Health Promotion Strategies Question : On the Healthy People 2020 website, the 2020 LHI topic, Social Determinants, explains that a national indicator of health is measured by \"Students who graduate with a regular diploma 4 years after starting 9th grade\" (para. 11). According to the data, as a nation, are we improving or declining, and why is this important to our health as a country?LessonHea ...[Show More]
Health Promotion Strategies
Question : On the Healthy People 2020 website, the 2020 LHI topic, Social Determinants, explains that a national indicator of health is measured by \"Students who graduate with a regular diploma 4 years after starting 9th grade\" (para. 11). According to the data, as a nation, are we improving or declining, and why is this important to our health as a country?
Health Promotion Strategies
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• Defining Community Health and Wellness
• Meet the Healthy People 2020 Leading Health Indicators
• Health Promotion Considerations for Selected Threats to Health and Wellness
• Nutrition, Physical Activity, and Obesity
• Substance Abuse and Tobacco
• The Nurse\'s Role in Community, Family, and Individual Health Promotion
• Holistic Health and Chamberlain Care
• Nurses, Wellness, and Stress Management
• Chamberlain Faculty and Colleague Contributors
Defining Community Health and Wellness
As a relatively new student nurse, you may tend to think of nursing as the care provided to one individual. As you progress through the curriculum, you will learn that caring for the family and community are just as important as successfully caring for individuals who are part of a family and community. Put another way, you will understand that nursing strategies and interventions for families and groups of people are critical for individuals. As you are now aware, Healthy People 2020 (U.S. Department of Health and Human Services [USDHHS], 2016a) has compiled a list of Leading Health Indicators (LHIs) based on the health risks and needs of groups of people. Of course, these groups are comprised of individuals with the same problems—such as children who do not receive childhood immunizations. Many communities across the United States include individuals with such high-priority health problems that they are recognized as groups that impact overall public health and contribute to health disparities. These groups become leading indicators of the country\'s health and bring attention to health promotion initiatives to mitigate their problem and, therefore, improve the health of the nation.
Healthy People 2020 Leading Health Indicators (LHIs)
The Healthy People 2020 LHIs place renewed emphasis on overcoming these challenges as we track progress over the course of the decade. The indicators will be used to assess the health of the Nation, facilitate collaboration across sectors, and motivate action at the national, state, and community levels to improve the health of the U.S. population (USDHHS, 2016a, para. 3).
Whether a community is geographical, such as a neighborhood that has contaminated drinking water, or disease-related, as with unimmunized children, what affects the community reflects the health and wellness of its individuals. Likewise, that which promotes health in the community promotes health in its individuals. In a parallel way, what affects the family affects the family member and vice versa.
Meet the Healthy People 2020 Leading Health Indicators
The Healthy People 2020 website has a page devoted to each of the 26 LHIs (USDHHS, 2016b) organized into 12 primary topics. On the page, each topic links to that topic\'s overview and impact, life stages and determinants, and most current data. That page also contains additional drill-down links to the LHIs themselves. After spending time with these areas, one readily understands what the health problem is and why it is a leading national indicator of the country\'s health status. Because the LHIs bridge the life span, taking action on one age range improves the health through the remaining ages. For example, increasing compliance with childhood immunizations decreases adult disabilities that result from the illness prevented by the immunization.
Take a moment to visit the Healthy People website and explore the LHI that interests you most. Notice that in the left-hand menu of the website, under In This Section, there is a link to the page \"Who\'s Leading the Leading Health Indicators?\" (USDHHS, 2016b). It provides monthly updates of the most current successes and stories about how different areas or cities in the country are successfully making a difference. It shares evidence of what is working and best practices for both community health nurses and those at the bedside. Can you find information for your area of interest? Whether you can or not, remember that the Healthy People 2020 website is a reliable source of evidence-based information related to promoting health and wellness of individuals, families, and communities, making the site an important tool for nursing practice.
Health Promotion Considerations for Selected Threats to Health and Wellness
In addition to explaining the 26 indicators that reflect the health of U.S. citizens, the LHIs provide data and examples to help communities, nurses, other healthcare professionals, and governments improve health. Yet what strategies and interventions can a nurse use to make a difference in the LHIs and the people each represents? Potter, Perry, Stockert, and Hall (2013) and Edelman, Kudzma, and Mandle (2014) help answer these questions.
