CHAPTER 3 Health Education and Health Promotion
HEALTH EDUCATION
o Is any combination of learning experiences designed to help individuals and communities improve their
health, by increasing their knowledge or influencing their attitudes.
o Health education is an independent function of nursing practice and is a primary nursing responsibility.
o All nursing care is directed toward promoting, maintaining, and restoring health; preventing illness; and
helping people adapt to the residual effects of illness
o It is important to nursing care because it affects the abilities of people and families to perform important
self-care activities.
Supporting Informed Decision Making and Self-Care (57)
o Because of the importance that American society places on health and the responsibility that all people
must maintain and promote their own health, members of the health care team, specifically nurses, are
obligated to make health education available
o Health education can help those with chronic illness adapt to their illness, prevent complications, carry out
prescribed therapy, and solve problems when confronted with new situations
o It is to positively influence the health behavior of individuals and communities as well as the living and
working conditions that influence their health. The goal of health education is to teach people to live life to
its healthiest—that is, to strive toward achieving their maximum health potential.
Promoting Adherence to the Therapeutic Regimen
o It is the various aspects of health managements which include drugs therapy, dietary management,
exercise, and cessation of social habits such as smoking and alcohol.
o One of the goals of patient education is to encourage people to adhere to their therapeutic regimen (a
routine that promotes health and healing)
o Adherence (the process of faithfully following guidelines or directions) to treatment usually requires that a
person make one or more lifestyle changes to carry out specific activities that promote and maintain
health.
o Examples of behaviors facilitating health include taking prescribed medications, maintaining a healthy diet,
increasing daily activities and exercise, self-monitoring for signs and symptoms of illness and changes in
baseline health status, practicing specific hygiene measures, seeking recommended health evaluations and
screening, and performing other therapeutic and preventive measures
Variables that influence the degree of adherence are the following:
1. Demographic variables
a. such as age, gender, race, socioeconomic status, and level of education
2. Illness variables
a. such as the severity of the illness and the relief of symptoms afforded by the therapy
3. Therapeutic regimen variables
a. such as the complexity of the regimen and uncomfortable side effects
4. Psychosocial variables
1
a. such as intelligence, motivation, availability of significant and supportive people (especially family
members), attitudes toward health professionals, acceptance or denial of illness, substance abuse,
and religious or cultural beliefs
5. Financial variables
a. especially the direct and indirect costs associated with a prescribed regimen
6. Health literacy or the capability of a person to obtain, communicate, process, and understand essential
health information for the purpose of securing health care services and for making health care decisions
a. effective use of communication and cultural skills, along with the presentation of health care
information, and a basic background of mathematical skills.
o To increase health literacy, providers must design and distribute accurate health information and must
ensure that these health materials are culturally appropriate for various populations
o Nurses can be instrumental in performing evaluation research on the educational undertakings that
support individuals, groups, or communities.
 must be directly involved in facilitating change through the development of health care policies
that address the promotion of a health literate society
 success with health education is determined by both the development of strong health literacy
and the ongoing assessment of the variables that affect patients’ ability to adopt specific
behaviors to obtain resources, and maintain a healthy social environment
Motivation
Teaching directed toward stimulating patient motivation results in varying degrees of adherence
o personal relevance of strategies for self-care, perceived control, and type of health problem must also be
considered
o learning contract or agreement can also be a motivator for learning.
 contract is based on assessment of patient needs; health care data; and specific, measurable goals
 a series of measurable goals is established, beginning with small, easily attainable objectives and
progressing to more advanced goals
 Frequent, positive reinforcement is provided as the person moves from one goal to the next
Gerontologic Considerations (58)
o Nonadherence to therapeutic regimens is a significant problem for older adults, leading to increased
morbidity, mortality, and cost of treatment
o frequently have one or more chronic illnesses that are managed with numerous medications, and their
disease course may be complicated by periodic acute episodes
o additional issues that affect adherence to therapeutic regimens, such as increased sensitivity to
medications and their side effects, difficulty in adjusting to change and stress, financial constraints,
forgetfulness, inadequate support systems, lifetime habits of self-treatment with over-the-counter
medications, visual and hearing impairments, and mobility limitation
o To promote adherence:
 variables that may affect health behavior should be assessed
2


Nurses must also consider that cognitive impairment may result in the older adult’s inability to
draw inferences, apply information, or understand the major points
Person’s strengths and limitations must be assessed to encourage the use of existing strengths to
compensate for limitations
THE NATURE OF TEACHING & LEARNING
Learning can be defined as acquiring knowledge, attitudes, or skills while Teaching is defined as helping
another person learn.
