Health promotion/risk reduction and disease prevention in women's health.

Abstract

This special issue is focused on health promotion, risk reduction, and disease prevention in women’s health. Women’s health care is an important focal area for nurse practitioners (NPs) and is specified as one of the population specialties for NP preparation. As well, the majority of patient care visits to NPs who specialize in adult, family, and gerontology practice are from women. Therefore, it is particularly apt for the Journal of the American Academy of Nurse Practitioners to offer this special issue highlighting research, literature reviews, and clinical papers that focus on aspects of health promotion, risk reduction, and disease prevention for women. Several national initiatives prioritize health promotion and disease prevention. National objectives detailed in Healthy People 2010 recognize that preventing illness, disability, and premature death by encouraging patients to pursue healthy lifestyle goals is in large part dependent upon the health promotion message conveyed by healthcare providers (Healthy People 2010, 2000). The Pew Commission’s final report recommended 21 competencies for the health professions (University of California San Francisco [UCSF], 1998). Competency number 7 challenged healthcare providers to rigorously practice preventive health care. For NPs, this mandate aligns with our overall philosophy of care and reflects our basic nursing backgrounds. NPs have always excelled at preventive health care that embraces health promotion, risk reduction, and disease prevention. In fact, the domains and core competencies of NP practice published by the National Organization of Nurse Practitioner Faculties (NONPF) in 1990 (updated in 1995 and 2000) specify five core competencies related to health promotion/health protection and disease prevention in the first domain, management of patient health/illness status (National Organization of Nurse Practitioner Faculties [NONPF], 1990, 1995, 2000). Further, primary care competencies in the specialty areas of adult, family, gerontology, pediatrics, and women’s health all have health promotion, health protection, disease prevention, and treatment as the first domain of practice (NONPF, 2002). Together these documents provide the parameters for NP primary care entry-level practice to be mastered by all. Several surveys of NP practice have been conducted that validate how NPs equate to their preventive health mandate. In a 2008 descriptive survey of NP practice, 24.8% of visits over a 6-month period were for nonillness and health promotion visits. In addition, of all primary care visits, NPs provided counseling in 84% of them (compared with physician colleagues at 61%) as therapeutic and preventive services, such as nutrition counseling, physical exercise, family planning, prenatal instructions, tobacco use, and growth and development (Deshefy-Longhi, Swartz, & Grey, 2008). An earlier study of Texas NPs’ (n = 442) health promotion attitudes and practices found that they had positive attitudes toward health promotion and were supportive of health promotion practices. As well, of the NPs who took care of women patients, 90% responded positively to the recent health promotion practices question on the survey. Findings from this study also note that 97% believed a smoking history should be taken from every patient and 99.5% believed health promotion is an important aspect of their professional role. Routinely, 56% counseled their patients about alcohol abuse, 58% about physical activity, 61% assessed for obesity, and 69% counseled about tobacco use (Reeve, Byrd, & Quill, 2004). Although these data are positive, they indicate that NPs can improve their preventive health services and periodic practice surveys can track progress. The collection of articles in this special issue underscores the many ways in which NPs encourage health promotion, risk reduction, and disease prevention activities with the women they serve. Thanavaro and colleagues developed an instrument specifically for women that measures coronary heart disease knowledge. The study used Pender’s Health Promotion Model as a framework and knowledge level was considered an individual characteristic with potential for impacting health promotion behaviors. Their work suggests that understanding the deficit of women’s knowledge is the first step in developing strategies to increase knowledge levels and thereby enhance health promotion and modifiable risk reduction behaviors. Their psychometrically sound tool can assist other healthcare providers in assessing their female patients’ knowledge of coronary heart disease and directing the provision of educational materials or other interventions to promote risk reduction behaviors. Genital piercing is a topic that Dr. Myrna Armstrong notes ‘‘arouses social provocation’’ and may result in personal challenges for the NP when providing health promotion/risk reduction advice. The authors report how NPs caring for clients with genital piercing might experience delay in providing important health management recommendations during the encounter. However, acknowledgement and acceptance of the piercings can open doors for critical conversations between the client