Learning Objectives
By the end of this section, you will be able to:
- Define key components of health promotion
- Identify factors that nurses must consider when developing a health-promotion plan of care
- Discuss the role of key components of health promotion and how to maintain a holistic, patient-centered approach to health promotion
Health promotion and preventive health measures are foundational nursing interventions, and they are becoming more and more important as the climate of the health-care industry shifts from a reactive to a proactive (preventive) model. Nurses need to understand why people value being healthy, what motivates them to make choices related to their health, what can convince them to make lifestyle changes for better health outcomes, and, of course, what health means. Nurses also need to understand that the concept of health has changed over time and varies according to culture and across the lifespan. Health was previously considered to be the absence of disease or similar problems. But current conceptions establish that health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (World Health Organization, 1946).
People may receive health information, but it does not always result in changes in lifestyle or health-related behaviors. The Health Belief Model (Rosenstock, 1974) suggests that even though people recognize the consequences of poor health behaviors, they will not take action to change their behaviors unless:
- they believe that they are susceptible to (at risk for) the health condition;
- the health condition poses serious consequences;
- behavior change will result in decreased risk;
- the benefits of change will outweigh the costs of change;
- they believe they can change their behaviors and the changes will pay off (Paul, 2020).
For nurses to positively affect people’s health through health promotion, according to the Health Belief Model, the information presented to patients must be individualized, relevant to their current lifestyle, and provide enough facts for the patients to make behavior changes. Consider the use of pamphlets; if a nurse determines that a patient is at risk for a sexually transmitted infection (STI), the nurse would typically provide the patient with a pamphlet to read regarding prevention of STIs. Evidence reveals, however, that providing pamphlets without additional educational interventions is ineffective (Bhattad & Pacifico, 2022). A written pamphlet may not include all the information needed for the patient to believe they can make the needed lifestyle change. The nurse should explain why the patient is susceptible to an STI, explain the consequences of contracting an STI, and provide the patient with education on safe sex practices.
Betty Neuman (2011), a nursing theorist, describes a person’s health as a continuum in which illness and wellness are opposite states of being. According to Neuman, the response to stressors (health issues) can move people across the continuum toward illness or wellness. A nurse’s responsibility when a person experiences a stressor is to intervene with the appropriate level of prevention, either primary, secondary, or tertiary. The prevention of health issues through identification of risk factors and education and intervention to reduce the amount of risk for those health issues before they ever occur is primary prevention. Examples include wearing a helmet while biking or getting immunizations. In secondary prevention, a provider decreases the impact of a health issue through early detection, intervention to slow the progression of an illness, or rehabilitating to a former health state. Examples include a Pap smear for detection of cervical cancer or a mammogram for detection of breast cancer. When a patient has a chronic health problem, tertiary prevention is intervention to prevent further complications, improve functional ability and quality of life, or extend life expectancy.
To focus nurses and other health-care providers on the most important health-care issues, the U.S. Department of Health and Human Services (2023) created the guide Healthy People 2030. The Healthy People 2030 guide supports the development of health promotion and wellness goals for U.S. residents. Healthy People 2030’s goal is for each member of society to have the ability to attain optimal health and well-being during each stage of their life (U.S. Department of Health and Human Services, 2023).
Link to Learning
Review the information on the priority areas of focus: health equity, social determinants of health, and health literacy from Healthy People 2030.
Health Promotion
The holistic and proactive process of prevention of health issues through which people are empowered to take control of their health-related choices and reach the best possible health status is called health promotion. In health promotion, nurses act as coaches and guides to promote healthy choices rather than authorities that offer prescriptive guidelines and treatment for established health issues only. Health promotion is a holistic practice, which is a departure from the traditional medical model. While the health-care provider plans and prescribes treatment based solely on the medical diagnosis, holistic health promotion empowers patients to meet their own health needs through knowledge and action in their personal, social, or environmental situations. For example, a person who has an addiction can be treated with medication to help decrease their cravings for a substance, but if that person is not empowered to change their social and environmental habits, they will find themselves in the same friend group or social group and will have barriers to maintaining their sobriety. If the patient with an addiction is given medication-assisted treatment, provided with social supports that encourage new relationship building, and empowered to feel strong enough to make needed behavioral changes, they are more likely to be successful in recovery.
