Health Promotion Prevention Strategies Health Protection

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Health Promotion / Prevention StrategiesHealth
Protection Promotion Plans

• Pender Chapter 5 and Chapter 6

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Developing a Health Protection and Promotion Plan

• 9 steps

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The Health Planning Process

• Review and summarize data from assessment
• Reinforce strengths and competencies of the
  client
• Identify health goals related to behavioural
  change options
• Identify behavioural or health outcomes that will
  indicate that the plan has been successful from
  the clients perspective

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The Health Planning Process

• Develop a behaviour change plan based on the
  clients preferences, on the stages of change,
  and on state of the science knowledge about
  effective interventions.
• Reiterate benefits of change and identify
  incentives for change from the clients
  perspective.
• Planning for any health promotion involves the
  critical thinking model what are the standards,
  knowledge , attitude and skill of the target
  individual or group or community?

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The Health Planning Process

• Address environmental and interpersonal
  facilitators and barriers to behaviour change.
• Determine a time frame for implementation.
• Commit to behavior-change goals and to structure
  the support needed to accomplish these specific
  health outcomes.

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Review and Summarize Data From Assessment . Use
the accurate Nursing Diagnoses based on the data

• Physical health status and developmental stage
• Functional health patterns
• Physical fitness
• Nutritional status
• Major health risk
• Sources of life stress

• Spirituality
• Family/ Social Support
• Key health beliefs
• Health-related life-style
• Family health beliefs and cultural practices
• Environmental and community support

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Reinforce Strengths and Competencies of Client

• The nurse and the client should come to a
  consensus regarding areas in which the client is
  performing independently
• Through teaching, guidance and support the nurse
  assists the client in enhancing existing
  competencies to meet health needs

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Consider an introduction of an exercise program

• The program will be implemented and maintained
  if the individual believes in
• benefit
• enjoyment
• minimal negative consequences
• feels competent with the activity
• can schedule the activity with competing
  time demands

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Identify Goals and Related Behaviour-Change
Options

• Identify personal/family health goals
• Prioritize
• Review related behaviour-change options
• Motivation for engagement in any health promotion
  plan is crucial ask the WHY

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Identify Behavioural or Health Outcomes

• Clear identification of outcomes guides the
  client in health behaviours
• Clients perception regarding the outcome is
  critical

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Develop a Behaviour-Change Plan

• Client ownership
• Value clarification
• Clients values for behaviour change
• Lifestyle
• Stage of change

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Reiterate Benefits of Change

• Frequently reiterate the benefit of change
• Have the client keep a formal list of the
  benefits to review as needed
• Include health related and non health related
  outcomes as anticipated by the client
• Health promotion activities should be simple,
  enjoyable, fun, achievable

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Address Environmental and Interpersonal
Facilitators and Barriers to Change

• Anticipate obstacles (when possible)
• Instrumental and emotional support from social
  network and the employer/ government. Ask
  yourself if Health Canada has a perspective and
  plan for the health promotion activity.
• Internal barriers
• Environmental barriers
• Significant others / feedback / culture belief

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Develop a Time Frame for Implementation

• It takes time to learn a new behaviour, integrate
  into lifestyle, and stabilize
• Attempting to change too many behaviours at once
  may result in confusion, discouragement, and
  abandonment of the health protection/promotion
  plan.
• Time frame allows knowledge and skills to be
  mastered prior to behaviour implementation.

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Commitment

• Consider a physical activity exercise plan
• If the person does not like the plan, does not
  think that he can perform the exercises and is
  not having fun, then the exercise regimen becomes
  a chore and the plan implementation will not work

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Commit to Behaviour-Change Goals

• Verbalize commitment
• Formalize commitment
• Nurse-client contract agreement
• Self-contracts
• Public announcements to family and friends
  regarding the intention to engage in new
  behaviour
• Integration of new health behaviours into daily
  or weekly calendar
• Purchase necessary supplies
• ( see Pender Figure 5.4, 5.4 and 5.6 for examples
  of the above terms)

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Revisions of the Health Protection / Promotion
Plan

