Levels of Care: Submitted By: Juliene Hannah V. Flores

Levels of Care
St. Dominic Savio College
S.Y. 2018-2019
1st Semester
NCM 101
Submitted by: Juliene Hannah V. Flores

OVERVIEW:
I. Health Promotion
II. Disease Prevention
III. Health Maintenance
IV. Curative Care
V. Rehabilitative Care
I. HEALTH PROMOTION
 Health promotion is an important component of nursing practice.
 It is a way of thinking that revolves around a philosophy of wholeness,

wellness, and well-being.
 Assessing and planning health care of the individual client is enhanced when
the nurse understands the concepts of individuality, holism, homeostasis, and
human needs.
Levels of Care: Health Promotion

INDIVIDUAL HEALTH
 Dimensions of individuality include the person’s total character, self-dentity,

and perceptions.
 Total character = behaviors, emotional state, attitudes, values, motives,

abilities, habits, and appearances.
 Self-identity = perception of self as a separate and distinct entity alone and

in interactions with others.
 Perceptions = the way the person interprets the environment or situation,

directly affecting how he or she thinks, feels, and acts in any given situation.

Concept of Individuality
 Clients are individuals who are different from every other human being, with a
different combination of genetics, life experiences, and environmental
interactions.
 Nurses need to focus on the client within both a total care and an individualized
care context.
 In the total care context, the nurse considers all the principles and areas that
apply when taking care of any client of that age and condition.
 In the individualized care context, the nurse becomes acquainted with the client
as an individual, using the total care principles that apply to this person at this
time.

Concept of Holism
 Nurses are concerned with the individual as a whole, complete, or holistic

person, not as an assembly of parts and processes.
 Holism emphasizes that nurses must keep the whole person in mind and strive
to understand how one area of concern relates to the whole person. The
nurse must also consider the relationship of the individual to the external
environment and to others.

Concept of Homeostasis
 It is the tendency of the body to maintain a state of balance or equilibrium

while continually changing.
 Two kinds of homeostasis:
Physiological Homeostasis & Psychological Homeostasis

PHYSIOLOGICAL HOMEOSTASIS
 Physiological homeostasis means that the internal environment of the body is

relatively stable and constant. All cells of the body require a relatively
constant environment to function; thus the body’s internal environment must
be maintained within narrow limits.

Homeostatic mechanisms have four main
characteristics:
1. They are self-regulating.
2. They are compensatory.
3. They tend to be regulated by negative feedback systems.
4. They may require several feedback mechanisms to correct only one physiological imbalance.

Self-regulation
 means that homeostatic mechanisms come into play automatically in the

healthy person. However, if a person is ill, or if an organ such as a lung is
injured, the homeostatic mechanisms may not be able to respond to the
stimulus as they would normally.

Compensatory
 Homeostatic mechanisms are compensatory (counterbalancing) because they

tend to counteract conditions that are abnormal for the person.
 An example is a sudden drop in air temperature. The compensatory

mechanisms are that the peripheral blood vessels constrict, thereby diverting
most of the blood internally, and increased muscular activity and shivering
occur to create heat. Through these mechanisms the body temperature
remains stable despite the cold.

System
 Homeostasis occurs within the physiological system, a set of interacting

identifiable parts or components.
 The fundamental components of a system are matter, energy, and

communication. Without any one of these, a system does not exist.
 The individual is a human system with matter (the body), energy (chemical or
thermal), and communication (e.g., the nervous system). The boundary of a
system, such as the skin in the human system, is a real or imaginary line

Two general types of systems
 These are : closed and open systems.
 A closed system does not exchange energy, matter, or information with its
environment; it receives no input from the environment and gives no output to the
environment.
 In an open system, energy, matter, and information move into and out of the
system through the system’s boundary.
 All living systems, such as plants, animals, people, families, and communities, are
open systems, because their survival depends on a continuous exchange of energy.
They are, therefore, in a constant state of change.

Open System
 An open system depends on the quality and quantity of its input, output, and
feedback.
 Input consists of information, material, or energy that enters the system.

