Journey Across the Life Span: Human Development & Health Promotion, 5th Edition PDF

JOLJ~NEY AC~OSS Human Development and Health Promotion 5TH EDITION 3961_FM_i-xiv 24/12/14 11:45 AM Page i JOURNEY ACROSS the Life Span Human Development and H...

JOLJ~NEY AC~OSS Human Development and Health Promotion 5TH EDITION 3961_FM_i-xiv 24/12/14 11:45 AM Page i JOURNEY ACROSS the Life Span Human Development and Health Promotion 3961_FM_i-xiv 24/12/14 11:45 AM Page ii Birth is a beginning And death a destination. And life is a journey: From childhood to maturity And youth to age; From innocence to awareness And ignorance to knowing; From foolishness to discretion And then, perhaps, to wisdom; From weakness to strength Or strength to weakness And often back again; From health to sickness And back, we pray, to health again; From offense to forgiveness, From loneliness to love, From joy to gratitude, From pain to compassion, And grief to understanding From fear to faith; From defeat to defeat to defeat Until, looking backward or ahead, We see that victory lies Not at some high place along the way, But in having made the journey, stage by stage, A sacred pilgrimage. Birth is a beginning And death a destination. And life is a journey, A sacred pilgrimage To life everlasting. With permission from The New Union Prayer Book. Central Conference of American Rabbis: New York, 1978, p. 283 3961_FM_i-xiv 24/12/14 11:45 AM Page iii JOURNEY ACROSS the Life Span Human Development and Health Promotion 5 TH EDITION Elaine U. Polan, RNBC, MS, PhD Retired Supervisor Practical Nurse Program Vocational Education and Extension Board School of Practical Nursing Uniondale, New York Daphne R. Taylor, RN, MS Retired Assistant Supervisor Practical Nurse Program Vocational Education and Extension Board School of Practical Nursing Uniondale, New York 3961_FM_i-xiv 24/12/14 11:45 AM Page iv F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2015 by F. A. Davis Company Copyright © 2015 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Acquisitions Editor: Megan E. Klim Developmental Editor: Rachel Miller Director of Content Development: Darlene D. Pedersen Content Project Manager: Echo K. Gerhart Electronic Project Manager: Jaclyn Lux Design & Illustration Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies un- dergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Control Number: 2014956160 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-3961-4/15 0 + $.25. 3961_FM_i-xiv 24/12/14 11:45 AM Page v In loving memory of my sisters Harriet and Joanne and my Mother. My Journey continues with the addition of Jonah, Alexis, Miles, and Gemma. Elaine U. Polan In loving memory of my mother, Jemima, and for the support of my husband and family. Daphne R. Taylor 3961_FM_i-xiv 24/12/14 11:45 AM Page vi 3961_FM_i-xiv 24/12/14 11:45 AM Page vii Preface Current trends indicate a need for changes in our text, are designed to draw the reader’s attention to health care system. The need is for a system that fo- important facts. Other pedagogical features include cuses on universal health care. This creates a need tables, boxes, illustrations, and photographs. New for emphasis on health promotion, maintenance, and with this edition are 10 Podcasts on the major chap- restoration. In this new health delivery system, ters. These are for students to use at their conven- health care workers are expected to provide care to ience. By first reading the chapters and then listening individuals in a variety of settings throughout their to the Podcasts, students have a clearer understand- life span. ing of the content. We hope that this new format will This textbook is designed to assist students in be enjoyable and educational. their study of the life cycle from conception to old At the conclusion of each chapter, a chapter sum- age. Instead of having to read only certain sections mary highlights key points, followed by one or more of a core text or portions of a pediatric or maternity Critical Thinking exercises to increase awareness text, students can now see the complete presenta- and to challenge thinking. Multiple-choice ques- tion of growth and development across the life tions at the end of each chapter help students test span. We hope this will be meaningful and will their content understanding. Suggested readings that assist students in developing an appreciation for in- enable students to further explore and research top- dividuals in their struggle to maintain, promote, and ics of interest and Web sites can be found on Davis restore health. Plus. This edition has 14 chapters, each designed to We wish to point out that the names of persons make the book user-friendly. The last chapter deals used in Critical Thinking exercises and in case stud- with the topics of death, dying, and bereavement. ies are fictional and that any resemblance to names The authors hope that readers will find comfort and of actual persons is coincidental. guidance from this chapter when dealing with either It is our hope that students will find this text easy personal or professional losses. A chapter outline, a to read and applicable to clinical practice and per- list of learning objectives, and a list of key terms, sonal growth. which are considered important to the reader’s un- derstanding of the material, precede each chapter. Elaine U. Polan, RNBC, MS, PhD Helpful Hints boxes, a special feature used in this Daphne R. Taylor, RN, MS vii 3961_FM_i-xiv 24/12/14 11:45 AM Page viii 3961_FM_i-xiv 24/12/14 11:45 AM Page ix Reviewers Janice Ankenmann, RN, MSN, Robin Pearson, BSN CCRN, FNP-C Nursing Instructor Vocational Nursing Program Director North Florida Community College Napa Valley College Madison, Florida Napa, California Polly Reynolds, BSN, RN Linda M. Fleshman, MSN, HCNE, Nursing Faculty Galen College of Nursing MST, RN Louisville, Kentucky Director/Instructor Mt. Hood Community College Diane Roney, RN, BSN, MSN, Certificate Gresham, Oregon of Nursing Administration Sharon Moore, RN, MSN-Ed Professor; Program Director of the Practical Nursing Practical Nursing Program Chair Program Forsyth Technical Community College Eastern Gateway Community College, Jefferson Winston Salem, North Carolina Campus Steubenville, Ohio ix 3961_FM_i-xiv 24/12/14 11:45 AM Page x 3961_FM_i-xiv 24/12/14 11:45 AM Page xi Acknowledgments We, the authors, wish to extend special thanks to the following individuals without whom we could not have completed this task. F.A. Davis and Acquisitions Editor Megan Klim, Project Editor Echo Gerhart, and Robert Craven III. We enjoyed working together again. Last, we thank the many students whom we have taught over the years. Each of our students has enriched our lives and help inspire us. We hope that students will find this text helpful and enjoyable. xi 3961_FM_i-xiv 24/12/14 11:45 AM Page xii 3961_FM_i-xiv 24/12/14 11:45 AM Page xiii Contents Chapter 1 Healthy Lifestyles 1 Chapter 2 Culture 17 Chapter 3 The Family 33 Chapter 4 Communication 47 Chapter 5 Theories of Growth and Development 57 Chapter 6 Prenatal Period to 1 Year 73 Chapter 7 Toddlerhood 101 Chapter 8 Preschool 119 Chapter 9 School Age 135 Chapter 10 Puberty and Adolescence 153 Chapter 11 Early Adulthood 171 Chapter 12 Middle Adulthood 187 Chapter 13 Late Adulthood 199 Chapter 14 Death and Dying 225 Appendices A. Community Help Services 237 B. Recommendations for Health Promotion 239 C. Sample of Living Will and Health Care Proxy 249 D. Answers to Multiple-Choice Questions 253 Glossary 255 Index 261 xiii 3961_FM_i-xiv 24/12/14 11:45 AM Page xiv 3961_Ch01_001-016 24/12/14 11:23 AM Page 1 CHAPTER Healthy Lifestyles 1 Key Words Chapter Outline anxiety History of Health Care Exercise apathy Healthy People Mental Health Health Care Delivery Anxiety disease prevention The Affordable Care Act Stressors emotions Types of Care Plans Maladaptive Responses to Stress empowerment Comparison of U.S. and Canadian A Healthy Self-Concept equilibrium Health Care Systems Role of the Nurse in Health World Health Organization Promotion fight-or-flight response The Concept of Health Summary general adaptation Promoting, Maintaining, and Critical Thinking syndrome Restoring Health Multiple-Choice Questions health Disease Prevention Healthy Lifestyles health promotion Nutrition health restoration Causes of Obesity holistic life expectancy malnutrition Learning Objectives nutrition A t th e e n d of th i s ch ap te r , y ou s h ou l d b e ab l e to: regression stress Describe the history of health. Describe the model for the nation’s health as proposed by Healthy People substance abuse 2020. wellness Describe the concept of health. List five healthy lifestyle practices. State the role of the practical nurse in health promotion. List two factors that interfere with people’s abilities to change their personal habits. 