Nurses Role in Primary Health Care, Health Promotion and Education

The present paper explores the primary health care (PHC) nursing role focusing primarily on health promotion, enabling people to improve their health and well-being. The primary objective of health promotion is to minimize the demands for rehabilitative and curative care. The essay also examines health campaign strategies for promoting tobacco cessation, with the focus principally on gain-loss-framed messages.

Part A. 1: Primary Health Care (PHC) Nursing Role

Health Promotion

The WHO defines health promotion a “the process of enabling people to increase control over and improve their health.” PHC is the first level of contact that communities, individuals, and families have with the healthcare systems (McManus, 2013). In Australia, this integrates personal care with health promotion, which refers to preventing diseases and community development. The health promotion role of primary care nurses includes health education, nutrition, child health care, sanitation, immunization control, and prevention of endemic diseases (McManus, 2013). Health promotion is essential in helping families, communities, and individuals to cultivate skills to improve and maintain their well-being and health. Through the practice of health promotion, the primary care nurse provides the patient with the necessary information to plan and eventually improve their health. The primary health care environment makes it convenient for the nurse to utilize routine collaborations with clients to educate them on health-related issues (Ashcroft, 2015). For instance, the nurse may take advantage of the wellness visit by new parents to educate them one their baby’s upcoming vaccinations. Or a nurse can utilize diabetes-related foot ulcer treatment sessions to review tricks and tips on how best to prevent or control high blood sugar levels. Providing the patient with accurate information while at the same time advocating for a healthy lifestyle is the primary role of PHC nurses (Ashcroft, 2015), and significantly helps the patient to gain better management and control of their health.

PART A.2: Importance of Health Promotion as a PHC Nursing Role

Study shows that policies that aim at strengthening health promotion as a nursing role in the primary care would enhance disease prevention, improve resilience, wellness, and health of the population, therefore, reducing the increased demand on and expenditure in tertiary and secondary care as well as improving economic prosperity (Australia Public Health Association, 2014). Encouraging PHC nurses to use their medical knowledge to promote health. For example, advising communities on diets, exercise, and dangers of alcohol and smoking are necessary for a healthy society. The impact of lifestyles and health behaviors on health outcomes is specific, and its cultural, environmental, and social determinants are eminent (Martinez, Bacigalupe, Cortada, Grandes, Sanchez, Pombo, & Bully 2017). For instance, the effects of tobacco smoking, alcohol, physical exercise, and diet on mortality and morbidity witnessed in our communities, and the consequent resource investment explains the mounting focus by the healthcare systems to the promotion of healthy lifestyle and the valuation of their impacts. The unhealthy behaviors and lifestyles contribute to about 40% of premature deaths and persistent disparities in health in the United States (Calderón, Balagué, Cortada& Sánchez 2011), hence the need for PHC nurses to advocate for promotion healthy lifestyles and behaviors among the population.

A survey indicates that about one in every four Americans turns to comfort eating alleviate problems or stress. About 31% of women admit that they are comfort eaters, and men are more likely than women to choose for unhealthy snacks at a fast-food restaurant (Smith, Saddleson, Homish, McKee, Kozlowski, & Giovino 2015). Comfort eaters have higher chances of experiencing health problems such as hypertension and high levels of cholesterol than the average American. Smocking and inactivity is another worrying trend—about 27% of the New York population are very anxious about their stress smoke every day. Americans who are incredibly concerned about their stress also exercise less (Smith et al., 2015). Some people also turn to alcohol to manage their stress. However, these health behaviors and lifestyles may be disastrous to health.

Primary health care nurses have many windows of opportunity to promote healthy lifestyles and behaviors in patients with effective clinical interventions. Health promotion emphasizes on holistically tackling health issues contrary to hectoring people on habits that adversely affect their health. PHC nurses are more concerned with ensuring access necessary resources to promote healthy behaviors. On many advanced levels, the nurses may also advocate for community changes to lessen resource scarcity that might obstruct health promotion. (Kemppainen, Tossavainen, & Turunen2013). The focus of the nurses’ role in health promotion has always been disease prevention and advocating for individual’s behavior change based on their health. However, responsibilities as health promoters are so complex, as they have multi-disciplinary experience and knowledge of health promotion in their nursing practice (Kemppainen, Tossavainen, & Turunen, 2013).

