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Chapter 6

Health and Wellness

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Healthy People: The Surgeon Generals 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

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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Healthy People
Documents (Cont.)

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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A model is a theoretical way of understanding a


concept or idea

Health beliefs

Health behaviors

Positive

Negative

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Models of Health and


Illness

Health Belief Model

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Health Promotion Model

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Maslows

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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Models of Health and Illness9


(Cont.)

Quick Quiz!
1. According to Maslows hierarchy of needs, which of
these needs would the patient seek to meet first?
A. Self-actualization
B. Psychological security
C. Shelter
D. Love and belonging

Case Study (Cont.)


Jack comes to the clinic today for routine followup for his diabetes. Jacks 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 Jacks blood glucose
levels down to avoid the long-term
complications of diabetes.

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influence health behavior or health practices.

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Variables Influencing
Health
and
Health
andand
Variables
influenceBeliefs
how a person thinks
acts.
Practices
Health beliefs can negatively or positively

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 Jacks
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!

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2. After evaluating a patients 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.

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

Secondary Prevention

True prevention that lowers the chances that a


disease will develop
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!

19

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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3. You will use the concept of primary prevention when


instructing a patient to:

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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Precontemplation
Contemplation
Preparation
Action
Maintenance stage

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Risk Factor Modification and


Changing Health Behaviors

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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Quick Quiz!

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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

Objective

Teaching strategies

Patient will reduce health risks related to poor


lifestyle habits through behavior change.

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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Risk Factor Modification


and Changing Health
Behaviors
Patient Teaching:(Cont.)
Lifestyle Changes

Definition of Illness
A state in which a persons 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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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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Behavioral and emotional changes

Impact on body image

Impact on self-concept

Impact on family roles

Impact on family dynamics

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Impact of Illness on the


Patient and Family

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 Im
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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