Integrative Health Promotion Conceptual Bases For Nursing Practice 2nd Edition by Susan Kun Leddy ISBN 9781284044294 1284044297
Integrative Health Promotion Conceptual Bases For Nursing Practice 2nd Edition by Susan Kun Leddy ISBN 9781284044294 1284044297
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INTEGRATIVE
H E A LT H
PROMOTION
CONCEPTUAL BASES FOR
NURSING PRACTICE
Second Edition
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Copyright © 2006 by Jones and Bartlett Publishers, Inc.
Cover Image: © Photos.com
All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in
any form, electronic or mechanical, including photocopying, recording, or by any information storage and
retrieval system, without written permission from the copyright owner.
Library of Congress Cataloging-in-Publication Data
Leddy, Susan.
Integrative health promotion : conceptual bases for nursing practice / by Susan Kun Leddy.— 2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-7637-3840-9
1. Holistic nursing. 2. Health promotion. 3. Alternative medicine.
[DNLM: 1. Health Promotion—methods. 2. Holistic Nursing. 3. Health Behavior. 4. Holistic Health.
5. Nursing Theory. WY 86.5 L472i 2005] I. Title.
RT42.L38 2005
610.73—dc22 2005024306
2116
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Susan Kun Leddy earned a bachelor of science in nursing from Skidmore College,
Saratoga, New York in 1960, a master of science in nursing (teaching medical-surgical nurs-
ing) from Boston University in 1965, a doctor of philosophy (nursing science) from New
York University in 1973, and did post-doctoral work at Harvard University (1985) and the
University of Pennsylvania (1996–98).
Dr. Leddy initially taught in diploma schools of nursing for four years and then in the bac-
calaureate program at Columbia University before completing doctoral work. She was then
one of four founding faculty for the RN-BSN program at Pace University. In 1976, after a
year as an NLN consultant, she was asked to do a feasibility study and then write the pro-
posal to the State of New York for a new RN-BSN program at Mercy College. She became
the first chairperson of the program (Mae Pepper was the first faculty member), which
opened in 1977.
Dr. Leddy left Mercy College in 1981 to first become dean of the School of Nursing, and
then dean of the reconstituted College of Health Sciences, at the University of Wyoming.
In 1988, she became dean of the School of Nursing at Widener University, Chester,
Pennsylvania, returning to graduate teaching there in 1993. She is now professor emerita in
the School of Nursing.
In addition to authoring Integrative Health Promotion: Conceptual Bases for Nursing Practice,
Dr. Leddy is the co-author with Lucy Hood of Conceptual Bases of Professional Nursing, 6th
edition, copyright 2006; Health Promotion: Mobilizing Human Strengths to Promote Wellness,
copyright 2006; and is working on a manuscript, Nursing Knowledge and Nursing Science, with
Jacqueline Fawcett. She has authored numerous periodical publications.
Dr. Leddy has two daughters, Deborah and Erin. Deborah is a student of veterinary med-
icine at the University of Pennsylvania, and Erin is a graduate student in the social work pro-
gram at West Chester University. Dr. Leddy’s granddaughter, Katie, was born October 12,
2001.
Dr. Leddy is an avid traveler, and especially enjoys traveling to exotic places. She also
knits, quilts, weaves (a little), and dabbles in watercolor painting and creative writing.
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Preface
I believe that the promotion of health is the core of professional nursing knowledge and
practice. Given this belief, I have been dismayed and frustrated by the overwhelming empha-
sis on disease and illness in most nursing educational programs. It is my hope that this book
will serve as an exemplar of health promotion content that should be taught, particularly in
graduate programs.
I have attempted to present a coherent synthesis of numerous, disparate literatures.
Chapter 1: Health, Health Promotion, and Healing, lays out a conceptual “map” for the book,
clarifying the critical differences between the “disease perspective” dominant in the bio-
medical, epidemiological, and public health literatures, and the “person perspective”, which
appears in nursing and alternative/complementary medical literatures. This edition, where
all chapters have been updated, presents theory and practical strategies from both perspec-
tives, toward the goal of integrative practice.
The content in Chapter 2, in my opinion, is of vital importance for nursing practice, yet
almost completely absent from the nursing literature. It is my long-standing and heartfelt
belief that nurses and clients need to utilize strengths as resources to address client weak-
nesses. Additionally, nurses must stop trying to be the expert who solves all problems, and,
instead, practice within an egalitarian model with power and expertise shared with the
client.