If health is defined as optimal functioning and the absence of physical, mental, or social problems, then health promotion must include:
- disease prevention and management
- patient participation in their health-care plans
- healthy lifestyle education
- patient understanding of treatment options
- partnership
- open communication
- social justice
- mental health support
The seven core principles of health promotion are summarized in Table 3.1.
| Principle | Description |
|---|---|
| Empowerment | Facilitating the patient’s independence and proactivity |
| Participation | Engaging the patient in their health-care decisions |
| Holism | Treating the patient as a whole being, addressing mind, body, and spirit |
| Intersectionality | Realizing that there is overlap in social categories (race, ethnicity, etc.) |
| Equity | Providing equal health care to every individual regardless of background |
| Sustainability | Maintaining change over a long period of time |
| Combining multiple strategies | Using more than one of the principles of health promotion at once |
Positive Health Concept for Ideal Health Promotion
A positive health concept is a subjective view of one’s health status that allows a person to function at optimal levels, cope with life’s stressors, and maintain a feeling of satisfaction, even though they experience stressors (Vermunt et al., 2018). Research by Dr. Martin Seligman (2024) found that people with a higher level of life satisfaction can cope with health issues better than those who have lower life satisfaction. An optimistic or positive health concept increases the acceptance of health promotion and teaching because the person believes that they are capable of behavior changes that will positively impact their health status. A patient’s outlook on their health can change the course of their well-being: Positive outlooks are linked to positive health outcomes, whereas negative outlooks are linked to more health challenges.
Participation and Involvement for Ideal Health Promotion
The concept of health is shifting from being defined as the absence of disease to a positive health model with the overall goal of positive health and wellness (Doornenbal et al., 2022). Ideal health promotion is a concept in which nurses partner with patients to help them achieve their personal health and wellness goals (Figure 3.2) (Fertner & Grim, 2022). Partnership between the patient and nurse is essential in creating individualized health and wellness optimization according to the patient’s values. Allowing room for this individualization based on the patient’s personal value set takes into consideration their cultural background, therefore improving cultural sensitivity in the delivery of health care.
Creating a patient partnership and involving the patient in their health-care choices is using a person-centered approach. When employing a person-centered approach, the nurse focuses on the person and their experiences instead of solely focusing on the disease process and its symptoms. A person-centered approach to health care builds on the nurse-patient partnership and allows patients to have information about and collaborate in the planning, delivery, and evaluation of their care while ensuring the patient’s dignity (Fertman & Grim, 2022).
Action Competence for Ideal Health Promotion
The action competence learning model is a critical thinking model that is used to create health-promotion activities (Figure 3.3). Action competence informs the health-promotion delivery process for nurses to plan, act, and evaluate actions with the aim of improving health outcomes for a patient population. The action competence learning model can be used with patients, nursing students, or nurses to guide them through the process of transferring knowledge and self-awareness, being accountable for the actions taken, and reflecting on the results of the action (Bergen & Santo, 2018).
When action competence is applied to a group, community, or population, it is considered collective action competence. Collective action competence can be applied to health promotion as the capability of a population to direct their health and wellness behaviors toward common health and wellness goals based on collective health-care literacy, collective health competence, and collective health needs or goals. One example from the Healthy People 2030 is to increase medical care to rural areas noted as underserved.
Equity and Health for Ideal Health Promotion
Health promotion, well-being, positive health, and optimal health should be facilitated through a health-care system that treats people from all backgrounds equally. Patients from all backgrounds should have the same opportunity to achieve their health-care goals through health promotion and the guidance of their health-care team. This equal opportunity to achieve desired health-care outcomes is called health-care equity. Nonetheless, health-care disparity is plaguing the U.S. health-care system and blocking certain groups from equal access to health care. When a certain group of people have worse health outcomes than other groups of people for no obvious medical reason, it is called health-care disparity. For example, recent data in the United States concludes Black maternal mortality (death) is 55.3 per 100,000 live births, whereas White maternal mortality is 19.1 per 100,000 live births (Hoyert, 2023).
Health promotion is not a privilege; it is a right that should be provided to every human. It is important to consider health-care equity when planning health-promotion activities for patient populations. The social determinants of health are factors that appear to fall outside of the health-care system but play an active role in the health outcomes of a population. Therefore, health-promotional activities should take social determinants of health into consideration and target a diverse audience while striving to improve the health outcomes for all. Social determinants of health take into consideration many aspects of a person’s life, such as birth, childhood, education, work, play, worship, and aging, which impact health, functioning, and quality-of-life outcomes. The World Health Organization (WHO, 2024) identifies the following items as social determinants of health:
- access to health services
- culture
- education levels
- employment and working conditions
- genetics
- gender
- income and social status
- personal behavior and coping skills
- physical environments
- social support networks
Link to Learning
Social determinants of health are not always easy to identify in a patient population. Using a screening tool can improve the identification rate of social determinants of health and increase the health promotion of people who are the most in need. A screening tool from the Centers for Medicare and Medicaid Service can be used with any patient population.
