Health Promotion and Roles of the Nurse

Overview of the Chapter

This chapter will include what is health promotion and prevention. Health promotion and disease prevention is very important and as as nurses, it is one of the role that the nurses implement everyday. It is important to provide patient education for health promotion and disease prevention. This chapter includes tools to provide patient education and provide effective patient teaching. This chapter will include concepts of health promotion, disease prevention, nurse’s role in teaching patients on health promotion.

Introduction

What do we understand by the terms health and health promotion?

Health: When broadly defined, it is a state of complete physical, mental and social wellbeing not merely the absence of disease or infirmity. According to this definition physical, social and psychological factors all contribute to health.

Health promotion: According to the Ottawa Charter, health promotion is defined as the process of enabling people to increase control over, and to improve, their health. Health promotion is aimed at reducing the underlying causes of ill-health so that there is a long term reduction in many diseases.

The 1984 WHO revised definition of health defined it as “the extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities. Thus, health referred to the ability to maintain homeostasis and recover from insults. Mental, intellectual, emotional, and social health referred to a person’s ability to handle stress, to acquire skills, to maintain relationships, all of which form resources for resiliency and independent living.

I. Health Promotion

Health promotion and disease prevention through population-based interventions, including action to address social determinants and health inequity from the World Health Organization (2023).

A. Disease prevention

Primary prevention are those preventive measures that prevent the onset of illness or injury before the disease process begins.  Services and activities include:

• Vaccination and post-exposure prophylaxis of children, adults and the elderly;
• Provision of information on behavioral and medical health risks, and measures to reduce risks at the individual and population levels;
• Inclusion of disease prevention programmes at primary and specialized health care levels, such as access to preventive services (ex. counselling)
• Nutritional and food supplementation
• Dental hygiene education and oral health services.
• Education about healthy and safe habits (e.g. eating well, exercising regularly, not smoking)

Secondary prevention are those preventive measures that lead to early diagnosis and prompt treatment of a disease, illness or injury to prevent more severe problems developing. Here health educators such as Health Extension Practitioners can help individuals acquire the skills of detecting diseases in their early stages.   This includes activities such as:

• Population-based screening programmes for early detection of diseases; screening for high blood pressure and breast self-examination.
• Provision of maternal and child health programmes, including screening and prevention of congenital malformations; and
• Suitably modified work so injured or ill workers can return safely to their jobs.

Tertiary prevention are those preventive measures aimed at rehabilitation following significant illness. At this level health services workers can work to retrain, re-educate and rehabilitate people who have already developed an impairment or disability.

• Cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.)
• Support groups that allow members to share strategies for living well
• Vocational rehabilitation programs to retrain workers for new jobs when they have recovered as much as possible.

B. Levels of Care: Differences Between Primary, Secondary, Tertiary, and Quaternary Care

In medicine, levels of care refer to the complexity of the medical cases doctors treat and the skills and specialties of the providers. Levels are divided into four categories.

Primary care is when you consult with your primary care provider. Secondary care is when you see a specialist such as an oncologist or endocrinologist. Tertiary care refers to specialized care in a hospital setting such as dialysis or heart surgery. Quaternary care is an advanced level of specialized care.

Levels of care refer to the complexity of medical cases, the types of conditions a physician treats, and their specialties.

• Primary care involves your primary healthcare provider. You see them for things like acute illnesses, injuries, screenings, or to coordinate care among specialists.
• Secondary care is the care of a specialist. These specialists may include oncologists, cardiologists, and endocrinologists.
• Tertiary care is a higher level of specialized care within a hospital. Similarly, quaternary care is an extension of tertiary care, but it is more specialized and unusual.

II. The Role of the Nurse

Registered nurses have the unique ability to work in a variety of environments and specializations. From bedside care to administrative work to home care and travel nursing, RNs aren’t limited to traditional hospital roles. Find out more about the career opportunities available to you as an RN. Review the different roles and opportunities nurses available. You may click on the different careers such as inpatient, outpatient or alternate to understand your roles and responsibilities in each setting or role. https://www.registerednursing.org/nursing-careers/#inpatient

A. Health Education can be applied at all three levels of disease prevention and can be of great help in maximizing the gains from preventive behavior.

• For example at the primary prevention level — you could educate people to practice some of the preventive behaviors, such as having a balanced diet so that they can protect themselves from developing diseases in the future.
• At the secondary level, you could educate people to visit their local health center when they experience symptoms of illness, such as fever, so they can get early treatment for their health problems.
• At the tertiary level, you could educate people to take their medication appropriately and find ways of working towards rehabilitation from significant illness or disability.

B. Health promotion

• Policies and interventions to address tobacco, alcohol, physical activity and diet (e.g.,  FCTC , DPAS , alcohol strategy and NCD best-buys)
• Dietary and nutritional intervention should also appropriately tackle malnutrition, defined as a condition that arises from eating a diet in which certain nutrients are lacking, in excess (too high in intake), or in the wrong proportions
  • Intersectoral policies and health services interventions to address mental health and substance abuse
  • Strategies to promote sexual and reproductive health, including through health education and increased access to sexual and reproductive health, and family planning services
  • Strategies to tackle domestic violence, including public awareness campaigns; treatment and protection of victims; and linkage with law enforcement and social services.

C. Support mechanisms for health promotion and disease prevention

• Multisectoral partnerships for health promotion and disease prevention
• Educational and social communication activities aimed at promoting healthy conditions, lifestyles, behavior and environments
• Reorientation of health services to develop care models that encourage disease prevention and health promotion
• Risk communication.

https://www.emro.who.int/about-who/public-health-functions/health-promotion-disease-prevention.html

III. Patient Education

Patient education is defined as “any set of planned educational activities , using a combination of methods (teaching, counseling, and behavior modification), that is designed to improve patient’s knowledge and health behaviors”(Friedman, Cosby, Boyco, Hatton-Bauer,&Turnbull, 2011). Nurses must have a basic understanding of the principles and process of teaching and learning to carry out their professional practice responsibilities effectively. All nursing practices acts including teaching within the scope of nurse’s responsibilities to assist patients to maintain optimum level of wellness and manage illness.

