Health Promotion Essay

This is an essay about a thirty year old woman called Molly who is a little bit anaemic, recently gave birth to her second born called Sebastian. Molly leaves with her husband called James and their three year old baby called Eric.

The purpose and aim of this essay is to define health and health promotion, a brief discussion about Molly’s anaemic. The key concepts in this essay will be defined such as health and health promotion. A rational for my plan will also be discussed as well as the dimension of Molly’s health such as her biomedical model oh health, her psychological model of health, her social model of health and also her psychological factors which may affect her wellness such as cognitive factors, behavioural factors and environmental factors which can be use to enhance Molly and her family’s health.

My rational for choosing to write about Molly is that, from research I did, I found out that anaemia is one of the most common pathological condition encountered in primary care. Its consequences, although mild in most cases, are potentially very sever. It was said in August 2009 that about 12,500 have anaemia, and in UK 1 in 7 children have mild iron deficiency anaemia. As this is due to the low red meat levels in our current diet, for similar reasons many women of menstruation age also iron deficient.

First of all, health is the absence of illness, by Naidoo and Wills(2000), whilst Dines and Cridd (1993) argued that health is a state of complete physical, mental and social well being, and not merely the absence of disease of infirmity. However, the World Health Organisation (WHO 1998) defined as the extent to which an individual is able to realize expectations and fulfil needs and to change or cope with the environment. Personally I think being healthy , is the absence of illness.

Blaxter (1990) undertook two studies on how various people defined their own health; one of a large side view of the population and one from a low social class disadvantaged families. She discovered that a negative definition of illness was used, among people defining health as the absence of diseases. However, there were clear differences between the various age groups and between sexes. Younger males likely to highlight issues linked to strength and fitness, while older males stressed mental well-being. Younger women focus on vitality and the ability to cope in various circumstances, while older women talk about satisfaction, but also include wider issues such as social relationships.

Howlett et al. (1992) used Blaxter’s data in a more comprehensive examination of ethnic differences in defining health. Their results recommended that there were differences among the various ethnic groups, with people of Asian origin defining health in a practical or functional way, while people from African-Caribbean origin were more likely to include fundamentals of health, although the research outcome for the definition of health was not clear however, health is not a simple idea; but quite multifaceted, among different groups defining it different ways, this means that, some ethnics think that being physically fit means you are healthy whiles other ethnic groups also think that when a person is fit and mentally sick means to them that the person is unhealthy.

According to the WHO (1998), health is a process of enabling individual to increase control over and improve their health. However, Tannahill (1996) explained health promotion in greater detail and defined health promotion as health education, health promotion and the prevention of illness. Health promotion is the prevention of ill health and the reduction in number known risk factors for disease, as well as the increase in social capital and the empowerment of individuals and communities. Empowerment is difficult to define and has been used to mean different things. Rissell (1994) (cited by Naidoo and Wills 2001) describes empowerment as the holy grail of health promotion, defining it as process through which people become strong enough to participate, share in the control of and influence events and institutions affecting their lives’ Tones (1995) (cited by Naidoo and Wills) argues that, for individuals to be empowered, they may need to acquire information or decision-making skills and has consistently argued that health education is the mainstay of population health promotion, health promotion will empower Molly to be aware of the dangers of his health.

Promoting health therefore means focusing not just on preventing disease but also on people’s social and mental health, therefore health promotion may include preventive activities, education, community-based social action, the creation of healthy environments and policies for example: The recent health strategy for England, Saving Lives: Our Healthier Nation (DOH, 1999), (cited by Naidoo and Wills 2001)”suggests that the public, the community and government has a role to play in health improvement and these roles has been identified as (a)Government and national players assessing risks, communicating these risks clearly to the public and ensuring supportive environments for health. b) Communities working in partnership with other agencies to provide better Information and services”. (Naidoo and Wills 2001 p280) The 1846 Public Health Act included that local authorities are require to provide clean water supplies and sewage disposable system, the no smoking policy in public areas etc. Tannahill (1985) (cited by Naidoo and Wills 2001) provided some examples of recognized expressive models of health promotion as prevention, health education and health protection.

First and foremost, I will talk about Molly’s biomedical health which is Anaemia. Biomedical model of health and can be defined mainly as the absence of disease. “Anaemia is a condition in which the number of red blood cells (RBCs) is reduced or there is a reduction in the level of haemoglobin in the blood”. Molly acquired her anaemia in her pregnancy since anaemia is associated with pregnancy in a serious health problem; it is also an important public health problem worldwide and the most vulnerable group are pregnant women like Molly. Molly being anaemic could be her iron deficiency which is probably the most common and important because, the physiological changes associated with pregnancy exert a demand of additional iron, which is needed for foetus.

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Molly’s health can promoted here through health education by the health practitioners about the consumption of food that are rich in vitamins, minerals and elements specifically identified as therapeutic for this condition. This education can gradually help Molly promote her health. Because health education plays an important role in health promotions as it covers all aspect of activities that help improve the health status of people and their surroundings. Ewles and Sinnet (2003) suggested that health promotion is the action of empowering individuals to enable them takes control over their lives, in order to improve their health and lifestyle. Naidoo and will (2000), further add that health promotion is frequently seen as prevention of disease, often through targeting groups with an increased like hood of developing specific disease.

The leaflet can be displayed at health clinic like GP surgeries, well woman clinic and hospital reception and wards so that health professionals can use it to educate, council, teach and empower women and also, be well informed. It can also be displayed at social clubs, schools and super markets so that everyone can get one and not necessarily go to their GP surgeries or hospital before being able to get one. The leaflet has been designed in a way that every individual will be able to read and understand. I believe it is very important to be brief and straight forward when designing a health promotion leaflet

Again, I will look at her psychological model of health. This is post natal depression. Psychological health is the effect of the mind and the relationship between physical activity and general aspect of psychological well-being for example smoking, alcohol, diet, exercise etc. Molly’s postnatal depression can be of a combination of many factors. (Physical, psychological and social). Molly can be depressed in so many ways; one can be due to the fact that her having another baby will be the biggest physical, emotional and social factor she will ever experience. Molly preparing adequately to meet her new born baby can be difficult and sometimes laced with unrealistic expectation. If Molly’s expectations are not are not met and also caring for her new baby proves to be difficult, she will tend to blame herself. However the postnatal depression can make Molly depress if her baby experiences severe baby blues, or having difficulties in her marriage with her husband and or lack of practical and emotional support or being the perfect mother and being ill prepared for the reality of parenting.

Moreover, Molly having a negative birth experience, experiencing unexpected complication, like baby born prematurely or unwell and lastly her new born demanding, having difficulties in feeding, experiencing colic and or being frequently unsettled. all these factors will contribute to make Molly depress. Molly’s health can be improving her through many different types of therapy and some of these are cognitive behavior therapy. This is where by a person thinks negatively about themselves. E.g. like I am a failure and no one loves me. It could be Molly’s thinks negatively about herself. Also interpersonal therapy, psychologist and psychiatrist.

Lastly, I will talk about her Social model of health which is isolation. the social model of health watchfully considers how bigger determinants than the occurrence or absence of disease have an impact on people’s health for example: poor housing, air pollution, poor drinking water leading to sickness like cholera. Some of these bigger determinants are a person’s culture and belief method or levels of relative income, access to housing, education achievement and opportunities as well as the wider environmental. Molly feels isolated due to the fact that she has got a new baby and would not get the chance to meet her friends and family as she used to do before. Below is a care plan done for Molly on how she can promote her health? Needs/problem|Health promotion Approach/strategy|Activity|

Anaemia (Biomedical Health)|·Identify the typical haemoglobin levels that define anaemia in children/adolescents and post-pubertal men and women. |·Eating iron rich foods and red meat.·To take vitamin B complex supplement.| Post natal depression (Psychological factor)|·Assess individual to see if they are under stress, depressed or also thinking about suicidal.|·Routine screening using the EPDS which is offered to delivered others prior to discharge.| Isolation (social factor)|·Check individual risk factors |·Reassurance·Encouragement·Empathy·Empowerment|

This care plan has been done on how Molly’s health can be improved. The Code of Professional Conduct (NMC, 2004) talks about promoting patients interest, by helping them gain access to their health care by providing them with the necessary information and support to their relevant needs, impact knowledge in order to develop skills and make an informed choice about their health behaviour (tones and tilford, 1994). Health promotion brings awareness of obesity and its associated health risks that cause early mortality. Most individual see the challenges to their need to change but refuse to because they don’t see the need to , due to still perceived advantages, in this case people need to be motivated to give some thoughts to enable them do something about their behaviour, and if possible set up an action plan with a possible reward system put in place to maintain a successful change in behaviour and to avoid relapse, though there may be occasional relapse to earlier stage (Prochashka and Diclemente, 1984).

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In summary, irrespective of health promotion strategies and models adopted, health promotion is an effective mean of educating, helping people understand their behaviour and how it can affect their health. This care plan can be useful tool to all health care professional involved in health promotion and because care plan alone cannot have the greatest impact on people behaviour. It is therefore important to advise them on the health risk associated with being anaemic and encourage them make their own choice for a healthier lifestyle.

REFERENCES

Becker M. (1974) The health belief model and personal behaviour. Throfare New Jersey: Slack.

Berkman LF, Glass T. Social integration, social networks, social support, and health. In: Berkman LF, Kawachi I, eds. Social Epidemiology. New York: Oxford; 2000.

