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Course: Fundamentals of Nursing

Topic: Disease Prevention and Health Maintenance

The Nurses International Community

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Module Goals

Learners will be able to:

Define the concept of disease prevention and health maintenance.
Explain the nurse's role in disease prevention and health maintenance for the general population.
Explain the nurse’s role of in disease prevention and health maintenance for the elderly.
Explain the nurse’s role in health maintenance of people with chronic health conditions.

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Health Maintenance

Refers to activities that preserve an individual’s present state of health and that prevent disease or injury occurrence.

Components of health maintenance are:

Maintain present state of health
Prevent diseases
Prolong life

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Disease Prevention

Focuses on reducing or eliminating exposure to a specific disease or injury that pose a risk to an individual, community or population¹.

There are three level interventions for disease prevention²:

Primary Prevention
Secondary Prevention
Tertiary Prevention

Rural Health Information Hub, n.d.
Institute for Work and Health, 2015

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Disease Prevention: Primary Prevention/Interventions

Prevent disease or injury before it ever occurs.

Actions by an individual or group to avoid exposure to disease or injury

Examples of interventions:

Vaccinations against infectious diseases
Wearing seat belts in motor vehicles and bike helmets
Avoidance of tobacco and illegal drugs
Eating healthy diet of fruits and vegetables

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Critical Thinking Question:

Can you think of other primary prevention activities that can be practiced every day?

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Disease Prevention: Secondary Prevention/Intervention

Aims at reducing the impact of a disease or injury that has already occurred.

Carried out through:

Detecting and treating disease or injury as soon as possible
Encouraging personal strategies to prevent re-injury or recurrence
Implementing programs to return people to their original health and function to prevent long-term problems

Examples of interventions:

Heart healthy diet for hypertension
Screening for breast and cervical cancer

Institute for Work and Health, 2015

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Disease Prevention: Tertiary Prevention/Intervention

Soften the impact of ongoing illness or injury that has lasting effects.

The goal is to improve quality of life by:

Reducing disability
Restoring function
Limiting or delaying complications

Achieved by supporting and facilitating people to manage long-term, often-complex health problems and injuries.

Examples of interventions:

Pain management
Rehabilitation programs

Institute for Work and Health, 2015

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Health Maintenance Activities: General Population

Getting immunizations¹
Consuming balanced diet/nutrition^1,2
Getting regular exercises^1,2
Getting minimum of 7 hours sleep²
Weight control^1,2
Practicing safe sex^1,2
Avoiding tobacco or illicit drugs use^1,2
Limiting or avoiding alcohol consumption^1.2
Regular whole body check-up^1,2
Monthly breast exams for women^1,2

American Academy of Family Physicians, 2020
Government Health and Safety Lead, 2018

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Health Maintenance Activities: General Population

Promoting supportive social environments and social networks

Building healthy connections with family, friends, colleague, neighbours^{1, 2}
Getting involved in community activities^1,2

Indulging in creative activities^1,2
Enhancing capacity to regulate emotions^1,2
Adopting alternatives to risk-taking behaviours²
Building resilience for difficult situations and adversities^1,2
Seeking appropriate treatment for the mental illnesses³

Government Health and Safety Lead, 2018
WHO, 2020
WHO, 2018

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Health Maintenance Activities Specific to Elderly

Social support: befriending initiatives, community and day centres for the aged¹.
Physical activities and exercises as tolerated².
Smoking and alcohol cessation².
Immunizations² : Tetanus, Influenza, Pneumococcal, Herpes Zoster.
Cancer screening²: Colorectal, Breast, Cervical, Prostate.
Screening² : Blood pressure, lipid, osteoporosis, Abdominal Aortic aneurysm, vision.
Assessment² and management of nutritional status, hearing loss, cognitive functions, depression, incontinence, financial/social resources.

WHO, 2018
Heflin, 2021

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Health Maintenance Activities Specific to Elderly

Using assistive devices to prevent falls and injuries.

