Health relevance and applicability in contemporary contexts

Healthcare Promotion, Prevention, And the Role of Nurses

According to the World Health Organization (2005), "health promotion is the process of enabling people to increase control over their health and its determinants, and thereby improve their health." In order to successfully implement healthcare promotion, it is also necessary to take a deeper look at the variables and factors that affect people's health on a daily basis. These factors often include aspects of a person's life including their income, background, work environment, and diet. Once it is understood that healthcare promotion is different for everyone, and that the many different factors that play varying roles in this field can change the dynamics from person to person and case to case, the act of healthcare promotion is more fully undertaken and understood. By taking a holistic approach to healthcare promotion, nurses can better educate and serve their patients while creating a better, more supportive hospital or clinical environment.

The purpose of health promotion in the nursing environment is to increase the effectiveness of the healthcare services while simultaneously helping to reduce the work load on the nurses themselves. This can be accomplished through thorough education and marketing strategies to help empower people to make their own informed decisions to help positively affect their health. If a nurse can be effective in educating their patient in how to maintain their own health, that nurse will not have to maintain the same work load as they would if the patient relied completely on them for healthcare support. It goes back to the old adage, "An ounce of prevention is worth a pound of cure." Nursing and prevention are the first steps in effectively and preemptively eliminating much of the inefficiencies that are created when people are not properly educated or indoctrinated relative to how they themselves can remain or become healthy.

Nursing roles are evolving greatly because of the recent focus on health promotion. Instead of treating patients at later stages of diseases or disorders, health promotion actually encourages patients to become active players in their own health and aspects of their lives that affect their health. This in turn promotes proactive attitudes, where patients can more aggressively recognize and self-treat the symptoms and signs of disease before they get out of hand. Nurses are still necessary to treat patients, but the nurses themselves have become an educational tool to be used in the fight against poor health. Health promotion posits that part of the responsibility for a person's health rests on that person. One great example is colon cancer. This disease is largely preventable and in its early stages is relatively easy to treat. But in the later stages, it is almost always fatal (Chung, 2008). This disease can be screened for and patients can be taught about how to avoid it through proper lifestyle choices.

Nurses in all areas of nursing are capable of health promotion. First of all, nurses are the first line of educational opportunity for patients. They can provide useful and accurate information about how to avoid certain diseases and disorders and can even help the patient decide if they should screen for them. This is the preventative or primary stage. Secondly, nurses can help patients understand diseases and help to maintain healthy lives while living with a disease through proper education and lifestyle commitment. If a patient discovers they have colon cancer quite early on, the nurse can help the patient understand their best course of corrective or secondary action. Finally, nurses can help provide patients with the best possible quality of life, especially if the disease is terminal. Patients who are not going to recover can still be taught how to maximize their remaining time and how to make themselves comfortable. This is the tertiary stage, where nurses help to maintain a certain level or quality of life for a patient.

The Chung (2008) article shows that nurses can help to prevent colon cancer through screening and lifestyle education. This, as was discussed earlier, is a great example of primary nursing care. Secondary nursing care revolves more around treating a disease. The Frasier-Hill, et. al. (2008) article talks about how nurses can help patients to fight colon cancer after it has been identified. Through proper care and education, people can maximize their fight against the disease while receiving in-patient treatment. The Chung and Saltz article (2007) revolves around tertiary care and the nurse's role in the final stages of advanced colon cancer. While there is some hope of treatment, the tertiary stage is typically characterized as a stage where the patient and nurse should work together to maintain a high quality of life until the patient is deceased. This care, as given by the nurse, focuses more on making the patient comfortable and helping them to accept their situation than really fighting the disease. While advances are being made against cancer, most stage three colon cancer patients have run out of real options and are to be made comfortable as their health deteriorates.

Health promotion is becoming a more and more crucial function of the nursing field. Nurses are the first wave of defense in all levels of care, from prevention to treatment to helping a terminally ill patient remain comfortable and to maintain their quality of life. Health prevention can help to save people's lives and at the very least, will give them to power to positively influence their own health and self-direction. It is absolutely essential that nurses understand that they play a very pivotal role in this and that their own role is changing and evolving to encompass a completely holistic type of treatment.

The elements that are central to the nursing field in terms of healthcare promotion and overall patient empowerment are many. First it is necessary to understand how to encompass and identify the problem areas that need to be focused one. One example would be the reduction or elimination of patient falls in a hospital or clinical setting. In order to identify the problem, a nurse needs to understand when and where most falls are taking place, and then needs to be able to link the environmental and psychological aspects of the behavior with the behavioral aspects (Tesoriero, 2010). When this is done, a road map for positive change can be drawn up. The value of having less falls is that patients will remain healthier and stronger for longer, which helps them to recover from other illnesses and diseases that may have brought them in to the hospital or clinic in the first place. These values are central to many other healthcare professionals, and nurses are certainly not on their own in terms of promoting good health and care for their patients whether that is primary, secondary, or tertiary promotion.

The strategy in which a nurse attacks a particular problem or approaches and focuses on an emphasized goal is important. The strategy needs to be both comprehensive enough to encompass all their patients in this case as well as specific enough to work for each individual and in each nursing environment (Tesoriero, 2010). Nurses may also try to develop strategies such as changing the way they transfer or ambulate a patient in order to eliminate the possibility of falls. These are just a couple examples of how nurses can reduce falls, but with a little teamwork and an understanding of their patient base as well as the environment they are working in, nurses can help to create a much more positive and healthy working and living environment.

