LEVELS OF PREVENTION IN COMMUNITY NURSING
Many of the most serious disorders treated in health care practice can be prevented or postponed by immunizations, chemoprophylaxis and healthier lifestyles, or detected and treated early with various screening and intervention. Health care professionals, like nurses, now have the opportunity, skills and resources to prevent disease and promote health, as well as cure disease. Community nursing care oriented to health promotion, wellness, and illness prevention can be understood in terms of health activities the levels of prevention. These levels of prevention are primary, secondary, and tertiary levels which are formulated by Leavell & Clark. Each level of prevention corresponds to specific nursing and medical interventions.
Primary prevention is true prevention. It is also referred to as specific protection. It precedes disease or dysfunction and is applied to clients considered physically and emotionally healthy. It comprises of measures applicable to a particular disease or group of diseases in order to intercept their causes before they involve the individual (World Health Organization, 2001).
Primary prevention aimed at health promotion for the community includes health education programs, immunization for the children, and physical and nutritional fitness activities. It can be provided to an individual or to a general population, or it can focus on individuals at risk for developing specific diseases (Potter & Perry, 2004).
Wellness activities are synonymous with the activities identified for primary prevention. Primary prevention includes all health promotion efforts, as well as wellness activities that focus on maintaining or improving the general health of individuals, families, and communities (Edelman & Mandle, 2002).
For health promotion, activities includes health education, good standard of nutrition adjusted to developmental phase of life, attention to personality development, provision of adequate housing and recreation as well as agreeable working conditions in communities, marriage counseling and sex education, genetic screening and periodic selective examinations. Activities geared towards specific protection include the use of specific immunizations, use of environmental sanitation, protection against occupational hazards, protection from accidents, use of specific nutrients, protection from carcinogens, and avoidance of allergens (Potter & Perry, 2004).
Primary level of prevention could be used to address issues in a community experiencing increasing level of family violence. Educating the individuals in the community regarding violence, how to stop them and how to avoid them could largely help in decreasing the levels of violence in the community. Activities that could help individuals occupy their time could shift thought of violence behavior to a more productive one. Thus by using primary prevention, individuals could be directed to do more productive activities than produce violence. Other than that, marriage counseling could help minimize the levels of family violence in communities. When couples and other family member would undergo counseling, issues and problems could be solved and violence prevented.
Secondary prevention focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications or worsening conditions. This is basically the level of prevention that focuses on treatment. It refers to measures to arrest a disease process already initiated, in order to prevent further complications and sequelae, limit disability, and prevent death (World Health Organization, 2001). Activities are directed at diagnosis and prompt intervention, thereby reducing severity and enabling the client to return to a normal level of health as early as possible (Potter & Perry, 2004).
A large portion of nursing care related to secondary prevention is delivered in homes, hospitals, or skilled nursing facilities. It includes screening techniques and treating early stages of disease to limit disability by averting or delaying the consequences of advanced disease.
Early diagnosis and prompt treatment for secondary prevention include case-finding measures and selective examinations to cure and prevent disease process, prevent spread of communicable disease, prevent complication and sequelae, and to shorten an individual’s period of disability. Activities for disability limitations include adequate treatment to arrest disease process and prevent further complications and sequelae, and the provision of facilities to limit disability and prevent death (Potter & Perry, 2004).
Tertiary prevention occurs when a defect or disability is permanent and irreversible. This level of rehabilitation involves measures aimed at disabled individuals, restoring their previous situation or maximizing the use of their remaining capacities (World Health Organization, 2001). It also involves minimizing the effects of long-term disease or disability by interventions directed at preventing complications and deterioration (Edelman & Mandle, 2002). It therefore comprises both interventions at the level of the individual and modifications of the environment.
Activities are directed at rehabilitation rather than diagnosis and treatment. Care at this level aims to help clients achieve as high a level of functioning as possible, despite the limitations caused by illness or impairment. This level of care is preventive care because it involves preventing further disability or reduced functioning (Potter & Perry, 2004).
Examples of activities that focus on tertiary prevention includes provision of hospital and community facilities for retraining and education to maximize use of remaining capacities, education of public and industry to use rehabilitated persons to fullest possible extent, selective placement, work therapy in hospitals, and use of sheltered colony (Kozier & Erb, 2004).
Preventive care cannot be delivered effectively without active client involvement. At the most basic level, clients must consent to receive preventive care. In the case of family members in the community that agree to undergo preventive treatment in order to reduce levels of violence, they must wholeheartedly consent to such an intervention. Every effort should be made to foster patient knowledge and interest in preventive care with the use of various educational materials. Members of communities must be thoroughly educated and health care professionals should come up with strategies that gauge if these individuals have indeed learned something, and if the intervention is indeed successful. These may be made conspicuously available at strategic locations throughout the office or clinic, as well as actively distributed to clients with special needs.
A comprehensive health care program should address all three levels of prevention. The nurse should develop a health care program that would focus on (1) health promotion and protection against specific disease problems and decrease probability of diseases, (2) early identification of health problems and prompt intervention to alleviate health problems and include specific screening programs and illness care, and (3) chronic disease rehabilitation to an optimal level of functioning and relates to situations where a disability is already present in an individual. Granting the fact that communities comprise of very diverse individuals with different demographic, sociopsychological and structural variables, nurses and other health care professionals must come up with a health care program that is comprehensive enough to cover such a diverse population and the diverse levels of illness and disease that come with them.
Addressing a health concern at this level of prevention is cost effective since it is like hitting three birds with one stone. By preparing for whatever could possibly happen to an individual in a community, the nurse could save time, effort and money in the prevention of illness and diseases. Perhaps in the primary level of prevention alone, this could help stop the spread and development of illness and diseases in the members of the community. Identifying risk factors, attempts to eliminate the stressor, focuses on protecting and strengthening defenses could help individuals from developing diseases and illness. If that is the case, not only will the health care professionals save on time and effort but the individuals in communities could also save costs on treatment for secondary prevention and even rehabilitation for tertiary prevention.
In conclusion, health care professionals most especially nurses must develop health care plans and strategies geared on prevention and taking into account the three levels of preventive care. A comprehensive health care program should address all three levels of preventive care. Aside from being an advantage since it could be used on any individual in the community, it is also cost effective. Individuals in communities and health care professionals must always remember that prevention is still better than cure.
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