After the input is absorbed by the system, it is processed in a way useful to
the system. This transformation is called throughput. For example, food is
input to the digestive system; it is digested (throughput) so that it can be
used by the body.

Open System (cont’d)
 Output from a system is energy, matter, or information given out by the

system as a result of its processes. Output from the digestive system includes
caloric energy, nutrients, urine, and feces.
 Feedback is the mechanism by which some of the output of a system is

returned to the system as input.

Feedback
 Feedback enables a system to regulate itself by redirecting the output back into the system, thus forming a feedback loop.
 This input influences the behavior of the system and its future output.
Negative feedback inhibits change; positive feedback stimulates change.

PSYCHOLOGICAL HOMEOSTASIS
 It refers to emotional or psychological balance or a state of mental well-

being.
 Each person has certain psychological needs, such as the need for love,
security, and self-esteem, which must be met to maintain psychological
homeostasis.
 When one or more of these needs is not met or is threatened, certain coping
mechanisms are activated to protect the person and provide psychological
homeostasis.

Prerequisites for a person to develop
psychological homeostasis:
 A stable physical environment in which the person feels safe and secure. For example, the
basic needs for food, shelter, and clothing must be met consistently from birth onward.
 A stable psychological environment from infancy onward, so that feelings of trust and love
develop. Growing children and adolescents need kind but firm and consistent discipline,
encouragement, and support to be their own unique selves.

Prerequisites for a person to develop
psychological homeostasis: (cont’d)
 A social environment that includes adults who are healthy role models. Children learn the
customs and values of society from these individuals.
 A life experience that provides satisfactions. Throughout life, people encounter many
frustrations. People deal with these better if enough satisfying experiences have occurred to
counterbalance the frustrating ones.

Assessing the Health of Individuals
 A thorough assessment of an individual’s health status is basic to health promotion.
 Components of this assessment are:
 Health history
 Physical examination
 Physical fitness assessment
 Lifestyle assessment
 Health risk appraisal
 Health beliefs review
 Life-stress review
APPLYING THEORETICAL FRAMEWORKS
 A variety of theoretical frameworks provide the nurse with a holistic overview of health
promotion for the individual and families across the life span.
 Two major theoretical frameworks that nurses use in promoting the health of the individual are:
needs theories and developmental stage theories.

Needs Theories
 In needs theories, human needs are ranked on an ascending scale according to how essential the
needs are for survival. Abraham Maslow (1970), perhaps the most renowned needs theorist,
ranks human needs on five levels

Maslow’s 5 level of human needs:
1. Physiological needs. Needs such as air, food, water, shelter, rest, sleep, activity, and
temperature maintenance are crucial for survival.
2. Safety and security needs. The need for safety has both physical and psychological aspects.
The person needs to feel safe, both in the physical environment and in relationships.
3. Love and belonging needs. The third level of needs includes giving and receiving affection,
attaining a place in a group, and maintaining the feeling of belonging.
4. Self-esteem needs. The individual needs both self-esteem (i.e., feelings of independence,
competence, and self-respect) and esteem from others (i.e., recognition, respect, and
appreciation).
5. Self-actualization. When the need for self-esteem is satisfied, the individual strives for self-
actualization, the innate need to develop one’s maximum potential and realize one’s abilities
and qualities. Levels of Care: Health Promotion
Developmental Stage Theories
 These theories categorize a person’s behaviors or tasks into approximate age ranges or in terms
that describe the features of an age group. The age ranges of the stages do not take into
account individual differences; however, the categories do describe characteristics associated
with the majority of individuals at periods when distinctive developmental changes occur and
with the specific tasks that must be accomplished.
 The nurse’s knowledge of developmental stage theories can be used in parental and client
education, counseling, and anticipatory guidance.

