By Megan M. Krischke, contributor
June 25, 2010 - Health care reform legislation and the rising number of Americans with chronic conditions have made “preventive care” a buzz word in health care circles. Not only is there a growing need for nurses to provide preventive care to patients and communities, but nurses’ training, and often their skill sets and strengths, make them well-equipped to provide this kind of care.
Suzanne Hughes, RN, MSN, director of health education and nursing research at Robinson Memorial Hospital, has spent most of her 36 years as a nurse in cardiology. She sees a number of growing opportunities for nurses in preventive medicine.
According to Suzanne Hughes, RN, MSN, director of health education and nursing research at Robinson Memorial Hospital in northeastern Ohio and board member of the Preventive Cardiovascular Nurses Association (PCNA), there are three levels of preventive care.
The first level is primary prevention, which works to prevent the risk factors for disease through programs like educating school children about the dangers of tobacco use and what constitutes a healthy balanced diet. The second level of prevention is to identify people with risk factors through screenings and routine care and work with them to reduce their risk factors and prevent the onset of disease. The final level of prevention is working to prevent further deterioration after someone already has a disease; for instance sending someone to cardiac rehabilitation after a heart attack.
“Usually the first two levels happen in the public health arena, but could also be addressed in the clinical setting. I think we often miss opportunities for embedding prevention in the current clinical context,” Hughes stated. “Say someone goes to their primary care provider because of a sore throat and gets their blood pressure taken. If the blood pressure level is high, the provider should take the opportunity to talk to the patient about reducing their sodium intake and watching their weight”
“Or, while a patient is the office for acute care,” she continued, “the provider could also review their chart and recommend scheduling age-appropriate screenings such as a mammogram or colonoscopy. Acute care visits can create a wonderful opportunity to provide preventive care.”
“Most of the conditions we are trying to prevent--heart problems, cancers, diabetes--require lifestyle changes, and it is very time-intensive to help people make those changes,” Hughes explained. “These patients don’t just need education, they need behavior change strategies and they need someone to talk with them to help them discover what changes they are willing and able to make.”
“Nurses, by virtue of their education, background and training are skilled at this sort of patient-centered approach,” she said. “Additionally, it is less expensive for a nurse, than a physician, to spend 45 minutes with a patient to help them with stress reduction, exercise plans and food choices.”
When nurse practitioners (NPs) are allowed to practice up to the level of their training, making certain diagnoses and prescribing a variety of medicines, they can serve as excellent primary care providers.
“Presently there are at least 28 state legislatures that are contemplating expanding the role of the NP, which presents an excellent opportunity for the intrepid RN interested in seeking out the additional education and licensing requirements necessary to become an NP,” stated Geneviève M. Clavreul RN, Ph.D., a health care management consultant, in her article, “What Health Care Reform Means for Nurses.”
“Many people say they would prefer to see a NP, than a physician, for their ongoing care.” Clavreul added in a phone interview. “Nurses should be filling the gap in chronic care because they offer more personalized care and are skilled in case management.”
“The reform legislation is creating many different preventive care opportunities for nurses as it looks to expand primary care and creates additional training slots for advance practice nurses. In fact, $15 million has been designated to create nurse-managed care centers,” said Mary Joan Ladden, RN, Ph.D., senior program officer on the human capital team at the Robert Wood Johnson Foundation. “As legislators look to expand access to primary care, they will need more providers and there will be more focus on preventive care and working to keep people out of acute care.”
“The majority of preventive care job opportunities are in ambulatory care, in community health centers, in retail clinics and in schools,” Ladden added. “Nurses who want to work in preventive care might have to hunt farther, but they are incredibly rewarding jobs. A couple areas you might not think of right away are working for health insurers as case managers or for large employers overseeing an employee health program.”
“If you want to make a big impact in preventive care, work with women in their childbearing years,” advised Hughes. “A lot of women use their OB/GYN or nurse midwife as their primary care provider. Women are known to make health care decisions for the whole family. So if you impact the woman, you have the opportunity to impact her children and spouse as well.”
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