?Health Promotion and Wellness Health Promotion and Wellness. Cultural Diversity. Environmental Health. Read chapter 4, 13 & 14 of the class textbook an
?Health Promotion and Wellness Health Promotion and Wellness.
Cultural Diversity.
Environmental Health.
Read chapter 4, 13 & 14 of the class textbook and review the attached PowerPoint presentations. Once done, answer the following questions;
Discuss various theories of health promotion, including Pender’s Health Promotion Model, the Health Belief Model, the Transtheoretical Theory, and the Theory of Reasoned Action.
Discuss at least two definitions of health.
Critically analyze racial and cultural diversity in the United States.
Describe the importance of air, water and food quality as a determinant of health.
As stated in the class syllabus please present your assignment in an APA format, word document, Arial 12 font attached to the forum in the discussion tab of the blackboard title “week 4 discussion questions”. The assignment must include at least 2 evidence-based references (excluding the class textbook) no older than 5 years. Refences must be quoted in the assignment in order to comply with APA. Two replies to any of your peers sustained with the proper references are required. A minimum of 700 words is required. Chapter 4
Health Promotion and Risk Reduction
Copyright © 2015, 2011, 2007, 2001, 1997,. 1993 by Saunders, an imprint of Elsevier Inc.
Health Promotion Is…
…any combination of health education and
related organizational, economic, and
environmental supports for behavior of
individuals, groups, or communities
conducive to health (Green & Kreuter, 1991)
…that which is motivated by the desire to
increase well-being and to reach the best
possible health potential (Parse, 1990)
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2
Health Protection Is …(Cont.)
… those behaviors in which one engages
with the specific intent to prevent disease,
detect disease in the early stages, or
maximize health within the constraints of
disease (Parse, 1990)
… an important step in maintaining health
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Defining Health
The way health is defined has shifted from a
focus on the curative model, to a focus on
multidimensional aspects such as the social,
cultural, and environmental facets of life and
health (Benson, 1996)
Health is viewed not only as an important
goal, but as a resource for living (WHO, 1986)
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4
Healthy People 2020 …
… is the health promotion initiative for the
nation.
… challenges individuals, communities, and
professionals … to take specific steps to
ensure that good health, as well as long life,
are enjoyed by all.
– U.S. Department of Health and
Human Services, 2012
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Healthy People 2020 …
(Cont.)
Broad goals
➢
➢
➢
➢
Attain high-quality, longer lives free of preventable
disease, disability, injury, and premature death.
Achieve high 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.
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Determinants of Health
Biology
Behaviors
Social environment
Physical environment
Policies and
interventions
Access to high-quality
health care
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Figure 4-1
From U.S. Department of Health
and Human Services.
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Theories in Health Promotion
Pender’s Health Promotion Model (HPM)
Health Belief Model (HBM)
Transtheoretical Model (TTM)
Theory of Reasoned Action (TRA)
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Risk and Health
Risk is “the probability that a specific event
will occur in a given time frame” (Oleckno,
2002).
A risk factor is an exposure that is associated
with a disease (Friis & Sellers, 2004).
Risk Assessment is a systematic way of
distinguishing the risks posed by potentially
harmful exposures.
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Steps in Risk Assessment
Hazard identification
Risk description
Exposure assessment
Risk estimation
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Risk Assessment
Modifiable risks
➢
➢
Individual has control
Examples: smoking, lifestyle,
eating habits, activities
Nonmodifiable risks
➢
➢
Individual has little or no control
Examples: genetics, gender,
age, environmental exposure
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Risk Reduction …
➢
➢
… is a proactive process
… enables individuals to react to
actual or potential threats to their
health
Risk communication …
➢
➢
… is the process of informing the
public regarding threats
… is affected by perceptions,
process, and actions
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Tobacco and Health Risk
Leading cause of preventable death
Most common in less educated populations
and those living below poverty level
Most common form of chemical dependency
Tobacco in all forms is harmful.
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Health Promotion Activities
Look for teachable moments
Assess client’s tobacco use
Explore willingness to quit
Refer to cessation programs
Encourage attempts to quit
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15
Alcohol Consumption and Health
Third leading lifestyle-related
cause of death for the nation
Short-term use causes acute
risks
Long-term effects have major
impact on health and social
issues
Influenced by legal drinking age
➢
# 1 used and abused drug among
U.S. youth
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Health Promotion Activities (Cont.)
Prevent underage drinking
Assist with enforcement of legal drinking age
Identify individuals and groups at risk of
abuse and dependence
Educate adults and youth on dangers of
alcohol
Requires a community-wide effort to address
the problem on several fronts
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Diet and Health
Diet—one of most modifiable risk
factors
Imbalance of caloric intake and
physical activity
Complex interplay among
metabolism, genetics, behavior,
environment, culture, and
socioeconomic status
Geographic areas, age, ethnicity all
influence weight
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Health Promotion Activities (Cont.)