Wellness
Wellness and health are often used in context to mean the same thing; however, wellness is the subjective interpretation of a person’s state of holistic health (Pender et al., 2018). When a person experiences wellness, they feel satisfaction with their physical, mental, spiritual, and social health status. Nurse coaching is a nursing specialty that focuses on assisting people to improve their overall wellness, gain a sense of well-being, and achieve life balance (Dossey & Keegan, 2020). The nurse coach partners with patients and provides a safe space for exploration of the patient’s wellness goals. The goal of the nurse coach/patient partnership is to engage the patient in the process of identifying, assessing, planning, and evaluating behaviors that could be changed to improve health or to reach wellness goals.
Physical Wellness
While exercise is extremely important for people to achieve optimal levels of health and wellness, it is not the only aspect of physical wellness that exists. A person’s physical wellness is their optimal physical function, which includes maintaining healthy nutrition, proactively seeking treatment for medical issues, and minimizing risky health behaviors (Melnyk & Neale, 2018). Table 3.2 lists the factors involved in maintaining physical wellness.
| Factor | Examples |
|---|---|
| Healthy dietary choices | Minimizing processed foods Drinking approximately two liters of water daily Consuming a variety of fruits and vegetables |
| Proactive health care | Establishing a relationship with a health-care provider Getting regular check-ups Preventive health care/testing Maintaining a consistent sleep schedule Reducing stress |
| Minimizing risky activities | Limiting alcohol consumption Avoiding nicotine Minimizing risky physical activities |
Mental, Emotional, and Social Wellness
The state in which a person feels satisfaction and can effectively cope with changes in their mental, emotional, and social health status is considered their mental, emotional, and social wellness. Emotional wellness requires the ability to identify, express, and manage the full range of emotions (Melnyk & Neale, 2018). Social wellness is based on the person’s interaction within their social system, meaning social wellness requires social support, relationships with respect and trust, and social connections that assist with stressful or challenging situations. “Mental wellness” refers to a state in which a person can effectively cope with the stressors in their life while maintaining relationships and contributing to their community.
The promotion of mental, emotional, and social wellness requires nurses to know the context in which the person is living. Mental, emotional, and social support are not always available given the patient’s situation. If mental, emotional, or social support is not present in a patient’s life, the nurse can help identify the need and provide resources to help the patient meet those needs. For example, a person of color may not be able to achieve emotional or social wellness in a racist environment that continually makes them feel unsafe. Providing this person with counseling and social support can help provide a safety net until the patient can improve their level of mental, emotional, and social wellness. The health-care system can also provide coping skills education and emotional intelligence education, and can connect the patient to social groups that can provide other types of support.
Spiritual Wellness
An important component of the holistic wellness model that should not be overlooked by nurses and other health-care professionals is spiritual wellness, the optimal functioning of a person’s spirit. This type of wellness is subjective and individualized to each person and, therefore, cannot be provided through a one-size-fits-all model. Spirituality can be just as important to holistic health as other aspects such as physical or emotional health. A person’s spirituality is what gives them a sense of meaning and purpose in life. Achieving spiritual wellness involves actively making choices that improve the capacity for creating a fulfilling spiritual life. The aspects of life that define spirituality include religion, faith, values, beliefs, principles, and morals (Ghiya, 2019). The organized system of beliefs that reflect a person’s approach to or understanding of spirituality is considered religion, but spirituality is broader than religion, and a person may be spiritual without being religious (Dossey & Keegan, 2020).
Supporting the spiritual health of patients requires conversations about spirituality and understanding of the individual’s spiritual history, symbols, beliefs, and practices. For example, if the nurse is promoting the health and well-being of a member of the Muslim population, it would be important to whether the person prays and, if they do, at what times of day in order to coordinate care around their prayer times. This type of accommodation should be looked upon as supporting the spirituality of the patient rather than an inconvenience of scheduling.
Spirituality is a sacred connection to something; it can be a connection to a sacred source (like God, Tao, or Allah), nature, others, or self. Health promotion regarding spirituality must provide for the connections to these things to be successful. Planning and building a sacred garden in an urban housing complex would support the spiritual connection to nature for the people who live there.
Ways to promote the spiritual health and well-being of patients include teaching communication skills, active listening, storytelling, encouraging regular practice of meditation (including prayer or centering), fostering connections, facilitating religious rituals, engaging in art, and allowing for periods of restful peace. Any of these recommended activities can support a patient’s spiritual health and well-being, but they may need guidance in how to incorporate them into their schedules or how to do them.
If spirituality is overlooked in a health-care situation, then the patient has not reached true holistic wellness and healing. Spirituality is an area in which nurses are challenged (and sometimes unable, due to lack of knowledge) to provide culturally competent and culturally relevant spiritual guidance. To provide holistic health care, more focus on educating nurses and other health-care providers about their roles in spiritual wellness is needed.