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Health Promotion 429v

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The Expanding Role of Nursing in Health Promotion
Robert W Lewis
Grand Canyon University NRS-429V
February 7, 2013

Nursing in the 21st century is being redefined. The population of the United States is increasingly diverse, with many cultural and religious influences on the health of the population. Legislative initiatives like the affordable health care act (AHC) will require a shift from the wellness-illness model to a practice focused on health promotion. When discussing a definition of health promotion published literature over the last 30 years has expanded and refined this role. One definition that is comprehensive is:
Health Promotion is the art and science of helping people discover the synergies between their core passions and optimal health, enhancing their motivation to strive for optimal health, and supporting them in changing their lifestyle to move toward a state of optimal health. Optimal health is a dynamic balance of physical, emotional, social, spiritual, and intellectual health. Lifestyle change can be facilitated through a combination of learning experiences that enhance awareness, increase motivation, and build skills and, most important, through the creation of opportunities that open access to environments that make positive health practices the easiest choice. (O'Donnell, 2009)
O’Donnell’s definition is broad and encompasses all of the areas of health promotion as it would be related to nursing practice.
Health promotion might be viewed more clearly and provide a more direct course of action if viewed with the following metaphor: You are standing on the edge of a river, a person floats by in obvious distress, you rush into the water, pull him to the shore. As you look downriver, you see another person in the same position. You rush in and again pull that person to the shore only to find a dozen more persons in distress floating downriver. Finally, having pulled the last person out of the water, you decide to look up stream to see why there are people in the water in the first place. You discover there is a large hole in the bridge spanning the river. You repair the hole, and there are no more people falling into the water (At Work, 2006). These are two examples of definitions of health promotion, providing a framework for the application of the concept. Leavell and Clark (1965) provide a framework describe a three-tiered model of prevention and therefore promotion of health. The first component of the triad is primary prevention, emphasizing the nurse’s role as teacher and coach; the emphasis would be on promoting positive health behaviors in the community and globally. These behaviors would be immunizations, adequate food and water supplies, avoidance of high risk behaviors (unprotected sex, smoking, drug use,) adequate sanitation, and, preventative medical care, including routine gynecological and other health screenings.
Secondary prevention is described by interventions to cure and prevent the disease process, prevent complications and shorten any period of disability.
Tertiary prevention focuses on the rehabilitative process and its role in limiting the ongoing results of existing disease processes. This could include education to maximize remaining functional status, promotion of sheltered work environments to provide for continued community involvement and educating the community as to the abilities of these individuals. The continuing evolution of nursing in the 21st century will by necessity shift from an acute care setting to a community-based setting. Community centers, home health agencies, housing developments, local and state health departments; neighborhood centers and parishes school health programs and worksites will be some of the venues in which nurses will practice primary health promotion (Kulbok, et al., 2012). The secondary level of health promotion is illustrated by the role of nursing prevention and treatment of hypertension on a global scale. High blood pressure affects between 600 and 800 million people worldwide, and the causes of over 7 million premature deaths. Evidence provided by Hong (2010) concluded that nursing interventions which stressed a decreased fat intake, limited sodium intake, and increased physical activity provided significant evidence of a positive effect on patients being treated for high blood pressure. This emphasis on education on the community level is an example of the evolving role of nursing. Implementing health promotion and tertiary care setting will require nursing to become more adept at understanding life changes and set life choices patients and relatives unrealistic expectations could be unveiled and reoriented therefore speeding the adaption and return to community life (Portillo, Collie, 2010). The reorientation of nursing practice to one of prevention from that of treatment will require nursing professionals to become more adept as both researchers and teachers in order to provide frameworks and programs that effectively change health promoting behaviors in the community at large.

References:
At Work, Issue 43, Winter 2006: Institute for Work & Health, Toronto http://www.iwh.on.ca/wrmb/primary-secondary-and-tertiary-prevention
Halpin, H., Morales-Suárez-Varela, M. M., & Martin-Moreno, J. M. (2010). Chronic Disease Prevention and the New Public Health. Public Health Reviews (2107-6952), 32(1), 120-154.
Kulbok, P. A., Thatcher, E., Park, E., & Meszaros, P. S. (2012). Evolving Public Health Nursing Roles: Focus on Community Participatory Health Promotion and Prevention. Online Journal Of Issues In Nursing, 17(2), 1. doi:10.3912/OJIN.Vol17No02Man01
O'Donnell, M. (2009). Definition of health promotion 2.0: embracing passion, enhancing motivation, recognizing dynamic balance, and creating opportunities. American Journal Of Health Promotion: AJHP, 24(1), iv. doi:10.4278/ajhp.24.1.iv
Portillo, M., & Cowley, S. (2011). Working the way up in neurological rehabilitation: the holistic approach of nursing care. Journal Of Clinical Nursing, 20(11/12), 1731-1743. doi:http://dx.doi.org.library.gcu.edu:2048/10.1111/j.1365-2702.2010.03379.x
Woi-Hyun S., H. (n.d). LITERATURE REVIEW: Evidence-based Nursing Practice for Health Promotion in Adults With Hypertension: A Literature Review. Asian Nursing Research, 4227-245. doi:10.1016/S1976-1317(11)60007-8

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