Promoting Health and Wellness: Strategies for Healthcare Professionals, Summaries of Nursing

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Promoting Health and Wellness:

Strategies for Healthcare

Professionals

Defining Health and Wellness

Health

Health is defined as a state of complete physical, mental, and social well- being, and not merely the absence of disease or illness.

Wellness

Wellness is a positive state of health that is continually changing.

Illness

Illness refers to a functional or structural disturbance.

Disease

Disease refers to physical indicators and subjective experience.

An individual can have wellness in the presence of illness. Many internal and external variables influence a person's health beliefs and health practices.

Internal Variables

Growth and development Intellectual background Emotional factors

External Variables

Family health practices Cultural background

Factors Related to Health

Factors that apply to health include: - Lifestyle choices - Environment in which you live - Psychological or mental health issues

Factors that do not apply to health include: - Genetic make-up - Disease or disability

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Factors Contributing to Wellness

The following factors contribute to wellness: - Mental state - Social state - Financial state - Physical state - Environmental state

Case Study: Client with Suicidal Thoughts

The 34-year-old male client has been laid off from his job and has many unpaid bills. He has been having thoughts of suicide but denies needing medical help and has reached out to his pastor for emotional support. The client does not have a primary healthcare provider because he has never been very sick. As a child, his caregivers did not have money to pay for healthcare provider visits, so this has never been a priority. The client is married and has a close network of friends through his church.

External Variables Influencing the Client's Health Practices

The external variables influencing the client's current health practices include: - Support from social networks - Family practice of not routinely seeing a healthcare provider - Difficulty paying bills

Role of Healthcare Professionals in Promoting

Health

Healthcare professionals are in a unique position to assist clients in achieving and maintaining optimal levels of health. Some ways they can do this include: - Encouraging healthy behaviors - Understanding the dimensions of wellness - Providing health education - Providing preventative care - Identifying actual and potential risk factors

Case Study: Jonathan, a Healthcare Student

Jonathan is a student in a healthcare profession program. To help pay for school, he works full-time in a family practice clinic caring for clients of all ages. Sometimes, Jonathan feels that there are not enough hours in the day to get schoolwork completed, study for exams, and work enough hours to pay the bills.

Growing up, Jonathan's caregivers taught him how to choose and prepare healthy foods, and he is active every day, either running or biking. However, his caregiver was against vaccinations, so Jonathan currently remains unvaccinated. Despite learning the importance of vaccinations, Jonathan feels good about his state of health, admitting that he is never sick.

Variables Affecting Jonathan's Health

The variables affecting Jonathan's health include: - Career choice (external) - Childhood experiences (external) - Degree of stress (internal) - Feelings about health (internal) - Financial struggles (external)

Recommendations to Improve Jonathan's Health

The essential recommendations to assist Jonathan in improving his health include: - Consider vaccination based on age recommendations - Explore stress reduction strategies, such as meditation or yoga

The nonessential recommendations include: - Quit job at family practice clinic to reduce stress - Eat more fast food to save money - Reduce exercise time to have more time to study

Benefits of Health Education

The benefits of health education include: - Developing health-oriented habits

• Informing understanding of healthy behaviors - Improving wellness management - Solving health-related problems - Promoting lifestyle changes

Lifestyle Changes and Their Impact on Health

The following lifestyle changes and their impact on Jonathan's health:

Improve Health: - Jonathan received a seasonal flu vaccine - Jonathan continues yoga classes - Jonathan reports reduced stress

Decline Health: - Jonathan stayed up all night to cram for a final exam - Jonathan begins drinking alcohol on the weekend with his friends

Models of Health

Positive and Negative Health Behaviors

Positive health behaviors include: - Annual medical screening exams - Adequate exercise - Immunizations - Access to education - Stress management

Negative health behaviors include: - Lack of medical insurance - Exposure to air pollution - Injury or violence - Obesity - Barriers to healthcare access

Transtheoretical Model of Change

The five stages of the Transtheoretical Model of Change are: 1. Precontemplation 2. Contemplation 3. Preparation 4. Action 5. Maintenance

Perceived Healthcare Benefits of Action

Examples of perceived healthcare benefits of action include: - A mother making an informed decision regarding her child receiving an immunization

• An adult female undergoing a mammogram screening test

Clarification Needed on Health Promotion Model

The statement that needs clarification is: "Perceived self-efficacy is not related to the model."

Health Promotion Model and Client with

Chronic Conditions

An overweight client with diabetes and coronary artery disease visits their primary care provider (PCP) for an annual examination. The PCP educates the client that diabetes and coronary artery disease are comorbidities and discusses losing weight to avoid serious complications.

Based on the health promotion model, the factors that match the client's actions or statements are: - Prior attempts at weight loss (Prior Related Behavior) - Family history of obesity (Biological Factor) - "Regular exercise and healthy eating will decrease cholesterol levels." (Perceived Benefit) - "My arthritis may limit my ability to exercise." (Perceived Barrier) - "My wife will go with me to the gym." (Interpersonal Influence)

Roles of Healthcare Professionals in Smoking

Cessation

The healthcare professional assumes different roles within the health promotion model to promote healthy change in an individual who is trying to quit smoking:

Precontemplation: - Guide: Helps the smoker through unfamiliar circumstances and guides plan development with evidence-based science. - Motivator/Change Agent: Creates motivation through honest involvement, active listening, and encouragement. - Coordinator: Links available resources and creates a supportive network for success.

Contemplation: - Counselor: Guides in problem solving, supports self- determination, and shows that change is possible and necessary. - Educator: Reinforces education about the evidence of smoking effects, success with abstinence, and available options to support smoking cessation. - Critical Thinker: Uses a specific process to support change with the client.

Preparation: - Communicator: Establishes therapeutic relationships upon which to build trust and honest, factual communication. - Educator: Available to provide accurate information so that an individual can weigh the pros and cons of behavior. - Supportive Advocate: Reaches out to encourage and offer help while protecting the individual's right to self-determination.

Action: - Coach: Provides training, prompting, leadership, and instruction. - Caregiver: Implements a specific process to assist with antismoking medications, patches, and other support materials and aids as appropriate. - Teacher: Provides practical strategies to deal with urges, withdrawal, and emotions.

Maintenance: - Mentor: Provides follow-up support, consultation, and referrals as needed. - Researcher: Measures outcomes over time to build effective interventions. - Innovator: Creates new solutions for unseen problems particular to each client's smoking recovery.

Jamal's Health Behaviors and Needs

Smoking Cessation and Sleep Habits

Jamal, a 55-year-old client, attended a community health fair where he was provided information about a smoking cessation program. When asked if he would like to join the program, Jamal stated, "I could never quit smoking! I've been smoking since I was 14 years old." This indicates that Jamal is in the precontemplation stage of the transtheoretical model of change, as he does not see the need to quit smoking.

Jamal also completed a questionnaire about his sleeping habits, indicating that he does not sleep well and eats snacks very late at night. He believes this issue is related to work stress, as he is unhappy with his current job and is searching for another.

Alternative and Complementary Therapies

At the health fair, Jamal visited a station that focused on teaching about alternative and complementary therapies to help with stress reduction. Jamal stated that he takes a daily multivitamin and melatonin to help him sleep most nights.

Immunizations

The last station at the health fair was for immunizations. Jamal consented to receive both the influenza vaccine and the shingles vaccine.

Positive and Negative Behaviors

Based on Jamal's visit to the community health fair, the following behaviors were identified:

Negative Behaviors: - Smoking for 41 years

Positive Behaviors: - Receives vaccines - Takes daily multivitamin - Snacking late at night (negative) - Work-related stress (negative)

Transtheoretical Model of Change

Over the next two months, Jamal attended several meetings of the smoking cessation program. His statements during this time can be matched to the appropriate stages within the transtheoretical model of change:

• "I could never quit smoking" - Precontemplation

"Maybe I could consider cutting back to one pack per day" - Contemplation "I only buy one pack of cigarettes every two weeks and smoke half of them each week" - Action "I will ask my healthcare provider for prescription medication to help me quit" - Preparation "For the past month, I have cut back to one-half pack per week" - Maintenance

Health Promotion Model

The healthcare professional is planning a follow-up phone call with Jamal after the health fair. Based on Jamal's reported sleep habits, the professional will recommend relaxation and music therapy in the evening before bedtime. This approach aligns with the holistic health model, which considers the whole person and their environment.

Transtheoretical Model and Healthcare Professional's

Response

At the health fair, Jamal stated that he could never quit smoking. Considering the transtheoretical model of change, the most appropriate response by the healthcare professional would be, "What do you think is the greatest challenge to stopping smoking?" This open-ended question encourages Jamal to reflect on his own barriers and readiness to change.

Effectiveness of Health Promotion Activities

Based on Jamal's actions as a result of participating in the community health fair, the following findings indicate the health promotion activities were effective:

Reduced number of cigarettes smoked per day Brought spouse to pharmacy to receive shingles vaccine

Health Belief Model and Testicular Self-

Examination

A healthcare professional is planning a health promotion program on testicular self-examination. Using the health belief model, the statement made by a participant that indicates perceived susceptibility to illness is, "My brother had testicular cancer when he was a teenager, so I know my risk is elevated."

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Transtheoretical Model of Change and

Lifestyle Change

Using the transtheoretical model of change, the steps needed to make a lifestyle change are in the following order:

The client recognizes the need to lose weight when struggling to play catch with the son. The client becomes angry when the healthcare provider suggests losing 40 pounds. The client joins a gym and hires a personal trainer. The client works out 4 days per week with their spouse. Six months after beginning the workout regiment, the client has lost 20 pounds.

Maslow's Hierarchy of Needs

According to Maslow's five-tier model, the needs are in the following ascending order:

Physiological Safety and Security Love and Belonging Self-esteem Self-actualization

The basic physiological needs according to Maslow's hierarchy are: - Food - Water - Sleep - Elimination - Oxygenation

The examples for each level of need are: - Physiological - Shelter - Safety and Security - Health and Well-being - Love and Belonging - Intimacy - Self- esteem - Independence - Self-actualization - Personal Growth

During the home care visit, the healthcare professional is addressing the physiological needs of the older adult couple by encouraging them to increase daily fluids and activity levels to help with their voiced concern about constipation.

Maslow's Hierarchy and Client Needs

The characteristics that match each level of Maslow's hierarchy are: - Physiological - Breathing - Safety and Security - Security of resources - Love and Belonging - Friendship - Self-esteem - Confidence - Self-actualization - Problem solving

The adolescent's concerns represent the following levels of Maslow's hierarchy: - Physiological - Not eating breakfast - Safety - Sleeping in the car, fear of being robbed - Belonging - Bullying in homeroom

Maslow's Hierarchy and Immunization

The need being met when a client presents to an immunization clinic to receive influenza and tetanus (Td) vaccines is safety and security.

The highest priority need after successfully getting the client to eat is physiological.

The potential unmet needs from the situation with the elderly client with dementia are: - Physiological - Not eating - Safety and Security - High fall risk, does not trust staff - Love and Belonging - Refuses to see family members

Maslow's Hierarchy and Samara's Unmet

Needs

Samara's unmet needs match the following levels of Maslow's hierarchy: - Physiological - Eviction notice - Safety and Security - Small paychecks - Love and Belonging - Rejection by boyfriend - Self-esteem - Struggling in school

The unmet need with the highest priority according to Maslow's theory is physiological.

The order of Samara's unmet needs from lowest to highest level is: 1. Physiological 2. Safety and Security 3. Love and Belonging

When providing care to Samara, the healthcare professional must consider that her basic physiological needs must always be met first.

Maslow's Hierarchy and Samara's Situation

The actions that are improving or declining Samara's situation are:

Improving: - Samara receives an extension on her eviction notice - Samara joins a support group for young mothers

Declining: - Samara is fired from her job for calling out sick

Maslow's Hierarchy and Client Care

Maslow's hierarchy of needs provides structure for client care by establishing priorities of care. It helps the healthcare professional communicate client needs concisely and focus on meeting the client's most pressing needs first.

Levels of Prevention

The levels of prevention and their descriptions are:

Primordial prevention - Preventing exposure risk factors that promote disease onset Primary prevention - Reducing the incidence of disease or injury Secondary prevention - Preventing the spread of disease, illness, or infection once it occurs Tertiary prevention - Managing a chronic condition to lessen long-term complications

The examples of primary and secondary prevention strategies are:

Primary Prevention: - Teaching a community class on heart-healthy eating - Wearing a car seat belt - A parent bringing children to a vaccine clinic - Attending a class on mindfulness - Screening by mammogram for women over age 45 years

Secondary Prevention: - Blood transfusion for anemia - Visiting the urgent care clinic for a sore throat - Using crutches due to a broken leg

The healthcare professional can promote health and assist clients in preventing disease through the following prevention strategies:

Primordial Prevention: Preventing the legalization of marijuana Primary Prevention: Avoiding second-hand smoke, increased physical activity, low-dose aspirin to prevent heart attack Secondary Prevention: Monthly testicular exams, teaching about the use of a spacer to a client with asthma Tertiary Prevention: Rehabilitation after stroke

The prevention strategies most likely to occur at the local, state, and national levels are:

Local: Trash pickup days increase during the holidays State: Vaccination clinics sponsored by the state health department National: Centers for Disease Control and Prevention's Childhood Lead Poisoning Prevention Program

Prevention Strategies for Michael

Based on Michael's physical examination, the healthcare professional should implement primary prevention strategies, such as weight loss, diet alterations, stress reduction, and increased physical activity. These strategies are effective in addressing the identified risk factors and preventing the development of conditions like heart attack, diabetes mellitus, and obesity.

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Primary Prevention, Secondary Prevention,

and Tertiary Prevention

Primary Prevention

Primary prevention focuses on preventing the development of a disease or condition before it occurs. Examples of primary prevention strategies include:

Reducing work hours Practicing meditation Joining a cycling club

Secondary Prevention

Secondary prevention aims to detect and treat a disease or condition early, before it progresses or causes complications. Examples of secondary prevention strategies include:

Taking medication to treat high blood pressure Screening annually for high blood sugar

Tertiary Prevention

Tertiary prevention focuses on managing a disease or condition to prevent further complications or disability. An example of tertiary prevention is attending cardiac rehabilitation after a heart attack.

Nurses as Promoters of Health

Health Promotion

Health promotion activities help individuals maintain or enhance their present level of health.

Wellness Education

Wellness education interventions teach people how to care for themselves in a healthy way.

Illness Prevention

Illness prevention activities protect people from actual or potential threats to health.

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Assessing Health Risks

Nurses assess health risks during each client encounter. By leading health promotion activities, nurses can improve healthcare outcomes.

Risk Factors

Nonmodifiable Risk Factors

Genetics Age Gender at birth Ethnicity Family health history Personal health history

Modifiable Risk Factors

Wearing a seatbelt Lifestyle Diet Stress Exercise Sleep pattern Substance misuse Tobacco

Health Promotion Models

Health Promotion Model

Nurses recognize individuals have unique personal characteristics and experiences that affect subsequent actions, and understand behavior- specific variables influence motivation to adopt healthy behaviors.

Transtheoretical Model

Nurses recognize that people are at different stages of readiness to adopt healthful behaviors.

Holistic Health Model

Nurses using this model recognize the natural healing abilities of the body, acknowledge, and incorporate complementary and alternative interventions into the plan of care.

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Maslow's Hierarchy of Needs

Nurses recognize that an individual's physiological needs are the highest order of priority need.

Health Belief Model

Nurses acknowledge that multiple factors influence a client's health perceptions, health beliefs, and likelihood of taking preventative health action.

Case Study: Jordan and Asthma

Jordan, a 6-year-old with asthma, developed worsening symptoms after his sister got a guinea pig. The nurse recognized that Jordan's issue stemmed from an environmental risk factor.

Primary Prevention Actions

Allergy testing Use an air filter in the home

Secondary Prevention Actions

Prescription for a rescue inhaler Clean the pet cage daily

The nurse advised the caregivers to consider a hypoallergenic pet or suggest a virtual pet, as Jordan and his sister were very sad to lose their pet.

Two weeks later, the caregivers reported that Jordan was no longer coughing and wheezing, indicating his situation was improving. However, they also reported that the children got a fish tank, which could potentially worsen Jordan's condition.

Health Promotion Strategies

Advocacy

The public health nurse recognized an increase in the incidence of diabetes mellitus type 2 among school-aged children and worked with local school nurses to improve lunch menus in the schools.

Equity

The public health nurse recommended telehealth medical appointments be available for clients with limited transportation.

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Mediation

A local elementary school wanted to implement a mask mandate to protect children from exposure to COVID-19, but the school board was resistant. The public health nurse presented information during a school board meeting.

Risk Factors for Diabetes Mellitus Type 2

Modifiable Risk Factors

Obesity Sedentary lifestyle

Nonmodifiable Risk Factors

45 years old Parent with diabetes mellitus type 2 African American History of gestational diabetes during pregnancy

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