Blaxter et al. (1996). How to research. Buckingham: Open University Press. Downie, R.S., Tannahill, C. & Tannahill, A. (1996). Health promotion: models and values. (2nd ed). Oxford: Oxford Medical Publications.

Ewles L, and Simnet I (2003) promoting Health ; A Practical Guide. 5th edition. Edinburgh: Bailliere Tindall.

House JS. Work stress and social support. Reading, MA: Addison-Wesley; 1981. Kemm J, and Close A. (1995) Health Promotion: Theory and practice London: Macmillan press.

Lincoln KS. Social Support, negative social interactions, and psychological well-being. Soc Serv Rev 2000;(June):231–552.

Naidoo J, Wills J. (2000) Health Promotion Foundations for Practice. 2nd edition. London: Bailliere Tindall.

Naidoo, J and Wills, J. (2001). Health promotion. Naidoo and Wills. Health studies An Introduction. London: PALGRAVE. P 275-290.

Nurising and Midwifery Council (2004) Code of Professional Conduct. London: NMC

Tones K, and Tilford S. (1994) Health Education: Effectiveness, Efficiency Chapman Hall. and Equity. 2nd edition. London: Chapman Hall.

Umberson D. Family status and health behaviors: social control as a dimension of social integration. J Health Soc Behav1987;28: 306–19.

World Health Organisation (1998) Education for Health, A Manul on Health Education in Primary Health Care. Geneva: WHO.

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Health Promotion Essay

According to the World Health Organisation, health promotion can be defined as “the process of enabling people to increase control over their health and its determinants and thereby improve their health” (WHO, 2005). This essay will focus on the socioeconomic influences on health, the models of health promotion and the factors influencing health promotion. It will also highlight how a health campaign can be used to support health promotion strategies.

1.1

Health is a state of wholistic well-being encompassing physical, mental and social aspects of life and not just the absence of disease or infirmity (WHO, 2014). Many factors have impact on the health of individuals and peoples in general. These include socioeconomic factors, physical factors as well individual or personal characteristics and behaviour patterns. Such socioeconomic factors include employment, income, education, lifestyle and citizenship status. This essay will focus on the effects of socio-economic factors on teenage pregnancy in Lambeth borough of London. Lambeth is one of the South Boroughs of London and constitutes part of inner London. It is 3 miles wide and 7 miles long. According to ONS figures the borough has the highest rate of teenage pregnancy in the United Kingdom.

Although it has witnessed a reduction in teenage pregnancy by more than 12.8% since 1998 the rate still remains high. 63% of pregnancy in Lambeth and its surrounding boroughs end in termination. As of 2011, Lambeth had a population of 7000 girls aged 15 – 19 years which is 5% of the family population. In the borough 34.8% of young women aged under 18 years conceived per 1000 population in 2011. Factors associated with higher chance of teenage pregnancy include low educational attainment, poverty, use of alcohol and drugs. Lambeth is ranked 27 of 149 most deprived local authorities thus implying a strong relationship between teenage pregnancy deprivation. Teenage parenting can be harmful to the mothers’ health apart from limiting the educational attainment and employment prospects.

Moreover, babies born to under age mothers are likely to end up as teenage parents as well. According to ONS most teenage mothers by age 30 have 22% more chance likelihood of living in poverty than those giving birth at the age of 24 or over and have less chances of being employed or living with their partners. Children born by teenage mothers are 63% more likely to have behavioural issues compared to babies born to mothers in their twenties. In order to reduce the incidence of teenage pregnancy in the borough, a number of measures can be taken.

These include school based or community based sex education linked to contraceptive services, programmes emphasising personal development and programmes promoting academic and social skills among young people. Also to ensure positive outcomes for underage mothers and their babies, good ante-natal care, home visit and support as well as child care support and career development are recommended.

Explain these socioeconomic factors such as employment, income, education, lifestyle, poverty and citizenship status.

1.2

Health inequalities are differences in health outcomes between communities. They are usually linked to socio-economic factors at individual and population levels. Government sources responsible for reporting these inequalities are the Health Survey England (HSE), Health and Lifestyle Survey (HALS) as well as Reports and Enquiries. The HSE and HALS was a principal tool created by government to plan health services and formulate policies for all citizens (HSCIC, 2014). It also helps the government to know the level of health inequalities in each borough. The survey is carried out annually by means of interviews and questionnaires.

The major challenges being faced by these government sources are manpower shortage to cover the whole country and inadequate funding. Another major problem is apathy on the part of respondents. In order to overcome these challenges, government needs to attract more personnel with good incentives both in cash and kind. More fund also has to be allocated for this important service possibly by imposing higher taxes on alcohol and tobacco products. It is suggested that more awareness should be created nationwide to encourage greater enthusiasm from respondents. Include statistics of teenage pregnancy

1.3

There are various types of barrier which could prevent individuals and communities from accessing healthcare. These maybe classified as physical barriers, psychological barriers, geographical barriers, financial barriers, resource barriers as well as cultural and language barriers. They include illiteracy, lack of communication skills, disability, and logistics problems. With respect to teenage pregnancy in Lambeth, education can be a barrier as some schools do not promote sex education as it can be a sensitive subject. Young people do not always take these sessions seriously, not paying attention and usually obtaining inaccurate information from their peers.

Parents are also reluctant to talk about sex with their wards as this may be perceived as giving them the green light to have sex. Another barrier is the psychological feeling of shame and fear due to the stigma associated with teenage pregnancy. Many teenagers do not visit the doctor and therefore fail to receive the medical attention that they need. They also do not inform their parents and do not receive medical treatment until late in the pregnancy which can create problems for them during pregnancy and childbirth. The last barrier is the cultural or language barrier.

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Some teenagers who come from families where English is not their first language may find it difficult to access healthcare because they are not able to communicate with health professionals. Some teenagers may also stop attending hospital appointments due to healthcare workers not being aware of their culture. The following recommendations will help to reduce teenage pregnancy and produce positive outcomes for teenage mothers. (i) Education on safe sex and provision of sexual health care services. (ii) Training of professional, carers and parents to help pregnant teenagers. (iii) Identifying and encouraging underage mothers to pursue their life goals (iv) Improving and building teenagers’ self-esteem.

Task 2

2.1

Health education is defined as any combination of learning experiences designed to help individuals and communities improve their health by increasing their knowledge or influencing their attitudes while health promotion seeks to give people control over their health by means of a robust public health policy which addresses socio-economic factors like income, housing, education, employment, food security and quality working conditions (WHO, 2014).According to Burton and Macdonald (2002) governments and public health officials tend to reduce health promotion to health education which attempt to change people’s health behaviour by means of public health campaigns such as ‘Promoting Better Health’ (DOH, 1987), Health of the Nation (1992) and ‘Prevention and Health Everybody’s Business’ (DOH 1976).

In the UK, government strategies for health promotion consists of vaccination programmes which help to strengthen the immune system against diseases like polio, measles, chicken pox, etc. it also includes anti – smoking campaigns, sun protection, campaigns for healthy eating, safety at home and every child matters. These strategies can be linked with health promotion models such as Becker (1974), Tannahill, Downie et al Model (1996) and Beattie (1991). According to the Tannahill et al model, health promotion is an umbrella concept comprising of health education, prevention and health protection. This correlates with the government immunisation, healthy eating and anti – smoking campaigns.

Tannahill, Downie

Et al

Model (1996)

Government aims to reduce smoking rates by banning TV and Press advertising, raising tobacco taxes and banning smoking in nearly all work places and public spaces (DOH, 2014). The government smoke – free campaign seeks to encourage people to change their behaviour by making people aware of the negative effects of smoking on health.

Anti-smoking campaign, Legislation/Fiscal Policies, Smoking Health Harm campaign

2.2

Health professionals have important roles to play in meeting government targets for health promotion. Health promotion involves enabling people to have more control over and to improve their health (Ottawa Charter, 1986).This can take the form of health education which involves facilitating learning and behavioural change in health workers and service users. It can also be by offering more effective and accessible services to the community (service improvement) or by activities which bring about changes in government and organisational policies (advocacy). A health visitor is a qualified nurse or midwife with additional training in child health and promotion. They offer parental support and advice on how to promote the well-being of children. They offer advice on feeding, weaning and dental health. They also arrange access to support groups such as sure start and housing agencies. Another health professional is the school nurse which helps to promote health and safety within the school environment.

They also collaborate with in house services to help children attain full capacity in self-management. As a smoking cessation officer I have the role to offer advice to clients to stop smoking, assessing their willingness and encouraging people to stop smoking in their houses and family cars, emphasising the effects on children and encouraging smokers to try and quit in the most effective way. The above strategies are in line with the Becker (1974) model of health promotion which postulate that people’s behaviour is a function of their perceived threat to their health of not taking a particular action and how they believe that action will address the threat.

As a smoking cessation officer in a GP Practice, I would make use of the Becker’s Health Belief Model to help reduce the number of registered smokers in the surgery by making them realise the health dangers of their smoking behaviour (respiratory & cardiovascular diseases), the benefits of stopping smoking which include a healthier and longer life and making them feel competent to succeed at changing their behaviour. Ajzen and Fishbein (1980) theory of reasoned action also incorporate these strategies. I will also provide them with self – help material and referral to more intensive support such as Stop Smoking England. It is also essential for me to provide them with on-going support in terms of positive reinforcement and reassurance.

