The Health Dimension

Conceptual Matrix to Learning

 

Because health is subjective, we must personally determine our state of health based on what we know, how we feel, whether we are able to meet reasonable expectations of society, and whether we are satisfied with our quality of life.


Here health is addressed as an asset and a privilege. Health professionals and community stakeholders play a role in promoting it, teaching it, modeling it in their lifestyle, and by innovating and participating in health-related interventions.


Modeling It -- Focus is on personal health choices that display our attitudes toward health and quality of life.   "What It Really Means to be Healthy!" is a 54-page book, I have written for the general public encouraging an optimum lifestyle.  It serves as a teaching tool for clients/patients by health professionals who are counseling individuals and groups. It is a companion book to "Empowering the Congregational Nurse," a guide for establishing a congregational nurse practice.  Both can be purchased as hard copy through Amazon.com.  Look for them under Linda Royer (author). 


Teaching It  -- Seizing opportunities in personal and professional roles to educate others about body requirements, disease and accident prevention, and quality of life.  This website is organized so that you have both the theory and practice resources in whole health--body, mind/emotional, spiritual, and social aspects.


Interventions & Strategies -- Successful programs or services, and those with the potential of success, are showcased here.

  • Taking Control, a mixed media tobacco cessation program is described and available for participation.

NUTRITION SPOTLIGHT

  • Meal Planner Pro - extensive healthy meal planner 
  • Power Plate - to help you plan a nutritious, disease-fighting menu
  • Healthy Recipes!  
    • Beverages
    • Vegetable Partners
    • Iron-Rich Foods
    • Wraps and How to Do It
  • Choose My Plate for a wealth of basic nutrition information


Details on the Health Promotion Course

Contents at a Glance -- "Transforming Lives"

 

Introduction

Section One

        Philosophical Underpinning
        Educational Intent
                Gardner’s Multiple Intelligences
                Taxonomy of Learning Objectives of Marzano
                Gagne’s Levels of Complexities in Human Skills
                Krathwohl’s Taxonomy of Affective Objectives
                Kohlberg’s Stages of Moral Development
                Benner’s Novice to Expert
                Azjen and Fishbein’s Theory of Reasoned Action
                Goleman’s Emotional Intelligence
                Martin and Reigeluth’s Affective Domain Model
                Biblical Principles of Learning

        Instructional Techniques Unique to Behavior Change
                Scaffolding
                Problem-based Learning

Section Two

        An Integration Approach to Learning
                Figure 1: Learning Framework
                Table 1: Theoretical and Conceptual Matrix to Learning
                Table 2: Comparing the Learning Achievement Levels Based on 3 Scientists
                Table 3: A Comparison of Affective or Emotional Aspects of Intelligence in the Learner
                Figure 2: Integration Approach to Coaching (Through Logic Modeling)

Section Three

        Countering Ambivalence or Resistance to Change
                Presentation 1:  The Power to Change Directions
                Presentation 2:  Motivational Interviewing
                Table 4:  Staged Motivational Interview

FrameWork & Framing Motivation

 The name  FrameWork Health alludes to the FRAMES Model of Motivational Interviewing (MI) developed by Samet, Rollnick, & Barnes (F=Feedback, R=Reframe, A=Advise, M=Menu of options, E=Empathy, S=Self-efficacy)1,2.  

The principles of of MI have become deftly incorporated in effective communication strategies, health promotion and behavior change, and subsequently, in leadership practices. The complexity of health care systems and avenues of delivery of care, the multiple professionals who contribute to healing, and the diverse characteristics of patients demand clarity, transparency, and exercise of various intelligences (Gardner - http://www.businessballs.com/howardgardnermultipleintelligences.htm), including the more recent addition to the theoretical field--Emotional Intelligence (Goleman - http://danielgoleman.info/topics/emotional-intelligence/).  

Refer to this graphic illustration . . .


The Spirit of Motivational Interviewing

Readiness to change is not a client trait, but a fluctuating product of interpersonal interaction.

The therapeutic relationship functions best as a partnership rather than an expert/recipient relationship.

Motivation to change should be elicited from the client, not imposed by the counselor.

It is the client's task, not the counselor's, to articulate and resolve his or her ambivalence.

The counselor is directive in helping the client examine and resolve ambivalence.

Direct persuasion, in which rational arguments for change are presented to the client by the expert, is not an effective method for resolving ambivalence.

The counseling style is generally a quiet and eliciting one.

