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Health Promotion

• Health promotion enables people to increase control over and improve their health.
• It encompasses health, wellness, disease, and illness.
• It represents a comprehensive social and political process.
• Actions strengthen individual skills and capabilities.
• Actions are directed towards changing social, environmental, and economic conditions.
• This aims to alleviate their impact on public and individual health.
• It enables people to increase control over the determinants of health.

Population Health

• Population health encompasses the health outcomes of a defined group of people.
• Also includes the distribution of health outcomes within the group.
• Involves an upstream approach to prevent things before they happen.

Patient Education.

• Patient education provides patients and families with information.
• Enables informed choices about their care, health, and wellbeing.
• Helps them gain knowledge and skills to participate in care or healthy living processes.
• It helps people learn health-related behaviors.
• These behaviors can then be incorporated into everyday life.
• Patient teaching is another name for it.

Leadership

• "An interactive process that provides needed guidance and direction”.
• Nurses should exhibit leadership when delivering patient care.
• Necessary when addressing issues affecting nursing practice.
• Dynamic elements include: leader, follower, and situation.

Communication

• A process of interaction between people.
• Involves using symbols to create, exchange, and interpret messages.
• Focuses on ideas, emotions, and mind states.

Collaboration

• Collaboration is the development of partnerships.
• Achieves the best possible outcomes.
• Outcomes reflect the particular needs of the patient, family, or community.
• Requires an understanding of what others have to offer.

Strengths-Based Nursing (SBN)

• SBN is an approach to care that promotes empowerment, self-efficacy, and hope.
• The nurse focuses on inner and outer strengths.
• It fosters the capacity for health and innate mechanisms of healing.
• SBN is based on 8 core values: holism, uniqueness, health and healing, subjective reality vs. created meaning, person and environment, self-efficacy, learning time and readiness, and collaboration.

Social Determinants of Health

• Social determinants are the broad range of personal, social, economic, and environmental factors.
• They determine individual and population health.
• Health is determined by circumstances and environment.
• Main determinants include: income and social status, employment and working conditions, education and literacy, childhood experiences, physical environments, social support networks, healthy behaviors, access to health services, biology and genetic endowment, gender, culture, and race/racism.

Health Disparities

• Health disparities are differences in health status among different population groups.
• Considered unavoidable.
• Racial or ethnic differences in healthcare quality are not due to access, clinical needs, preferences, or intervention appropriateness.
• Differences occur by gender, race, ethnicity, education, income, disability, location, or sexual orientation.
• National Institute of Health has two definitions related to health care disparities:
• Healthcare disparities are differences in access to facilities/services.
• Health status disparities are variations in disease occurrence rates and disabilities between socioeconomic/geographically defined groups.
• HRSA replaced health disparities with health equity.

Health Inequities

• Refers to health inequities that are unfair or unjust.
• Often due to unfair distribution of underlying social determinants of health.

Health Equity

• Health equity is the absence of disparities or avoidable differences.
• Occurs among socioeconomic and demographic groups or areas.
• Affects health status and outcomes like disease, disability, or mortality.

Social Justice

• The equitable, or fair, distribution of society's benefits, responsibilities, and their consequences.
• Focuses on the relative position of social advantage of one individual or social group in relation to others in society.
• Focuses on the root causes of inequities and what can be done to eliminate them. -Social injustice is leading to deaths on a grand scale.

Canada Health Act

• Medicare-tommy douglas

Alma Ata (WHO/UNICEF Report on Primary Health Care) Advocates!!!

• Stresses the need for action by governments, health and development workers and the world community.
• Meant to protect and promote the health of all people in the world.

Ottawa Charter (1986)

• A milestone document which places responsibility for health on society as a whole.

• Key concept is empowerment.

• Influential health promotion document

• Promotes health by enabling people to increase control. -Identified prerequisites for health: peace, shelter, income, food, etc

• Health is viewed as dynamic and positive, having both social and individual dimensions.

