Nurses in preventive care identify risk factors and strive to detect disease in the early stages to prevent the spread or worsening of symptoms and in conjunction with other medical professionals, help maintain the good health and quality of life for all individuals.2
Registered Nurses are becoming the nexus of community patient care. Nurse competencies constitute significant potential in the area of preventive care as well as the more traditional roles in treatment and recovery. While Nurses often provide Senior Care, In Home Care and Long Term Care, they also are also the sources of education for all ages to help prevent disease and promote overall wellness.
Specialty trained Registered Nurses work to prevent risk factors for disease through patient education, giving instructions in such areas as:
- Healthy diets
- Immunizations, and
- Lifestyle conditions
Preventive Care Levels
Preventative care encompasses a wide range of techniques to identify, educate, prevent and treat diseases in populations. There are three types of prevention that nurses take part in on a regular basis depending on their position in health care facilities or organizations:7
A. Primary Prevention
The U.S. Preventative Services Task Force (USPSTF) describes primary prevention as the measures taken to provide individuals with knowledge to prevent the onset of a targeted condition. In this type of prevention, nurses play the part of educators that offer information and counseling to communities and populations that encourage positive health behaviors. From providing immunizations to reinforcing the use of seat belts, programs are designed to avoid suffering and illness in patients, as well as avoid any type of cost supplementary to disease treatment. Primary prevention is typically the most economical method of health care, as it attempts to eliminate the potential of health issue before it can start.
B. Secondary Prevention
Secondary prevention, a form of early disease detection, identifies individuals with high risk factors or preclinical diseases through screenings and regular care to prevent the onset of disease. Once identified, nurses work with these patients to reduce and manage controllable risks, modifying the individuals’ lifestyle choices and using early detection methods to catch diseases in their beginning stages when treatment may be more effective. Regular screenings, conducted by a preventative health care nurse, are the most common method of secondary prevention and can dramatically diminish the development of certain illnesses.
C. Tertiary Prevention
The third tier of prevention, tertiary prevention, is slightly different. This method involves the treatment of existing diseases in patients. At this point of care, nurses are tasked with helping individuals execute a care plan and make any additional behavior modifications necessary to improve conditions. As the primary and secondary methods have been unsuccessful, this stage encompasses methods of minimizing negative effects and preventing future complications.
Impact of the Affordable Care Act
Originally conceived as a method to serve largely disadvantaged populations, Federally Qualified Health Centers, with the primary financial support of Medicaid, initially developed Preventive Care Nursing for the reduction of preventable health issues. The passage of the Affordable Care Act (ACA) brought Preventive Care on the national forefront, expanding support for community health centers through grants for capital improvements and expanded preventive and primary care services.3 More importantly, the ACA also provides grants or contracts for care coordination services provided by community health teams that work with primary care practices to integrate clinical and community preventive and health promotion services and offer health coaching and support for medication management across all demographics.4 The ACA recognizes and supports the increased usage of preventive care of newly health insured individuals, and supports the initial increase of the patients doctor’s visits, management of disease, screenings and other preventive practices, and use of prescribed medications required for the patient’s well-being.5,6
Barriers to Improving Preventive Care Measures
Nurses working hard to perform Preventive Care measures for patients and their communities at times run into barriers on three levels:8
- System Level
- Registered Nurse Level
- Patient Level
System barriers include clinical delivery systems organized better to respond to acute care needs than to proactively address prevention, the underuse of multidisciplinary teams to include health promotion specialists or the lack of standing orders for nurses to deliver routine immunizations and screening, and the inadequate use of health information technology.
Registered Nurse barriers include competing demands in primary care settings; the lack of time and resources, which is hampered by inadequate reimbursement for counseling services; and the lack of clinical decision support tools and automatic reminders that could help ensure patients are receiving the right care at the right time.