__________________

In our company, FrameWork Health, we have modified FRAME to the rubric of:

F = Freedom from addictive/deleterious behavior

R = Restoration of health through quality living

A = Appreciation for personal strengths, creative power of God,

 and Divine intervention through human sources

M = Meaningful life purpose

E = Experience of efficacy through helping relationships

I hope you will find inspiration in this concept.


..........Linda


1.  Emmons K. M., Rollnick S.  “Motivational Interviewing in Health Care Settings: Opportunities and Limitations.”  American Journal of Preventive Medicine 2001:20(1), pp. 68-74.

2.  Samet J. H., Rollnick S, Barnes H.  “Beyond CAGE: A Brief clinical Approach After Detection of Substance Abuse.” Archives of Internal Medicine, Vol. 156, Nov 11, 1966, pp. 2287-2293.

 ________________________________________________________________

I want to introduce you to an excellent website for emerging nurse leaders where you may converse (it's a blog) about concerns in today's workforce, learn about helpful resources for leadership, and enjoy the benefits of a community of professionals in your shoes.  It is The Emerging RN Leader -- http://www.emergingrnleader.com/  I found a review there of a book entitled "Nursing Leadership and the Power of Framing" --  good stuff.


Get Downloads Below Section


Transforming Lives: A Course in Health Promotion


Motivational Interviewing Presentation


Motivational Interviewing

Motivational Interviewing (ppt)

Download

More Dimensions of Health - 2

Food Security

 Organic Food Security 

  • Standards and Practice 

Organic gardening is growing food without synthetic fertilizers or pesticides. "But gardening organically is much more than what you don't do. When you garden organically, you think of your plants as part of a whole system within Nature that starts in the soil and includes the water supply, people, wildlife and even insects. An organic gardener strives to work in harmony with natural systems and to minimize and continually replenish any resources the garden consumes. Organic gardening, then, begins with attention to the soil. You regularly add organic using locally available resources wherever possible. . . The other key to growing organically is to choose plants suited to the site.

 

The "science" of organic gardening is dependent on compliance to standardized regulations that assure to the nation's consumers that when they choose food labeled as "organically grown or produced" it truly is of the purity grade they expect. It would do the reader well to read the National Organic Program regulations below to gain an understanding of the rigor involved.
Food that is marketed and sold as "100% organic" must comply with the U.S. Department of Agriculture's National Organic Program regulations. Organic crop food must meet the following standards: [The NOP Standards] 

STANDARDS

To be sold or labeled as "100 percent organic," "organic," or "made with organic (specified ingredients or food group(s))," the product must be produced and handled without the use of:

" Synthetic substances and ingredients, except as provided in § 205.601:

(a) As algicide, disinfectants, and sanitizer, including irrigation system cleaning systems.
   (1) Alcohols.
        (i) Ethanol.
        (ii) Isopropanol.
   (2) Chlorine materials - Except, That, residual chlorine levels in the water shall not exceed the maximum residual disinfectant limit under the Safe Drinking Water Act. 
        (i) Calcium hypochlorite.
        (ii) Chlorine dioxide.
        (iii) Sodium hypochlorite.
    (3) Copper sulfate--for use as an algicide in aquatic rice systems, is limited to one application per field during any 24-month period. Application rates are limited to those which do not increase baseline soil test values for copper over a timeframe agreed upon by the producer and accredited certifying agent.
    (4) Hydrogen peroxide.
    (5) Ozone gas--for use as an irrigation system cleaner only.
    (6) Peracetic acid--for use in disinfecting equipment, seed, and asexually propagated planting material.
    (7) Soap-based algicide/demossers.
(b) As herbicides, weed barriers, as applicable.
    (1) Herbicides, soap-based - for use in farmstead maintenance (roadways, ditches, right of ways, building perimeters) and ornamental crops.
    (2) Mulches.
        (i) Newspaper or other recycled paper, without    glossy or colored inks.
        (ii) Plastic mulch and covers (petroleum-based other than polyvinyl chloride (PVC).