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2.3

A routine is a prescribed, detailed course of action to be followed in regularly (thefreedictionary.com, 2014). In relation to healthy living these include regular bed times, eating regularly, having regular exercises as well as regular periods of rest and relaxation. According to Healthskills (2011) having a routine which integrates the body’s requirements helps to keep the body functioning at a physiological level. The 5 – day plan to quit smoking originally published by McFarland and Folkenberg (1964) and endorsed by the WHO is based on replacing the smoking habit with a new set of routine habits.

These include eating a balanced diet, drinking six to eight glasses of water daily, regular exercise three to five days weekly, having adequate rest, sleep and relaxation while avoiding overeating, alcohol, tea and energy drinks. The client is also to avoid places where others smoke, think of the benefits of not smoking and affirming to himself “I choose not to smoke”. These routines will help the individual to quit smoking and to reap the benefits of not smoking which include avoidance of cancer, heart attack, impotence, infertility and premature skin wrinkles. These are in addition to getting rid of bad smell and saving money.

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Health Promotion Essay

In today’s society, individuals do not recognize that every phase of their life is influenced by their health. People cannot accomplish their goals in society to their full advantage when they are unhealthy. In order to help the population improve their overall health, health promotion is essential. Health promotion and its objective will be discussed in this paper. In addition, it will further examine what our responsibilities are as nurses in the structure of health promotion. Furthermore, health promotion is separated into three levels: primary, secondary, and tertiary prevention, all benefitting the individual. The U.S. Public Health Service identifies health promotion as “the process of advocating health in order to enhance the probability that personal, private, and public support of positive health practices will become a societal norm” (Edelman & Mandle, 2010, p. 14).

In addition to offering information to patients regarding their health, health promotion incorporates supporting patients to enhance their general well-being and recognize their individual health potential (Skybo & Polivka, 2007). Health promotion provides patients with the understanding of the different elements that can alter their health and inspires them to obtain control of it (Bennett, Perry, & Lawrence, 2009). As well as enhancing patient outcomes, health promotion assists in reducing costs, which are consistently rising in health care (Edelman & Mandle, 2010). According to Edelman & Mandel, health promotion can be used on a public level, community level, or personal level (2010). For instance, on the public level, health promotion could include granting assistance or low-income housing programs by the government. The community level might incorporate Habitat for Humanity, which is a great advantage for that particular population.

Lastly, the personal level would include individuals who vote to favor programs that assist the community (Hoyle, Bartee, & Allensworth, 2010). Health promotion, a frequently used phrase, is especially critical to the nursing career. It encompasses many concepts that nurses encounter daily. Because education is crucial to succeed, nurses are an essential part in health promotion. Every day, nurses provide education to their patients. To assist them in maintaining and enhancing their well-being, nursing interventions benefit individuals by expanding their resources (Edelman & Mandle, 2010). Since there are various settings in nursing, this is the ideal opportunity to educate individuals. With the help of nurses, healthy communities, homes, and schools can exist with proper education.

Regardless of the specialty, all nurses need to educate patients on how to remain fit so they can live a longer, healthier life. Currently, collaboration occurs with an interdisciplinary team, which all assist in improving patients’ lives. Team members may include physicians, therapists, social workers, and dietitians. By working together to create a diverse educational background, this team helps patients overcome their illnesses or helps them manage the disease affecting their life (Bennett et al., 2009). Since health promotion is employed entirely across nursing, nurses are accountable for facilitating the best outcome for each individual patient. Health promotion includes three levels; primary, secondary and tertiary (Edelman & Mandle, 2010). Primary prevention includes delivering strategies and education to help patients avoid illnesses (Edelman & Mandle, 2010).

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For example, when a nurse delivers an immunization to a patient, she educates them about the potential risks of the disease and how the immunization will help prevent them from contracting the disease. In addition to the community, primary education is also applied in schools as an informative tool, to educate students about harmful diseases such as those taught in sex education classes. This offers support to students, enabling them to make informed decisions about protecting their health from such diseases. Secondary prevention is the next level of health promotion. This includes timely diagnosis of an illness and immediate therapy (Edelman & Mandle, 2010). This level aids in reducing occurrences of illness and inhibiting development between patients (Bennett et al., 2009).

By offering community screenings for diabetes or hypertension, nurses are applying secondary prevention. Public health screenings allow nurses to identify potential diseases at an early stage, as well as provide the patient with beneficial information to slow the progression of the illness. Lastly, the tertiary level consists of helping the patient with rehabilitation and recovery (Edelman & Mandle, 2010). This stage identifies the disease and makes the patient cognizant of their health challenges. The nurse’s role in this level is to deliver education to help reduce complications. If a patient is admitted to the hospital with a stroke, physical and occupational rehabilitation may be initiated to retain the maximum stage of function and to avoid another stroke from transpiring (Skybo & Polivka, 2007).

The three levels of health promotion are utilized every day and positively assist patients with improving themselves. Nursing will continually incorporate health promotion and the prevention of illnesses. To help support the best outcome for all patients, it is essential that nurses adapt to change. Primary, secondary, and tertiary are the principle levels of health promotion in the nursing profession. These three levels will contribute to patients living longer, healthier lives.

References

Bennett, C., Perry, J., & Lawrence, Z. (2009). Promoting health in primary care. Nursing Standard, 23(47), 48-56. Retrieved from http://library.gcu.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2010367201&site=ehost-live&scope=site Edelman, C., & Mandle, C. L. (2010). Health promotions throughout the life span (7th ed.). St. Louis, MO: Mosby. Hoyle, T., Bartee, R., & Allensworth, D. (2010). Applying the process of health promotion in schools: A commentary. Journal Of School Health, 80(4), 163-166. doi:10.1111/j.1746-1561.2009.00483.x. Retrieved from http://library.gcu.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2010582507&site=ehost-live&scope=site Skybo, T., & Polivka, B. (2007). Health promotion model for childhood violence prevention and exposure. Journal Of Clinical Nursing, 16(1), 38-45. doi:10.1111/j.1365-2702.2006.01621.x. Retrieved from http://library.gcu.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=2009481108&site=ehost-live&scope=site

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Health Promotion Essay

According to the World health organization (WHO), health promotion is defined as the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions. (World Health Organization, 2014) Nurses play a pivotal role in health promotion that include disease prevention, follow-up treatment, patient education and behavioral changes in respect to their health. Health promotion by nurses have led to positive outcomes including patient awareness, knowledge of diseases process, self-management, and improved quality of life. (Kemppainen, Tossavainen, & Turunen, 2013) This paper will focus on health promotion in the nursing practice through literature review, the evolution of nursing roles and responsibilities in health promotion, the implementation methods for health promotion that encompasses all areas of nursing, and the three levels of health promotion prevention. Primary Prevention

Primary prevention is the first level of health promotion. The goal is to protect healthy individuals from acquiring a disease or experiencing injury before it occurs. Primary interventions used by nurses include but are not limited to education about nutrition, the importance of daily exercise, seat belt and helmet use, dangers of tobacco and other related drugs, routine exams, screenings, immunizations, and identifying potential hazards in the work place. (Institute for work and health, 2009) The concept of primary prevention is traditionally used in reference to physical health but in the article, “Education in primary prevention in psychiatric-mental health nursing for the baccalaureate student”, it focuses on the concept of primary prevention in reference to mental health. This can be difficult for nurses because mental and emotional problems are related to complex emotional and behavioral factors.

For primary prevention the focus for nurses is on providing interventions to groups before a crisis situation could occur. The focus from this article was on implementation of preventative programs for target groups. Alcoholism prevention, prevention of child abuse, and child care for the populations of elementary and junior high school children. Rape prevention, loss or bereavement, drug or alcoholism prevention, and teen-age pregnancy prevention for adolescents. Parenting, child-birth classes, child abuse prevention, stress management for young adults. Reproductive and sexual concerns for middle aged adults. Sensory loss, rape prevention, loss of loved ones for elderly patients. (Welch, Boyd, & Bell, 2009) Secondary prevention

The next level of health promotion is secondary prevention. These interventions used by nurses are used after the patient has an illness or is at serious risk. The goal is to recognize the disease process at its earliest stage and slow or stop its progression. Interventions include medication compliance for example: reminding patients to continue their low-dose aspirin to prevent further heart attacks, TIA’s, or strokes. Regular exams and screenings are recommended for those patients at risk. (Institute for work and health, 2009)

In the article,” Primary and secondary tobacco prevention”, primary prevention focused on education and prevention of experimentation and use. Secondary prevention is used for individuals who are currently using tobacco products. Interventions used are successful cessation courses, evidence-based treatment of tobacco dependence, pharmacotherapy, individual and group counseling. This is utilized at the earliest stages of tobacco addiction to help patients quit and remain smoke free. (Tingen, Andrews, & Stevenson, 2009)

Tertiary prevention

The last level in health promotion is tertiary prevention. These interventions focus on the management and care of patients with disease and the prevention of further deterioration while maximizing the quality of life. (Institute for work and health, 2009) Tertiary prevention is used when managing long-term health problems such as diabetes, heart disease, and cancer. Some examples of tertiary prevention include programs for cardiac or stroke patients, support groups, and pain management programs. In the article, “Tertiary prevention for individuals: Healing the wounds”, prevention is focused on healing. Primary and secondary preventions were used in the treatment of stress but with all the interventions stress continues to occur in most individuals.

