Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 2 Health Promotion and Disease Prevention

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Health and Illness Community-based care concentrates on true “health care” activities to promote health and prevent illness and injury. Shift in thinking from a focus on sick care to disease and injury prevention

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Definition of Health Health: state of physical, mental, and social well-being and not merely absence of disease or infirmity (WHO, 1986) Updated WHO definition (2008)included characteristics, behaviors, and physical, social, and economic environment Seen as a resource for everyday living

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Health-Illness Continuum Care in the acute care settings is usually directed to resolving immediate health problems. In the community, care focuses on maximizing individual potential for self-care. The client assumes responsibility for health care decisions and care provision, with the client’s ability to function the primary concern.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Healthy People 2020 Missions To identify nationwide health improvement priorities To increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress To provide measurable objectives and goals applicable at the national, state, and local levels

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Healthy People 2020 Missions (cont.) To engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge To identify critical research, evaluation, and data collection needs

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Healthy People 2020 Goals Attain higher quality, longer lives free of preventable disease, disability, injury, and premature death Achieve health equity, eliminate disparities, and improve the health of all groups Create social and physical environments that promote good health for all Promote quality of life, healthy development, and healthy behaviors across all life stages

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Promotion Versus Disease or Injury Prevention? Health promotion: activities to help individuals change their lifestyle to move toward a state of optimal health (a balance of physical, emotional, social, spiritual, and intellectual health) Disease prevention: activities undertaken to avoid the occurrence of a disease or injury and minimize the consequences. Intended to prevent future illness. Health protection: environmental or regulatory measures that confer protection on population groups

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Levels of Prevention Primary prevention: prevention of the initial occurrence of a disease or an injury Secondary prevention: early identification with prompt intervention to prevent or limit disability Tertiary prevention: assistance to halt further disease progress and to meet one’s potential and maximize quality of life

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Public Health Nursing Intervention Wheel

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Levels of Public Health Practice Individual-focused practice –Changes knowledge, attitudes, beliefs, practices, and behaviors of individuals –Practice level directed at individuals alone or as part of a family, class, or group –Receive services because they are part of population at risk

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Levels of Public Health Practice (cont.) Systems-focused practice –Changes organizations, policies, laws, and power structures –Focus is not directly on individuals and communities but focuses on systems that impact health. –More effective and long lasting way to impact population health

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Levels of Public Health Practice (cont.) Community-focused practice –Changes community norms, community attitudes, community awareness, community practices, and community behaviors –Directed toward entire population, groups within the community, or target groups –Measured in terms of what proportion of population actually changes

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Levels of Public Health Practice (cont.) Population-based –Public health interventions are population-based if they consider all levels of practice. –Represented by all three inner rings of the intervention wheel –Interventions may be focused at population or on individuals and families known to be at risk.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Public Health Interventions Surveillance Disease and other health event investigation Outreach Screening Case-finding Referral and follow-up Case management

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Public Health Interventions (cont.) Delegation functions Health teaching Counseling Consultation Collaboration Coalition building Community organizing

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Public Health Interventions (cont.) Advocacy Social marketing Policy development Policy enforcement

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Summary Nursing practice has evolved as a reflection of society’s need to focus on health rather than illness. Healthy People 2020 provides a framework to put disease prevention into action. Prevention is a key concept in community-based care.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Student nurses go into a neighborhood door-to-door. They identify individuals who have not had flu shots and direct them to the local community center’s flu clinics. This is an example of –A. Screening –B. Outreach –C. Health teaching –D. Surveillance

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Outreach Rationale: Outreach is locating populations of interest or populations at risk and providing them with information about the nature of the concern, what can be done about it, and how services can be obtained.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question A nurse meets with Edna, an elderly woman who has been hospitalized with a broken hip, and her family. They discuss what self-care Edna can manage on her own and how the family may be able to assist her once she goes home and determine the community resources available to assist with her care. These actions would be considered –A. Health teaching –B. Case management –C. Collaboration –D. Case-finding

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Case management Rationale: Case management optimizes the self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services.

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question The nurse is providing blood pressure screening at the local senior center. This is an example of which level of prevention? –A. Health promotion –B. Primary prevention –C. Secondary prevention –D. Tertiary prevention

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Secondary prevention Rationale: Screening is considered secondary prevention because the nurse is identifying the presence of disease.