Health Promotion in Nursing Practice( Pearson New International Edition)

357 Pages·2013·3.362 MB·English

by  Nola Pender

H
e
a
l
t
h

P
r
o
m
o
t
i
o
n

i
n

N
u
r
s
i
n
g

P
r
a
c
t
i
c
e

P
e
n
d
e
r

M
u
r
d
a
u
g
h

P
Health Promotion in Nursing Practice
a
r
s Nola J. Pender Carolyn L. Murdaugh
o
n Mary Ann Parsons
s
Sixth Edition

ISBN 978-1-29202-782-1
6
e
9 781292 027821
Pearson New International Edition

Health Promotion in Nursing Practice
Nola J. Pender Carolyn L. Murdaugh
Mary Ann Parsons
Sixth Edition
International_PCL_TP.indd 1 7/29/13 11:23 AM
ISBN 10: 1-292-02782-7
ISBN 13: 978-1-292-02782-1
Pearson Education Limited
Edinburgh Gate
Harlow
Essex CM20 2JE
England and Associated Companies throughout the world
Visit us on the World Wide Web at: www.pearsoned.co.uk
© Pearson Education Limited 2014
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the
prior written permission of the publisher or a licence permitting restricted copying in the United Kingdom
issued by the Copyright Licensing Agency Ltd, Saffron House, 6–10 Kirby Street, London EC1N 8TS.
All trademarks used herein are the property of their respective owners. The use of any trademark
in this text does not vest in the author or publisher any trademark ownership rights in such
trademarks, nor does the use of such trademarks imply any affi liation with or endorsement of this
book by such owners.
ISBN 10: 1-292-02782-7
ISBN 10: 1-269-37450-8
ISBN 13: 978-1-292-02782-1
ISBN 13: 978-1-269-37450-7
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
Printed in the United States of America
Copyright_Pg_7_24.indd 1 7/29/13 11:28 AM
111122221368247924691111711933577
P E A R S O N C U S T O M L I B R AR Y
Table of Contents
1. Introduction: Global Health Promotion: Challenges of the 21st Century
Nola Pender/Carolyn Murdaugh/Mary Ann Parson 1
2. Toward a Definition of Health
Nola Pender/Carolyn Murdaugh/Mary Ann Parson 13
3. Individual Models to Promote Health Behavior
Nola Pender/Carolyn Murdaugh/Mary Ann Parson 35
4. Community Models to Promote Health
Nola Pender/Carolyn Murdaugh/Mary Ann Parson 67
5. Assessing Health and Health Behaviors
Nola Pender/Carolyn Murdaugh/Mary Ann Parson 87
6. Developing a Health Promotion-Prevention Plan
Nola Pender/Carolyn Murdaugh/Mary Ann Parson 121
7. Physical Activity and Health Promotion
Nola Pender/Carolyn Murdaugh/Mary Ann Parson 141
8. Nutrition and Health Promotion
Nola Pender/Carolyn Murdaugh/Mary Ann Parson 171
9. Stress Management and Health Promotion
Nola Pender/Carolyn Murdaugh/Mary Ann Parson 197
10. Social Support and Health
Nola Pender/Carolyn Murdaugh/Mary Ann Parson 221
11. Evaluating Individual and Community Interventions
Nola Pender/Carolyn Murdaugh/Mary Ann Parson 241
12. Self-Care for Health Promotion Across the Life Span
Nola Pender/Carolyn Murdaugh/Mary Ann Parson 269
13. Health Promotion in Community Settings
Nola Pender/Carolyn Murdaugh/Mary Ann Parson 293
I
333124199
14. Health Promotion in Vulnerable Populations
Nola Pender/Carolyn Murdaugh/Mary Ann Parson 311
15. Promoting Health Through Social and Environmental Change
Nola Pender/Carolyn Murdaugh/Mary Ann Parson 329
Index 349
II
I N T R O D U C T I O N
Global Health Promotion:
Challenges of the
21st Century
The establishment of health promotion as an integral aspect of health care and society
continues to present challenges for all nations. Accumulating evidence indicates that
health promotion holds promise for maintaining vigor, vitality, and productivity
into the eighth and ninth decades of life for an increasing proportion of the world popula-
tion. Governments of many countries are developing national health promotion plans to
shape the future direction of health care, as the link between a healthy and productive
population and national welfare and economic prosperity is now recognized. Overall
goals are to help people of all ages stay healthy, to optimize health in the presence of
chronic disease or disability, and to create healthy environments in which to live.
The Commission on Social Determinants of Health, formed by the World Health
Organization (WHO) in 2005, examined the evidence on equity in implementing health
promotion strategies and how to foster a worldwide approach to achieve equity. The
commission’s final report, Closing the Gap in a Generation(WHO, 2008a), expressed the
commission’s aspirations for actions that involve government, civil society, local com-
munities, businesses, global and international organizations, and research institutions.
Resulting health-oriented public policy can facilitate positive changes in health behav-
ior norms as well as provide health-promoting and health-enhancing environments on
a national and international scale (Laxminarayan et al., 2006). Health is the responsibil-
ity of all, not just the health care sector. Individual, community, and political will and
resources all working together are necessary to achieve health for all (WHO, 2008a).
GLOBAL PROGRESS TOWARD HEALTH PROMOTION