• It identified 5 strategies to achieve “health for all by the year 2000":

  • Strengthen community action- Encourage people to get involved and take action in decisions that affect their communities' health.
  • Build health public policy- Enforce public laws and rules that keep health in mind

• Create supportive environments- Making safe and satisfying environments for work and play.

• Develop personal skills- Providing support, education, and information to help people make healthy choices.

• Reorient health services- Creates services which change the focus from illness to prevention.

• Health is created where people learn, work, play, and love.

• Health is created by caring for oneself and others.

• Making decisions and control over one's life circumstances improves health.

• Ensuring a society creates conditions that allow the attainment of health by all its members also improves health.

Epp Report/Framework

• Framework for health promotion: Achieving health for all.
• Identified 3 major challenges not met by current health care practices and policies: -Disadvantaged groups have lower life expectancy, poorer health, higher disability -Preventable disease continues to decrease the health of Canadians -Increased chronic disease/lack of community support

Shifting Paradigm Conference

• Challenged the healing paradigm of Western medicine.
• Gave rise to 2 ideas: -Self responsibility for health -Health and lifestyles are affected by social structures and conditions

Beyond Health Care Conference

-International think tank that brought health promotion into the political arena.

• Provided 2 ideas: -Health public policy -Health cities/communities projects

Population Health Promotion Model

• Cube: with who? How? And on what?

Lalonde Report 1974

-A break from medical to holistic perspective.

• Recognized the dynamic nature of health.
• 4 Key areas: human biology, environment, lifestyle, and health care organization.

Lalonde Report: health field concepts (1974)

• Report that started focusing on lifestyle.
• Decreasing behavioral risk factors.
• Focuses on populations at risk (how we can support).
• Entire population rather than individual (why make those choices).
• Recognized value of research.
• Important concerns include: Smoking, substance abuse, lack of exercise and unhealthy eating.

Health Belief Model (Rosenstocks)

• Model to explain individual decisions for health screening opportunities, the three primary points of his model are: -The individual's perception of his/her susceptibility to and the severity of the disease are the primary motivators to learn and change behaviour -A belief must exist that the illness can be avoided, and that taking action can reduce the risk -The individual must also believe that he/she is capable of making the necessary changes
• Designed to explain health behavior and health behavior change.
• Focuses on the individual.
• Focuses on beliefs about health.
• Framework for motivating people.
• Negative consequences are prime motivator.

Health Promotion Model

• Developed by Pender, this model depicts a complex process associated with behavioral change for health promotion.
• Focus is on optimizing wellness versus avoiding disease.
• Patient motivation is influenced by social support and competing priorities.
• Patient perceptions of benefit and the ability to succeed affect outcomes.
• Do not get be confused with cube model.

Transtheoretical Model of Change (Stages of Change Model)

• Determine where person is in terms of behavior change.
• Readiness for change.
• Respect the person's right to choose
• The stages are precontemplation, contemplation, planning, action and maintenance -Precontemplation: Not considering behavior change -Contemplation: Seriously considering a specific behavior change in next 6 months -Planning: Starting to change or seriously thinking about making change in the next month -Action: Made behavior change; Change persisted for 6 months -Maintenance: 6 months after change; Continues indefinitely

Diffusion of Innovation Model

• Individuals adopt innovation at different rates and are classified into one of these 5 categories: -Innovators (Quick adopters) -Early Adopters (Keeners) -Early majority -Late majority -Laggards (Resistant to adopting innovation)

Diffusion of innovation theory

• Clients are more likely to adopt health-related practices if the following conditions exist: -Compatibility -Flexibility -Reversibility -Simplicity -Advantageousness -Cost-efficiency

SMART Goals

• Specific, Measurable, Achievable, Realistic, Time-phased.
• Specific: -Should provide who and what -Use only one action verb -Avoid verbs with vague meanings -Greater the specificity greater the measurability
• Measurable: -How much change is expected, the amount should be quantified -provides a reference point
• Achievable: -Should be attainable within given time frame and viable resources
• Realistic: -Accurately address scope of the problem/issue -Need to directly relate to context
• Time-phased: -Should provide a time frame indicating when the objective will be measured. -Can be short or long term

Social Cognitive Theory (Learning theory) Bandura (1997)

• Emphasizes the influence of efficacy beliefs on health behavior.
• Self efficacy: individuals belief in their ability to influence own health.
• Includes roles of reinforcement and observational learning in explaining health behavior.
• Modelling.
• Provides opportunities for imitating behaviors.
• Useful to demonstrate desired behaviors
• Ex: Parents model behavior for their child.