1 3961_Ch01_001-016 24/12/14 11:23 AM Page 2 2 Journey Across the Life Span HISTORY OF HEALTH CARE any medical care during pregnancy, increasing the risk for both themselves and their infants. Early civilization was concerned with health and Other areas of improvement include recognition diseases. Illness was often attributed to natural and of the risks associated with tobacco use, genetic supernatural forces. Sometimes illness was thought counseling, motor vehicle safety, and advances in to be the result of some evil wrongdoing. Diseases diagnosis and treatment for heart disease and were often warded off by incantations, magic, or strokes. Improvements in the workplace regarding charms or with the use of herb concoctions. At times safety and job-related hazards have helped further drastic measures were taken to rid the body of reduce mortality rates. The mortality (death) rate demons, such as beating, torturing, or starving the today is lower than at any other time in history. sick. Other cures relied on magic and folk remedies. Even primitive surgery existed before the advent of Healthy People Greek medicine. In about the sixth century BC med- For three decades, the U.S. Department of Health ical schools were established in Greece. Hippocrates and Human Services has published a 10-year agenda was the first physician to believe that treatment for improving the nation’s health called Healthy should be based on the belief that nature has a strong People. Healthy People provides the scientific base healing component. Diet, exercise, and hygiene for a 10-year projection that addresses national became important to treatment. health care goals and objectives. The first volume Throughout the Middle Ages medicine and re- published was Healthy People 2000, and the aim ligion were interwoven. Plagues and epidemics was to reduce health disparities among Americans. killed millions of people. Understanding of disease Building on the objectives first identified, processes did not occur until the development of Healthy People 2010 was published and continued bacteriology, which took place in the 19th century. its belief in a systematic approach to improving Louis Pasteur, Robert Koch, and Joseph Lister health. Healthy People 2010 identified two major are some of the important scientists who made a national health goals. The first goal was to increase significant impact contributing to the scientific un- the quality and years of a healthy life. Life ex- derstanding of health and disease during this time. pectancy is the average number of years a person During the 20th century a major cause of death was is expected to live. Life expectancy has increased infectious diseases, but environmental improve- from 47.3 years at the beginning of the 20th century ments in sanitation, water, and food supply helped to nearly 77 years today. Healthy People 2010 to further improve the quality of life. Between the sought not only to extend life expectancy but also years 1936 and 1954, the discovery and use of vac- to improve the quality of life. The second goal was cines and antibiotics further reduced the number of to eliminate the health disparities among persons deaths from infectious diseases. that exist according to gender, race, ethnicity, edu- Despite all the improvements toward limiting the cation, income, disability, location, and sexual incidence and numbers of deaths from infectious orientation. Regardless of differences, this initiative diseases, several diseases surfaced and reappeared was dedicated to making certain that all persons in in the 20th century. Diseases such as tuberculosis our nation have equal access to fulfilling their and measles have resurfaced, and new infectious health care needs. diseases such as HIV, AIDS, Ebola virus, and drug- Healthy People 2020, launched in December resistant strains of organisms (Staphylococcus au- 2010, continues the tradition with a 10-year agenda reus, Streptococcus pneumonia, and Salmonella) that promotes health and disease prevention services have become the current health challenges facing aimed at improving the health of all Americans. the population today. Healthy People 2020 promotes collaboration across Many other achievements have contributed to communities to disseminate health information longevity and health. Improvements and advance- needed to empower the individual to make decisions ments in maternal care have led to decreases in about his or her health. The outcome of these preven- maternal and infant mortality rates. Better nutri- tative health strategies is also continuously measured tion, better hygiene, and improved technology have and evaluated. also greatly reduced the risks to both mothers and The overarching goals of Healthy People 2020 infants during the first year of life. Still, the issue are to improve the quality of life of all Americans of access to health care for all remains a concern. and keep them free of preventable diseases, dis- Great numbers of childbearing women do not seek ability, injury, and premature death. Equity in 3961_Ch01_001-016 24/12/14 11:23 AM Page 3 Healthy Lifestyles 3 health care and the elimination of disparities lump sum at the time of death to cover final medical among different groups will improve the health of expenses and the cost of funeral and burial. all Americans. An emphasis must also be placed The Great Depression, which started in 1929, on a good quality of life and healthy behaviors at changed the financial security of hospitals and all stages of development across the life span for physicians. The AMA continued to protest the con- all individuals. cept of health insurance, recommending that “per- The health indicators spotlight the major health sons save for the time of sickness.” In 1935 the priorities for the nation. The Leading Health Indi- Social Security Act was passed by Congress. This cators are listed in Box 1.1. act established federal aid to states for public health and assistance. The Social Security Act became the foundation for the growth of Medicare and HEALTH CARE DELIVERY Medicaid legislation in 1965. Many factors influ- ence the financing of the health care system today, The U.S. health care system in the 19th and early including providers, employers, purchasers, con- 20th centuries was dominated by physicians and sumers, and politicians. Controlling the rising costs hospitals. In these early times there was a close and making provisions for the estimated 48 million relationship between patient and doctor. Physicians Americans who are underinsured or uninsured are set fees, billed, or collected payments. Often physi- the two most pressing concerns today. cians adjusted fees based on the patient’s ability to pay. For many years the American Medical Associ- ation (AMA) fought against having any third party The Affordable Care Act interfere or come between the patient and physician The U.S. health care delivery system is one of regarding any medical matter. the most complicated and expensive systems in the In the early part of the 19th century some indi- world. Despite its sophistication, this system has viduals had medical insurance from their trade been unable to adequately address the need for uni- union, fraternal order, or some commercial carrier. versal coverage. On March 21, 2010, the first step This