All people of the world are part of a global community or health mega system. In today’s
world, what affects one country affects other countries as well. The Bangkok Charter for
Health Promotion in a Globalized World identifies actions and commitments needed to
address the determinants of health in a globalized world through health promotion
(WHO, 2005). The charter builds on the values and strategies for health promotion estab-
lished by the Ottawa Charter for Health Promotion, which defines health promotion as a
From Health Promotion in Nursing Practice, 6/e. Nola Pender. Carolyn Murdaugh. Mary Ann
Parsons. Copyright © 2011 by Pearson Education. All rights reserved.
1
Introduction
process enabling people to increase control over and improve their health (WHO, 1986).
Both charters emphasize the necessity of including individuals as well as communities,
societies, governments at all levels, and international organizations to achieve health.
This broader approach to health promotion is well illustrated by the Healthy Cities
Projects, which WHO initiated more than 25 years ago in Europe. The ongoing project
engages local governments in health development through extensive community partici-
pation and institutional changes to implement comprehensive city plans for health pro-
motion. The target endpoints are evaluated on not only morbidity and mortality but also
prevalence of health-promoting behaviors, quality of the physical and social environ-
ment, and extent of community empowerment and action. Each five-year plan focuses
on core priority themes. The Phase V (2009–2013) overarching goal focuses on health
equity through caring and supportive environments, healthy living, and healthy urban
design. Building healthy cities is an ecological approach that has yet to reach its full po-
tential for improving the health of people. An improvement in well-being throughout
the life span, especially for vulnerable populations, will enable cities and nations to ben-
efit from greater economic prosperity and improved national welfare (WHO, 2008b).
The health-promoting features of social policies, organizations, and environments
are highlighted in a report published 30 years after the defining international primary
health care conference in 1978 at Alma-Ata, Kazakhstan. The 2008 report, Primary
Health Care: Now More Than Ever (WHO, 2008c), was dedicated to reemphasizing pri-
mary health care and offers an assessment of global health with a focus on primary
care. The report emphasizes primary care as a way to help meet the challenge of con-
siderable and increasing health inequities and the effects of globalization on the burden
of chronic and communicable as well as noncommunicable diseases.
Reforms identified in the report reflect a convergence among the values of primary
care, the performance of the health system, and the expectation of citizens. They include:
•Universal coverage to ensure equity, social justice, and the end of exclusion
•Service delivery organized around people’s needs and expectations
•Public policy that secures healthier communities through integration of public
health and primary care
•Leadership that is reflective of inclusion, participation, and negotiation (WHO, 2008c)
A major challenge worldwide is to develop credible, widely recognized, high-quality
standards to evaluate the effectiveness of multicultural health promotion interventions.
This task presents a formidable challenge given the complexity of health promotion in-
terventions ranging from changing individual and group behaviors to changing policies
that set norms for behavior. Use of behavioral surveillance systems is critical to assessing
progress toward health promotion objectives, as are time-sensitive strategies to analyze
and use data to make strategic decisions about “what works.” Meeting these challenges
is essential to further the global agenda for health promotion (Abbott & Coenen, 2008).
INFLUENCE OF TECHNOLOGICAL ADVANCES ON
GLOBAL HEALTH PROMOTION
In an age of rapid advances in technology, innovations in communication technology
offer unprecedented opportunities to provide health-related information worldwide.
Innovative use of interactive computer technology and interactive television through
2
Introduction
worldwide networks is enabling health professionals and consumers to collaborate as
never before in tailoring health communications to the special needs of individuals and
families from diverse cultures and sociocultural backgrounds (Smeets, Brug, & de
Vries, 2008; McDaniel, Schutte, & Keller, 2008).
The accelerated technological revolution has multiplied the potential for im-
proving health globally. Health systems are increasing their capabilities to literally
“reach around the world” to provide open access to the latest health knowledge
and create a national and international resource for informed health care decision
making by both providers and consumers. Improving vulnerable populations’ ac-
cessibility to and competence in using computerized information systems must be a
