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Chapter: Medical Surgical Nursing: Health Education and Health Promotion

Health Promotion

Health teaching and health promotion are linked by a common goal—to encourage people to achieve as high a level of wellness as possible so that they can live maximally healthy lives and avoid preventable illnesses.

Health Promotion



Health teaching and health promotion are linked by a common goal—to encourage people to achieve as high a level of wellness as possible so that they can live maximally healthy lives and avoid preventable illnesses. The call for health promotion has become a cornerstone in health policy because of the need to control costs and reduce unnecessary sickness and death.


The nation’s first public health agenda was established in 1979 and set goals for improving the health of all Americans. Addi-tional goals defined as the “1990 Health Objectives” identified improvements to be made in health status, risk reduction, public awareness, health services, and protective measures (U.S. Public Health Service, 1990).


Health goals for the nation were also established in the publi-cation, Healthy People 2000. The priorities from this initiative were identified as health promotion, health protection, and the use of preventive services. The most recent publication, HealthyPeople 2010, defines the current national health promotion anddisease prevention initiative for the nation. The two essential goals from this report are (1) to increase the quality and years of healthy life for people, and (2) to eliminate health disparities among various segments of the population (U.S. Public Health Service, 2000) (Chart 4-3).




The concept of health promotion has evolved because of a chang-ing definition of health and an awareness that wellness exists at many levels of functioning. The definition of health as the mere absence of disease is no longer accepted. Today, health is viewed as a dynamic, ever-changing condition that enables a person to function at an optimum potential at any given time. The ideal health status is one in which people are successful in achieving their full potential regardless of any limitations they might have.


Wellness, as a reflection of health, involves a conscious and de-liberate attempt to maximize one’s health. Wellness does not just happen; it requires planning and conscious commitment and is the result of adopting lifestyle behaviors for the purpose of at-taining one’s highest potential for well-being. Wellness is not the same for every person. The person with a chronic illness or dis-ability may still be able to achieve a desirable level of wellness. The key to wellness is to function at the highest potential within the limitations over which there is no control.


A significant amount of information has shown that people, by virtue of what they do or fail to do, influence their own health. Today, many of the major causes of illness are chronic diseases that have been closely related to lifestyle behaviors (eg, heart disease, lung and colon cancer, chronic obstructive pulmonary diseases, hypertension, cirrhosis, traumatic injury, HIV [human immuno-deficiency virus] infection, and acquired immunodeficiency syn-drome [AIDS]). Consequently, a person’s health status to a large extent is reflective of lifestyle.




Since the 1950s, many health-promotion models have been con-structed to identify health-protecting behaviors and to help ex-plain what makes people engage in these preventive behaviors. A health-protecting behavior is defined as any behavior performed by people, regardless of their actual or perceived health condition, for the purpose of promoting or maintaining their health, whether or not the behavior produces the desired outcome (Downie, Fyfe,


 Tannahill, 1990). One framework, the health belief model, was devised to foster understanding of what made some healthy people choose actions to prevent illness while others refused to engage in these protective recommendations (Becker, 1974).


Another model, the resource model of preventive health be-havior (Downie, Fyfe, & Tannahill, 1990), addresses the ways that people use resources to promote health. Nurse educators can use this model to assess how demographic variables, health be-haviors, and social and health resources influence health promo-tion. LaLonde’s (1977) health determinants model views human biology, environment, lifestyle, and the health care delivery sys-tem as the four determinants of a person’s health.


A model for promotion of health, designed by Becker and colleagues (1993), is based on the premise that four variables in-fluence the selection and use of health promotion behaviors. The first variable, demographic and disease factors, includes client characteristics such as age, gender, education, employment, sever-ity of illness or disability, and length of illness. Barriers, the next component, are defined as factors that lead to unavailability or difficulty in gaining access to a specific health promotion alter-native. The third variable, resources, encompasses such items as financial and social support. The last variable, perceptual factors, consists of how people view their health status, self-efficacy, and the perceived demands of their illness. The developers of this model conducted research to substantiate that these four vari-ables have a positive correlation with a person’s quality of life.


The health promotion model developed by Pender (1996), is based on social learning theory and emphasizes the importance of motivational factors that influence the acquiring and sustain-ing of health-promotion behaviors. This model explores how cognitive-perceptual factors affect one’s view of the importance of health. It also examines perceived control of health, self-efficacy, health status, and the benefits and barriers to health promoting behaviors.


These models, along with other examples that can be found in the health promotion literature, can serve as an organizing frame-work for clinical work and research that supports the enhance-ment of health. Further efforts, however, are needed to advance understanding of the health promotion behaviors of families and communities.



