Secondary and tertiary levels of health promotion

journal articles (one of each of the primary, secondary, and tertiary levels of health promotion) in nursing practice.

Health promotion as a whole is defined as the best way to promote health of the patient, be that by preventing disease from occurring, by impeding the illness in its beginning stages, or by reducing pain and helping the patient feel comfortable.

The purpose of nursing is that healing can properly occur once health promotion is practiced. Nursing equals health promotion for ‘nursing’ literally means making the patient better. However, nursing is a holistic practice which also extends to making the patient feel comfortable and showing him / her how to prevent the disease form occurring in the first place. Nursing, in other words, doesn’t only extend to curing disease, but also to alleviating pain and to instructing prevention of disease.

For that reason, health promotion (namely, nursing) falls into the following three areas:

Primary — prevention of disease that enables individuals to gain an acceptable level of health in order to lead a socially and economically productive life

2. Secondary — Action which halts progress of disease and prevents complications. This is the clinical stage and is more expensive and less effective than the first. It is not always effective in halting transmission of disease.

3. Tertiary – all measures to reduce / limit suffering, limit impairment, assuage suffering, and to promote patient’s adjustment to irremediable situation. This is an at-the-end-of life situation.

These three areas of nursing can be evidenced in the following three articles: Broe et al. (2008); Bhatnagar’s et al. (2012) research, and that of Hanlon et al. (2010).

The purpose of Broe et al. (2008) research was to identify whether Vitamin D — and if so which level of Vitamin D — would prevent risk of falling of elderly.

The problem is that elderly are at great risk of falling and, consequently, injuring themselves. Injury, sometimes, leads to death. There is a high rate of falls amongst the elderly Broe et al. (2008) wanted to prevent these falls from occurring.

The second area involves secondary methodology which is treatment (or attempted treatment) of the disease. This area is exemplified by Bhatnagar’s et al. (2012) research that focused on cancer. The researchers used a cancer curing laser equipment. Cancer can be detected using laser induced ultrasound .They used this in conjunction with the normal laser curing mechanism used in cancer treatment and claimed that with this new method, pathologists could be able to examine an entire biopsy and identify the general area of the node that has cancer, and simultaneously cure it.

The study of Hanlon et al. (2010) dealt with tertiary features. Their purpose was to determine the prevalence of pain, describe its treatment, and determine factors associated with pain in older residents. Their study focused on residents assigned to a hospice unit or receiving services from a hospice/palliative care/end-of-life program in U.S. nursing homes. The researchers discovered that pain was still present in more than one third of the nursing home hospice/palliative care residents despite use of opioids treatment. Focusing on pain management, researchers advocated further studies to improve the management of pain in these situations.

The difference between each is that Broe et al. (2008) focused on prevention, Bhatnagar’s et al. (2012) focused on treatment, whilst Hanlon et al. (2010) focused on relieving pain.

There are many implementation methods for health promotion that encompass primary, secondary, and tertiary levels of health promotion. This essay will just mention the following three:

The primary implementation method would be evidence-based nursing where all three areas are implemented according to recent, authoritative peer-reviewed scientific evidence.

Jane Watson’s approach would be another where the entire patient is considered and nursing accomplished in a spiritual, care-based format. This considers the patient within the general holistic milieu and extends to all three areas of nursing.

One may also say that Nightingale’s Theory of Environment is conducive to capturing all three areas since Florence Nightingale stressed the importance of the environment. The person adapts to changes in internal and external environment as measure of health. Health is a continuum with well-being on the one end and death on the other. In all three areas clean environment and other aspects such as optimum diet and sleep play a major role.

Nursing roles and responsibilities are becoming more complex and less instruction-driven than in the past. Nurses are becoming more independent and using evidence-based for instance to assess their learning and to assess which practices they should best adopt according to their scientific value.

Nursing is also become more technical and technological minded with many new instruments helping the nurses in their roles. These distress the lives of nurses.

It has also become increasingly important to realize that the patient is not the entire structure and that efficient nursing extends to considering other aspects of the patient such as community and family. At the same time, it is recognized that comfort is a portentous part of the nursing profession and that this, sometimes, involves, ceasing treatment and allowing the patient to dictate, as well as, at the end of life (or in other situations), fashion his own decisions regarding dying.

On the one hand, therefore, nursing has become more patient-centered. On the other hand, nurses have become more independent and have / are stepping away from their traditional role as simply doctor’s assistant. In all ways, however, nursing continues to be focused on the three areas of health promotion: primary, secondary, and tertiary.


Bhatnagar, S. et al. (2012) Advanced Laser Technology for Curing Cancer Affected Melanoma-Cell Journal of Electronic Design Technology, Vol 3, No 1

Broe, K et al. (2008) A Higher Dose of Vitamin D Reduces the Risk of Falls in Nursing

Home Residents: A Randomized, Multiple-Dose Study JAGS 55:234 — 239

Hanlon, JT et al. (2010) Pain and Its Treatment in Older Nursing Home Hospice/Palliative Care Residents J. Am Med Dir Assoc. 11(8): 579 — 583.

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