sickness insurance, as it was first known, was in realizing health care reform took place with the simple coverage for lost time during sickness or in- passing of President Barack Obama’s reform bill. jury. Years later this coverage was extended to in- The goal was to offer health insurance to the mil- clude workers’ dependents and others. Before World lions of Americans who are uninsured and improve War I there was some impetus toward compulsory the coverage of those who have insurance. health insurance following the initiative taken by The main objectives of the Affordable Care Act several European countries. “Industrial” policies (ACA) are to move away from a focus on illness and were sold by Metropolitan Life and Prudential Life toward a focus on prevention and wellness, with the Insurance Companies. This early form of health in- goal of creating a more equally accessible system surance was low cost but provided for only a small for the population. The act also emphasizes improv- ing the quality of care, improving patient care B O X outcomes, accountability, and cost reduction. The ACA will be phased in over several years. The 1.1 L ead i n g H eal t h I n d i c at or s major change is an expansion of Medicaid coverage, Access to health care which will begin in 2014. Most of the population will Clinical preventive services then be covered by Medicaid and by the Children’s Environmental quality Health Insurance Program (CHIP). The federal gov- Immunization ernment will pay 100% of the cost for the delivery of Injury and violence care from 2014 to 2016 and 90% thereafter. Maternal, infant, and child health Mental health Some of the important provisions are as follows: Oral health Families are eligible for certain preventive health Overweight and obesity services at no cost. Physical activity Insurance companies are no longer able to refuse Reproductive and sexual health health insurance to individuals with pre-existing Social determinants Substance abuse health conditions. Tobacco use Uninsured children will be covered by their par- ents insurance until age 26. 3961_Ch01_001-016 24/12/14 11:23 AM Page 4 4 Journey Across the Life Span All companies with 50 or more employees must system. Individuals may also choose their own provide health insurance. provider at their own financial risk. State health care exchange programs will be cre- Official and voluntary public health agencies ated to allow consumers who are not covered by operate at the state, federal, and local levels. Health their employer or other types of entitlement pro- promotion, disease prevention, and education are grams to shop for health insurance coverage. key aspects of these agencies. Comparison of U.S. and Canadian Types of Care Plans Health Care Systems Current health care delivery in the United States is The health care systems of Canada and the United provided by both public and private sector organi- States are often compared. The two countries had zations. These organizations own and operate health somewhat similar systems until the 1970s, when care delivery facilities. Payment for care is tradition- Canada reformed its health care system into a group ally through health care insurance, the majority of of socialized insurance plans that offered coverage which is provided by the government and the rest to all Canadian citizens. This system is publicly by private businesses. The government agencies that funded and covers preventive medical treatment pay for health care are Medicaid, Medicare, CHIP, through primary care physicians, hospitals, dentists, and the Veterans Health administration (VHA). and other providers. Other individuals pay private insurance companies, Most Canadians qualify for coverage regardless and 15% to 16% of Americans remain uninsured. of medical history, income, and standard of living. Traditionally, a person entered the health care Statistics indicate that Canadians have a longer setting and contracted directly with a health care life expectancy and lower infant mortality rate than provider. The provider was then paid a fee for Americans. Many factors are believed to have con- service. In the 1970s, managed health care grew tributed to these statistics, including different racial from the belief that costs could be contained by makeup, alcoholism, and obesity rates. Similarities managing health care service delivery. Managed also exist between the countries, including health care health care has become the dominant form of costs that are rising faster than the rate of inflation. health care service in the United States today. Under this system a primary care provider (PCP) is assigned to provide basic health care services. World Health Organization The primary health care provider is a physician, The World Health Organization (WHO) is part of the nurse, or physician’s assistant. The aim of this sys- United Nations and exists at the international level. tem is to reduce the numbers of hospital admis- It is concerned with worldwide health promotion, sions, costly procedures, and referrals. including disease prevention, early detection of dis- Health maintenance organizations (HMOs) be- ease, and treatment. The WHO also strives to improve came the managed care structures responsible for access to health care in some local communities, as the financing, organization, and delegation of ser- a lack of access impacts all aspects of a person’s vices for their members. The HMO provides a plan physical, mental, and social health. The organization that has the provider assume some of the financial coordinates global health care efforts against public risks and uses primary providers as the gatekeepers. health threats, such as the severe acute respiratory Preferred provider organizations (PPOs) estab- syndrome (SARS) and H1N1 (swine flu) outbreaks, lished a network of providers that deliver services and emergencies that require humanitarian aid. The to the private sector for a discounted fee. The pa- WHO monitors global health care issues, such as the tient assumes the financial burden rather than the re-emergence of infectious diseases like tuberculosis provider. Those patients wishing to use providers and others, as increased international travel and com- outside the network can do so but will pay extra. merce may contribute to the spread of such diseases. For the PPO to make payment, the PPO must provide prior approval of visits to specialists or for hospitalization. Other plans are available that THE CONCEPT OF HEALTH mimic features found in HMOs and in individual choice systems. In these plans, known as point-of- Today’s nurse must be knowledgeable about what service (POS) plans, providers are paid a preset constitutes health because one of the primary goals payment based on membership or a risk-based of nursing is to assist the individual in achieving 3961_Ch01_001-016 24/12/14 11:23 AM Page 5 Healthy Lifestyles 5 the highest level of health. In 1947 the WHO de- T A B L E fined health as “a state of complete physical, men- 1.1 A Ho listic M o d el o f Health tal, and social well-being, not merely the absence Internal Forces External Forces of disease or infirmity.” The authors here attempt Body systems Culture to define for the reader a concept of health that is Mind Community holistic in its approach. That is, we consider health Neurochemistry Family to include not only physical aspects, but also psy- Heredity Biosphere chological, social, cognitive, and environmental influences. Physical health is influenced by our genetic makeup, which includes all the character- istics that people inherit from their parents. These characteristics not only include physical features, but also may encompass genetic weaknesses or disease. Genetic inheritance is further explored in Chapter 6. Psychological health refers to how a person feels and expresses emotions. Social health, however, deals with everyday issues of economics, religion, and culture and the interactions of people living together. Cognitive health encompasses a person’s ability to learn and develop. Environmen- tal