Health Promotion/Screening and Disease Prevention (Nursing)

00:01 I’m Jessica Spellman, and this is health promotion, disease prevention, and health screening. After taking this course, you will be able to differentiate between health promotion and disease prevention. Recognize the nursing role in health promotion and disease prevention.

00:18 Identify health screening priorities across the lifespan. The old definition of health was the absence of disease. The more modern definition of health focuses on a state of physical, mental, and social well-being, and not merely the absence of disease.

00:38 Wellness is a proactive and holistic approach to health. It extends to emotional, social, spiritual health, not just physical health. Health promotion is the process of enabling people to increase control over and to improve their health. Focuses on bringing the concept of wellness to communities and encouraging individual behavior that maximizes health, not just prevent illness. Again, it focuses on emotional wellness, physical wellness, social wellness, and spiritual wellness. It includes efforts not only to prevent disease but to minimize its effects after diagnosis. Primary disease prevention prevents ailments or disease. Example is vaccinations and wellness behaviors. Secondary disease prevention focuses on identifying risk factors before disease is diagnosed. An example is health screenings. Tertiary disease prevention focuses on treating a medical condition in order to prevent disease progression. An example is taking medication to treat hypertension to prevent complications. Medical models have focused more on the tertiary care of disease than on primary prevention. The nurses’ role in health promotion and disease prevention is to assess patient’s perception of health and willingness to learn, perform appropriate health screenings, educate patients at all levels of health promotion and disease prevention, mentor patients efforts to improve their health, and evaluate patient’s understanding of education and provide feedback. So it is important for nurses to understand the leading cause of death throughout the lifespan. They need to tailor education to each individual patient. And the Center for Disease Control and Prevention regularly publishes this data. The top ten causes of death in the United States, as reported by the CDC in 2012. First, under age one- birth defects, premature complications, and Sudden Infant Death Syndrome. For ages 1 through 4: accidents, birth defects, and homicide. Age 5 to 9: accidents, cancer, and homicide. Age 10 to 14: accidents, cancer, and suicide. Age 15 to 24, and age 25 to 34, accidents, suicide, and homicide. Age 35 to 44: accidents, cancer, and heart disease. Age 45 to 54, and 55 to 64: cancer, heart disease, and accidents. And greater than age 65: heart disease, cancer, and respiratory illnesses. It is easier to remember this information if you look at the common themes. Accidents are the number one cause of death ages 1 through 44. Heart disease and cancer are among the leading cause of death for everyone over age 35.

04:01 And violence is among the leading cause of death in children and adolescents. I want to take a look at accidents throughout the lifespan. In infants, they have a high risk for falls, asphyxia, and burns. So their nursing education should focus on sleeping on the back, water safety, specifically never leaving children alone in the water, and checking the temperature of the water, as well as car safety and using car seats.

04:33 For toddlers, they are curious and more mobile, so they have high risks in those areas, as well as poisoning, choking, and drowning. So the nursing education needs to focus on home safety, specifically baby gates, outlet covers, and baby proofing the home. Keep medication, cleaners out of reach, car safety, and the use of car seats. In school-age children, they have much more safety risks, including traffic, water, fire, strangers, accidents during play. So for the school-age children, their nursing education is to focus on fire safety, water safety, traffic safety, stranger danger, using car seats and boosters until the child is 4’9” and 80 lbs. In the adolescent group, their risks for accidents are caused from an increase of independence and an invincible attitude. They don’t believe anything bad will ever happen to them. So, nursing education needs to focus on driver education, sexual health information, alcohol and substance abuse. For adults, motor vehicle accidents and sport and leisure-related accidents. So promoting motor vehicle’s safety and fire safety, as well as wellness promotion and injury prevention. In older adults, falls, medication side effects, and increase in physical and cognitive impairments are their highest risks. For our older adults, we want to review medication in side effects, assess for elder abuse, neglect and fall risk, as well as evaluate for confusion and ability to complete self-care activities. Promoting health is one aspect of primary disease prevention. The role of the nurse is to educate about healthy behaviors, specifically, diet, exercise, and lifestyle, role modeling healthy behaviors, and identifying patient’s barriers to health and wellness and overcoming them.

06:49 Examples of primary prevention include: stress management, exercise, complementary and alternative therapies, immunizations, promote regular visits specifically to the dentist and the primary care physician. Secondary disease prevention includes a lot of health screening.

07:11 There are innumerable guidelines for health screening, based upon age, sex, and family history. It is impossible to review all of the guidelines for every disease.

07:22 Instead, it is the nurses’ role to identify opportunities for health screenings across the lifespan, focus health screenings on the leading causes of death for specific age groups, educate individuals on the results of their health screening, and recommend interventions to decrease the risk of specific disease developing. Some recommendations for health screening specifically for blood sugar include the World Health Organization and American Diabetes Association suggest the fasting glucose level of less than 125. And the National Institutes of Health report that one-third of patients with diabetes are unaware that they have it.

08:08 Recommendations for blood pressure: BP less than 140/90, and is named the silent killer because many people do not know that they have hypertension. Fasting lipid profile, adults should have lipid profiles at least every four to six years. More if they’re at high risk. Total cholesterol should be less than 200. Triglycerides should be less than 150. HDL should be greater than 40 in men, and greater than 50 in women, and LDL less than 100. Colorectal screening. Men and women should begin this at age 50. Prostate screening. A digital rectal exam is recommended at an annual physical. Previous recommendation was an annual prostate-specific antigen or PSA test every year for men over 50. New guidelines caution against testing anyone less than 40 or greater than 70 with the PSA. Men age 41 through 69 should discuss the test with their physician. Mammograms. The U.S. Preventative Services Task Force mammogram guidelines recommend that women begin screening at age 50 and repeat the test every two years.

09:28 The American Cancer Society and other organizations recommend screening begin at age 40 and continue annually. Tertiary disease prevention was the focus of the healthcare industry for the past decade. It is an approach to healthcare that teaches patients how to manage a chronic disease. Patients receive education and learn about guidelines and resources to assist them with the care of their chronic disease. As nurses, we need to have an interdisciplinary approach to caring for patients with chronic disease, and we need to base our care on national guidelines and evidence-based practice. The aim is to avoid potential problems or exacerbation of a health problem. The benefits of disease management are that it empowers patients and families with information to care for themselves or their loved ones. It should reduce complications and decrease hospitalizations, as well as improve the quality of life for individuals.

10:34 So the nursing role in disease management focuses on educating patients and families regarding the condition, assess and overcome barriers to education and implementation of interventions, as well as coordinate care across disciplines, and provide support and understanding for individuals and families. Education also needs to take into account other social determinants of health. These include socioeconomic status, education level, literacy, access to healthcare and insurance coverage, culture and language, access to technology, safe housing, access to healthy food, exposure to crime and violence, as well as transportation. So health is more than just the absence of disease. Its focus is shifting to holistic wellness and promoting health. Disease prevention is still vital, though. And nurses’ role and disease prevention includes educating about health and wellness prevention and promotion, health screening to educate regarding risk reduction, and disease management and education. Providing education is the key role for nurses.

11:51 It is important to provide patient-centered education, take into account all social determinants of health, brainstorm about ways to overcome barriers, evaluate patient understanding of education, provide support, encourage accountability, and coordinate services.

12:12 This is Jessica Spellman, and this has been health promotion, disease prevention, and health screening.