Access to Health Services
In 2010, one fifth of children in the United States had no healthcare insurance and only one quarter of Americans had a primary care provider (PCP) (USDHHS, 2016b). As a result, the emergency room has been used as a primary means for obtaining healthcare by many, even for nonemergent conditions, such as colds. Healthy People 2020 emphasizes that access to health services remains a significant problem in the United States, despite the advent of the Patient Protection and Affordable Care Act (ACA, 2010). Complicating this situation has been the political battle between the federal and state governments, making access to care even more uncertain. Yet strategies and interventions exist that nurses can take to increase access to quality healthcare, and the first is advocacy.
The American Nurses Association\'s (2015a) code of ethics, in its third provision, explains that nurses advocate for (i.e., stand up for, defend, support, and champion) the health and safety of the patient. This includes protecting the patient\'s rights, whether the patient is an individual, family, or community. Simply stated, nurses are expected to protect patients. The ANA (2015b) standards explain that advocacy is an essential foundation of nursing practice at all levels of nursing care. Nurses educate individuals to make informed choices about managing their own care. Nurses provide social, case management, and resource support for families. Nurses work in communities and through organizations to change culture, improve societal and environmental conditions, and even change laws and healthcare policy.
As members of the healthcare community, nurses work to create access to care for their patients, who are often unskilled in navigating the healthcare environment. In doing so, nurses improve the processes that limit access. For example, nurses have discovered many strategies to decrease emergency room waiting times, improving timely access to care for those with true emergencies. Nurses are also seeking higher education and specialization, allowing them to have the knowledge and skills needed to advocate for specific populations in need. For example, family nurse practitioners are able to provide alternative, quality access to care for countless Americans. Potter et al. (2013) explain that nurses are in a unique position to advocate for access to care as they view the healthcare environment from both the patients\' and the system\'s viewpoint in addition to their own. Nurses are often the first caregivers who identify problems and become the voices of those in need. In fact, nurses have a responsibility to speak out for those not being heard.
What are some access to care interventions you might be able to make now as a nursing student?
Nutrition, Physical Activity, and Obesity
Healthy People 2020 (USDHHS, 2016b) provides insights into this topic\'s LHIs, offering strategies and interventions that you, as a nursing student, can appreciate and even start to implement for yourself and others. The LHIs provide evidence that many Americans are overweight, do not get enough exercise or activity, and fail to eat balanced diets. This combination has resulted in the increase of metabolic syndrome, diabetes, dental caries, cardiovascular disease, hypertension, and osteoporosis, to mention a few (Edelman et al., 2014).
Many individuals are not aware that they suffer the unhealthy effects of living in a food desert without fresh vegetables, fruits, and other healthy food choices nearby. Furthermore, many are economically challenged to the point that they cannot afford adequate food. This food insecurity often leads to cheaper fast food alternatives that contribute to obesity, making the nutritional challenge worse—especially in children who naturally follow the same food routines and choices as their caregivers. This means education is one of the most effective interventions nurses can provide. Nurses are knowledgeable about nutrition, monitor therapeutic diets of those in their care, and provide nutritional assessments as a part of the nursing process. As a result, nurses are able to provide accurate nutritional information to patients, families, and communities to improve health and wellness.
To break the cycle of poor nutrition, inactivity, and obesity in the United States, nurses have made a big impact in a number of primary and secondary school settings by increasing the nutritional value of school lunches, creating activity programs, and developing classroom curricula that fight childhood obesity. School nurses have worked with nationally funded school breakfast and lunch programs at the local level to influence the selection of foods offered. These same nurses routinely assess body mass index (BMI) in children to monitor both the health of the children and the effectiveness of health promotion efforts.
Education most often starts with dietary guidelines, and both Edelman et al. (2014, p. 238) and Potter et al. (2013, p. 1001) provide excellent explanations of ChooseMyPlate.gov, a good teaching aid about healthy nutritional choices.
Teaching food safety is another important intervention that supports this LHI. Food borne illnesses may be life threatening and can result from uninformed meal preparation practices, such as lack of hand hygiene, cross contamination (e.g., raw poultry), undercooking, or storing foods at the wrong temperature.
Want to know more about impacting health through interventions for nutrition, physical activity, and obesity? This LHI topic will be explored more deeply when you reach NR228 Nutrition Health and Wellness.
