Health Promotion and Illness Prevention

Introduction

Health promotion and illness prevention are increasingly emphasized in health care. Rising health care
costs have created significant government and consumer demands to decrease the incidence of disease
and minimize risk factors that predispose individuals to illness. Concepts of health promotion and illness
prevention are essential for nurses to utilize in planning nursing care and developing collaborative goals
and interventions to protect optimal health and coordinate illness management.

Upon completion of this lesson, you will be able to:

Discuss health promotion and illness prevention.

Description of Health Promotion

Health promotion has been described as “the art and science of helping people discover the synergies
between their core passions and optimal health and become motivated to strive for optimal health”
(O'Donnell, 2009). Optimal health implies a balance of physical, emotional, social, spiritual, and
intellectual well-being.

Spiritual

Love, hope, charity

Social

Communities, families, friends

Emotional

Care for emotional crisis, stress management

Intellectual

Education, achievement, career development

Health Promotion: Passive and Active

Health promotion strategies for individuals and communities can be categorized as passive or active.
Health promotion activities are most effective when they require minimal effort or when the individual
is consistently motivated and committed to lifestyle changes that support positive health behaviors.

Nurses can support and encourage an individual's participation in health promotion activities through
the use of a variety of interventions such as health education and assistance with overcoming barriers to
lifestyle changes.

Passive Strategies
Passive strategies of health promotion are actions or conditions that benefit an individual's health and
do not require the individual's active involvement. Examples of passive health promotion strategies
include fluoridation of municipal drinking water and the fortification of homogenized milk with vitamin
D.

Active Strategies

Active strategies of health promotion require individuals to be engaged participants in activities to

improve and maintain health. Examples of active health promotion strategies include weight reduction
and smoking-cessation programs, dietary changes, participation in stress-reduction classes, and
managing sleep habits.

Illness Prevention

Illness prevention involves activities and interventions that delay or prevent symptoms, complications,
and death related to illness. Nursing activities and interventions related to illness prevention are
designed to motivate individuals to avoid declines in health or functional levels.

Illness prevention activities include:

- Promotion of the use of proper protective equipment to protect workers from hazardous
material exposure
- Immunization programs to protect individuals from actual or potential threats to health
- Screening programs to detect disease
- Educating individuals on safe-sex practices to avoid acquiring a sexually transmitted disease
- Educating parents on the use of sunscreen in children to prevent the long-term development of
skin cancer

Risk Factors

A risk factor is any situation, habit, condition, or other variable that increases the susceptibility of an
individual or group to physical or mental harm.

Risk factor reduction is step-by-step minimization of risk factors with resulting improvement of
individual health factors. These combined improvements lower the likelihood of developing a disease.

An example of risk reduction in an individual is:

An overweight, sedentary middle-aged smoker with a family history of cardiac disease has noticed a
steady rise in his blood pressure over a three- to four-year period. He is concerned about his elevated
blood pressure and begins walking 20 to 30 minutes in the evenings, and reduces his cigarette smoking
habits from 20 cigarettes per day to 10. He has taken the first steps in reducing risk factors for cardiac
disease, but significant risk factors remain.

Evidence-Based Resources for Risk Reduction Plans

Nurses can support risk factor reduction by helping patients develop and implement risk reduction
plans. Several evidence-based standardized resources and tools are available to help people achieve
their goals for a healthy lifestyle.

Healthy People 2020

Healthy People, published every 10 years by the U.S. Department of Health and Human Services, is a set
of goals and objectives with 10-year targets designed to guide national health promotion and disease
prevention efforts.

Healthy People 2020 provides educational materials for individuals, families, and communities, enabling
them to lead healthier lifestyles and to make permanent changes in wellness habits. The program
provides information about annual checkups, medical terminology, and decision-making about health
concerns.

The Healthy People 2020 initiative addresses many risk factors and personal risk behaviors, but in
particular, focuses on the following leading health indicator topics:

- Access to health services

- Clinical preventive services
- Environmental quality
- Injury and violence prevention
- Maternal, infant, and child health
- Mental health
- Nutrition, physical activity, and obesity
- Oral health
- Reproductive and sexual health
- Social determinants of health
- Substance abuse
- Tobacco (U.S. DHHS, 2014)

Nurses can refer patients to a variety of personal health quizzes for risk assessment of their health status
and lifestyle. The available quizzes allow individuals to track their health and wellness status over a
period of years and identify trends in disease risk factors that can be modified through lifestyle
interventions or preventive measures before the disease occurs.

Online Health Promotion and Statistics Resources

Resources for health and wellness promotion activities related to specific conditions or populations are
found in the U.S. health agency links for state departments of public health. International information is
available from the United Nations World Health Organization (WHO) website.

Topics of particular interest to nurses found within these sites include hospital mortality rates, disease
prevalence, epidemiology statistics, and behavioral risk factor analysis.

Cardiac health

www.heart.org/HEARTORG

www.nlm.nih.gov/medlineplus/heartdiseases.html
Neurologic care

www.nlm.nih.gov/medlineplus/neurologicdiseases.html

www.ninds.nih.gov

www.nlm.nih.gov/medlineplus/stroke.html

Pulmonary health

www.nhlbi.nih.gov/health/public/lung/index.htm

www.lungusa.org

Cancer prevention

www.cancer.org

www.cancer.gov

www.cancer.gov/cancertopics

General topics for health and wellness

www.nhlbi.nih.gov

www.nih.gov

http://nihseniorhealth.gov

www.who.int/topics/en

Three Levels of Preventive Care

Illness and disease prevention measures are described as primary, secondary, or tertiary depending on
the stage of health or disease of individuals receiving preventive care.

Primary prevention focuses on the prevention of disease.

- primary prevention: a program of activities directed at improving general well-being while also
involving specific protection for selected diseases, such as immunization against measles

Secondary prevention is aimed at detecting hidden disease.

- secondary prevention: a level of preventive medicine that focuses on early diagnosis, use of
referral services, and rapid initiation of treatment to stop the progress of disease processes or a
handicapping disability.

Tertiary prevention is designed to treat and manage diagnosed disease.

- tertiary prevention: a level of preventive medicine that deals with the rehabilitation and return
of a patient to a status of maximum usefulness with a minimum risk of recurrence of a physical
or mental disorder.
Primary Prevention

Primary prevention is instituted before disease becomes established by removing the causes or
increasing resistance. The goal of intervention during this phase is to modify risk factors to avoid the
onset of disease and prevent disease from occurring (Leavell and Clark, 1965).

Many health-promoting activities are nonmedical, such as lifestyle changes, nutrition improvement, and
environmental alterations. They contribute to the prevention of many diseases and enhance patients'
overall vigor and health. Specific protection strategies are undertaken when health promotion efforts
are unsuccessful or inappropriate. The objective is to address a specific disease or potential injury.

Examples of primary prevention include health promotion and illness prevention activities:

- General health promotion, such as promoting regular exercise, stress reduction, smoking
cessation, and healthy eating habits
- General health education, such as education about negative effects of smoking on health, or
positive effects of exercise on health
- Genetic screening to determine genetic risk for developing a condition
- Protection against community-acquired infections such as colds through handwashing
- Protection against specific diseases through immunizations
- Protection against weather elements and unsanitary conditions through the provision of
adequate housing and environmental sanitation
- Protection from effects of accidents through the promotion of seatbelt use in cars and helmet
use when riding bicycles
- Protection from sexually transmitted diseases through promotion of safe sex practices
- Protection from carcinogens or poisons through promotion of the use of sunscreen or personal
protective equipment

Secondary Prevention

Secondary prevention measures are taken to detect latent (hidden) disease. The target populations for
secondary prevention efforts are any individuals who are at risk for certain complications. The goal of
secondary prevention is early detection and diagnosis of health problems before patients exhibit
symptoms of disease (Leavell and Clark, 1965). Identifying a disease at its earliest stage facilitates
prompt and appropriate management. Successful secondary prevention can reduce the impact of the
disease.

Examples of secondary prevention include individual and mass screening and diagnosis activities, such
as:

- Screening for tuberculosis using the purified protein derivative (PPD) skin test
- Screening for colorectal cancer using the fecal occult blood test
- Screening for vision problems, hearing deficiencies, and scoliosis in school-age children
- Screening for breast cancer through mammography
- Screening for HIV through blood testing
 - Professional diagnosis of a disease in its early stage so that treatment and symptom
management may begin
- While implementing screening and early diagnosis efforts, nurses often also provide preventive
health education for patients, which is considered a primary prevention effort.

Tertiary Prevention

Tertiary prevention, also known as the treatment or rehabilitation stage of preventive care, is
implemented when a disease, illness, or condition is permanent and irreversible. The goals of tertiary
prevention are to reduce the number and impact of complications and help patients attain the highest
level of physical and mental health achievable within the parameters of impairment caused by the
disease or disability. Collaborative efforts are a necessary function of tertiary prevention because the
patient often has health needs encompassing numerous health disciplines that might not have been
involved in the initial stage of illness.

Examples of tertiary prevention are management of complications and limitations such as:

- Interventions to reduce suffering and assist an individual in adjusting to incurable conditions

- Nursing care, physical therapy, and occupational therapy to retrain and maximize use of
remaining abilities
- Medication, radiation, or other treatment to stop the disease process and prevent further
complications
- Education of public and industry to employ rehabilitated persons in productive customized
positions

Collaboration in Preventive Care

An important function of the nurse is to coordinate health promotion and illness prevention efforts with
collaborative partners at all three prevention levels. Prevention is not solely the responsibility of the
nurse; it involves active participation by the individual and the combined services of practitioners in a
spectrum of health care disciplines as varied as nutrition, physical therapy, exercise physiology, and
pharmacy.

Considerations include:

- Collaborative health care partnerships are designed to deliver well-balanced care to the patient
as a whole, rather than rendering fragmented care involving a single element of a disease
process.
- Patient education responsibilities are not delegated to assistive personnel or other members of
the health care team and are considered a cornerstone of nursing care.
- Collaborative preventive care can be mandated in the form of health care legislation, with rates
for reimbursement of practitioners determined by the individual provider's ability to collaborate
and develop innovative methods for delivering high-quality, cost-effective health care services.
More information about collaborative efforts in preventive health care services that are patient-
centered and value-driven is available at the Institute for Clinical Systems Improvements.

Summary

There has never been a more important time to focus on health and wellness in our society. Nurses are
poised to navigate the challenges of promoting health and wellness by helping patients achieve and
maintain the highest level of physiologic functioning and mental well-being possible.

The Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health (2011), calls
for nurses to be full partners in transforming health care in the United States. Nurses have the
responsibility and the expertise to help educate, enable, and encourage people of all ages to adopt
healthier lifestyles and to become proactive about health care practices that can prevent or minimize
illness and disease. Day to day, nurses continue the commitment of contributing to the wellness of
patients, families, and communities by supporting initiatives, programs, and projects that promote a
culture of health and self-care.