Patient barriers are substantial and can include lack of knowledge regarding what preventive services are appropriate for themselves and family, lack of access to health care, lack of community and family support for healthy living habits, and inadequate health literacy that interferes with shared decision making with their NP. All these areas are potential foci for research.9
Benefits of Preventive Care
Significant cost savings and increased wellness, being led primarily by preventive care education provided by Registered Nurses include:
- People who increased physical activity (2½ hours a week) and had 5 to 7 percent weight loss reduced their risk of developing type 2 diabetes by 58 percent regardless of race, ethnicity, or gender.10
- Annual health care costs are $2,000 higher for smokers, $1,400 higher for people who are obese, and $6,600 higher for those who have diabetes than for nonsmokers, people who are not obese, or people do not have diabetes.11
- A 1% reduction in weight, blood pressure, glucose, and cholesterol risk factors would save $83 to $103 annually in medical costs per person.12
- Increasing use of preventive services, including tobacco cessation screening, alcohol abuse screening and aspirin use, to 90 percent of the recommended levels could save $3.7 billion annually in medical costs.13
- Medical costs are reduced by approximately $3.27 for every dollar spent on workplace wellness programs, according to a recent study.14
These are but a few examples of the power of successful implementation of preventive care that can be administered by the Registered Nurse, in numerous environments. These cost savings will not only allow individuals to live longer, but save money on the ever-increasing costs of healthcare to the U.S. population.
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1Tothova, V., et al, “The nurse’s role in preventive care in the field of community nursing,” Neuroloendocrinolology Letters, 2014;35 Supplement, 1:26-33.
2 “What is a Nurse’s Role in Curative, Preventive, Rehabilitative, and Palliative Care?” Health Science Degree Guide, 2016.
3Health Resources and Service Administration (HRSA) Bureau of Primary Health Care, U.S. Department of Health and Human Services. The Affordable Care Act and Health Centers. Washington, DC.
4Thomas, Veronica.“What works in care coordination? Activities to Reduce Spending in Medicare Fee-for-Service.” Academy Health, Research Insights. June 2, 2012.
5 Spetz, Joanne. “Health reform and the health care workforce.” Baker Institute Policy Report. No. 12. James A Baker III Institute for Public Policy of Rice University, March 2012.
6 Buchmeuller, Thomas C., Kevin Grumbach, Richard Kronick, & James G. Kahn. “The effect of health insurance on medical care utilization and implications for insurance expansion: A review of the literature.” Medical Care Research and Review, 2005, Vol 62, No. 1.
7“The Role of the Nurse in Preventative Health Care,” Benedictine University, 2016
8 Whitlock, E.P., Orleans, C.T., Pender, N., & Allan, J., “Evaluating primary care behavioral counseling interventions: An evidence-based approach,” American Journal of Preventive Medicine, 2002, Volume 22, Number 4, 267-284.
9 Woolf, S.H., Glascow, E.E., Krist, A., Bartz, C., Flocke, S.A., Holtrop, J.S., et al., “Putting it together: Finding success in behavior change through integration of services,” Annals of Family Medicine, 2005, Volume 3(Supplement 2), S20-S27.
10 “Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin,” New England Journal of Medicine, 2002;346:393-403.
11 Solberg LI, Maciosek MV, Edwards NM, Khanchandani HS, Goodman MJ. “Repeated tobacco-use screening and intervention in clinical practice: health impact and cost effectiveness,” American Journal of Preventive Medicine, 2006; 31(1):62-71.
12 Henke RM, Carls GS, Short ME, Pei X, Wang S, Moley S, Sullivan M, Goetzel RZ., “The Relationship between Health Risks and Health and Productivity Costs Among Employees at Pepsi Bottling Group,” Journal of Occupational & Environmental Medicine, 2010;52(5): 519-527.
13 Maciosek MV, Coffield AB, Flottemesch TJ, Edwards NM, Solberg LI., “Greater Use of Preventive Services in U.S. Health Care Could Save Lives At Little Or No Cost,” Health Affairs, 2010;29(9):1656-60.
14 Baicker K, Cutler D, Song Z., “Workplace Wellness Programs Can Generate Savings,” Health Affairs, 2010;29 (2):304-311.