SITES FOR HEALTH PROMOTION
ACTIVITIES
 at home, in the community setting, schools, hospitals, or worksites
 Some individuals may feel more comfortable having a nurse, diet counselor,
or fitness expert come to their home for teaching and follow-up on individual
needs. This type of program, however, is not cost effective for most
individuals. Many people prefer the group approach, find it more motivating,
and enjoy the socializing and support. Most programs offered in the
community are group oriented.

HEALTH PROMOTION MODEL
 It is a competence- or approach-oriented model in which the motivational source for behavior

change is based on the individual’s subjective value of the change—that is, how the client
perceives the benefits of changing the given health behavior. The HPM does not include “fear”
or “threat” as a motivating source for changing health behavior

Detailed
explanation is
provided in
the following
Behavior-Specific Cognitions and Affect
 This set of variables is of major motivational significance for acquiring and maintaining health-
promoting behaviors.
 Behavior-specific cognitions constitute a critical “core” for intervention because nursing

interventions can modify them. They include the following:
 Perceived benefits of action
 Perceived barriers to action
 Perceived self-efficacy
 Activity-related affect
 Interpersonal influences
 Situational influences
Perceived benefits of action
 Anticipated benefits or outcomes (e.g., physical fitness, stress reduction) affect the person’s
plan to participate in health-promoting behaviors and may facilitate continued practice.
 Prior positive experience with the behavior or observations of others engaged in the behavior is
a motivational factor.

Perceived barriers to action
 A person’s perceptions about available time, inconvenience, expense, and difficulty performing
the activity may act as barriers (imagined or real).
 Perceived barriers to action affect health-promoting behaviors by decreasing the individual’s

commitment to a plan of action.

Perceived self-efficacy
 This concept refers to the conviction that a person can successfully carry out the behavior
necessary to achieve a desired outcome, such as maintaining an exercise program to lose
weight.
 Often people who have serious doubts about their capabilities decrease their efforts and give
up, whereas those with a strong sense of efficacy exert greater effort to master problems or
challenges.

Activity-related affect
 The subjective feelings that occur before, during, and following an activity can influence
whether a person will repeat the behavior again or maintain the behavior. What is the
individual’s reaction to the thought of the behavior? Is it perceived as fun, enjoyable, or
unpleasant?
 A behavior associated with a positive affect or emotional response is likely to be repeated, and
behaviors associated with a negative affect are usually avoided.

Interpersonal influences
 Interpersonal influences are a person’s perceptions concerning the behaviors, beliefs, or

attitudes of others. Family, peers, and health professionals are sources of interpersonal
influences that can influence a person’s health-promoting behaviors.
 Interpersonal influences include expectations of significant others, social support (e.g.,

emotional encouragement), and learning through observing others or modeling.

Situational influences
 These are direct and indirect influences on health-promoting behaviors and include perceptions of
available options, demand characteristics, and the aesthetic features of the environment.
 An example of an individual’s perception of available options can include easy access to healthy
alternatives such as vending machines and restaurants that provide healthful menu options.
 Individuals are more apt to perform health promotion behaviors if they are comfortable in the
environment versus feeling alienated. Environments that are considered safe as well as interesting
are also desirable aesthetic features that facilitate health promotion behaviors.

Commitment to a Plan of Action
 Commitment to a plan of action involves two processes: commitment and identifying specific
strategies for carrying out and reinforcing the behavior.
 Strategies are important because commitment alone often results in “good intentions” and not
actual performance of the behavior.

Immediate Competing Demands
and Preferences
 Competing demands are those behaviors over which an individual has a low level of control. For
example, an unexpected work or family responsibility may compete with a planned visit to the
health club, and not responding to this responsibility may cause a more negative outcome than
missing the exercise routine.
 Competing preferences are behaviors over which an individual has a high level of control;
however, this control depends on the individual’s ability to be self-regulating or to not “give in.”
For example, a person who chooses a high-fat food over a low-fat food because it tastes better
has “given in” to an urge based on a competing preference.

