Health Promotion; Lifestyle
Management; Health Education; Patient Education
Martucci, RN, MS
Meg Gulanick, RN, PhD
NANDA: The state in which a patient in stable health is actively
seeking ways to alter personal health habits and/or the environment in order to
move toward a higher level of health
Health promotion activities include a wide range of topics, such
as smoking cessation; stress management; weight loss; proper diet for
prevention of coronary artery disease, cancer, osteoporosis, and others;
exercise promotion; prenatal instruction; safe sex practices to prevent
sexually transmitted diseases; protective helmets to prevent head trauma and
other practices to reduce risks for diabetes, stroke, and others.
Patients of all ages may be involved in improving health habits,
though younger patients often more aggressively approach risk factor reduction
in areas where research has documented beneficial effects. Less research has
been conducted with the elderly population, though patients of any age should
be encouraged to adopt a healthy lifestyle to improve their quality of life.
Age is also a consideration in designing specific interventions such as
exercise. Elderly patients require a longer warm-up period when initiating
exercise, and their target heart rate may be lower.
Social cognitive theory identifies factors (behavior, cognition
and other personal factors, and the environment) that influence how and to what
extent people are able to change old behaviors and adopt new ones. Psychosocial
factors such as stress and anxiety regarding perceived risk for disease, along
with social support for engaging in the health-promoting behaviors must be
considered. Finally, the action plan must be tailored to fit with the patient's
values and belief systems.
The setting in which health promotion activities occurs may range
from the privacy of one's home, group activities such as weight maintenance
groups or health clubs, or even the work setting (especially targeted programs
for hypertension management and weight reduction). This care plan gives a
general overview of health-seeking behaviors and then focuses on one specific
- New condition, altered health status
- Lack of awareness about environmental hazards affecting
- Absence of interpersonal support
- Limited availability of health care resources
- Unfamiliarity with community wellness resources
- Lack of knowledge about health promotion behaviors
- Perceives optimum health as a primary life purpose
- Expresses desire to seek higher level of wellness
- Expresses concern about current health status
- Demonstrated or observed lack of knowledge of health promotion
- Actively seeks resources to expand wellness knowledge
- Expresses sense of self-confidence and personal efficacy
toward health promotion
- Verbalizes perceived control of health
- Anticipates internal and external threats to health status and
desires to take preventive action
- Patient identifies necessary environmental changes to promote a
- Patient engages in desired behaviors to promote a healthier
- (i) independent
- (i) Determine cultural influences on health
- Certain ethnic and religious groups hold unique beliefs and
health practices that must be considered when designing educational
- (i) Question patient regarding previous
experiences and health teaching.
- Adults bring many life experiences to learning sessions.
Often patients have previously tried unsuccessfully to engage in a specific
health practice. Reasons for difficulties need to be explored.
- (i) Assess patient's individual perceptions
of health problems.
- According to models such as the Health Belief Model, the
patient's perceived susceptibility to and perceived seriousness and threat of
disease affect health-seeking behaviors.
- (i) Determine at what stage of change the
patient is currently.
- The Transtheoretical Model emphasizes that interventions
for change should be matched with the stage of change at which patients are
situated. For example, if the patient is only "contemplating" starting an
exercise program, efforts may be directed to emphasizing the positive aspects
of exercise; whereas if the patient is in the "preparation" or "action" stages,
more specific directions regarding exercise (e.g., places to exercise,
equipment, target heart rate, warm-up activities, and others) can be
- (i) Identify priority of learning need within
the overall plan of care.
- Patients learn material most important to them.
- (i) Identify any misconceptions regarding
material to be taught.
- (i) Assess patient's confidence in his or her
ability to perform desired behavior.
- According to the self-efficacy theory, positive conviction
that one can successfully execute a behavior is correlated with performance and
- (i) Identify patient's specific strengths and
- Every patient brings unique strengths to the health
planning task (i.e., motivation, knowledge, social support).
- (i) Identify health goals and areas for
- Systematically reviewing areas for potential change can
assist patients in making informed choices.
- (i) Identify possible barriers to change
(i.e., lack of motivation, interpersonal support, skills, knowledge, or
- If the patient is aware of possible barriers and has
formulated plans for dealing with them should they arise, successful behavioral
change is more likely to occur. For example, if trying to engage in more
exercise, shopping malls can be substituted for outdoor activity during periods
of inclement weather.
- (i) independent
- (i) Clearly define the specific behavior to be
- The more precisely defined the behavior is, the greater the
chance of success.
- (i) Guide the patient in setting realistic
- Goals that are too global, such as "lose 30 lbs," are
difficult to achieve and can foster feelings of failure. Shorter range goals
such as "losing 5 lbs in a month" may be more achievable and therefore
- (i) Promote positive expectations for
- Patients with stronger self-efficacy to perform a behavior
are much more likely to engage in it.
