Foundations-health promotion & screening(10-15) Explore various definitions of health and related terns Functional health Disease Illness

Health promotion emphasis is being placed on the quality of a person's life as a component of health indicates that there are multiple factors contributing to a person's perception of his or her health defined as the failure of a person's adaptive mechanisms to counteract stimuli and stresses adequately, resulting in functional or structural disturbances. made up of the subjective experience of the individual and the physical manifestation of disease the science and art of helping people change their lifestyle to move toward a state of optimal health. the process of advocating health in order to enhance the probability that personal (individual, family, and community), private (professional and business), and public (federal, state, and local government) support of positive health practices will become a societal norm defined by the absence, and illness by the conspicuous presence, of signs and symptoms of disease. defines health in terms of individuals' ability to perform social roles. Role performance includes work, family, and social roles, with performance based on societal expectations. Illness would be the failure to perform roles at the level of others in society. This model is the basis for occupational health evaluations, school physical examinations, and physician-excused absences. people's ability to adjust positively to social, mental, and physiological change is the measure of their health. Illness occurs when the person fails to adapt or becomes maladaptive to these changes exuberant well-being indicates optimal health. This model emphasizes the interactions between physical, social, psychological, and spiritual aspects of life and the environment that contribute to goal attainment and create meaning. Illness is reflected by a denervation or languishing, a lack of involvement with life. useful for promoting health at individual, family, community, and societal levels. In this way, the ecological model of health is more compatible with Smith's descriptions of health as adaptation and eudemonia (self-actualization)

clinical model role performance model adaptive model of health eudaimonistic model

ecological model of health

Discuss current health promotion theories theory of reasoned action by Ajzen & Fishbein (1980) theories of behavior by Bandura (1976, 1999, 2004), the health belief model by Rosenstock (Janz et al., 2002), Pender's Health Promotion Model (Pender et al., 2006) stages of change theories by Prochaska (Prochaska et al., 2004)

Describe the role of the nurse in health promotions 1. Advocate- the nurse strives to ensure that all persons receive high-quality, appropriate, and cost-effective care. 2. Care Manager- to prevent duplication of services and to reduce costs. 3. Consultant- provide knowledge about health promotion and disease prevention to individuals and groups as a consultant. 4. Deliverer or Services- delivery of direct services such as health education, flu shots, and counseling in health promotion. 5. Educator- Teaching may range from a chance remark by the nurse, based on a perception of desirable individual behavior, to structurally planned teaching according to individual needs. Selection of the methods most likely to succeed involves the establishment of teacher-learner goals. 6. Healer- requires the nurse to help individuals integrate and balance the various parts of their lives. Healing resides in the ability to glimpse or intuit the interior of an individual, to sense and identify what is important to that other person, and to incorporate the specific insight into a care plan that helps that person develop his or her own capacity to heal. Researcher- use research findings as their foundation for clinical decision-making.

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Describe the role of the nurse in health screening 1. Decision maker and planner- responsible for reviewing all the issues concerning a screenable disease a. the criteria specific to the disease b. the medical and economic ethics c. community resources that are affected 2. Development of a care plan a. Efficient referral system 3. Screening individuals 4. Educator about healthy lifestyles and decreased risks ID advantages and disadvantages of screening Advantages of screening Preclinical illness and previously unrecognized disease in individuals may be detected via screening efforts the ability to apply the screening process to both individuals and large groups. the ability to provide one-test specific screening or multiple test screenings. screening creates an opportunity for providing health education to a group of individuals who may not otherwise receive it. screening activities provide early diagnosis and treatment of nutritional, behavioral, and other related problems.

Disadvantages of screening the margin of error can precipitate serious consequences.