• With mastery of target behaviours, the client is
  ready to move on to other areas
• Changes in the clients values or priorities
  occur
• Awareness of new or expanded options for the
  client are now available

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Example of planning
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Planning a Fitness Program

• General principles of fitness training
• Base the program on FITT
• F frequency
• I intensity
• T time
• T type of training general fitness,
  cardiovascular fitness

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Directions for Research in Behaviour Change

• Impact of computerized feedback during assessment
• Effective interventions to reinforce cultural
  health practices
• When is extrinsic motivation preferred in the
  change process
• What factors affect rate of behaviour changes at
  different life stages
• What are the major barriers to community based
  interventions
• What types of community interventions are most
  effective?

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Directions for Practice in Health Planning

• The nurse must be able to implement all of these
  steps in order to assist client in developing a
  realistic, positive health plan
• Consult other disciplines to help achieve goals
• Identify family and all other significant
  support for the client
• The plan must be adaptable to age, gender and
  socio-economic status
• Knowledge of cultural issues is needed by all
  parties
• Incorporate technology whenever possible

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Individual Case Study

• James is a 75 year old African American male with
  a family history of heart disease. He has a
  supportive wife and 2 adult daughters. He is the
  caregiver for his elderly spouse. He has been a
  cigarette smoker since grade school. He weighs
  200 lbs 20 more than he weighed a decade ago.
  His current exercise is walking from the auto
  park to the grocery store and pharmacy weekly.
  When he visits his health care provider he
  chooses to take the stairs instead of the
  elevator slow elevator.

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Develop a Health Promotion Plan

• Nursing Diagnoses
• Three Behavioural Health Outcomes

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Risk for Activity Intolerance r/t de-conditioning
or belief in access and time pressures

• James will include regular exercise for one hour
  every other day in his daily routines
• James will increase his activity tolerance within
  the normal limits of his BP, pulse and
  respirations
• James will state three benefits to regular
  exercise

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Family Case Study

• The Smiths are an Asian American family of three,
  mother (38) and 2 sons (8 and 10) with a
  supportive extended family
• Develop a family protection/promotion plan with
  the following risks
• Father recently deceased (cancer) and mother has
  part time professional employment
• Both sons moderately obese and committed to
  computer games at school, not in any sports
  activity
• Inactivity for all three members in leisure time
• Recent major life change for family

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Develop a Health Promotion Plan

• Nursing Diagnoses
• Three Behavioural Health Outcomes

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Readiness for Enhanced Family Coping potential
for growth

• All family members will participate in regular
  scheduled family outings
• Each family member will adjust to the new family
  form
• Both boys will develop and use a regular exercise
  program in the next year to replace a portion of
  the computer based leisure time

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Community based case study

• Nancy is a 46 year old woman who does not
  consider herself to be overweight. She has a
  stressful managerial position and many family
  responsibilities. She tells you the occupational
  health nurse in her office that she feels tired
  and has no energy. She was never an athlete in
  school, never participated in any team sports and
  was always chosen last to belong to any team. She
  tell you that she is shy and would never go to
  the noon hour aerobics classes offered by the firm

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Your recommendations for Nancy?

• What are her risks?
• What are her strengths?
• Your nursing diagnosis developed with Nancy?

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Diagnosis Physical Activity Deficit

• Behavioural Outcomes for Nancy

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WHO Definition of Health Promotiona process of
enabling individuals and communitiesto increase
control over the determinants of health

• Income social statusSocial supports
  networksEducationEmployment/working
  conditionsSocial environmentsPhysical
  environments

• Personal health practices coping
  skillsHealthy developmentBiology and genetic
  endowmentHealth services- access and use
• GenderCulture including the spiritual domain.