The purpose of patient education is to increase patient’s competence and confidence for self-management. Effective patient education can result increase patient satisfaction, improved quality of life, ensure continuity of care and decreased anxiety. Other benefits are reduced complications, promotion of adherence to treatment plan, maximize independence and empower planning own care.

A. Patient education Process: is a systematic, sequential, logical, scientifically based, planned course of action consists of learning and teaching. This education process is compared to nursing process. It depicts  the steps of the nursing process parallel to the education process.

Adapted from “essentials of patient education” S.B. Bastable

B. Nursing Process

The patient education process has 4 equal components to be addressed by the nurse: assessment, planning, implement, and evaluation. Excellent patient education is an “art” and “science” using nuances and evidence-based strategies to effectively educate. The assessment and evaluation components often use nuanced approaches (motivational interviewing, teach back) to engage the patient/caregiver respectfully, whereas planning and implementation rely more on evidence-based strategies such as the patient education assessment of materials. Nurses should provide education that is simple, patient centered, and multimodal to meet the health literacy needs of patients/caregivers.

C. Learning Domains

Teaching and instructions are deliberate interventions  that involve sharing of information to meet intended learner outcomes in cognitive, affective and psychomotor domains according to an educational plan.

• Cognitive: Memorization, recall, comprehension, ability to analyze, apply ideas & evaluate ideas EXAMPLE: understanding traffic laws, ability to recall & apply learned information when driving. (Lecture)
• Affective: Responding to new ideas, demonstrating commitment to new ideas, & integrating new ideas into their value system. EXAMPLE: Driving when rested, pulling over when tired, driving sober (Discussion)
• Psychomotor: Sensory awareness of cues involved in learning as well as imitation & performance of skills & creation of new skills. EXAMPLE: Successfully driving using both feet & hands appropriately.  A patient changes his dressing after observing it done by nurse the day before. (Demonstration: Successfully giving yourself an insulin injection after acquiring the skills to do so.)

The ASSURE  model is developed to help nurses to organize and carry out education process.

ASSURE Model

D. Barriers to Teaching

Factors interfering with the health professional’s ability to teach include:

• Lack of time
• lack of motivation and skill
• negative influence of the environment (lack of space, and privacy, noise)
• absence of third-party reimbursement
• low priority status of client education
• lack of confidence and competence
• questionable effectiveness of client education
• documentation difficulties

• Sensory deficits include: impaired or loss of vision and hearing 
• language barrier and culture Barrier
• Literacy Barrier: ability to read, write and speak in English and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and to develop one’s knowledge and potential.
• Physical and Environmental Barriers
• Learning Styles
• Teaching Methodologies

For effective delivery of health information and education, the nurse must be aware of the barriers that can impede the patient’s ability and readiness to learn. Awareness of the potential barriers of literacy, culture, language, and physiological factors will help the nurse determine what tools he or she may need to assist in the delivery of information. Awareness of one’s biases and prejudices and overcoming them will assist in the education process.

IV. Application in Practice

V. Reflections

VI. Recommended Resources 

Health Disparities: https://www.cdc.gov/healthyyouth/disparities/index.htm

Health Promotion Activities: https://www.cdc.gov/chronicdisease/programs-impact/health-promotion/index.htm 

Patient-education tips for new nurses: https://journals.lww.com/nursing/Fulltext/2013/10000/Patient_education_tips_for_new_nurses.24.aspx

National Center for Health Promotion and Disease Prevention: https://www.prevention.va.gov/

Health Promotion and Disease Prevention Interventions for the Elderly: A Scoping Review from 2015–2019: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432678/pdf/ijerph-17-05335.pdf

health.gov: healthy PEOPLE 2023:https://health.gov/

Impact Quick Facts: https://www.cdc.gov/chronicdisease/pdf/impacts-H.pdf

What is Nursing?: https://www.nursingworld.org/practice-policy/workforce/what-is-nursing 

Duties of a Registered Nurse | in a Hospital and Nursing Home: https://www.registerednursern.com/duties-of-a-registered-nurse-in-a-hospital-and-nursing-home/

Tackling the Teach-Back Method: https://engage.healthynursehealthynation.org/blogs/8/4537

References and Attributes

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 Health, 106(2), e205-e208. https://doi.org/10.17269/CJPH.107.5317

The World Health Organization (2023). Retrieved from https://www.emro.who.int/about-who/public-health-functions/health-promotion-disease-prevention.html

Bastable, S. B. (2016). Essentials of patient education. Jones & Bartlett Learning.

Differences Between Primary, Secondary, Tertiary, and Quaternary Care: Retrieved from https://www.verywellhealth.com/primary-secondary-tertiary-and-quaternary-care-2615354

Burke, A. (2020, January 15). Collaboration with interdisciplinary team: NCLEX-RN. RegisteredNursing.org. https://www.registerednursing.org/nclex/collaboration-interdisciplinary-team/#collaborating-healthcare-members-disciplines-providing-client -care↵

J. Baker (n. d):  1.2: Three Levels of Health Promotion/Disease Prevention  LibreTexts platform https://med.libretexts.org/Bookshelves/Health_and_Fitness/Contemporary_Health_Issues_(Baker)/01%3A_Introduction_to_Personal_Health/1.02%3A_Three_Levels_of_Health_Promotion_Disease_Prevention