Preventative Care for the Child: The Nurse’s Role

1. Preventative Care for the Child: The Nurse’s Role Promoting Early Education and Providing Effective Care for Every Child

2. What is Preventative Care? • A combination of nursing and medical care that concentrates on diseaseprevention and health maintenance • Divided Into Three Levels • Primary Prevention • Secondary Prevention • Tertiary Prevention

3. Why is Preventative Care Important? • In 2000, 46.7% of all deaths in the United States were caused by modifiable health behaviors • The U.S. Department of Health and Human Services estimates that approximately 33% of all deaths in the United States are attributable to three modifiable health behaviors: smoking,physical inactivity,andpoor eating habits

4. Pediatric Chronic Illnesses on the Rise • Childhood obesity rates have doubled in children and quadrupled in adolescents in the past 30 years • Linked to higher risk factors for cardiovascular disease • High cholesterol • Hypertension • Increases the risk of developing other health issues • Bone and joint problems • Cancer • Stroke • Type 2 Diabetes • 33% increase in Pediatric Type 2 diabetes incidence and prevalence seen within the past decade • Sleep apnea • Social and psychological issues

5. The Financial Side • Chronic diseases are the leading cause of direct healthcare costs. • Researchers estimate that 75% of all healthcare costs are directly linked to preventable chronic health conditions (such as type 2 diabetes, hypertension, and obesity)

6. Promoting Preventative Care • Children who receive preventative care and grow up in households that follow these standards live healthier, longer, lives than children whom do not • Introducing these principles at a young age improves the maintenance of self-care throughout the lifespan, and prevents the occurrence of avoidable chronic diseases

7. The Dahlgren Whitehead Model of HealthLayers of Influence on Health • Useful in providing a framework of the layers to health, the probability of changing specific factors, and the corresponding action that would be required to influence related factors in other layers • The individual lifestyle factors are displayed as the most • influential modifiable determinant of health

8. How Can Nurses Help? • As patient advocates, nurses hold a unique position to affect change and improve patient care standards • Ensure provision of safe and healthy environments for child • Promote preventive health care for child, and teach child and family of its importance

9. First Step: Primary Prevention • Methods taken before any medical condition arises • Prevent the onset of disease and accidents • Controlling risk factors that may lead to illnesses and accidents

10. Nurse’s Role in Primary Prevention • Newborn Screening • APGAR Scoring, Growth Assessment • Initial/Interval Maternal and Birth History • Physical Exam • Pediatric Assessment • Physical– Fine and gross motor development, sexual development • Cognitive– problem solving, reasoning, and self-care skills • Language– terminology, comprehension, and articulation • Social– Peer relations, school performance, family issues • Ensure educational arrangements and activities are employed to reach developmental milestones

11. Nurse’s Role in Primary Prevention • Immunizations • Help patient/family stay on top of immunization schedule, according to national recommendations • Check Ups • Assist with and help schedule well-child visits • Regular dental visits • Hearing and vision screening • Patient and Family Education Counseling • Diet and nutrition • Exercise and fitness promotion • Sun safety • Clinical Breast and Pelvic exam and Pap testing (8 to 21 years) • Motor vehicle injury prevention • Safety, injury and violence prevention- Family violence/abuse • Dangers of alcohol, tobacco, and substance use • Media exposure Overall: nurses must assist in an effort to prevent the onset of disease, especially in patients with known risk factors

12. Secondary Prevention • Early detection • Take prompt action once initial symptoms are identified • Early intervention • Reduce progression of disease

13. Nurse’s Role in Secondary Prevention • Prevent the Spread of Communicable Diseases • Encourage frequent, proper hand hygiene • Promote vaccinations • Sex education and counseling • Recommend and Schedule Screenings • STD screening • Pregnancy screening • Mammogram screening- detect or treat breast cancer in its earliest stages if applicable • Colonoscopies if applicable

14. Nurse’s Role in Secondary Prevention • Test blood sugar levels • Routinely and/or if high risk • Recommend ‘Pre-diabetes’ programs if borderline • Monitor Blood Pressure Measurements • Routinely and/or if high risk • Treatment of hypertension to reduce progression of associated diseases • Test for Hearing Loss • Advocate protection if associated risk Overall: prevent further problems

15. Tertiary Prevention • Maximize quality of life • Improve patient function • Control symptoms • Reduce pain • Slow the progression/minimize the impact of disease • Reduce degree of disability • Prevent or delay complications • Prevent or delay reoccurrences • Restore health and function

16. Nurse’s Role in Tertiary Prevention • Help restore self-sufficiency • Refer to PT, OT, support groups, etc. • Recommend self-management programs • Relapse prevention of disease • Positive reinforcement, provide goal charts • Refer back to teaching methods Overall: Provide appropriate care and guide patients and families to regain health control

17. What If Preventative Care Is Not Covered By My Patient’s Insurance Plan? • Under the Affordable Care Act, most health plans are required to cover a set of preventive health services for children at no cost when delivered by an in-network provider • This includes Marketplace and Medicaid coverage

18. Affordable Care Act • Removes cost sharing for the recommended clinical preventive services • Promotes free preventive screenings • Blood pressure and cholesterol tests, mammograms, colonoscopies, etc. • Offers coverage for vaccines ** These rights do not apply to health plans created or bought before March 23rd, 2010, which are known as “grandfathered” plans **

19. Uninsured • Inform families of low-cost health care at a nearby Community Health Center • Price is dependent on family income • Located in both urban and rural areas • Provides: • Prenatal care • Infant shots • General primary care • Referrals to specialized care, including mental health, substance abuse, and HIV/AIDS

20. Take-Home Messages Families may not pursue preventive care because they are uninformed of its importance, or unaware of the changes to their coverage • It is our job as nurses to: • Inform families of clinical preventive service benefits provided through their health plan • Promote consistent and appropriate use of recommended clinical preventive services • Educate importance of preventative care and leading a healthy lifestyle • Implement programs that promote disease prevention • Support community-based and worksite-based preventive service interventions

21. References Agency for Healthcare Research and Quality. (2012). The Guide to Clinical Preventive Services: 2012 Recommendations of the U.S. Preventive Services Task Force. Retrieved from http://www.ahrq.gov/professionals/clinicians- providers/guidelines-recommendations/guide/guide-clinical-preventive- services.pdf Campbell K.P., Lanza, A., Dixon, R., Chattopadhyay, S., Molinari, N., Finch, R.A. (2006). A Purchaser's Guide To Clinical Preventive Services: The Role Of Clinical Preventive Services In Disease Prevention And Early Detection. National Business Group on Health. Retrieved from http://www.businessgrouphealth.org/pub/f31603f5-2354- d714-5126- a6d440aa2f8a. Centers for Disease Control and Prevention (2014). Childhood Obesity Facts. Centers for Disease Control and Prevention. Atlanta, GA: U.S. Department of Health and Human Services. Retrieved from: http://www.cdc.gov/healthyyouth/obesity/facts.htm Chung, P. , Lee, T., Morrison, J.L., Schuster, M.S. (2006). Preventive Care for Children in the United States: Quality and Barriers. Annual Review Public Health, 27(10): 491-515. Retrieved from http://escholarship.org/uc/item/0ms0n3nt Kaufman, F. Type 2 Diabetes in Children and Young Adults: A “New Epidemic.” Clinical Diabetes Journal, 20 (4):217-218. Retrieved from: http://clinical.diabetesjournals.org/content/20/4/217.full Kraft, C. (2012). Preventive Services for Children: Getting the Message to Parents and Caregivers. The Accreditation Council for Continuing Medical Education. Medscape Education Business of Medicine. Retrieved from http://www.medscape.org/viewarticle/770504

22. References (cont.) Massachusetts Health Quality Partners (2014). Pediatric Routine Preventive Care Guidelines. Office of MassHealth Operations. Retrieved from: http://www.mhqp.org/guidelines/pedPreventive/pedPreventive.asp?nav=04 1100 Mosby's Medical Dictionary. (2009). 8th edition. Preventative Care. Elsevier, 8. Retrieved from http://medicaldictionary.thefreedictionary.com/preventive+care National Public Health Partnership (2006). The Language of Prevention. Melbourne: NPHP. Retrieved from http://www.nphp.gov.au/publications/language_of_prevention.pdf National Vital Statistics System from the National Center for Health Statistics (2013). Percent Of All Age‐specific Injury‐related Deaths In Parentheses. Centers for Disease Control and Prevention. Retrieved from:  http://www.cdc.gov/injury/wisqars/index.html. Accessed April 4, 2013. Pozzo, A.M. (2014). Pediatric Type 2 Diabetes Mellitus: Practice Essentials. Medscape Education. Retrieved from: http://reference.medscape.com/article/925700- overview  United States Department of Health and Human Services. (2012). U.S. Key Features of the Affordable Care Act. Retrieved from https://www.healthcare.gov/what- are-my-preventive-care-benefits/