Tertiary treatment was designed to return those individuals suffering from high levels of stress back into their home or work environment and minimize the recurrence of stress. Tertiary prevention relies on both help from the individual and help from other medical professionals. It reaches out for additional assistance from employers and outside resources to ensure appropriate programs are available. (Quick, Wright, Adkins, Nelson, & Quick, 2013) Evolution of nursing roles and responsibilities

Health promotion used by nurses is commonly associated with the general principles of basic nursing. Patient education is a regularly used intervention used by nurses in an everyday setting. Health educators are taught health promotion, interventions, state regulations, specific policies, and they must have the ability to apply this education to their patients. Because of the growing diverse population, nurses must become more patient-focused health promoters. While general education is still used, the different patient groups require different health promotional needs. (Kemppainen, Tossavainen, & Turunen, 2013) Implementing health promotion skills is a must for all nurses. The most important skill is effective communication.

They must be able to encourage their patients and their families to have an active participation in their treatment planning. The patients must feel comfortable expressing their feelings about their plan of care. Nurses can help their patients by leading by example. This can be achieved by being healthy role models, living healthy lifestyles, and through positive and caring attitudes that promote health and well-being. Nurses must also possess skill-related competencies including teamwork, time management, data collection, critical thinking, and interpretation of information given from a variety of sources. (Kemppainen, Tossavainen, & Turunen, 2013) Conclusion

In conclusion, health promotion is more important than ever. Health promotion includes primary, secondary, and tertiary preventions. These include education, practice, research, and reinforcement that teaches patients how to prevent and manage diseases. The future of nursing focus on keeping individuals healthy. Nurses must have a strong understanding of health promotion in order to communicate to a variety of groups. As the population grows and becomes more educated through primary prevention overall health of the population will improve.

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References

Institute for work and health. (2009). What researchers mean about primary, secondary, and tertiary prevention. Retrieved from Institute for Work & Health: http://www.iwh.on.ca Kemppainen, V., Tossavainen, K., & Turunen, H. (2013). Nurses’ roles in health promtion practice: an integrative review. Oxford journals. Quick, J., Wright, T., Adkins, J., Nelson, D., & Quick, J. (2013). Preventive stress management in organizations. American Psychological Association, 183-198. Tingen, M., Andrews, J., & Stevenson, A. (2009). Primary and secondary tobacco prevention in youth. Annual review of nursing research, 171-193. Welch, M., Boyd, M., & Bell, D. (2009). Education in primary prevention in psychiatric-mental health nursing for the baccalaureate student. International nursing review, 126-130. World Health Organization. (2014). Health Promotion. Retrieved from World health organization: http://www.who.int/topics/health_promotionHealth promotion is the art and science for helping people develop of their preferences between optimal health and their major passions. What motivate people to achieve optimal health, and what supporting then in lifestyle changing to movie forward to the optimal health. I strongly believe that optimal health is emotional balance, physical, spiritual, intellectual, and social health. Changing of lifestyle based on combination of increase motivation, learning experiences, build skills and creation of different opportunities that give us access to environment that provide positive health practice like the best choice. Moreover, health promotion is amount of information for individuals, communities, and family education. Health promotion is promotion of healthy lifestyle and healthy ideas and help people to achieved their best status of health.

According to the definition of Health Promotion motivate people to take control over to improve their health. For health promotion we need to have support such as: create supportive environment for health and develop personal skills. Health promotion is the most important part of nursing care. Nurse plays important role in public health promoting. Focus for health promotion for nurses more point of disease prevention and changing lifestyle of individuals and their behavior. Moreover, that main purpose of health promotion in nursing is educate people and encourage them respect their health. Nursing role as health promoters is very complex, because of multi-disciplinary experience and knowledge of health promotion in nursing practice. Main idea of health promotion developed to improve community based practice according to the health policies. My idea is that healthcare professionals guide other people to the right health decisions.

Nurses make people re-evaluate their health ideas and moreover we help not just for individual, we help even families, organizations, and communities. Nurses proved models toward health promotion and appraise how effective is evidence-based practice for the future researches. How are nursing roles and responsibilities evolving in health promotion? Nursing of public health practice is focused on population and required a lot of different knowledge, skills and competencies. Nurse must have unique knowledge by focusing working in the community participation in health promotion and prevention. Nursing Role in primary care very important and can redesign of the primary nursing care system when patient is the center of the medical facility. All nursing field working for patient’s care such as: communication with the patients, visit patients at the home for their daily care.

Many resources used for public health nursing practice and centered on improving health of population by prevention methods. Moreover, nurses are advocates and planning for the patients by multi level view of health. We know what our patients needs because we are at bedside and in the community. We take care of patients every day and every hour because nursing is 24 hour care. Nurses improve the health outcome for everybody in the community by applying their clinical skills and experience in health care. Health promotion is focusing on removing bad influences on health to developing healthy environment and supporting individuals and communities to take control and charge of their own health.

Moreover, health promotion build on health education and help people prevent many illnesses and injuries by supporting right healthy behavior. Programs for health promotions include intervention such as lifestyle changing, smoking cessation and primary method of prevention. Unfortunately, people rarely change their behavior that’s why implementation methods must be started in community as a first step for global changes. Local health promotion will bring to the people right set of priorities which can support to promote health.

Health Promotion has three levels: primary prevention, secondary prevention and tertiary prevention. The major one is to protect people from experiencing an injury and protect people from developing a disease. For example: education about quit smoking, the importance of exercise regularly, good nutrition , dangers of alcohol and other drugs. Regular screening tests to monitor risk for illness. Secondary prevention is intervention after disease or risk factor have already diagnosed. The goal is to catch disease in slow face or in earliest stage. As educators we have to tell people to take daily low dose of aspirin as a prevention of stroke or heart attack. We can recommend regular screening tests and exams in people who have risk factors for diseases. Tertiary prevention more about helping people take care of long-term health problems such as diabetes, cancer, and heart attack.

For example rehabilitation programs for stroke, support group chronic pain management programs for the patients. I am nurse in Rehabilitation Center and Long –term facility. I have seen every day how rehabilitation program help people to manage their new lifestyle and how to fight with their illnesses. Else in our facility we have support groups. People can discuss to each other about their health problems, their prognosis and future expectations. Moreover in that group people share with their own experiences and can provide right and helpful information for the patient who just was diagnosed and have a long way ahead to accept that new role in family and community. For a lot of health problems primary, secondary and tertiary interventions combination is necessary to achieve a right level of protection and prevention. For ideal world Primary prevention is the best but unfortunately in our modern busy world not all of us follow the best way.

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The main role here play limit of knowledge about causes of some particular injury or diseases. Although, primary and secondary prevention are clear in areas as heart disease and cancer, may be not that much useful for musculoskeletal illness. In that case prefer to have primary prevention then secondary and tertiary. I am wound care nurse in long term facility and I believing that primary prevention for pressure ulcers is the best way to promote health for all patients. Bed sores are not a disease process and preventive method must be on the first place. Elderly population has higher risk factors to have bed sores because of age, fragile skin, complicated disease, chronic disease.

Prevention is the best way to keep such patients in a good level of health. Many resources now available to prevent pressure ulcers in the long-term facilities: Air mattresses, turning and reposition every two hours and as needed, incontinence care every two hours and as needed, skin barrier, Moreover, physical and occupation therapy intervention: schedule patients for out of bed daily, special cushion to prevent pressure ulcer from prolong sitting. All of that can promote health to geriatric population and make their lives longer and more comfortable.

Else, in wound care preventive measures less cost than treatment. Money that is saved on treatment can be good resources for future researches of wound care field. Wound Care still needs new researches to promote healing. The main reason of prevention in wound healing is sepsis which can lead to death of the patient. We have to take care about our patients and the best care is prevention method. By that we can save people lives and make them feel better and more comfortable in their diseases and injuries.

Art of science of Health Promotion Conference Michael P. O’Donnell (2009) Definition of Health Promotion 2.0: Embracing Passion, Enhancing Motivation, Recognizing Dynamic Balance, and Creating Opportunities. American Journal of Health Promotion: September/October 2009, Vol. 24, No. 1, pp. iv-iv. International Journal of Healthcare Management. Apr2014, Vol. 7 Issue 1, p53-59. 7p. DOI: 10.1179/2047971913Y.0000000058. , Database: Business Source Complete ASCs for the promotion of the wound healing of radiation ulcers via angiogenesis. ….. J Plast Reconstr Aesthet Surg 2010 JOURNAL OF WOUND CARE SORBION SUPPLEMENT 2010.

http://www.jcn.co.uk/key-topics/wound-care/

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Health Promotion Essay

Diversity among individuals, as well as cultures, provides a challenge for nurses when it comes to delivering meaningful health promotion and illness prevention-based education. How do teaching principles, varied learning styles (for both nurses and patients), and teaching methodologies impact the approach to education? How do health care providers overcome differing points of view regarding health promotion and disease prevention? Provide an exampleAccess to health care to obtain a complete physical examination before starting to exercise and the quality of the work or neighborhood environment available for exercise can contribute to success or failure of this objective. This objective is related to other objectives such as nutrition, obesity, and stroke prevention.

Additionally, current knowledge about physical activity and specific populations was considered when creating the Healthy People 2020 objectives. Women, low-income populations, Black and Hispanic people, people with disabilities, and those older than age 75 exercise less than do White men with moderate-to-high incomes (U.S. Department of Health and Human Services, 2012). These health disparities can influence the number of people in these groups who develop high cholesterol or high blood pressure measurements, which further increases their risk of heart disease and stroke. Although this objective addresses adults, other objectives address the need for beginning exercise activities at an early age and encouraging young adults to be actively engaged in exercise. How might this objective be adjusted to the needs of an older adult population? (Edelman 7)

Edelman, Carole, Elizabeth Kudzma, Carol Mandle. Health Promotion Throughout the Life Span, 8th Edition. Mosby, 2014. VitalBook file.