Behavioral Outcome
 Health-promoting behavior, the outcome of the Health Promotion Model, is directed toward
attaining positive health outcomes for the client. Health-promoting behaviors should result in
improved health, enhanced functional ability, and better quality of life at all stages of
development

STAGES OF HEALTH BEHAVIOR CHANGE
 Health behavior change is a cyclic phenomenon in which people progress through several stages.
In the first stage, the person does not think seriously about changing a behavior; by the time the
person reaches the final stage, he or she is successfully maintaining the change in behavior.
Several behavior change models have been proposed.
 The stages are (a) precontemplation, (b) contemplation, (c) preparation, (d) action, (e)
maintenance, and (f) termination. If the person does not succeed in changing behavior, relapse
occurs.

Pre-contemplation Stage
 In the pre-contemplation stage, the person does not think about changing his or her behavior in
the next 6 months. They may be uninformed or under-informed about the consequences of the
risk behavior(s). The person who has tried changing previously and was unsuccessful may now
see the behavior as his or her “fate” or believe that change is hopeless. Individuals in this stage
tend to avoid reading, talking, or thinking about their high-risk behaviors (Prochaska et al.,
2009, p. 100).

Contemplation Stage
 During the contemplation stage, the person acknowledges having a problem, seriously considers
changing a specific behavior, actively gathers information, and verbalizes plans to change the
behavior in the near future (e.g., next 6 months).
 The person, however, may not be ready to commit to action. Some people may stay in the
contemplative stage for months or years before taking action.

Preparation Stage
 This occurs when the person intends to take action in the immediate future (e.g., within the
next month). Some people in this stage may have already started making small behavioral
changes, such as buying a self-help book.
 At this stage, the person makes the final specific plans to accomplish the change.

Action Stage
 The action stage occurs when the person actively implements behavioral and cognitive
strategies of the action plan to interrupt previous health risk behaviors and adopt new ones.
 This stage requires the greatest commitment of time and energy.

Maintenance Stage
 During the maintenance stage, the person strives to prevent relapse by integrating newly
adopted behaviors into his or her lifestyle. This stage lasts until the person no longer
experiences temptation to return to previous unhealthy behaviors. It is estimated that
maintenance lasts from 6 months to 5 years (Prochaska et al., 2009, p. 100).

Termination Stage
 The termination stage is the ultimate goal; it is the point at which the individual has complete
confidence that the problem is no longer a temptation or threat. It is as if the person never
acquired the habit in the first place or the new behavior has become automatic (Prochaska et
al., 2009, p. 102).
 Experts debate whether some behaviors can be terminated versus requiring continual
maintenance. For example, adults who automatically buckle their seat belts when getting in
their vehicle may reach the termination stage.
 Other behaviors, such as smoking or overeating, may never reach the termination stage because
relapse temptations are too strong. The goal of maintenance may be more appropriate for those
individuals.

THE NURSING PROCESS
AND HEALTH PROMOTION
 A thorough assessment of an individual’s health status is basic to health promotion.
 As nurses move toward greater autonomy in providing client care, expanded assessment skills
are essential to provide the meaningful data needed for health planning.

Assessing
 Components of this assessment are:
 health history and physical examination
 physical fitness assessment
 lifestyle assessment
 spiritual health assessment
 social support systems review
 health risk assessment
 health beliefs review
 life-stress review
Health History and Physical Examination
 The age of the individual must be considered when collecting data. For example, an
environmental safety assessment and immunization history must be appropriate to the person’s
age.
 A nutritional assessment is an important part of the health history.
 The nurse must consider both age and body build of the client when gathering information on
dietary patterns.

Physical Fitness Assessment
 During an evaluation of physical fitness, the nurse assesses several components of the body’s
physical functioning: muscle endurance, flexibility, body composition, and cardiorespiratory
endurance.
 Specific guidelines for obtaining measurements and the optimal values for men, women, and
children can be found in physical fitness texts. See table on the next slide.
 Older adults need to be monitored carefully for fatigue during strength and endurance tests.

