DQ1 Life expectancy slow and steadily increased during the course of the 20th century resulting in a change in the concept of health for both individuals and society. Today’s definition of health is more modern including different factors such as “the ability to cope and continue to live well in spite of disease states” (Falkner, 2018). The US allocates a big chunk of money to healthcare in return for poor patient outcomes and the high cost of care has led to severe health disparities between demographic groups. Due to the lack of proper sanitation in the early 19th century, infectious diseases were widespread and hard to control. Because of there being so many diseases, health at that time was “view in basic terms as being free of disease” (Falkner, 2018). Later in the 19th century into the beginning of the 20th century, sanitation had become more common and diseases were more manageable to handle. Because of the shift in health, the concept of health changed “to mean the ability to remain a functional part of society” (Falkner, 2018). In the 20th century, vaccines were invented and administered to now prevent disease from occurring. There is a push now towards value-based health system, with payment tied to outcomes aimed at redirecting cost while improving the quality of care to individual patients. Health promotion is now viewed as a combination of Physical, mental, and spiritual wellness (Falkner, 2018). Rather than making the focus on treatment, it is important to try to prevent the disease from ever occurring. In the 1970s, John Travis created the illness-wellness continuum which is defined as “the movement between illness and high-level functioning throughout the lifespan” (Falkner, 2018). Despite our thoughts on the word “illness”, it does not have a correlation with disease. Illness occurs when there is a physical or emotion shift and treatment is required to be more balance in the center of the paradigm. Environmental issues and culture factors also play a role in the balance of wellbeing. It is important for nurses to promote health promotion at every stage in life. The best way to maintain health is to preserve it through a healthful lifestyle, rather than waiting until you are sick to put things right. This state of enhanced well-being is referred to as wellness. Maintaining wellness and optimal health is a lifelong daily commitment. Steps that can help maintain our health include - balanced nutritious diet, regular exercise, screening for diseases, learning to manage stress and maintaining positive outlook and appreciating what you have. Well-being includes the presence of positive emotions and absence of negative emotions (Ainsworth, 2018). Health promotion is the process of enabling people to increase control over and improve their health. It is important that nurses implement health promotion based on evidence based practice (EBP). The evolution of pay-for-performance and heightened focus on quality outcomes for regulatory bodies and payers continue to sustain the drive for EBP. To achieve magnet status an organization must demonstrate that nurses are innovators and contribute to quality patient outcomes through EBP (Ainsworth, 2018). A culture of clinical inquiry is essential to actualize EBP in nursing. There are six steps of the EBP process - ask, gather, appraise, act, evaluate and disseminate. Finally nurses play an important role in promoting public health. It is the nurse’s responsibility to help their patient adopt lifestyles that will promote their health and help avoid health problems in the future. References: Ainsworth, B. (2018). Promoting physical activity in a public health context. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMc6180553/ Falkner, A. (2018). Health Promotion in Nursing Care. In Health Promotion: Health & Wellness Across the Continuum. Retrieved from https://lc.gcumedia.com/nrs429vn/health promotion-health-and-wellness-across-the-continuum/ DQ2 Over time, the concept of health has become a multidimensional concept that encompasses more than the absence of illness or disease (Potter et al., 2017). It is very interesting that the definition of health can vary from person to person and from culture to culture. What one person feels is good health may be very different than another’s. “Health is a state of being that people define in relation to their own values, personality, and lifestyle (Potter et al., 2017). This is why it is important for a nurse to assess a patient’s perspective on health to understand what they believe and what education will be most beneficial for them personally. Illness is when a person’s state of emotional, mental, spiritual, social or developmental functioning is not functioning at the patient’s normal levels. This is different than a physical disease because one person with cancer (a disease) may not be as emotionally or mentally affected by the disease as another person with the same disease. The patient whose emotional, developmental or social states are impaired is considered ill (Potter et al., 2017). The Ottawa Charter for Health Promotion defines health promotion as, “‘the process of enabling people to increase control over and improve their health’ (Povlsen & Borup, 2015, para. 6) The word “enabling” gives meaning to the role of patient education for nurses. The more nurses can teach patients, at their level of health literacy and readiness to learn, the more control they empower their patient’s with. If a patient can grasp the significance of making specific changes to their lifestyle that will enhance their level of well-being and health, the more enabled they will be to make those sometimes-difficult changes. The reason it’s so important for nurses to use evidence-based practice in their patient care and health promotion efforts is so patients are receiving the “most effective, timely and appropriate clinical decisions” from their nurse and other health care provider (Potter et al., 2017). References: Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2017). Fundamentals of nursing (9th ed.) St. Louis, MO: Elsevier Inc. Povlsen, L., & Borup, I. (2015). Health promotion: A developing focus area over the years. Scandinavian Journal of Public Health, 43, 46-50. Retrieved from https://journals.sagepub.com/doi/pdf/10.1177/1403494814568595 DQ3 Overtime health has evolved to become more than just healing the sick. Caring for the sick was largely a religious undertaking, practiced by healers. As time moved on the medicine men, who were the primary practitioners, were overtaken by visionary women who ushered in the dawn of evidenced-based practice. Nightingale realized that a clean environment and proper handwashing reduced the number of sick patients overall. Overtime health became more about preventing illness than simply caring for the sick. In the wake of prevention, the U.S. Office of Disease Prevention and Health Promotion joined forces the states to create hospitals and wellness centers (Mallee, 2017). As we began to set the groundwork for prevention overall wellness became the next hurdle. John Travis, illness-wellness continuum, “portrays wellness as achievable through a combination of factors, including health promotion behaviors and healthy living choices, such as health screenings and proper nutrition, respectively” (Falkner, 2018, para. 9). The evolution of health has influenced health promotion and the desire to cure, prevent, and manage illness; as well as educate patients about precipitating factors that influence health and wellness. Health promotion has come such a long way. Smallpox, once a deadly uncurable disease was eventually eradicated with the introduction of vaccinations. Through the advancement of health promotion, the community becomes more involved and aware of health risk and beneficial lifestyle behaviors. As nurses, we must ensure that our patients are informed and armed with the tools to care for themselves through sickness and health. As evidence-based practice advances and more emphasis is placed on the patient as a whole (mind-body, environment, family, education), disease lessened, and wellness began to prevail. References Falkner, A. (2018). Understanding Families and Health Promotion. Health Promotion: Health & Wellness Across the Continuum. Retrieved from https://lc.gcumedia.com/ nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/ chapter/2 Mallee, H. (2017). The evolution of health as an ecological concept. Retrieved from https://sustainabilitycommunity.nature.com/posts/20580-science-paradigms-healthenvironment-evolution DQ4 Prevention as it relates to health, is really about avoiding diseases before it starts. It has been defined as the plans for, and the measures taken to prevent the onset of a disease or other health problems before the occurrences of the undesirable health event. There are three distinct levels of health prevention - Primary, secondary and tertiary prevention. Most of these actions fall within the role of health professionals and health care providers in primary care, hospitals and community services environment (Perlmutter, 2017). Each of the three approaches has an important role to play in disease prevention. However, upstream approaches, e.g. primary prevention, generally tend to be cheaper and more efficient, and they entail lower morbidity and mortality rates. Health promotion (EPHO 4) is inextricably intertwined with disease prevention. A recent self-assessment of public health services in 41 of the 53 countries in the WHO European Region found that: Primary prevention: routine immunization programs are established in some form in all countries, and in most cases are well developed and effective. Intervening before health effect occurs through measures such as vaccinations, altering risky behaviors as poor eating habits, tobacco use. Etc. However, arrangements for delivery of vaccine programs are under-developed in some countries, especially for minority populations. Some Commonwealth of Independent States has seen an increase in vaccine-preventable diseases following the breakdown of services available in the Soviet era. Secondary prevention: routine screening for major forms of cancer now exists in many countries, but not in all of them. Screening to identify diseases in the earliest stages, before the onset of signs and symptoms through measures such as mammography and regular blood pressure testing. Screening programs are not always evidence-based and systemic health checks for noncommunicable diseases are not routine in most countries. Tertiary prevention: lack of availability and affordability of treatment for early-stage cancers is a limiting factor in some countries. Staff needs training in evidence-based treatment and management approaches for noncommunicable diseases, and modern equipment. Managing diseases post diagnosis to slow or stop disease progression through measure such as chemotherapy, rehabilitation and screening for complications. As a result, a recommendation was made to ensure a balance in the three disease prevention approaches: primary (vaccination and health promotion), secondary (screening and early detection of disease) and tertiary (integrated patientcentered disease management (WHO, 2018). Health education can be applied at all 3 levels of disease prevention and can be of great help in maximizing the gains from preventive behavior. For example at the primary level - you could educate people to practice some of the preventive behaviors such as having a balanced diet so they can protect themselves from developing diseases in the future. At the secondary level - You could educate people to visit their local health center when they experience symptoms of illness, such as fever so they can get early treatment for their problems. At the tertiary level -you could educate people to take their medication appropriately and find ways of working towards rehabilitation from significant illness or disability. Finally primary prevention activities will actually stop the illness happening, secondary activities stop illness from getting worse while tertiary activities is about managing the illness. Reference Perlmutter, F. (2017). An instrument for differentiating programs in prevention— primary, secondary and tertiary. American Journal of Orthopsychiatry, 46(3), 533–541. https://doi-org.lopes.idm.oclc.org/10.1111/j.1939-0025.2017.tb00953.x WHO. (2018). Public Health Services. Retrieved from http://www.euro.who.int DQ5 Primary, Secondary and Tertiary prevention are the three primary broad categories of health promotion and disease prevention. The primary difference in these categories they vary in their target population, goals and activities. Prevention is a holistic approach to general health for society. Prevention means anticipate before it occurs (onset of the disease) and take measure accordingly to avoid such undesirable health issues. According to the World Health Organization - there are three levels of prevention: 1. improving the overall health of the population (primary prevention) 2. improving (secondary prevention) 3. improving treatment and recovery (tertiary prevention). ("Public Health Service," 2019, p. 1) Primary prevention: Goal of primary prevention is to limit the incidence of disease and disability in the broader population which includes the healthy population also. For example, using vaccination within the population to avoid any outbreak. Discourage smoking through health promotion so the younger population does not uptake smoking. Educate population about healthy sexual relationship to avoid STD's such as HIV/AIDS etc. Secondary prevention: Goal of Secondary prevention to prevent the progression of disease within a sub-group of people. Early detection and/or intervention is the key to success in secondary prevention. For example, women go through regular breast cancer screening programs to avoid any occurrence. Routine hearing tests for workers who are exposed to excessive noise day in day out. The target population for secondary prevention is limited. Tertiary prevention: Goal of Tertiary prevention is to reduce the consequences of established disease. At this stage prevention is limited. The main goal here is to reduce the progression of the disease and patients quality of life by employing a change in behaviors. The target population for Tertiary prevention is those individuals who already have the disease and show sign of it. example: cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.) " Patient education needs to be comprehensive and easily understood. Health educators (in particular nurses) must understand that greater than 50% of Americans are health care illiterate. This has nothing to do with their ability to read and write; but rather their inability to understand health care information and what they need to do with that information." ("Patient Education," 2019, p. 1). Educating the patient is time-consuming for physicians and nurses. Handing over the printout does not work for many of the population as half of the population do not have health literacy. References EPHO5: Disease prevention, including early detection of illness1178. (2019). Retrieved from http://www.euro.who.int/en/health-topics/Health-systems/public-health- services/policy/the-10-essential-public-health-operations/epho5-disease-prevention,including-early-detection-of-illness2 Tips to Improve Patient Education. (2019). Retrieved from https://nursejournal.org/ community/tips-to-improve-patient-education/ DQ6 Primary, secondary, and tertiary levels of prevention focus on ways to prevent the onset of illness, diagnose and treat illness early, or initiate rehabilitation services after major illness (Falkner, 2018). They also allow individuals the ability to continue to be in control of their health and function in society. The nurse as an advocate provides education and resources so that patients may have the information they need to make informed decisions for themselves. All levels are aimed at preventing undesirable events as it relates to health. As far as how these levels contrast, primary prevention looks at groups who are at risk of developing illness such as young children for example. Families are encouraged to vaccinate their children to prevent diseases such as measles or chicken pox. Secondary prevention has to do with screening and early treatment or intervention of disease such as a woman who felt a lump during a self-breast exam and promptly went to the doctor for treatment. In tertiary prevention, the goal is to prevent worsening or reoccurrence of a known disease. For example, depending on deficit level, a patient who has had a stroke will need physical therapy to strengthen them and get them on the road to recovery and doing some things for themselves. They will also need measures to control cholesterol and blood pressure with the goal on preventing future complications. Nurses need to implement educational and interventional methods through evidence based practice aimed at health promotion. With each level of prevention comes educational needs, and nurses need to assess the patients’ needs depending on the level of prevention. If a patient is at the primary level, the nurse may encourage a healthy diet and exercise routine. If they are the secondary level she would encourage a prediabetic to monitor their glucose level and also encourage healthy diet and exercise. Those who are at the tertiary level need education on making sure they continue taking medications for their heart and blood pressure if they have history of a heart attack and for all levels encourage regular check-ups. The goal in all cases is to prevent, improve and promote health in all individuals no matter if they are healthy or in need of preventing complications from a known illness (Falkner, 2018). Reference Falkner, A. (2018). Health promotion: Health & wellness across the continuum. Retrieved from https://lc.gcumedia.com/nrs429vn/health-promotion-health-andwellness-across-the-continuum/v1.1/#/chapter/2
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