As general health promoters, PHC nurses use education as a promotion intervention, educating them on health behaviors and lifestyle. PHC nurses also respond to different patient groups such as the aging people or families with chronic illnesses, who have diverse health promotion demands. In promoting the health needs of these various groups, PHC nurses are considered as patient-focused health promoters. Nurses also assume the responsibility of managing health promotion projects. They supervise and lead research projects and development actions in nursing—coordinating developmental and educational interventions in communities and health care units (Whitehead 2018).

PART B: Health Promotion and Education Resource

PART B 1: General Characteristics of the Intended Consumer Group for This Resource

The communication, “Stop Smoking Start Repairing,” target adult cigarette smokers age 18 years and above. Study shows that current cigarette smoking in the U.S. is highest among adults aged 25-44 years, and lowest among adults aged 18-24 years (CDC 2020). Most people maintain that they smoke a cigarette for stress relief, others for pleasure, while the rest of the groups smoke out of a social condition such as customs and traditions. Smoking has proven to significantly affect adults, who are also the largest group of smokers. Heart diseases, lung diseases, stroke, diabetes, and chronic obstructive pulmonary disease (COPD) are prevalent in adults aged 30 years and above (Jamal et al. 2015). Sadly, this group falls under the population aged 25-44 years, which is the largest population of smokers in the U.S. (CDC 2020). Evidence-based preventive health promotion strategies are necessary to decrease tobacco use and the health burdens.

PART B 2: Intended Purpose of the Resource

This communication aims to help achieve a reduction in the rate of smoking the target American population. Tobacco smoking remains the sole major preventable cause of disease and death in the U.S. Cigarette smoking kills approximately over 480,000 Americans annually. Besides, smoking-related conditions in the U.S. cost over $300,000 every year, including about $170,000 spent on the direct medical care of adults and nearly $150 billion in lost productivity (CDC, 2020). A study conducted in 2018 indicated that an estimated 34.2 million or 13.7 of the United States adults from 18 years were current active cigarette smokers. About 74.6% of the number comprised of people who smoke daily (CDC, 2020).

PART B 3: The Suitability of Resources

“Stop Smoking Start Repairing” communication is suitable for adult smokers as it highlights the different positive effects one is likely to achieve by quitting cigarettes, both from health and economic perspective. The bold message is that “EVERY CIGARETTE YOU DON’T SMOKE IS DOING YOU GOOD.” For instance, not smoking improves your sense of taste and smell, lung function, reduces excess carbon monoxide in the bloodstream, saves over $8,300 a year, improves skin appearance, and reduces nicotine level in the body and risk of heart diseases. Besides, the risk of having a pre-term baby reduces to that of a non-smoker when one quits smoking before getting pregnant. The method used in this message is a gain-framed communication, where the emphasis is on the outcome, not the adverse effects. Prospect theory proposes that since smoking cessation is a deterrence behavior with fairly definite results, gain-framed communications seem more convincing than loss-framed messages when the aim is to promote smoking cessation (Kim & Lee 2017). People respond differently to factually or empirically equivalent messages. The response is determined by whether the message is framed to stress on the benefits (gain-framed) or costs (loss-framed) (Kim & Lee 2017). The same notion applies to health promotion messages.

PART B 4: Benefits or Challenges of the Resource In Relation To Health Promotion

Student shows that gain-framed messages have more substantial positive impacts on the intention to quit smoking compared to loss-frame messages when the emphasis is on short-term outcomes. When effectively adopted, the method translates to cigarette withdrawal and ultimately leaving. A statement such as “your taste and sense of smell improves in just one week when you stop smoking today” is likely to attempt the audience to retreat and see the short-term impact. The message seems persuasive compared to “smoking affect your task and sense of smell.” A smoker is likely to react with expressions such as “so what” for the latter.

