Community Focused Nursing

Winter 2023

Community Focused Nursing

Health Promotion Models and Primary Health Care
Class 3 Study guide by Eliz B.
Overview:
“Health promotion is a complex social and political process that has been the focus of
much international discussion over the last few decades; however many of the large-scale
potential benefits of health promotion have yet to be realized” (Lind, Lind-Kosten,&
Loewen, 2015, p. 135).
The Ottawa Charter (WHO, 1986) defines health as an action or with a sense
of movement over time with the words “to reach a state of complete physical, mental, and
social wellbeing, an individual or group must be able to identify and to realize
aspirations, to satisfy needs, and to change or cope with the environment” (Stanhope,
Lancaster, Jakubec & Pike-MacDonald, 2017, p.100). The WHO describes health as a
“resource for everyday living” (ibid). So, if health is a resource, as nurses we want to
promote and enable people on their health journey. The purpose of this class is to
explore health promotion as an important concept under the broader health umbrella of
primary health care for nurses working in community health.

10 Objectives for this Class:

1) Define and describe the concepts of health and health promotion
2) Review the differences between upstream and downstream approaches to
addressing health issues in a population.
3) Explain the significance of the Ottawa Charter, and identify key issues from other
charters for health promotion.
4) Understand the strategies and methods used in population health promotion.
5) Define social marketing and discuss the “four Ps” of marketing.
6) Identify social justice issues in the context of “at risk” populations.
7) Discuss nursing interventions that exemplify five levels of prevention.
8) Explore the harm reduction philosophy and the role of the community health
nurse when working in harm reduction.
9) Understand the importance of research, activism, and advocacy in health
promotion practice.
10) Describe community development and capacity building.

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1. Define and describe the concepts of health and health promotion

Health: A dynamic process with multiple assumptions and understandings that evolve
over time and evolve with varying professional perspectives and purpose.
Health promotion: The process of enabling people to increase control over, and to
improve, their health.
A key component of health promotion is the concept of empowerment

2. Review the differences between upstream and downstream approaches to

addressing health issues in a population.
Upstream approaches are
a. often prevention and promotion strategies focused on policy interventions that benefit
the whole population
b. extend beyond addressing individual behaviours and identify programs, policies, and
environmental changes
PHC interventions that focus on people’s well-being by addressing and taking action on
the root causes of preventable diseases and injuries.
Downstream approaches
• Acute care services are usually tertiary prevention measures, are focused on
individual treatment and cure, and are considered downstream interventions.
• Downstream approaches, on the other hand, focus on treating existing health
problems. This approach typically involves providing medical care and treatment for
individuals who are already ill, and may include access to hospitals, medications,
and specialist services.
3. Explain the significance of the Ottawa Charter, and identify key issues from
other charters for health promotion.

The Ottawa Charter for Health Promotion is a landmark document that was adopted by
the World Health Organization (WHO) in 1986. It outlines the key principles and action
areas for promoting health and well-being, and is widely considered to be the foundation
of the modern health promotion movement.

4. Understand the strategies and methods used in population health promotion

Population health promotion: is a process of taking action on the interrelated
conditions that affect a population’s health, to create healthy change.

• Builds trusting relationships and rapport, builds personal confidence and skills
through valuing clients’ expertise and knowledge
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• Engages in empowering educational strategies, connecting to broader social

networks, and tapping into clients’ strengths

The PHPM incorporates a number of values and assumptions:

• Comprehensive action needs to be taken on all the determinants of health
• Multiple entry points for planning and implementing are essential
• Health problems may affect some groups more than others
• Solutions to problems involve changing social values and structures
• Meaningful participation of community members is needed

5. Define social marketing and discuss the “four Ps” of marketing.

Purpose: Use of marketing principles and techniques to advance a social cause, idea,
or behaviour to promote changes in social behaviours.
The goal of social marketing is to encourage health-promoting behaviours, or to
eliminate or significantly reduce behaviours that negatively impact a population’s
health.
discuss the “four Ps” of marketing: page 158 of textbook defines….
a) Product: being sold is an idea or behaviour related to better health
b) Price: refers to the cost to the target audience, for example: the price of
quitting alcohol or tobacco use may be incurring withdrawal symptoms, loss
of comfortable coping strategy.
c) Place: The right time and place refers to considering the timing for and
means by which , the social product is delivered to the target audience.
d) Promotion: The right promotion refers to the means by which the product is
promoted or advertised to the audience. Example: action may be phone
number to call, a website to visit, or a product to purchase.

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6. Identify social justice issues in the context of “at risk” populations.

The underlying values of Primary Health Care (PHC) are social justice and equity.
There are five principles of PHC: (page 138 of textbook)
1. accessibility: healthcare is universally available to all people regardless of geographic
communityand is delivered in timely manner.
2. public participation: means people are actively encouraged to participate in making
decisions about their own health and in identifying the health needs of their community
3. health promotion
4. appropriate technology: means that appropriate modes of care are available based on
society’s social, economic, and cultural development
5. intersectoral collaboratio: Everyone will participate in gov’t policy formation that impacts
the health and well-being of people in their society.
7. Discuss nursing interventions that exemplify five levels of prevention.
a) Levels of prevention 1: Primary
This level of prevention aims to prevent the onset of disease and promote health and
well-being in populations.
Promotes health through an upstream approach using the dientification of potential risk
factors and the mobilization of policy and public awareness to avoid injury or illness.
Some nursing interventions at this level include promoting the use of seatbelts,
advocating smoke-free public spaces, public education to help stop the spread of STIs in
all age group.

b) Levels of prevention 2: Secondary (reference page 152 of textbook)

This level of prevention aims to detect and treat health problems at an early stage, before
they become more serious. Examples of secondary prevention interventions in nursing
include screening programs, health assessments, and early detection and treatment of
health problems. Other examples are: screening measures such as examining skin for

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signs of melanoma, blood tests for diabetes, testicular self-exam, yearly cholesterol tests
and colonoscopies.

c) Levels of prevention 3: Tertiary

This level of prevention aims to manage and treat existing health problems and reduce the
impact of disease and disability. Examples of tertiary prevention interventions in nursing
include rehabilitation, chronic care management, and palliative care.

d) Levels of prevention 4: Quaternary

This level of prevention aims to prevent overdiagnosis, overtreatment, and unnecessary
harm from medical interventions. Examples of quaternary prevention interventions in
nursing include shared decision-making, evidence-based practice, and reducing
unnecessary tests and treatments.
Axelle’s PowerPoint explains that:
Quaternary prevention identifies people who may be at risk for medical mishaps and
addresses patient safety and necessity of evidence-informed decision making
In quaternary prevention the focus shifts to ethical practices
My understanding (lol): refers to preventing unnecessary harm from medical treatments.

e) Health promotion
This level of prevention aims to create conditions that enable individuals and populations
to achieve their full health potential. Examples of health promotion interventions in
nursing include health education and literacy programs, community-based interventions,
and creating supportive environments.
Another example: Tobacco Control and Prevention: Programs that aim to prevent and
reduce tobacco use and exposure to second-hand smoke, such as smoking cessation
programs and public education campaigns. Physical Activity Promotion: Programs that
encourage regular physical activity, such as sports and fitness programs, and initiatives to
create safe and accessible public spaces for physical activity.

8. Explore the harm reduction philosophy and the role of the community health
nurse when working in harm reduction.

1. Harm reduction focuses on protecting the health of, and reduce secondary harm
for, individuals who engage in high-risk activities associated with poor health
outcomes.
2. Goal: to reduce the more immediate and related harms arising from engaging in
that behaviour.
3. Strategies seek to address health inequities and bring meaningful health care to
individuals who might otherwise be marginalized by some health care providers.
4. Goal of care is to protect health by reducing harm while recognizing complexity
of social issues.

In the context of community health nursing, the role of the nurse is to work with
individuals and communities to implement harm reduction strategies and support
individuals in reducing the harm associated with high-risk behaviors.

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Examples of harm reduction strategies that a community health nurse might support
include:
a. Needle and syringe exchange programs: to reduce the spread of blood-borne
infections among individuals who inject drugs.
b. Overdose prevention and response: to reduce the harm and prevent deaths associated
with drug overdoses.
c. Harm reduction-based substance use treatment: to support individuals with
substance use disorders in reducing the harm associated with their substance use.
d. Sexually transmitted infection prevention: to reduce the spread of sexually
transmitted infections and promote safer sexual practices.
e. Harm reduction-based mental health support: to support individuals with mental
health disorders in reducing the harm associated with their mental health issues.

9. Understand the importance of research, activism, and advocacy in health

promotion practice.
Activism as a public health intervention has been used to:
• Effect change for the people living in poverty;
• Changes for child labour;
• Fight for women’s right to vote; and
• Distribute birth control information to women
It’s important for research and action to seek partnership with and promote the health
of individuals and communities.
• Advocacy is a social justice issue and a mandatory component of public health
and community nursing practice.
• Nursing practice within communities will create more opportunities for nursing
practice focused on health promotion and different forms of advocacy and
activism.

10. Describe community development and capacity building.

 Community development and capacity building are interrelated concepts that aim to
empower individuals, groups, and communities to take control of their own lives,
and to address the issues and challenges that affect them.
 Community development is a process that involves working with communities to
identify their strengths, assets, and needs, and to mobilize the resources and support
needed to address them. The goal of community development is to create a more
equitable and sustainable future for the community, by empowering individuals and
groups to work together to create change.

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