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Health Promotion Essay

The World Health Organization delineated health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (WHO, 1946). Scientists define health promotion as the course of action taken to facilitate people to have power over and to enhance their health generally. To carry on and augment wellbeing some practices such as restraining from smoking, exercising at least three times a week to sustain fitness, reducing contact to radiation and toxic components, eating adequate amount of nutrients and minerals seem essential. In nursing practice, health promotion exists through education to facilitate inhabitants to create choices to keep them in good physical shape. According to the American Journal of Health, “Health Promotion is the science and the art of helping people change their lifestyles to move toward an optimal health.” Other factors that can encourage reaching out the purpose of health promotion are nursing roles and responsibilities, implementation methods that covers all areas of nursing, and the levels of health support. The World Health Organization (WHO) created a movement named Healthy people 2010 to make all Americans cognizant of a variety of ways to prevent diseases and improve their health.

The association placed nurses in the forefront by giving them the lead of the action due to the fact of their constant contact with individuals, families, and communities because they can help them make the right decision to promote health (WHO, 2000.) In addition, they acquire skills through evidence-based practice in critical moments of life to implement essential interventions through education after assessing, using a diagnosis, developing a plan the care of patients; a thorough evaluation of chosen activities always follows to assure a contented turning point. Nurses assist to promote health by helping groups of people in different settings to cultivate healthy lifestyle. The Institute of Medicine has a new research that clarifies responsibilities by stating the important role nurses play to implement and evaluate actions to promote health in the population.

As advocate for the sick, the nurse-client interrelationship should take place for health promotion in order to teach people good habits in the choice of adequate diet to avoid obesity, to stop polluting the environment by quitting smoking for instance and access to clean water seem indispensable; moreover, inhabitants must not permit damaging social conditions that wipe out health to continue as they convey unhealthy states (Sullivan, 2000). Health promotion movements are meant to guard and advance health, and to avoid illness. These activities are grouped into three subsequent levels. The foremost and initial level of health promotion prevention is intended to stop diseases from starting or a trauma from happening. Diseases or trauma to prevent include immunization, household hazards, abstinence from smoking, measures that decrease the risk for stroke, educating and counseling regarding the use of vehicle passenger restraints and bicycle hat.

The primary prevention averts the beginning of an aimed condition. It targets the greatest number of people in a community who might become at risk for a specific health dilemma like asthma which happened to be one of the most frequent respiratory diseases in modern countries. Furthermore, the secondary avoidance measures are those that spot and care for asymptomatic people at risk but in whom the provision is not clinically obvious. Activities of secondary escaping involve early case findings of disease without any sign that occurs and has major risk for harmful result exclusive of cure. Screening tests to detect hyperlipidemia, hypertension, breast and prostate cancer are model of secondary prevention actions. Lastly, when the disease has already started its course of action, tertiary prevention care is given to patient, attempts are made to re-establish highest function and stop sickness-related complications.

Health is a store for everyday life that includes physical, mental, social comfort; consequently, health promotion activities will empower individuals and communities to raise their control over decisions that affect their health. With the possession of interpersonal skills, nurses contribute to encourage patients through teaching to make constructive changes that will keep them in good physical shape throughout life. The three levels of health promotion are supported through education. Within their scope of practice, nurses can allow individuals and communities to gain greater control over the determinants of their wellbeing to achieve the purpose of Health promotion. .

References

Edelman, C., & Mandle, C. L. (2010). Health promotion throughout the life spans (7th ed.). St. Louis: Mosby.

Eisenberg & Neighbors, (2007). National Research Council and Institute of Medicine [NAS-IOM], (2009). A national study by Kessler et al. (2005) According to a report from Institute of Medicine and the National Research Council (IOM and NAS) National Prevention, Health Pro Nola J. Pender, Carolyn L. Murdaugh, and Mary Ann Parsons. Motion, and Public Health Council. (2011). Annual status report [Internet]. Washington (DC): The Council; 2011 Jun 30 [cited 2011 Sep 30]. Available from: http://www.healthcare.gov/ prevention/nphpphc/2011-annualstatus- report-nphpphc.pdf Nola J. Pender, Carolyn L. Murdaugh, & Mary Ann Parsons. (2006). Health Promotion in Nursing Practice (5th ed.) Upper Saddle River, NJ: Pearson Education INCIndividual behavior and state of mind has been noted to have an impact on disease prevention and its associated death. These factors being put into consideration in health promotion puts a demand on the individual to make changes in many aspects of life. Nurses play important role in health promotion by intervening in actions that direct people towards developing resources to maintain or enhance their wellbeing. In this essay three recent publication of professional journal articles reviewed will be discussed as it relates to nursing practice and three level of health promotion. How the role of nurses changed regarding health promotion and the numerous ways nurses implement all aspects of nursing in health promotion. The three levels of health promotion will also be compared. Health Promotion Definition Health promotion is a new model in healthcare. O’Donnell defines it as “the science and art of helping people change their lifestyle to move towards a state of optimal health.”(Edelman & Mandel, 2010, p. 14).

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Nevertheless, health promotion is mainly all about inhibition and living healthy life style that leads to lower rate of diseases and death. Health promotion is different methods of life style people adopt to maintain good health. These actions lead to good quality life that brings about well-being and improve the quality of life and not only absence of disease. Individuals attain good health by exercising, eating healthy, living stress free life to take charge of their life. The purpose of health promotion in nursing practice is to bring about change in people’s attitude and action to start healthy lifestyle that will sustain or enhance their wellbeing .This helps individuals reach goal towards optimum health. Nurses are in the fore front of this program with main role in health promotion and disease prevention .

They engage in changing the healthcare system from old way of managing and curing illness to model of health promotion. The nursing role and responsibilities in health promotion is an active one because they function in all the areas encouraging and reinforcing the positive actions individuals demonstrate towards lifestyle changes. Nurses use evidence base practice, education, providing positive support to reach progress towards goal. In the literature reviewed the three level of health promotion were used to manage diabetes type two in Latino community with positive outcome. With education of the people progress was made towards achieving health promotion.

These were done in the public, community level and personal level. The nursing roles and responsibilities evolving in health promotion, and implementing methods for health promotion that encompasses all areas of nursing. In health promotion nurses work together with other health care associates and the community displaying a variety of roles: Advocate by striving to ensure that everybody attain high-quality life style, suitable, and at low cost Case manager role involves gathering of reliable data to make sure there is no duplication of services. Consultant role in their areas of practice or advance practice stand.

Primary prevention in type two Diabetic patients in literature review.

The first measure includes immunization against disease and disability, good water supply, and safety. The next step is promotion of health by healthy life style ,eating healthy, exercising clean living environment and stress management. Primary prevention is taking initiative and advantage of available programs to detect and stop disease especially for those with risk factors, for example yearly medical exam and screening that will include blood work like fasting blood sugar and HgA1c.as was seen in the literature review.

Through the screening and education of the people in this community type two diabetes was successful prevention. The interventions and practices include but are not limited to identification of those with the risk factors, weight reduction, blood works for fasting blood sugar and hga1c.These people were noted to have knowledge deficit on self-care. And with education the main tool used in primary level progress was made towards goal by the evidence in lifestyle modifications leading to significant weight loss and reduction in hemoglobin A1C.(Surucu & Turkey, 2011)

Secondary prevention in type two diabetic patient literature reviews. In secondary prevention diseases are found in its earliest stages, before it becomes symptomatic. Identification and diagnosing the disease early leads to positive outcome in the healing process, its progression are slowed down prevented and complications, are controlled bringing disability to minimum. This literature review was community based. Learning sensitivity tests, ethnically designed life style for weight reduction and diabetes risk reduction within low-income group were carried out in Spanish-speaking Latinos high risk diabetics. They were erratically allocated to lifestyle intervention care (IC) or usual care.

They also examined the success of life style intervention conducted in lower cost lower intensity format to high risk populace. It was found compared with the usual care the IC care had a modest but significant weight reduction and medically meaningful decrease in hemoglobin A1C, insulin resistance and greater reductions in percentage of calories from total and saturated fat. They developed an inexpensive culturally sensitivity diabetes (Ockene et al, 2012) prevention program that resulted in weight loss, improved HbA1c and improved insulin resistance in high risk Latino populace.(American Journal of Public Health 2012)

Tertiary prevention in type two diabetic patient literature reviews. If prevention and secondary prevention fails to improve the patient’s health, tertiary prevention will be the next option to combat the ailment. Tertiary prevention program is mainly maintenance of quality of life in individuals affected with some diseases. Complications and disabilities severity reduced with advancement of disease stopped. Therapy is done to restore function. It was conducted by health care professionals and physical therapists.

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This stage includes follow-up and reviewing of all prescribed medications with reinforcement of its compliance, dietary and lifestyle modifications by community health nurses. In this literature review, the physical therapy was for gait training and stability to improve standing balance control in neuropathic patients with type two diabetes.(2011(Journal of Rehabilitation Research and Development 2011). In conclusion nurses are the main people that direct health promotion but the success depends on how individuals, families, communities take charge of their health by practicing all the mentioned life style modifications.

