Fundamentals of Nursing: Lecture 2

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Focuses on health promotion and protection against specific
health problems
Primary prevention
Its purpose is to decrease the risk or exposure of the individual or
community to disease.
Focuses on early identification of health problems and prompt
intervention to alleviate health problems
Secondary prevention - 3 levels of prevention (Leavell and Clark)
Its goal is to identify individuals in an early stage of a disease
process and to limit future disability.
Focuses on restoration and rehabilitation
Tertiary prevention - 3 levels of prevention (Leavell and Clark)
It aims to return the individual to an optimal level of functioning
In practice, these 3 levels may overlap.

A client may have experienced a heart attack, and a goal of

Leavell and Clark's 3 Levels of Prevention
secondary prevention is to limit disability. The teaching (lifestyle
changes) for the client's rehabilitation will be similar to the health
education activities used for primary prevention teaching.
• Quit smoking
• Avoid/limit alcohol intake
• Exercise regularly
• Eat a well-balanced diet
Primary prevention - Behaviors associated with the • Reduce fat and increase fiber in the diet
levels of prevention • Take adequate fluids
• Avoid overexposure to sunlight
• Maintain ideal body weight
• Complete Immunization Program
• Wear PPE on work site
• Have an annual physical examination
• Regular Pap smear for women
Secondary prevention - Behaviors associated with the • Monthly BSE for women 20 years and older
levels of prevention • Sputum examination for Tuberculosis
• Annual stool guaiac test and rectal examination for clients over
50
• Self-monitoring of blood glucose among diabetics

• Physical therapy after CVA (stroke) = participation in Cardiac

Tertiary prevention - Behaviors associated with the Rehabilitation after MI (heart attack)
levels of prevention
• Attending self-management education for diabetes

• Undergoing speech therapy after laryngectomy

Information Dissemination

Health Appraisal and Wellness Assessment Programs

(5) Types of health promotion programs Lifestyle and Behavior Change Programs

Worksite Wellness Programs

Environmental Control Programs

Use of variety of media to offer information to the public about the
Information Dissemination particular lifestyle choices and personal behavior, the benefits of
changing that behavior and improving the quality of life
Appraise individuals of their risk factors that are inherent in their
lives in order to motivate them to reduce specific risk and develop
Health Appraisal and Wellness Assessment Programs
positive health habits

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Wellness assessment programs are focused on more positive
methods of enhancement
Basis for changing health behavior
Lifestyle and Behavior Change Programs
Geared toward enhancing the quality of life and extending the life
span
Include programs that serve the needs of persons in their work-
Worksite Wellness Programs
place
Developed to address the growing problem of environment pollu-
Environmental Control Programs
tion: air, land, water, etc.
The totality of services offered by all health disciplines

Its main purpose in the past was to provide care to the ill or injured

Healthcare system (healthcare delivery systems) In modern times, healthcare systems have changed with increas-
ing awareness of health promotion and illness prevention

Nurses have different roles within these different systems of

healthcare delivery
Primary Prevention: Health Promotion and Illness Prevention

Secondary Prevention: Diagnosis and Treatment

(3) Types of healthcare services
Tertiary Prevention: Rehabilitation, Health Restoration, and Pal-
liative Care
Types of Healthcare Services Often classified in relation to the 3 Levels of Prevention
Based on the concept of maintaining an optimum level of wellness,
the WHO developed a project called Healthy People with the
following goals:

Attain healthy, thriving lives and well-being, free of preventable

disease, disability, injury, and premature death

Eliminate health disparities, achieve health equity, and attain

health literacy to improve the health and well-being of all

Create social, physical, and economic environments that promote

attaining full potential for health and well-being for all

Promote healthy development, healthy behaviors, and well-being

Primary Prevention: Health Promotion and Illness Prevention
across all life stages

Engage leadership, key constituents, and the public across mul-

tiple sectors to take action and design policies that improve the
health and well- being of all

Primary prevention programs address areas such as adequate

and proper nutrition, weight control and exercise, and stress re-
duction

Providing immunizations

Smoking cessation programs environmental programs like smoke

emission testing for vehicles

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Traditionally, most healthcare services were dedicated to the di-
agnosis and treatment of illness

Major agencies: hospitals and doctors' offices

Hospitals continue to focus on emergency, intensive, and

around-the-clock acute care

"Freestanding" diagnostic and treatment facilities have evolved

and serve ever-growing numbers of clients

MRI and other diagnostic procedures are commonly performed at

physician- or corporate-owned centers

Similar structures exist in outpatient surgical units

Urgent care centers and independent emergency rooms are also

more common in recent years

Also included as a health promotion service is "early detection" of

disease, accomplished through:

Routine screening of the population

Focused screening of those at-risk

Secondary Prevention: Diagnosis and Treatment
Regular dental exams from childhood throughout life