These definitions indicate that the teaching-learning process is an active one, requiring the involvement of
both teacher and learner in the effort to reach the desired outcome, a change in behavior. The teacher does
not simply give knowledge to the learner but instead serves as a facilitator of learning.
The interpersonal interaction between the person and the nurse who is attempting to meet the person’s
learning needs may be formal or informal, depending on the method and techniques of teaching.
Most significant factors influencing person’s learning:
1. Learning Readiness: the optimum time for learning to occur, which usually corresponds to the learner’s
perceived need and desire to obtain specific knowledge
a. For adults, readiness is based on culture, personal values, physical and emotional status, and past
experiences in learning
b. nurses must conduct an individual cultural assessment instead of relying only on generalized
assumptions about a particular culture
c. A person’s values and behaviors can be either an asset or a deterrent to readiness to learn
d. Feedback (the return of information given to a person) about progress also motivates learning
e. Experiential readiness refers to past experiences that influence a person’s ability to learn
f. nutrition (the science that deals with food and nourishment in humans)
2. Learning Environment
a. Learning may be optimized by minimizing factors that interfere with the learning process
b. the room temperature, lighting, noise levels, use of functional assistive devices such as glasses and
hearing aids, and other environmental conditions should be appropriate to the learning situation
c. the time selected for teaching should be suited to the needs of the individual person
3. Teaching Techniques and Resources
a. enhance learning if they are appropriate to the patient’s needs
b. Nurses use a variety of teaching techniques to educate patients in many different settings
c. Techniques that are available include the following:
i. Lectures
ii. Group teaching
iii. Demonstration and practice
iv. Reinforcement and follow-up
v. Motivational interviewing
vi. Electronic, online, or Internet information
3
vii. Teaching aids
4. Teaching Special Populations
a. People with Disabilities
b. Elderly
The Nursing Process in Patient Education (60)
1. Assessment
o Assessment in the teaching–learning process is directed toward the systematic collection of data about the
patient’s and family’s learning needs and readiness to learn
o identifies all internal and external variables that affect the patient’s readiness to learn
o nurse organizes, analyzes, synthesizes, and summarizes the assessment data collected and determines the
patient’s need for teaching
2. Nursing Diagnosis
o The process of formulating nursing diagnoses makes educational goals and evaluations of progress more
specific and meaningful
o Examples of nursing diagnoses that help in planning for educational needs are impaired health
maintenance and decisional conflict.
3. Planning
o The planning component of the teaching–learning process is established in accordance with the steps of
the nursing process:
1.Assigning priorities to the diagnoses
2.Specifying the immediate, intermediate, and long-term goals of learning
3.Identifying specific teaching strategies appropriate for attaining goals
4.Specifying the expected outcomes
5.Documenting the diagnoses, goals, teaching strategies, and expected outcomes of the teaching plan
o the most critical needs should receive the highest priority.
o Outcomes should be realistic and measurable, and the critical time periods for attaining them should be
identified.
o The entire planning phase concludes with the formulation of the teaching plan
o This teaching plan communicates the following information to all members of the nursing team:
 The nursing diagnoses that specifically relate to the patient’s learning needs and the priorities of
these diagnoses
 The goals of the teaching strategies
 The teaching strategies that are appropriate for goal attainment
 The expected outcomes, which identify the desired behavioral responses of the learner
 The critical time period within which each outcome is expected to be met
 The patient’s behavioral responses (which are documented on the teaching plan)
Concept Mastery Alert
4
The nurse needs to keep in mind that before the teaching strategy can be determined, the goals of learning
must be developed.