Lifestyle Assessment
 Categories of lifestyle generally assessed are physical activity, nutritional practices, stress
management, and such habits as smoking, alcohol consumption, and drug use. Other categories
may be included. Several tools are available to assess lifestyle.
 The goals of lifestyle assessment tools are to provide the following:
1. An opportunity for clients to assess the impact of their present lifestyle on their health
2. A basis for decisions related to desired behavior and lifestyle changes.

Spiritual Health Assessment
 Spiritual health is the ability to develop one’s inner nature to its fullest potential, including the
ability to discover and articulate one’s basic purpose in life; to learn how to experience love,
joy, peace, and fulfillment; and to learn how to help ourselves and others achieve their fullest
potential (Pender et al., 2011, p. 104).
 Spiritual beliefs can affect a person’s interpretation of events in his or her life and, therefore,
an assessment of spiritual well-being is a part of evaluating the person’s overall health.

Social Support Systems Review
 Understanding the social context in which a person lives and works
 is important in health promotion.
 Individuals and groups, through interpersonal relationships, can provide comfort, assistance,
encouragement, and information.
 Social support fosters successful coping and promotes satisfying and effective living.
 Examples of social support systems include family, peer support groups (including computer-
based support groups), community-organized religious support systems (e.g., churches), and
self-help groups

Social Support Systems Review (cont’d)
 The nurse can begin a social support system review by asking the client to do the following:
 List individuals who provide personal support.
 Indicate the relationship of each person (e.g., family member, fellow worker or colleague, social
acquaintance).
 Identify which individuals have been a source of support for 5 or more years.
 This assessment allows the nurse and client to discuss and evaluate the adequacy of the client’s
support system together and, if necessary, plan options for enhancing the support system.

Health Risk Assessment
 It is an assessment and educational tool that indicates a client’s risk for disease or injury during
the next 10 years by comparing the client’s risk with the mortality risk of the corresponding age,
gender, and racial group.
 The client’s general health, lifestyle behaviors, and demographic data are compared to data
from a large national sample. Individual risk reports are based on statistics for the population
group that match the individual’s surveyed characteristics.
 The HRA includes a summary of the person’s health risks and lifestyle behaviors with educational
suggestions onhow to reduce the risk.

Health Risk Assessment (cont’d)
 HRAs are helpful for assessing individual and group health risks. They are not, however,
substitutes for medical care and are not appropriate for all individuals. For example, people
with chronic illnesses such as cancer or heart disease may not obtain accurate risk assessments.
Certain populations (e.g., very young, older adults, some sociocultural groups) may not be fully
represented in the population databases and, therefore, the HRA may not project an accurate
risk assessment.

Health Beliefs Review
 Clients’ health beliefs need to be clarified, particularly those beliefs that determine how they
perceive control of their own health care status.
 Locus of control is a measurable concept that can be used to predict which people are most
likely to change their behavior

Health Beliefs Review (cont’d)
 Assessment of clients’ health beliefs provides the nurse with an indication of how much the
clients believe they can influence or control health through personal behaviors.
 Several cultures have a strong belief in fate: “Whatever will be, will be.” If people hold this
belief, they do not feel that they can do anything to change the course of their disease. An
example is doing diabetic teaching, which often requires many lifestyle changes in diet and
exercise and close control of glucose to prevent complications. If the person believes he or she
has no control of the outcome, it is difficult to provide motivations to make the necessary
changes.

Life-Stress Review
 There is abundant literature about the impact of stress on mental and physical well-being.
 A variety of stress-related instruments can be found in the literature. For example, Holmes and
Rahe (1967) developed a Life-Change Index, a tool that assigns numerical values to life events.
For example, life changes (e.g., death of a spouse, divorce, marital separation, pregnancy, etc.)
have an impact score. The individual adds up all of the current life events and compares the
total life-changes score to the likelihood of illness in the near future. Studies have shown that a
high score is associated with the increased possibility of illness.

