Understanding Health Promotion Interventions in Nursing Practice The nursing profession is one of the largest health care professions, providing important opportunities for health promotion with potential to reform health at the legislative level. Health promotion is defined by Kreuter and Devore (1980) as, “the process of advocating health in order to enhance the probability that person (individual, family, and community), private (professional and business), and public (federal, state, and local government) support of positive health practices will become a societal norm” (p. 6).
Health promotion in nursing practice focuses on changing behaviors and lifestyles empowering people to proactively be responsible for their health. However, unless the barriers are recognized, the goals of health promotion and disease prevention cannot be achieved. Nurses play an important role in promoting health and disease prevention to reduce risk, chronic disease, and enhancing the quality of life cost-effectively.
One of the main roles of a nurse is educating in all health components for attaining maximum health. Upon this role and the nurse’s ability to use appropriate knowledge does health promotion and prevention heavily rely (Edelman & Mandel, 2010a). Endless opportunities in a diverse society present challenges for nurses to use different levels of prevention intervention for effective health promotion, based on the situation and risk factors.
The three levels of prevention, each having five steps are defined by Leavell & Clark (1965) in the following, “These steps include health promotion and specific protection (primary prevention); early diagnosis, prompt treatment, and disability limitation (secondary prevention); and restoration and rehabilitation (tertiary prevention)” (p. 13). Primary prevention consists of activities that eliminate disease, such as immunizations and promoting healthy lifestyles.
However, according to Edelman & Mandel (2010c), “Primary prevention can also include advocating for policies that promote the health f the community and electing public officials who will enact legislation that protects the health of the public” (p. 13). Secondary prevention consists of activities to prevent complication, progression of disease, and preventing disability. Associated with secondary prevention are screenings and tests, such as pap smears, mammograms, x-rays, among many others, upon which the physician recommends treatment. Tertiary prevention activities include hospital and community facilities for restoration and rehabilitation for those in well-established or advanced disease.
These activities include the prevention of complications, retarding progression of disease, and preventing disability. Tertiary prevention interventions are among the most invasive and expensive treatments available, but promise better functioning, fewer complications, and improved quality of life. The nurse must determine which intervention will be most successful in producing behavior changes for optimal health. The following illustrations compare these interventions and how they were implemented in health promotion.
The first illustration addresses risk factors for youth smoking, using primary and secondary tobacco prevention, with implications for future research, policy, and practice. Primary prevention of tobacco use was aimed at preventing youth from ever trying tobacco. The tobacco prevention interventions implemented by nurses were not limited to the school environment, but also included family-based approaches, churches, and faith-based organizations as a positive influence on youth.
While primary prevention efforts target preventing experimentation and use, secondary prevention is aimed at helping individuals who use tobacco with successful cessation” (Tingen, et al. , 2009, p. 182). Evidence-based guidelines for treating tobacco use and dependence, which include pharmacological nicotine replacement therapies are recommendations for adult populations only. Therefore, evidence-based guidelines for youth smokers are lacking, other than counseling.
Tingen summarizes (2009), “With focused and sustained endeavors of rigorous research, policy initiatives, and diligent practice, nursing can help achieve smoke-free environments, decrease risk factors and enhance protective factors in youth, develop and implement effective interventions that prevent initiation and foster successful cessation, and prevent numerous adverse health outcomes in this vulnerable population and the future of America: the youth” (p. 188).
The second illustration focused on primary, secondary and tertiary interventions using occupational health activities at a Japanese company for metabolic syndrome to determine changes in lifestyle. Their purpose was to devise the annual health promotion plan. Primary prevention included individual interview, occupational health education for groups of employees several times annually, and health consultations. Secondary prevention included post-screening referrals for those employees with abnormal findings, and tertiary prevention included visits to hospitalized employees and support for their returning to work.
Ariyoshi et al. (2010) concluded, “Occupational health activities based on a health promotion philosophy and aimed at primary and secondary prevention are more effective than diagnostic activities and other types of health management aimed at tertiary prevention” (p. 383). The third illustration includes the provision of primary, secondary and tertiary health promotion activities of occupational therapy in the older population of New Zealand.
Occupational therapists in New Zealand engage in both secondary and tertiary health promotion with the provision of assistive devices and rehabilitation programs with people experiencing degenerating chronic conditions. Falls prevention and aspects of lifestyle management was used as secondary health promotion. Wilson, Andrew & Wilson (2012) concludes, “There is evidence that health promotion activities with well older people are both effective and economically cost-effective” (p. 36).
Changes in society bring evolving demands for nursing to shift emphasis from acute care in the hospital to preventive, community based care. The trend to establish primary medical care homes (PCMH), home health services, along with the changing demographics of the U. S. , makes the home as a major community setting for care. According to Edelman & Mandel (2010b), “As the home and community become the existing sites for care, nurses must assume more blended roles, with a knowledge base that prepares them to practice across settings using evidence-based practice” (p. 17).
Different health care settings require the nurse to perform a variety of roles in today’s health care system. As a collaborative team member the nurse is a patient advocate, case manager, consultant, deliverer of services (i. e. , flu shots or counseling in health promotion), educator, healer, and researcher. Understanding health promotion and how to implement appropriate levels of prevention intervention effectively will translate in improving quality of health. Adapting to a diverse society across the spectrum of healthcare settings will strengthen healthcare promotion.