Chapter 1 Health Defined: Objectives for Promotion and Prevention PDF

Chapter 1 Health Defined: Objectives for Promotion and Prevention  Overview  Health is core concept  Related concepts: wellness, illness, disease, disability  Theories of health address underlying dynamics  Larger societal and environmental concerns...

Chapter 1 Health Defined: Objectives for Promotion and Prevention  Overview  Health is core concept  Related concepts: wellness, illness, disease, disability  Theories of health address underlying dynamics  Larger societal and environmental concerns determine health outcomes  Healthy People 2030 latest permutation of the federal Healthy People initiative  Epidemiology: study of health and disease from a societal perspective 2  Exploring Concepts of Health Wellness-Illness Paradigm  Wellness-illness continuum – 1st of 2 paradigms  Health viewed as dichotomy  High-level wellness vs depletion of health  Wellness is the positive end of continuum  High-level wellness: sense of well-being, life satisfaction, quality of life  Adaptation is the negative end of the continuum  Adaptation to disease/disability through various levels of functioning ability 3  Exploring Concepts of Health Developmental Paradigm  Health viewed as a developmental phenomenon – 2nd of 2 paradigms  Present in literature since 1970s and 1980s  Expanding consciousness, pattern, and meaning recognition, personal transformation and actualization  Person is view as part of a complex, interconnected system of person and environment  Health is an outcome of the person-environment interaction  Various models within this paradigm 4  Social Ecological Model of Health  Comprehensive and multidimensional  Interconnection between people and physical/social environments  Promotes health on multiple levels  Individual, family  Community, society  Social determinants of health  Includes socioeconomic status, education, physical environment, employment, support networks as access to health care  Healthy People 2020 and 2030 objectives are based on this model objectives 5  Historical Perspectives of Health  Before 1940: health = absence of disease  Infectious diseases prominent  Physician: independent primary practitioner  Government: start public health/welfare  1940s to 1950s: health = ability to fulfill roles  Physicals for fitness  Physicians linked to hospital services  Increased federal role: hospital expansion, federal programs 6  Historical Perspective of Health  1960s to present: health = adaptation and reaction to environment  Disease prevention/health promotion  Emphasis on individual responsibility/lifestyle choices  Advance practice nurses became health providers  Government: control costs  Quality of life seen as component of health Person/family perception important  Person-centered care – holistic care with patient input 7  Current Views of Health  Emphasis placed on quality of life where quality is a subjective as well as an objective judgment  Functional Health or health-related quality of life, both of which refer to self-rated health and function  Gordon’s views relate to functional health and form the basis of the info presented in this text.  Resiliency is an important determinant of health  Resilience is one’s ability to deal with stress and trauma 8  Models of Health  Clinical  Absence s/s disease; prevention not emphasized  Role performance  Health based on whether person can perform societal roles  Occupational health evals, school physicals, medically-excused absences  Adaptive  Ability to adapt positively to change (social, mental, physiologic) Example: adaptation of older adult 9  Eudaimonistic Model  Exuberant well-being indicates optimal health.  Emphasis on interaction and interrelationships in multiple aspects of life  Congruent with integrative modes of therapy  Address more comprehensive health needs  Compatible with complementary and alternative medicine (CAM)  Health is more broadly defined and can encompass more individuals and more diverse life circumstances 10  Wellness-Illness Continuum  Dichotomous depiction of health vs illness  Wellness is positive state - represented as positions above midpoint  Increases involve improved physical or mental states  Illness: incremental decreases below midpoint  Fits well with clinical model of health  Useful when analyzing the transition from wellness to illness 11  High-Level Wellness  Wellness is positive state with increases in health beyond midpoint of continuum  Dunn (1961) expanded concept of health to include favorability of environment  Progression toward a higher level of functioning  Emphasizes interrelationship between environment and health on personal and societal level  Fits well with eudaimonistic model of health 12 High-Level Wellness 13  Health Ecology  Evolving view which recognizes interconnection between people & physical - social environment  Health is multidimensional  Incorporates systems approach  Utilizes developmental framework (Newman 2003) and functional health patterns (Gordon 2020)  Health incorporates context in which a person functions 14  Functioning  Health requires the ability to function  Functioning can be high-level or low level  Physical, mental and social levels of function  Loss of function may be sign of disease  Loss of function commonly signals need for health care intervention  For the elderly decline in functioning may be sentinel event for future loss and death 15  Illness, Disease and Health  Disease  Failure of adaptive mechanisms  Results in functional or structural disturbances  Multifactorial approach increases chance of successful intervention  Illness  Subjective experience of individual and physical manifestation of disease—psychological, spiritual, and social components  Mismatch re needs and resources to meet the needs 16  Planning for Health  Previous focus was disease prevention  Over past 30 years promotion of health has become the driving force  Healthy People initiative started in 1979 by US Department of Health, Education, and Welfare  Call to action to set goals for next 10 years  Interest waned during the 1980s  Healthy People 2000—renewed interest—became landmark document (initiated 1990) 17  Healthy People Initiative  Healthy People 2000  Increase the span of healthy life  Reduce health disparities  Create access to preventive services for all  Core focus: illness prevention is foundation for health  Healthy People 2010  Increase quality and years of healthy life  Eliminate health disparities 18  Healthy People 2020  National Guidelines to Promote Health  Four