References

.

Last name, first initial (2011, December 7th).Title of the article. Journal of Rehabilitation Research and Development (JRRD). 48(issue) pgs.

Edelman, C. L., & Mandel, C. L. (2010). Health Promotion Throughout Life Span (seventh edition ed.). Location: Pulisher Ockene et al, I. (2012). Research and Practice Peer Review. American Journal of Public Health, 102.(2) pg. Surucu, H. A., & Turkey, S. K. (2011). Selfcare Deficit Nursing theory in the Self-management with type two diabetes. , Journal title, Volume #, (Issue Number) pgs.

Comments: Chigo, you did a great job defining and discussing the definition of health promotion and the purpose of nursing in health promotion. This was excellent. You also looked at the roles of nursing in health promotion. Including how these roles are evolving was a needed element. You reviewed a few implementation methods, but this discussion was needed additional details outlining how this encompasses all areas of nursing and utilizing the reviewed articles to support ideas presented. You compared the 3 levels of prevention and reviewed 3 articles related to each level. There were multiple grammatical errors and some of the paragraphs and organization was confusing. Make sure to proof-read the paper. There were several APA errors, missing references, and missing elements for the references listed. Please refer to the APA style guide to help with these issues. Again, you did a great job discussing the definition and purpose of nursing in health promotion. Melanie

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Health Promotion Essay

The World Health Organization(WHO) defines health promotion as “the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being (World Health Organization, 2013).

What health promotion means to my nursing practice is ensuring that all my patients are treated with a holistic perspective. Not only are their physical needs met but they are mentally and socially able to effectively go back into the community with the appropriate resources to help them prosper. Nurses play a huge role in illness prevention and health promotion. We, as nurses assume the role of ambassadors of wellness. I believe that nurses play just as an important role in caring for the well as they do in caring for the sick. Caring for the well can actual be more important than caring for the sick because prevention is key. If we can preserve wellness, we reduce the number of times a person needs to enter the health-care system, thus reducing costs. To facilitate that process, we must provide people with appropriate information. Nurses have a key role in providing that information in the form of health teaching.

An example was when I was caring for one of my patients who was awaiting long term care. She was in with a diagnosis of failure to cope. She did not have many physical needs that needed to be met except assistance with ADL’s and medications. However, she stated to me numerous times how she was lonely and how her family was not able to come visit her often. She was in need of therapeutic communication. She had felt very lonely being trapped in a closed environment such as the hospital for such a long time. Not only was it important for me to meet her physical needs she was in desperate need for her social well-being. I would set a certain amount of time in my day aside to ensure I had time to interact with her throughout my shifts. Being

confined and isolated in the hospital can become very lonely thus, is it vital to ensure adequate communication aside from disease related communication is provided to patients.

One client for whom I have cared for was a 74 year old female who presented with a primary diagnosis of right hip fracture. She had secondary diagnoses of emphysema, asthma and hypertension. The surgery she had performed was right monopolan. She was transferred to the unit after initially arriving at emergency with a fractured hip. She had previously experienced a fall which resulted to her injury.

Psychological needs include oxygen, food, water, a sense of security, sense of self esteem, to learn to be able to give and receive love, affection and feel a sense of belonging. The patient was very independent and lived on her own in a single storey house prior to her fall. I wanted to discuss with the patient how this injury makes her feel in regards to her independence. She was quite upset about the possible fact she might not be able to return to her lifestyle prior to her surgery. I explained to her the many resources she will have available in the community if she wanted to continue to reside alone such as CCAC. I discussed with her they will be able to come to her house if she required assistance with ADL’s following her discharge from the hospital. By addressing her concerns about her illness she portrayed a sigh of relief and became more comfortable about her recovery process.

A patient can begin to feel very lonely once they are admitted to the hospital because it is a very confined space with many strangers that can make some patients uncomfortable. I ensured that I tried to spend enough time with the patient to ensure she was not feeling anxious or alone. I also instructed her to include her family and friends in her recovery. I discussed with her that going on walks with her family when they come to visit, taking a walk to the sunroom in a more interactive environment would make her feel happier and not just a patient in the hospital.

Cultural and spiritual aspects in a individuals life can have a huge aspect in their recovery. I discussed with her what she believed in. She explained

to me that she was a Jehovah witness. She also explained to me that she did not want any blood products due to her beliefs. She told me she was quiet religious and how that helped her a lot throughout her life. I advised her to continue with her routine even while at the hospital and how that would help with her recovery.

Physical needs were also met, with routine meals throughout the day. She was on a full adult diet. Many times the patient was hungry between meals, which is when I would offer her toast, or a sandwich from the kitchen. She was very good with diet, she understood when she was full and when she needed more. She explained to me that she ate a very well-balanced diet at home consisting of fruits, vegetables and protein. She was 160.02 centimeters with a healthy weight of 58.967 kilograms. She was also an active individual, always wanting to try to get up to go to washroom, or going for walks to the sunroom or just around the unit. Her lab results showed that her white blood cells were high at 17.2 which was most likely due to her surgery. Her hemoglobin was slightly low at 105 and similarly her hematocrit at 0.33 for which she was taking ferrous gluconate twice a day. Due to her surgery and her age she was also taking routine calcium and vitamin D tablets. She also had a history of hypertension which was well managed at 122/65 with lopressor (Metoprolol) and cozaar (Losartan potassium). She was also taking a multivitamin (Centrum) for overall nutrients and vitamins. Due to her lab results her potassium was slightly low at 3.0 therefore Apo-K was ordered once daily. The client was having adequate elimination and however, she stated she was not having routine bowel movements although she was taking Colace (Docusate sodium). I explained to her that this was most likely due to her decrease in activity since her surgery. I explained to her once she was able to ambulate more often that they should go back to how they were prior to her injury. I also used this as an opportunity to educate her on how to manage her hypertension through diet. I explained to her how it was important to avoid foods high in salt and fat in order to reduce and maintain her blood pressure. I encouraged her to increase her fluid intake so we could disconnect her from her IV fluids. She was an active participant in her physiotherapy and was quite motivated to ambulate and recover so she could return home.

One obvious wellness diagnosis for this patient was risk of injury from fall related to mobility impairment, compromised musculoskeletal and post-op hip surgery manifested by use of assistive devices, age >65, difficulty ambulating, and weakness in extremities (Ackley & Ladwig, 2008, p. 344).

A second diagnosis is acute pain related to surgical incision on right hip manifested by facial grimace, guarding behavior and verbal report of pain felt in right hip (Perry & Potter, 2010).

A third is risk of infection related to post operative incision on right hip manifested by incision line, open wound and a dressing (Ackley & Ladwig, 2008).

Another diagnosis is activity intolerance related to generalized weakness, right hip surgery manifested by verbal report of pain & weakness, imbalance between oxygen supply and demand portrayed by need for oxygen (Ackley & Ladwig, 2008).

Lastly, a diagnosis of readiness for enhanced self-care related to independence in maintaining life, health, personal development and well-being manifested by verbal desire to return home, desire for independence, well-balanced meals, increase in fluid intake and active participation in physiotherapy (Ackley & Ladwig, 2008).

References

Ackley, B.J., & Ladwig, G.B. (2008). Nursing diagnosis handbook: An evidence-based guide to

planning care (8th ed.). St. Louis: Mosby Elsevier.

Perry, A. G. & Potter, P. A. (2010). Clinical nursing skills and techniques (7th ed.). St. Louis: Mosby. World Health Organization. (2013). Ottawa charter for health promotion. Retrieved from: http://www.who.int/healthpromotion/conferences/previous/ottawa/en/Health Promotion and Prevention

Monica Covarrubias

Grand Canyon University- NRS 429V

September 8, 2013

Nurses are in the forefront for becoming great, influential leaders in the transformation of future healthcare through the use of education and health promotion. As the population continues to grow, nurses are sought out as educators and not just caregivers. Nurses are also capable of providing the public with the education it needs to prevent illness and disease, and promote quality healthcare. By expanding emphasis not only on the individual, but family and community groups as well, a wider outreach for public health, promotion, and education can be addressed. There are three types of prevention described as primary, secondary and tertiary, which aim to prevent the onset of a targeted condition (GCU, 2011). Implementing health education to avoid health conditions as the primary prevention, aiding and treating symptomatic individual’s as the secondary prevention, and restore function and negative effects of an already acquired disease as the tertiary prevention, the hopes to overcome and implement a cost- efficient, healthy lifestyle can be achieved (Fitzgerald, 2011).

Through health promotion, prevention, and intervention, the future of healthcare can be based on educating the public to promote longevity and quality of life by using primary, secondary and tertiary preventions. The World Health Organization (WHO) defines health promotion as “the process which enables people to improve control over the determinants of health, and as a result to improve their own health” (Jadelhack, 2012). By providing health promotion to others, the nurse is enabling the individual to take control, responsibility and action for their own healthcare. “Individually and through national associations, nurses, along with other healthcare providers, can be effective in paving the road for good health through health promotion” (Jadelhack, 2012). Through seminars, lectures, handouts, and teaching, nurses are educating the public to become their own advocates of care.

Through the use of health promotion and education, the nurse is teaching the individual about disease, prevention, and how to promote for the care of themselves and their families. The American Nurses Association (ANA) states, “Nursing must expand its efforts to design and implement interventions which support promotion of health and prevention of disease/illness and disability” (ANA, 2007). There are multiple dimensions that must be taken into consideration when referring to the health of an individual including, physical, mental, spiritual, and social. With the evolution of healthcare, nurses must begin to increase their efforts in health promotion by viewing the individuals they serve as holistic, and also considering the families and communities as well.

