Role in Wellness

Wellness is a lifestyle through which we continually strive to enhance our level of health. This text provides information, strategies, and techniques about food, nutrition, and health. These tools allow nurses and clients to achieve wellness through personal nutrition lifestyles.

Nutrition is a hot topic that generates interest easily; everyone seems to have opinions about what to eat and concerns about their own eating styles. The public is flooded with information and techniques related to health promotion through nutrition. Health literacy is the ability to acquire and comprehend basic health concepts, such as nutrition, and apply them to one’s own health decisions.¹

So how does health literacy develop? It is not the same as literacy of the printed word, although it is related. Health literacy develops through education on topics related to health promotion and illness. This process of education occurs in three different forms: formal, nonformal, and informal. Formal education is purposefully planned for implementation in a school setting. Nonformal education takes place through organized teaching and learning events in hospitals, clinics, and community centers. Informal education encompasses a variety of educational experiences that occur through daily activities. These informal experiences may include watching television, reading newspapers and magazines, browsing the Internet, and conversing with other people. Health information from many sources becomes part of an individual’s database of knowledge. Some information may be valid, some may be partially true, and some may be completely false. Our goal is to ensure that health decisions are based on accurate information.

Health literacy allows for education to be most effective, resulting in behavior changes. Nurses, through formal, nonformal, and informal educational interactions, can introduce knowledge and strategies for personal lifestyle choices that consider the health context of patients’ lives.² Health context takes into account the influence of cultural, social, and individual factors on the acquisition of health literacy. Cultural factors may encompass ethnic, religious, and racial traditions surrounding health issues. Social factors create the settings for which members of a community receive support or lack support for health-promoting behaviors. Individual factors reflect on the choices people make regarding willingness to acquire and then apply health knowledge. Health literacy actualization means being able to use acquired health knowledge and skills. The extent to which this occurs within health care settings is influenced by the level to which health care providers are supportive of literate health populations seeking greater involvement in their health care (Figure 1-1).

Nurses are involved with the development of client health literacy (see the Teaching Tool box Literacy and Health). Formal education may be conducted by school nurses who teach health courses; topics can be approached through the health and nutrition issues of the ethnic and cultural groups of the particular school’s population. Nonformal education occurs when associations such as the American Heart Association or hospital wellness programs teach courses on risk-reducing lifestyle changes; these courses are usually open to the community. Informal education takes place when a nurse chats with a patient and his or her family, explaining the purpose of the dietary modifications recommended for the patient’s particular disorder.

Never before have we had so much information about the effects of our personal behavior patterns on our level of health. Changing (or maintaining) our patterns of behaviors—and therefore our lifestyles—is the key to achieving wellness. Many social, community, and occupational forces affect our ability to change. Strategies and techniques ease our ability to modify our personal behaviors.

Modifying behaviors means changing lifestyles. Because this book is about food and nutrition, patterns of behaviors affecting the foods we choose to eat constitute our nutrition lifestyles. Not all of us have the same nutrition lifestyles. Some of us are caught up in extremely hectic work, college, or sports schedules; we’re lucky to find time to eat at all. Others find our families of origin still at the center of our eating patterns; our families, however, may not have adopted recent recommendations to decrease the risks of diet-related diseases. Many of us are part of new social settings on campus and need to adjust to rigid schedules and school cafeteria menus. Yet, despite these variances, we have in common the ability to improve wellness through our nutrition lifestyles.

As health care professionals, we need to be concerned with our own nutritional patterns as well as those of our clients. To reflect a health promotion perspective, individuals cared for by health professionals to maintain health are called clients. Those who are ill or recuperating from illness are called patients.

Enhancing personal health provides the stamina and well-being to fulfill the rigorous demands of the nursing practice. A fundamental responsibility of nursing is client education. When teaching clients about nutritional wellness, nurses also function as role models for the positive effects of enhanced nutrition lifestyles.

Definition of Health

In the past, health was defined as the absence of disease or illness. Modern medicine has conquered many life-threatening diseases, such as smallpox and polio. Public health measures of pasteurization and sanitation have reduced the risk of foodborne and environmental hazards. As concern about the physical status of the human body has lessened, we’ve been able to consider other aspects of the qualities of health.

