Chapter 1

Health Defined: Objectives

for Promotion and Prevention

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Exploring Concepts of Health

Wellness-illness continuum

High-level wellness

Health as dichotomy: High-level wellness vs.

depletion of health
Sense of well-being, life satisfaction, quality of life

Negative end

Adaptation to disease/disability

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Exploring Concepts of Health

(Cont.)

Unitary patterning of person-environment

(1970s and 1980s)

Unidirectional
Developmental
Expanding consciousness, pattern/meaning
recognition
Health outcome of ongoing patterns
person/environmental interaction
Person is a complex, interconnected system

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Ecological Model of Health

Comprehensive and multidimensional

Interconnection between people and
physical/social environments
Promotes health on multiple levels

Individual
Family
Community
Society

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Historical Perspective of Health

Before 1940: Health = absence of disease

Infectious diseases prominent

Physician: independent primary practitioner
Government: start public health/welfare

1940s-1950s: Health = ability to fulfill roles

Physicals for fitness

Physicians linked to hospital services
Increased federal role: hospital expansion, federal
programs

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Historical Perspective of Health

(Cont.)

1960s-present: Health = adaptation and reaction

to environment

Disease prevention/health promotion

Emphasis on individual responsibility/lifestyle choices
Growing number/diversity of primary providers
Government: control costs
Quality of life seen as component of health
Patient/family perception important

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Models of Health

Clinical

Role performance

Health based on whether person can perform societal

roles

Adaptive

Absence s/s disease; prevention not emphasized

Ability to adapt positively to change

Eudaimonistic model

Exuberant well-being: interaction and

interrelationships in multiple aspects of life
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Key Health Concepts

Functioning

Health

State of physical, mental, spiritual, and social functioning within

developmental context
Both individual and societal responsibility

Disease

Levels reflected in terms of performance/social expectations; loss

indicator of need for nursing intervention

Failure of adaptive mechanisms

Results in functional or structural disturbances

Illness

Subjective experience of individual and physical manifestation of

disease
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Healthy People 2020

National Guidelines to Promote Health

Define national emphasis for health promotion and

disease prevention efforts

Four overarching 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
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Healthy People 2020 (Cont.)

Forty-two focus areas

Guide for health care research, practice, education,

policy, and communications

Twelve leading health indicators (e.g., access

to health services, environmental quality,
physical activity, obesity, tobacco use)

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Planning for Health: Healthy

People 2020 (Cont.)

Research of current health incorporated

Responsibility for intervention

Individuallifestyle/behaviors
Health care providersoffer preventative
services/monitoring behaviors
Community partnerships to promote health (e.g.,
work sites, faith communities)

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Levels of Prevention
Levels of Prevention

Steps of Prevention

Primary

1. Health promotion and

specific protection

Secondary

2. Early diagnosis
3. Prompt treatment
4. Disability limitation

Tertiary

5. Restoration and
rehabilitation

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Primary Prevention

Precedes disease/dysfunction
Interventions

Focus: Maintain/improve general

individual/family/community health
Passivenot personally involved

Health promotion (e.g., education)

Specific protection (e.g., immunization, reducing
exposure to carcinogens, occupational hazards)

Public health effortsclean water/sewer

Activepersonally involved

Lifestyle changes
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Transtheoretical Model of Health

Promotion

Example of health promotion model

Incorporates:

Stages of change
Decisional balance
Self-efficacy
Processes of change
Six stageseach provides nursing opportunity for
information and support

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Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Secondary Prevention

Screening

Goal: Identify individuals in early, detectable stage of

disease

Treating early stages of disease

Limiting disability
Interventions similar to primary prevention but
applied to individuals/ populations with disease

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Tertiary Prevention

Defect/disability permanent or irreversible (e.g.,

stroke)
Minimizing effect to prevent
complications/deterioration
Objective: Return to useful place in society,
maximize remaining capacity

Surveillance
Maintenance
Rehabilitation
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The Nurses Role

Emphasis shifting from acute, hospital-based

care to preventative community-based care
Nurses must assume blended roles with a
knowledge base using evidence-based
practice

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Nursing Roles in Health

Promotion and Protection

Advocate
Care manager
Consultant
Deliverer of services
Educator
Healer
Researcher

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Evidence-Based Practice

Conscientious, explicit, and judicious use of

current best evidence in making decisions
about the care of individual patients
Integrating individual clinical expertise with the
best available external clinical evidence from
systematic research (ANA, 2004)

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Improving Prospects for Health

Population effects

Shifting problems

Increased diversity
Changes in age distribution (older population)
Health promotion approaches may need to adapt
Environmental pollution
Stress
Lifestyle (obesity, substance abuse)
Increase in chronic conditions

Moving toward solutions

Individual involvement (lifestyle changes, motivation)

Governmental involvement (legislation and financing)
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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Copyright 2014 by Mosby, an imprint of Elsevier Inc.

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