A traditional approach to health care in general is one in which the goal of intervention is disease management in an attempt to minimize the harmful effects of a health crisis. Once a health crisis occurs, the quality of life for an individual is already negatively impacted. Therefore, health promotion is an equally, if not more important, component of health care that aims to improve the quality of life. Through the primary prevention efforts of health promotion, emphasis on avoiding disease and adopting a healthy lifestyle offers the greatest opportunity for a healthy and fulfilling life. As primary care givers, nurses play an important role in health promotion by demonstrating proper attitudes and behavior modeling, by providing valuable patient education and by advocating for and empowering patients and their families. There are numerous nursing theories which provide a framework for nurses to employ health promoting strategies in their practice. Defining Health and Health Promotion
One of the most widely used definitions of health is that of the World Health Organization (WHO): “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Since the publishing of the WHO definition, changes in population demographics, the aging of society, and the changing nature of disease have caused researchers to question the relevance of this definition in today’s world. One criticism is that the concept of complete health disregards those with chronic illnesses who can learn to live fulfilling lives (Huber et. al, 2011). According to O’Donnell (2009) health is not a constant state, but a state that continually evolves with life circumstances. Regardless, health isclearly a complex state that exists both to, and apart from, its relationship to illness.
Health promotion is a process that benefits both the individual and society. The essence of health promotion is the preservation of health. Caring for the sick is a reactive intervention to health care issues whereas health promotion is a proactive strategy for prevention. An important step necessary to shift the momentum of healthcare to a proactive role is making the public aware of how they can actively participate in managing and improving their own health. As noted by Jadelhack (2012), “Health promotion is carried out by and with people, not on or to people” (p. 85). Education is a key factor in this step, as well as providing people with the resources needed to live out strategies for a healthy lifestyle. Improved health reduces healthcare costs and improves the overall quality of life. The Role of Nursing Theory
Nursing theory and nursing practice are interrelated processes, and neither one holds value without the other. Theories unapplied are speculative, and practice without purpose is ineffective. To adequately participate in health promotion strategies, nurses must understand the basis for, and the goal of, their practice. Two theories that demonstrate health promotion are Neuman’s Systems Model and Roy’s Adaptation Model of Nursing. Both models provide a solid framework for nurses to develop and employ health promotion strategies when caring for their patients. In the Neonatal Intensive Care Unit (NICU), application of these theories can contribute to the health status of both infants and their families. These theories complement each other in the process of the developmental care practices that are found to be an essential component of health promotion in this unique patient population. Two Theories
Betty Neuman’s System model focuses on how patients respond to environmental stressors, and on how nurses can help maintain wellness through the use of prevention strategies aimed at attaining, maintaining, or retaining what Neuman’s model refers to as patient system wellness. According to this theory, patients are multidimensional beings, having a physiological, psychological, socio-cultural, spiritual and developmental element. Maintaining stability in all these elements is necessary for preserving the state of wellness. The internal environment, the external environment, and the created environment can both positively or negatively affect wellness. Neuman proposes that illness and death are the results of environmental stressors that deplete the patient’s energy resources needed to maintain a state of health. It would stand to reason then, if stressors are reduced or eliminated, less energy would be consumed and could be available for the process of health maintenance. Similarly, Sister CallistaRoy’s Adaptation Model addresses the interaction between an individual and their environment. This model considers an individual’s ability to adapt to a changing environment. According to Roy, adaptation involves how a person views themselves, their role in a situation, interdependence, and meeting physiological needs. Two important processes in the adaptation theory include an automatic physiological response and a coping mechanism which facilitate the adaptive process. Practical Application
Both Neuman’s and Roy’s theories are applicable in the Neonatal Intensive Care Unit (NICU), a highly specialized area of nursing that cares for one of the most vulnerable patient populations; the preterm and critically ill infant. Both theories focus on the patient and their environment. The very nature of the NICU environment can negatively affect the infant who is already struggling with an imbalance in their internal environments. Immature physiological, structural, and neurological systems are not prepared to handle the external world outside the womb. Using Newman’s model, nursing practices aimed at reducing stress from the external environment and those facilitating stability within the internal environment of the infant are key to optimizing outcomes for the at-risk premature infant. The practice of developmentally supportive care evolved from the realization that preterm infants are not only affected by the external environment of the NICU, but are also active members responding to their environment and caregivers (Gibbins et. al, 2008). Core measures for developmentally supportive care include protected sleep, pain and stress assessment and management, developmental activities of daily living, family-centered care and a healing environment are identified as health promotion interventions for the NICU patient (Coughlin, Gibbins, & Hoath, 2009).
Practices such as cycled lighting, low noise levels, facilitated handling, and kangaroo care are measures which help reduce the negative effects of the NICU environment, stabilize the internal environment of the infant, and promote positive human relationships. The principles of Roy’s Adaptation Model can be applied to the process of family-centered care as it relates to a parent’s ability to adapt to the unexpected delivery of a premature infant. This unexpected event interferes with the psychosocial adaptation of the family, complicating transition to parenthood and the incorporation of a new child into the family system (Zimmerman & Bauersachs, 2012). Allowing parents to be active participants in their infant’s care is a key factor toward promoting emotional, psychological, and physical health of the members in the family unit. Barriers to Health Promotion
Because of the unique environment of the NICU, barriers to health promotion activities through developmental and family-centered care efforts lie in family, health care provider and institutional challenges rather than in the NICU patient themselves. Problems with inadequate resources, insufficient staffing, and a lack of education and support for both nursing and parents often impede these efforts (Bamm & Rosenbaum, 2008). Interventions used in the stabilization of infants and competition for resources often draw nurses toward task oriented care, pushing parents to the “periphery of the NICU environment” (Galarza-Winton et. al., 2013). Fear, insecurity, and powerlessness are barriers for parents that can be abated by developing strong nurse-parent relationships based on mutual respect and trust, and through the promotion of family-centered care. Successful health promotion through developmental care practices are evidenced by parental bonding and confidence in caregiving as well as improved weight gain, earlier discharge, and improved developmental outcomes for infants. Conclusion
Despite advances in health care, health care costs continue to rise. In 2006, costs in the U.S. exceeded two trillion dollars, with three-fourths of that money used to treat chronic diseases (Goetzel, 2009). Smoking, alcohol and drug use, obesity, inactivity, poor quality nutrition, and limited access to health care are all examples of modifiable risk factors that contribute to illness and chronic disease. Poor health reduces the general quality of life and places a burden on individuals, families, and societies. Strategies for health promotion must be developed at many levels including the community, healthcare providers and the government. The aim of health promotion is empowering people to take responsibility for their health, as well as providing them with adequate preventative care. As Benjamin Franklin once noted “An ounce of prevention is worth a pound of cure.”
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