(c) As compost feedstocks.
Newspapers or other recycled paper, without glossy or colored inks.
(d) As animal repellents.
Soaps, ammonium - for use as a large animal repellant only, no contact with soil or edible portion of crop.
(e) As insecticides (including acaricides or mite control).
    (1) Ammonium carbonate - for use as bait in insect traps only, no direct contact with crop or soil.
    (2) Boric acid - structural pest control, no direct contact with organic food or crops.
    (3) Copper Sulfate - for use as tadpole shrimp control in aquatic rice production, is limited to one application per field during any 24-month period. Application rates are limited to levels which do not increase baseline soil test values for copper over a timeframe agreed upon by the producer and accredited certifying agent.
    (4) Elemental sulfur.
    (5) Lime sulfur - including calcium polysulfide.
    (6) Oils, horticultural - narrow range oils as dormant, suffocating, and summer oils..
    (7) Soaps, insecticidal.
    (8) Sticky traps/barriers.
        (f) As insect management. Pheromones.
(g) As rodenticides.
    (1) Sulfur dioxide - underground rodent control only (smoke bombs).
    (2) Vitamin D3.
(h) As slug or snail bait - None.
(i) As plant disease control.
    (1) Coppers, fixed - copper hydroxide, copper oxide, copper oxychloride, includes products exempted from EPA tolerance, Provided, That, copper-based materials must be used in a manner that minimizes accumulation in the soil and shall not be used as herbicides.
    (2) Copper sulfate - Substance must be used in a manner that minimizes accumulation of copper in the soil.
    (3) Hydrated lime.
    (4) Hydrogen peroxide.
    (5) Lime sulfur.
    (6) Oils, horticultural, narrow range oils as dormant, suffocating, and summer oils.
    (7) Peracetic acid - for use to control fire blight bacteria.
    (8) Potassium bicarbonate. 
    (9) Elemental sulfur.
    (10) Streptomycin, for fire blight control in apples and pears only.
    (11) Tetracycline (oxytetracycline calcium complex), for fire blight control only.
(j) As plant or soil amendments.
    (1) Aquatic plant extracts (other than hydrolyzed) - Extraction process is limited to the use of potassium hydroxide or sodium hydroxide; solvent amount used is limited to that amount necessary for extraction.
    (2) Elemental sulfur.
    (3) Humic acids - naturally occurring deposits, water and alkali extracts only.
    (4) Lignin sulfonate - chelating agent, dust suppressant, floatation agent.
    (5) Magnesium sulfate - allowed with a documented soil deficiency.
    (6) Micronutrients - not to be used as a defoliant, herbicide, or desiccant. Those made from nitrates or chlorides are not allowed. Soil deficiency must be documented by testing.
        (i) Soluble boron products.
        (ii) Sulfates, carbonates, oxides, or silicates of zinc, copper, iron, manganese, molybdenum, selenium, and cobalt. 
    (7) Liquid fish products - can be pH adjusted with sulfuric, citric or phosphoric acid. The amount of acid used shall not exceed the minimum needed to lower the pH to 3.5.
    (8) Vitamins, B1, C, and E.
(k) As plant growth regulators. Ethylene gas - for regulation of pineapple flowering.
(l) As floating agents in postharvest handling.
    (1) Lignin sulfonate.
    (2) Sodium silicate - for tree fruit and fiber processing.
(m) As synthetic inert ingredients as classified by the Environmental Protection Agency (EPA), for use with nonsynthetic substances or synthetic substances listed in this section and used as an active pesticide ingredient in accordance with any limitations on the use of such substances. 
    (1) EPA List 4 - Inerts of Minimal Concern.
    (2) EPA List 3 - Inerts of unknown toxicity - for use only in passive pheromone dispensers.
[Substances allowed by this section, except disinfectants and sanitizers in paragraph (a) and those substances in paragraphs (c), (j), (k), and (l) of this section, may only be used when the provisions set forth in § 205.206 (a) through (d) prove insufficient to prevent or control the target pest.]

" Nonsynthetic substances prohibited such as:
(a) Ash from manure burning, 
(b) Arsenic.
(c) Calcium chloride, brine process is natural and prohibited for use except as a foliar spray to treat a physiological disorder associated with calcium uptake.
(d) Lead salts.
(e) Potassium chloride unless derived from a mined source and applied in a manner that minimizes chloride accumulation in the soil.
(f) Sodium fluoaluminate (mined).
(g) Sodium nitrate - unless use is restricted to no more than 20% of the crop's total nitrogen requirement; use in spirulina production is unrestricted until October 21, 2005.
(h) Strychnine.
(i) Tobacco dust (nicotine sulfate).

" Nonagricultural substances used in or on processed products:
The following nonagricultural substances may be used as ingredients in or on processed products labeled as "organic" or "made with organic (specified ingredients or food group(s))" only in accordance with any restrictions specified in this section.
(a) Nonsynthetics allowed:
Acids (Alginic; Citric - produced by microbial fermentation of carbohydrate substances; and Lactic).
Agar-agar.
Animal enzymes - (Rennet - animals derived; Catalase - bovine liver; Animal lipase; Pancreatin; Pepsin; and Trypsin).
Bentonite.
Calcium carbonate.
Calcium chloride.
Calcium sulfate - mined.
Carageenan.
Colors, nonsynthetic sources only.
Dairy cultures.
Diatomaceous earth - food filtering aid only. 
Enzymes--must be derived from edible, nontoxic plants, nonpathogenic fungi, or nonpathogenic bacteria.
Flavors, nonsynthetic sources only and must not be produced using synthetic solvents and carrier systems or any artificial preservative.

