Chapter 1 – Introduction to Health Assessment

Integrative Approach to Health Promotion and Assessment

As a nurse conducting a health assessment, you have an obligation not only to document and respond to the data you yield through your health assessment, but also to offer guidance to your clients. An integrative, individualized, and adapted approach to health promotion means that you partner with clients to identify their needs. You may apply all three approaches – behavioural, relational, and structural – to health promotion. For example, some situations may call for a behavioural approach: perhaps the client is seeking strategies to reduce their cholesterol. Other occasions may call for a relational approach, such as working with a family experiencing a loss; still others may require a structural approach, such as helping a client complete application forms to cover their medication costs.

All of the health promotion approaches and strategies rely on the nurse’s assessment skills and their capacity to prioritize what is important to the client, their family and community in that particular moment. Although health determinants remain relevant, Gewurtz et al. (2016) also proposed approaching health promotion by focusing on “the integration of physical, mental, social and spiritual components of health and well-being. … [within the context of the person’s] patterns of daily activity” (p. e205).

This marks a change from the traditional prescriptive nature of past approaches, which neglected to truly engage the client as an expert in their own lives – it also includes considering the client’s daily patterns of activity that should be the driving force of health promotion interventions. An effective and integrated health promotion approach that is shaped by the client’s daily patterns of activity, will require that you understand the person’s day-to-day life and what is important to them.

Therefore, when collaboratively developing a health promotion intervention with a client, your assessment should include questions like:

  • Tell me about your day-to-day activities.
    • What does a typical day look like for you?
    • Who is involved in these activities with you?
  • Have you had any recent changes in your day-to-day activities in the past year?
  • In order to be a healthier you, how would you like these day-to-day activities to be different?

Table 1.7 presents an adapted example based on Gewurtz et al.’s (2016) health promotion approach: it is based on patterns of activity. This example is informed by clinical judgment, which requires identifying health-related cues and the identifying of actions to promote a client’s health and wellbeing. As with all interventions, you should engage the client in identifying what is important to them in terms of their health and wellbeing.

Table 1.7: Example of health promotion

Client description 

Clinical judgement 

Health promotion 

An international student has moved to a large city to attend their first year of university. They had a close group of friends and family in the small town they grew up in, and now feels lonely. Their day-to-day activities used to be much fuller and they used to feel engaged, and now they just go to class and study.

The nurse recognizes the cues of missing a social group. The student’s activity patterns have been disrupted, leading to loneliness and disengagement. To further analyze these cues, the nurse should explore what other activities the student used to do where they grew up and what activities they may enjoy here.

Health promotion interventions should be collaboratively co-created with the student based on their needs and wants. Interventions might include connecting with their old social circle via social media/video-conference, and also developing new patterns of social activities at the university, for example by joining extra-curricular groups.

Clinical Tip 

A focus on health promotion is important in all healthcare settings including primary care settings and hospital/acute care settings. Although health promotion is categorized as a third-level priority of care, you should integrate knowledge of health determinants into all assessments. A focus on health promotion can help promote client engagement and overall health and wellbeing while reducing negative effects.


Gewurtz, R., Moll, S., Letts, L., Lariviere, N., Levasseur, M., & Krupa, T. (2016). What you do every day matters: A new direction for health promotion. Canadian Journal of Public Health106(2), e205-e208.

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