False negatives- individuals leave with a false sense of a healthful state False Positives -

Healthy People (4-6Q) What is healthy people? 2010(focus areas, indicators, agegroups)/2020*(mission/vission, overall goals, new topic areas)

Healthy People 2010 emphasis on responsibility

Healthy People 2020 Vision A society in which all people live long, healthy Lives

Goals 1. Increase quality and years of healthy life 2. Eliminate health disparities among Americans 10 Leading Health Indicators Physical Activity Overweight and Obesity Tobacco Use Substance Abuse Responsible Sexual Behavior Mental Health Injury and Violence Environmental Quality Immunization Access to Health Care Age groups 1. Infants 2. Children 3. Teens and young adults 4. Olderadults

Goals 1. Attain high-quality longer lives free of preventable diseases, disability, injury and premature death. 2. Achieve high equity, eliminate disparities,and improve the health of all groups. 3. Create social & physical environments that promote good health for all. 4. Promote quality of life, healthy development, & healthy behaviors across the lifespan. New Topic Areas Adolescent Health Blood Disorders/ Blood Safety Early and Middle Childhood Dementia, including Alzheimers Disease Genomics Global Health Health-Related Quality of Life & Well-Being Healthcare-Associated Infections Lesbian, Gay, Bisexual & Transgender Health Older Adults Preparedness Sleep Health Social Determinants of Health

Prevention levels & nursing interventions.(4-8Q) Discuss the 3 levels of prevention and related nursing interventions Primary prevention Secondary Prevention precedes disease or dysfunction ranges from providing screening activities is therapeutic in that it includes health as and treating early stages of disease to beneficial to well-being, it uses limiting disability by averting or delaying therapeutic treatments, and, as a process the consequences of advanced disease. or behavior towards enhancing health, it involves symptom identification when teaching stress reduction techniques. Specific Protection Its purpose is to decrease the vulnerability of the individual or population to disease or dysfunction. Nursing Interventions health promotion, such as health education about risk factors for heart disease specific protection, such as immunization against hepatitis B. advocating for policies that promote the health of the community and electing public officials who will enact legislation that protects the health of the public. Nursing Interventions Screening Health Teaching

Tertiary Prevention involves minimizing the effects of disease and disability by surveillance and maintenance activities aimed at preventing complications and deterioration.

Nursing Interventions rehabilitation to help people attain and retain an optimal level of functioning regardless of their disabling condition. ensure that persons with disabilities receive services that enable them to live and work according to the resources that are still available to them. Teaching lifestyle change to prevent additional complications

Health Teaching (10-15 Q) Define health education any combination of planned learning experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire the information and the skills needed to make quality health decisions Panel Discussion- review questions, roles Teach-back technique Learning Steps Active learner participation Learner must be ready to learn Information must be relevant Simple to complex Repetition Learning Styles Visual Spatial prefer using pictures, images, and spatial understanding.

Aural Auditorymusical prefer using sound and music.

Verbal Linguistic prefer using words, both in speech and writing.

Physical Kinesthetic prefer using your body, hands and sense of touch.

Logical Mathematical prefer using logic, reasoning and systems.

Social prefer to learn in groups or with other people.

Solitary prefer to work alone and use self-study.

Levels of Learning -Blooms Taxonomy Knowledge: person recalls facts and the concept Comprehension: person understands the meaning of the concept Application: person uses the concept Analysis: person can examine or explain the concept Synthesis: person integrates the concept with other learning Evaluation: person judges or compares the concept 3 learning domains cognitive the development of new facts or concepts, and building on or applying knowledge to new situations

psychomotor involves developing physical skills from simple to complex actions.

affective the recognition of values, religious and spiritual beliefs, family interaction patterns and relationships, and personal attitudes that affect decisions and problem-solving progress.

Learning Barriers the lack of time to prepare/present material the nurse who is not prepared to teach lack of motivation make teaching a low priority lack of space and privacy to present the content little reimbursement for time spent teaching less emphasis on health outcomes not having standardized teaching informal documentation Discuss learning principles that affect health education Use methods that stimulate a variety of senses. Involve the person actively in the learning process. Establish a comfortable, appropriate learning environment. Assess the readiness of the learner, which may be affected by physical and emotional factors. Make the information relevant by connecting with the existing needs and interests of the learner. Use repetition. Review and reinforce concepts several times in a variety of ways.