Bone density studies for menopausal women

Community-based agencies provide such services:

Clinics provide mammograms and education regarding early de-

tection of breast cancer

Voluntary HIV testing and counseling

Some malls and shopping centers have walk-in clinics that pro-
vide diagnostic tests or screening for cholesterol and high blood
pressure

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Goal of tertiary prevention is helping individuals return to their
previous level of health / previous capabilities or the highest level
attainable at their current health status

"Rehabilitative care" assists with adequate functioning in the

physical, mental, social, economic, and vocational areas of client's
lives

Someone with an injured neck or back from an automobile crash

may have restrictions in the ability to perform work or ADLs if the
injury is temporary, rehabilitation can assist in return to former
function

If the injury is permanent, rehabilitation assists the client in ad-

justing the way activities are performed in order to maximize the
client's abilities

Tertiary Prevention: Rehabilitation, Health Restoration, and Pal- Rehabilitation may begin in the hospital, but will eventually lead
liative Care clients back into the community for further treatment and follow-up
once health has been restored

An example of tertiary mental health prevention is an outreach

program that follows individuals with mental disorders in the com-
munity to ensure that they adhere to their medication regimens

Such programs can reduce acute psychiatric hospital admis-

sions and long-term institutionalization, and enable individuals
with mental disorders to live independently

Sometimes, individuals cannot be returned to health

A growing field of nursing and tertiary prevention services is that

of "palliative care" - providing comfort and treatment for symptoms

End-of-life care may be conducted in many settings, including the

home
Public Health
Physician's Offices/Clinics
Ambulatory Care Centers
Occupational Health Clinics
Hospitals
Subacute Care Facilities
Extended (Long-Term) Care Facilities
(14) Types of Healthcare Agencies
Retirement and Assisted Living Centers
Rehabilitation Centers
Home Healthcare Agencies
Day Care Centers
Hospice Services
Crisis Centers
Mutual Support and Self-Help Groups
Government agencies are established at the local and national
levels to provide public health services

Local health departments are responsible for developing pro-

grams to meet the health needs of individuals and communities,
providing necessary nursing staff and facilities to carry out pro-
Public Health
grams

National health organizations are responsible for assisting local

health departments, allocating funds from taxpayers' money, and
developing nationwide health promotion and illness prevention
programs

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Majority of physicians either have their own offices or work with
several other physicians in a group practice

Clients usually go to a doctor's clinic for routine health screening,

illness diagnosis, and treatment

Physician's Offices/Clinics Nurse practitioners (NPs or APRNs) sometimes practice along-

side physicians in some medical offices

Doctor's clinics usually do not need an RN to function in clinics

with an N, they have a variety of roles and responsibilities, like
preparing the patient for examinations, obtaining health info, and
providing health education
One type of outpatient setting used in many communities

Most have diagnostic and treatment facilities that provide medical,

nursing, laboratory, and radiologic services

May or may not be associated with a hospital

APRNs may provide services without a physician

Ambulatory Care Centers
Some cater to minor surgical procedures

Advantages:
They permit the client to live at home while obtaining necessary
healthcare

They free up costly hospital beds for seriously ill clients

More companies now recognize the value of healthy employees,
and encourage healthy lifestyles by providing exercise facilities
and coordinating health promotion activities

Community health nurses in the occupational setting have a vari-

ety of roles
Occupational Health Clinics
Nursing functions in industrial healthcare now include work safety
and health education, annual emplovee health screening to TB,
and maintaining immunization info

May include screening for hypertension and obesity, caring for

employees following injury, and counseling
Vary in size from the 12-bed rural hospital to the 1500-bed met-
ropolitan hospital

Classified according to ownership or control as governmental

Hospitals (public) or nongovernmental (private)

Also classified by the services they provide:

Military, private, academic medical centers, general, specialty ser-
vices
Military hospitals Provide care to military personnel and their families
Are often operated by churches, corporations, communities, and
charitable organizations
Private hospitals
May be for-profit or non-profit
Academic medical centers Are hospitals that are directly associated with a medical school
Admit clients requiring a variety of services: medical, surgical,
General hospitals
obstetric, pediatric, and psychiatric

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A variation of inpatient care designed for someone who has an
acute illness, injury, or exacerbation of a disease process

Clients may be admitted after, or instead of, acute hospitalization

Subacute Care Facilities or to administer one or more technically complex treatments

Generally, the client's condition does not require care that de-
pends on high-technology monitoring or complex diagnostic pro-
cedures
Formerly called nursing homes

Are now often multilevel campuses that include independent liv-

ing quarters for older adults, assisted living facilities, and skilled
nursing facilities
Extended (Long-Term) Care Facilities
Providing personal care for those who are chronically ill or unable
to care for themselves without assistance

