SCHOOL OF NURSING RN-BSN PROGRAM

COLLEGE  OF  HEALTH  AND URBAN AFFAIRS

COURSE DESCRIPTION

GENERAL INFO REQUIREMENTS

SCHEDULE DUE DATES

RN-BSN MAIN PAGE

Transition to Professional Nursing
HEALTH PROMOTION/WELLNESS

To e-mail the instructor  phillips@fiu.edu

CLASS HANDOUT  

DEFINITIONS
Terms related to health promotion, health prevention, and health protection can be interchanged, since one activity, such as exercise, can be carried out for numerous reasons. 

Levels of prevention (Leavell and Clark, 1965)

• Primary prevention  

  • Focuses on health promotion and protection against specific disease problems.

  • Decreases probability of diseases (education regarding smoking hazards, immunizations).

• Secondary prevention  

  • Focuses on early identification of health problems and prompt intervention to alleviate health 
    problems.  

  • Includes specific screening programs (blood sugars) and illness care.  

• Tertiary prevention  

  • Focuses of chronic disease and rehabilitation to an optimal level of functioning.  

  • Relates to situations where a disability is already present.

Health promotion vs. primary prevention (Pender, 1987)

• Health promotion--activities directed toward sustaining or increasing well-being.  

• Primary prevention--activities that decrease probability of specific diseases.

Health promotion vs. health prevention programs (Stachtchenko and Jenicek, 1990)

• Health promotion programs—process of granting individuals and communities control over 
  determinants of health.  

• Health prevention programs—focus on risk reduction and target specific populations.

Healthy People 2010 Objectives (US Public Health Service, 2001)

• Health promotion--individual and community activities to promote healthful lifestyles.   
  EX: Improving nutrition, preventing alcohol and drug misuse, restricting smoking, maintaining fitness, exercising.

• Health protection--actions by government and industry to minimize environmental health threats.   
  EX: Maintaining occupational safety, controlling radiation and toxic agents, preventing infectious diseases and accidents.

• Preventive health services--actions of health care providers to prevent health problems.   
  EX:  Control of hypertension and STDs, immunizations, family planning, prenatal care.  

World Health Organization (Maglacas, 1988)

• Positive health--health is considered in context of its contribution to social and economic development 
  so that all people have the social/economic support to lead satisfying lives.  

• Positive health promotion--process of enabling people to improve and increase control over their 
  own health.
  

CONCEPTS OF HEALTH PROMOTION (Schultz, 1995)
Health promotion:

• Maintains and enhances health.

• Develops the resources and skills of the person or community.

• Alters personal or communal habits and the environment.

• Defines health as a continuum.

• Is self-directed.  
  

COMPARISON OF TRADITIONAL CARE AND HEALTH PROMOTION

HEALTH PROMOTION (NURSING) MODELS
Pender’s Health Promotion Model (Pender, 1987)
Cognitive-perceptual factors and modifying factors that predict likelihood of an individual's participation in health-promoting activities. 

The likelihood  that a person will take action depends on internal cues (such as personal awareness of 
potential for growth) and external cues (such as conversations with others and mass media information).

• Cognitive-perceptual factors are the following:  

  • Importance of health—value placed on health; a high value results in health seeking behavior.  

  • Perceived control of health—perceived control over health; control increases likelihood of using preventive services vs. people who feel powerless.  

  • Perceived self-efficacy—conviction that a person can successfully carry out behavior to achieve a 
    goal; high efficacy increases effort; low efficacy results in doubts and giving up.   

  • Definition of health—how the person defines health influences the extent to which a person engages 
    in health promoting behaviors.  

  • Perceived health status—perception of health status influences the frequency and intensity of health promoting behaviors.  

  • Perceived benefits of health promoting behaviors—perceived benefits affect a person’s level of participation in and continued practice of health promoting behaviors.

  •   Perceived barriers to health promoting behaviors—perceived barriers (time, access to facilities, difficulty in performance) affect a person’s level and continued practice of health promoting behaviors.  Barriers can be real or imagined.  
    

• Modifying factors are the following:

  • Demographic factors—include age, sex, race, ethnicity, education, income.  

  • Biological factors—include % of body fat, total body weight, genetic influences.  

  • Interpersonal factors—include expectations of significant others, family patterns of health care, interactions with health professionals.  

  • Situational factors—include ease of access for activities, availability of environmental options (vending machines, menus).  

  • Behavioral factors—include successful previous experiences, knowledge, and skills (knowing how 
    to swim).
    

Kulbok’s Resource Model of Preventive Health Behavior (Kulbok, 1985)
People act in ways to maximize their “stock in health.”  The greater a person’s social and health resources, the more frequently the person will perform preventive behaviors.

• Social resources—include educational level, family income.  

• Health resources—include general psychological well-being, perceptions about health, health status and energy level, capability to take care of one’s own health, participation in social groups, number and closeness of friends and relatives.  

• Preventive health behaviors—include physical activity, diet, sleeping, smoking, drinking alcohol, drinking caffeine, dental hygiene, seat belt use, use of preventive health services, controlling hypertension.
  