Historically, the antismoking campaign messages have emphasized the adverse impact of not quitting (loss-frame) instead of the benefits of quitting (gain-frame). For instance, Surgeon General’s cautions on cigarette packs are characteristically loss-framed messages such as “Smoking causes lung cancer, heart disease, emphysema, and may complicate pregnancy.” The effectiveness of these communications is, however, unclear. Research evidence spanning nearly five decades lately reviewed the Surgeon General indicates that smoking damages almost every body organ resulting in a myriad of illnesses and reducing the lifespan of smokers in general. However, despite the warnings on the adverse effects of smoking, the number of smokers are still relatively higher. Cigarette smoking kills nearly over 480,000 Americans annually, according to a study by the Center for Disease Control (CDC 2020). Quitting cigarette smoking has both immediate and long-term benefits, including reduced risks for illnesses caused by smoking and improving an individual’s health in general.

Prospect theory recommends that since cigarette smoking cessation is a deterrence behavior, and the outcomes are specific, gain-framed messages are more convincing than loss-framed statements (Kim & Lee 2017). Gain-frame is beneficial when the results are precise. For instance, gain-framed communications are more valuable in encouraging prevention activities (Covey 2014), such as using beach sunscreen because the behavior generates relatively inevitable consequences, preventing skin cancer. Similarly, quitting cigarette smoking is connected to preventing health completion, such as lungs and heart diseases (Kim & Lee 2017). This explains why health promoters should begin to emphasize on gain-framed persuasive messages when trying to promote smoking cessation. The only challenge with gain-framed communication is that it focuses mostly on short-term outcomes (Kong, Cavallo, Camenga, Morean & Krishnan-Sarin, 2016). However, this might not be a problem parse with smoking cessation since quitting effectively begin by realizing short-term benefits. 

References

Ashcroft, R. (2015). Health promotion and primary health care: examining the discourse. Social work in public health, 30(2), 107-116. doi.org/10.1080/19371918.2014.938395

Australia Public Health Association, (2014). Public Health Association of Australia:

Calderón, C., Balagué, L., Cortada, J. M., & Sánchez, Á. (2011). Health promotion in primary care: how should we intervene? A qualitative study involving both physicians and patients. BMC health services research, 11(1), 62.

 CDC. (2020.) Burden of Cigarette Use in the U.S.: Current Cigarette Smoking Among U.S. Adults Aged 18 Years and Older. Center for Disease Control

Covey, J. (2014). The role of dispositional factors in moderating message framing effects. Health Psychology, 33(1), 52.

Jamal, A., Homa, D. M., O’Connor, E., Babb, S. D., Caraballo, R. S., Singh, T., … & King, B. A. (2015). Current cigarette smoking among adults—United States, 2005–2014. Morbidity and mortality weekly report, 64(44), 1233-1240.

Kemppainen, V., Tossavainen, K., & Turunen, H. (2013). Nurses’ roles in health promotion practice: an integrative review. Health Promotion International, 28(4), 490-501.

Kim, H. K., & Lee, T. K. (2017). Conditional effects of gain–loss-framed narratives among current smokers at different stages of change. Journal of Health Communication, 22(12), 990-998.

Kong, G., Cavallo, D. A., Camenga, D. R., Morean, M. E., & Krishnan-Sarin, S. (2016). Preference for gain-or loss-framed electronic cigarette prevention messages. Addictive behaviors, 62, 108-113.

Martinez, C., Bacigalupe, G., Cortada, J. M., Grandes, G., Sanchez, A., Pombo, H., & Bully, P. (2017). The implementation of health promotion in primary and community care: a qualitative analysis of the ‘Prescribe Vida Saludable’strategy. BMC family practice, 18(1), 23.

McManus, A. (2013). Health promotion innovation in primary health care. The Australasian medical journal, 6(1), 15. doi: 10.4066/AMJ.2013.1578

Policy-at-a-glance – Primary Health Care Policy. https://www.phaa.net.au/documents/item/266

Smith, P. H., Saddleson, M. L., Homish, G. G., McKee, S. A., Kozlowski, L. T., & Giovino, G. A. (2015). The relationship between childhood physical and emotional abuse and smoking cessation among US women and men. Psychology of Addictive Behaviors, 29(2), 338.

Whitehead, D. (2018). Exploring health promotion and health education in nursing. Nursing Standard, 33(8).