top priority.
NATIONAL PROGRESS TOWARD HEALTH PROMOTION
Unhealthy lifestyles and environments are responsible for a high percentage of the
morbidity and mortality in the United States. Unless the health care system is signifi-
cantly changed to influence lifestyles and environments, the nation’s health profile will
continue to deteriorate (Brahan & Bauchner, 2005). Demographic changes toward an
older population and a more ethnically and culturally diverse population create new
demands for health promotion and prevention services in primary care and public
health (U.S. Department of Health and Human Services, 2006).
Public support continues to grow for coverage of health promotion and illness
prevention services by third-party payers. There is also an increased interest in health
promotion and preventive services that have been shown to be effective in promoting
positive behavior change and decreasing health care costs. The federal government and
private insurers have a mandate to continue to evaluate the impact of providing an ar-
ray of health promotion services to individuals and families, including the millions of
citizens in the United States who are currently uninsured or underinsured.
Healthy People: The U.S. Surgeon General’s Report on Health Promotion and Disease
Preventionis an initiative to set science-based objectives for promoting health and pre-
venting disease, and to monitor the outcomes of these national health objectives. The
objectives address a broad range of health needs, encourage informed decision making,
promote collaboration, and measure the effect of the outcomes on individuals, groups,
families and communities. Healthy People provides users with up-to-date information
on health status, public health priority setting, and significant statistical analyses on
health promotion and disease prevention. Initiated in 1979, the process involves gov-
ernmental officials, businesses, professional groups, researchers and academic institu-
tions in setting the vision, mission, goals and objectives every 10 years.
Midway through each decade the U.S. Department of Health and Human
Services conducts a midcourse review of the national objectives and assesses progress
toward meeting them. In 2006 the midcourse review of the 2010 objectives showed that
only 10% met the set target of 281 objectives with baseline data available. Less than half
(49%) moved toward the target, and 14% demonstrated mixed progress. Moreover, 6%
showed no change, and 20% moved away from the target. The assessment of the qual-
ity and years of healthy life showed that while overall life expectancy continues to im-
prove, the white population continues to have a longer life expectancy than the black
population; all women have a longer life expectancy than men with greater expected
3
Introduction
years in good or better health and free of limitations and chronic diseases; a slight
increase was noted for men in expected years in good or better health.
The assessment of the second goal of Healthy People 2010—to eliminate health
disparities—concluded that substantial disparities continue between all minority pop-
ulations and the white non-Hispanic population. There was no change in disparities
among all racial populations for 81% of the objectives. Disparity based on education
level, gender, income level, geographic location, and disability status had mixed out-
comes, but overall minimal improvement was noted at the midcourse review (U.S.
Department of Health and Human Services, 2006).
The process for developing Healthy People 2020was initiated in 2009 with a vision
of “a society in which all people live long and healthy lives” (www.healthypeople.gov/
HP2020). Addressing a long-standing criticism, the Healthy People 2020 process moves
from setting aspirational goals (i.e., increase quality and years of life, and eliminate
health disparities), to setting realistic and achievable goals:
•Achieve health equity, eliminate disparities, and improve health for all groups
•Eliminate preventable disease, disability, injury, and premature death
•Create social and physical environments that promote good health for all and
•Promote healthy development and healthy behaviors across every stage of life
The development and implementation of Healthy People 2020 can be viewed at www.
healthypeople.gov/HP2020.
Achieving Healthy People objectives is a continuing challenge. The process of de-
veloping the plan has been very successful, but the resources required and commitment
needed from individuals, families, schools, and communities to implement the plans
have resulted in meeting or exceeding only a minimal number of objective targets.
Increased attention to the social determinants of health means that local, state and na-
tional policy changes and resources are necessary to improve the health and well-being
of persons of all ages and increase the prevalence of healthy lifestyles in the population.
The National Health Interview Survey (NHIS) provides another view of our na-