As in practically all other areas of scientific knowledge, definitive research evidence to
support health promotion practice is just not available. Abstracts of research are presented
throughout the book, and the “state of the art” is reviewed wherever possible. However, the
very limited evidence derived from well designed research continues to be of concern.
Additionally, the health promotion literature is largely atheoretical. I have attempted to
present what theory/models I could find. Theory-based scholarship is critically needed to
advance the science.
My rationale in organizing the book has been to present the conceptual bases of health
promotion in Section I, followed by several chapters in Sections II and III that address pri-
marily either the disease or person worldview. The chapters in Section IV apply the concep-
tual content from both worldviews to nursing practice.
Integrative health promotion is a vision. It is my sincere hope that by presenting a glimpse
of what might be, that this book will further a reality of knowledge-based health promotion
practice as an essential and substantial component of professional nursing.
I
CONCEPTUAL BASES OF
HEALTH PROMOTION
Section I, Conceptual Bases of Health Promotion, includes seven chapters that provide a con-
textual exploration of the meaning of health promotion and healing in a variety of health belief
systems, health strengths models and theories, and cultures. This section also includes chapters
on legal and ethical influences and health promotion, and integrative approaches to client assess-
ment. Chapter 1, Health, Health Promotion, and Healing, differentiates between health protection
(the prevention of disease risk factors and disease), health promotion (facilitating health-related
lifestyle changes), and healing to promote wholeness, integration, harmony, and, therefore,
health. The disease and the person world views, and their implications for beliefs about health,
are compared and contrasted. In Chapter 2, Health Strengths, the theory of healthiness is discussed
as are its various concepts. It is proposed that strengths serve as resources to promote health and
healing. In Chapter 3, The Meaning of Health: Health Care Belief Systems, a number of lay, com-
munity-based (Cuanderismo and Shamanism), and professional (Western biomedicine and tradi-
tional—including Chinese, Ayurveda, and naturopathic and homeopathic medicines) health
care belief systems are described, so that the student can appreciate the diversity of belief systems
that provide a context for integrative nursing. Chapter 4, The Meaning of Health: Models and The-
ories, presents 11 models or theories that can guide the promotion of health and healing in nurs-
ing practice. Chapter 5, The Meaning of Health: Cultural Influences, explores the influence on
health promotion of indigenous cultural beliefs of Asian Americans (Vietnamese Americans),
Appalachians, Hispanics (Mexican Americans), African Americans, and Native Americans, and
concludes with a presentation of multiple characteristics, influences, and practices that should be
considered in multicultural health promotion planning. Chapter 6, Ethical and Legal Influences on
Health Promotion, presents issues of power and empowerment, preferential valuing among the eth-
ical principles of autonomy, nonmaleficence, beneficence, and justice, and a non-traditional
model for professional ethics. The chapter concludes with a review of licensing issues, negligence,
electronic transmittal of health information, and implications of food and drug regulation, with
2 Section I Conceptual Bases of Health Promotion
special considerations for integrative health promotion. Chapter 7, Beyond Physical Assessment,
reviews guidelines for risk and disease screening, presents numerous frameworks for the assess-
ment of healthiness, and discusses integrative techniques (tongue and pulse assessment) to
broaden the database from which the client and nurse develop a health promotion plan.
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THOUGHT
Think nobly!
For the things we ponder are the sum
Of what we treasure and we do become
The fashion of our thinking—just as from
The chain we know the linking.
Therefore think nobly!
Think purely!
For our meditation is the glass
Through which our spirit doth in vision pass,
The face of God beholding—and the grace
Of his divine unfolding.
Therefore think purely!
Think truly!
For a true ideal is the light
By which we struggle up the lofty height
Of Truth’s supreme divineness—and the right
To which it doth incline us.
Therefore think truly!
WH EN I’M NO MO RE
O Country of my altar,
Where the incense flame doth burn
And a priestly hand doth part the Temple-veil—
Let me ne’er in purpose falter,
Let me never from thee turn
Nor the vision of the holy ever fail—
O my country, till I learn
How to purpose not to palter,
Let the vision of the holy never pale!
O altar of my Country,
Sealed with bloody sacrifice,
Yet glorious with living triumph, too,
May I nobly offer on thee
Duty’s most devoted price,
Never doubting it to be thy sacred due!
From thy altar let me rise
All to offer, O my country,
That I treasure most supreme and true!
(From “Greatheart.”)
TH E STAR S O F DESTINY
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