- (i) Assist patient in developing a
- Contracts help to clarify the goal and enhance the
patient's control over the behavior, creating a sense of independence,
competence, and autonomy.
- (i) Assist in developing a time frame for
- Changes need to be made over a period to allow new
behaviors to be learned well, integrated into one's lifestyle, and
- (i) Allow periodic evaluation, feedback, and
revision of health plan as necessary.
- This provides a systematic approach for movement of patient
toward higher levels of health and promotes adherence to plan. Appropriately
timed feedback is critical to successful behavior change.
- (i) Reward positive efforts and
- Rewards may consist of verbal praise, monetary rewards,
special privileges (earlier office appointment, free parking), or telephone
- (i) Inform patient of appropriate resources
in the community; use referrals and agencies that enhance the learning of
- (i) Implement the use of modeling to assist
- Observing the behavior of others who have successfully
achieved similar goals helps exemplify the exact behaviors that should be
developed to reach the goal. Use of videotapes with people performing the
desired behavior have been quite effective.
- (i) Provide a comprehensive approach to
health promotion by giving attention to environmental, social, and cultural
- The various health promotion models emphasize that focusing
only on behavior change is doomed to failure without simultaneous efforts to
alter the environment and collective behavior.
- (i) Use a variety of teaching methods.
- Learning is enhanced when various approaches reinforce the
material that is being taught.
- (i) Prepare for lapses and relapses.
- Relapse prevention needs to be addressed early in the
- (i) Encourage participation of family or
significant others in proposed changes.
- This may enhance overall adaptation to change.
SPECIFIC PATIENT BEHAVIORS FOR SMOKING
- (i) independent
- (i) Determine that the patient is interested
in quitting smoking.
- The health care provider should validate the importance of
quitting smoking so the patient is clear about the goal.
- (i) Choose an approach to quitting most
suitable for the specific patient, as in the following:
- (1) cold turkey--abrupt cessation from one's addictive level of
(2) tapering--one smokes fewer cigarettes each day until down to
(3) postponing--one postpones the time to start smoking by a
predetermined number of hours each day eventually leading to no cigarettes;
(4) joining a smoking cessation program;
aids--nicotine patches, gum;
(6) acupuncture, hypnosis.
Different approaches appeal to different
- (i) Formally set a date to quit smoking,
either verbally or by contract.
- This reinforces the intent and behavior to be
- (i) Avoid temptation or situations associated
with the pleasurable aspects of smoking. Suggest the following:
- (1) instead of smoking after meals, brush teeth or go for a
(2) instead of smoking while driving, take public transportation;
(3) avoid having a cocktail before dinner if it is associated with
(4) limit social activities or situations to those where smoking
(5) if in a social situation where others smoke, try to
associate with the nonsmokers present;
(6) develop a clean, fresh,
nonsmoking environment at work.
- (i) Find new activities to make smoking
difficult, impossible or unnecessary (e.g., swimming, jogging, tennis,
handball, racquetball, aerobics, biking).
- (i) Maintain clean taste in mouth by brushing
teeth often and using mouthwash.
- (i) Do things that require the use of the
hands (e.g., crossword puzzles, needlework, gardening, writing letters).
- (i) Keep oral substitutes handy: carrots,
pickles, sunflower seeds, sugarless gum, celery, apples, and others.
- Oral gratification helps reduce the urge to smoke.
Low-calorie foods should be chosen because ex-smokers burn fewer calories, and
25% may experience a weight gain when they stop smoking.
- (i) Learn relaxation techniques to reduce
urge: make self limp, visualize a soothing, pleasing situation.
- Breathing exercises help release tension and overcome the
urge to smoke.
- (i) Seek social support.
- Commitment to remain a nonsmoker can be made easier by
talking with friends and family.
- (i) Mark progress and reward self for not
smoking. Each week, month, or more, plan a special celebration and periodically
write down reasons one is glad for quitting and post them.
- (i) Instruct patient that relapses can occur.
If they do, recognize the problem, review reasons for quitting, anticipate
triggers, and learn how to avoid them.
- (i) Pursue various coping skills to alleviate
further problems and re-sign a contract to remain an ex-smoker.
- It is difficult to remain an ex-smoker. A slip means that a
small setback has occurred; it does not mean that the patient will start
smoking again. Despite strong resolve to quit, patients often find themselves
in situations that may encourage relapse. Being prepared to recognize these and
offering other options or sources of assistance enhances the patient's ability
to cope and minimizes relapses.
Education/Continuity of Care
- (i) independent
- (i) Provide instruction as described in
- (i) Explore community resources.
- (c) Refer patient to self-help groups as
Self-Modification Assistance; Health Education; Patient
Contracting; Smoking Cessation
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