4. Implementation
o the teaching–learning process, the patient, family, and other members of the nursing and health care team
carry out the activities outlined in the teaching plan
o Flexibility and ongoing assessment of patient responses to the teaching strategies support modification of
the teaching plan as necessary
o ends when the teaching strategies have been completed and when the patient’s responses to the actions
have been recorded
5. Evaluation
o Determines how effectively the patient has responded to teaching and to what extent the goals have been
achieved
o measurement techniques can be used to identify changes in patient behavior as evidence that learning has
taken place
 directly observing the behavior; using rating scales, checklists, or anecdotal notes to document the
behavior; and indirectly measuring results using oral questioning and written tests
 Using more than one measuring technique enhances the reliability of the resulting data and
decreases the potential for error from a measurement strategy
o After measurement data interpretation and judgments about learning and teaching must be completed
o The information gathered during evaluation should be used to redirect teaching actions, with the goal of
improving the patient’s responses and outcomes.
HEALTH PROMOTION (63)
o Healthy People 2030 defines the current national health promotion and disease prevention initiative for
the nation
o The overall goals are to (1) increase the quality and years of healthy life for people and (2) eliminate health
disparities among various segments of the population
Health promotion: those activities that assist people in developing resources that maintain or enhance wellbeing and improve their quality of life. Health promotion is the process of enabling people to increase control
over, and to improve their health.”
Health
It is viewed as a dynamic, ever-changing condition that enables people to function at an optimal potential at
any given time. The ideal health status is one in which people are successful in achieving their full potential,
regardless of any limitations they might have.
Wellness
5
It is a reflection of health, involves a conscious and deliberate attempt to maximize one’s health. Wellness
does not just happen; it requires planning and conscious commitment and is the result of adopting lifestyle
behaviors for the purpose of attaining one’s highest potential for well-being.
HEALTH PROMOTION MODELS (64)
o Identify health-protecting behaviors and seek to explain what makes people engage in preventive
behaviors
o A health-protecting behavior is defined as any behavior performed by people, regardless of their actual or
perceived health condition, for the purpose of promoting or maintaining their health, whether or not the
behavior produces the desired outcome
1. Health Belief Model
It is developed by Becker and colleagues (1974) is based on the premise that four variables influence the
selection and use of health promotion behaviors.
The (4) variables:
1. Demographic and disease factors
o It include patient characteristics such as age, gender, education, employment, severity of illness or
disability, and length of illness
2. Barriers
o It defined as factors leading to unavailability or difficulty in gaining access to a specific health
promotion alternative.
3. Resources
o It encompass such factors as financial and social support.
4. Perceptual factors
o It consist of how the person views his or her health status, self-efficacy, and the perceived demands of
the illness.
Becker and colleagues demonstrated that these four variables have a positive correlation with a person’s
quality of life.
2. the Resource Model of Preventive Health Behavior
addresses the ways in which people use resources to promote health
o It described by Pender, Murdaugh and Parsons (2006) is based on social learning theory and
emphasizes the importance of motivational factors in acquiring and sustaining health promotion
behaviors.
o This model explores how cognitive-perceptual factors affect the person’s view of the importance of
health.
o It also examines perceived control of health, self-efficacy, health status, and the benefits and barriers
to health-promoting behaviors.
3. Determinants of Health
6
o The Canadian health promotion initiative, Achieving Health for All, builds on the work of Lalonde
(1977), in which four determinants of health—human biology, environment, lifestyle, and the health
care delivery system—were identified. Determinants of health were defined as factors and conditions
that have an
o factors and conditions that have an influence on the health of individuals and communities
o provide a framework for assessing and evaluating the population’s health
4. the Awareness, Motivation, Skills, and Opportunity (AMSO) Model
o Crafted to address organizational and individual health behavior change
o The four components of this model focus on empowering people, understanding their individual
priorities, and assisting them to change in personal ways that promote and maintain their optimal
level of health
o dimensions of optimal health are physical, emotional, social, intellectual, and spiritual
o Optimal health is a dynamic condition kept in balance by a combination of efforts to sustain
awareness, maintain motivation, build skills, and have opportunities to practice positive health
behaviors
5. Transtheoretical Model of Change
o also known as the stages of change model, is a framework that focuses on the motivation of a person
to make decisions that promote health behavior change.
o Research indicates that people seeking assistance from professional or self-help groups progress
through these stages of change.
