Chapter 6
Health and Wellness
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Healthy People Documents
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Healthy People: The Surgeon General’s
Report on Health Promotion and Disease
Prevention, 1979
Healthy People 2000: National Health
Promotion and Disease Prevention
Objectives
Healthy People 2010
Healthy People 2020
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Healthy People 2020 Goals
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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.
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Case Study
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Jack is a 59-year-old man with a history of
type 2 diabetes, hypertension, and obesity.
He is married and works 50 to 60 hours per
week in a computer technology position.
His wife works the same number of hours,
although she tends to travel more with her job
and sometimes works the night shift.
Therefore, both Jack and his wife have a hard
time fitting exercise into their daily routine,
and they often eat in restaurants.
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Definition of Health
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Health is more than the absence of disease!
A state of complete physical, mental, and
social well-being, not merely the absence of
disease or infirmity (WHO, 1947)
A state of being that people define in relation
to their own values, personality, and lifestyle
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Models of Health and Illness
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Health Belief Model
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Addresses the relationship between a person’s
beliefs and behaviors
Health Promotion Model
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Directed at increasing a patient’s level of wellbeing
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Models of Health and Illness (cont’d)
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Basic Human Needs Model
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Attempts to meet the patient’s basic needs
Holistic Health Model
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Attempts to create conditions that promote optimal
health
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Case Study (cont’d)
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Jack comes to the clinic today for routine
follow-up for his diabetes. Jack’s laboratory
data reveal that his blood glucose level is
consistently running high. His blood pressure
is on the high side of normal.
Sally, the diabetes nurse educator, is working
with Jack for the second time. Sally knows
she wants to find a way to get Jack’s blood
glucose levels down to avoid the long-term
complications of diabetes.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Maslow’s Hierarchy of Needs
Self-actualization
Self-esteem
Love and Belonging
Safety and Security
Physiological
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Variables Influencing Health
and Health Beliefs and Practices
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Variables influence how a person thinks and
acts.
Health beliefs can negatively or positively
influence health behavior or health practices.
Health beliefs and practices are influenced by
internal and external variables and should be
considered when planning care.
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Quick Quiz!
1. According to Maslow’s hierarchy of needs,
which of these needs would the patient seek
to meet first?
A. Self-actualization
B. Psychological security
C. Shelter
D. Love and belonging
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Internal Variables
Developmental Stage
Intellectual Background
Perception of Functioning
Emotional Factors
Spiritual Factors
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External Variables
Family Practices
Socioeconomic Factors
Cultural Background
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Because Jack occasionally exercises, Sally
decides to focus her teaching on the
importance of routine exercise to improve
Jack’s health and help with the management
of diabetes.
Sally finds out that 6 months ago, Jack was
using his treadmill for 20 minutes on most
mornings. Since then, he has gotten out of
the habit because he now tries to arrive at
work 30 minutes earlier.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Quick Quiz!
2. After evaluating a patient’s external variables,
the nurse concludes that health beliefs and
practices can be influenced by
A. Emotional factors.
B. Intellectual background.
C. Developmental stage.
D. Socioeconomic factors.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Health Promotion, Wellness,
and Illness Prevention
1. Immunization Programs
2. Routine Exercise, Good Exercise
3. Physical Awareness, Stress Management,
Self-Responsibility
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Levels of Prevention
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Primary
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Secondary
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True prevention that lowers the chances that a
disease will develop
Focuses on those who have a disease or are at
risk to develop a disease
Tertiary
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Occurs when a defect or disability is permanent or
irreversible
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Quick Quiz!
3. You will use the concept of primary
prevention when instructing a patient to
A. Get a flu shot every year.
B. Take a blood pressure reading every day.
C. Explore hiring a patient with a known
disability.
D. Undergo physical therapy following a
cerebrovascular accident.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Risk Factors
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Variables that increase the vulnerability of an
individual or a group to an illness or accident
Risk factors include:
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Genetic and physiological factors
Age
Environment
Lifestyle
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Risk Factor Modification and
Changing Health Behaviors
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Precontemplation
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Contemplation
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Not intending to make changes within the next 6
months
Considering a change within the next 6 months
Preparation
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Making small changes in preparation for a change
in the next month
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Case Study (cont’d)
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Sally wants to apply the stages of behavior
change with Jack. By using this model, she will
work with Jack regarding what he is ready to do
rather than simply telling Jack to be more active.
To do this, she first asks Jack how he feels about
exercise and what his plans are. Jack states, “I
know that exercise would be good for me and I
should probably work on it.”
This tells Sally that Jack is at the contemplation
stage.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Risk Factor Modification and
Changing Health Behaviors (cont’d)
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Improvement in health may involve a change
in health behaviors.
Action
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Actively engaged in strategies to change behavior;
lasts up to 6 months
Maintenance stage
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Sustained change over time; begins 6 months
after action has started and continues indefinitely
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Illness
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A state in which a person’s physical,
emotional, intellectual, social, developmental,
or spiritual functioning is diminished or
impaired
Acute Illness
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Short duration and severe
Chronic Illness
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Persists longer than 6 months
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Quick Quiz!
4. Sally has decided to set aside 30 minutes a
day to walk after work next week. Sally is in
what stage of risk factor modification?
A. Precontemplation
B. Contemplation
C. Preparation
D. Action
E. Maintenance
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Illness Behavior
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Involves how people monitor their bodies and
define and interpret their symptoms
Influenced by many variables and must be
considered by the nurse when planning care
Internal variables
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Perception of illness and nature of illness
External variables
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Visibility of symptoms, social group, cultural
background, economics, and accessibility to
health care
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Impact of Illness on the Patient and
Family
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Behavioral and emotional changes
Impact on body image
Impact on self-concept
Impact on family roles
Impact on family dynamics
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Patient Teaching: Lifestyle Changes
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Objective
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Patient will reduce health risks related to poor
lifestyle habits through behavior change.
Teaching strategies
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Provide active listening, ask about perceived
barriers, assist the patient in establishing goals,
and reinforce the process of change.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Teaching strategies:
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Practice active listening and determine what Jack
understands regarding health risks related to poor
lifestyle.
Ask Jack what barriers and benefits he perceives
with the planned lifestyle change of consistently
exercising.
Help Jack set achievable goals for change.
Work with Jack to establish realistic time lines for
modification of exercise habits.
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Case Study (cont’d)
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At the next appointment,
Jack says, “I saw there
was a sale on walking
shoes. If I’m going to
start walking, do you
think I need to get new
shoes? Next week, I am
taking a week of
vacation, just doing
things around the house,
and I thought this would
be a good time to start.”
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Patient Teaching: Lifestyle Changes
(cont’d)
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Evaluation
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Have the patient maintain an exercise and eating
calendar to track adherence, and provide positive
reinforcement.
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Case Study (cont’d)
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Evaluation strategies
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Have Jack maintain an exercise log to track
adherence, and provide positive reinforcement.
Ask Jack to discuss his success with lifestyle
changes, such as minutes spent in activity.
Have Jack identify community resources used in
making a change.
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