Health Promotion and Preventive Care



Health Promotion and Preventive Care





CONCEPTS IN PROMOTION AND PREVENTION


Principles of Health Promotion

Health promotion is defined as the actions taken to develop a high level of wellness and is accomplished by influencing individual behavior and the environment in which people live.


Levels of Prevention



  • Disease prevention is aimed at avoiding problems or minimizing problems once they occur.



    • Primary prevention is the total prevention of a condition.


    • Secondary prevention is the early recognition of a condition and the measures taken to speed recovery.


    • Tertiary prevention is the care given to minimize the effects of the condition and prevent long-term complications.


  • Preventive care should involve assessment for people at risk for specific disorders.


Healthy People 2020



Evidence Base


Centers for Disease Control and Prevention, National Center for Health Statistics. (2011). Healthy People 2010 final review. Available: www.cdc. gov/nchs/healthy_people/hp2010/hp2010_final_review.htm.


Centers for Disease Control and Prevention, National Center for Health Statistics. (2009.) Healthy People 2020. Available: www.cdc.gov/nchs/healthy_people/hp2020.htm.



  • Health promotion goes beyond prevention to help people manage their health and live longer and feel better.


  • Health promotion has become a priority since the U.S. Department of Health and Human Services (DHHS) initiated its Healthy People 2000 campaign in 1990.


  • For the Healthy People 2010 campaign, launched in 2000, 23% of the campaign’s stated objectives were reached or exceeded, whereas 48% of the stated objectives were approached. The two major goals of Healthy People 2010 were to enhance life expectancy while improving quality of life and to reduce health disparities due to gender, race and ethnicity, income and education, disabilities, and other factors.


  • Healthy People 2020 consists of four overreaching goals with 42 topic areas (see Box 3-1, page 22):



    • Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death.


    • Achieve health equity and eliminate disparities.


    • Create social and physical environments that promote good health for all.


    • Promote quality of life, healthy development, and healthy behaviors across all life stages.


  • For more information, see www.healthypeople.gov.


Millennium Development Goals



  • The Millennium Development Goals (MDGs) were approved by the United Nations in 2000 to address the most pressing needs of the poor worldwide, including some health needs.



  • Goals to be achieved by 2015 focus on the following areas:



    • Eradicating extreme hunger and poverty.


    • Achieving universal primary education.


    • Promoting gender equality.


    • Reducing child mortality.


    • Improving maternal health.


    • Combating human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome, malaria, and other diseases.


    • Ensuring environmental sustainability.


    • Developing a global partnership for development.


  • Nurses are at the forefront of health care throughout the world and can make tremendous strides in reaching these goals by caring for families and communities and advocating for vulnerable populations.


  • Review progress of the MDGs at www.un.org/millenniumgoals.



BOX 3-1 Healthy People 2020 Topic Areas



  • Access to quality health services


  • Adolescent health


  • Arthritis, osteoporosis, and chronic back conditions


  • Blood disorders and blood safety


  • Cancer


  • Chronic kidney disease


  • Dementias, including Alzheimer’s disease


  • Diabetes


  • Disability and secondary conditions


  • Early and middle childhood


  • Educational and community-based programs


  • Environmental health


  • Family planning


  • Food safety


  • Genomics


  • Global health


  • Health communication


  • Health care-associated infections


  • Health-related quality of life and well-being


  • Hearing and other sensory or communication disorders


  • Heart disease and stroke


  • Human immunodeficiency virus


  • Immunization and infectious disease


  • Injury and violence prevention


  • Lesbian, gay, bisexual, and transgender health


  • Maternal, infant, and child health


  • Medical product safety


  • Mental health and mental disorders


  • Nutrition and weight control


  • Occupational safety and health


  • Older adults


  • Oral health


  • Physical activity and fitness


  • Preparedness


  • Public health infrastructure


  • Respiratory disorders


  • Sexually transmitted diseases


  • Sleep health


  • Social determinants of health


  • Substance abuse


  • Tobacco use


  • Vision


Nursing Role in Health Promotion



  • Nurses have played key roles in prevention in such areas as prenatal care, immunization programs, occupational health and safety, cardiac rehabilitation and education, and public health care and early intervention.


