Health promotion and teaching are important tools for nursing. By promoting health and health teaching, nurses can help lay the foundation for a healthier future. Major Concepts and Definitions Belief-a statement of sense, declared or implied, that is intellectually and / or emotionally accepted as true by a person or group. Attitude-a relatively constant feeling, predisposition, or a set of beliefs that is directed toward an object, a person, or a situation. Value-a preference that is shared and transmitted within a community. Behavioral diagnosis-the delineation of the specific health actions that are most likely to effect a health outcome.

Health Belief Model-a paradigm used to predict and explain health behavior that is based on value-expectancy theory. Perceive-how one views oneself's health. Expectancies-outcomes and evaluation of how behavior is determined. Divided into three types.

Environmental cues-sub concept of expectancies, beliefs how events are connected. Outcome expectation-sub concept of expectancies, consequences of one's own actions. Efficacy expectation-sub concept of expectancies, one's own competence to perform the behavior required to influence outcomes. Incentives- value of a particular object or outcome. Domains of learning-information, skills, and attitudes needed to be taught to achieve the appropriate level of learning.

Cognitive domain-sub concept, development of new facts or concepts, building on or applying past knowledge to new situations. Psychomotor learning-sub concept, development of physical skills from simple to complex actions. Affective learning-recognition of values, religious and spiritual beliefs, family interaction patterns and relationships and personal attitudes that affect decisions and problem-solving progress. Teaching-a planned and purposeful activity that nurses use to increase the likelihood that individuals will learn.

Major Assumptions Major assumptions are taken from Rosenstock's (1966) Health Belief Model, Bandura's (1986) Social Cognitive Theory (Edleman & Mandle, 1998), and the teaching process (Boyd, Graham, Gleit, & Whitman, 1998). According to Leddy & Pepper (1993), assumptions from the Health Belief Model include the following aspects: 1. Perceived susceptibility, the client's perception of his likelihood of experiencing a particular illness. 2. Perceived severity, the client's perception of the severity of the illness and its potential impact on his life.

3. Benefits of actions, the client's assessment of the potential of the health action to reduce susceptibility or severity. 4. Costs of action, the client's estimate of financial costs, time and effort; inconvenience; and possible side effects such as pain or discomfort.

According to Edleman & Mandle (1998), assumptions for Bandura's (1986) Social Cognitive Theory are: 1. Behavior is determined by expectancies and outcomes. 2. Behavior is regulated by its consequences, but only as those consequences are interpreted and understood by the client. According to Boyd et al. (1998), assumptions from the teaching process include: 1.

The teaching process is a planned and purposeful activity that nurses use to increase the likelihood that individuals will learn. 2. The teaching process follows the same steps as the nursing process: assess, plan, implement and evaluate. Man Man is an individual, holistic being, comprised of social, psychological, spiritual and biological entities. Man is in constant interaction with the environment. Man's well being is the perception of his or her health which is enhanced by nursing actions involving health promotion.

Man is an outcome of his environment, beliefs, attitudes, values and willingness to learn. Environmental cues affect man's reaction to health promotion and teaching. Nursing Nursing is a profession needed by man to promote health with an outcome of enhancing man's perception of one's health. A behavioral diagnosis can be accomplished by using the teaching process and incorporating the three domains of learning (a) cognitive, (b) psychomotor, and (c) affective.

The goal of nursing is to educate man to help reduce the susceptibility or severity of any illness or disease resulting from interaction from the environment. This encompasses disease prevention and aiding in restoration of health. It is the nurse's responsibility to assist each client to perceive themselves at their optimal level of functioning. Since behavior is regulated by its consequences (but only as those consequences are interpreted and understood by man) (Edleman & Mandle, 1998), it is nursing's practice to assist man by working with beliefs, attitudes, values and environment to help achieve positive outcomes and efficacy expectation. Nursing is also responsible to assist man to realize outcome expectations. Health Health is man perceiving oneself at his or her optimal level of functioning.

Health can be achieved even in a diseased state by assisting clients to achieve the highest perceived state of health as possible. Health is a direct result of environmental factors and health teaching and promotion. It is important to incorporate the teaching process and recognize the different domains of learning in order to achieve the most effective, positive behavioral changes. Since man is in constant interaction with his environment, and each client has different beliefs, cultures and values, health promotion and teaching are important for man to achieve his or her optimal level of functioning. This is achieved by incorporating the Health Belief Model to promote healthy lifestyle changes. Environment The environment is anything external to man.

This encompasses physical and nonphysical elements from religion to economy to food and water. All these elements impact man. Since man is in constant interaction with this environment, it is imperative nursing analyzes what type of nursing interventions would be most effective in modifying behavior. This can be guided by connecting three types of expectancies (a) environmental cues, (b) outcome expectation, (c) efficacy expectation and incentives as described in Bandura's (1986) Social Cognitive Theory (Edleman & Mandle, 1998). For nurses to assess the client and the environment, the nurse must consider the following from the Health Belief Model: 1. Individual perceptions or readiness for change.

2. Modifying factors about the person. 3. Motivating and environmental factors. 4. Client-nurse transaction factors which include past use of health services, perceived benefits of health action and barriers to promotion action (Edleman & Mandle, 1998).

These are all external factors to man which make up the environment. Since environment is ever changing, it is necessary to continuously assess, plan, implement and evaluate. Relationships or Linkages This model focuses on health promotion and teaching. The concepts of man, health and environment are linked to this central theme.

Since every man is comprised of different cultures, beliefs, values and environments and health can be altered by these factors, it is up to nursing to assess, plan, implement and evaluate a method of health promotion and teaching to assist clients in achieving optimal health. This can be done by using the Health Belief Model, Social Cognitive Theory and the teaching process and incorporating the different domains of learning. Application to Nursing This model is valuable for nursing practice because the goal is to promote health. The model is useful in the community healthcare setting. The visiting nurse can use the teaching process to assess the client. The Health Belief Model and the Social Cognitive Theory can help the nurse to analyze factors that contribute to man's perceived state of health.

Working with the client in the proper domain of learning, the nurse will be able to assist the client to achieve the optimal level of functioning. This model can also be used with chronically ill patients. Again, the goal for the client is to achieve the optimal level of functioning. Difficulties in application to nursing practice would be the comatose patient or the terminally ill patient with no cognitive skills.

Health promotion and teaching are valuable nursing tools but only if applied properly so the client is able to make healthy behavior changes with the goal being to achieve his or her optimal level of functioning. References Boyd, M. D. , Graham, B. A. , Gleit, C.

J. , & Whitman, N. I. (1998). Health teaching in nursing practice: A professional model (3 rd ed. ).

Stamford, CT: Appleton & Lange. Edleman, C. L. , & Mandle, C. L. (1998).

Health promotion throughout the lifespan (4 th ed. ). St Louis, MO: Mosby, Inc. Leddy, S.

, & Pepper, J. M. (1993). Conceptual bases of professional nursing (3 rd ed.

). Philadelphia: J. B. Lippincott.