Health Promotion
Potter and Perry pg 10-11
Health Promotion: is directed toward increasing the level of well-being and self
actualization.
Disease Prevention (primary prevention): Action to avoid illness/disease
The Ottawa Charter views health promotion as the process of enabling people to increase
control over, and improve their health.
3 level of Disease prevention correspond to the natural history of disease:
Primary Prevention: Activities protect against a disease before signs and symptoms
occur. (prepathogenesis stage of disease). Example: Immunization (to prevent infectious
diseases) and reduction of risk factors i.e.: inactivity, smoking and exposure to air
pollution.
Secondary Prevention: Activities promote early detection of disease once pathogenesis
has occurred, therefore treatment can be initiated to halt disease and limit disability.
Example: preventive screening for cancer (mammography, testicular self exam), blood
pressure to detect hypertension and blood glucose screening to detect diabetes.
Tertiary Prevention: Activities are initiated in convalescence stage to disease; it is
directed towards minimizing residual disability and helping people live productively with
limitations. Example: Cardiac Rehabilitation program after a myocardial infarction.
Health Promotion strategies are often political because they emphasize addressing
structural systemic inequities and have a strong philosophy of social justice. Health
promotion is guided by these principles:
 Health promotion addresses health issues in contexts
 Health promotion supports a holistic approach
 Health promotion requires a long term perspective
 Health promotion is multisectoral
 Health promotion draws knowledge from social, economic, political,
environmental, medical, nursing sciences and first hand experiences.
Health Promotion Strategies
The Ottawa Charter identified five broad strategies to enhance health:
1) Build Healthy Public Policy
-advocating healthy public policies is a priority strategy for health promotion in Canada
-it is used in a collaborative effort to identify the most important areas in which policy
can make a difference.
- As a nurse, you might work with others to develop policy options, encourage public
dialogue, persuade decision makers to adopt the healthiest option and ensure the policy is
implemented.
-Example (Box 1-1, pg 10): Cathy Crowe, a Toronto “street nurse” is an example of a
nurse who advocates for healthy public policy she works to reduce homelessness.
-More emphasis is placed on policies that create healthy living conditions and enable
people who are least powerful to express their concerns
-This priority is reflected in Toronto Charter on social determinants of health, which
focuses specifically on determinants that have policy implications.
-Healthy public policy extends beyond traditional health agencies and government health
departments to other sectors such as:
 Agriculture
 Education
 Transportation
 Labour
 Social services
 Energy
 Housing
2) Create Supportive Environments
-this strategy helps ensure that physical environments are healthy and safe
-living and working conditions are stimulating and satisfying
-creating supportive environments also means protecting the natural environment and
conserving natural resources
-Examples that help create supportive environment:
 Comprehensive school health initiative, which focuses on improving school
environment by providing health instruction, social support, support services and
positive physical environments.
 Flexible workplace policies and quality child care programs that support early
childhood development and parental employment
3) Strengthen Community Action
-is a requisite for successful health promotion and for community health nursing practices
in Canada.
-Often referred to as community development-where communities identify issues and
work together to make changes that will enhance health.
- Example: Health professionals help community groups indentify important issues and
organize and implement plans and strategies to resolve issues.
-public participation in all phases of community programming is key to community
development.
4) Develop Personal Skills
In order for clients to make healthy lifestyle choices:
 helps clients develop personal skills
 enhance coping strategies
 gain control over their health and environments
-Personal skills development includes: health education and emphasizes adequate support
and resources
-Example of interventions to enhance personal skills include:
 Early intervention programs for children
 Homevisiting by public health nurse
 Parenting classes
 School health education focuses on developing interpersonal skills and health
practices.
5) Reorient Health Services
-Health System reform has 2 objectives:
1) To shift emphasis from treating disease to improving health
2) To make the health care system more efficient and effective
-A proactive approach to health requires improved access to:
 Primary healthcare services
 Increased community development
 Improved community based care services
 Increased family-based care
 Public participation
Population Health Promotion Model: Putting It All Together
-shows how evidence-informed decision making is a foundation to ensure that policies
and programs focus on the right issues, take effective action and produce successful
results.