 Make the learning encounter positive. Structure it to achieve progress recognizable by the individual and provide frequent, positive feedback. Start with what is known and proceed to what is unknown, moving from simple to complex. Apply the concepts to several settings to facilitate generalization. Pace the learning appropriately for the individual. Writing Objectives- SMART criteria

Literacy - AMA literacy Video JCAHO has mandates that patients and family members be assessed to determine any literacy needs when the nurse is doing client teaching within the health care setting. Considerations to planning- age, culture, background Age Children learn best by using all their senses. Learning activities are interesting and meaningful. Teachers show love and respect for all children. Good teaching is based on theory, philosophy, goals, and objectives. Children's learning is enhanced through the use of concrete materials. Teaching is centered on the child. Teaching moves from the concrete to the abstract. Teaching is based on the children's interests ID steps in preparing a teaching plan Expected learning Assessment outcomes Id the learners characteristic and needs

Culture English as a second langueafe Take the time to assess cultureal beliefs that influence social and health practices Provide culturally sensitive client education

Background Consider Literacy level th 40% above 6 grade reading level Use active voice Use plain language

Formulate a teaching plan Critical content to be covered Learning strategies

Implementation How to implement What would you need

Evaluation Anticipate how to meet the learning objectives

Partnership Model- Professionals role The partnership process allows the client to remain in control of their health plan. The professional works with the client involving them in every step of the way. They form a relationship which allows mutual goal setting and ongoing support. With this approach, the problem identified by the health team may not always be solved.
Scope and Standards of Practice describes health teaching and health promotion as primary nursing responsibilities. This includes educating people about healthy lifestyles, risk reduction, developmental needs, activities of daily living, and preventive self-care (American Nurses Association, [ANA], 2004). ANA's social policy statement also addresses health teaching and health counseling (ANA, 2003). This responsibility to teach individuals is balanced by their right to know about diagnosis, treatment, risks, benefits, costs, and alternatives. The nurse's role is to support the right of individuals to know their health status and to assess and assist a person's physical, psychosocial, and spiritual responses to that knowledge. The nurse also provides health teaching and health counseling based on individual interest and decisions (Bandman & Bandman, 2002)

Stress Management (10-15Q) Define stress and stressor Stress - a state of threatened homeostasis or disharmony and is counteracted by a complex repertoire of physiologic and behavioral responses that reestablish homeostasis Stressor - any psychological, social, environmental, physiological, or spiritual stimulus that disrupts homeostasis thereby requiring change or adaptation Effects of stress -physiologic Response

Types of Responses to stress the musculoskeletal system tension and tone

the autonomic nervous system heart rate, blood pressure, and respiratory rate (via sympathetic NS)

the psychoneuroendocrine system

stimulates the hypothalamic-pituitary-adrenal axis and the secretion of corticosteroids (primarily cortisol) blood shifts from the visceral organs to the blood glucose levels large muscle groups. influencing sodium retention the anti-inflammatory response Current research is demonstrating that the human body was never meant to deal with prolonged chronic stress. Immediate response to threat: Adrenal glands pump adrenaline. BP and HR increase in preparation for activity. Liver pours our glucose and calls up fat reserves in order to provide energy. Circulatory system diverts blood to non essential functions. Brain sends out hormones and neurotransmitters to protectively dull bodys sense of pain & improve memory and thinking. Delayed response to threat @ 5-10 minutes, hypothalamus signals for pituitary to produce ACTH (stimulates the adrenal cortex to produce glucocorticoids-most important one is cortisol). Hippocampus is activated by these hormones to increase learning and memory. Also affect immune system by diminishing infection fighting in an effort to increase available energy.