Validating Assessment Data
 Following the collection of assessment data, the nurse and client need to review, validate, and summarize the information. The nurse and the client carry
this step out together.
 The nurse and client need to consider the following:
 Any existing health problems
 The client’s perceived degree of control over health status
 Key health beliefs
 Level of physical fitness and nutritional status
 Illnesses for which the client is at risk
 Current positive health practices
 Spirituality
 Sources of life stress and ability to handle stress
 Social support systems
 Information needed to enhance health care practices
 Client strengths.

Diagnosing
 Nursing diagnoses accepted by NANDA International have generally focused on impaired or

imbalanced health patterns or problems.
 The definition of the NANDA health promotion domain is “the awareness of well-being or
normality of function and the strategies used to maintain control of and enhance that well-being
or normality of function” Health promotion diagnoses can be applied to any health state and do
not require current levels of wellness.

Diagnosing (cont’d)
 A health promotion diagnosis is preceded by the modifier “readiness for enhanced.”
 The following examples are included in the NANDA International taxonomy:
 Readiness for Enhanced Religiosity
 Readiness for Enhanced Coping
 Readiness for Enhanced Nutrition
 Readiness for Enhanced Knowledge (Specify)
 Readiness for Enhanced Relationship
 Readiness for Enhanced Self-Concept
 Readiness for Enhanced Self-Care
 Readiness for Enhanced Health Management
 Readiness for Enhanced Urinary Elimination.

Planning
 Health promotion plans need to be developed according to the needs, desires, and priorities of the
client.
 The client decides on health promotion goals, the activities or interventions to achieve those goals,
the frequency and duration of the activities, and the method of evaluation.
 During the planning process, the nurse acts as a resource person rather than as an adviser or
counselor. The nurse provides information when asked, emphasizes the importance of small steps to
behavioral change, and reviews the client’s goals and plans to make sure they are realistic,
measurable, and acceptable to the client.

Steps in Planning
1. Review and summarize data from assessment. The nurse shares with the client a summary of
the data collected from the various assessments (e.g., physical health and fitness, nutrition,
sources of stress, spirituality, health practices).
2. Reinforce strengths and competencies of the client. The nurse and the client come to
consensus about areas in which the client is doing well and areas that need further development.
3. Identify health goals and related behavior-change options. The client selects two or three top
priority personal health goals, prioritizes them, and reviews behavior-change options.

Steps in Planning (cont’d)
4. Identify behavioral or health outcomes. For each of the selected goals or areas in step 3, the
nurse and client determine what specific behavioral changes are needed to bring about the desired
outcome.
5. Develop a behavior-change plan. A constructive program of change is based on client

“ownership” of those behavior changes selected for implementation within everyday life (Pender et
al., 2011, p. 128).

6. Reiterate benefits of change. The positive benefits will probably need to be

reiterated by both the nurse and the client even though the client is committed
to the change.
7. Address environmental and interpersonal facilitators and barriers to

change. Environmental and interpersonal factors that support positive change
should be used to reinforce the client’s efforts to change lifestyle.

8. Determine a time frame for implementation. By developing a time frame,

the appropriate knowledge and skills can be developed before a new behavior is
implemented.
9. Formalize commitment to behavior-change plan. Commitments to changing

behaviors have usually been verbal. Increasingly, a formal, written behavioral
contract is being used to motivate the client to follow through with selected
actions (see Chapter 27 ).

Exploring Available Resources
 Another essential aspect of planning is identifying support resources available to the client.
 These may be community resources such as a fitness program at a local gymnasium, or

educational programs such as stress management, breast self-examination, nutrition, smoking
cessation, and health lectures.

Implementing
 Implementing is the “doing” part of behavior change.
 Self-responsibility is emphasized for implementing the plan.
 Depending on the client’s needs, the nursing interventions may include supporting, counseling,
facilitating, teaching, enhancing the behavior change, and modeling.

Providing and Facilitating Support
 A major nursing role is to support the client. A vital component of lifestyle

change is ongoing support that focuses on the desired behavior change and is
provided in a nonjudgmental manner.
 Support can be offered by the nurse on an individual basis or in a group

setting. The nurse can also facilitate the development of support networks for
the client, such as family members and friends.