Glucono delta-lactone - production by the oxidation of D-glucose with bromine water is prohibited.
Kaolin.
Magnesium sulfate, nonsynthetic sources only.
Nitrogen - oil-free grades.
Oxygen--oil-free grades.
Perlite--for use only as a filter aid in food processing.
Potassium chloride.
Potassium iodide.
Sodium bicarbonate.
Sodium carbonate.
Tartaric acid.
Waxes - nonsynthetic (Carnauba wax; and Wood resin).
Yeast - nonsynthetic, growth on petrochemical substrate and sulfite waste liquor is prohibited (Autolysate; Bakers; Brewers; Nutritional; and Smoked - nonsynthetic smoke flavoring process must be documented).

(b) Synthetics allowed:
Alginates.
Ammonium bicarbonate - for use only as a leavening agent.
Ammonium carbonate - for use only as a leavening agent.
Ascorbic acid.
Calcium citrate.
Calcium hydroxide.
Calcium phosphates (monobasic, dibasic, and tribasic). 
Carbon dioxide. 
Cellulose - for use in regenerative casings, as an anti-caking agent (non-chlorine bleached) and filtering aid.
Chlorine materials - disinfecting and sanitizing food contact surfaces, Except, That, residual chlorine levels in the water shall not exceed the maximum residual disinfectant limit under the Safe Drinking Water Act (Calcium hypochlorite; Chlorine dioxide; and Sodium hypochlorite).
Ethylene - allowed for postharvest ripening of tropical fruit and degreening of citrus.
Ferrous sulfate - for iron enrichment or fortification of foods when required by regulation or recommended (independent organization).
Glycerides (mono and di) - for use only in drum drying of food.
Glycerin - produced by hydrolysis of fats and oils.
Hydrogen peroxide.
Lecithin - bleached. 
Magnesium carbonate - for use only in agricultural products labeled "made with organic (specified ingredients or food group(s))," prohibited in agricultural products labeled "organic."

Magnesium chloride - derived from sea water.
Magnesium stearate - for use only in agricultural products labeled "made with organic (specified ingredients or food group(s))," prohibited in agricultural products labeled "organic."

Nutrient vitamins and minerals, in accordance with 21 CFR 104.20, Nutritional Quality Guidelines For Foods.
Ozone.
Pectin (low-methoxy).
Phosphoric acid - cleaning of food-contact surfaces and equipment only.
Potassium acid tartrate.
Potassium tartrate made from tartaric acid.
Potassium carbonate.
Potassium citrate.
Potassium hydroxide - prohibited for use in lye peeling of fruits and vegetables except when used for peeling peaches during the Individually Quick Frozen (IQF) production process.
Potassium iodide - for use only in agricultural products labeled "made with organic (specified ingredients or food group(s))," prohibited in agricultural products labeled "organic."
Potassium phosphate - for use only in agricultural products labeled "made with organic (specified ingredients or food group(s))," prohibited in agricultural products labeled "organic."
Silicon dioxide.
Sodium citrate.
Sodium hydroxide - prohibited for use in lye peeling of fruits and vegetables.
Sodium phosphates - for use only in dairy foods.
Sulfur dioxide - for use only in wine labeled "made with organic grapes," Provided, That, total sulfite concentration does not exceed 100 ppm.
Tartaric acid.
Tocopherols - derived from vegetable oil when rosemary extracts are not a suitable alternative.
Xanthan gum.

" Nonorganic agricultural substances used in or on processed products:
Any nonorganically produced agricultural product may be used in accordance with the restrictions specified in this section and when the product is not commercially available in organic form.

(a) Cornstarch (native).
(b) Gums - water extracted only (arabic, guar, locust bean, carob bean).
(c) Kelp - for use only as a thickener and dietary supplement.
(d) Lecithin - unbleached.
(e) Pectin (high-methoxy).

" Excluded methods, except for vaccines, Provided, That, the vaccines are approved in accordance with § 205.600(a);
" Ionizing radiation, as described in Food and Drug Administration regulation, 21 CFR 179.26; and " Sewage sludge." 