-Evidence is informed by research, experiential learning and evaluation of programs,
polices and projects.
Values and assumptions that are the foundation of the model:
 Stakeholders representing the various determinants must collaborate to address
health determinants
 Society is responsible for its members health status
 Health status is a result of people’s health practices and their social and physical
environments
 Opportunities for healthy living are based on social justice, equity and
relationships of mutual trust and caring, rather than on power and status
 Health care, health protection and disease prevention complement health
promotion
 Active participation in policies and program is essential
Potter and Perry p.24
5 Levels of Care
 Promotive
 Preventive
 Curative (diagnoses and treatment)
 Rehabilitation
 Supportive (i.e., home care, long-term care and palliative care)
Level 1: Health Promotion
-focuses on the process of enabling people to increase control over, and to improve their
health
-Example:
 Provision of wellness services
 Antismoking education
 Promotion of self esteem in children and adolescents
 Advocacy for healthy public policy
-Health promotion takes place in many settings such as community clinics, offer prenatal
nutrition classes that promote health of woman, fetus and infant.
- As mentioned earlier, the Ottawa Charter for Health Promotion lists 5 action strategies.
- The Ottawa Charter for Health Promotion details how health care professionals can
enable client to make decisions that affect their own health.
-The foundation of health promotion consists of fundamental conditions and resources for
health which include:
 Peace
 Shelter
 Education
 Food
 Income
 Stable ecosystem
 Sustainable resources
 Social justice and equity.
Level 2: Disease and Injury Prevention
-includes illness prevention services to help clients families and communities reduce risk
factors for disease and injury.
-Prevention strategies include:
 Clinical actions (screening, immunizing)
 Behavioral aspects (lifestyle change, support groups)
 Environmental Actions (societal pressure for a healthy environment)
Level 3: Diagnoses and Treatment
-focus on recognizing and treating clients’ existing health problems
-Within this level of care, 3 sublevels exist that refer to health care activities aimed at
individuals rather than families and communities:



Primary Care
Secondary Care
Tertiary Care
Primary Care:
-First contact of a client with the health care system that leads to a decision regarding a
course of action to resolve any actual or potential health problem.
-Primary care providers include, physicians and nurse practitioners in practice settings
such as physicians offices, nurse managed clinics, schools and occupational setting.
-focus is on early detection and routine care, with emphasis on education to prevent
recurrences.
Secondary Care:
-occurs usually in hospital or home settings
-involves provision of a specialized medical service by physician specialist or a hospital
on referral from a primary care practitioner.
-deals with clients seeking definitive diagnoses or requiring further diagnostic review
Tertiary Care:
-Specialized and highly technical care in diagnosing and treating complicated or unusual
health problems.
-clients requiring tertiary care have an extensive, often complicated pathological
condition
-care occurs in regional, teaching, university or specialized hospitals that house
sophisticated diagnostic equipment and perform therapeutic procedures.
Level 4: Rehabilitation
-the restoration of a person to his/her fullest physical, mental, social and vocational
functioning as possible
-clients require rehab after a physical or mental illness, injury or chemical addiction
-rehabilitation is necessary until clients return to previous level of function or reach a new
level of function limited by their illness or disease.
-Goal: to assist a client in regaining maximal functional status, therefore enhancing
quality of life while promoting independence and self care
-Rehabilitation nurses work closely with physiotherapy, occupational, speech therapy and
social services.
-Rehabilitation begins the moment a client enters health care setting for treatment
-Examples: Orthopedic programs have clients undergo physiotherapy exercises before
major joint repair to enhance recovery
Level 5: Supportive Care
-clients of all ages with illness or disabilities that are chronic or progressive may require
supportive care
-consists of health, personal and social services provided over a prolonged period to
people who are disabled, who do not function independently, or who have a terminal
disease
-Palliative Care is a component of supportive care
 Includes services for people living with progressive, life-threatening
illnesses/conditions
 Palliate means to soothe or relieve
 Goal of Palliative Care: To meet the physical, emotional, social and spiritual
needs of client and family
 Can be provided in hospital, hospices or homes
-Respite Care is another component of supportive care
 Provides short-term relief or time off for family caregivers
 Example: Adult Day Care
-it can be provided within the home by health care professionals and trained volunteers.