Health promotion can be defined as those activities that assist in-dividuals in developing resources that will maintain or enhance well-being and improve their quality of life. These activities in-volve a person’s efforts to remain healthy in the absence of symp-toms and do not require the assistance of a health care team member.

The purpose of health promotion is to focus on a person’s po-tential for wellness and to encourage appropriate alterations in personal habits, lifestyle, and environment in ways that will re-duce risks and enhance health and well-being. Health promotion is an active process; that is, it is not something that can be pre-scribed or dictated. It is up to the individual to decide whether to make the changes that will promote a higher level of wellness. Choices must be made, and only the individual can make these choices.


The concepts of health, wellness, health promotion, and dis-ease prevention have been extensively addressed in the lay litera-ture and news media as well as in professional journals. The result has been a public demand for health information and a response by health care professionals and agencies to provide this infor-mation. Health-promotion programs that were once limited to hospital settings have now moved into community settings such as clinics, schools, churches, businesses, and industry. The work-place is quickly becoming an important site for health promotion programs, as employers strive to reduce costs associated with ab-senteeism, health insurance, hospitalization, disability, excessive turnover of personnel, and premature death.




Certain principles underlie the concept of health promotion as an active process: self-responsibility, nutritional awareness, stress reduction and management, and physical fitness.




Taking responsibility for oneself is the key to successful health promotion. The concept of self-responsibility is based on the understanding that individuals control their lives. Each of us alone must make those choices that determine how healthy our lifestyle is. As more people recognize the significant effects that lifestyle and behavior have on health, they may assume responsi-bility for avoiding high-risk behaviors such as smoking, alcohol and drug abuse, overeating, driving while intoxicated, risky sex-ual practices, and other unhealthy habits. They may also assume responsibility for adopting routines that have been found to have a positive influence on health, such as engaging in regular exer-cise, wearing a seat belt, and eating a balanced diet.


A variety of different techniques have been used to encourage people to accept responsibility for their health, ranging from exten-sive educational programs to reward systems. No one technique has been found to be superior to any other. Instead, self-responsibility for health promotion is very individualized and depends on a person’s desires and inner motivations. Health promotion pro-grams are important tools for encouraging people to assume re-sponsibility for their health and to develop behaviors that improve health.


Nutrition as a component of health promotion has become thefocus of considerable attention and publicity. A vast array of books and magazine articles address the topics of special diets, natural foods, and the hazards of certain substances, such as sugar, salt, cholesterol, artificial colors, and food additives. Good nutri-tion has been suggested as the single most significant factor in determining health status and longevity.


Nutritional awareness involves an understanding of the im-portance of a properly balanced diet that supplies all of the essential nutrients. Understanding the relationship between diet and disease is an important facet of a person’s self-care. Some clinicians believe that a healthy diet is one that substitutes “nat-ural” foods for processed and refined ones and reduces the intake of sugar, salt, fat, cholesterol, caffeine, alcohol, food additives, and preservatives.


Stress Management


Stress management and stress reduction are important aspects ofhealth promotion. Studies have shown the negative effects of stress on health and a cause-and-effect relationship between stress and infectious diseases, traumatic injuries (eg, motor vehicle crashes), and some chronic illnesses. Stress has become inevitable in con-temporary societies in which demands for productivity have be-come excessive. More and more emphasis is placed on encouraging people to manage stress appropriately and to reduce stress that is counterproductive. Techniques such as relaxation training, exer-cise, and modification of stressful situations are often included in health promotion programs that deal with stress. Further infor-mation on stress management, including health risk appraisal and stress reduction methods such as biofeedback and the relaxation response.




Physical fitness is another important component of healthpromotion. Clinicians and researchers (Anspaugh, Hamrick & Rosata, 1994; Edelman & Mandle, 1998; U.S. Department of Health & Human Services, 1996) examining the relationship be-tween health and physical fitness have found that a regular exer-cise program can promote health by improving the function of the circulatory system and the lungs, decreasing cholesterol and low-density lipoprotein concentrations, lowering body weight by increasing calorie expenditure, delaying degenerative changes such as osteoporosis, and improving flexibility and overall mus-cle strength and endurance. On the other hand, exercise can be harmful if it is not started gradually and increased slowly in ac-cordance with the individual’s response. An exercise program should be designed specifically for the individual, with consider-ation given to age, physical condition, and any known cardio-vascular or other risk factors. An appropriate exercise program can have a significantly positive effect on the individual’s perfor-mance capacity, appearance, and general state of physical and emotional health (Nursing Research Profile 4-2).


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