  • Nurses in all settings can meet health promotion needs of patients, whether their practice is in a hospital, clinic, patient’s home, health maintenance organization, private office, or community setting.


  • Health promotion is primarily accomplished through patient education, an independent function of nursing.


  • Health promotion should occur through the life cycle, with topics focused on infancy, childhood, adolescence, adulthood, and older adults. Specific preventive services are evidence-based and recommended by the United States Preventive Services Task Force (www.ahrq.gov/clinic/prevenix. htm), the Canadian Task Force on Preventive Health Care (www.canadiantaskforce.ca/index.html), the National Institute for Health and Clinical Excellence (www.nice.org.uk) in the United Kingdom, as well as other agencies (see Table 3-1).



    • For infancy, teach parents about the importance of prenatal care, basic care of infants, breastfeeding, nutrition, and infant safety (see Chapter 42).


    • For childhood, stress the importance of immunizations; proper nutrition to enhance growth and development; and safety practices, such as use of car seats and seat belts, fire prevention, and poison-proofing the home (see Chapter 42).


    • For adolescence, focus on motor vehicle safety; avoidance of drug, alcohol, and tobacco use; sexual decision making and contraception; and prevention of suicide.


    • For adulthood, teach patients about nutrition, exercise, and stress management to help them feel better; also teach cancer-screening techniques, such as breast and testicular self-examination; and risk factor reduction for the leading causes of death—heart disease, stroke, cancer, and chronic lung disease.


    • For older adults, stress the topics of nutrition and exercise to help people live longer and stay fit, safety measures to help them compensate for decreasing mobility and sensory function, and ways to stay active and independent (see Chapter 9).


Theories of Behavior Change

Lifestyle changes that promote wellness and reduce or prevent illness are often difficult to accomplish. Although education and support by nurses are key, lifestyle changes are ultimately up to
the patient. Nurses should understand the concepts and processes related to behavior change in order to help direct interventions for successful outcomes in individual patients or groups.








Table 3-1 Preventive Services Resommended by the USPSTF
























































































































































































































































































The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians discuss these preventive services with eligible patients and offer them as a priority. All these services have received an “A” (strongly recommended) or “B” (recommended) grade from the Task Force.


RECOMMENDATION

MEN

WOMEN

PREGNANT WOMEN

CHILDREN


Abdominal Aortic Aneurysm, Screening (1)

[check mark]




Alcohol Misuse Screening and Behavioral Counseling interventions

[check mark]

[check mark]

[check mark]


Aspirin for the Primary Prevention of Cardiovascular Events (2)

[check mark]

[check mark]



Asymptomatic Bacteriuria in Adults, Screening (3)



[check mark]


Breast Cancer, Screening (4)


[check mark]



Breast and ovarian Cancer Susceptibility, Genetic risk Assessment and BrCA Mutation Testing (5)


[check mark]



Breast-feeding, Primary Care interventions to Promote (6)


[check mark]

[check mark]


Cervical Cancer, Screening (7)


[check mark]



Chlamydial infection, Screening (8)


[check mark]

[check mark]


Colorectal Cancer, Screening (9)

[check mark]

[check mark]



Congenital Hypothyroidism, Screening (10)




[check mark]


Depression (Adults), Screening (11)

[check mark]

[check mark]



Folic Acid Supplementation (12)


[check mark]



Gonorrhea, Screening (13)


[check mark]



Gonorrhea, Prophylactic Medication (14)




[check mark]


Hearing loss in Newborns, Screening (15)




[check mark]


Hepatitis B virus infection, Screening (16)



[check mark]


High Blood Pressure, Screening

[check mark]

[check mark]



Human immunodeficiency virus (Hiv), Screening (17)

[check mark]

[check mark]

[check mark]

[check mark]


Iron-Deficiency Anemia, Prevention (18)




[check mark]


Iron-Deficiency Anemia, Screening (19)



[check mark]


Lipid Disorders in Adults, Screening (20)

[check mark]

[check mark]



Major Depressive Disorder in Children and Adolescents, Screening (21)




[check mark]


Obesity in Adults, Screening (22)

[check mark]

[check mark]



Obesity in Children and Adolescents, Screening (23)




[check mark]


Osteoporosis, Screening (24)


[check mark]



Phenylketonuria, Screening (25)




[check mark]


