behavior or health practices.

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 Quick Quiz!

1. According to Maslow’s hierarchy of needs,

which of these needs would the patient seek
to meet first?
A. Self-actualization
B. Self-esteem
C. Shelter
D. Love and belonging

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Internal Variables

Developmental Stage

Intellectual Background

Perception of Functioning

Emotional Factors

Spiritual Factors

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External Variables

Family Practices

Socioeconomic Factors

Cultural Background

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 Case Study (Cont.)

 Because Jack occasionally exercises, Sally

decides to focus her teaching on the importance
of routine exercise to improve Jack’s health and
help with the management of diabetes.
 Sally finds out that 6 months ago, Jack was
using his treadmill for 20 minutes on most
mornings. Since then, he has gotten out of the
habit because he now tries to arrive at work 30
minutes earlier.

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 Quick Quiz!

2. After evaluating a patient’s external variables,

the nurse concludes that health beliefs and
practices can be influenced by
A. emotional factors.
B. intellectual background.
C. developmental stage.
D. socioeconomic factors.

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 Health Promotion, Wellness,
and Illness Prevention

1. Immunization Programs

2. Routine Exercise, Good Nutrition

3. Physical Awareness, Stress Management,

Self-Responsibility

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 Levels of Preventive Care

 Primary Prevention
 True prevention that lowers the chances that a
disease will develop
 Secondary Prevention
 Focuses on those who have health problems or
illnesses and are at risk for developing complications
or worsening conditions
 Tertiary Prevention
 Occurs when a defect or disability is permanent or
irreversible

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 Quick Quiz!

3. You will use the concept of primary

prevention when instructing a patient to:
A. get a flu shot every year.
B. take a blood pressure reading every day.
C. explore hiring a patient with a known
disability.
D. undergo physical therapy following a
cerebrovascular accident.

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 Risk Factors

 Variables that increase the vulnerability of an

individual or a group to an illness or accident
 Risk factors include:
 Genetic and physiological factors
 Age
 Environment
 Lifestyle

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Risk Factor Modification and Changing
Health Behaviors

Precontemplation

Contemplation

Preparation

Action

Maintenance stage

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 Case Study (Cont.)

 Sally wants to apply the stages of behavior

change with Jack. By using this model, she will
work with Jack regarding what he is ready to do
rather than simply telling Jack to be more active.
 To do this, she first asks Jack how he feels
about exercise and what his plans are. Jack
states, “I know that exercise would be good for
me and I should probably work on it.”
 This tells Sally that Jack is at the contemplation
stage.
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Risk Factor Modification and Changing
Health Behaviors (Cont.)
 Patient Teaching: Lifestyle Changes
 Objective
• Patient will reduce health risks related to poor lifestyle habits
through behavior change.
 Teaching strategies
• Provide active listening, ask about perceived barriers, assist
the patient in establishing goals, and reinforce the process of
change.
 Evaluation
• Have the patient track adherence, and provide positive
reinforcement.

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 Illness

 A state in which a person’s physical, emotional,

intellectual, social, developmental, or spiritual
functioning is diminished or impaired
 Acute Illness
 Short duration and severe
 Chronic Illness
 Persists longer than 6 months

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 Quick Quiz!

4. Sally has decided to set aside 30 minutes a

day to walk after work next week. Sally is in
what stage of risk factor modification?
A. Precontemplation
B. Contemplation
C. Preparation
D. Action
E. Maintenance

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 Illness Behavior

 Involves how people monitor their bodies and

define and interpret their symptoms
 Variables influencing illness and illness behavior
 Internal variables: Perception of illness and nature of
illness
 External variables: Visibility of symptoms, social
group, cultural background, economics, and
accessibility to health care

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 Impact of Illness on the Patient and
Family
 Behavioral and emotional changes
 Impact on body image
 Impact on self-concept
 Impact on family roles
 Impact on family dynamics

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 Case Study (Cont.)

 Teaching strategies:
 Practice active listening and determine what Jack
understands regarding health risks related to poor
lifestyle.
 Ask Jack what barriers and benefits he perceives with
the planned lifestyle change of consistently
exercising.
 Help Jack set achievable goals for change.
 Work with Jack to establish realistic time lines for
modification of exercise habits.

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 Case Study (Cont.)
 At the next appointment,
Jack says, “I saw there
was a sale on walking
shoes. If I’m going to
start walking, do you
think I need to get new
shoes? Next week, I am
taking a week of
vacation, just doing
things around the house,
and I thought this would
be a good time to start.”

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 Case Study (Cont.)

 Evaluation strategies
 Have Jack maintain an exercise log to track
adherence, and provide positive reinforcement.
 Ask Jack to discuss his success with lifestyle
changes, such as minutes spent in activity.
 Have Jack identify community resources used in
making a change.

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 Caring for Yourself

 Eat a nutritious diet

 Get adequate sleep
 Engage in exercise and relaxation activities
 Establish a good work-family balance
 Engage in regular nonwork activities.
 Develop coping skills
 Allowing personal time for grieving
 Focus on spiritual health
 Find a mentor
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