Levels of Prevention (Nursing)

by Heide Cygan, DNP, RN

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    00:01 Today we're going to talk about the levels of prevention.

    00:04 As a reminder, public health nurses protect and maintain the health of the public through health promotion and disease prevention.

    00:11 Now there are three main levels of disease prevention- primary, secondary, and tertiary.

    00:17 As you can see, a lot goes into each level of prevention.

    00:20 When developing plans for each level, we first consider the target population.

    00:25 So whose health are we aiming to improve? Then the objective.

    00:29 What's our goal of the intervention? And lastly, we consider the strategy.

    00:33 What are we going to do to impact health? So let's take a look at each level in detail.

    00:41 Primary prevention is aimed at individuals or groups who are at risk for an illness but do not yet have an illness.

    00:48 The goal here is to prevent the transmission or the onset of disease.

    00:52 And we can do this through a variety of different strategies.

    00:56 Here are some strategies that public health nurses can use to prevent the transmission or the onset of disease for those who are at risk.

    01:04 Administration of vaccines help to decrease the risk of vaccine preventable diseases.

    01:09 Education can also be used as a strategy here to make communities aware of the risks of a specific disease and ways to prevent it.

    01:18 Use of personal protective equipment or PPE is one way that nurses help prevent transmission of disease in a clinical setting.

    01:25 Working into control or eliminate vectors in the environment could also be done as a means of primary prevention.

    01:33 So let's use the example of measles in school-aged children to apply all levels of prevention.

    01:39 Starting here first with primary prevention.

    01:41 Here we have three healthy children who are at risk of contracting measles, but do not yet have the disease.

    01:48 In primary prevention, our goal is to stop them from contracting the measles.

    01:52 For school-aged children, one of the most effective primary prevention strategies against the measles is receiving the measles, mumps, and rubella or MMR vaccine.

    02:03 A public health nurse might engage in direct care and administer the vaccine, or maybe even work behind the scenes to collaborate with community organizations to run a large scale vaccine clinic in response to an outbreak.

    02:15 Both are examples of primary prevention.

    02:19 Secondary prevention is aimed at individuals or groups who have a disease or an illness, but they're very early in the disease process and most likely asymptomatic.

    02:29 Our goal here is to prevent or inhibit the disease in instances where it's already occurred.

    02:36 There are several strategies that public health nurses can use to inhibit disease once it's already occurred.

    02:42 The first step here is screening, screening to determine if the disease is present in individuals who are asymptomatic.

    02:49 This allows the public health nurse to do case finding an early intervention to decrease the impact and the spread of the disease.

    02:57 Early intervention should be disease specific.

    03:00 And education is also important in secondary prevention.

    03:04 Once an individual or a group has been diagnosed with an illness or a disease, education is necessary to inform those who are impacted about the disease, about screening techniques, about ways to inhibit its progress, and most importantly, ways to decrease the spread.

    03:20 So back to our example of our children, our school-aged children with the measles.

    03:24 So for our children here, early diagnosis and treatment is the key to inhibiting the spread of measles.

    03:30 This might entail seeking care for a child who's been in contact with an infected friend, and is just starting to show some of those very early signs of disease.

    03:39 By seeking early care, it's possible to screen, diagnose and provide early intervention as secondary prevention techniques.

    03:48 And most importantly, here we can provide education to ensure that the disease is not spread.

    03:56 Moving on finally to tertiary prevention.

    03:58 Tertiary prevention is aimed at individuals or groups who have established disease and are showing signs and symptoms of that disease.

    04:06 Our goal here is to prevent morbidity and mortality related to the disease process.

    04:11 Again, we have a variety of strategies that public health nurses can use.

    04:15 Oftentimes, this requires treatment of disease specific symptoms.

    04:20 Treatments could be pharmacological or nonpharmacological.

    04:24 Tertiary prevention also requires that complications of the disease are managed if they arise.

    04:29 And once again, we see the need for education in tertiary prevention.

    04:33 Education at this level may be focused on different treatment options, or informing patients and families when they should seek more advanced care.

    04:42 Okay, and now here we have our school-aged children again who now all have the measles.

    04:47 There are several strategies that we can employ within tertiary prevention.

    04:50 We can educate them and their families about over-the-counter medications that can be taken to ease the symptoms, we can encourage rest, we can encourage fluids.

    05:00 But it's also important to remember that as public health nurses, our client, our unit of care is the school community.

    05:07 So within tertiary prevention, in order to decrease morbidity and mortality for the entire school community, we may provide some education, education to parents, to faculty, to teachers, to administrators, to teach them about the signs of symptoms, and most importantly, prevention of the measles.

    05:27 So here, we have all three levels back together in one place, what I want you to remember is that the level of prevention is determined by the target population, and your intervention objective, not necessarily the strategy that you use, because as you can see on this table, education as a strategy spans all three levels.

    05:46 So remember, think outside of this box, and really focus on the target population, and the objective of the intervention in order to determine what level of prevention you're working at.

    05:59 Now, primary, secondary, and tertiary prevention are the three levels that we hear about the most.

    06:05 However, there are two other levels.

    06:07 And these two book and the three that we just talked about.

    06:10 They are primordial prevention, and quaternary prevention.

    06:14 So let's take a look at each of these.

    06:17 With primordial prevention, the target population is the entire population that may be at risk for an adverse health outcome.

    06:25 The objective here is to address the social conditions that promote the onset of disease.

    06:31 Strategies in this level or to prevent disease by addressing those underlying social conditions that put entire populations at risk for disease in the first place.

    06:41 An example is the implementation of policies that prevent or discourage negative health behaviors, such as increasing taxes on cigarettes, or putting in sidewalks or bike lanes to encourage physical activity and decrease the risk of disease for the entire population.

    06:58 Now, all the way on the other side, we have quaternary prevention.

    07:01 The target at this level is those who have illness and are already receiving treatment.

    07:07 The goal here is to protect individuals or populations from medical interventions that are likely to cause more harm than good.

    07:15 Strategies here can include educating patients or healthcare providers on how to make sure that unnecessary treatments are not encouraged.

    07:23 This could also include treatment for the effects of interventions that have already caused more harm than good.

    07:30 So now, if we go back to our measles example, here are strategies that fit into these levels.

    07:35 At the level of primordial prevention, one strategy would be to advocate for strong state level immunization policies that require all eligible children to have the MMR vaccine before school entry.

    07:48 On the opposite end of quaternary prevention, one strategy would be to make sure that children who are already diagnosed with measles and are receiving treatment are only receiving evidence based care, no unnecessary care that could do more harm than good.

    08:05 Now, if you're planning to go into acute care, you might be wondering why this is important.

    08:10 As nurses no matter where we work or our specialty, we have a shared goal of keeping our patients healthy, or preventing disease before it even begins.

    08:19 By understanding the levels of prevention, you'll be more prepared to collaborate with your patients and communities to move them towards wellness.

    About the Lecture

    The lecture Levels of Prevention (Nursing) by Heide Cygan, DNP, RN is from the course Basic Concepts in Public Health Nursing.

    Included Quiz Questions

    1. Primary
    2. Secondary
    3. Tertiary
    4. Quarternary
    1. Primary
    2. Secondary
    3. Tertiary
    4. Quarternary
    1. Secondary
    2. Primary
    3. Tertiary
    4. Quarternary
    1. Tertiary
    2. Secondary
    3. Primary
    4. Quarternary

    Author of lecture Levels of Prevention (Nursing)

     Heide Cygan, DNP, RN

    Heide Cygan, DNP, RN

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