Professional Nursing Practice Concepts and Perspectives Seventh Edition

Professional Nursing Practice Concepts and Perspectives Seventh Edition Chapter 7 The Nurse as Health Promoter and Care Provider Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Learning Objectives 7. 1 Differentiate between health prevention or protective care and health promotion. 7. 2 Discuss essential components of health promotion. 7. 3 Discuss the overarching goals, foundation health measures, topics, and objectives of Healthy People 2020. 7. 4 Identify various types of and sites for health promotion programs. 7. 5 Compare and contrast the locus-of-control and health belief models as they relate to healthcare decision making. 7. 6 Compare and contrast Pender’s Health Promotion Model (HPM) and the Neuman Systems Model as they relate to health-promotion decision making. 7. 7 Discuss Prochaska and Di. Clemente’s five-stage model of behavior change. 7. 8 Analyze the nurse’s role in health promotion. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Hallmark Features • A focus on foundational knowledge related to professional nursing – Includes nursing history, nursing theory, ethics, and legal aspects, etc. • An overview of professional nursing roles, issues, and changes in the profession – Discusses nurses as healthcare providers, learners and teachers, and leaders Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Challenges and Opportunities • Health care and nursing traditionally oriented toward curing and treating – Shift of focus toward maintaining and promoting health and wellness – Role of health promoter provides nurse with many opportunities to ª Educate ª Practice in variety of settings Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Learning Objective 7. 1 Differentiate between health prevention or protective care and health promotion. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Defining Health Promotion • Universally accepted definition does not exist; confused with health education • World Health Organization (2015 a) definition – “The process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions. ” Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Defining Health Promotion • Maville and Huerta (2013) definition of health promotion – “Any endeavor directed at enhancing the quality of health and well-being of individuals, families, groups, communities, and/or nations through strategies involving supportive environments, coordination of resources, and respect for personal choice and values. ” Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Learning Objective 7. 2 Discuss essential components of health promotion. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Defining Health Promotion • Leavell and Clark levels of prevention – Primary ª Health promotion ª Protection against specific health problems – Secondary ª Early identification ª Prompt intervention – Tertiary ª Restoration and rehabilitation Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Defining Health Promotion • Pender, Murdaugh, and Parsons – Health promotion ª Approach behavior ª Not disease oriented ª Expand positive potential for health – Health protection (primary prevention) ª Avoidance behavior ª Avoiding specific problems ª Thwart occurrence of insult to health and well-being Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Learning Objective 7. 3 Discuss the overarching goals, foundation health measures, topics, and objectives of Healthy People 2020. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Healthy People 2020 • Builds on prior Healthy People documents by identifying four goals – Attain high-quality, longer lives – Achieve health equity, eliminate disparities, and improve the health of all groups – Create environments that promote good health for all – Promote quality of life, healthy development, and healthy behaviors across all life stages Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Healthy People 2020 • Leading Health Indicators (LHI) reflect highpriority issues, used to – – Assess health of the nation Facilitate collaboration across sectors Motivate action Track progress using specific objectives Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Healthy People 2020 • Leading Health Indicators – – – Access to health services Clinical preventive services Environmental quality Injury and violence Maternal, infant, and child health Mental health Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Healthy People 2020 • Leading Health Indicators – – – Nutrition, physical activity, and obesity Oral health Reproductive and sexual health Social determinants Substance abuse Tobacco Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Healthy People 2020 • Four foundation health measures, indicators of progress – General health status ª Provides information on overall health of a population – Health-related qualify of life and well-being ª Physical, mental, emotional, and social functioning are integrated whole of health status – Determinants of health ª Factors that influence health status – Disparities ª Difference in illness/injury occurrence, health access or health outcomes based on various factors Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Learning Objective 7. 4 Identify various types of and sites for health promotion programs. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Health Promotion Activities • Health promotion organizations, wellness centers, traditional healthcare centers offer different approaches • Health programs on an individual level can be passive or active – Passive (client recipient of effort) ª Clean water and air – Active (client committed to involvement) ª Diet management ª Self-help ª Exercise Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Health Promotion Activities • Types of programs – Information dissemination ª Billboards, posters, Internet – Health risk appraisal/wellness assessment – Lifestyle and behavior change ª Stress management, nutrition awareness, weight control, smoking cessation, and exercise – Environmental control ª Safe air, food, and water Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Health Promotion Activities • Sites for health promotion activities – – – – Home Schools Hospitals Work sites Religious organizations Gyms and fitness centers Shopping malls Internet sites Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Learning Objective 7. 5 Compare and contrast the locus-of-control and health belief models as they relate to healthcare decision making. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Health Locus-of-Control Model • Internal locus of control – People who believe they have major influence on own health status; more likely to take initiative, to be more knowledgeable, and to adhere to prescribed regimens • External locus of control – People who believe their health is largely controlled by outside forces; may need assistance to become more internally controlled in order to change behavior Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Health Belief Model • Health belief model (HBM) provides framework for understanding why people do not adopt disease prevention strategies – – – Individual perceptions Modifying factors Cues to action Likelihood of action Self-efficacy Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Learning Objective 7. 6 Compare and contrast Pender’s Health Promotion Model (HPM) and the Neuman Systems Model as they relate to healthpromotion decision making. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Pender’s Health Promotion Model • Focuses on health-promoting behaviors rather than health-protecting or preventive behaviors • Assumptions emphasize the active role of the client in shaping and maintaining health behaviors and in modifying the environmental context for health behaviors Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Pender’s Health Promotion Model • Five components – – – Individual characteristics and experiences Behavior-specific cognitions and affect Commitment to a plan of action Immediate competing demands and preferences Health-promoting behavioral outcomes Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Pender’s Health Promotion Model • Individual characteristics and experiences – Prior related behavior ª Previous experience, knowledge, and skill in health-promoting actions – Personal factors ª Biological, psychological, and sociocultural factors Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Pender’s Health Promotion Model • Behavior-specific cognitions and affect – – – Perceived benefits of action Perceived barriers to action Perceived self-efficacy Activity-related affect Interpersonal influences Situational influences Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Pender’s Health Promotion Model • Commitment to a plan of action – Commitment to carry out a specific health promotion activity at a given time and place and with specific persons or alone – Identification of specific strategies for determining, initiating, and continuing the health promotion behavior Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Pender’s Health Promotion Model • Immediate competing demands – Factors over which the individual has a low level of control ª Family and work responsibilities • Immediate competing preferences – Factors over which the individual has a high level of control ª Taste • Behavioral outcome – Adoption and integration of health-promoting behaviors into the individual’s lifestyle Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Neuman Systems Model • Wellness oriented, views health promotion as intervention component of prevention • Designed to strengthen a person’s lines of defense • Stages of prevention – Primary – Secondary – Tertiary Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Learning Objective 7. 7 Discuss Prochaska and Di. Clemente’s five-stage model of behavior change. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Stages of Health Behavior Change • Cyclical phenomenon in which people progress through several stages – Precontemplation ª Negative aspects of the change outweigh the benefits – Contemplation ª Seriously considers changing a specific behavior – Preparation or planning ª Advantages of changing the behavior outweigh the disadvantages and person makes specific plans to accomplish the change Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Stages of Health Behavior Change • Stages – Action ª Actively implements the behavioral and cognitive strategies to interrupt previous behavior patterns and adopt new ones – Maintenance ª Integrates newly adopted behavior patterns into his or her lifestyle – Termination ª Person has no desire to return to previous unhealthy behavior and believes he or she will not relapse Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

Learning Objective 7. 8 Analyze the nurse’s role in health promotion. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

The Nurse’s Role in Health Promotion • Work with people, not for them; act as a facilitator of the process • Maville and Huerta identified roles of the nurse as – – – Activist/proactive change agent Advocate Educator Empowering agent Communicator Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved

The Nurse’s Role in Health Promotion • Roles of the nurse as – – – – Consultant Coordinator of care Member and leader of the health profession Provider of care Research user Researcher into health promotion models Role model Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved