Nineteenth century medical pioneer Florence Nightingale defined health as the absence of disease and illness.
Over time, that definition has evolved. For example, the World Health Organization (WHO) currently defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
WHO also defines health promotion as “the process of enabling people to increase their control over and improve their health.” Both definitions have implications for those working in the healthcare profession, especially nurses who play a vital role in the practice of health promotion and preventive care.
A more focused area of nursing known as public health primarily focuses on bringing health promotion and preventive care to large, at-risk populations. The role of a public health nurse includes collaborating and partnering with communities and populations to address obstacles to health.
While public health nurses have been credited with critical improvements in health for vulnerable populations, all nurses should be aware of the critical role that health promotion and preventive care play when it comes to the well-being of their patients.
Through the practice of health promotion, nurses provide patients the information they need to manage and ultimately improve their health. A nurse’s work environment makes it easy to take advantage of a routine interaction with a patient and use it as an opportunity to educate.
For example, a nurse can educate new parents at their baby’s wellness visit on their child’s upcoming vaccines. Or a nurse can use the time treating a patient’s diabetes-related foot ulcer to review tips and tricks regarding how to best control blood sugar levels. Equipping patients with accurate information, while also advocating for a healthy lifestyle, can help them gain better control of their health.
It can also have a big effect on healthcare costs. With an industry-wide focus on cost reduction and staffing shortages in healthcare facilities, effective health promotion can reduce the frequency with which an individual must seek out treatment.
The Journal of Professional Nursing acknowledged health promotion has become a popular buzzword, and concluded health promotion is aimed at mitigating the determinants of health through community action, action by health professionals and group action.
Health promotion focuses on holistically addressing health issues, as opposed to lecturing individuals concerning habits that are negatively affecting their health. Often, individuals may be aware of health practices they should make habits (exercise) or stop (smoking). However, health promotion is more about ensuring access to the resources needed to improve healthy behavior. On a much higher level, nurses might also be able to advocate for societal changes to reduce resource scarcity that may impede health promotion.
There are a number of conceptual models that attempt to organize the main elements that affect health. Some models list five elements, some six. In general, though, there are six main dimensions of health that comprise most models:
- Biophysical: Physical risk factors for disease, including age, genetics and any anatomical abnormalities
- Psychological and emotional: Coping mechanisms, ability to adapt, level of cognition, and inclination and drive to adapt healthy behaviors
- Behavioral: Lifestyle choices that impact health, whether beneficial, like an exercise regimen or detrimental, like a smoking habit
- Social-cultural: Individual-level attributes like socioeconomic status and support systems, as well as broader social influences including beliefs, practices and values influenced by culture
- Physical environment: Anything in a patient’s environment that may impact health, including water and air quality
- Health systems: A patient’s ability to access healthcare systems, both because of the individual’s willingness to do so and his or her ability to pay for and access appropriate care
As technology continues to develop, educating patients through the practice of health promotion will become easier. Nurses no longer must be face-to-face with their patients in to share information.
Medical technology improvements such as telehealth have expanded patient access to nurses, which allows patients to contact a healthcare professional via phone or a video chat.
As healthcare costs continue to rise, preventive care has become a more valued service. For example, most insurance companies now fully cover any services that fall under this category. The practice of preventive care focuses on helping patients maintain their health instead of merely treating diseases and illnesses as they arise.
Preventive care goes hand in hand with health promotion and consists of three levels:
- Primary prevention, which involves developing strategies to prevent risk factors and the development of unhealthy behaviors
- Identifying people who currently possess risk factors for various diseases such as heart disease
- Managing illness and disease that has already occurred to avoid further deterioration
At its core, preventive care centers on the patient, which is a focus of nurses’ clinical education. The daily interactions nurses have with patients are opportunities to educate them and monitor for the development of certain risk factors.
When practiced regularly, preventive care can save lives. According to the Centers for Disease Control and Prevention, chronic illnesses cause seven out of 10 American deaths annually, and almost half of all American adults suffer from some type of chronic disease – many of which can be prevented.
When the Affordable Care Act went into effect, the National Prevention Strategy was created to provide better health and wellness to America. The four strategic goals of the strategy include:
- Building health and safe community environments
- Making more quality preventive services available in both clinical and community settings
- Educate people so they can make healthy choices
- Eliminate health disparities
To help achieve these strategic goals, seven evidence-based recommendations were identified that are projected as most likely to reduce the leading causes of preventable deaths and major illnesses. These recommendations include:
- Tobacco-free living
- Preventing drug and alcohol abuse
- Healthy eating
- Active lifestyles
- Living free from injury and violence
- Reproductive and sexual health
- Mental and emotional wellness
Some of the main challenges nurses face when it comes to providing preventive care are language, literacy, religious beliefs, mental challenges and/or physical limitations. For example, the CDC reports that racial and ethnic minorities report higher rates of chronic disease, including obesity, cancer, diabetes and AIDS.
However, approaching patient education with varied methods that take cultural differences into account can help combat these barriers. Understanding and adapting the approach to patient education is critical not just for nurses, but all healthcare professionals.