Concepts of Health Promotion and Illness Prevention

Introduction

 Health promotion and illness prevention are not new notions. We have long been hearing to get a good nights rest, eat our vegetables and exercise frequently. While health promotion and illness prevention are certainly related, they are different concepts. Health promotion can be looked at as a state of mind around physical, emotional, financial and social well-being, a wide range of social, environmental and medical interventions or a combination of both. Illness prevention differs from health promotion because it focuses on specific efforts aimed at reducing the development and severity of chronic diseases and other morbidities (“Defining health promotion and disease prevention – RHIhub toolkit,” n.d.). Both health promotion and illness prevention have the ability to empower the individual to take control over their present and future and steer it towards one of happiness, wholeness and co-morbidity free living.

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 This paper will divulge into the many different factors and challenges that healthcare professionals, a patient, or both may encounter while attempting to promote health and prevent illness. Such challenges include knowledge deficits, socioeconomic and sociocultural factors, readiness and willingness to learn and how these issues affect the individual, as well as the community at large. Finally, tips and interventions will be revealed to motivate the patient and health care provider for the common goal of health promotion and illness prevention.

Challenges to Health Promotion and Illness Prevention

 Challenges to health promotion and illness prevention could be deeply personal or affect a wide range of the community. Personal challenges that may affect the ability to capitalize on resources could include a knowledge deficit on the subject at hand. For example, if a doctor mentions you need to start lowering your blood sugar or you could become diabetic, but doesn’t tell you exactly how to do that or what foods could be beneficial in achieving that goal, positive results are unlikely. It is the doctors responsibility to first assess your current knowledge on the topic, and then further guide you with tools and resources that are realistic and obtainable to your current situation. Another challenge becomes a patient’s willingness to learn or acknowledge the problem at hand. A patient’s denial of his or her illness, lack of physical endurance or lack of human or financial resources could be a major barrier to why the patient is hesitant to accept help. Objectively, low-income groups are less likely to seek medical care to prevent illness and high-income groups are more prone to stress related habits and illness. On top of this, Taylor, Lillis, LeMone and Lynn, 2011, believe “The family and culture to which a patient belongs to, often influence their pattern of living and values about health and illness; such patterns are often unalterable” (p. 46).

Opportunities to Promote Health and Prevent Illness

 Nurses have the ability to guide patients towards healthier living by modeling and demonstrating those same positive behaviors they are trying to promote. It is reasonable to say your nurse should not come into the room with smoking cessation paperwork for you, while she smells of cigarettes herself. One effective way to promote health is to ask each patient at the time of check in or triage, “How do you learn best? Do you absorb material by reading it, hearing it out loud or demonstrating it yourself?” This gives the nurse a head start in how to deliver and customize teaching material to provide to the patient that will benefit them in the most optimum way. Research supports the fact that educated patients experience better health and have fewer complications. This results in fewer hospitalizations and emergency department, clinic and physician visits (Taylor, et al., 2011, p.468). Nurses have the unique ability to be able to screen people anywhere and look for risk factors for commons diseases and disorders. This is typically done at health fairs, grocery stores, a pharmacy or any other high trafficked area. You can often find free blood pressure screenings, blood sugar assessments or see if you are in the healthy range for your body mass index at local community events. Blais and Hayes (2016) state, “Nurses are respected by the public and are knowledgeable about healthcare matters. They are in a position to provide opportunities to educate the public about healthy living and illness prevention” (p.154).

Issues and Factors That Impede Health Promotion and Illness Prevention

 It is easy to quickly point a finger at an obese patient as to why their blood pressure is as high as it is. But what happens when we start to look at all of the factors surrounding those details such as; the patients access to a doctor, access to health insurance, their family genetics, race, age, poverty level or simply where they live? There is not really one finger to point now, is there? A significant factor to be considered is the patients current economic state. The patient must be able to realistically follow through with the plan of care by having the finances to purchase the ordered medicine, materials, co-payments or therapies to achieve the specific goals in mind. A $200 blood pressure medicine cannot be prescribed to someone who depends on government assistance to keep him or her fed. Alternatives must be ready and available for different scenarios and must be considered and offered while providing the patient the same medical expertise. A similar barrier to health promotion and illness prevention is the patients home location. If the nearest doctors office or hospital is one hour away, the patient is less likely to seek advice or treatment for every “small” ailment that presents. For example, a patient in a rural area may develop a cough but decides to ignore it because driving to and from the doctors office would take up half the day. Two weeks later, the patient presents to your hospital with a serious case of sepsis and pneumonia because he or she was never assessed when the symptoms first started. This minor example is all too real for those living in rural and under developed areas.

 Access to healthcare has been a wildly popular topic of conversation in the past few years. Programs like the Affordable Care Act (ACA) were put in place to make health insurance more accessible to more individuals. Another goal of the ACA was to expand the Medicaid program to cover all adults below a certain poverty level. Lastly, the ACA would support innovative medical care delivery methods designed to lower the cost of health care in general (“Affordable care act (ACA) – Healthcare.gov,” n.d.).

A patients age introduces a new type of challenge when trying to teach health promoting and illness prevention skills. You must take into consideration the patients current learning level and ability to accept new material. A child can learn a vast array of new material, but has a short attention span. Most children also prefer to learn by visualizing the concept or getting a chance to demonstrate the skill through play. While an older geriatric patient may need to have the same material reinforced many times, and perhaps written on note cards to keep in familiar places. There are also factors that predispose an individual to an increased risk of illness; one example is your race. African American men and women statistically have the highest rate of individuals with hypertension, whereas Hispanic children and adolescents hold the highest prevalence of obesity in America (National Center for Health Statistics, 2016).

The Effect on Healthcare and Nursing

 One could argue that without illness, we wouldn’t have doctors, nurses or pharmaceuticals. However, with illnesses, and some new laws being placed, the same could soon be true. The Maryland Readmissions Reduction Incentive Program (RRIP) incentivizes hospitals to reduce avoidable readmissions by linking rewards and penalties to improvements in readmissions rates, and to attainment of relatively low readmission rates. Readmissions occur when a patient is discharged from a hospital and is admitted to any hospital within 30 days of the discharge. Preventable hospital readmissions may result from complications from previous hospitalization and/or inadequate care coordination, and generate substandard care quality for patients and unnecessary costs (The Maryland Health Services Cost Review Commission, n.d.). This sounds like a positive thing, right? The hospital is being incentivized/penalized to keep readmissions low. Except, the medical professional only has control over the situation for so long. Assuming the patient was provided with the appropriate literature, teaching and follow up recommendations for their hospital discharge, it is now up to them to follow those instructions and take matters into their own hands towards health promotion and illness prevention. If the same patient goes to any hospital within 30 days of that discharge, even if it is for an entirely different reason and is admitted, Medicare has the ability to reimburse the hospital the bare minimum or none of the costs for that visit. This certainly becomes frustrating for the hospital that has put in place policies and protocols to assist the patient after discharge, yet, their readmission rate is still above the state average. Medicare’s penalties can be upward of ten million dollars. This type of deficit can force a hospital to start cutting back on the amount of hours their doctors, nurses, pharmacists, technicians or laboratory specialists are allowed to perform. The readmission penalty, although with a positive goal in mind, seems to create a lose-lose situation for all involved. With less physicians and nurses able to assists patients due to budget cuts, there becomes an increased risk for medical errors… how does one then expect the readmission rate to decrease?

 Chronic diseases, along with physical, mental and emotional health are steadily placing huge economic and resource demands on our nation and healthcare professionals.  The direct medical expenditure cost for cardiovascular disease and stroke in 2009 alone was $313.8 billion dollars (Centers for Disease Control and Prevention, 2009). Nurses are inundated with high acuity patients and unsafe patient ratios due to budget cuts and staffing issues. It has long been projected that a major nursing shortage is approaching due to baby boomers reaching the age of retirement. In a study published in the journal BMJ Quality & Safety in May 2013, researcher Heather L. Tubbs-Cooley and colleagues observed that higher patient loads were associated with higher hospital readmission rates (American Association of Colleges of Nursing, 2017). It is effortless to see how these issues are interconnected and how follow through with health promotion and illness prevention is needed throughout a patients care under medical supervision.

