Reading Chapters

Healthy People 2020

Definition of Health

Health is not merely the absence of disease. Health is the presence of total well-being. Well-being
includes physical, mental, social, and spiritual aspects of the person. The healthcare system is
constantly developing into a health promotion model with a focus on wellness, prevention, and
health maintenance. Nurses have the responsibility to share in health promotion and teach people
how to be well.

Developing Healthy People

The United States Department of Health and Human Services (HHS) uses research to formulate 10year national objectives to promote health and prevent disease called Healthy People. Healthy
People is simply a set of health goals used to identify health threats and develop strategies to
reduce those health threats. Historically, the Healthy People agenda has defined national health
objectives, monitored progress of health goals in health objectives, encouraged collaboration among
healthcare organizations, educated the publicindividuals, families, and communitiesin making
wise healthcare decisions, and measured the impact of health prevention.
The Healthy People initiative provides a framework in which healthcare professionals, including
nurses, accept the challenge of health promotion and disease prevention in patients, families, and
communities. Healthy People 2010 increased the quality and length of American lives in addition to
decreasing health disparities associated with race, ethnicity, and socioeconomic status. It was a
good start, but now we are moving on to Healthy People 2020.

Healthy People 2020

Healthy People 2020 renews the focus on major health objectives of wellness, creating new
healthcare policy, and focuses on issues related to creating environments that promote health and
prevent disease. The vision of the future focuses on a society in which all people will live long,
healthy, and vibrant lives by meeting healthcare goals. The goals include the following: eradication of
preventable disease; reducing health disparities through a determinants of health approach by
improving the holistic health of all groups of people; creation of environments to promote good health
for all; and promotion of health development across all ages (Healthy People 2020, 2010).

e NEW Topic Areas for Healthy People 2020

Adolescent Health

Blood Disorders and Blood Safety

Dementias, Including Alzheimers Disease

Early and Middle Childhood

Genomics

Global Health

Healthcare-Associated Infections

Health-Related Quality of Life and Well-Being

Lesbian, Gay, Bisexual, and Transgender Health

Older Adults

Preparedness

Sleep Health

Social Determinants of Health

You can help support the national health objectives of Healthy People 2020 by following these
simple steps:

Share information about Healthy People 2020 in your practice setting, at health events, and
via professional and community publications.
Use Healthy People 2020 in your professional practice. The Healthy People 2020 site has
links to www.healthfinder.gov, a reliable gateway to health information for the public, as well
as links to leading health indicators

Definition of Health Assessment

Health assessment is comprised of the health history and the physical examination. These two
elements lay the foundation for the entire diagnostic and treatment process.
The health history review assesses the patients overall health. Furthermore, it compares the
patients view of his or her body with what is considered normal in health. The health history
interview consists of

determining the reason for the patient visiting the healthcare provider;
recording the patients family history; and

reviewing the patients experience of health and illness in all systems.

Cultural Awareness in Healthcare

Cultural awareness encompasses knowledge of biocultural, psychological, sociological, and
linguistic differences among people. Misunderstandings due to cultural differences lead to
workplace stress and poor healthcare outcomes.
Todays healthcare organizations are multicultural microcosms of todays society. Cultural
competency is vital to effective healthcare staff relationships, as well as healthcare delivery.
Nurses must adapt health assessment strategies to meet the needs of patients of different cultural
groups. Cultural differences must be carefully considered to obtain an accurate health assessment
and provide optimal care.
Cultures develop values, behaviors, and traditions that are considered the norm for individuals,
families, groups, communities, and populations. Patients should not be expected to adapt to the
foreign customs or speak the language of a different culture. Illness is a stressful time when patients
rely on traditions and cultural beliefs. Those beliefs help the patient adapt to the physical and
environmental stressors encountered when health is not optimal. For example, it is important to
understand cultural beliefs in obtaining patient information. Patients within some Asian cultures may
not request pain medication because they believe that illness is due to some wrongdoing on their
part. On the other hand, it is relatively common for individuals from Mediterranean cultures to
request pain medication for only slight discomfort.
The United States is a multicultural society and nurses will frequently encounter patients from
diverse cultural backgrounds. It is important to develop insight and appreciation for patients of
different cultures and to respect and uphold the rights of culturally diverse patients, families, and
communities.

Cultural Health Assessment Strategies

It is also important to gather cultural data in order to understand the environment in which the
patient exists. There are six cultural indicators that a nurse must understand when doing a
health assessment. Those include communication, space, social organization, time, environmental
control, and biological variation.

Communication is often viewed as only encompassing language barriers in health

assessment. But language barriers are not just present when there is a different language
spokenlanguage barriers can occur within the same language. Some commonly used
words or phrases in one group may have a derogatory meaning to others who speak the
same language. In addition, communication addresses nonverbal language. For example,

patients from certain cultural groups consider direct eye contact disrespectful. Lack of eye
contact in other cultural groups is considered a sign of lying.
Space relates to the level of personal space in the health assessment process. It is important
to understand cultural practices of proximity during communication. It is also important to
note varying cultural beliefs of body movement, eye contact, and use of touch.

Social organizations address the patterns of cultural behavior. For instance, health-related
authority may rest with either the eldest male or eldest female within the family or community.
It is also necessary to understand the roles of various family members. Last, ethnicity is not
the only factor when considering culture. Geography, age, religion, gender, sexual
orientation, and socioeconomic factors in patients, families, and communities are integral to
an accurate patient health assessment and history.

The perception and importance of time is another cultural consideration that is

sometimes not taken into consideration in the health-assessment process. Some
cultures are past orientated, and patients from those cultures may be reluctant to institute
new healthcare practices. On the other hand, some cultures are more present oriented. In
those cultures, the patient may not be concerned about the future or the consequences of
poor health practices.

Environmental control in health assessment refers to the control of the nature of the
surroundings. The environment may encompass health practices, values, and understanding
of health and illness.

Biological variation in the assessment process is described as understanding differing body

structures among racial or ethnic groups, including color of skin, texture of hair, and other
physical characteristics. In addition, it is important to consider biologic susceptibility to
disease, nutritional preferences and deficiencies, and psychological characteristics.

It is imperative that the nurse consider cultural phenomena in the health assessment process. When
considering cultures in health assessment, a checklist would include the following:

Normal standards of behavior belief system

Belief system about time, money, education, beauty, and change

Relationships, including roles within family and community

Communication beliefs

Economic values, political systems, and educational beliefs

Nutrition and diet beliefs

Religion and healing beliefs

Health and illness beliefs

Over the next few weeks, you will learn how to perform a health assessment, including the physical
examination that takes into account psycho-social-cultural considerations. Enjoy your journey!

D'Amico, D., &Barbarito, C. (2012). Health & physical assessment in nursing (2nd ed.). Upper
Saddle River, NJ: Prentice Hall.
U.S. Department of Health and Human Services. (2010). Healthy People 2020. Retrieved from
http://www.healthypeople.gov/2020/about/new2020.aspx