Perspectives on learning and practicing health promotion in hospitals:
Nursing students’ stories (Readings in course manual) pp 229-240
-Health promotion has a specific meaning and is perceived as being distinct from lifestyle
change, illness prevention, or health education.
-Health promotion (as mentioned earlier) for the purposes of the nursing program is
defined as a process of enabling people to increase control over and to improve health.
Three pillars of health promotion:
 Three primacy of people
 Empowerment
 Enabling
The primacy of people:
-means acceptance of certain assumptions that underlie it
-students educated in a nursing program are taught to value and care for the person, not to
focus upon disease
-students are taught that it is the person, not the skill or task being done for the person
that is the core of health promotion nursing practice
-students are taught to value the uniqueness and diversity of individuals
-respect for differences, whether of race, culture, sexual orientation, or way of thinking
about the world is important in health promotion
-students are taught that people experience the world as whole human beings and make
meaning of the world that they experience.
-students are encouraged to view people as whole beings who cannot be separated into
component parts
-students are taught that people are always situated in time and place, and cannot be
understood outside of that context.
-It is the realization that people do not live in hospitals but rather in homes and
communities and that, nurses need to deal directly with people’s social, political and
historical contexts in relation to health choices
-overall intention is that students will learn to value people and their experiences as
central to nursing rather than thinking that diseases or skills are the primary focus of
nursing.
-Brief Example of primacy of people (reflective journal entry p.234, course pack
reading)
Regarding a student nurse learned a lot about herself by taking care of an HIV positive
client. In the beginning the student was full of fear that she could somehow get infected.
Over the weeks she had really spent some time getting to know one another and was able
to look past her disease process and really understand her client and realize that a patient
is a person first and a patient second.
Empowerment:
-If people are to increase control over and improve their health, they need not only the
power to do so but also the requisite knowledge and skills
-In hospital settings nurses do have more power than clients so they need to learn to
develop relationships with clients in which power is negotiated
-Nurses have power in knowledge, not only of medical condition and how to assist clients
to heal, but also of the system and the rules by which it functions.
-Nurses have a choice of using their power:
 Creating “power over” or “power with” relationships with clients
 “Power over” relationships value nurses’ knowledge over clients’ knowledge and
nurses with “power over” relationships attempt to educate clients to hospital
routine and the hospitals way of doing things.
 “Power with” relationships are characterized by valuing clients’ experiences,
respecting their point of view and creating a shared understanding of the situation
-Overall, it is the coupling of the nurses’ knowledge with the patients’ understanding and
experience that creates the basis of care planning and decision making.
-Brief Example of empowerment (reflective journal entry p.236, course pack reading)
This is where a student spent a great deal of time talking to her client and gave him
choices of care that she was going to provide for him. For example, would you like to be
washed up or when would he like to go for a walk…the client said to the student nurse,
“You’re the one running the show, it doesn’t matter what I want.” The student nurse
replied “Yes it does, you have a say in the care you receive.” The student nurse created a
“power with” relationship by valuing client, respecting clients’ point of view, giving
options and creating a shared understanding of the situation.
Enabling:
-closely related to empowerment
-to increase control over and improve one’s health, one must possess the requisite skills,
resources and knowledge.
- To enable clients, nurses need to develop collaborative relationships with them and
begin “where the client is”
-Nurses focus on clients’ strengths and see people as their own best resource who often
need only support or understanding to better appreciate their health issues or problems.
-Nurses include clients as partners in the care planning process.
-Clients are viewed as facing challenges and nurses act as facilitators to assist clients to
deal with these challenges.
- Example of enabling (reflective journal entry p.237-239, course pack reading)
Data Collection:
-After students had clinical experiences, students were asked to write stories (narratives).
After writing their narratives, students were asked to critically reflect on their experience
using an analytical framework.
-New insights were developed as students engaged in the reflective process, which
assisted them to re-evaluate their experiences and link new ideas with existing knowledge
and feelings and translate thoughts and ideas into action.
-This encouraged reflection and iterative dialogical process was created between teacher
and students. The iterative dialogical process was created to encourage students to
critically reflect on their clinical experiences.