Protection-Motivation Theory

• Social marketing.
• You are scared you are going to die from smoking.
• Installs fear

Code of Ethics

• Central foundation provides guidance for ethical relationships, behaviors, and
• decision making to be used with professional standards, best practice, research, laws, and regulations that guide practice.
• Code of ethics offer guidelines not only about responsibilities for ensuring good care
• About responsibilities for recognizing and addressing barriers to service.
• Services as an ethical basis for nurses to advocate for quality practice environments that support the delivery of safe, compassionate, competent, and ethical care.
• In the societal context in which nurses work is constantly changing.
• Nurses need to anticipate future health needs and political activity when necessary to ensure health promotion.

Biomedical Approach

• Health is defined by the absence of signs and symptoms of disease and illness.
• The target for intervention is high-risk individuals.
• Examples of health promotion strategies that use a biomedical approach include such activities as immunization and screening.
• Goals of include decreased morbidity and prevalence of physiological risk factors, like high blood pressure.

Behavioral Approach

• Lalonde report (When he changed it from western to behavioral)(talked about lifestyle)
• Limited list of determinants of health
• Epp report (Wanted health for all: looked at the wrong things that needed to be changed) and Ottawa Charter (Health for everyone by year 2000) expand Lalondes work
• Pace responsibility for health on individuals
• Social marketing and health education campaigns
• Improve individuals lifestyle
• Refinement of health promotion practices
• Some success with anti-smoking campaigns and exercise campaigns (participACTION).

Socio-environmental Approach

• Social context of health.
• Social determinants of health.
• Looks beyond the individual (Holistic approach).
• Recognises the complexity of health (not just making good choices).
• Other factors affect health.

Primary Care vs. Primary Health Care

• Primary Care: Focus is on personal health services, like going to the emergency room.
• Primary Health Care: Includes primary care and health education, nutrition, maternal, and child health care, family planning, immunizations, and control of locally endemic disease.

Primary Health Care

• Essential health care made accessible to individuals and families in the community.
• Is accessible through means acceptable to them through their full participation.
• Cost is affordable for the community and country to maintain self-reliance and self-determination.
• Emphasis is on health promotion and disease prevention.

Primary Care

• Focus is on personal health services. There are 5 types of care:
• Promotive
• Preventative
• Curative
• Rehabilitation
• Supportive/Palliative

Social marketing

• Social marketing may be defined as a process to influence the acceptability of a social idea or cause. -A planned process for influencing change.
• The application of marketing technologies developed in the commercial sector to the solution of social programs where the bottom line is behavior change.
• These programs are designed to influence voluntary behavior of certain people (Target population) to improve their personal welfare and societies as a whole.
• It is an integrated part of health promotion strategies at health canada
• It is used to deliver health promotion messages to specific Canadian populations -Designed to help Canadians make decisions related to maintaining and improving their health and well being.

Social Marketing VS Advertising

• Terms are often confused with advertising
• The message is based on promotion strategies, is so much more than just advertising.
• Commercial marketing tries to change people's behaviour for the benefit of the marketer.
• Social marketing tries to change people's behaviour for the benefit of the consumer, or of society as a whole.