concerns include such issues as water and air quality, noise, and biochemical pollution. Throughout this text we refer to specific develop- mental theorists to support the holistic view of growth and development. These theorists include Freud (psychoanalytic theory), Erikson (psychosocial the- ory), Piaget (cognitive theory), Maslow (human needs theory), and Kohlberg (moral theory). The holistic approach to health, which recognizes individuals as whole beings, promotes consideration of all aspects of a person’s life. This approach helps the practical nurse to understand each person and attach signifi- cance, value, and meaning to each life. The holistic view further helps identify similarities and differences FIGURE 1.1 Exercise at all ages helps maintain health. among people, allowing decision making from the person’s own unique perspective. Positive nursing throughout the life cycle, health is not static but dy- outcomes using the holistic approach emphasize namic and can move backward and forward from a patient independence and maximize potential. state of wellness to illness or disease. Throughout this text we use the terms health and Traditionally, health care has focused on an ill- wellness synonymously. We believe that health, ness model, in which the primary role of the nurse from the holistic perspective, is a balance of internal is to relieve pain and suffering. Today, disease pre- and external forces that leads to optimal functioning vention is evolving as an area of nursing concern. (Table 1.1). True health produces a state in which This change places new demands on the practical individuals are able to meet their needs and interact nurse, emphasizing his or her role in patient educa- with their environments in a mutually beneficial tion and health promotion throughout all stages of manner. Healthy individuals exhibit effective coping the life cycle. patterns and experience a certain degree of comfort and pleasure in their activities. Health may be visu- alized on a scale or continuum (Fig. 1.1). One end PROMOTING, MAINTAINING, of the continuum depicts optimal health or wellness, AND RESTORING HEALTH whereas the other end shows disease, total disability, or death. Disease refers to an imbalance between the Health promotion means health care directed to- internal and external forces. Individuals find that, ward the goal of increasing one’s optimal level of 3961_Ch01_001-016 24/12/14 11:23 AM Page 6 6 Journey Across the Life Span wellness. Leading a healthy life means having full continue educating adults on health issues. Health functional capacity at each stage of the life cycle, promotion emphasizes nutrition, exercise, mental from infancy through old age (Fig. 1.2). Promotion health, and avoidance of substance abuse. These of health can occur at any time and relates to indi- health promotion issues are addressed throughout vidual lifestyles and personal choices. Health pro- the text as they relate to specific age groups. motion allows people to enter into satisfying The practical nurse’s first step in promoting relationships at work and play. Health means being health is assessing individuals and families for po- vital, productive, and creative and having the capac- tential risks. Physical, social, and individual values ity to contribute to society. must be considered essential components of the The national aspirations for health promotion in- nursing assessment. Nurses can encourage patients clude three goals: healthy lives for more Americans, to assume full responsibility for their behavior and elimination of health care disparities among all eth- to adopt a healthier lifestyle. Empowerment is a nic and racial groups, and access to preventive ser- form of self-responsibility that encourages people vices for everyone. The essential component of to take charge of their own decision making. The health promotion begins with the sharing of knowl- practical nurse can play an important role in edu- edge. The acquisition of knowledge then influences cating and guiding patients so that they have attitudes and leads to a change in behavior. Health enough information to make critical decisions and promotion is most successful when placed in a sup- be informed health consumers. Nurses must de- portive social environment. This environment first velop ways to help patients recognize their own begins within the home and extends into the com- needs, solve their own problems, and access re- munity. The community includes schools, churches, sources that give them a sense of control over their and businesses. Schools provide the location for the own lives. Acts that empower patients place the dissemination of health information among the nurse in the role of patient advocate. Nurses must young. More than 85% of American adults spend be careful not to express their personal opinions, the greater part of the day in the workplace. The but rather to share enough information so that pa- workplace, therefore, is another excellent site to tients can make informed decisions. An example of the nurse’s role as an empowering agent occurs when a patient newly diagnosed with cancer at- tempts to choose among the different treatment modalities offered by the physician. The nurse helps to assess the patient’s knowledge level, com- municates clear information, and supports the pa- tient’s decision concerning treatment. Throughout this text we discuss health-promoting activities that enable patients to maintain wellness, strive for their full potential, and enjoy a high quality of life. The recent focus on health promotion and disease prevention has resulted in the introduction of alter- native therapies as treatment modalities. Many of these therapies originated centuries ago in Eastern civilization. Today in the United States, these thera- pies are used along with Western scientific medical treatment. Managed care organizations may provide reimbursement for a few selected therapies. Nursing includes the practice of some of these therapies, such as therapeutic touch, acupuncture, and reflexology. Disease Prevention Disease prevention comprises three levels: primary, secondary, and tertiary (Table 1.2). Primary preven- tion occurs before there is any disease or dysfunc- FIGURE 1.2 Health and wellness are promoted through an tion. The term health promotion may sometimes active lifestyle. be used interchangeably with primary prevention. 3961_Ch01_001-016 24/12/14 11:23 AM Page 7 Healthy Lifestyles 7 T A B L E 1.2 L evel s of Di s eas e Pr even t i o n Primary Prevention Secondary Prevention Tertiary Prevention Immunization Screening Rehabilitation Controlling risk factors Treatment Physical therapy, diet, exercise, stress reduction HIV/AIDS education Disease control Pain control An example of primary prevention includes patient the following groups (see the CDC website for education on basic hygiene, nutrition, and exercise. up-to-date recommendations): Other examples of primary prevention include im- Children aged 6 months and up; adults up to munizations against infectious diseases, avoidance 24 years of age of substance abuse, and regular dental examinations. Pregnant women The most significant public health achievement People 50 years of age and older in the past century is the reduction in the incidence People of any age with certain chronic medical of infectious diseases. Many factors have helped conditions that put them at higher risk for eradicate infectious diseases. Improvements in basic influenza-related complications hygiene, food handling, and water treatment and the People who live in nursing homes and other widespread use of vaccines have contributed to long-term care facilities disease control. Antibiotics have further helped to People who live with or care for those at high successfully treat infectious diseases. Infants, older risk for complications from flu, including: adults, minority groups, and health care workers Health care workers and emergency medical are at increased risk for infectious diseases. All services personnel causative organisms, even those