1. Professional Nursing Practice Concepts and Perspectives
Seventh Edition
Chapter 7
The Nurse as Health Promoter and Care Provider

2. 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 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 DiClemente’s five-stage model of behavior change. 7.8 Analyze the nurse’s role in health promotion.

3. 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

4. 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
Educate
Practice in variety of settings

5. Learning Objective 7.1
Differentiate between health prevention or protective care and health promotion.

6. Defining Health Promotion
Universally accepted definition does not exist; confused with health education
World Health Organization (2015a) 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.”

7. 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.”

8. Learning Objective 7.2
Discuss essential components of health promotion.

9. Defining Health Promotion
Leavell and Clark levels of prevention
Primary
Health promotion
Protection against specific health problems
Secondary
Early identification
Prompt intervention
Tertiary
Restoration and rehabilitation

10. Defining Health Promotion
Pender, Murdaugh, and Parsons
Health promotion
Approach behavior
Not disease oriented
Expand positive potential for health
Health protection (primary prevention)
Avoidance behavior
Avoiding specific problems
Thwart occurrence of insult to health and well-being

11. Learning Objective 7.3
Discuss the overarching goals, foundation health measures, topics, and objectives of Healthy People 2020.

12. 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

13. Healthy People 2020
Leading Health Indicators (LHI) reflect high- priority issues, used to
Assess health of the nation
Facilitate collaboration across sectors
Motivate action
Track progress using specific objectives

14. 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

15. Healthy People 2020 Leading Health Indicators
Nutrition, physical activity, and obesity
Oral health
Reproductive and sexual health
Social determinants
Substance abuse
Tobacco

16. Healthy People 2020
Four foundation health measures, indicators of progress
General health status
Provides information on overall health of a population
Health-related qualify of life and well-being
Physical, mental, emotional, and social functioning are integrated whole of health status
Determinants of health
Factors that influence health status
Disparities
Difference in illness/injury occurrence, health access or health outcomes based on various factors

17. Learning Objective 7.4
Identify various types of and sites for health promotion programs.

18. 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)
Clean water and air
Active (client committed to involvement)
Diet management
Self-help
Exercise

19. Health Promotion Activities
Types of programs
Information dissemination
Billboards, posters, Internet
Health risk appraisal/wellness assessment
Lifestyle and behavior change
Stress management, nutrition awareness, weight control, smoking cessation, and exercise
Environmental control
Safe air, food, and water

20. Health Promotion Activities
Sites for health promotion activities
Home
Schools
Hospitals
Work sites
Religious organizations
Gyms and fitness centers
Shopping malls
Internet sites

21. Learning Objective 7.5
Compare and contrast the locus-of-control and health belief models as they relate to healthcare decision making.

22. 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

23. 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

24. Learning Objective 7.6
Compare and contrast Pender’s Health Promotion Model (HPM) and the Neuman Systems Model as they relate to health-promotion decision making.

25. 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

26. 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

27. Pender’s Health Promotion Model
Individual characteristics and experiences
Prior related behavior
Previous experience, knowledge, and skill in health-promoting actions
Personal factors
Biological, psychological, and sociocultural factors

28. 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

29. 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

30. Pender’s Health Promotion Model
Immediate competing demands
Factors over which the individual has a low level of control
Family and work responsibilities
Immediate competing preferences
Factors over which the individual has a high level of control
Taste
Behavioral outcome
Adoption and integration of health-promoting behaviors into the individual’s lifestyle

31. 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

32. Learning Objective 7.7
Discuss Prochaska and DiClemente’s five-stage model of behavior change.

33. Stages of Health Behavior Change
Cyclical phenomenon in which people progress through several stages
Precontemplation
Negative aspects of the change outweigh the benefits
Contemplation
Seriously considers changing a specific behavior
Preparation or planning
Advantages of changing the behavior outweigh the disadvantages and person makes specific plans to accomplish the change

34. Stages of Health Behavior Change
Action
Actively implements the behavioral and cognitive strategies to interrupt previous behavior patterns and adopt new ones
Maintenance
Integrates newly adopted behavior patterns into his or her lifestyle
Termination
Person has no desire to return to previous unhealthy behavior and believes he or she will not relapse

35. Learning Objective 7.8
Analyze the nurse’s role in health promotion.

36. 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

37. 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