Substance Abuse and Tobacco
Consider these facts about two LHIs—substance abuse and tobacco.
Tobacco use is the single most preventable cause of disease, disability, and death in the United States, yet more deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined (USDHHS, 2016c, para. 1).
Substance abuse—involving drugs, alcohol, or both—is associated with a range of destructive social conditions, including family disruptions, financial problems, lost productivity, failure in school, domestic violence, child abuse, and crime (USDHHS, 2016d, para. 2).
Here are the substance abuse and tobacco indicators that measure these LHIs (USDHHS, 2016b, para. 12 and 13).
1. Adults who are current cigarette smokers
2. Adolescents who smoked cigarettes in the past 30 days
3. Adolescents using alcohol or any illicit drugs during the past 30 days
4. Adults engaging in binge drinking during the past 30 days
As you can see, these are particularly troubling indicators of the country\'s health (or lack of it), especially considering the involvement of adolescents, whom Erikson and Erikson (1998) place in the developmental stage of forming identities threatened by role confusion. Peer pressure, especially if the adolescent identifies with those who smoke and drink, is the primary determinant of this behavior.
You, as we established in Unit 6, the 24-year-old Chamberlain College of Nursing student, are in a better position than I, the 65-year-old Chamberlain colleague and professional nurse, to make an impact today on these national indicators. How many adolescents are influenced by your behavior? How many see you as peers or role models? Reflecting on your normal (explored in Unit 6), how many others (adolescents and adults) see you as normal, making what you do a statement much louder than what you say (remember communications basics in Unit 5)? Encouragement from the right peer often creates the motivation for lasting change, breaking a habit, or seeking help.
Other relevant indicators from the Healthy People 2020 topic list are directly related to the four under discussion. Consider their relationship and how they impact the country\'s wellness.
• Environmental Quality: Children who are exposed to secondhand smoke
• Injury and Violence: Fatal injuries and homicides
• Maternal, Infant, and Child Health: Infant deaths and preterm live births
• Mental Health: Suicides and adolescent depression
Healthy People 2020 LHI Website Review
Before you leave the Healthy People 2020 website, review the remaining topics and indicators and explore the website.
1. “2020 LHI Topics”: Topics & Indicators at https://www.healthypeople.gov/
2. “Who’s Leading the Leading Health Indicators?”: https://www.healthypeople.gov/
3. “Healthy People 2020 Leading Health Indicators: Progress Update”: https://www.healthypeople.gov/
The Nurse\'s Role in Community, Family, and Individual Health Promotion
The importance of peer influence and role modeling was established earlier in relation to alcohol and tobacco use, and both greatly influence adolescents and adults seeking help from many community interventions in this country, from alcohol and drug abuse support groups to smoking cessation clinics and resources. The nurse\'s role in health promotion is significant, locally, nationally, and internationally. Nursing students also make an impact.
Chamberlain College of Nursing\'s Global Health Education program allows students to provide healthcare and promote health through education at almost every encounter. Chamberlain students recently visited the Dominican Republic and provided health care to 1,400 people over a 2-week period. During that time, students provided almost nonstop health promotion education about basic health, hygiene, and safety information to individuals who had not previously been educated on these topics. Dr. Susan Fletcher, the director of the program, shared this story and the following pictures upon their return.
\"While in the Dominican Republic, we taught over 200 police, bus drivers, students, and teachers basic first aid and CPR. When we had our free day and went on a hike to a waterfall, one of our team members fell and broke her arm. Our translator, who had attended our first aid class, came up with a sling made of material found at the site (sticks and banana leaves). In Kenya, we treated and educated over 3,000 clients in a two week period in clinics and home visits. Since the program began, we have treated over 50,000 clients internationally.\"
As you progress through school, consider the nurse’s role as an educator for individuals, families, and communities in each nursing class. Explore the proactive approach nurses take with their patients, their community involvement that brings attention to wellness, and their global impact through organizations, such as the World Health Organization and the Clinton Foundation. In all of these encounters, nurses educate, both formally and informally, through interpersonal contact as well as formal publicity campaigns.
