Ch02

Health Promotion StrategiesHealth Promotion Strategies
Through the Life SpanThrough the Life Span
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Health Promotion Strategies Through the Life Span, Eighth Edition
Ruth Beckman Murray, Judith Proctor Zentner, and Richard Yakimo
Chapter 2
Health Promotion:
Concepts and Theories

Organizations and InitiativesOrganizations and Initiatives
 Organizations involved in promoting health
for all populations in the United States
– Healthy People 2010 Initiative
– American Nurses Association
– Sigma Theta Tau, International
– American Academy of Nursing
– National Alliance on Mental Illness

National InitiativesNational Initiatives
 Organizations are striving for
– Public research
– Research for direct practice
– Change in accessibility of delivery systems
– Improved data bases and clinical information
systems
– Altered incentives for health promotion
practices

Healthy People 2010Healthy People 2010
 Presents 28 specific areas for health
improvement
 Lists 467 objectives
 Details ways to achieve and evaluate
progress to the goals for health promotion
and disease prevention

Increased Risks for DiseasesIncreased Risks for Diseases
 More people and goods travel to and from
the United States
– Creates higher risk of diseases being brought
to the USA
– Creates need for better health care for people
globally

Global StrategiesGlobal Strategies
 Inform, educate, and provide decision-
making opportunities to people
 Strengthen local health care systems
 Improve education for health care
professionals
 Apply science and technology to health
care problems

Global Strategies, contGlobal Strategies, cont
 Use new approaches to problems
 Provide culturally appropriate assistance
to less developed countries
 Establish a process to examine world
challenges to health

Definition of HealthDefinition of Health
 State of well being
 Using adaptive responses to respond to
stimuli or stressors appropriately
 Maintaining stability and comfort to
achieve objectives

Health and DiseaseHealth and Disease
 Health Promotion
– Behavior motivated
by desire to
increase well-being
and health
potential; not
disease specific
 Disease Prevention
– Behavior motivated
by a desire to avoid
disease, detect it
early, or maintain
functioning with
disease or illness

Primary PreventionPrimary Prevention
 Preventing or decreasing the probability of
– Occurrence or injury
– Physical or mental illness
– Health-threatening situation
– Event or illness in the population
 Examples: immunization, health
education, exercise, environmental
policies

Secondary PreventionSecondary Prevention
 Screening and early diagnosis
 Treating problem promptly
 Shortening duration or severity of
consequences
 Preventing disability or complications
 Example: HIV screening

Tertiary PreventionTertiary Prevention
 Restoring person to optimum function
within constraints of irreversible problem
 Including long-term treatment and
rehabilitation
 Preventing further progression of
complications or deterioration
 Examples: Improve survival and quality of
life for person with diabetes

Health Care DisparitiesHealth Care Disparities
 Inequalities of service
– Cultural factors
– Unavailability of care facilities
– Financial factors

Health DisparitiesHealth Disparities
 Include differences in incidence,
prevalence, mortality, and burden of
disease
 Barriers could be demographic (age,
education, occupation), cultural (religious
beliefs, social customs), or health care
system barriers (lack of bilingual staff, lack
of insurance)

Communication Barrier ExamplesCommunication Barrier Examples
 Conveying negative feelings
 Appearing too busy or uncaring
 Not paying attention to client
 Using wrong vocabulary
 Offering false reassurance
 Requiring explanations or making
challenges
 Belittling a person’s feelings

Addressing BarriersAddressing Barriers
 Groups addressing barriers to care
– United States Department of Health and
Human Services
– Health Resources and Services
Administration
– National Alliance on Mental Illness

Improvements Needed for CareImprovements Needed for Care
 Improved access to care
 Appropriate and acceptable treatment
plans
 Workforce of sufficient numbers and
qualifications
 Agreement on indicators for quality health
care
 Responsible patients who follow through

Benefits of ResearchBenefits of Research
 Learn more about vulnerable groups and
other health care systems
 Contributes to theories and models
– Used to overcome barriers to or disparities in
health care
– Explains dynamic behind behavior related to
maintaining health or the secondary or tertiary
levels of prevention

Theories and ModelsTheories and Models
 Behavior and Social Learning Theories
– Imitating health habits of elders or peers
– Behavioral capacity
– Efficacy
 Health Belief Model and Health Promotion
Model
– Variables that motivate health-seeking
behavior

Theories and Models, contTheories and Models, cont
 Coping Theory
– Ability to stay healthy
 Motivation and Emotional Arousal Theory
– Feelings that affect behavior during health or
illness
 Communication Theory
– Using therapeutic techniques to communicate
 Therapeutic Relationship Theory
– Therapeutic relationship is key to health
promotion

Positive Coping StrategiesPositive Coping Strategies
 Affiliation
 Altruism
 Anticipation
 Assertiveness
 Humor
 Self Observation

Theories of Stress and CrisisTheories of Stress and Crisis
 Theory of Stress and General Adaptation
Syndrome
 Crisis Theory

Theory of Stress and General AdaptationTheory of Stress and General Adaptation
SyndromeSyndrome
 Describes physiologic adaptive response
to stress
 Stress: physical and emotional state
always present in a person
– Influenced by various environmental,
psychological, and social factors

StressorsStressors
 Cause physical and emotional
mechanisms within the body
 Types of stressors: Physical, Chemical,
Microbiologic, Microbiologic, Physiologic,
Psychological, Developmental,
Sociocultural, Environmental

StressStress
 Eustress
– Stress that comes with successful adaptation
– Promotes development
 Daily hassles
– Repeated and chronic strains of life
 Distress
– Negative stress
– Occurs when adaptive capacity is decreased
or exhausted