Traditionally, these facilities only catered to the elderly, but now

they provide services to all ages who require rehabilitation or
custodial care
Consist of separate houses, condominiums, or apartments for
residents

Residents live relatively independently; however, many of these

Retirement and Assisted Living Centers facilities offer meals, laundry services, nursing care, transporta-
tion, and social activities

Some centers have an affiliated hospital to care for residents with

short-term or long-term illnesses
Usually are independent community centers or special units

However, because rehabilitation ideally starts the moment the

client enters the healthcare system, nurses who are employed
on orthopedic, pediatric, psychiatric, stroke, or surgical units of
hospital also help to rehabilitate clients
Rehabilitation Centers
Play an important role in assisting clients to restore their health
and recuperate

Drug and alcohol rehabilitation centers help free clients of drug

and alcohol dependence and assist them to re-enter the commu-
nity and function to the best of their ability
Some agencies provide home healthcare services to clients by
assigning or deploying a private-duty nurse

Home Healthcare Agencies These nurses who are hired by home healthcare agencies provide
nursing care in the home setting to a particular client who needs
assistance with daily activities or intensive nursing care in order
to function or survive on a day-to-day basis
Serve many functions and many age groups

Some provide care for infants and children while parents work

Others provide care and nutrition for adults who cannot be left at
Day Care Centers home alone but do not need to be in an institution

Some centers provide counseling and physical therapy

Nurses may provide medications, treatments, and counseling as

well
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Hospice is a practice where an interprofessional healthcare team
provides services for the dying, which may be provided in the
home or other setting
Hospice Services
Clients are usually terminally ill, where the central concept is not
saving life but improving or maintaining the quality of life until death

The focus is on palliative care and comfort, not treatment or cure

Provide emergency services to clients experiencing life crises

May operate out of a hospital or in the community, and most

provide 24-hours telephone support
Crisis Centers
Some also provide direct counseling to individuals at the center or
in their homes

Primary purpose: helping individuals cope with an immediate cri-

sis and then provide guidance and support for long-term therapy
These groups may be for the client or for the friends and family of
Mutual Support and Self-Help Groups
the client, who also need education, guidance, and support
Formed in 1935
Alcoholics Anonymous
Served as the model for Mutual Support and Self-Help Groups
Also referred to as the "healthcare team" or "health professionals"

Consists of nurses and health personnel from different disciplines

who coordinate their skills to assist clients
Providers of Healthcare
Mutual goal: to restore a client's health and promote wellness

The choice of personnel for a particular client

depends on the needs of that client
Nurse
Alternative (Complementary) Care Provider
Assistive Personnel
Case Manager
Dentist
Dietitian or Nutritionist
Emergency Medical Personnel
Occupational Therapist
(17) Types of health professionals/healthcare team Paramedical Technologist
Pharmacist
Physical Therapist
Physician
Physician Assistant
Podiatrist
Respiratory Therapist
Social Worker
Spiritual Support Personnel
The role of the nurse varies with:
- The needs of the client
- The nurse's credentials
- The type of employment setting
Nurse
Can pursue different specialties: critical care mental health, on-
cology, diagnostics/imaging

RN, LVN, LPN, NPs, nurse midwives, certified registered nurse

anesthetists, and clinical nurse specialists

RN

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Assesses a client's health status, identifies health problems, and
coordinate care
Licensed Vocational Nurse (LVN) or Licensed Practical Nurse
Provides direct client care under the supervision of an RN
(LPN)
Provide direct client care as NPs, nurse midwives, certified regis-
tered nurse anesthetists, and clinical nurse specialists

Have education and credentials that may allow them to:

APRNs
- Provide primary care
- Prescribe medications
- Receive third-party (insurance) reimbursement directly for their
services
Refers to those practices not commonly considered part of West-
ern (modern) medicine which may include:

chiropractors
massage therapists
herbalists
reflexologists
acupuncturists
holistic health healers

These providers may practice alongside Western healthcare

providers

Clients may seek their services in addition to, in combination with.

or instead of Western medicine
Are healthcare staff who assume delegated aspects of basic
client care, including bathing, assisting with feeding, and collecting
specimens

Include nurse's aides, hospital attendants, nurse technicians,

client care technicians, and orderlies
Assistive Personnel
Some AP roles require standardized education and job duties:
certified nursing assistants (CNAs)

"Carers" or "caregivers" in nursing homes and other extended

care facilities account for the majority of staff in these healthcare
systems
This role is to ensure that clients receive fiscally sound, appropri-
ate care in the best setting

This role is often filled by the member of the healthcare team who
Case Manager is most involved in the client's care

Depending on the nature of the client's concern, the case man-

ager may be a nurse, social worker, an occupational therapist, a
physical therapist, or any other member of the healthcare team
Diagnoses and treats mouth, jaw, and dental problems
Dentist
Dentist and dental hygienists are also actively involved in preven-
tive measures to maintain healthy oral structures
Has special knowledge about the diets required to maintain health
and to treat disease

Dietitian or Nutritionist In hospitals, they are generally concerned with therapeutic diets
and supervise the preparation of meals to ensure that clients
receive the proper diet, and may design special diets to meet the
nutritional needs of individual clients
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Is an individual who has special knowledge about nutrition and
food

In a community setting, they recommend healthy diets and provide

broad advisory services about the purchase and preparation of
foods
Nutritionist
Community nutritionists often function at the preventive level

They promote health and prevent disease, for example, by advis-

ing families about balanced diets for growing children and preg-
nant women
Several different categories of providers are associated with am-
bulance or emergency medical services agencies (ex: fire depart-
ments) that provide first responder care in the community

Emergency Medical Personnel Titles, education, and certification vary for emergency medical
technicians (EMTs) and paramedics

These personnel are trained to assess, treat, and transport clients

experiencing a medical emergency, accident, or trauma
Assists clients with impaired function to gain the skills to perform
activities of daily living (ADLs)

For example, an occupational therapist might teach a man with

severe arthritis in his arms and hands how to adjust his kitchen
utensils so that he can continue to cook
Occupational Therapist
Teaches skills that are therapeutic and at the same time provide
some fulfillment

For example, weaving is a recreational activity but also exercises

the arthritic man's arms and hands
Two examples/kinds:
Paramedical Technologist
Laboratory technologists and Radiologic technologists
Paramedical Means "having some connection with medicine"
Examine specimens such as urine, feces, blood, and discharges
Laboratory technologists from wounds to provide exact information that facilitates the med-
ical diagnosis and the prescription of a therapeutic regimen.
Assist with a wide variety of examinations that employ the use
of radiation (X-rays) and ultrasound/magnetic waves to create
images of the inner structures of a patient's body
Radiologic technologists
The visualization of these organs or tissues allows other members
of the healthcare team to diagnose and treat illnesses that may
be caused by anatomical abnormalities or underlying damage or
injury
Prepares and dispenses pharmaceuticals in hospital and commu-
Pharmacist
nity settings
A specialist who guides primary care providers in prescribing
medications
Clinical pharmacist
They also work directly with clients and with other healthcare team
members to ensure safe integration of medications into the client's
comprehensive health plan

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Assist clients with musculoskeletal problems

They treat movement dysfunctions by means of heat, water, ex-

ercise, massage, and electric current

Their functions include:

Assessing client mobility and strength, providing therapeutic mea-

Physical Therapist sures (exercises and heat applications to improve mobility and
strength)

Teaching new skills (how to walk with an artificial leg)

Some PTs provide their services in hospitals

However, independent practitioners establish offices in communi-

ties and serve clients either at the office or in the home
Responsible for medical diagnosis and for determining the therapy
required by an individual who has a disease or injury

Their role has traditionally been the treatment of disease and

trauma

They include health promotion and disease prevention

Physician
Some are primary care practitioners (general or family practition-
ers)

Others are specialists: Dermatologists, neurologists, oncologists,

orthopedists, pediatricians, psychiatrists, radiologists, or sur-
geons
Hospitalists Physicians who specialize in the care of clients in hospitals
Intensivists Hospitalists who specialize in critical care
Are those who provide the first point of contact for most clients and
can include

Allopathic (Western) medical doctors (MDs) - Trained in areas

Primary care physicians
such as internal medicine, gynecology, and geriatrics

Doctors of osteopathy (DOs) - a branch of medicine traditionally

focused on primary care
Perform certain tasks under the direction of a physician and are
increasingly positioned to provide primary care

They treat various diseases, conditions, and injuries

Physician Assistant
In many states, nurses are not legally permitted to follow a PA's
orders unless they are co-signed by a physician

In some settings, PAs and NPs have similar job descriptions

Diagnose and treat foot and ankle conditions
Podiatrist - Doctors of podiatric medicine (PM)
They are licensed to perform surgery and prescribe medications

Are skilled in therapeutic measures used in the care of clients with

respiratory problems
Respiratory Therapist
They are knowledgeable about oxygen therapy devices, respi-
rators, mechanical ventilators, and accessory devices used in
inhalation therapy

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They also administer pulmonary function tests

Counsels clients and their significant others regarding problems
such as finances, marital difficulties, and adoption of children
Social Worker
They are particularly familiar with both public and private re-
sources available to clients according to their socioeconomic
backgrounds
Chaplains, pastors, rabbis, priests, and other religious or spiritual
Spiritual Support Personnel advisers serve as part of the healthcare team by attending to the
spiritual needs of clients

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