Special populations have different nutritional
needs
For individualized plans, see
http://myplate.gov/
Educate clients about:
➢
Balancing caloric intake and physical activity
➢ Servings vs. portion control
➢ Eating away from home affects “portion distortion”
➢ Using social media and mobile applications to help
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Physical Activity and Health
Physical activity serves both
health promotion and
disease prevention
purposes
Leisure activities are
influenced by level of
education, gender, age,
economic level, geography
One’s environment plays a
significant role in activity
level
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Health Promotion Activities (Cont.)
Support and develop
“walkable” neighborhoods and
cities
Determine recommended
exercise levels for individuals
Visit
http://www.cdc.gov/physicalacti
vity/data/facts.html
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21
Sleep and Health
Sleep is an essential component of
chronic disease prevention and
health promotion
Requirements change with age and
life circumstances
Regulated by waking time and
circadian rhythms
Hormones during sleep affect
memory, blood pressure, and kidney
function.
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Health Promotion Activities (Cont.)
Sleep assessment is important
➢
➢
Identify disorders that may affect
daily activities
Keep sleep log
Practice sleep hygiene
➢
➢
Establish environment that
promotes sleep
Avoid food and activities that
interfere with sleep
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Chapter 13
Cultural Diversity and Community Health
Nursing
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Cultural Competence
Cultural competence is respecting and
understanding the values and beliefs of a certain
cultural group so that one can function effectively in
caring for members of that cultural group.
Culturally competent community health nursing
requires that the nurse understand…
➢
➢
➢
Lifestyle
Value system
Health and illness behaviors of diverse individuals, families,
groups, and communities
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Standards of Practice for Culturally
Competent Nursing Care
1.
2.
3.
4.
Social Justice
Critical Reflection
Knowledge of Cultures
Culturally Competent
Practice
5. Cultural Competence in
Health Care Systems
and Organizations
6. Patient Advocacy and
Empowerment
7. Multicultural Workforce
8. Education and Training
in Culturally
Competent Care
9. Cross-Cultural
Communication
10. Cross-Cultural
Leadership
11. Policy Development
12. Evidence-Based
Practice and Research
From: Expert Panel on Global
Nursing and Health (2010)
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Population Trends
In 1970
➢
By 2010
➢
Minority groups increased to 36% of population
By 2025
➢
Minority groups were 16% of population
More than half of all children will be minorities
By 2050
➢
➢
More than 54% of total population will be minorities
First time in U.S. history that minorities will make up a
majority of the population
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4
Population Trends (Cont.)
By 2060, projected demographic trends:
➢
White 44%
➢ Hispanic 30%
➢ African American 15%
➢ Asian 9%
➢ American Indians & Alaska Natives 2%
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5
Immigration to the United States
Since 1991, more than 13 million legal
immigrants
In 2010, almost 40 million foreign-born
individuals in the United States (12.9% of
population) from:
➢
➢
➢
➢
Latin America 53.1%
Asia 28.2%
Europe 12.1%
Other regions 9%
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Diversity Among Nurses
Minorities are generally
underrepresented by nursing workforce
(HRSA, 2009):
➢
➢
➢
➢
➢
White/non-Hispanic 81.8%
African American 4.2%
Hispanic 1.7%
Asian and Pacific Islander 3.1%
Native American and Alaska Native 0.3%
Minority groups tend to be geographically
distributed in the United States.
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Cultural Perspectives and Healthy
People 2020
Developed a set of national health
targets…eliminating racial and ethnic
disparities in health
Embraced and focused on ways to
close the gaps in health outcomes
Focused on disparities among racial
and ethnic minorities, women, youth,
older adults, people of low income and
education, and people with disabilities
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Health Disparities
AHCRQ (2005) reveals that:
Cancer mortality rates are 35% higher in
African Americans than in whites.
African Americans with diabetes are seven
times more likely to have amputations and
develop renal failure than are whites with
diabetes.
30% of Hispanics and 20% of African
Americans lack a usual source of health care
(compared with less than 16% of whites).
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Health Disparities (Cont.)
AHCRQ (2005) reveals that:
Hispanic children are nearly three times as
likely as non-Hispanic white children to have
no usual source of health care.
African Americans (16%) and Hispanic
Americans (13%) are more likely to rely on
hospitals or clinics for health care than are
whites (8%).
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Addressing Racial and Ethnic
Disparities in Health Care
Disparities can be reduced or
eliminated when adults have:
➢
➢
Health insurance and
A medical home
– Commonwealth Fund, 2007
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11
Transcultural Nursing
“…a formal area of study and practice
focused on a comparative analysis of different
cultures and subcultures in the world with
respect to cultural care, health and illness
beliefs, values, and practices with the goal of
using this knowledge to provide culturespecific and culture-universal nursing care to
people.”