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Sense of Coherence

• Belief that you are interacting well within your
  environmentYour world is comprehensible,
  manageable with the resources available to you
  meaningful.
• Interventions which attempt to increase internal
  locus of control, without changing the
  environmental conditions, may increase
  frustration and lead to greater perceived
  powerlessness (Wallerstein, 1992)

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Community Empowerment

• Research shows there is a reciprocal interaction
  between individual psychological empowerment
  community empowerment
• Community Competence
• A competent community is one whose members can
  collaborate effectively in identifying problems,
  can reach consensus on goals and strategies, and
  can cooperate in the necessary actions to acquire
  resources to solve those problems (Wallerstein,
  1992)

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Powerlessness
Physical social risk factors
Living in Poverty Low in Hierarchy High
Demand Psychological Physical Low
Control Perceived External Locus Learned
Helplessness Actual No Decision Making Lack
Economic/Political Power Chronic Stress Lack of
Social Support Lack of Resources
Powerlessness
Disease
Lack of Control Over Destiny
Wallerstein , N. (1992). Powerlessness,
Empowerment, and Health Implications for Health
Promotion Programs American Journal of Health
Promotion 6(3), 197 205.
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Empowerment
Psychological Empowerment Self-efficacy to
Act Political Efficacy Motivation to Act Belief
in Group Action
Reduce Social Risk Factors
Sense of Community Increased Participation
in Decision-Making Community Actions Increased
Empathy
Critical Thinking Conscientization
Community Empowerment Increased Local
Action Stronger Social Networks Community
Competence Transformed Conditions Improved Heath
Policies Resource Access/Equity
Reduce Physical Risk Factors
Wallerstein, N . (1992), . Powerlessness,
Empowerment, and Health Implications for Health
Promotion Programs. AJHP 6(3), p.201.
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Behaviour Change Approaches

• Effective health promotion strategies must take
  into account the dynamic relationship between
  individuals families changing social
  environmental contexts
• Pender suggested that any health promotion
  strategy that targets individual behavioural
  change alone will fail. There needs to be
  simultaneous efforts to alter the physical
  social environment as well as the collective
  behaviour of the community.

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Health is a Social Goal

• Health needs to be identified as a social goal
  not just an individual goal
• Health as a social goal requires the integration
  of theories that address social change with
  theories that address individual behaviour change
  and family change. Both are necessary to address
  the complex dynamics of health promotion
  initiatives

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Health Promotion Strategies Umbrella
Health Promotion Strategies
Self Help
Public Policy
Health Education
Mass Communication
Advocacy
Fiscal Measures
Community Development
Legislation
Organizational Change
Allison, K., Bollenbach, S., Pederson, A.,
Davis, B. (1987). Restating the case for health
education. A summary paper presented at 38th
Annual Educational and Scientific Meeting of the
Ontario Public Health Association.
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Promotion Health through Public Policy

• Personal, social, and political factors all
  influence the development and implementation of
  health policy (Physical Activity initiatives in
  School Health Programs)
• Health policies are needed that encourage
  individuals and communities to place a higher
  value on health and provide them with the
  necessary resources to make healthy changes

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Promoting Health through Environmental Control

• Eliminating health damaging features of the
  environment
• Augmenting Health-promoting features of the
  environment

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Small group exercise for students

• You and your colleagues have collectively
  developed a sedentary lifestyle as adult students
  in a university program. Consider the health
  damaging features of your current scholastic
  environment and study requirements.
•  Outline health promotion strategies and self
  contracts to address the issue taking into
  consideration the population at risk, current
  laws, and the risk to health (both short-term and
  long-term) Use Pender Chapter 6 as a basis for
  your plan
•  Groups to present their findings to peers

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Small group exercise for students

• Physical Activity Plan for the Older Adult
• You and your clinical group have recognized that
  in your long term care clinical placement there
  are barriers for some residents who choose not to
  join the twice weekly exercise group as scheduled
  in the neighbourhood where the residents live.
• Identify the barriers to individual participation
  for this population. Be specific.
• What are the issues for immobility in this age
  group? Use Pender Chapter 6 and Ross Kerr and
  Woods Chapter 42

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Physical Activity for the Older Adult continued.

• Consider the role of the agency in promoting the
  physical activity program
• Identify your various roles as a student nurse
  clinical group that will demonstrate your
  commitment to the health promotion plan/ events.
• Write a contract for you as nurses to promote the
  scheduled events in your agency. Use Pender
  Chapter 5 as a basis for your contract