Neuman’s Systems Model (Neuman, 1995)
Neuman’s model is based on the individual’s reaction in stress, the reaction to it, and adaptation factors that are dynamic in nature.  Nursing interventions focus on retaining or maintaining system stability.  Interventions are carried out at three preventive levels:

• Primary prevention—identifies risk factors, attempts to eliminate the stressor, focuses on protecting and strengthening defenses.  Symptoms have not occurred, but the risk is known.  

• Secondary prevention—relates to interventions or active treatment initiated after symptoms have occurred.  The focus is to strengthen internal lives of resistance, reduce the reaction and increase resistance factors.  

• Tertiary prevention—refers to interventions.  The focus is on re-adaptation and stability and 
  protecting adaptation and wellness following treatments.  Emphasis is on education and strengthening resistance to stressors and ways to prevent a recurrence or regression.

HEALTH BELIEF MODELS
Health belief models (such as the Multidimensional Locus of Control or Health Belief Model) are based on locus of control and motivational concepts.

• Health Locus of Control  

  • Internal locus of control

    • People who believe that they have a major influence on their own health status.  

    • More likely to take the initiative in their own health care.  

  • External locus of control  

    • People who believe their health is controlled by outside forces (chance, luck, others).  

    • Less likely to take initiative in own health care—may need assistance to increase their internal 
      locus of control.
      

Health Belief Model (Becker, 1974)
Becker’s Health Belief Model is based on the assumption that good health is an objective and positive health motivation is common to all people.  Individual perceptions, modifying factors, and likelihood to action are components in the model.

• Individual perceptions—includes perceived susceptibility to disease and perceived seriousness of disease. These perceptions combine to determine the total perceived threat of the illness.

• Modifying factors—includes demographic variables (age, sex, race, etc.), sociopsychological variables (social influence from others), structural variables (knowledge, prior experiences), cues to action (internal cues such as fatigue; external cues such as media campaigns or articles, advice, relative illness, advice).

• Likelihood of action—Perceived benefits (weight loss, preventing cancer) and perceived barriers (cost, inconvenience,  lifestyle changes).
  

STAGES OF HEALTH BEHAVIOR CHANGE (Prochaska and DiClemente, 
1982)
Health behavior change is a cyclic phenomenon in which people progress through stages related to health-promoting behaviors.  Nurses can intervene at all stages.

Pre-contemplation stage—person is not interested in changing behaviors; the negative aspects of making a change still outweigh the benefits. 

• Introduce healthy behaviors in general (exercising, healthy diet, etc.).

• Provide individualized information about benefits.

• Explore client’s beliefs related to health behaviors

• Identify previous successful changes to increase confidence.

Contemplative stage—person seriously considers changing behavior, gathers information, and verbalizes plans. The person has increased belief in value of change and increased self-confidence that he/she can make the change.  This stage can last for months or 
years.

• Provide available alternatives for informed choices.

• Encourage expression of ambivalent feelings.  Get spouse involved, if appropriate.

• Identify social pressures that encourage positive behaviors (smoking bans).

• Encourage client to “visualize” the future benefits after being successful.

Preparation stage—person undertakes cognitive and behavioral activities that prepare for the change.   
Now the advantages or benefits outweigh the disadvantages.

• Discuss specific plans for the change, such as self-help groups.

• Assist in identifying stimuli that trigger unhealthy behaviors.

• Assist client in substituting activities to counteract unhealthy behaviors.  

• Plan appropriate rewards for reaching goals. 

Action stage—person actively engages in behavioral and cognitive strategies and adopts new behavior 
patterns. To prevent recurrences, the stage needs to continue for weeks or months.

• Review plans and specific strategies.  

• Help client set realistic goals.  

• Encourage positive self-talk that supports change.  

• Provide positive feedback, support and encouragement for partial or complete 
  achievement of goals.

Maintenance stage—person integrates new behaviors into his/her lifestyle.

• Encourage continuing use of support networks.  

• Continue to identify and encourage strategies that support behaviors.

HEALTH PROMOTION PROGRAMS
Can be passive (water treatment) or active (life style changes).

Policy Dimensions

• Economic dimensions--costs and benefits  

  • Cost benefit analysis--calculates all benefits and outcomes to determine whether there is a 
    positive payoff (EX: laws regarding seatbelt use).  

  • Cost effectiveness analysis--seeks to determine which intervention is most effective and least 
    costly (EX: TV ads vs. print ads).  

  • Cost efficiency--compares costs and benefits of single program (EX: getting children immunized 
    or HIV testing).  
    

• Evaluation of effectiveness--extent to which program or activity achieves intended objectives 
  (EX: increased immunization rates).
  

Types of health promotion programs

• Information dissemination.  

• Health appraisal and wellness assessment.  

• Lifestyle and behavior change.

• Work  site wellness programs.  

• Environmental control programs.

Sites for health promotion activities

• Community settings (health fairs)  

• Schools  

• Hospitals  

•  Work sites

NURSES ROLE IN HEALTH PROMOTION

• Model healthy lifestyles and attitudes.

• Facilitate client involvement in assessment, implementation and evaluation of health goals.

• Teach clients self-care strategies to enhance health-promoting behaviors.

• Assist individuals, families, and communities to increase levels of health.

• Educate clients to be effective health care consumers.

• Assist individuals, families, and communities to develop and choose health-promoting options.

• Guide clients 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.