– Leininger (1978)
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12
Transcultural Nursing Terminology
Culture specific refers to the
“particularistic values, beliefs,
and patterning of behavior
that tend to be special, ‘local,’
or unique to a designated
culture and which do not tend
to be shared with members of
other cultures”
– Leininger (1991)
Culture universal refers to
the “commonalties of values,
norms of behavior, and life
patterns that are similarly
held among cultures about
human behavior and
lifestyles and form the bases
for formulating theories for
developing cross-cultural
laws of human behavior”
– Leininger (1978)
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Transcultural Nursing Terminology
(Cont.)
Ethnocentrism is a
person’s tendency to
view his or her own way
of life as the most
desirable, acceptable, or
best, and to act in a
superior manner toward
another culture.
Cultural imposition is
a person’s tendency to
impose his or her own
beliefs, values, and
patterns of behavior on
individuals from another
culture.
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Leininger’s Theory of Culture Care
Diversity and Universality
Describes, explains, and projects nursing
similarities and differences focused primarily
on human care and caring in human cultures.
Uses world view, social structure, language,
ethnohistory, environmental context, and the
generic or folk and professional systems to
provide a comprehensive and holistic view of
influences in cultural care and well-being.
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15
Leininger’s Sunrise
Model depicting the
theory of cultural
care diversity and
universality
Figure 13-1
From Leininger MM: Culture, care,
diversity, and universality: a theory of
nursing, New York, 1991, National
League for Nursing Press.
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Overview of Culture
Culture refers to the complex whole, including
knowledge, beliefs, art, morals, law, customs,
and any other capabilities and habits
acquired by virtue of the fact that one is a
member of a particular society (Tylor, 1871).
Culture represents a person’s way of
perceiving, evaluating, and behaving within
his or her world, and it provides the blueprint
for determining his or her values, beliefs, and
practices.
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Overview of Culture (Cont.)
Four basic characteristics of culture—it is:
1. Learned from birth through the processes of
language acquisition and socialization
2. Shared by members of the same cultural
group
3. Adapted to specific conditions related to
environmental and technical factors and to
the availability of natural resources
4. Dynamic
– Sir Edward Tylor, 1871
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Subculture
A fairly large aggregate of people who share
characteristics that are not common to all
members of the culture
Enables them to be a distinguishable
subgroup
May be based on ethnicity, religions,
occupation, health-related characteristics,
age, gender, sexual preferences, or
geographic location
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Culture and Formation of Values
Common human problems related to values and
norms:
➢
➢
➢
➢
➢
What is the character of innate human nature (human nature
orientation)?
What is the relationship of the human to nature (personnature orientation)?
What is the temporal focus of human life (time orientation)?
What is the mode of human activity (activity orientation)?
What is the mode of human relationships (social
orientation)?
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Human-Nature Orientation
Innate human nature may be good, evil, or a
combination of good and evil.
The dominant U.S. cultural group chooses to
believe the best about a person until that
person proves otherwise.
– Kohls (1984)
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Person-Nature Orientation
Destiny, in which people are
subjugated to nature in a
fatalistic, inevitable manner.
Harmony, in which people and
nature exist together as a single
entity.
Mastery, in which people are
intended to overcome natural
forces and put them to use for the
benefit of humankind.
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Time Orientation
The focus may be on the past, with traditions
and ancestors playing an important role in the
client’s life.
The focus may be on the present, with little
attention paid to the past or the future.
The focus may be on the future, with progress
and change highly valued.
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Activity Orientation
Being, in which a spontaneous
expression of impulses and desires is
largely nondevelopmental in nature.
Growing, in which the person is selfcontained and has inner control,
including the ability to self-actualize.
Doing, in which the person actively
strives to achieve and accomplish
something that is regarded highly.
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24
Social Orientation
Lineal relationships: Exist by virtue
of heredity and kinship ties. Follow an
ordered succession and have
continuity through time.
Collateral relationships: Focus
primarily on group goals—and family
orientation is important.
Individual relationships: Personal
autonomy and independence
dominate; group goals become
secondary.
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Culture and the Family
Cross-cultural differences may exist in:
➢
Structural differences
➢ Functional diversity
➢ Socialization context
➢ Sex roles and parenting values
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26
Culture and Socioeconomic Factors
Socioeconomic status (SES) is a composite
of the economic status of a family or
unrelated individuals based on:
➢
Income
➢ Wealth
➢ Occupation
➢ Educational attainment
➢ Power
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
27
Culture and Socioeconomic Factors
(Cont.)
Poverty guidelines
➢
Determined by comparing pretax cash income
with the poverty threshold adjusted for family size
and composition issued annually by USDHHS.
➢ The U.S. Census Bureau (2012) reported that the
poverty rate in 2011 was 15%
• African American population—27.6%
• Asian populati…
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