Learning Objectives
By the end of this section, you will be able to:
- Describe strategies for helping to improve physical health
- Describe strategies for helping to improve psychosocial health
Recent changes and trends in health-care access, information, and technology, including incorporating the consequences of the COVID-19 pandemic, have emerged as standard practice. Nurses’ use of social media, telehealth, and other online platforms to educate patients and promote health have increased.
During the pandemic, people heightened their focus on physical health by adopting preventive measures like hand hygiene and mask-wearing and prioritizing immune-boosting behaviors such as sleep and exercise. The pandemic also exacerbated mental health challenges due to stressors like fear, economic instability, and social isolation. Coping with changes in routines and experiencing grief added to emotional strain. Individuals adapted by reassessing priorities, spending more time with family, and embracing self-care practice. Communities responded by supporting at-risk groups and promoting mental health awareness through initiatives like online support groups and education campaigns.
Physical Exercise
Physical exercise decreases the risk for obesity, chronic illness, and age-related changes. Physical exercise can not only prevent disease, but it can also help with stress management and improve well-being. It is important to provide options to people when promoting physical exercise because finding a physical exercise regimen that is enjoyable increases the likelihood that the person will continue to engage in the activity.
There are four basic components required for a well-balanced physical exercise routine (Dossey & Keegan, 2016). They are:
- flexibility
- muscle strength
- cardiorespiratory endurance (aerobics)
- postural stability
Each patient should be encouraged to engage in all four components of physical exercise to provide the most health benefits. Doing so keeps patients from getting bored with their exercise routine and allows them to find exercise modalities that they enjoy. Table 3.3 provides more details on the four components of well-balanced exercise routines.
| Component | Examples | Benefits |
|---|---|---|
| Flexibility |
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| Muscle strength |
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| Cardiorespiratory endurance |
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| Postural stability |
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Exercise has cumulative benefits, meaning that any effort to exercise is an improvement from the baseline and provides positive health effects. This is important for patients who may have tried to implement exercise routines in the past and were unsuccessful. Encouraging patients to incorporate small amounts of exercise into their routines and then expanding those efforts is less intimidating for a person with a sedentary lifestyle.
Nurses should avoid approaching the subject of physical exercise from a shaming and blaming standpoint. Shaming a patient does not improve exercise efforts. Exercise should be discussed in a nonjudgmental way that allows the patient to view physical exercise as a part of their lifestyle rather than a punishment for previous lifestyle choices. The challenges of physical exercise should be discussed with patients of all ages, cultures, and weights, not just patients identified as having obesity.
Mindful Self-Care
Mindfulness and self-care are essential to the holistic health and well-being of patients and their communities. A mindfulness practice allows a person to quiet the mind and focus their awareness on the present state of being. A self-care practice promotes the health and well-being of the individual and gives time for patients to focus on what their body needs. Mindful self-care suggests that a person quiet the mind, becoming aware of the current state of their health and well-being, and identify ways to promote or improve the state of well-being through self-care. promote or improve the state of well-being through self-care.
Clinical Safety and Procedures (QSEN)
Mindfulness
An individual’s state of awareness, achieved through personal focus, being in the present, and/or meditation is called mindfulness. Paying attention and being fully cognizant of a situation without extreme reaction can provide calming and centering. The practice of mindfulness dates back to ancient times and was originally grounded in Buddhist and Hindu traditions. Practicing mindfulness can improve a person’s overall sense of well-being and mental health. In addition, the use of mindfulness techniques—being fully present in the moment and being aware of one’s surroundings, environment, and senses—is another protective factor that reduces stress and thereby lowers risk factors for mental illness. Examples of mindfulness techniques include meditation and keeping gratitude journals, instead of ruminating about the “what-ifs.” By mastering the capacity to pay attention in the present moment and the ability to recognize the reality of our complex lives, the nurse can address all QSEN competencies and then is able to skillfully provide the patient with the same set of knowledge and skills.