that are presently Household contacts of persons at high risk for rare, may pose a potential threat of recurrence long complications from the flu after eradicating the illness. An example of this is Household contacts and out-of-home caregivers the current reappearance of tuberculosis and small- of children younger than 6 months of age (these pox. One major national goal is to effectively deliver children are too young to be vaccinated) immunizations to at least 90% of the preschool population. Special efforts should target minority Note: Current studies indicate the risk for flu in- populations, particularly African Americans and fection among persons older than 65 years of age is Hispanics, who, even today, receive fewer immu- less than the risk for persons in younger age groups. nizations than the general population. In 2009, scientists discovered a new and very dif- Many illnesses can be prevented worldwide by ferent flu virus called novel 2009-H1N1, sometimes improving environmental quality. In recent years the referred to as swine flu, which caused many more United States has effectively moved to ensure clean people to get sicker than a regular flu would. It also water, safe food, and proper waste disposal, thus re- caused more hospital stays and deaths than regular ducing the risk of infectious diseases. We still need seasonal flu. It was first detected in people in the to further improve air quality and develop new United States in April 2009, with the symptoms re- methods to eradicate other pollutants and environ- sembling those of seasonal flu. The H1N1 vaccine mental hazards. Environmental hazards today have is now included in the influenza vaccine. taken on a new meaning since September 11, 2001. Personal injury is one of the leading causes of Concerns for the safety of air, water, food, and travel death in the United States. We must each identify have evolved as a result of world terrorism. All per- and reduce our high-risk behaviors at home, on the sons are responsible for becoming informed and job, and when we travel. The different health haz- aware of their environment and its hazards. ards that exist at each stage of the life cycle are Some people, such as older people, young chil- outlined in later chapters. dren, pregnant women, and people with certain Secondary prevention begins with diagnosis of health conditions (such as asthma, diabetes, or heart disease or infectious processes. It focuses on the disease), are at increased risk for serious complica- need for early diagnosis and treatment of disease to tions from seasonal flu illness. The U.S. Centers for prevent permanent disability. Secondary prevention Disease Control and Prevention (CDC) currently includes all interventions used to halt the progress recommends the influenza vaccination each year for of an already-existing disease state. It includes 3961_Ch01_001-016 24/12/14 11:23 AM Page 8 8 Journey Across the Life Span screening of all types (for example, breast self- B O X examination or testing for hypertension and sickle- 1.2 Health-P ro mo ting B ehav io rs cell disease). In the latter stages of disease, second- Sound nutritional practice ary prevention often includes activities that prevent Chemical avoidance further disability. For example, the practical nurse Regular physical exercise may help the patient with diabetes prevent ulcera- Stress management tion and loss of a limb by teaching and helping the Disease prevention patient to practice good foot care. Healthy self-concept Tertiary prevention begins when a permanent disability occurs. Tertiary prevention is also re- ferred to as health restoration. Health restoration changes. The family must demonstrate healthy eat- begins once the disease process is stabilized. Nurs- ing. Get children involved in meal planning and ing care is directed toward rehabilitation and restor- preparation. ing the person to an optimal level of functioning. The goal of tertiary prevention is to regain lost function and develop new, compensatory skills, Nutrition possibly with the use of an assistive device such as Nutrition is a science that studies the body’s need a cane or hearing aid. Another goal is to help for foods, how foods are digested, and how food patients, including those with incurable diseases, choices relate to health and disease. It is important attain the maximal level of health. To help patients throughout the life span, from conception to old achieve this objective, the nurse may collaborate age, to foster growth and maturation, and it is an with other health professionals, such as physical important factor in promoting optimal health. Stud- and occupational therapists. The nurse is also ies have shown that the five leading causes of death responsible for offering psychological support to associated with poor dietary habits are coronary patients and family members. The practical nurse heart disease, cancer, stroke, non–insulin-dependent can help an elderly patient who has had a stroke to diabetes mellitus (type 2 diabetes), and coronary ar- achieve optimal functioning by first treating him or tery disease. Malnutrition is poor dietary practice her with dignity and respect. Second, the nurse that results from the lack of essential nutrients or must provide individualized care that maximizes the failure to use available foods. Malnutrition may the person’s strengths and minimizes weaknesses. involve undernutrition, including the symptoms of deficiency diseases, or overnutrition. This text fo- cuses on dietary needs at each stage of growth and HEALTHY LIFESTYLES development One of the goals of Healthy People 2020 is to In recent years it has become evident that many promote health and reduce disease by promoting illnesses are preventable and that certain lifestyles the consumption of a healthy diet and maintaining greatly reduce the incidence of heart disease, stroke, a healthy body weight. An adequate diet provides and other diseases. There is a strong need to empha- sufficient energy and essential fatty and amino size healthy behavior to reduce our current mortality acids, vitamins, and minerals needed to support rates. The overwhelming need is to learn to identify optimal growth and maintain and repair body tissues. behaviors that place individuals at great risk for ac- It is not possible to design one diet for everyone be- quiring and possibly spreading disease. An individ- cause individual needs for nutrients vary greatly with ual’s health also depends on his or her access to age, sex, growth rate, and amount of physical activ- quality health care. An important goal on a national ity, in addition to other factors, including social fac- level is to expand health care opportunities and elim- tors (Box 1.3). Because most nutrients are widely inate any disparities. distributed in a variety of foods, it is possible to de- Health promotion campaigns should target nutri- sign a healthy diet or meal plan that satisfies an in- tion, exercise, mental health, substance abuse, self- dividual’s personal and cultural preferences and concept, and disease prevention (Box 1.2). Important lifestyle needs. to the success of any health promotion plan is the This means selecting a variety of foods from the need to motivate and encourage patients to take five food groups as listed in the MyPyramid and responsibility for their own actions and health care MyPlate charts, while limiting intake of saturated practices. Involve the whole family in the needed fats, sugar, and alcohol. MyPlate, introduced in 3961_Ch01_001-016 24/12/14 11:23 AM Page 9 Healthy Lifestyles 9 B O X B O X 1.3 Soc i al F ac t or s T h at I n f l u en ce Diet 1.4 N utrients Attitude Proteins Economic and price structuring Proteins are broken down in the body into amino acids, Food and agricultural policy which are the building blocks needed for repairing the Food assistance programs body’s cells and tissue. Sources of protein include Knowledge meat, fish, eggs, legumes, milk, cheese, and nuts. Skills Carbohydrates Social support Carbohydrates are starches and dietary fiber that