Enhancing Behavior Change
 To help clients succeed in implementing behavior changes, the nurse needs to

understand the stages of change and effective interventions that focus on
progressing the individual through the stages of change.

Evaluating
 Evaluation takes place on an ongoing basis, both during the attainment of

short-term goals and after the completion of long-term goals. Goals are
written during the planning phase, and a date is determined for attaining the
specific results or behaviors that are desired to promote health or prevent
illness.
 During evaluation, the client may decide to continue with the plan, reorder
priorities, change strategies, or revise the health promotion-prevention
contract. Evaluation of the plan is a collaborative effort between the nurse
and the client.

II. DISEASE PREVENTION
 It is behavior motivated by a desire to actively avoid illness, detect it early, or maintain

functioning within the constraints of illness (also called health protection, illness prevention)
 Nurses work to prevent risk factors for disease through patient education. They provide
instruction on healthy diets, immunizations, and exercise. They also discuss the dangers of risky
behavior, such as tobacco and drug use. Nurses in preventive care identify risk factors and strive
to detect disease in the early stages to prevent the spread or worsening of symptoms.
Levels of Care: Disease Prevention

Disease prevention (cont’d)
 In preventive care, nurses work with other medical professionals to provide
preventive care to help maintain the good health and quality of life for all
individuals.
 It is different from health promotion.

“Health Protection/Disease Prevention”
is different from “Health Promotion”
 A 40-year-old male may begin a program of walking 3 miles each day. If the goal of
his program were to “decrease the risk of cardiovascular disease,” then the
activity would be considered disease prevention or health protection.
 By contrast, if the motivation for his walking regimen were to “increase his overall
health and feeling of well-being,” then the activity would be considered a health
promotion behavior.
 It is most helpful to think of health promotion and health protection as being

complementary processes because both affect quality of health.
 Health promotion can be offered to all clients regardless of their health and
illness status or age.

Levels of prevention
 Leavell and Clark (1965) defined 3 levels of prevention:
1. Primary prevention
2. Secondary prevention
3. Tertiary prevention

Primary prevention
 It focuses on:
(a) health promotion, and
(b) protection against specific health problems

e.g., immunization against hepatitis B
 The purpose of primary prevention is to decrease the risk or exposure of the

individual or community to disease.

Secondary prevention
 Focuses on
(a) early identification of health problems, and

(b) prompt intervention to alleviate health problems.
 Its goal is to identify individuals in an early stage of a disease process and to

limit future disability.

Tertiary prevention
 Focuses on restoration and rehabilitation with the goal of returning the

individual to an optimal level of functioning.

III. HEALTH MAINTENANCE
 It is central to health care, especially to nursing care at all levels (primary,

secondary, and tertiary) and in all patterns (preventive, episodic, acute,
chronic, and catastrophic).
 Examples of these activities include developmental screening or surveillance

to identify early deviations from normal development, providing
immunizations to prevent illnesses, and teaching about common childhood
safety hazards.
Levels of Care: Health Maintenance

Health Maintenance (cont’d)
 Health maintenance activities are commonly preventive in nature and

terminology common to community or public health nursing explains the
levels and aims of preventive actions (see Levels of Prevention table in slide
82).

Health Maintenance (cont’d)
 Health maintenance activities are commonly preventive in nature and

terminology common to community or public health nursing explains the
levels and aims of preventive actions (see Levels of Prevention table in slide
82).

Health Maintenance & Health Promotion
 Health promotion and health maintenance activities are closely linked and often
overlap, but they are different from one another.
 Health maintenance focuses on known potential health risks and seeks to

prevent them, or identify them early so that intervention can occur.
 Health promotion looks at the strengths and goals of individuals, families, and
populations, and seeks to use them to assist in reaching higher levels of
wellness. It involves partnerships with the family as health goals are set, and
with other health professionals and resources to provide for meeting the goals.
IV. CURATIVE CARE
 Curative care involves treatment intended to alleviate the symptoms or cure

a current medical condition.
 It strives to reduce pain, improve function, and help improve the quality of
life for patients.
 Examples of treatment options include medications, casts and splints for

broken bones, dialysis for kidney conditions, and chemotherapy for cancer.
Levels Of Care: Curative Care