The context of the nursing setting is quite complex. Without first understanding the role of the nurse and the environment, it is nearly impossible to successfully convey the contextual and value-driven niche that nurses fill. Doctors and specialists are trained in specific areas to help treat specific conditions and diseases. Nurses on the other hand are a bit of a catch all profession. They must be familiar with enough of the healthcare industry and world to treat many different diseases and to help populations of people who are both recovering and who will likely never fully recover or who are dying.

One specific skill set that nurses must possess is the ability to properly educate and encourage their patients to take care of themselves and recognize how they can help prevent many of the conditions and diseases that affect the general population. This nursing role is perhaps the most important because it empowers patients to take control and responsibility of their own lives and health. Nurses must be able to properly and accurately educate their patients using a variety of tools (Kelleher and MacDougall, 2009). One of the best tools at their disposal is word of mouth. Nurses are supposed to encourage their patients to live a healthy lifestyle, and since many people are not familiar with the very fundamentals of a healthy diet, exercise, and other positive health aspects, it is therefore part of the nurse's job to help educate the public. Another great way for nurses to impact people through education and prevention is by leading by example. Nurses, who have first hand knowledge and understanding of how to live healthy and how to take proper care of themselves, are far better equipped to teach others about these concepts. Certain populations can benefit greatly from prevention, especially those who are prone to specific types of diseases or conditions.

One of the most common behaviors that leads to many chronic and often very damaging health conditions is smoking. Smoking can cause a multitude of diseases and conditions from emphysema to heart disease to lung cancer (Chapman, 2007). The list goes on and on. But smoking is 100% preventable and nurses need to understand not only how to treat these smoking-related diseases but how to more importantly discourage and prevent people from smoking in the first place. Many nurses agree that this behavior leads to many of the worst case scenarios for people with pre-existing chronic conditions. It is therefore important for nurses to first understand the effects of smoking in order to be able to properly and successfully educate patients about them. Once an understanding occurs, nurses must have the initiative to educate the public about the ills of smoking as well as the discipline to understand that they lead by example and that as a healthcare professional they should not take up behaviors and habits that could lead to chronic health conditions in the future (Chapman, 2007).

Once the problem here is specified, as it has been with smoking-related diseases, it can therefore be attacked through a couple of different avenues. Patients need to first feel empowered themselves to be able to change their behavior (Tesoriero, 2010). Whether that means keeping a non-smoker from smoking or helping a lifelong smoker to quit, this empowerment is a very key piece of the nursing field as well as in other healthcare professions. Patients need to conceptualize the problems in order to understand them, and nurses can help do so. Next, nurses must also understand that this empowerment process has different parts to it. These parts include self-learning and development skills as well as analyzing the relationship between themselves and their own authority (Tesoriero, 2010). Patients tend to listen to nurses as healthcare professionals so nurses need to recognize their own authority in the healthcare field. Through promotion of participation and the psychological authority that nurses possess, it is possible to positively empower and influence people's decisions.

The three different types of approaches discussed by Tesoriero (2010) also fall into separate categories in the nursing profession. Just as nurses are tasked with education and being a positive role model, these approaches are part of the nursing agenda and can be seen quite clearly as three separate avenues in approaching the problem of smoking and smoking-related conditions and diseases. For many people who are already smokers, the main mode of treatment is medical or high risk. These types of treatments include surgery to remove a tumor in their lung to heart surgery or bypass surgery. These procedures while relatively commonplace currently, are high risk and represent the last resort in the process of evaluating a patient's options and acting accordingly (Rice and Stead, 2006). Nurses are trained to assist with these procedures and to help patients both prepare for and recover from them. But the other two approaches to this problem seem to be much more effective when it comes to prevention of disease.

The behavioral or multi-risk approach tends to yield better results overall in large populations than the medical approach. This behavioral approach allows nurses to empower patients by first identifying the problem (smoking) and then creating a solution to their problem (Tesoriero, 2010). People need to feel as though they can control their behavior and that the nurse is telling them something worthwhile and valuable. This is where the authority of a healthcare professional comes in once again. The nurse has the authority to make an impression on the patient (Rice and Stead, 2006). Behavior changes may include cutting down on smoking or quitting altogether. Others may have a hard time not smoking when others around them are doing so, and nurses should recognize this and encourage them to surround themselves with non-smokers if it is going to become an issue.

The final approach to this problem is the socioenvironmental or community approach. Nurses need to recognize that they are part of a larger whole, or team that is helping to both educate and empower people to make positive and healthy decisions (Tesoriero, 2010). Nurses are certainly not alone in trying to keep people from engaging in risky or unhealthy behavior such as smoking. There are other resources and communities that can help in the fight to both prevent people from smoking and help those who have already started to quit. Nurses can use a person's family or community to help them understand the ills of this particular behavior as well as the risk factors involved (Rice and Stead, 2006). This is an excellent example of primary care, and is much less risky than removing a lung from a patient who has been smoking for decades.

One of the most intriguing and important questions that is often asked about healthcare promotion is whether or not mental health promotion is different from health promotion as a whole (Tesoriero, 2010). This question is likely answered by understanding that the nurse's role is holistic, and is not comprised of treating the body exclusively. In order to change a behavior like smoking, which often involves physical, mental, and emotional addiction, nurses need to be able to successfully deal with the mental and emotional aspects of the behavior in order to combat it. Since addiction is clinically diagnosable, nurses need to be familiar with its characteristics and also need to be able to work toward a solution (Rice and Stead, 2006). Prevention is the easiest way to combat addiction. If a substance like nicotine is known to be addictive, nurses can educate their patients about these substances and keep them from even putting them in their bodies in the first place. It is impossible to be addicted to something without first trying it.