pro- Societal and cultural factors vide fuel for energy in the body. Carbohydrates are Tobacco or drug usage needed for brain, muscle, and heart function. They are divided into simple and complex forms: Simple carbo- hydrates are simple sugars found in fruits, while com- 2011, builds on the basic MyPyramid. These plex carbohydrates come from grains. Other sources guidelines are developed to help Americans make for carbohydrates are breads, cereals, and vegetables. better food choices and understand that caloric in- The fiber from carbohydrates is very important in low- take must match energy output. See Figure 1.3 for ering blood cholesterol levels. the MyPlate chart. Fats Some of the conditions that are related to an un- Fats, also called lipids, cushion and provide insulation healthy diet are obesity, malnutrition, iron defi- for the vital organs in the body. Fats also aid in the ab- ciency anemia, heart disease, hypertension, type sorption of vitamins. They are divided into saturated or 2 diabetes, osteoporosis, oral disease, constipation, unsaturated: Saturated fats are those oils that are solid diverticular disease, and some cancers. Food provides at room temperature, and unsaturated fats are oils that are liquid at room temperature. Unsaturated fats are the the nutrients necessary to maintain health. These nu- best types of fats to eat and cook with. Saturated fats trients include protein, carbohydrates, fats, vitamins, raise the body’s cholesterol levels. Sources of fats in- minerals, and water (Box 1.4). clude meats, vegetables, and milk. Causes of Obesity Vitamins Vitamins are inorganic compounds that assist in build- Researchers believe that individuals can have a ge- ing body tissues and are important in all chemical re- netic predisposition for obesity. Other factors that actions in the body. They are found in a wide range of can contribute to obesity are medications, fast foods, foods. Vitamin K is made by bacteria in the bowel. and a sedentary lifestyle, which might include more Minerals than 2 hours a day watching TV. See individual Minerals are inorganic substances that come from the earth and are important in body function. Calcium intake aids in the conversion of foods to energy; strengthens bones, teeth, and muscles; and aids in blood clotting. Iron is needed to make hemoglobin to carry oxygen to tissues. Minerals are found in a wide range of foods. Water Water aids in the regulation of body temperature, lu- bricates and cushions joints, protects the spinal cord, and eliminates waste from the body via urine, perspi- ration, and bowel movements. chapters for further information on obesity and ways to counteract this growing health issue in different age groups. Exercise FIGURE 1.3 The MyPlate chart clearly outlines a balanced meal and diet. The MyPlate icon and the ChooseMyPlate.gov Regular exercise improves muscle strength and en- web page are from the U.S. Department of Agriculture. durance, increases lung capacity, decreases tension 3961_Ch01_001-016 24/12/14 11:23 AM Page 10 10 Journey Across the Life Span and stress, and helps maintain adequate cardiovas- personal problems without undue stress, and still cular functioning. Studies have confirmed that contribute to society in a meaningful manner. Men- regular exercise is useful in preventing heart dis- tally healthy individuals see themselves and others ease, osteoporosis, diabetes, and other illnesses. realistically. A person’s state of mental health fluc- The optimal benefits of exercise are seen when tuates from day to day but maintains a certain degree physical fitness is maintained throughout the life of continuity and consistency. Certain behaviors span (Fig. 1.4). Table 1.3 lists the positive effects may be normal in moderation but unhealthy in of exercise. excess. For example, washing one’s hands as part There are two important points to remember about of everyday hygienic practices is considered accept- exercise. First, before beginning an exercise program, able. However, repeated hand washing unrelated to the individual should check with a physician. Second, any activity is seen as bizarre and mentally un- moderation is better than excessive practice. The ob- healthy. A factor that may affect one’s mental health stacles that many individuals face when trying to in- is stress. Stress may be defined as anything that corporate regular exercise into their daily lifestyles upsets our psychological or physiological equilib- include lack of time and no place to safely exercise. rium, or balance. Responses to stress may be phys- It is recommended that adults get at least 30 minutes iological, emotional, or intellectual. of moderate physical exercise daily or on most days. All humans experience many emotions. What is Children should limit inactivity and get at least interesting is that human emotions are not the same 60 minutes of physical activity daily. The need for ex- for everyone. One individual may respond differ- ercise and its applicability to the stages of growth and ently to a situation than another individual. During development are explored in each chapter of the text. the course of a day, individuals experience a large range of different emotions. Emotions are best defined as a feeling state. Mental Health Our emotions produce both physiological and psy- Mental health is a fluctuating state in which the in- chological changes. The physiological changes dividual attempts to adjust to new situations, handle associated with an emotion are the result of motor, FIGURE 1.4 The health-illness continuum. T A B L E 1.3 P o si t i ve Ef f ec t s of Ex er c i s e System Effects Cardiovascular system Increases blood volume and oxygen content Increases blood supply to muscles and nerves Decreases serum triglycerides and cholesterol levels Reduces resting heart rate Increases heart muscle size Respiratory system Increases blood supply Increases exchange of oxygen and carbon dioxide Increases functional capacity Neurological system Reduces stress Improves mental health Decreases depression Musculoskeletal system Increases muscle mass Reduces body fat Increases muscle tone Improves posture 3961_Ch01_001-016 24/12/14 11:23 AM Page 11 Healthy Lifestyles 11 glandular, and visceral activity. Specific areas of when individuals are able to control their responses the brain and the autonomic nervous system play and can express their emotions in socially appropri- a huge role in producing some of the physical ate ways. changes one associates with an emotion. The areas Some of the common physiological responses of the brain known to play this role in a person’s to stress include increased heart rate, respiratory emotional response include the cerebral cortex and rate, and blood pressure. Emotional responses to the limbic system. The cerebral cortex functions stress include irritability, restlessness, and a sense by receiving incoming sensory information. The of discomfort. Intellectual responses to stress often limbic system of the brain comprises intercon- include forgetfulness, preoccupation, and altered nected nuclei that affect memory and emotions. concentration. Conduction pathways in the brain produce many Many years ago Hans Selye described three dis- changes in the cardiac and smooth muscle contrac- tinct stages of physiological response to stress, known tions and in the secretion of some glands. Anger as the general adaptation syndrome (GAS): and fear produce an increased sympathetic activity. 1. Alarm stage: Hormones from the adrenal cortex Increased heart rate, breathing, and intestinal tight- place the body in a state of readiness known as ening and cramping are just a few of the physio- the fight-or-flight response. logical reactions to certain emotions. 2. State of resistance: The body attempts to adapt At birth, an infant’s emotional experiences are to the stressors. simple and spontaneous. Most of their emotional 3. State of exhaustion: After prolonged exposure responses are the result of their basic needs. For to stress, the body’s energy becomes depleted. example, when the infant is hungry, his or her This may result in disease or destruction. emotional response is likely to be crying with intense physical movements. Once satisfied, his or Anxiety her response is one of pleasure and calm. With Stress is a necessary part of life. It is unrealistic to maturation and learning, emotional responses be- expect to be able to eliminate all the stress from come more discriminating and individualized. See one’s life, and it would not be healthy to do so. Figure 1.5. Stress triggers anxiety. Anxiety is the response to Older children’s and adults’ emotions are ex- a stressful situation. Anxiety may be seen in four pressed in a wide variety of responses with varying different levels: mild, moderate, severe, and panic. degrees of intensity. In fact, different stimuli produce Mild anxiety is a part of normal, everyday life. different emotional responses in individuals. Com- Individuals experience some physical signs of mild mon emotions include anger, jealousy, happiness, af- anxiety such as restlessness, irritability, and mild fection, fear, and anxiety. Emotional maturity exists discomfort. Mild anxiety sharpens one’s percep- tions and prepares the individual to act. Mild anxiety helps the student prepare for an exam. An example of mild anxiety can be demonstrated with the scenario of a young mother driving home with her children as it begins to snow and visibility is slightly hampered. The mother starts to feel tense and tells her kids that she has to concentrate on the road. Moderate anxiety occurs with increasing discom- fort. The individual’s perceptions decrease. Persons experiencing moderate anxiety may focus only on certain aspects of what is happening. They tend to tune out what is considered less relevant. Learning can occur at this level of anxiety but not as effec- tively as at the mild level. Physical symptoms in- crease at this level, including heart palpitations, increased pulse and respirations, and mild gastric discomfort. The young mother is now experiencing FIGURE 1.5 Infants’ emotional experiences are instant and greater difficulty driving through a heavier snowfall. spontaneous. She starts to feel gastric tightness, headache, and 3961_Ch01_001-016 24/12/14 11:23 AM Page 12 12 Journey Across the Life Span marked irritability. She is unable to answer or talk illness. It may also come from external sources, to her kids as she recognizes the need to stay such as family, school, or peers. Stress can be focused on her driving. acute or chronic. Severe anxiety decreases one’s perceptions even Typical stressors in childhood include such further. The individual can focus only on one small events as birth of a sibling, death of a family mem- detail of an event. Learning cannot take place at this ber, onset of schooling, illness, and separation anx- heightened level of anxiety. Individuals may appear iety, to name a few. The practical nurse may witness confused and complain of many physical symp- stress or separation anxiety that a young child feels toms. They experience a sense of doom and gloom. as a result of hospitalization. Separation anxiety At this point the young mother has veered off the may be seen in three phases: protest, despair, and road and narrowly missed another car. She is in detachment. Protest is evidenced by loud crying, severe anxiety, and starts to cry and ignores her restlessness, and dissatisfaction with substitute kids’ responses. caregivers. Despair produces a sense of hopeless- The panic level is the most extreme form of anx- ness and is seen as a quieter period. Detachment is iety. Individuals are unable to think clearly, reality a state of withdrawal and apathy, or lack of interest is distorted, communication may be ineffective, and in one’s surroundings. The nurse’s awareness of behavior is nonpurposeful. Physical symptoms are these stages of separation helps both the child and exaggerated. Our young mother has continued on the caregivers cope with and adapt to the stress. her trip through very heavy snow and skids into Regression, the return to an earlier stage of devel- another car. Although no one is hurt in either opment, may be another childhood adaptation to vehicle, the young mother is in a state of panic. stress. The stress of serious illness or hospitaliza- When bystanders approach her, she is unable to de- tion may cause the youngster to show regressive be- scribe what has happened and does not know how haviors. The practical nurse can reassure the parent to proceed. that bed-wetting after illness in a previously toilet- trained child is only temporary. After recovery from Stressors the illness, the child will return to the previous level Each of us perceives stressors differently, depend- of accomplishment. ing on our learned behavior, age, and personality Typical stressors during adolescence relate to an (Fig. 1.6). For example, some individuals find air individual’s search for identity. Decision making travel pleasurable, whereas others find it stressful. and the struggle for independence lead to family dis- Stress may come from internal sources, such as cord. Nurses can best assist adolescents in their struggles for independence by being supportive and Responses to Stress encouraging decision making. The main stressors of adults relate to their key relationships. According to the Social Readjustment Conflict on the job Rating Scale (SRRS), death of a spouse, divorce, and separation are the events adults perceive as most stressful. During old age, life stressors include the loss of a spouse, retirement, and illness or loss of function. Nurses can help older adults cope effec- tively with stress by identifying and mobilizing their available support systems. For example, when an elderly patient is hospitalized, the family members need to be involved in the plan of care. Family in- “I need to buckle volvement and frequent family contact help reduce “I know I will be fired” down and be stress for all involved persons. Another part of stress focused” management is identifying what is perceived to be overly stressful. After identifying the stressor, a person must either reduce it or learn how to manage Heightened Tolerable it in a healthy way. Healthy ways of adapting to Stress Stress stress include relaxation, exercise, humor, and guided imagery. Box 1.5 describes two techniques FIGURE 1.6 Responses to stress. for reducing stress. 3961_Ch01_001-016 24/12/14 11:23 AM Page 13 Healthy Lifestyles 13 B O X responsibility are needed to further reduce the inci- 1.5 St r es s - R ed u c t i on T ec h n i q u es dence of smoking in future generations. Practice these techniques several times a day. Although moderate alcohol use may be benefi- cial in lowering blood cholesterol levels, alcohol Relaxation Exercise abuse presents a serious health problem in our so- 1. Assume a comfortable position. ciety. Alcohol abuse is not measured according to 2. Eliminate other distractions. the specific amount consumed; rather, alcohol 3. Close your eyes. abuse occurs when the person cannot curtail the 4. Regulate your breathing pattern and focus on inhal- ing and exhaling. amount of alcohol he or she consumes or when 5. Progressively relax your muscles. alcohol interferes with the person’s daily function- 6. Refocus on your breathing, as needed. ing. Alcohol use has been documented to begin at 7. Continue for 10 to 15 minutes. an early age. Recent studies have shown that many children ages 12 to 17 admit to drinking. Guided Imagery Long-term alcohol use has been linked to liver 1. Take a relaxed position. 