Rh(D) incompatibility, Screening (26)



[check mark]


Sexually Transmitted infections, Counseling (27)

[check mark]

[check mark]

[check mark]


Sickle Cell Disease, Screening (28)




[check mark]


Syphilis infection, Screening (29)

[check mark]

[check mark]

[check mark]


Tobacco Use and Tobacco-Caused Disease, Counseling and interventions (30)

[check mark]

[check mark]

[check mark]


Type 2 Diabetes Mellitus in Adults, Screening (31)

[check mark]

[check mark]



Visual impairment in Children Younger Than 5 Years, Screening (32)




[check mark]


1. One-time screening by ultrasonography in men ages 65 to 75 who have ever smoked.


2. When the potential harm of an increase in gastrointestinal hemorrhage is outweighed by a potential benefit of a reduction in myocardial infarctions (men age 45 to 79 years) or in ischemic strokes (women age 55 to 79 years).


3. Pregnant women at 12 to 16 weeks’ gestation or at first prenatal visit, if later.


4. Biennial screening mammography for women age 50 to 74 years; (2002 recommendations: age 40 and older, every 1-2 years).


5. Refer women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes for genetic counseling and evaluation for BRCA testing.


6. Interventions during pregnancy and after birth to promote and support breastfeeding.


7. Cytology every 3 years (age 21 to 65) or cotest (cytology/HPV testing) every 5 years (age 30-65).


8. Sexually active women age 24 and younger and other asymptomatic women at increased risk for infection. Asymptomatic pregnant women age 24 and younger and others at increased risk.


9. Adults age 50 to 75 using fecal occult blood testing, sigmoidoscopy, or colonoscopy.


10. Newborns.


11. When staff-assisted depression care supports are in place to ensure accurate diagnoses, effective treatment, and follow-up.


12. All women planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400 to 800 mcg) of folic acid.


13. Sexually active women, including pregnant women age 25 and younger, or at increased risk for infection.


14. Prophylactic ocular topical medication for all newborns against gonococcal ophthalmia neonatorium.


15. Newborns.


16. Pregnant women at first prenatal visit.


17. All adolescents and adults at increased risk for HIV infection and all pregnant women.


18. Routine iron supplementation for asymptomatic children age 6 to 12 months who are at increased risk for iron-deficiency anemia.


19. Routine screening in asymptomatic pregnant women.


20. Men age 25 to 35 and older and women over age 20 who are at risk for coronary disease; all men age 35 and older.


21. Adolescents (age 12 to 18) when systems are in place to ensure accurate diagnosis, psychotherapy, and follow-up.


22. Intensive counseling and behavioral interventions to promote sustained weight loss for obese adults.


23. Screen children age 6 years and older for obesity and offer them or refer them to comprehensive, intensive behavioral interventions to promote improvement in weight status.


24. Women age 65 and older and women under age 65 at increased risk for osteoporotic fractures.


25. Newborns.


26. Blood type and antibody testing at first pregnancy-related visit. Repeated antibody testing for unsensitized Rh(D)-negative women at 24 to 28 weeks’ gestation unless biological father is known to be Rh(D) negative.


27. All sexually active adolescents and adults at increased risk for STIs


28. Newborns.


29. Persons at increased risk and all pregnant women.


30. Ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco; provide augmented, pregnancy-tailored counseling to pregnant women who smoke.


31. Asymptomatic adults with sustained blood pressure greater than 135/80 mm Hg.


32. To detect amblyopia, strabismus, and defects in visual acuity; screen children ages 3-5 years.


Guide to Clinical Preventive Services, 2012: recommendations of the U.S. Preventive Services Task Force. AHrQ Publication No. 12-05154, october 2012. Agency for Healthcare research and Quality, rockville, MD. http://www.ahrq.gov/clinic/pocketgd2012/

Only gold members can continue reading. Log In or Register to continue

Related posts:

  1. Intravenous Therapy
  2. Gynecologic Disorders
  3. Pediatric Immunologic Disorders
  4. Diabetes Mellitus and Related Disorders

Stay updated, free articles. Join our Telegram channel
Tags:
Jul 20, 2016 | Posted by in NURSING | Comments Off on Health Promotion and Preventive Care

Full access? Get Clinical Tree
Get Clinical Tree app for offline access