Principles of StressPrinciples of Stress
 Behavioral response
 Cumulative impact
 Circumstances affect impact of stressor
 People highly adaptable
 Psychological and social factors affect
impact of stressor
 Conditioning is important

Local Adaptation SyndromeLocal Adaptation Syndrome
 Method used to wall off and control effects
of physical stressors locally

General Adaptation SyndromeGeneral Adaptation Syndrome
 Alarm Stage
– Instantaneous
– Person feels helpless, insecure, and
uncomfortable
– Hormone levels cause person to feel more
prepared, alert, and more able to adapt

General Adaptation Syndrome, contGeneral Adaptation Syndrome, cont
Figure 2-3
Alarm Stage, General
Adaptation Syndrome:
physiologic responses to
sympathetic nervous
system stimulation.

 Stage of Resistance
– Body’s way of adapting to disequilibrium
caused by stressors
– Includes use of body resources, tissue
anabolism, antibody production, hormonal
secretion, changes in blood sugar levels and
volume
– Ends when stressors diminish or person finds
adaptive mechanisms

Figure 2-4:
Stage of Resistance,
General Adaptation
Syndrome: signs of
emotional, intellectual,
and physiologic distress

 Exhaustion Stage
– May occur if body resistance is not
maintained
– Can lead to disease or even death
 Lack of homeostasis
– Emotional factors precipitate or exacerbate
nearly every organic disease and may
increase susceptibility to disease
– Causes anxiety and chronic stress

Stress and HealthStress and Health
Figure 2-5 Reaction pattern in chronic stress

Stress and Health, contStress and Health, cont
 Psychosomatic or psychophysiologic
– Process of physical or organic symptoms of
disease resulting from feeling states
 Somatopsychic
– Feeling states of depression or worry in
response to physical states

General Adaptation Syndrome inGeneral Adaptation Syndrome in
Health CareHealth Care
 Help people cope with Alarm Stage
 Maintain Resistance Stage
 Foster return to normal function or
homeostasis

General Adaptation Syndrome inGeneral Adaptation Syndrome in
Health Care, contHealth Care, cont
 Assess physical, emotional, and cognitive
state
 Determine state of adaptation
 Teach client to recognize signs of stress
response and how to activate relaxation
response
 Counsel as necessary
 Prevent or reverse Exhaustion Stage

Characteristics of a Helping RelationshipCharacteristics of a Helping Relationship
 Respectful
 Genuine
 Attentive
 Accepting
 Positive
 Strong
 Secure
 Knowledgeable
 Sensitive
 Empathetic
 Nonjudgmental
 Congruent
 Unambiguous
 Creative

Helping Relationship in HealthcareHelping Relationship in Healthcare
 Orientation phase
– Problem-defining phase
 Working phase
– Active phase of problem solving
 Termination phase
– Problem has been resolved or handled
– Nurse teaches measures to prevent further
illness and maintain self-care

Crisis TheoryCrisis Theory
 How people respond psychologically and
behaviorally when they cannot cope with
stressors
 Temporary situation that cannot be
handled with person’s usual coping
mechanisms
 Requires person to change in order to
remain adaptive

Developmental (Maturational) CrisisDevelopmental (Maturational) Crisis
 Occurs during transition points
 New relationships are often formed or old
relationships take on new aspects
 Unable to make healthy role change
– Unable to picture himself or herself in new
role
– Lack of intrapersonal or communication skills
– Lack of past opportunities to learn to cope
– Prevented by others in social system

Situational CrisisSituational Crisis
 External event or situation
– Often unexpected
– Examples: natural disasters, divorce, death,
loss of job, illness, additions to family, forced
geographic relocation
 Demands a change in behavior

Phases of a CrisisPhases of a Crisis
 Shock
 Defensive retreat
 Acknowledgement and mourning
 Adaptation or resolution

Factors Affecting Outcome of CrisisFactors Affecting Outcome of Crisis
 Perception of event
 Degree of perceived dependency on lost
subject
 Physical and emotional status
 Coping techniques and level of maturity
 Previous experiences and cultural influences
 Realistic aspects of situation
 Availability of support groups

Crisis Theory in Health CareCrisis Theory in Health Care
 Assess anxiety levels, feelings,
perceptions, and presence of emotional or
physical symptoms
 Explore support system and usual coping
strategies
 Clarify crisis event
 Provide comfort measures to help client
maintain physiological homeostasis

Crisis Theory in Health Care, contCrisis Theory in Health Care, cont
 Help client develop plan to resolve crisis
 May refer client for additional services
 Maintain follow-up care
 Evaluate effectiveness of interventions

CAM/CATCAM/CAT
 Complementary or alternative
medicine/therapies (CAM or CAT)
– Nontraditional or nonmedical approaches that
are considered holistic or integrative to
promote health or treat illness
– Not part of conventional medical practice
– May supplement conventional therapies
taught in Western medical schools

Examples of CAM/CATExamples of CAM/CAT
 Mind/body
interventions
 Biological-based
interventions
 Botanical
interventions
 Manipulations
 Biophilia Therapy
 Positive Thinking
 Spiritual
interventions
 Energy field
interventions
 Sensory therapy
 Pet therapy
 Homeopathy

CAM/CAT in Health CareCAM/CAT in Health Care
 Be familiar with therapies
 Assess client’s knowledge about therapies
 Assist client to gain access to and
understanding about therapy or
qualification of therapist
 Encourage client not to substitute
therapies for necessary conventional
treatment

Ch02

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