One of the first expanded definitions of health was provided by the World Health Organization (WHO): “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity.”³ Although this definition addresses the concern that health is more than just the absence of disease, health is presented as a static concept that individuals achieve.

A more expanded definition of health was presented by Rene Dubos, biologist and philosopher, who wrote, “Health is a quality of life involving social, emotional, mental, spiritual, and biologic fitness on the part of the individual, which results from adaptations to the environment.”⁴ This view leads to our present understanding of health as a complex concept best represented by physical and psychologic dimensions, as follows:

Health is the merging and balancing of the five physical and psychological dimensions of health: physical, mental, emotional, social, and spiritual. This holistic view incorporates many aspects of human existence. Using this definition of health allows more individualized assessment of health status. As our own health and the health of our clients are evaluated in relation to each dimension, some dimensions will be stronger than others (see the Teaching Tool box Dimensions of Health).

Role of Nutrition

Nutrition is the study of nutrients and the processes by which they are used by the body. Nutrients are substances in foods required by the body for energy, growth, maintenance, and repair. Some nutrients are essential; they cannot be made by the human body and must be provided by foods.

Because the primary role of nutrients is to provide the building blocks for efficient functioning and maintenance of the body, nutrition may appear to belong only within the physical health dimension. However, the effects of nutrients and their sources on the other health dimensions are far reaching. Nutrition is the cornerstone of each health dimension.

Physical health is dependent on the quantity and quality of nutrients available to the body. The human body, from skeletal bones to minute amounts of hormones, is composed of nutrients in various combinations.

Intellectual health relies on a well-functioning brain and central nervous system. Nutritional imbalances can affect intellectual health, as occurs with iron deficiency anemia. Although milk is an excellent source of protein, calcium, and phosphorus, it provides a negligible amount of iron. Some young children drink so much milk that it affects their appetite for other foods such as meats, chicken, legumes, and leafy green vegetables, all of which are good sources of iron. As a result, iron deficiency may affect children with nutritional imbalances. The cognitive abilities of iron-deficient children may be affected, which could lead to possible learning problems.

Emotional health may be affected by poor eating habits, resulting in hypoglycemia or low blood glucose levels. Low blood glucose occurs normally in anyone who is physically hungry. When the body’s need for food is ignored (e.g., when we miss meals because of poor planning or are too busy to eat), feelings of anxiety and confusion and trembling may occur. Emotions may be harder to control when we feel this way. Although blood glucose levels may affect our emotions, there are, of course, other factors that influence emotional health.

Social health situations often center around food-related occasions, ranging from holiday feasts to everyday meals. Nutritional status is sometimes affected by the quality of our relationships with family and friends. Are family meals an enjoyable experience or a tense ordeal? How might this affect a person’s dietary intake?

Spiritual health often has ties to food. Several religions prohibit the consumption of specific foods. Many followers of Islam and Judaism adhere to the dietary laws of their religions. Both forbid consumption of pork products. Seventh Day Adventists follow an ovo-lacto vegetarian diet in which they consume only plant foods and dairy products. In India cows are viewed as sacred, not to be eaten but revered as a source of sustenance (milk), fuel (burning of feces), power (as a work animal), and fertilizer (manure).

Health Promotion

Health promotion consists of strategies used to increase the level of the health of individuals, families, groups, and communities. In community and occupational health settings, health promotion strategies implemented by nurses often focus on lifestyle changes that will lead to new, positive health behaviors. Development of positive behaviors may depend on knowledge, techniques, and community supports, as follows (see the Teaching Tool box Literacy and Health):

Role of Nutrition

For more than 30 years, national health targets have been set. In 1979 the first initiative, the Surgeon General’s report titled Healthy People, laid out life-stage targets that continue to be tracked today. Since then, health targets have been updated every 10 years through collaboration among the government, voluntary and professional health associations, businesses, and individuals under the direction of the secretary of the Department of Health and Human Services. The objectives focus on the decisions and policies that affect prevention efforts and create a standard from which to later assess the performance of meeting these goals. In addition, the interrelatedness of the health of communities and individuals is emphasized. The health status of an individual is dependent on the health supports accessible within the community. (This theme is also discussed in Chapter 2 under the heading “Community Nutrition.”)

The target results of the previous report are used to develop the next set of target goals. Data generated by Healthy People 2010 (HP2010) are being used to develop the next set of national health targets, Healthy People 2020 (HP2020).