Id physical psychological social and behavioral stressors physical psychological stressors over which people have no control (extrinsic Negative mood states, factors), such as the weather, including anxiety, depression, a traffic jam, or the death of a hostility, and anger. spouse

social social interactions

behavioral stressors created or exacerbated (intrinsic factors) catastrophic negative thinking (expecting the worst) poor communication procrastination poor time management

Effects of Stress on health and illness Elevated cortisol levels and resultant effects on the immune system. Stress and specifically depression have been associated with increased susceptibility to cardiovascular disease Proinflammation associated with stress is emerging as a common pathway in a variety of diseases such as asthma, angina, cardiac arrhythmias, pain, tension headaches, insomnia, and gastrointestinal complaints Stress can produce hyper- or hyporeactivity of hormones regulated by the psychoneuroendocrine system Measuring Stress- Social readjustment rating scale

Crisis and Stress Stress - a collective physiological and emotional response to any stimulus that disturbs an individuals homeostasis. Crisis an event that occurs when a person faces an obstacle to their important life goals that are, for a time, insurmountable through the customary methods of problem solving. Usually lasting 1-6 weeks with an identifiable beginning middle and end General Adaptation Syndome (GAS)

Alarm fight-or flight response

Resistance New level of homeostasis characterized by increase resistance to stress

Exhaustion Life-threatening physiological exhaustion

Eustress vs distress Eustress - to a certain extent, stress can be challenging and useful Distress - when stress becomes chronic or excessive, the body is unable to adapt and maintain homeostasis

Managing Stress- recognition and coping Describe stress management interventions that can be used in clinical practice Developing self awareness helps people learn about interactions among mind, body, and spirit; increases a sense of control; and counters selfdefeating perceptions. Recognizing warning signs balanced eating patterns appropriate caloric intake and body weight that is appropriate for height Cognitivebehavioral Restructuring technique that helps some people become unstuck from these moods so that they can experience a broader range of feelings and try out new behaviors 1.Stop 2.Breathe deeply 3.Reflect 4.Choose

Healthy Diet encourage people to monitor their daily dietary patterns to gain awareness of how they use food in times of stress.

Physical Activity help individuals increase physical activity by suggesting a variety of activities in which they might engage each day

Sleep hygiene nurses can help individuals improve their sleep patterns by counseling them to follow several sleep hygiene or behavior guidelines (keeping a sleep diary, having a regular sleepwake cycle, and making prudent dietary changes)

Affirmations Nurses coach individuals to create an affirmation as a way of developing a more helpful, realistic belief system.

Social Support Nurses do much to facilitate social support to promote effective coping and reduce stress. Using information available in their local communities or through national organizations, nurses suggest support groups Website chat rooms, educational classes, and exercise facilities, to name a few.

Eliciting the relaxation response Mini-relaxations self-confessional writing: describe unfolding personal responses to life events Assertive Communication Nurses help individuals match statements with intentions. This process requires that individuals recognize distorted, exaggerated thoughts and emotions and take responsibility for their part of the conversation. Nurses help people recognize that they have a right and a responsibility to speak up and to do so in an assertive manner.

Empathy Nurses recommend use of stress management skills that include active listening techniques to facilitate effective communication which, in turn, reduces conflict and stress.

Healthy Pleasures (activities that bring feelings of peace, joy, and happiness

Spiritual Practice Nurses suggest a referral to a chaplain or clergy member, provide spiritual music or art work, recommend spiritual reading material, and provide personal presence

Clarifying Values and Beliefs When people assess their values and beliefs, they employ the ability to make their own choices rather than relying on beliefs and values dictated to them by others.

Setting Realistic Goals Nurses encourage individuals to challenge themselves when their behaviors are not consistent with what they identified as important and meaningful to them. Goals should be specific, concrete, measurable, and achievable.

Humor enjoyable and effective antidote to stress for many people

Humor can open different perspectives on problems and facilitate objectivity