kozier - chapter 16 - health promotion

Kozier & Erb's Fundamentals of Nursing, 8eBerman, Snyder, Kozier, ErbCopyright 2008 by Pearson Education, Inc.

Chapter 16

Health Promotion

Copyright 2008 by Pearson Education, Inc.

Question 1

A nurse and a primary care provider inform a client that chemotherapy is recommended for the diagnosis of cancer. Which of the following nursing actions is most representative of the concept of holism?

1. Offer to come to the client’s home to provide needed physical care.

2. Contact the client’s spiritual adviser.3. Inquire how this will affect other aspects of the

client’s life.4. Provide the client with information about how to

join a support group.


Rationales 11. Although arranging for home care may be appropriate,

the nurse begins a holistic approach to care by examining, with the client, in what ways the illness influences the various segments of her life.

2. Although facilitating spirituality, may be appropriate, the nurse begins a holistic approach to care by examining, with the client, in what ways the illness influences the various segments of her life.

3. Correct. Holism implies consideration of all aspects of the client’s life. The client is the best source of information regarding personal needs. Assessment should always precede intervention.

4. Although offering coping resources may be appropriate the nurse begins a holistic approach to care by examining, with the client, in what ways the illness influences the various segments of her life.


Question 2While hospitalized a client is very worried about business activities. The client spends a great deal of time on the phone and with colleagues instead of resting. Which of the following principles of need therapy applies?

1. His higher level need cannot be met unless the lower level physiologic need is met.

2. His lower level physiologic needs are being deferred while higher needs are addressed.

3. The higher need takes precedence and the lower need no longer must be met.

4. It is necessary for someone else to meet his higher level needs so he can focus on the lower level need.


Rationales 2

1. Incorrect.2. Correct. Choices are often related to

learned experiences, lifestyle, and values. The client obviously values the business more than physical health. When a person feels strongly enough, a lower level need (rest) can be postponed until a higher level need (success, safety) is met. It is very likely that no one else can meet that need for him and the lower need must still be met eventually.

3. Incorrect.4. Incorrect.


Question 3

A client who is 46 pounds overweight tells you, “I was just born to be fat. I don’t have the willpower.” Although weight loss occurred while attending two previous programs that “guaranteed” weight loss, the weight returned along with extra pounds after each program. According to the Health Promotion Model, the nurse is most likely to focus on which of the following behavior-specific cognitions and affects variable for this client?

1. Perceived barriers to action2. Perceived self-efficacy3. Interpersonal influences4. Situational influences


Rationales 3

1. Option 1 is a person’s perceptions about available time, inconvenience, expense, and difficulty performing the activity.

2. Correct. Perceived self-efficacy is the confidence the person has for achieving the desired outcome.

3. Option 3 is the person’s perceptions concerning the behaviors, beliefs, or attitudes of others.

4. Option 4 refers to the person’s perception of the environment and how it assists or detracts from the healthy behavior.


Question 4

A client is admitted for heart failure. The nurse assesses that the client’s BP is below normal range and the apical pulse is 110. The nurse knows that the increase in the client’s pulse illustrates which aspect of the client’s homeostatic mechanism?

1. Compensation2. Decompensation3. Self-regulation4. Equilibrium


Rationales 4

1. Correct. The compensatory mechanism of increasing the heart rate is the body’s way of trying to balance an ineffective cardiac output since the BP has decreased.

2. Decompensation occurs when the compensatory mechanism is ineffective.

3. Self-regulation refers to the homeostatic mechanisms that come into play automatically in the healthy person.

4. Equilibrium is balance through adaptation to the environment.


Question 5

Using Maslow’s framework, which statement characterizes the highest level of need?

1. “Nurse, my pain is severe . . . is it time for my shot?”

2. “I felt welcomed when I first joined the group and I look forward to the monthly meetings.”

3. “I’m very proud of receiving the Employee of the Month award.”

4. “There have been home break-ins with burglary in our neighborhood. We are thinking of moving.”


Rationales 5

1. This is a physiological need.2. This is a love and belonging need.3. Correct. This is a self-esteem

need.4. This is a safety and security need.


