Primary, secondary, and tertiary health promotion prevention strategies

Health Promotion in Nursing Practice: An Overview of the Current Literature

Primary

Feinstein, Alvan. (Jan 2005) "Does 'health promotion' really promote health? American

Journal of Economics and Sociology. Retrieved 11 Dec 2006 at http://findarticles.com/p/articles/mi_m0254/is_1_64/ai_n13798793/pg

According to Alvan Feinstein of The American Journal of Economics and Sociology, because of the success of "prophylactic" health promotion activities during the early 20th century, such as improved sanitation in cities and vaccination for infectious diseases, the attention of the medical profession has been turned towards encouraging other forms of health promotion. "Prevention has been subclassified into primary, secondary, and tertiary activities. The primary activities include not only the old 'one-shot' types of vaccination, but the short-term use of antibiotics in healthy persons, such as college students, to prevent the spread of small epidemics, such as meningitis. In primary prophylaxis, individual healthy persons are encouraged to eliminate or reduce 'risk factors' in diet, smoking, or physical sloth. Secondary prophylaxis involves efforts to reduce an asymptomatic physiologic abnormality, such as an elevated blood pressure or serum cholesterol, to prevent future diseases such as heart attacks or stroke. Tertiary prophylaxis, for diseases that already exist, is given with the hope of keeping them [sick or admitted patients] from getting worse," often in a hosptial or controlled health care setting like a nursing home. (Feinstein, 2005, p.1)

However well-intended such health promotion activties may be, Fienstein contends, they are often quite problematic when viewed in terms of their measurable positive effects. Feinstein is especially concerned with primary interventions in so-called healthy persons. Although dietary, pharmaceutical, and exercise interventions for asymptomatic people with the appropriate risk factors for heart disease, for example, may be a good thing, quite often they are not accompanied by psychological counseling and motivation to change behaviors that contribute to obesity. Lifestyle issues, unlike one-shot medications, require additional psychological support from nursing staff or other medical personnel, else they do little else but create a sense of guilt, and do not fundamentally alter behavior, especially if the effects of obesity, smoking, and sedentary behavior are currently not being 'felt,' and seem like far-off rather than real risks. (Feinstein, 2005, p.2)

Article 2: Secondary

Dyson, Pam. (Apr 2004) "Diet and diabetes -- the new recommendations." Journal of Diabetes Nursing. Retrieved 11 Dec 2006 at http://findarticles.com/p/articles/mi_m0MDR/is_4_8/ai_n6180372

Even for patients who have already developed diabetes as a result of poor lifestyle choices, however, "diet remains a contentious issue," and while it has been shown that "nutritional therapy is an integral part of effective management of diabetes and has a vital role in helping people with diabetes achieve and maintain optimal glycaemic control," often there is little or conflicting media information about what constitutes the "best diet," and how to help diabetics follow such a diet. (Dyson, 2004, p.1) This can be frustrating from the point-of-view of the nursing practitioner, becase quite often, even expert advice may vary, which can make patient compliance even more problematic, as Type II Diabetes patients may find it difficult to agree to monitor their sugar or caloric intake.

Sugar is a particularly controversial issue in diabetes treatment. Limiting sugar consumption is often seen as a way to mitigate the potential for the condition to spiral out of control. Traditionally, sugar is supposed to be limited for persons with diabetes. However, some current research suggests that in health promotion for diabetics, sugar-containing foods in and of themselves are not the primary culprit, rather the problem is that sugar results in overall caloric increase, causing further weight gain, and weight gain is often at the heart of the reason that the patient developed Type II Diabetes in the first place. Theoretically, sucrose can provide up to 10% of total energy intake for a diabetic without compromising glycaemic control, but it can be difficult for patients who have a problem limiting calories and foods that are energy dense such as chocolate, cookies, and cakes to stop at 'just one.'

It is important to remember the role of weight loss in diabetes health promotion and maintaining a healthy lifestyle. A nurse must stress the need for caloric limitation, as well as merely monitoring blood sugar and consumption of high-sugar foods, as fat-dense, high calorie foods that contribute to obesity can be equally dangerous. (Dyson, 2004, p.1) This can be difficult when patients do not experience complications from their condition, but merely have diabetes as a silent presence in their lives. Nurses must provide support to making lifestyle changes, and accomodating cultural tastes and needs, as well understanding as psychological conflicts over conflicting media advice when ensuring that the secondary health promotion intervention is effective.

Conclusion

In all of these articles, health promotion is defined as enabling the individual to engage in more effective self-monitoring and self-care, not simply on a physical level, but on a psychological level, as away from the nurse's immediate supervison, the patient must continue to monitor his or her exercise, diet, and other aspects of health. The purpose of health promotion in nursing practice is to promote a desire for healthy 'habits,' to enable such habits to be psychologically feasible for the patient, and to impress upon the patient the positive results of such habits, even if these actions may not be immediately manifest -- i.e. weight loss on a primary level might not be immeidately obvious, the long-term consequences of high blood sugar might not be currently problematic for the patient, etc. Nursing roles and responsibilities evolving in health promotion are thus holistic, and even nurses not explicitly involved in daily care, such as nurses involved in hospital work, can help to implement health promotion by ensuring that the patient understands the impact of lifestyle and its role in daily health, and the role of accurate information and monitoring of their lifestyle in the prevention and treatment health conditions.