Holistic Health and Chamberlain Care
In Unit 1, you learned that holistic healthcare includes emotional, spiritual, and cultural well-being. Nursing holistically accepts the natural healing abilities of the body and supports alternative and complementary ideas not only to maintain wellness and achieve health but also to accomplish healing and restoration.
These complementary and alternative medical (CAM) approaches to wellness and healing may include use of herbs, aroma therapy, acupuncture, and other non-Western medicine approaches. To promote health and wellness, nurses frequently participate in CAM approaches, such as meditation, focused breathing, imagery exercises, and creative visualization. Nurses may complete additional training to administer biofeedback, tai chi, yoga, therapeutic touch, massage, acupressure, and acupuncture. Often nurses are involved in herbal counseling, especially regarding safe medication administration.
One of the most effective complementary nursing therapies is relaxation therapy. Both progressive relaxation and modified progressive or passive relaxation are effective in managing the stress of illness and the daily challenges of life. Talking others through the progression of tightening and relaxing muscle groups is an effective method of relaxation training. Physically, the tension of stress and state of relaxation are polar opposites—one cannot dominate while the other is in control. As such, relaxation is an effective management tool for countering stress, which is a primary harmful component for a majority of patients and many Americans.
Nurses, Wellness, and Stress Management
Although you will learn much more about the psychopathology and pathophysiology of stress as you move through different nursing courses, especially NR320/NR326 Mental Health Nursing, managing stress is an essential component of wellness, without which an individual\'s health status, immune system, and ability to recover from illness are compromised. As you learn to apply concepts of holistic health to health promotion planning, stress management education and therapeutic techniques will become essential components of your strategy.
Holistically, nurses realize that stress affects individuals physically, mentally, and spiritually. For many, including yourself, developing an understanding of the warning signs of stress and the immediate actions to counter or reduce it can greatly lesson its effects. Moreover, preparing for stress through healthy lifestyle behaviors is an important wellness prerequisite. Nutritional health, sleep hygiene, and exercise establish healthy physical, mental, and spiritual conditions necessary to effectively manage stress in the modern American environment.
As you remember that Chamberlain Care starts with self, perform an assessment of yourself to discover how healthy your lifestyle routines are as a nursing student, and reflect on your warning signs. What physical, emotional, and spiritual reactions can you identify to school deadlines, requirements, and tests? Through healthy lifestyle choices, cognitive restructuring, attentiveness to warning signs, and implementation of stress reducing techniques, you can make a difference not only in your own stress reactions but also those of others. As a nurse, the lessons you learn now will be invaluable to your patients in the future, both in health and illness.
This unit touched on just a few strategies and interventions for health promotion. Through an examination of LHIs, you now have added new insight to the wellness picture in your frame and can identify the Healthy People 2020 goals to meet so that the LHIs show improvement in the country\'s health. You have formed the foundation for nursing through an understanding of the nurse\'s role in community, family, and individual health promotion. All of these concepts apply to you first through Chamberlain Care of self. As you apply holistic thinking to your management of stress, wellness, and health promotion in school, you will better understand its application to others in your care.
American Nurses Association. (2015a). Code of ethics for nurses with interpretative statements by American Nurses Association. Washington, DC: Author.
American Nurses Association. (2015b). Nursing: Scope and standards of practice. (3rd ed.). Silver Spring, MD: Author.
Edelman, C. L., Kudzma, E. C., & Mandle, C. L. (2014). Health promotion throughout the life span. (8th ed.). St. Louis, MO: Mosby.
Erikson, E. H., & Erikson, J. M. (1998). The life cycle completed (extended version). New York, NY: W. W. Norton & Company.
Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 et seq. (2010).
Potter, P., Perry, A., Stockert, P., & Hall, A. (2013). Fundamentals of nursing (8th ed.). St. Louis, MO: Mosby Elsevier.
U.S. Department of Health and Human Services. (2016a). 2020 LHI. Healthy People 2020 website. Retrieved from https://www.healthypeople.gov/
U.S. Department of Health and Human Services. (2016b). 2020 LHI topics. Healthy People 2020 website. Retrieved from https://www.healthypeople.gov/
U.S. Department of Health and Human Services. (2016c). Tobacco. Healthy People 2020 website. Retrieved from https://www.healthypeople.gov/
U.S. Department of Health and Human Services. (2016d). Substance abuse. Healthy People 2020 website. Retrieved from https://www.healthypeople.gov/
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