The Role of Nursing and Management

In the State of Maryland, a Registered Nurse has many roles and responsibilities. The registered nurse should provide teaching to patients and the community that address and promote healthy living, risk-reducing behaviors, developmental needs, activities of daily living and illness/injury prevention. Before the nurse is able to teach a patient new material, the nurse must first assess what the patient already knows, their readiness to accept the new material/diagnosis and how the patient learns best. If the patient is exhibiting signs and symptoms of denial regarding their new or current diagnosis, a therapy or social work referral may be warranted. It is helpful to print the information for the patient to reference at another time as learning is inhibited during stressful times. Blais and Hayes (2016) state, “It is important that health professionals inform patients and consumers of the reliability of information on the Internet. Organizations such as the American Heart Association, American Lung Association and the Alzheimer’s Association provide specific information about risk factors, ways to lower risk and strategies for self-management” (p. 129).

A significant tool for those living in rural areas is the newer concept of “Telemedicine”. Telemedicine is based off the patient and health care professional having a virtual consultation where the patient can be evaluated, diagnosed and treated, all without essentially either of them having to leave their home. Patients enjoy the privacy, reduced travel time to and from appointments, along with the added benefit of not being exposed to other illnesses. A big factor in reducing readmissions is providing better preventive care and this is where telemedicine excels. Remote monitoring allows patients to check in more frequently with their physicians or nurses and also increases the chance that they’ll seek advice when experiencing an unscheduled medical care need before it advances to a more serious condition. By catching a sudden change in status, a patient can be seen by a primary care physician rather than being readmitted to the hospital, thus impacting a hospital’s penalties (Raegen, 2017).

The most important skill a nurse can acquire is the ability to conform to the needs of each individual patient at the present moment. No two patients, their history or their circumstances will ever be the same. Therefore, the way they are assessed, treated and educated should be individualized to their specific needs as well.

Summary

Health promotion and illness prevention is a complicated topic. It must be looked at on a singular level individualizing the plan for each and every patient, all the while, looked at on the bigger spectrum, holding the nurses, doctors, hospitals and community responsible for assisting the individual when they are discharged. On top of all of this, the patient must hold themselves accountable and desire to promote their own health to stay illness free. As previously mentioned, factors such as a patients culture, age, race or geographical location could make them predisposed to extenuating knowledge deficit or disease factors. It is these patients that health care professionals need to recognize, act on prophylactically to make them aware of their risk factors and educate them on signs and symptoms of a worsening disease process. Together, a healthier population will live longer, happier and be able to manage their disease processes better.

References

Affordable care act (ACA) – Healthcare.gov. (n.d.). Retrieved from https://www.healthcare.gov/glossary/affordable-care-act/

American Association of Colleges of Nursing. (2017, May 18). Nursing shortage fact sheet. Retrieved from https://www.aacnnursing.org/News-Information/Fact-Sheets/Nursing-Shortage

Blais, K. K., & Hayes, J. S. (2016). Professional nursing practice- Concepts and perspectives (7th ed.). Boston, MA: Pearson.

Centers for Disease Control and Prevention. (2009). The power of prevention- Chronic disease… the public health challenge of the 21st century. Retrieved from https://www.cdc.gov/chronicdisease/pdf/2009-power-of-prevention.pdf

Defining health promotion and disease prevention – RHIhub toolkit. (n.d.). Retrieved from https://www.ruralhealthinfo.org/toolkits/health-promotion/1/definition

The Maryland Health Services Cost Review Commission. (n.d.). Readmission reduction incentive program. Retrieved from http://www.hscrc.state.md.us/Pages/init-readm-rip.aspx

National Center for Health Statistics. (2016). Health, United States, 2015, With special feature on racial and ethnic health disparities. Retrieved from https://www.cdc.gov/nchs/data/hus/hus15.pdf

Raegen, C. (2017, April 10). 5 ways telemedicine is helping rural hospitals & their communities. Retrieved from https://relymd.com/blog-5-ways-telemedicine-is-helping-rural-hospitals/

Taylor, C. R., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of nursing- The art and science of nursing care (7th ed.). Philadelphia, PA: Lippincott-Raven.