The Steps of Social Marketing

• Identify behavior(s) which require change
• Identify audience
• Identify true barriers to change
• Reduce barriers to change
• Pretest idea on small group
• Ex: Youth health campaign

The 4 p's of social marketing

• Product
• Price
• Place
• Promotion

Products

• What is being promoted to the target audience?
• The actual product: Specific behavior being promoted (intangible object)
• The augmented product: Tangible objects offered
• The core products: the benefits that the target audience will experience

Price

• Can be monetary or non-monetary
• Intangibles: -Time, effort -Risk, embarrassment (if they fail) -Disapproval

Place

• Where will the product reach consumers
• When

Promotion

• Persuasive communication
• The tool that ensures that the target knows the offer, believes they will experience the stated benefits, and is inspiring to act.
• Promotion has 2 components:

Messages

• Tactics (Media advertisements, posters, public service announcements)
• Other P's
• Partnerships
• Policy
• Politics

The Challenges with Social Marketing

• Measuring: Measuring outcomes occur or measuring the wrong outcomes too early before change.
• Failing: Failing to measure exposure is expecting too much from a limited intervention.

Primordial Prevention

• The newest level of prevention- before risk factor
• The original 3 levels were developed in the 1945s-1950s
• Reflects policy - level intervention
• Aimed at affecting health before at risk lifestyle behaviors are adopted
• Occurs at national, provincial, community levels
• Examples: Healthy eating school based programs, reduction of sodium in food supply, creating bike/walking paths (sidewalks)

Primary Prevention

• Precedes disease/dysfunction
• Interventions- health protection
• Health promotion (Eg. education)
• Vaccines are primary prevention interventions
• Focus: maintain/improve general individual, family, and community health
• Health protection- reducing threats to health -Health promotion- Encouraging lifestyle change to move toward health

Secondary Prevention

• Focus on early detection
• Earlier treatment results in more favorable outcomes
• Limit disabilities from disease
• Screening can occur when there are individual and population concerns
• Examples: Colon cancer screening, and pap tests

Tertiary Prevention

• Focuses on restoration and rehabilitation
• Minimize long term sequelae of disease
• Restore function; Prevent further injury/disease
• Example: Cardiac rehab after MI, ROM to maintain mobility after CVA, and turning q 2h to prevent pressure sores

Domains of Learning

• Cognitive: Development of new facts or concepts, and building on and applying new knowledge to situations.
• Affective: Expressions of feelings and acceptance of attitudes, opinions or values, spiritual beliefs, family interaction patterns and relationships that affect decisions and problem solving
• Psychomotor: Acquiring skills that require the integration of mental and muscular activity; developing skill from simple to complex actions (developing physical skills).

Erikson Developmental Model

• Individuals need to develop a sense of trust and personal worth.
• Based on eight critical stages.
• Each stage requires a solution of conflict between two opposing forces.
• Each stage depends on preceding stages that must be successfully accomplished to proceed.
  • Infancy: Trust vs mistrust
  • Toddler: Autonomy vs shame and doubt
  • Preschool: Initiative vs guilt
  • School-age: Industry vs inferiority (Can they do math homework)
  • Adolescence: Identity vs role confusion
  • Young adult: Intimacy vs isolation (meaningful relationships)
  • Middle adult: Generativity vs. Stagnation
  • Older adult: Ego integrity vs. despair

Piaget Theory of Cognitive Development

• Piaget's theory of cognitive development uses the term “ scheme" to describe a pattern of action or thought.
• Schemes are used to assimilate (take in) or accommodate (modify) new experiences.
• Individuals strive to maintain balance between assimilation and accommodation.
• Piaget's stages of cognitive development is shown as a progression: must develop before they can learn from birth - 15 years old
  • Sensorimotor (0-24 months): reflexes, object permanence
  • Preoperational (2-6 years): Advancing language and movement, egocentric, magical thinking
  • Concrete operations (7-11): logical approaches to solving concrete problems, understanding cause and effect.
  • Formal operations (11-15): True logical thought, abstract concepts, morality.