With the evolution of nursing into public, community, and home healthcare settings, nurses must now have a wide knowledge base, adequate critical thinking skills, and an active involvement in disease prevention, to promote quality health (Edelman & Mandle, 2010). The nurse must utilize the nursing process by assessing the individual’s learning style and educational background in order to adequately present material to the individual. The nurse must plan, implement and evaluate the individual’s change in lifestyle habits including physical activity, healthy eating, and motivation, need and desire in order to transform into a healthier way of life. The nurse has evolved into a primary care giver and “Therefore, the attitudes of the nurses towards health promotion may well affect their willingness and ability to promote health” (Cross, 2005). Health promotion is an important concept for nursing as it encompasses the nurse in collaboration with other healthcare professionals.

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The nurse’s role may include patient advocate, healer, client educator, care manager, and nursing researcher (Edelman & Mandle, 2011). “Much of the nursing role is involved with health teaching…health education is clearly a nurses role” (Edelman & Mandle, 2010). Nurses must incorporate the three levels of prevention when implementing health promotion throughout all areas of nursing including acute care settings, long-term care settings, community and public health, and mental health. By utilizing each type of prevention, nurses are able to educate and advocate quality client care to the public in a way that will be most beneficial to them. Primary prevention “reduces both the incidence and prevalence of a disease” (CDC, 2007). Of each prevention type, primary prevention is the most beneficial, as it helps to avoid or avert any health illness, disease, or negative lifestyle behavior before it originates. Health education about risk factors and specific protection towards illness are utilized to decrease the vulnerability of the individual to disease or dysfunction (Edelman & Mandle, 2010). Secondary prevention has been said to “include screening and clinical interventions aimed at the prevention of ill health and recurrence of episodes of ill health…” (Peckham, et. al., 2011).

The use of secondary prevention is valuable to the individual who might have a certain health illness or condition and is unaware as its primary focus is aimed at screening and identification of illnesses before they begin. Tertiary prevention is focused on maintenance and care of an illness that is already prevalent and has already been established (GCU, 2011). While tertiary prevention is classified as a prevention type, it emphasizes its efforts on managing and conserving illnesses after they have already been recognized unlike those in the primary and secondary prevention levels. Although there are three levels of prevention and all are different, they may overlap at times, which should not be confused by healthcare providers. In order to maximize education and quality health promotion, it is essential to determine which type of intervention should be utilized to improve and increase quality care for each individual. With the ever-changing healthcare system, healthcare professionals should focus their efforts on curing not just caring.

With the use of technology today and the ever-changing healthcare system, the nurse can adequately inform the community about healthcare promotion and education to evolve the future into a healthy way of life. By investing in the promotion of quality health, we are saving in healthcare costs as prevention promotes for fewer hospitalizations and long term health care. Through the use of education, health promotion and prevention can become a widespread, economical intervention in the move to implementing a healthy, quality lifestyle.

References:

Center for Disease Control (CDC). (2007). Module 13: Levels of Disease Prevention. Retrieved September 6, 2013 from

http://www.cdc.gov/excite/skincancer/mod13.htm

Cross, R. (2005). Accident and emergency nurses’ attitudes towards health promotion. Journal Of Advanced Nursing, 51(5), 474-483. doi:10.1111/j.1365-2648.2005.03517.x Doody, C. M., & Doody, O. (2012).

Health promotion for people with intellectual disability and obesity. British Journal Of Nursing, 21(8), 460-465. Edelman, Mandle, C. (2010). Health Promotion Throughout the Life Span (7th ed). Mosby. Retrieved from

http://pageburstls.elsevier.com/books/9780323056625/id/B9780323056625000012_p0790 Fitzgerald,M. (2011). Primary, Secondary, and Tertiary Prevention:
Important in Certification and Practice. Retreived September 6, 2013 from http://fhea.com/main/?p=certificationcols/level_prevention.htm Grand Canyon University. (2011). Health Promotion in Nursing Care. Retreived September 1, 2013 from https://lc-ugrad1.gcu.edu/learningPlatform Jadelhack, R. (2012). HEALTH PROMOTION IN NURSING AND COST-

EFFECTIVENESS. Journal Of Cultural Diversity, 19(2), 65-68.

Peckham, S., Hann, A., & Boyce, T. (2011). Health promotion and ill-health prevention: the role of general practice. Quality In Primary Care, 19(5), 317-323.

The American Nurses Association (ANA). 2007. Health of the Public. Retreived September 1, 2013 from

http://web.archive.org/web/20071027171411/http://www.nursingworld.org/MainMenuCategories/HealthcareandPolicyIssues/HoP.aspxToday people believe that they are all healthy. Later, when there are any variations in regard to their health condition, they got shocked. People are not foreseeing how their health affects in every aspect of everyone’s life. In this essay we will describe health promotion of health and its principle. Further it will explain the roles of nurses in promotion of health. The health promotion is divided into 3 levels as the primary, secondary, and tertiary levels of prevention. Health Promotion

Among so many health promotion definitions, the United States Public Health Service defines the promotion of health as “the process of advocating health in order to enhance the probability that personal, private, and public support of positive health practices will become a societal norm” (Edelman & Mandle, 2009). For the better effectiveness of health promotion, people should be in command of all aspects in reference to their health and their lifestyles. They can’t hold someone or something responsible when there is a decline in their health. Each individual must be held liable for the decisions they take in reference to their own health.

The purpose of Health Promotion The main purpose of promoting health is to train public about their health and to be in command of all the views about their way of life which in turn affect health. It also promotes different types of education to maintain the awareness about health that public need to make helpful decisions in life. We can use health promotion on the public level, the private level, and in the community (Edelman & Mandle, 2009), which are all essential when it come to educating. Roles and Responsibilities of Nursing Promotion of health is vital in the career of nursing because we take part in a major role through edification.

As nursing professional, we have to know that different elements that affect the patient’s health other than their way of life choice. (Bennett, Perry, & Lawrence, 2009, p. 49). Nursing professionals are the primary care providers for the patients. Nurses are refining the patients with discussions regarding their illness, computer journals or pamphlets and videos. As nurses train them constantly the patients do not even recognize that it is done. Implementing Health Promotion The nursing career offers an extensive diversity of job opportunities. Because of various setting, the nurses can train patients on all the levels.

As an instance, for a hospitalized patient, the nurses will make use of nursing diagnoses to teach the individual. When nursing care is carried out in a public health center, the patient education can be in a group setting or on a one-on- one base with movable units for the homeless. Whatever the situation, nurse work collectively with professionals of an interdisciplinary group whose main objective is the improvement of patient’s life with tutoring and proper care of the patient. Health Promotion and Prevention levels There are 3 levels in the promotion of health as primary, secondary, and tertiary levels of health promotion.

(Edelman & Mandle, 2009). Primary prevention consists of giving teaching lessons to patients and they will help them to identify the risky elements for illness and implement a plan to avoid this disease (Edelman & Mandle, 2009). One illustration for this is the teaching regarding Cardiovascular Disease. We have to keep in mind that a few measures cannot be distorted like the age and gender of the individual. But some risk measures which can be altered includes “weight, blood pressure, cholesterol and blood sugar levels”. (Jansen & de Bont, 2010, p. 396).

These levels of risk measures can be reduced with weight control, do exercises, changing the eating practice and to either lessen or stop smoking, with the aim of quitting. With proper teaching, this will strengthen the patient to formulate the essential changes for a improved way of life to put a stop to and guard them from this illness. In reference to Edelman and Mandle (2010), the secondary level of prevention consists of tools like laboratory results and treats the sickness in its early stage. Throughout this level further elements that can influence training comprise of behavioral and dietary changes.

The secondary level is using for the treatment of the illness in early stages and to stop more development of the illness. (Bennett et al. , 2009). Nursing interventions are important for the good results for the patient and the needs to be efficient for general enhancement of health. (Abraham & Johnson, 2011). For an instance, an individual is diagnosed with Cardiovascular Disease. He is on prescription for hypercholestermia. We have to perform follow up labs at intervals particulate by the doctor, with altering their eating and activity habits.

The patient can decrease or stop his medication dosage related to their precise circumstances and changes made to their way of life. The third stage is tertiary promotion which consists of reinstallation and rehabilitation after the illness has been recognized (Edelman & Mandle, 2009). The objective at this stage is, try to replace as much independent living as can after a serious illness or incident. For instance, an old patient who was living independently but fell down and got hip fracture. After the surgical procedure the patient may be transferred to a rehab unit.

In this, physical therapy will be used for strengthening and walking training and occupational therapy will be used for teaching in daily activities of living. Once discharged, there can be further Physical Therapy and Occupational Therapy planned for the assistance of the client to improve. It may take place in an outpatient clinic or in home care to support independency. (Ryburn, Wells, & Foreman, 2009). Authors agree a fact that suggests therapy has a positive outcome on the psychosocial and physical health, and value of life. (Ryburn et al. ,2009). Conclusion

These three levels for the promotion of health are used daily along with the care of patient in the nursing field. If we utilize appropriately, health promotion levels will raise the life expectancy and the quality of life. A nurse’s role encompass as consultants and advocate for the patients, dietician, educators and many other tasks which concerns about the patient. Education has a major role in the promotion of health to our patients. References Abraham, C. , & Johnson, B. T. (2011). Editor’s Introduction to the Special Issue on Health Promotion Interventions. Psychology and Health, 26(2), 129-132. Bennett, C.

, Perry, J. , & Lawrence, Z. (2009). Promoting Health in Primary Care. Nursing Standard, 23(47), 48-56. Edelman, C. L. , & Mandle, C. L. (2009). Health Promotion Throughout the Life Span (7 ed. ). : VitalSource Bookshelf. Jansen, Y. , & De Bont, A. (2010). The Role of Screenings Methods and Risk Profile Assessments in Prevention and Health Promotion Programmes: An Ethnographic Analysis. Health Care Anal, 18, 389-401. Ryburn, B. , Wells, Y. , & Foreman, P. (2009). Enabling Independence: Restorative Approaches to Home Care Provision for Frail Older Adults. Health and Social Care in the Community, 17(3), 225-234.The 21st century poses vast challenges for public health, with environmental threats, cultural diversity and an ever aging population. The role of health promotion is as important as ever, within this assignment I will look at the issues we face and the techniques used to alter public perception and behaviour. One definition widely highlighted from the World Health Organisation states that health is ‘a state of complete physical, mental and social well being’ (WHO 1947). This definition encompasses the indicators of poor health but does seem to view health as something that is quite conventional and static. This can be contrasted to a definition from Parsons who defines health as ‘the state of optimum capacity for an individual for the effective performance of the roles and tasks for which they have been socialised’ (Parsons 1971). Here we are viewing health as something maintained to the standard needed for us to perform our lifestyles. Health promotion is of great apprehension not only for the NHS but also many other groups that are involved in health care such as social, environmental and welfare practices. At its core is the intention of empowering individuals and communities to allow greater control of their health by providing information, education and support.

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Varying methods and strategies are used to change people’s perceptions of health, with the aim of working toward the creation of stronger communities and improved future health for all. The health belief model emphasises the function of beliefs and perceptions in human decision making. Originally developed by Rosenstock in 1966 it looks to predict patterns in health behaviour, such as willingness to partake in vaccinations and act upon health advice. It suggests that the factors that govern an individual changing their behaviour are based around an assessment of how feasible change is and the benefits provided. It puts forward the idea that people need relevance or a trigger to initiate decision making (Naidoo, Wills 1994). This model incorporates Bandura’s concept of self-efficacy. This suggests that an individual must believe they have the capability and insight to see an intended behaviour change through (Bandura 1991).

The empowerment model seeks to expand the individual’s capability to control their own health. This model facilitates a move toward change by building an individual’s sense of worth and identity, allowing them to indentify their own health concerns (Naidoo, Wills 1994). It aims to develop decision making and problem solving skills, giving the individual the tools needed to see changes through with independent thought and action. This model can be very effective for young people who sometimes struggle to make independent decisions and are susceptible to peer and environmental pressures. There is a strong relationship between employment and health. The main negative being occupational ill health, this can be an issue for many people working within manual job roles, as well as people working in stressful high pressure environments. It’s shown that having little or no control over work processes and being in lower positions can contribute to ill health (Marmot et al 2006). Unemployment is of a greater risk to ill health than employment, moving people into work can be seen as a health promotion in its own right. Employment brings higher living standards, more disposable income, improved confidence and wellbeing. Gender is still a large determinant, men generally work in more manual roles and take poorer care of their health overall. Loosing work can actually double the risk of a middle aged man dying within the following five years. Evidently there are strong links between employment and men’s wellbeing. Men over the age of 65 are also three and a half times more at risk of developing coronary heart disease than women (DH, 1998). Men’s life expectancy still lags behind that of women and within Europe there are large inequalities in life expectancy. These differences are greatest in men, where as the difference between the best and worst countries for male life expectancy is 17 years, for women it is 12 (BBC, 2013). Clearly there are health inequalities within gender that need to be addressed.

The promotional campaign stoptober is clearly targeted toward working classes; the majority of the subjects pictured are in uniforms that are associated with lower paid roles. There is evidence to suggest that smoking related deaths are higher amongst poorer social classes (ASH, 2006). The branding used is very simple and appeals to people’s logic through the use planning, note making and goals toward quitting. This appeals to the individual and gives a greater sense of empowerment and personal involvement in the process of creating change. The campaign seems to utilise the stages of change model, the process is broken down into stages and encourages involvement in the planning process. Initially encouraging the participant to write down why they are taking part (contemplation) and then take part in a planning process (preparing to change) along with accepting extra support (Prochaska, DiClemente 1992). Evidence from studies shows that when people are involved in a planning process there is a higher probability they will succeed (McLeod, Clark 1993).

There is no mention of the harms of smoking and shock tactics are not used. Raising awareness of the dangers is clearly not enough and more personal tactics are used. With addictive habits highlighting the negative consequences does not seem to help create behavioural change, clearly ‘short term gratification is a greater incentive than long term harm’ (Nanidoo, Wills, 1996, pg 182). There is a very collaborative feel behind the promotional material with comments like ‘you’re not in this alone’ and ‘were with you all the way’. There is clear intent to show that the task of quitting is achievable and by anyone. As Bandura states ‘seeing people similar to oneself succeed by sustained effort raises observers beliefs that they too possess the capabilities to succeed’ (Bandura 1994). This is clearly a core strategy of this campaign, when we see someone succeeding this helps to increase own self efficacy. Health has broad range of definitions and many see health as an all encompassing ideal state. Some however acknowledge that a functional state of health can be achieved despite the presence of illness or disease. The role of health promotion is to help people work towards their personal health potential, at the same time reducing the strain on services. With the recent rises in poverty there is clearly demand for new and effective health promotions. Stoptober meets these needs well by using tried and tested health promotion techniques. It is an effective and socially relevant campaign and last years figures of ‘160 000′ quitters speaks volumes on its success. Word count 1100

References

ASH (2006) Major Online Mapping Project Shows ‘Iron Chain’ Between Smoking and Deprivation http://www.ash.org.uk/media-room/press-releases/major-online-mapping-project-shows-iron-chain-between-smoking-and-deprivation. (Accessed 02/11/13)

Bandura, A. (1991). Self-efficacy mechanism in physiological activation and preventing behaviours. Cambridge University press Bandura, A. (1995). Self-efficacy in changing societies. Cambridge University Press BBC (2013) European men lag behind in life expectancy. (Online). Available at: http://www.bbc.co.uk/news/health-21760905 (Accessed 03/11/13) Boseley,S. (2006) Iron chain links smoking and poverty. Guardian. Available at: http://www.theguardian.com/uk/2006/oct/09/smoking.socialexclusion (accessed 02/11/13) Current Nursing. (2012) Stages of change model (Online): Available at: http://currentnursing.com/nursing_theory/transtheoretical_model.html Davidson, N. Lloyd, T. (2001) Promoting Men’s Health: A guide for practitioners. Harcourt Publishers Naidoo, J. Wills, J. (1994) Health Promotion: Foundations for practice. London. Bailliere Tindall Marmot,M. Wilkinson, R. (2006) Social Determinants of Health, 2nd Edition. Oxford. Oxford University Press. NHS, Smokefree. (2013). Stoptober. (Online).Available at: http://www. http://smokefree.nhs.uk/stoptober/. (Accessed 25/10/13) NHS, Smokefree (2013) Stoptober (leaflet) (Accessed 14/10/13) Ogden, J. (2012) Health Phychology: A Textbook. Berkshire. Open University Press. Prochaska J, DiClemente C, Norcross, J (1992). In search of how people change: Applications to Addictive Behaviours. American Psychologist, Vol. 47, No 9 Tones, K. Tilford, S. (2001) Health promotion: Effectiveness, efficiency and equity. Cheltenham. Nelson Thornes WHO, (2013). World Health Organisation. (Online).Available at: http://www.who.int/en/. (Accessed 23/10/13)

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Throughout history public health effort has been directed to the control of transmissible diseases, reduction of environmental hazards, and provision of safe drinking water. The Greeks believed that ill health developed from an imbalance between man and his environment, not unlike contemporary public health theories of multifactorial disease causations, in which environment plays a prominent role (pg 5). In the middle ages (AD 500-1500), epidemics of infectious disease spurred collective activities by communities to promote the public’s health, presaging the later formation of boards of health and public health departments In the 1800s. Medieval cities were run by councils who supervised disease prevention, sanitation, and protection of community health.

The first public health revolution was the struggle against infectious disease in the late 1800s and early 1900s, which involved sanitation and immunization. The second revolution was spurred by the prevalence of chronic disease, including heart disease and cancer. In 1979 Healthy People marked a turning point in the approach and strategy for public health in the US. Americans adopted simple measures to enhance health including: Eliminating cigarette smoking, reduction of alcohol misuse, moderate dietary changes to reduce the intake of excess calories, fat, salt, and sugar. Other ways to enhance health include moderate exercise, periodic screenings such as high blood pressure and certain cancers.

Healthy people recognized that in the past, individuals did not have complete control or responsibility over their health status in part because of socioeconomic and environmental determinants (pg 29). The differences between historical and contemporary health promotion is that they were both based from different time periods, where back then there preventions were based off the knowledge they had. In the present times we have gained and learned so much more especially from our history, that we now have better advanced ways to promote health with preventative measures learned and understood through findings and experience. The differences developed in order to continue with the promotion of health in a better advanced way, which will better the future for generations to come.

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