2. Close your eyes. damage, heart disease, and an increased risk of 3. Recall an image, event, or place that is pleasurable neonatal disorders. Statistics indicate that alcohol to you. contributes to serious social and health problems, in- 4. Focus your energy and thoughts on the image while cluding automobile accidents. Alcohol use is impli- relaxing your muscles from head to toe. cated in almost one-half of the deaths caused by 5. Concentrate on the image for 10 to 15 minutes. motor vehicle crashes. It is also responsible for one- third of all homicides, drownings, and boating deaths. Intravenous drug users and their sexual partners are at increased risk for AIDS and related sexually Maladaptive Responses to Stress transmitted diseases (STDs). Drug treatment pro- Unhealthy or maladaptive responses to stress in- grams, counseling, education, and frequent testing clude denial, withdrawal, and acting-out behaviors. reduce the many risks associated with drug use. One example of denial is a surviving spouse who, after a prolonged period of mourning, is unable to change the deceased spouse’s bedroom, leaving A Healthy Self-Concept clothes and belongings in place as if the person were Knowing and practicing healthy behaviors and going to return. A detailed discussion on maladap- avoiding risky behaviors do not guarantee good tive responses to stress can be found in Chapter 5. health. Many factors influence an individual’s health Substance abuse commonly refers to the abuse status, including family and community relation- of drugs such as alcohol, nicotine, and caffeine, ships, perception of various social pressures, and and legal and illegal pharmaceutical preparations. individual temperament. All of these factors cause See Chapter 10 for further discussion of substance each person to respond to the environment in a abuse. A substance abuser has more than a strong unique and sometimes unpredictable manner. Fur- desire for the substance. Substance abuse is marked thermore, perceptions of the environment, reactions by gradual reduction in awareness, decline in self- to it, and individual needs are affected by a person’s esteem, and withdrawal from involvement. Re- self-concept. cently, much attention has been given to educating The relationship between the individual and the the public about the effects of substance abuse. To- environment is reciprocal—that is, a person’s self- bacco use is one of the most important preventable concept is affected by the environment in which he causes of death in our society today. Recent research or she lives. Self-concept also is affected by the shows that every day 3,000 young persons start individual’s stage of development. Throughout this smoking. The connection between smoking and text we discuss the stages of development and how lung disease has been well documented for more they might affect the individual’s health and choices than 40 years. Smoking also contributes to heart dis- related to a healthy lifestyle. ease and fetal and neonatal abnormalities and Chapter 5 provides an explanation of several the- deaths. Health promotion is aimed at encouraging ories related to individual development: psychoan- cessation of smoking and avoiding exposure to sec- alytical, psychosocial, cognitive, moral, and others. ondary smoke. Because all behavior is influenced Good health is more than a visit to the doctor. by role modeling, social education and individual Healthy decisions, such as what we eat for lunch or 3961_Ch01_001-016 24/12/14 11:23 AM Page 14 14 Journey Across the Life Span the amount of exercise we get, can be made every B O X day. Although many Americans are moving toward 1.7 P erso nal Health Assessment P lan healthy living, others still need encouragement to In any health assessment it is important to first become practice healthy behaviors. Each person must set re- aware of your personal quality of life. Complete the alistic goals that will reinforce positive behaviors. following statements and determine your personal The first step is to make an inventory of healthy and health action plan. unhealthy behaviors and develop a health assess- 1. Based on my readings, my personal health issues of ment plan (Boxes 1.6 and 1.7). most concern are: ROLE OF THE NURSE IN 2. My top-priority health issue is: HEALTH PROMOTION As changes occur in the health care system, the role 3. I can address the preceding issues by taking the fol- of the practical nurse also needs to change to meet lowing actions: the demands of the new health care delivery system. Practical nurses will need to work not only in tradi- tional hospital settings, but also in the community. 4. My goal is to: B O X 1.6 H e a l t h B eh avi or I n ven t or y Before beginning any lifestyle change, it is important Emphasis will be on prevention and health promo- to assess your behavior. List below the healthy and un- tion. All levels of nurses will be accountable to both healthy things that you do. the employer and the client. Healthy Behavior: In the future, the practical nurse will have five roles and responsibilities: 1. Caregiver: Delivering health care services 2. Teacher: Educating the client, family, and community Unhealthy Behavior: 3. Advocate: Helping clients choose between available options 4. Collaborator: Working as a member of a team, sharing and exchanging information 5. Role model: Practicing healthy lifestyle behav- iors that will influence and reinforce clients’ actions SUMMARY 1. Early civilization was concerned with health 4. Health is a balance of internal and external and diseases. forces leading to optimal functioning. 2. Many improvements have contributed to 5. Health promotion refers to health care today’s increased life expectancy. directed toward increasing one’s optimal level of wellness. 3. Healthy People 2020 established two major goals for the nation: the first is aimed at in- 6. A change in lifestyle or personal habits is often creasing the quality and years of a healthy life, necessary to promote maximal health. and the second is aimed at the elimination of health disparities. 3961_Ch01_001-016 24/12/14 11:23 AM Page 15 Healthy Lifestyles 15 7. Health maintenance focuses on prevention and 11. Emotions are best defined as a feeling state. the need for early diagnosis and treatment. Our emotions will produce both physiological and psychological changes. 8. An important goal on a national level is to ex- pand health care opportunities and eliminate 12. Factors that influence a person’s health disparities. behavior include family, role models, social pressures, and self-concept. 9. Health restoration begins after the disease process is stabilized. The goal is to either re- 13. Disease prevention is composed of three store function or help the person compensate levels: primary, secondary, and tertiary. for losses. 14. The five roles for the practical nurse in health 10. Leading a healthy lifestyle includes paying promotion are caregiver, teacher, advocate, attention to nutrition, exercise, mental health, collaborator, and role model. substance abuse avoidance, and disease prevention. CRITICAL THINKING Exercise #1 Larry Woodhill, a 47-year-old bank manager, attends the wellness clinic offered by his organization. Larry weighs 230 pounds and is 5 feet, 8 inches tall. He has smoked two packs of cigarettes per week for the past 30 years. His recreational activities begin on Friday nights at the local bar, where Larry consumes five or six cans of beer. This activ- ity is repeated on Saturday nights but not on Sundays. Through the wellness clinic, Larry embarks on an exercise program. 1. Without other major behavior changes, how do you evaluate the benefits of exer- cise for Larry? 2. Develop an approach to dietary counseling that may be beneficial for Larry. 3. What other healthy choices could Larry incorporate into his lifestyle? 4. Which of Larry’s behaviors are considered high risk? Exercise #2 A student begins classes after being out of school for several years. Prior to his first exam the student notes that he is becoming increasingly nervous and stressed. The night before his exam he stays up all night studying. On the morning of the exam he arrives feeling sick with stomach cramps and diarrhea. His muscles are tense, and he is jittery and sweaty. 1. What physiological responses is he experiencing? 2. Describe your own physiological responses to stress. 3. Describe what measures can be used to lower one’s stress response in this situation. 3961_Ch01_001-016 24/12/14 11:23 AM Page 16 16 Journey Across the Life Span MULTIPLE-CHOICE QUESTIONS 1. In early civili