Vygotsky Theory of Cognitive Development

-Proposed that learning precedes development

• Focuses on the cultural, social, political, and individual influences on learning/development -Zone of proximal development: distance between between the current and potential developmental level
• Guidance from others is called “scaffolding"

Kohlberg Theory of Moral Development

• Based on Piaget's theory of cognitive development.
• Places emphasis on an ethic of justice. The stages of moral developments proceed during school age, adolescent, and young adult years.
  • Preconventional (children, some animals)
  • Conventional (Adolescents, adults)
  • Postconventual (individuals and society)

Gilligan Theory of Moral Development

• (Gender Biased)
• Doctoral research with Kolberg noted women scored lower than men using Kohlberg's tool.
• Suggests a different process of moral development in exists in women
• Woman are relationship based vs cognitive development.
• Women think and act based on caring and relationships in contrast to Ethics and Justice of men

Behavioural-Biological Development

• The development of genetics as its related to environment
• Evidence that environmental experiences can change gene functioning.
• Implications for disease development.
• Regulatory changes occur in early childhood.
• Epigenetics: scientific investigation of capacity of cell to react to the environment

The Slideshow of Development

• Development: the sequence of physical, psychological, cognitive development changes that take place over the human lifespan. There are three aspects of change:
  • Physical growth
  • Differentiation
  • Maturation.
• Developmental tasks of infancy:
• Psychological equilibrium: tasks go to survive the basic psychosocial function.
• The oral stage of development.

Stimulation and environmental interaction includes:

- Progressive connections of dendrites
- Increased vascular ration of brain structures
- Myelination of brain and nerves

Concepts of infant development Eriksons: trust vs mistrust:

-Trust includes future relationships
-Need max gratification/ minimum frustration

Cognitive development Piaget:

-Sensorimotor: mastering coordination activities through sense and motor activity
-Reflexes: response following stimulation
-Rooting no sucking reflex

Measuring growth and development:

• Denver developmental screening test ii:
• Screening tool birth to age 6
• Screen at 3-4 months, 10 months and 3 years
• Areas of development: personal social, fine motor-adaptive, language, gross motor
• CDC growth-charts: height, weight, head circumference. Plotted on a standardized grid

Nutritional metabolic pattern:

• Breastfeeding the perfect food: -Exclusive: preferred method first 6 months -Continued: breastfeeding for the first year and beyond -Nurses encourage it

Introduction of solid food with the following recommendations:

• 4-6 months
• Recommendation wait till 6 months to lower risk of food allergy
• Sequence of foods: cereal, meat, fruits, veggies
• Iron fortification by 6 months

Nutritional metabolic pattern:

• Weaning: introducing infant to a cup
• Gradual process 5-6 months
• Development milestones: -Extrusion reflex needs to be absent -Infant can sit only slightly supported
  • Be able to turn head away to indicate refusal: Avoid baby bottles: aspiration
  • Baby bottle syndrome causing tooth decay

Elimination pattern:

• Bowel elimination: -Breastfeed: softer, clean smell, several daily -Bottle feed: harder, smellier, need vitamin D if being bottle fed. There is delay in Toileting until 18 months

Urinary elimination:

-6-12 times first few months

• Voiding involuntary

Sleep needs to correlate growth:

-80% at birth
-12 hours daily at 12 months
-naps 2-3 daily

Sleep rest pattern sudden infant death syndrome:

• 10th leading cause of death for 1 month and 1 year age
• The Recommendation: -Avoid risk factors -Supine sleep position offer pacifier -No sleep positioners device should be used

Cognitive perceptual pattern:

• Vision: initial eye muscles weak, vision unfocused, without meaning, eye movements coordinate at 3 months but mature at 6 months
• Hearing: acuity ability sound incrimination a important developmental task
• Smell: fully developed can differentiate odor of mothers milk from others at 2 months
• Taste: present at birth salivation at 3 months
• Touch and motion: tactile sensation well developed
• Touch relieves infant tensions and speed neuromuscular development
• Language development: sensory stimulation important, cooing by 2 months, babbling at 6 months, single word by 12 months.

Self-perception self concept pattern:

• 4 months age: differentiate between self in mirror image

Play for infant:

• Non symbolic
• playing alone
• choice of toys
• Music
• Smiling faces
• looking at them saves
• Reading singing
• Tummy time

Common Immunisation schedule

• Immunizations child health clinics at 2,4,6,12 Months

-Toddlers

• 1 to 3 are a time of great growth and change.
• A typical toddler will gain command of motor, cognitive and behavioral skills at a rapid rate.