Mindful self-care can take many forms, such as meditation, journaling, or breathing exercises. These activities are as varied as the patients who practice them and should be individualized for the patient’s optimal idea of well-being. Whatever the activity, it should encourage development of one’s inner consciousness, support well-being, and focus on creating balance and satisfaction in life. Mindful self-care should be practiced daily in a comfortable environment. If the patient is having trouble working mindful self-care practices into their daily routine, some quick options include taking deep breathing breaks throughout the day, journaling for 10 minutes a day, joining a mindful/self-care group like a drumming circle (Figure 3.4), planning a mindfulness or self-care retreat, or finding a friend who has a similar goal and practicing together.
Work-Life Balance
Work-life balance can be achieved through the creation and maintenance of healthy boundaries. A healthy boundary is a guideline that people set to regulate relationships. In this case, it is the relationship between work and home life where people need to achieve a healthy balance. Examples of healthy boundaries regarding work include not checking email after work hours, working only during “work hours” (this will depend on the person’s work schedule), or not being available for calls or meetings on weekends. Healthy work boundaries are more difficult to set for people who work from home, have on-call hours, or are in a management or salaried position. Completing a thorough assessment of how work and home life feel out of balance will help you and the patient identify where boundaries need to be drawn.
Work-life balance is a common cause of stress for patients. Research indicates that those who have small children, a new marriage or job, caregiving responsibilities, or any number of other responsibilities are more susceptible to work-life challenges (Rathnaweera & Jayathilaka, 2021). If there are things that the patient can cut out of their schedule to make it less stressful, it is recommended to do so according to how important each activity is to them. For example, if the patient is working a full-time job, has children, works part-time at a senior center, and volunteers for a local charity, the patient can identify which of these are the least important and cut it out of their schedule to decrease the demands on their time. This would require the patient to consider the advantages and disadvantages of each activity and determine which activity, if removed, would decrease their stress level to a manageable level. When creating a healthy work-life balance, the patient needs to learn to prioritize and set boundaries to create the healthiest scenario for themselves. The nurse’s role is to help the patient identify when there is a work-life imbalance, empower the patient to take steps toward achieving work-life balance, and provide resources to make the process successful. Less stress can lead to more productive work and feelings of being more present in one’s home life (Rathnaweera & Jayathilaka, 2021).
Healthy Eating
The food that people consume is the basis for all the energy needed for the body to function normally. Foods should be nutrient dense and satisfying. Fad diets or unproven diet plans should be avoided. When educating patients, recommend simple, whole-food options. The most nutritious diets contain a variety of fruits, vegetables, healthy fats, and lean proteins (Figure 3.5), whereas the least nutritious diets contain large amounts of processed ingredients, high sugar content, and large amounts of unhealthy fats.
Promoting healthy eating habits starts with educating the patient. It is also important to encourage small, manageable changes in eating habits, such as portion control. These small changes can be managed in the long term rather than trying to change everything all at once. Some other examples of small changes include swapping out sugary drinks for water, eating one meatless dinner each week, and eating freshly prepared meals instead of pre-made processed meals.
Sleep Hygiene
The rituals a person practices surrounding their bedtime and sleep routine is called sleep hygiene. The sleep routine is an underutilized health-boosting practice. The benefits of having a healthy sleep hygiene routine include longer, more restful sleep, less daytime sleepiness, and more energy.
A healthy sleep hygiene routine is one that is consistent. Many people do not have the ability to maintain a consistent schedule due to work or other obligations, but sleep routines should be prioritized as much as possible. Consistently going to bed and waking up at the same time promotes the natural rhythm of the body. Avoiding stimulants, like nicotine and caffeine, prior to going to bed will allow the body to fall asleep more readily. If a patient is having trouble sleeping, identify nonpharmacological sleep aids and avoid over-the-counter options. Nonpharmacological sleep aids include meditation, diffusing lavender or chamomile essential oils, massage, and a relaxing bath before bed. Aspects of a healthy sleep hygiene routine include exercising during the day to expend extra energy, adjusting bedroom temperature, avoiding screens (TV or phone) in bed, darkening the room while sleeping, and making the room quiet. Doing the same ritual before lying down to sleep is also helpful, like bathing, brushing teeth, and plugging in the phone.