overarching goals  Attain high quality, longer lives free of preventable disease, disability, injury, and premature death  Achieve health equity, eliminate disparities, and improve the health of all groups  Create social and physical environments that promote good health for all  Promote quality of life, healthy development, and healthy behaviors across all life stages 19  Healthy People 2020  Forty-two focus areas—expansion on previous area are evidenced-based  Guide for health care research, practice, education, policy, and communications  Twelve leading health indicators  Examples: access to health services, environmental quality, physical activity, obesity, tobacco use  Continued emphasis on eliminating healthcare disparities  Person-centered care is important  2018 work begun for Healthy People 2030 20  Healthy People 2030  Current process of updating to 2030 is underway  Goals and topics of previous decade evaluated  Topics changed, added or removed  Objectives specific to topics developed by experts  Three levels of objectives proposed for 2030  Core objectives, Developmental objectives  Research objectives  Five overarching goals identified  Community leaders and the public will have input for the first time with 2030 21  Healthy People 2030 Five Overarching Goals 1. Attain healthy, thriving lives and well-being, free of preventable disease, disability, injury, and premature death 2. Eliminate health disparities, achieve health equity and attain health literacy to improve health and well being of all. 3. Create social, physical and economic environments that promote attaining full potential for health and well being for all. 22  Healthy People 2030 Five Overarching Goals 4. Promote healthy development, healthy behaviors and well-being across all life stages 5. Engage leadership, key constituents as the public across multiple sectors to take action and design policies that improve the health and well-being of all. * * 2030 is the first time leadership and the public will be consulted 23  Levels of Prevention Levels of Prevention Steps of Prevention Primary 1. Health promotion and specific protection Secondary 2. Early diagnosis 3. Prompt treatment 4. Disability limitation Tertiary 5. Restoration and rehabilitation 24  Primordial Prevention  Newest level of prevention – before risk factor  Original three levels developed in 1945s to 1950s  Reflects policy-level intervention  Aimed at affecting health before at-risk lifestyle behaviors are adopted  Occurs at national, state, community levels  Examples: healthy eating school-based programs, reduction of sodium in food supply, creating bike/walking paths 25  Primary Prevention  Precedes disease/dysfunction  Interventions—health protection  Health promotion (e.g., education)  Vaccines are primary prevention interventions  Focus: maintain/improve general individual, family, community health  Health protection – reducing threats to health  Health promotion – encouraging lifestyle change to move toward health 26 Administering immunization is a primary prevention intervention. The goal is to intervene before the disease process occurs 27  Health Promotion  Social nature of health promotion  Individuals, families and communities must be active  Active and passive nature of health promotion  Passive: clean water and sanitary sewage  Active: individual adopts lifestyle changes  Transtheoretical Model of Heath Promotion  Incorporates 6 stages of change – each provides nursing opportunity for information and support  Specific protection: inoculation, reducing exposure to carcinogens, occupational hazards 28  Health Promotion Six Stages of Change  Precontemplative—not considering change  Contemplative—aware but not considering change soon  Preparation—planning to change  Action—has begun to make behavioral change (recent)  Maintenance—continued commitment to behavior (long term)  Relapse—reverted to old behavior 29  Secondary Prevention  Focus on early detection  Earlier treatment results in more favorable outcomes  Limit disabilities from disease  Screening falls under secondary prevention  Individuals  Populations  Examples: Colon cancer screening, Pap tests 30 Secondary prevention: testing site to determine if individual is positive for Covid-19. Administering Covid-19 vaccine is primary prevention 31  Tertiary Prevention  Focus on restoration and rehabilitation  Minimize long term sequella of disease  Restore function; prevent further injury/disease  Examples  Cardiac rehab after MI  ROM to maintain mobility after CVA  Turning q 2h to prevent decubiti 32  The Nurse’s Role  Emphasis shifting from acute, hospital-based care to preventative community-based care  Nurses must assume blended roles with a knowledge base using evidence-based practice  Greater emphasis on promoting and maximizing health  Health in All Policies – collaborative attempt to consider social determinants of health  Refers to considering the health of communities when enacting any policy 33 Nursing Roles in Health Promotion and Protection  Advocate – directly assists persons to obtain services needed  Care manager – assists individuals to obtain care - coordinates care  Consultant – specialize skills and knowledge  Deliverer of services – provides direct care  Educator – promotes patient literacy  Healer – helps individuals integrate and balance  Researcher—evidence-based practice 34  Evidence-Based Practice  Definition: searching for best evidence to answer clinical research questions  Using research findings to make decisions  Conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual persons  Integrating individual clinical expertise with the best available external clinical evidence from systematic research (ANA, 2004) 35  Evidence-Based Practice  Quantitative studies—measure, test, and quantify variables related to care  Qualitative studies—describe phenomenon or define historical, cultural, or philosophical nature of care  Applied research—focus is to directly affect clinical practice 36  Improving Prospects for Health  Population effects  Increased diversity in the US population  Changes in age distribution (↑ older population)  Health promotion approaches may need to adapt  Shifting problems  Environmental pollution  Stress  Lifestyle (obesity, substance abuse)  Increase in chronic conditions 37  Improving Prospects for Health  Moving toward solutions  Numerous health-related challenges  Individual involvement (lifestyle changes, motivation)  Governmental involvement (legislation and financing)  Nursing has important role in implementing solutions 38