Piaget sensorimotor:

• 12-24 months
• no longer repeats behaviours-object permanence, space perception and time perception
• Begins to solve problems

Erikson: autonomy vs shame and doubt:

Increased cognition, language, motor skills and develop self-concept and self-esteem

• Me do it

Autonomy:

• Using negativism
• Displaying temper
• Dawdling
• Using rituals
• Exploring even when parents object

The Physical changes:

• Growth rate
• Advanced gross and fine motor development.
• Bone development like the fontanelle.
• Teeth 20 of them
• Vision 20/40
• Hearing
• Vital signs

cognitive development:

• Active trial and error
• Begins to solve problems
• Attention span increases
• Object per menace
• Imaginary thinking
• Egocentric thought

Speech and language:

• Understands before speaking
• Words based on the symbolic function and memory
• Facilitated through social interaction
• 2 year old 2 word sentence
• 3 year old 3 word sentence

Word use progression

• At 2 (50 words) by 3 (1000, 1word sentences)

Social: play and exercise;

• Explore and learn through play
• Solitary and parallel play
• Imaginary playmates
• Dramatic play/ imitate adults
• Teach parents importance of play and safety

Sleep and rest:

• Need 12-14 hours per night
• One nap in the day
• Maintain a schedule
• Rituals are common
• Night terrors/ nightmare

Toilet training:

• Bowel before bladder control
• Spincheter control/ brain maturation
• Significant affected by parental expectations and attitudes
• Problem: beginning before child is ready

Coordination milestones in Months

• 12-15 Walks independently and Clumbs stairs
• 15-18 Runs but still falls, Walks backwards, sideways, Clumbs to get objects, picks up small items & elctric outlets, cords or tablecloths
• 18-24 Falls from outdoor equipment, walks stairs alone or reaching for finger foods & takes apart toys
• 24-30 Quick Runs, Turns Door Handles,Feed them self & brushes teeth, throws a ball overhead
• 30-36 Walcks with Balance, runs well and balances on 1 ft, walcks on tiptoes, jumps from chair & pedals tricycle,turns on faucet, assembles puzzle, draws & paints

Receptive Language milestones

• 1 year : Understands : no-no, bye-bye, pat-a-cake, mama and dada
• 1 1/2 years - Understantds simple Verbal instructions, can identify 3 by parts, points for needs & names objects in Simple pictures
• 2 years - Understantds simple Verbal instructions, can identify 5 by parts, can name objects inSimple pictures obays simple commands
• 2 1/2 years - Can point to up to 15 pictures, obeys 2-3 simple commands

Presumptive of pregnancy signs are:

• Nausea and vomiting with the following treatment pathways
• Change in breast sensations/size which is due to Increased urinary frequency with
• Missed menstrual period . N/V occur in up to 80% of women with drug treatments that include
• FDA recently approved drug diclegis D-oxylamine (antihistamine) with pyridoxine (B12) and the main
• Side effect is drowsiness due
• Dietary changes as an appropriate & non medical treatments
• Thalidomide: biggest anthropogenic medical disaster ever

Positive signs of pregnancy include:

• of fetal heart tones by auscultation, ultrasound or doppler
• Palpitations of fetal body parts using Leopoldo maneuvers
• Objective detection of fetal movements & radiologic or ultrasonic rhino demonstration of fetal parts

In the Reproductive system:

• Uterus: increased from fist size to 3.2-4.5 kg infant and placenta with Fundus moves higher as the
• Breasts: enlarge early pregnancy. Late pregnancy: secrete colostrum with
• Vagina Vulva: greater blood supply more Vaginal Secretions

Sample recommendation for pregnant women include:

• Vaccination and Supplementations such as MMR, hepatitis B and folic acid
• Chronic Disease management to include Diabetes ,Hyperthyroidism
• Screening for STI which include Depression & violence
• Lifestyle modifications for smoking Alcohol drugs or obesity

Main areas for recomended weight gain:

• Healthy women with normal BMI 25-35 lb
• Underweight women 28-40lb
• Overweight women 15-25lb
• Obese women 11-20lb
• infants with obese mothers: premature birth, stillbirth risks & neonatal death through congenital abnormalities through this can cause Obese mothers: complications: such as diabetes , embolism and preeclampsia (high blood pressure in pregnant mothers)

Key health perception pattern & health management requirements

• Viewed Illness Vs Normal pregnancy as a healthy state of the
• Active participant in in Circle Career where needed
• Choose provider with similar view to
• Affect when mother seeks prenatal care

Viewed Illness related to Prenancy with consideration to

• Withdraw from work/social obligations that May make unhealt choice for Pregnancy or deny
• To enable a Nutritional metabolic pattern :
• good nutrition essential for proper growth/ development which is
• Affected by pre nutrition Finances culture with
• Best nurturant teaching before pregnancy

Key Recomendations

• Anemia of affects most Pregnant mothers globally
• Weight gain 25-35 lb for 300 calories per
• Well balanced diet is six groups
• 8-10 glasses of water are needed for 70g of Protein need to be
• Increase via & 30mg plus 400 mcg that enables access to Carbohydrates for energy needs
• Fats & for
• Requires constant review of Activity exercise pattern that includes the;
• Early pregnancy requires spontaneous movements
• A mother to be require some for activity at 16 to report to monitor

Active movement monitoring that requires the following:

• Active movement patterns that requires the report decreased activities
• Active women need a balance and to aim for activity at least 30 per
• The exercise regime improves , lowers risk
• Avoid height

The Self perception key conepts the Body image

• Accept that bodies in image
• Requires the internal and the need to disscuss feelings with

Key aspects of Pregnancy

• Requires partner or family that may be absent or have abusive tendencies
• Children : Changes between mother father and grandparents
• Feels reminders of new that can remind person with
• Reminders of the burden associated with aging

Key requirments during the Early postnatal period are to:

• Promote skin to skin contact
• Breastfeeding initiation
• Rooming in which can enable the the option for early transfer for early and continued
• Home

key Nutrtional needs are:

• The science of optimal cellular metabolism and its impact on health and disease

Key steps for Self-Management are:

• Ability to take care of yourself and have optimal health

Imortance of the Canada FOOD Guide can include:

Supports with healthy eating to ensure in order to to lower risk of through the way it

• Sustains and information as well as
• Reduces with confusing nutrition in forms a the way it
• Provides reliable and sustainable in eating Canada's food guide at a glance:
• Enables an suite of with key points to remember for

Has with advice resources that will help to sustaing to improve and

• Mobile advice for all to
• To encourage to change from current habits we aim to:
• Uses online for support and
• Provides how to rather than as the
• Encourages that focuses to for use
• Updates specific with recomendatrions

Aim tp eat a a varity of foods everday:

• Eat with of all your

• Eat with of fruits and

• The most important thing to consider for

• High the most important thing fibres or Minerals through eating

• Choice for taste

• Use and to aid

Always aim to protein with with key recommendations for you heart

• Plant most important thing be beneficial the your
• Beans as to with will encourage with and choose with and of in or
• Recomended is sodium use with the most minimum option in

The best foods to chose are:

• The most important thing you is of your plate

Key foods include:

• Eat and Whole Grain or
• Whole to with with most

Always be wary of how important rich is most:

• Eat and and

Make of choice but know what you will drink:

• Drink choice

The benifits

• To always use as with

Other for drinking include:

• Water/ with used bevereges can replace

Healthy eating is more than just the types of food you eat:

• Be mindful of your when in eating that you follow as always

Choose what is better for you or for your health

• Create or follow
• Use your in is most

Weigh with for with you: Choose to plan of with : -Share with you -Get when

Make sure to ENJOY the foods you choose to enjoy!

• Reflect to choice Create the perfect and with is

A food chart should look to the following:

• Use

Always be and of for those and and and you and and you .

Dietary is Always note that that replaced dietary (RDA's) which will Reflect (lower and upper limits)

-Serve food nutrition and There is that will will due will due can affect

Micronutrients should come from: