Nurses and Health Promotion

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Health promotion at all levels has become a major concern or patients and healthcare professionals alike.  The general population has never before had more access to health promotion information than they do right now thanks to the internet, and that easy access has both positive and negative effects on the responsibilities of doctors and nurses.  A clear and accurate understanding of what health promotion entails at the three different levels is necessary for nurses, as the primary point of contact for most patients in a professional healthcare environment, so they can provide an authoritative and beneficial service to patients.  Specific examples of the different levels of health promotion can be used to demonstrate the ways that nurses have become even more integral to the healthcare process.

In general, health promotion is about improving and managing the health of individuals.  It operates at three levels: primary, secondary, and tertiary.  Primary health promotion is entirely preventative, concerned with improving on good health and avoiding illness or injury.  Secondary health promotion is concerned with immediate response to illness or injury to limit its effects on the patient and hopefully speed healing.  Tertiary health promotion is an inevitable third stage in which a chronic or long-term health problem is managed as much as possible in an effort to improve the patient’s comfort and quality of life.

Unlike direct healthcare, health promotion is considered preventative as much as responsive.  It is largely about education and patient participation.  Ideally, health promotion begins with healthcare professionals, as authorities on the subject, and is then taken home by individuals who can apply it in their daily lives to avoid and minimize their need for direct healthcare.  A focus on health promotion means that the role of nurses is more important than ever since they are in the best position to educate patients about health promotion at whatever level is most applicable.  This has made it the responsibility of nurses to become as educated as possible about the preventative methods that are relevant to as many different conditions as possible.  Nurses must also know how to learn about health promotion methods when they do not already know what is called for.  Finally, they have to be an expert in communicating this information to their patients.

The best way to demonstrate the different levels of health promotion in action is with specific examples.  As an example of primary health promotion, the article “Evidence-based suicide prevention screening in schools” demonstrates how health promotion can be applied to psychological issues as well as physical ones.  Since youth suicide has increased over 300 percent in the last 60 years, it is clearly a major health concern (Joe & Bryant, 2007, p. 219).  It is also safe to classify as a matter for primary health promotion since its absolute prevention is the primary goal.  An argument could be made that secondary or even tertiary health promotion could be aimed at youths who have attempted suicide or have done so repeatedly, but the emphasis of this article is on identifying first-time at-risk youths.  The article focuses on the role of social workers in identifying and preventing suicide risks in teens and children.  Its claim is that “given the appropriate training, time, and financial resources, [social workers] could be instrumental in the implementation of screening and preventive education programs” (Joe & Bryant, 2007, p. 226).  While this is certainly true, the question becomes, who will provide that training?  It is here that the role of nurses comes in.  Nurses with psychiatric training are already familiar with the warning signs that the article suggests social workers need to be trained in, so they are a natural source of information in implementing this example of primary health promotion since they are also trained in the practical application of what medical or psychiatric doctors might only understand in theory.

For secondary health promotion, one of the most common health concerns in modern times, cancer, serves as a good example.  The article, “Awareness and impact of education on breast self-examination among college going girls” discusses the importance of detecting and treating breast cancer as quickly as possible, as is the case with any cancer.  This article is particularly suited to a discussion of health promotion because it focuses on not only educating potential patients but also on how they can disseminate that education among their families and friends (Shalini. Varghese, & Nayak, 2011, p. 150).  Since one of the major goals of health promotion is the spread of positive health information and practices, this article is a natural example of health promotion.  And much like the case of the social workers, the target individuals in this example need to be educated by someone.  While nurses are of course capable of assisting in and even performing breast exams, this particular case of secondary health promotion aimed at rapidly diagnosing and then responding to an existing condition without direct healthcare, if necessary, requires nurses to go beyond simply applying their knowledge.  In order to implement this kind of secondary health promotion, nurses have to teach individuals how to properly perform examinations and educate them when to seek professional diagnosis or treatment.

The third level, tertiary health promotion, is perhaps one of the most challenging for nurses and patients alike.  Improper implementation of tertiary health promotion could have serious consequences, especially if a patient is not properly educated regarding the severity of their condition.  The article “Patient education for the prevention of diabetic foot ulcers” discusses a common condition that would clearly benefit from an application of tertiary health promotion.  As the article states, “Self-care is fundamental in diabetes management and prevention and existing state the need for patient education as a prerequisite to prevent ulceration” (Gershater, Pilhammar, Apelqvist, & Alm-Roijer, 2011, p. 102).  For the most part, diabetes is not a critical condition and so it is likely to be difficult to attract the attention of a doctor.  But nurses are trained to deal with patients who have questions and relatively minor needs like might arise with diabetes.  Because of this, they are perfectly positioned to educate diabetics about tertiary health promotion.  It is already the responsibility of diabetics to learn how to care for themselves; but since the stakes are so high, it also becomes the responsibility of nurses to determine when patients are improperly educated or simply not taking the correct preventative steps to manage their condition.  This is an example of how tertiary health promotion is some of the most urgent work a nurse can do since it is likely the only thing standing between a relatively healthy individual and a serious medical crisis.

For the most part, the implementation of health promotion at all levels for nurses is simply a matter of education.  They are trained in these methods and are often in direct contact with patients, so they are ideally placed to pass on that education.  Nurse training also tends to focus on the practical application of medical science, which is all the patients need to know for their own preventative and management needs.  Finally, it is the responsibility of nurses to identify faulty practices that may come from improper education or simple laziness.  The role of nurses in health promotion is as the point of contact between the healthcare profession and everyday citizens.  Their responsibility is perhaps the greatest in determining and applying the different levels of health promotion to particular situations.  If properly implemented, health promotion may be one of the greatest weapons a nurse has in the future against the majority of medical problems.


Gershater, M. A., Pilhammar, E., Apelqvist, J., & Alm-Roijer, C. (2011). Patient education for the prevention of diabetic foot ulcers. Eur Diabetes Nursing, 8(3), 102-107.

Joe, S., & Bryant, H. (2007). Evidence-based suicide prevention screening in schools. Children & Schools, 29(4), 219-227.

Shalini., Varghese, D., & Nayak, M. (2011). Awareness and impact of education on breast self-examination among college going girls. Indian Journal of Palliative Care, 17(2), 150-154.