HP2020 is guided by a framework based on the vision of “a society in which all people live long, healthy lives.”⁵ The mission is “to improve health through strengthening policy and practice.”⁵ Four overarching goals present pathways to achieve the vision and mission. Details of the HP2020 framework are listed in Box 1-1.

BOX 1-1

Healthy People 2020 Framework

Vision

A society in which all people live long, healthy lives.

Mission

To improve health through strengthening policy and practice, Healthy People will:

• Identify nationwide health improvement priorities

• Increase public awareness and understanding of the determinants of health, disease, and disability, and the opportunities for progress

• Provide measurable objectives and goals that can be used at the national, state, and local levels

• Engage multiple sectors to take actions that are driven by the best available evidence and knowledge

• Identify critical research and data collection needs

Overarching Goals

• Eliminate preventable disease, disability, injury, and premature death

• Achieve health equity, eliminate disparities, and improve the health of all groups

• Create social and physical environments that promote good health for all

• Promote healthy development and healthy behaviors across every stage of life

From U.S. Department of Health and Human Services, Public Health Service: Phase 1 Report: Recommendations for the framework and format of Healthy People 2020. Accessed January 2010 from www.healthypeople.gov/HP2020/advisory/Phase1/summary.htm.

The Action Model to Achieve Healthy People 2020 Overarching Goals (Figure 1-2) suggests priorities for change based on determinants of health such as living and working conditions, as well as individual behaviors as affected by the traits of individuals such as age, sex, race, and biological factors. The implementations of strategies are assessed by their outcomes. The outcomes are then evaluated, distributed, and used to create additional interventions.⁵ These actions will bring us as a nation closer to achieving the goals by 2020.

Definition of Wellness

Wellness is a lifestyle (pattern of behaviors) that enhances our level of health. This occurs by developing each of the five dimensions of health. Individuals engaged in wellness lifestyles feel a sense of competency and achievement in their ability to modify their behaviors to increase or maintain positive levels of health.

Hectic contemporary schedules may seem to interfere with efforts to achieve wellness. The aim is to strive for wellness even if the path may seem more like a roller coaster than a smooth uphill climb (Figure 1-3). At times, clients may falter in their efforts, but the key is to renew positive behaviors as soon as possible.

Disease Prevention through Nutrition

Disease prevention is the recognition of a danger to health that could be reduced or alleviated through specific actions or changes in lifestyle behaviors. The hazard may be caused by disease, lifestyle, or genetic factors, or an environmental threat. The three classifications of disease prevention are primary, secondary, and tertiary. Disease prevention has strong ties to nutrition (see the Cultural Considerations box Healthy People and Culturally Competent Care).

Primary prevention consists of activities to avert the initial development of a disease or poor health. A primary disease prevention approach is to eat a variety of foods to avert nutrient deficiencies. Adopting a low-fat, high-fiber eating style before diet-related health problems develop is a form of primary prevention.

Secondary prevention involves early detection to halt or reduce the effects of a disease or illness. Some diseases cannot be prevented, but early detection can minimize negative health effects. Secondary prevention strategies are useful to reduce the effects of chronic diet-related diseases. Controlling the intake of certain nutrients can decrease the severity of some disorders. Some individuals with high blood pressure (hypertension) are sodium sensitive, and simply reducing the amount of sodium consumed can decrease blood pressure levels and thus bring the disorder under control. Because hypertension is a risk factor for coronary artery disease, stroke, and renal disease, reduction of blood pressure through decreased sodium consumption is a secondary prevention strategy.

Tertiary prevention occurs after a disorder develops. The purpose is to minimize further complications or to assist in the restoration of health. These efforts may involve continued medical care. Often, learning more about the disorder is helpful for patients and their families. Tertiary prevention frequently involves diet therapy. Direct treatments of many disorders have a dietary component. Some of these disorders include ulcers, diverticulitis, and coronary artery disease; they usually occur during the middle and older years of adulthood. Other disorders may affect food intake and the ability of the body to absorb nutrients. For example, chemotherapy for cancer may have the side effects of nausea and loss of appetite. Nutrition counseling during and after these treatments is necessary so patients are as well nourished as possible to aid the healing process. The five dimensions of health can be an excellent teaching tool in promoting health and preventing diseases related to nutrition.