Social and Family Support
Encouraging patients to seek social and family support can cause hesitation in some individuals who view the act of seeking help as a weakness rather than a strength. Identification and introduction to social support systems within their communities are important to improve overall health outcomes. Assisting patients with these difficult conversations with family members is an appropriate nursing role and will improve the chances of opening communication between the patient, family members, and identifying support people.
Lifestyle Changes
What motivates an individual to make lasting lifestyle change? How can a nurse influence an individual so profoundly that they make the necessary changes to improve their health? Examining these questions assists nurses with goal development and care when assisting patients with successful lifestyle changes.
A nurse’s role in the promotion of lifestyle changes in patients is that of coach or facilitator. To facilitate changes in lifestyle, a nurse must assess the patient’s daily practices. This assessment, called a lifestyle assessment, identifies a patient’s everyday patterns of living and establishes how those activities influence the patient’s overall health (Pender et al., 2018). Once the assessment is completed, the nurse can determine which area presents the most need for the patient. Together the nurse and patient can create a plan of action that will help the patient make specific lifestyle changes. This plan includes self-determined goals, feedback on progress, identifying and responding to challenges, and determining success.
Lifestyle health promotion activities can be divided into two categories: preventive and reactive. A preventive lifestyle health-promotion activity is geared toward preventing adverse health outcomes, whereas a reactive health-promotion activity focuses on stopping poor lifestyle behaviors that are known to lead to disease. For instance, a preventive lifestyle health-promotion activity is planned to increase consumption of a healthy diet, this healthy diet will prevent development of disease or illness. A reactive lifestyle health-promotion activity would focus on a group of patients diagnosed with diabetes. The identified goal would be making appropriate changes in the diet to prevent complications of diabetes.
Lifestyle changes do not have to be extreme; in fact, the change of small behaviors may be more sustainable than making a complete overhaul. Small scale lifestyle behaviors that can lead to improved health include things like:
- eating more fruits and vegetables
- substituting water for sugar-filled drinks
- avoiding processed foods
- eating out less often
- replacing unhealthy snacks with healthier options
- incorporating stretching into the daily routine
- proactively staying up to date on current vaccination recommendations
- minimizing noise levels when possible
- removing electronic devices from sleeping area
- avoiding electronic devices one hour prior to sleeping
- engaging in social activities with friends or relatives
- using a reflection journal for 5–10 minutes each day (Gorstein, 2019)
Reactive lifestyle health-promotion activities are essential to improve the quality of life for patients who are already experiencing health concerns. Health-promotion activities focused on smoking cessation, reducing alcohol consumption, avoiding illicit drug use, safe sexual practices, and heart-healthy diets are examples of reactive lifestyle health-promotion activities.
Community Involvement
A community is the group of people of which an individual is a part. A community is a collective of people who have something in common or “belong” together. They share values, have social norms or traditions, have established communication patterns, and work together to solve problems (Pender et al., 2018). Being a part of a community is an important aspect of human existence; it can determine a person’s health status through the social norms established by that community. Social norms in a community can influence how often a person exercises, how they engage in self-care, what a person eats, and their level of emotional intelligence.
Humans are not meant to be solitary beings, so being part of a community is essential to the holistic health and well-being of an individual. Communities provide their members with resources and relationships that can promote optimal health, decrease stress, and improve mental health (Salfas et al., 2019). The improved health of an individual community member helps to optimize overall community health.
The role of health promotion in a community setting extends from each individual community member to the whole community. Community health promotion can be used to change the entire community’s health status. Examples of Healthy People 2030 goals that could be improved by community health initiatives include increased screenings for oral health, decreasing drug overdose deaths, decreasing suicide rates, and decreasing infant death rates (U.S. Department of Health and Human Services, 2021). The community must recognize that the health goal is important to the health of the community members to buy into the health-promotion campaign.