Chapter 2
Health Promotion
and Disease Prevention
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Health and Illness
• Community-based care concentrates on true “health
care” activities to promote health and prevent illness and
injury.
• Shift in thinking from a focus on sick care to disease and
injury prevention
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Definition of Health
• Health: state of physical, mental, and social well-being
and not merely absence of disease or infirmity (WHO,
1986)
• Updated WHO definition (2008)included characteristics,
behaviors, and physical, social, and economic
environment
• Seen as a resource for everyday living
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Health-Illness Continuum
• Care in the acute care settings is usually directed to
resolving immediate health problems.
• In the community, care focuses on maximizing
individual potential for self-care. The client assumes
responsibility for health care decisions and care
provision, with the client’s ability to function the
primary concern.
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Healthy People 2020 Missions
• To identify nationwide health improvement priorities
• To increase public awareness and understanding of the
determinants of health, disease, and disability and the
opportunities for progress
• To provide measurable objectives and goals applicable at
the national, state, and local levels
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Healthy People 2020 Missions (cont.)
• To engage multiple sectors to take actions to strengthen
policies and improve practices that are driven by the best
available evidence and knowledge
• To identify critical research, evaluation, and data
collection needs
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Healthy People 2020 Goals
• Attain higher quality, longer lives free of preventable
disease, disability, injury, and premature death
• Achieve health equity, eliminate disparities, and improve
the health of all groups
• Create social and physical environments that promote
good health for all
• Promote quality of life, healthy development, and healthy
behaviors across all life stages
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Health Promotion Versus Disease or
Injury Prevention?
• Health promotion: activities to help individuals change
their lifestyle to move toward a state of optimal health (a
balance of physical, emotional, social, spiritual, and
intellectual health)
• Disease prevention: activities undertaken to avoid the
occurrence of a disease or injury and minimize the
consequences. Intended to prevent future illness.
• Health protection: environmental or regulatory measures
that confer protection on population groups
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Levels of Prevention
• Primary prevention: prevention of the initial occurrence
of a disease or an injury
• Secondary prevention: early identification with prompt
intervention to prevent or limit disability
• Tertiary prevention: assistance to halt further disease
progress and to meet one’s potential and maximize
quality of life
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Public Health Nursing Intervention Wheel
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Levels of Public Health Practice
• Individual-focused practice
– Changes knowledge, attitudes, beliefs, practices, and
behaviors of individuals
– Practice level directed at individuals alone or as part
of a family, class, or group
– Receive services because they are part of population
at risk
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Levels of Public Health Practice (cont.)
• Systems-focused practice
– Changes organizations, policies, laws, and power
structures
– Focus is not directly on individuals and communities
but focuses on systems that impact health.
– More effective and long lasting way to impact
population health
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Levels of Public Health Practice (cont.)
• Community-focused practice
– Changes community norms, community attitudes,
community awareness, community practices, and
community behaviors
– Directed toward entire population, groups within the
community, or target groups
– Measured in terms of what proportion of population
actually changes
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Levels of Public Health Practice (cont.)
• Population-based
– Public health interventions are population-based if
they consider all levels of practice.
– Represented by all three inner rings of the
intervention wheel
– Interventions may be focused at population or on
individuals and families known to be at risk.
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Public Health Interventions
• Surveillance
• Disease and other health event investigation
• Outreach
• Screening
• Case-finding
• Referral and follow-up
• Case management
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Public Health Interventions (cont.)
• Delegation functions
• Health teaching
• Counseling
• Consultation
• Collaboration
• Coalition building
• Community organizing
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Public Health Interventions (cont.)
• Advocacy
• Social marketing
• Policy development
• Policy enforcement
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Summary
• Nursing practice has evolved as a reflection of society’s
need to focus on health rather than illness.
• Healthy People 2020 provides a framework to put disease
prevention into action.
• Prevention is a key concept in community-based care.
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Question
• Student nurses go into a neighborhood door-to-door.
They identify individuals who have not had flu shots and
direct them to the local community center’s flu clinics.
This is an example of
– A. Screening
– B. Outreach
– C. Health teaching
– D. Surveillance
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Answer
• B. Outreach
• Rationale: Outreach is locating populations of interest or
populations at risk and providing them with information
about the nature of the concern, what can be done about
it, and how services can be obtained.
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Question
• A nurse meets with Edna, an elderly woman who has
been hospitalized with a broken hip, and her family. They
discuss what self-care Edna can manage on her own and
how the family may be able to assist her once she goes
home and determine the community resources available
to assist with her care. These actions would be
considered
– A. Health teaching
– B. Case management
– C. Collaboration
– D. Case-finding
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Answer
• B. Case management
• Rationale: Case management optimizes the self-care
capabilities of individuals and families and the capacity of
systems and communities to coordinate and provide
services.
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Question
• The nurse is providing blood pressure screening at the
local senior center. This is an example of which level of
prevention?
– A. Health promotion
– B. Primary prevention
– C. Secondary prevention
– D. Tertiary prevention
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Answer
• C. Secondary prevention
• Rationale: Screening is considered secondary prevention
because the nurse is identifying the presence of disease.
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