Stopping driving as appropriate.

Assessment and protection from mistreatment, abuse.

Informed decisions on advanced directive, power of attorney, living wills.

Heflin, 2021

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What Would a Nurse Do?

A nurse is caring for a 75 years old woman in outpatient clinic. Which of the following would a nurse carry out as tertiary prevention intervention?

Screening for breast cancer through breast exam
Education on importance of influenza vaccines
Education on importance of rotating insulin injection sites
Education on using walker to prevent fall

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Answers: c. Education on importance of rotating insulin injection sites.

Tertiary prevention interventions are aimed at reducing impact of disease or injury which have already occurred and has lasting effect. Rotating insulin injection sites help prevent lipodystrophy that hampers insulin absorption in diabetic client. Education about it helps in preventing further complications in diabetic client. Thus it is tertiary prevention intervention.

Education on importance of influenza vaccines is one of the interventions to prevent flu, and education on using walker to prevent fall. Therefore, these are part of primary prevention intervention.

Screening for breast cancer through breast exam does not prevent breast cancer but it will help in identifying breast cancer in early stage if it occurs so breast cancers can be treated. Thus, falls in secondary prevention.

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Health Maintenance in People with Chronic Conditions

Finding reliable information about the disease, its treatment and management.
Taking medication appropriately.

what it is specifically for, any special instructions and potential side effects.

Setting realistic goals.

Short-term goals will give sense of how one is progressing.

Developing skills to manage pain and fatigue.
Getting emotional support – speak to others going through similar situation, as well as leaning on family and friends when needed.

State Government of Victoria, n.d.

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Health Maintenance in People with Chronic Conditions

State Government of Victoria, n.d.

Good lifestyle choices:

Proper diet/nutrition
Keeping physically active
Proper sleep/rest, avoiding naps during the day

For multiple health conditions:

Seeking medical advice from pertinent healthcare specialists
Making sure all health care specialists communicate treatments and medications that are prescribed

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Health Maintenance in People with Chronic Conditions

Maintaining social support:

Catching up with family, friends
Informing family of the disease conditions, and help needed
Considering new sources of support, such as support groups, clubs, Interest groups and volunteer opportunities

Looking after mental health:

Keeping positive attitude
Focusing on variety of things throughout the day
Performing activities that challenges the mind
Get help with stress/worries: Talk to a friend, join a support group or seek specialist help through a psychologist or psychiatrist

State Government of Victoria, n.d.

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Nurse’s Role in Disease Prevention/Health Maintenance

Have better opportunity to:

Build rapport with the client
Gather holistic information about the client

Assessment and identification of risks for disease and injury

Includes domestic violence and mental illnesses (family history of mental illness, stress, chronic disease, traumatic experiences, use of drugs or alcohol)

Assessment of social issues
Provide individualized client education on disease prevention and health maintenance activities

Must be based on evidence based research and recommendations

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Nurse’s Role in Disease Prevention/Health Maintenance

Help make referrals to appropriate specialists, social services

Provide information on resources available in the community

Examples: screening facilities, support groups, rehabilitation programs, etc.

Advocators of client/public health and safety

Starting from hospital administration to national health policy

Plan and coordinate health programs that contribute to disease prevention and health maintenance

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Nurse’s Role in Disease Prevention/Health

Maintenance with Chronic Disease

Screen and Identify:

The need for pain/fatigue management in clients
Risks for falls and injuries
Need for referrals such as psychiatrist, social worker, etc.

Coordinate client care with multidisciplinary team member involved

Provide education on:

Non-pharmacological pain management strategies
Prescribed medications for management of pain and diseases
Healthy life-style choices

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What Would a Nurse Do?

Which of the following nursing interventions addresses disease prevention and health maintenance needs of clients with chronic conditions?

Advocate for public health safety
Coordinate care of an individual with multidisciplinary team members
Education provision on low salt diet for client with hypertension
Ask client about concerns, worries, feelings

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Answers: b, c, d

Coordinating care of an individual with multidisciplinary team members prevent further complications by ensuring medications and treatments prescribed do not interfere with each other or cause harm in clients with chronic conditions.

Low salt diet helps in managing blood pressure of clients with high blood pressure.

Clients with chronic conditions may suffer from stress related to long-term effects, treatments, and management hassle of chronic conditions. Asking clients about concerns, worries, other feelings help nurse identify needs for emotional, psychological support or referral to psychiatrist.

All of the above are nursing interventions that prevents further complications and maintain health of the clients with chronic conditions.

Advocating for public health safety falls under nursing interventions for primary prevention of diseases or injury, and under disease prevention/health maintenance of clients who already have chronic disease.

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Nurse’s Competencies in Disease Prevention

and Health Maintenance

Able to apply nursing process:

Accurate Assessment, Identification, Planning, Intervention and Evaluation of disease prevention/health maintenance interventions.

Acquire uptodate knowledge on evidence based practices on:

Health and its determinants.
Treatment and management of diseases.
Education and learning theories, behaviour change.

Effective communicator.
Effective collaborator and coordinator of multidisciplinary team
Knowledgeable of available support and resources in the communities for referrals.

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Nurse’s Competencies in Disease Prevention

and Health Maintenance

Context of people’s lives determine their health
Determinants of health are:

Age
Genetics
Gender
Physical environment
Social Environment
Income
Education
Access to health services

Without accurate assessment, an effective management is not possible
Nurses must assess determinants of health of an individual to

Accurately identify health risks and care needs for disease prevention/health maintenance
Plan and support effective interventions

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WHO Team (n.d.) states following to be the determinants of health:

Income and social status - higher income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.
Education – low education levels are linked with poor health, more stress and lower self-confidence.
Physical environment – safe water and clean air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions – people in employment are healthier, particularly those who have more control over their working conditions
Social support networks – greater support from families, friends and communities is linked to better health. Culture - customs and traditions, and the beliefs of the family and community all affect health.
Genetics - inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behaviour and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.
Health services - access and use of services that prevent and treat disease influences health
Gender - Men and women suffer from different types of diseases at different ages.

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Cultural Considerations

Nurses must individualize the health education and care appropriately with consideration for the cultural differences in health belief and practices with respect to disease prevention and health maintenance.

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References:

American Academy of Family Physicians (2020, August 3). What Can You Do to Maintain Your Health. Familydoctor.org. https://familydoctor.org/what-you-can-do-to-maintain-your-health/
Heflin, M.T. (2011, October 17). Geriatric health maintenance. In H.N. Sokol (Ed.) UpToDate. https://somepomed.org/articulos/contents/mobipreview.htm?38/27/39345

Institute for Work and Health (2015, April). Primary, secondary and tertiary prevention. https://www.iwh.on.ca/what-researchers-mean-by/primary-secondary-and-tertiary-prevention

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References:

Rural Health Information Hub (n.d.). Defining Health Promotion and Disease Prevention. Retrieved on September 27, 2021 from: https://www.ruralhealthinfo.org/toolkits/health-promotion/1/definition

State Government of Victoria, Department of Health (n.d.). Managing long-term illness and chronic conditions. Better Health Channel. Retrieved on September 27, 2021 from: https://www.betterhealth.vic.gov.au/health/ServicesAndSupport/managing-long-term-illness-and-chronic-conditions

The Government Health and Safety Lead (2018). A guide for maintaining health and well-being [PDF]. https://www.healthandsafety.govt.nz/assets/Documents/A_Guide_for_Maintaining_Health_and_Wellbeing.pdf

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References:

WHO (2018, March 30). Mental health: Strengthening our response. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

WHO (2020, September 8). Adolescent mental health. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health

WHO Team (n.d.). Determinants of Health. Retrieved on September 27, 2021 from: https://www.who.int/news-room/q-a-detail/determinants-of-health

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