Stages In the Transtheoretical Model Of Change
a. Precontemplative - the person is not thinking about making a change.
b. Contemplative - the person is only thinking about change in the near future.
c. Decision making - the person constructs a plan to change behavior.
d. Action - the person takes steps to operationalize the plan of action.
e. Maintenance - the person works to prevent relapse and to sustain the gains made from the actions
taken.
f. Termination - the person has the ability to resist relapse back to unhealthy behavior(s).
COMPONENTS OF HEALTH PROMOTION (65)
There are several components of health promotion as an active process:

Self-Responsibility personal accountability for one’s actions or behavior
o Taking responsibility for oneself is the key to successful health promotion.
o The concept of self-responsibility is based on the understanding that the individual controls his or
her life.
o individualized and depends on a person’s desires and inner motivations
7
•
Nutritional Awareness
• as a component of health promotion, has become the focus of considerable attention and
publicity with the growing epidemic of obesity in the United States
• Research suggests that good nutrition is the single most significant factor in determining
health status, longevity, and weight control
• it involves an understanding of the importance of a healthy diet that supplies all of the
essential nutrients.
• Understanding the relationship between diet and disease is an important facet of a person’s
self-care.
•
Stress Reduction and Management
• Stress management (behaviors and techniques used to strengthen a person’s resources
against stress)
• It has become inevitable in contemporary societies in which demands for productivity have
become excessive.
• Techniques such as relaxation training, exercise, and modification of stressful situations are
often included in health promotion programs dealing with stress.
•
Physical Fitness
• Clinicians and researchers who have examined the relationship between health and physical
fitness have found that a regular exercise program can promote health in the following ways:
-Improve the function of the circulatory system and the lungs
-Decrease cholesterol and low-density lipoprotein levels
-Decrease body weight by increasing calorie expenditure
-Delay degenerative changes such as osteoporosis
-Improve flexibility and overall muscle strength and endurance
o An appropriate exercise program can have a positive effect on a person’s performance capacity,
appearance, and level of stress and fatigue, as well as their general state of physical, mental,
and emotional health
Colonoscopy Screening - At age 50 y/o every 3-5 years, especially to those who have a family history of it.
Influenza Vaccine - must be given yearly. Mammogram Screening - at age of 40 y/o
Health Promotion Strategies Throughout the Lifespan (66)
Health promotion starts before birth and extends through childhood, adolescence, adulthood, and old age
 includes health screening, counseling, immunizations, and preventive medications
Adolescents
 The goal has been to detect health problems at an early age so that they can be treated at that time
8


Health promotion goes beyond the mere screening for illnesses and disability and includes extensive
efforts to promote positive health practices at an early age
Although the negative results of practices such as smoking, risky sex, misuse of drugs and alcohol, and
poor nutrition are explained in these educational programs, emphasis is also placed on values training,
self-esteem, and healthy lifestyle practices
Young and Middle-Aged Adults
 represent an age group that not only expresses an interest in health and health promotion but also
responds enthusiastically to suggestions that show how lifestyle practices can improve health
 Because of the nationwide emphasis on health during the reproductive years, young adults actively
seek programs that address prenatal health, parenting, family planning, and women’s or men’s health
issues.
 he outreach idea for health promotion programs has served to meet the needs of many adults who
otherwise would not avail themselves of opportunities to strive toward a healthier lifestyle.
 Programs offered at the workplace usually include employee health screening and counseling, physical
fitness, nutritional awareness, work safety, and stress management and stress reduction.
Gerontologic Considerations
 80% of people older than 65 years have one or more chronic illnesses and many are limited in their
activity
 the older adult population experiences significant gains from health promotion
 although their chronic illness and disability cannot be eliminated, these adults can benefit from
activities and education that help them maintain independence and achieve an optimal level of health
 The activities directed toward health promotion for older adults are the same as those for other age
groups: physical fitness and exercise, nutrition, safety, and stress management
Nursing Implications of Health Promotion (68)
Nurses play a vital role in health promotion
 they initiate health promotion and health screening programs or participate with other health care
personnel in developing and providing wellness services in various settings
 have a responsibility to promote activities that foster well-being, self-actualization, and personal
fulfillment
 Every interaction with consumers of health care must be viewed as an opportunity to promote positive
health attitudes and behaviors.
9