This case study provides you with an opportunity to immerse yourself in the role of a Community Health Nurse and examine primary, secondary, or tertiary prevention strategies related to two population health problems. As you work through the case, reflect on what you have learned from this course about community health nursing and apply it to this scenario.
Your role: You continue to work as a community health nurse in your local health department. At a department meeting several months ago, new epidemiological data was presented that showed a disturbing increase in alcohol abuse rates. A community wide coalition was convened to assess these problems and you volunteered to be a member of this task force. The task force has met several times and analyzed assessment data and is beginning to consider intervention options.
Task force members:
• Christina is a social worker with the health department.
• Tracey is a case worker from Child Protection Services.
• Paul is a pastor at a local church.
• Susan is the school nurse with the elementary and middle schools.
• Eric is the director of a local emergency department.
Visit The Community Guide website (https://www.thecommunityguide.org/) to explore interventions related to excess alcohol consumption. https://www.thecommunityguide.org/alcohol/index.html
Choose one evidence-based intervention (one that is recommended) and present this intervention to the task force.
• Summarize this intervention and the Community Health Nurse’s role in implementing this strategy.
• Describe whether it (evidence-based intervention) is considered a primary, secondary, or tertiary prevention strategy and include your rationale (see Nies & McEwen, 2015, Chapter 1, p. 7 for a review of levels of prevention).
Nies & McEwen, 2015, CHAPTER 1 PAGE 7 EXCERPT BELOW:
Leavell and Clark (1958) identified three levels of prevention commonly described in nursing practice: primary prevention, secondary prevention, and tertiary prevention.
Primary prevention relates to activities directed at preventing a problem before it occurs by altering susceptibility or reducing exposure for susceptible individuals. Primary prevention consists of two elements: general health promotion and specific protection. Health promotion efforts enhance resiliency and protective factors and target essentially well populations. Examples include promotion of good nutrition, provision of adequate shelter, and encouraging regular exercise. Specific protection efforts reduce or eliminate risk factors and include such measures as immunization and water purification (Keller et al, 2004a, McEwen and Pullis, 2009).
Secondary prevention refers to early detection and prompt intervention during the period of early disease pathogenesis. Secondary prevention is implemented after a problem has begun but before signs and symptoms appear and targets those populations that have risk factors (Keller et al, 2004a).
Mammography, blood pressure screening, scoliosis screening, and Papanicolaou smears are examples of secondary prevention.
Tertiary prevention targets populations that have experienced disease or injury and focuses on limitation of disability and rehabilitation. Aims of tertiary prevention are to keep health problems from getting worse, to reduce the effects of disease and injury, and to restore individuals to their optimal level of functioning (Keller et al, 2004b, McEwen and Pullis, 2009). Examples include teaching how to perform insulin injections and disease management to a patient with diabetes, referral of a patient with spinal cord injury for occupational and physical therapy, and leading a support group for grieving parents.
Much of community health nursing practice is directed toward preventing the progression of disease at the earliest period or phase feasible using the appropriate level(s) of prevention. For example, when applying “levels of prevention” to a client with HIV/AIDS, a nurse might perform the following interventions:
•Educate students on the practice of sexual abstinence or “safer sex” by using barrier methods (primary prevention)
•Encourage testing and counseling for clients with known exposure or who are in high-risk groups; provide referrals for follow-up for clients who test positive for HIV (secondary prevention)
•Provide education on management of HIV infection, advocacy, case management, and other interventions for those who are HIV positive (tertiary prevention) (McEwen and Pullis, 2009).
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