Chapter 32

Health Maintenance, Health Promotion, and Wellness

32-2Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.

Health is the process through which a person seeks to maintain an equilibrium that promotes stability and comfort.

Health is a dynamic process that varies according to a person’s perception of well-being.

Health, Illness, and Wellness

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Health refers to all aspects of a person’s life.• Physical status• Emotional well-being• Social relationships• Intellectual functioning• Spiritual condition

Health, Illness, and Wellness

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Health, Illness, and Wellness

Illness is the inability of an individual’s adaptive responses to maintain physical and emotional balance, which results in an impairment of functional abilities.

Wellness is the condition in which an individual functions at optimal levels.

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Models of Health

Health is the maintenance of harmony and balance among body, mind, and spirit.• Balance or homeostasis is an equilibrium

among psychological, physiological, sociocultural, intellectual, and spiritual needs.

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Models of Health

Clinical model Health-belief model High-level wellness model Social learning theory Host-agent-environment model Health promotion model

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Cultural Influence on Health

Culture affects how an individual views health and illness.

One’s cultural background influences health-related behaviors and expectations of treatment when illness occurs.

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Family Influences on Health Care

Families help determine the following:• Whether or not to seek treatment.• What type of treatment is appropriate.• Who should provide the treatment or care.• Where the treatment or care should be

provided.

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Families are often the major caregivers for their relatives.

Extended families and communities have traditionally acted as a buffer against excessive stress and illness.

Family Influences on Health Care

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Family Influences on Health Care

Lack of social support from family or significant others results in psychological and spiritual isolation, which may negatively impact a person’s physiological state.

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Illness Perspectives

Illness is the result of a disease or injury that affects functioning and occurs when there is an inability to meet one’s needs.

An acute illness is usually characterized by a rapid onset, intense manifestations, and a relatively short duration.

A chronic illness is usually characterized by a gradual, insidious onset with lifelong changes, usually irreversible.

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Wellness Perspectives

Wellness places health on a continuum, from one’s optimal level (wellness), to a maladaptive state (illness).

High-level wellness means functioning to one’s maximum health potential while remaining in balance with the environment.

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Health Behaviors and Variables Influencing Health

Behavior is defined as the observable response of an individual to external stimuli.

All behavior has meaning.

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Health Behaviors and Variables Influencing Health

Variables Influencing Health • Lifestyle• Locus of Control• Self-Efficacy • Health Care Attitudes • Self-Concept• Cognition

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Health Behaviors and Variables Influencing Health

Variables Influencing Health• Age and Developmental Levels• Gender• Previous Experiences with the Health Care

System• Environment• Economic Resources

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Health Maintenance

Behavior directed toward maintaining a current level of health

Health maintenance activities are the activities/behaviors an individual performs to maintain or improve a current level of health.

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Health Maintenance

Characteristics of Health Maintenance• Perception• Motivation• Maintenance

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Health Promotion and Disease Prevention (Health Protection)

Health Promotion • Behavior motivated by the desire to shape a

health lifestyle.• Process of enabling people to increase

control over their health and to improve their health.

• Includes avoidance of unhealthy behaviors.• Health promotion efforts intervene with

healthy, rather than ill populations.

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Health Promotion and Disease Prevention (Health Protection)

Disease Prevention • Activities/behaviors that protect people from

the ill effects of actual or potential health threats

- Primary prevention- Secondary prevention- Tertiary prevention

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Health Promotion on a Global Level

World Health Organization • Organizes international conferences and

meetings and disseminates successful health promotion strategies, programs, and policies.

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Health Promotion on a Global Level

Fifth Global Conference on Health Promotion• Established Priorities for Health Promotion in

the 21st Century

“Healthy Cities” Movement• A vehicle to stimulate local-level health

promotion• Public, private, and nonprofit responsibility

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Health Promotion in the United States

Healthy People Initiative• Promote healthy behaviors.• Promote healthy and safe communities.• Improve systems for personal and public

health.• Prevent and reduce diseases and disorders.

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Assessment

Risk Factor Identification in Health Maintenance• Physical, environmental, psychological

behaviors that increase the vulnerability of an individual to disease or injury

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Assessment

Laboratory and Diagnostic Tests and Health Maintenance• Laboratory data includes cholesterol levels,

blood glucose, urine studies.• Health maintenance behaviors may be

measured with varieties of diagnostic tests and equipment.

• Client education about what to do with results obtained from these tests is given.

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Nursing Diagnosis

Ineffective Health Maintenance Health-Seeking Behavior Noncompliance Deficient Knowledge Ineffective Therapeutic Regimen

Management

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Planning and Outcome Identification

In many ineffective health maintenance situations, desired outcomes of care are best accomplished in small increments.

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Implementation

Health Promotion and Vulnerable Populations• Children• The Elderly• Economically Disadvantaged• Homeless

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Implementation

The Individual as a Holistic Being • The client with health maintenance

considerations is a holistic being.• Individuals function as complete units that

cannot be reduced to the sum of their parts.

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Implementation

Needs and Health • The entire person (mind, body, and spirit) is

influenced by satisfaction of needs.• Basic human needs are those that are

necessary for every person’s survival.

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Maslow’s Hierarchy of Needs

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Needs and Health

Physiological Dimension • Focuses on achievement of the basic needs

of a client.• The nurse must assess for system

alterations and then provide interventions to meet these needs.

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Physiological Dimension of Needs and Health

Physical Self-Examination Techniques Health Maintenance in Nutrition-

Management Behaviors Health Maintenance and Alterations in

Sleep Patterns

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Psychological Dimension of Needs and Health

Treating the client as a unique individual. Protecting confidentiality. Using touch and personal space in a

therapeutic manner. Recognizing and respecting cultural

differences. Decreasing anxiety through stress

management techniques.

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Sociocultural Dimension of Needs and Health

Empowerment is a process of enabling others to do for themselves.

Nurses empower clients by teaching them and their families how to develop skills for self-care and for healthier living.

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Intellectual Dimension of Needs and Health

Cognitive function and development can be impaired by multiple factors.• Infection• Exposure to toxins• Substance abuse• Trauma• Psychological problems

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Spiritual Dimension of Needs and Health

Spirituality assists a person in determining the sense of meaning or purpose in one’s life.

Spirituality is multidimensional.• A sense of one’s self• A sense of connection with others• A relationship with a higher power or divine

source

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Sexual Dimension of Needs and Health

Sexuality refers to all aspects of being male or female, including feelings, attitudes, beliefs, and behavior.

Sex roles are culturally determined patterns associated with being male and female.

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Evaluation

The client and nurse together measure how well the client has achieved the goals specified in the plan of care.

Factors that contribute to a goal achievement are identified.

Certain goals may need to be reevaluated.