Assessing and Planning Health Care

• Enhanced when nurses understand:– Individuality– Holism– Homeostasis– Human needs


Individuality

• Each individual is a unique being • Focus on total care and individualized

care context• Total care context considers all the

principles that apply when taking care of any client

• Individualized care context means using the total care principles that apply to the person at this time


Holism

• Concerned with the individual as a whole, not as an assembly of parts

• Strive to understand how one area of concern relates to the whole person

• Consider the relationship of individuals to the environment and to others


Characteristics of Homeostatic Mechanisms

• Self-regulatory• Compensatory• Regulated by negative feedback

systems• Feedback mechanisms


Theoretical Frameworks used in Individual Health Promotion

• Needs Theories – Maslow– Kalish

• Developmental Stage Theories


Maslow’s Hierarchy of Needs

Physiologic

Safety and security

Love and belonging

Self-esteem

Self actualization


Maslow’s Characteristics of the Self-actualized Person

• Realistic, sees life clearly, and is objective

• Judges people correctly• Has superior perception, is more decisive• Has clear notion of right and wrong• Is usually accurate in predicting future

events• Understands art, music, politics, and

philosophy



• Possesses humility, listens to others carefully

• Is highly creative, flexible, spontaneous, courageous, and willing to make mistakes

• Is open to new ideas• Is self-confident and has self respect• Has low degree of self-conflict; personality is

integrated• Respects self, does not need fame,

possesses a feeling of self control• Is highly independent, desires privacy



• Can appear remote and detached• Is friendly, loving, and governed more

by inner directives than by society• Can make decisions contrary to

popular opinion• Is problem-centered rather than self-

centered• Accepts the world for what it is


Healthy People 2010

• Two major goals are:– To increase quality and years of healthy

life– To eliminate health disparities


Healthy People 2010

• Organized around 28 focus areas to improve health

• Establishes a set of leading health indicators reflecting public health concerns

• Indicators will help develop action plans to improve the health of both individuals and communities

• Individual health closely linked to community health and reverse

• Vision is “healthy people in healthy communities”


Health Promotion and Health Protection/Illness Prevention

The difference is the individual’s motivation for behavior


Health Promotion

• Not disease oriented• Motivated by personal, positive

approach to wellness• Seeks to expand positive potential

for health


Health Protection/Illness Prevention

• Illness or injury specific• Motivated by avoidance of illness• Seeks to thwart the occurrence of

insults to health and well-being


Types of Health Promotion Programs

• Health promotion• Specific protection• Screening for early detection of

disease


Sites of Health Promotion Programs

• Various settings for programs:– In home– Community– Schools– Health care organizations– Worksites


Health Promotion Model (HPM)

Link to HPM Figure• Competence or approach-oriented

model • Motivational source for behavior

changes based on individual’s subjective value of the change


Variables of HPM

• Individual characteristics and experiences– Prior related behaviors– Personal factors

• Behavior-specific cognitions and affect– Perceived benefits of action– Perceived barriers to action– Perceived self-efficacy– Activity-related affect– Interpersonal factors– Situational influences


Variables of HPM

• Commitment to a plan of action• Immediate competing demands and

preferences• Behavioral outcome


Stages of Health Behavior Change


Stages of Health Behavior Change

Link to Stages Diagram• Precontemplation• Contemplation• Preparation• Action• Maintenance• Termination


Nurse’s Role in Health Promotion

• Model healthy lifestyle• Facilitate client involvement• Teach self-care strategies• Assist clients to increase levels of

health• Educate clients to be effective health

care consumers


Nurse’s Role in Health Promotion

• Assist clients to develop and choose health-promoting options

• Guide development of 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


Assessment of Health

• Health history • Physical examination• Physical fitness assessment• Lifestyle assessment• Spiritual health assessment• Social support system review• Health risk assessment• Health beliefs review• Life-stress review


Developing Health Promotion Plans

• Based on health needs, desires, and priorities of the client

• Client decides on: – Goals– Activities or interventions to achieve

these goals– Frequency and duration of activities– Method of evaluation


Implementing Health Promotion Plans

• Emphasis on self responsibility• Nursing interventions include:

– Supporting– Counseling– Facilitating– Teaching– Consulting– Enhancing the behavior change– Modeling


Evaluating Health Promotion Plans

• Ongoing • Collaborative effort• Client actions may include:

– Continue the plan– Reorder priorities– Change strategies– Revise the contract


Question 1

A nurse and a primary care provider inform a client that chemotherapy is recommended for the diagnosis of cancer. Which of the following nursing actions is most representative of the concept of holism?

1. Offer to come to the client’s home to provide needed physical care.

2. Contact the client’s spiritual adviser.3. Inquire how this will affect other aspects of the

client’s life.4. Provide the client with information about how to

join a support group.