More Dimensions of Health - 3

Nutritional Management & Food Security

This case study addresses personal weight management challenges in the context of current concerns of hungering sub-populations on a global scale, corporate hubris, increasing obesity and the attendant consequential health insults, and stewardship of resources.  Following the introduction of factors which exert tremendous impact on society and, by extension, individuals, you will be given a scenario with which to imaginatively apply theory sources.

A. Factors that influence Agribusiness (or industry)

  1. Since the birth of the industrial era, followed by international conflicts in which land was destroyed and populations moved, the U.S., because of its rising power in technology and productivity, held forth with the mantra that we must “feed the world.”   Large monopoly farm conglomerates began to share the land with small family farms, subsequently followed by large food-processing plants and manufacturing plants to serve them.  Grains, meat, packaged foods, and other natural products were shipped to other countries—then as interventions for hunger, now more so as objects of trade.  Admittedly, that early philanthropic mission intent has been specious. And we are blessed in the ability to aid other countries in the name of democracy.  It also strengthened our political role as a superpower in the world and brought great profits to the companies involved, leading eventually to a spirit of greed for some.   
  2. Trade of agribusiness products has become so immense and remote that we now experience an uncertainty of food quality due to:
    1. The distance of food sources and the time in transport (in spite of refrigeration and other preservative techniques)
    2. The weaknesses in public health standards in other countries
    3. Our limited ability to examine all food stuffs brought in
    4. Local warehousing and shipping conditions
    5. Productivity-driven crop and livestock management practices such as:
      1. Genetic modifications 
      2. Pesticides
      3. Herbicides
      4. Fertilizers 
      5. Use of antibiotics and hormones in animals, poultry, and fish
      6. Warehousing of large numbers of livestock, poultry, and fish
  3. Environmental and cultural challenges to households in obtaining, storing, and using food:
    • With an increasingly diverse society, cultural food preferences may be challenged by availability
    • Resources for storing food in an economical method may be thwarted
    • To avoid eating processed and packaged foods, individuals in some communities do not have access to fresh food markets or to resources for doing their own gardening.
    • Purchasing fresh, non-tainted food (organic) may be prohibitive in cost
    • Widespread distracting advertising of non-healthy or less healthy foods influence decisions and subsequent purchase of food supplied.

  1. Personal challenges to eating a healthy diet are:
    • Lack of education concerning nutritional choices and healthy meal-planning.  This may arise at the high school level where there is a lack of good basic nutrition course; or it may begin with poor orientation to decision making skills and critical thinking as early as elementary school.
    • The individual’s poor self-regard, or feelings of worth – an emotional intelligence deficit
    • Lack of vision, purpose of life, of hope
    • Dependency on others
    • Mobility deficits for physical activity

I am sure you can think of more factors and, perhaps, even disagree with some I have mentioned.  These are ideas born of time and observation that are meant to stir your thinking about the background to reticence and resistance of individuals to change lifestyle behavior into a healthy quality of life.


Seeking Solutions Using Practiced Theory

If you have already viewed the case study on Nicotine Addiction, you will be familiar with how you might plan an intervention for change using the theories and concepts from Volume I as guides or structures in your choices.   I provide you with a variety of options for characteristics in the scenario below with which to create your own family scenario and develop an intervention for weight loss/management, general health, and food security strategies for changing behaviors.  You can see that motivational interviewing will require creative means to gain attention from this family.

  1. Family of 5: Mother, Dad, boys 4 and 7, and girl 11.  
  2. Their culture may be (1) Caucasian/European, (2) Mexican-American, (3) Haitian.  
  3. Father is an (1) over-the-road (long-distance) truck driver, (2) realtor, (3)construction foreman of commercial buildings.
  4. Mother is an (1) elementary school teacher, (2) quality control manager for a food processor, (3) receptionist for a dental practice.
  5. They live in the suburbs of a small city (80,000).
  6. Mother is 100# overweight with apparent little concern for losing it.
  7. Father is normal weight, but takes medication for hypertension and elevated cholesterol.
  8. Youngest child goes to day care during the day while mother is at work; other children attend public schools.
  9. Daughter is 40# overweight, receives critical comments from the boys at school, is shy and quietly angry, has limited social life—watches TV a lot.
  10. 4 year-old boy is asthmatic.
  11. 7 year-old boy like to write songs on the computer, not engaged in sports, rides his bike sometimes.
  12. Family eats take-out or micro-wave suppers during the week; don’t have fruit out on the counter nor fresh veggies in the fridge, sodas are readily available, as are processed sandwich foods. 

Learn More

How would you intervene as a health professional in this case study to enhance quality of life in the family?