Curative Care (cont’d)
 Nurses provide and coordinate curative care for patients in various

environments. They set up plans for the care of patients, carry out medical
treatments, observe patients, and discuss conditions with doctors and other
medical staff. They also assist with diagnostic testing and evaluating results.
 Nurses perform an important role in instructing patients and families on how

to manage their medical condition and explain home care and follow up
treatments.
Levels Of Care: Curative Care

V. REHABILITATIVE CARE
 In rehabilitative care, nurses assist patients with temporary and long-term

disabilities or chronic illnesses.
 They assist in adapting to their conditions, meeting their highest potential,

and living more independent lives.
 They commonly use holistic approaches to medical treatment to meet all

needs of patients.
 They work with patients and family members to establish a treatment plan
and establish short and long-term goals.
Levels Of Care: Rehabilitative Care

Rehabilitative Care (cont’d)
 They also prepare patients and caregivers for changes that occur in
rehabilitative treatment.
 Many rehabilitative nurses join the Association of Rehabilitation Nurses to

access continuing education options and various other resources.
Levels Of Care: Rehabilitative Care

Levels of Care: Submitted By: Juliene Hannah V. Flores

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Levels of Care

St. Dominic Savio College

Submitted by: Juliene Hannah V. Flores

II. Disease Prevention

III. Health Maintenance

IV. Curative Care

 Health promotion is an important component of nursing practice.

 It is a way of thinking that revolves around a philosophy of wholeness,

Levels of Care: Health Promotion

 Dimensions of individuality include the person’s total character, self-dentity,

 Total character = behaviors, emotional state, attitudes, values, motives,

 Self-identity = perception of self as a separate and distinct entity alone and

 Perceptions = the way the person interprets the environment or situation,

Levels of Care: Health Promotion

Levels of Care: Health Promotion

 Nurses are concerned with the individual as a whole, complete, or holistic

Levels of Care: Health Promotion

 It is the tendency of the body to maintain a state of balance or equilibrium

 Two kinds of homeostasis:

Physiological Homeostasis & Psychological Homeostasis

Levels of Care: Health Promotion

 Physiological homeostasis means that the internal environment of the body is

Levels of Care: Health Promotion

1. They are self-regulating.

2. They are compensatory.

3. They tend to be regulated by negative feedback systems.

Levels of Care: Health Promotion

 means that homeostatic mechanisms come into play automatically in the

Levels of Care: Health Promotion

 Homeostatic mechanisms are compensatory (counterbalancing) because they

 An example is a sudden drop in air temperature. The compensatory

Levels of Care: Health Promotion

 Homeostasis occurs within the physiological system, a set of interacting

 The fundamental components of a system are matter, energy, and

Levels of Care: Health Promotion

 These are : closed and open systems.

Levels of Care: Health Promotion

 Input consists of information, material, or energy that enters the system.

Levels of Care: Health Promotion

 Output from a system is energy, matter, or information given out by the

 Feedback is the mechanism by which some of the output of a system is

Levels of Care: Health Promotion

Levels of Care: Health Promotion

 It refers to emotional or psychological balance or a state of mental well-

Levels of Care: Health Promotion

Levels of Care: Health Promotion

Levels of Care: Health Promotion

 A thorough assessment of an individual’s health status is basic to health promotion.

 Components of this assessment are:

 Physical fitness assessment

 Health risk appraisal

 Health beliefs review

Levels of Care: Health Promotion

Levels of Care: Health Promotion

Levels of Care: Health Promotion

Levels of Care: Health Promotion

 It is a competence- or approach-oriented model in which the motivational source for behavior

Levels of Care: Health Promotion

 Behavior-specific cognitions constitute a critical “core” for intervention because nursing

 Perceived benefits of action

 Perceived barriers to action

Levels of Care: Health Promotion