tional progress toward health. The Centers for Disease Control and Prevention’s
National Center for Health Statistics (2007) sponsor the annual NHIS household survey
conducted by the U.S. Census Bureau. The result of the 2006 survey of 24,275 civilian,
noninstitutionalized adults was based on a response rate of 71%. Of adults over 18 years
of age, 61% reported excellent or very good health, yet 62% reported they never partici-
pated in vigorous leisure-time physical activity, one-fifth (21%) were smokers. Based on
body mass index estimates, 35% were overweight and 26% were obese (Pleis &
Lethbridge-Cejku, 2007). Females were more likely to report fair or poor health.
The Youth Risk Behavioral Surveillance System (YRBSS) is administered annually
to monitor priority health risk behaviors that contribute to the leading causes of death,
disability, and social problems among youth in America (Eaton et al., 2008). A 2007
midyear report showed that motor vehicle crashes, other unintentional injuries, homi-
cide, and suicide accounted for 72% of all deaths among persons aged 10–24 years.
Age-adjusted and non-age-adjusted health statistics for U.S. children are available
from the 2006 NHIS on selected health measures for noninstitutionalized population of
children under 18 years of age. In this survey, 82% of children had excellent or very
good health. Only 5% of children had no usual place of health care and 10% had no
health insurance. Poverty status was associated with the health of the respondent. Four
4
Introduction
out of ten children in poor families reported excellent health while six out of ten chil-
dren in families that were not poor reported excellent health (Bloom & Cohen, 2007).
A national children’s prospective, multiyear, epidemiologic study of 100,000
American children, funded by the U.S. Congress through the Children’s Act of 2000, began
in 2007. Children will be followed from conception to 21 years of age. Environmental
exposures are assessed in the children’s homes, schools, and communities. Genetic mate-
rial is also collected to permit study of gene–environment interactions. The results of this
study will guide future development of a comprehensive blueprint for health promotion
and disease prevention in children (Landrigan et al., 2006).
Much progress has been made to prevent and control disease processes. The priority
health problems among America’s children, youth, and adults stem from risky behaviors
and lifestyle choices. More effective individual, family, and community interventions are
needed to reduce risk and improve health outcomes to move the nation toward a more
healthy society.
HEALTH PROMOTION AND DISEASE PREVENTION:
IS THERE A DIFFERENCE?
The most important difference between health promotion and disease or illness preven-
tion is in the underlying motivation for the behavior on the part of individuals and ag-
gregates. Health promotion is behavior motivated by the desire to increase well-being
and actualize human health potential. Disease prevention, also called health protection, is
behavior motivated by a desire to actively avoid illness, detect it early, or maintain
functioning within the constraints of illness. The actualizing tendencyunderlying health
promotion increases states of positive tension in order to promote change and growth,
which is often experienced as a challenge and facilitates behaviors expressive of human
potential. The stabilizing tendencyunderlying disease prevention is evident in the func-
tioning of homeokinetic mechanisms and is directed toward maintaining balance and
equilibrium. The stabilizing tendency is responsible for protective maneuvers, prima-
rily maintaining the internal and external environments within a range compatible
with continuing existence.
The purest form of motivation for health promotion exists in childhood through
young adulthood when energy, vitality, and vigor are important to attain but the threat
of chronic illness seems remote. Youth may engage in health behaviors for the pleasure
of doing so or for the improvement of physical appearance and attractiveness to others.
In the adult years, when human vulnerabilities become more apparent, both motiva-
tions for health behavior usually coexist. For example, an older adult may be motivated
to jog in order to improve stamina and energy (health promotion) but also to avoid car-
diovascular disease (disease prevention). Regulatory measures for clean air may be
passed to prevent exposure to asbestos as a cancer risk factor (disease prevention) but
also to improve the overall quality of the environment (health promotion). Three im-
portant theoretical differences exist between health promotion and disease prevention:
1. Health promotion is not illness or disease specific; prevention is.
2. Health promotion is “approach” motivated, whereas prevention is “avoidance”
motivated.
3. Health promotion seeks to expand positive potential for health, whereas preven-
tion seeks to thwart the occurrence of insults to health and well-being.
5