Primary Health Care

Introduction to Role of The Nurse in Health Promotion

Rheumatic heart disease presents as a chronic disease burden among the less privileged population globally. It is a sequela of acute rheumatic fever, caused by Group-A Streptococcus and in order to prevent this disease adequate health promotion is required (Coffe, Ralph & Krause, 2018). The first Health Promotion International Conference was held in Ottawa, Canada and the conference aimed to recognise actions to achieve the objectives of Health for all initiative by the World Health Organization. The aim of this essay is to discuss the role of nurses in health promotion in rheumatic heart disease through the five main strategies identified in the Ottawa Charter for Health Promotion (WHO, Health and Welfare Canada & CPHA, 1986). Here in the discussion section all the three steps of Ottawa charter health promotion which includes strengthening community action, developing personal skills, building healthy public policy, creating a supportive environment and reorienting health services will be discussed in relation of rheumatic heart disease with the help of credible sources. 

Discussion on Role of The Nurse in Health Promotion

The five main strategies for health promotion as per the Ottawa Charter include building healthy public policy, creating a supportive environment, strengthening of community action, developing personal skills and reorienting health services (WHO, 2020). These can be brought into action by the means of advocacy, enabling and mediation. Advocating that good health is a vital source for personal, social as well as economic growth and an essential for improving the quality of life. Enabling paths that focus on achieving equitable health by making available equal opportunities for everyone to attain full health potential. Mediating health promotion through coordinated action between the government, social, health and economic sectors (Victorian Government Department of Health & Human Services, 2020).

Strengthening Community Action: Rheumatic heart disease is referred to as the disease of poverty, but the exact integrands of poverty that lead to this disease are still unclear (Coffe, Ralph & Krause, 2018). Within the community, a dramatic influence of the social, behavioural, economic and behavioural conditions has been observed on the spread of streptococcal infection as well as the progression of rheumatic heart disease. Community nurses work at the forefront of the healthcare system and play an essential role in community prevention of different diseases (Roden et al., 2016). They have the potential to spread awareness as well as promote better hygiene, healthy habits and information about different infections and diseases within the community. Hence, nurses can work as advocates here and can motivate and promote the government to invest increasingly in the education and training of community nurses as well as fund various policies and strategies that strengthen the provisions and development of community health services.

Developing personal skills: The health-promoting activities should have a wider vision and a multi-level approach which includes inter-sectoral, individual and collective commitment. Health promotion can also include health education activities such as group discussions, professional guidance from the doctors and nurses as a team and also exchange of experiences. The nurses highlighted that they aim to improve the quality of life of the individual, family and community through the health-promoting activities (Maceno & Heidemann, 2016). Through a close positive relationship formed by the nurses with the patients, the nurses can promote health in a better way. The nurses can help the people of community to be acquainted with all the necessary knowledge and skill so that they can have a better control on their health and can prevent diseases like rheumatic heart disease. According to Caldron (2011), strengthening of the primary care systems has substantial capacity for improving the opportunities and potential of the nurses for health-promoting activities which is in line with the National Primary Health Care Strategy (Australian Government Department of Health and Ageing, 2010).

With the evolution of medical science and technologies, there are new approaches for diagnosis, treatment and prognosis developing each day. These advancements can be used by the nurses for developing skills among people to control this disease. Through effective screening and assessment, the nurses can analyse the risk factors and causes of the disease which can be shared with the people to better control these factors and prevent the spread of rheumatic heart disease. A new method has been developed to screen and detect subclinical cases of rheumatic heart disease through an echocardiograph (Engelman et al., 2016). This can help with secondary prevention of rheumatic heart disease, however, it is constrained by inadequate training of the healthcare providers. Training the nurses to carry out focused cardiac ultrasound can help with screening as well as health promotion and awareness of rheumatic heart disease.

Building healthy public policy: Rheumatic heart disease poses as a major preventable cause of cardiovascular death as well as cardiovascular disability, especially in developing countries. It is linked with poor sanitation, overcrowding and other social determinants of poor health (Watkins et al., 2017). Some developed countries have eradicated or successfully reduced the occurrence of the disease and this success is attributed to better socio-economic conditions and increased use of penicillin G benzathine to treat infections by streptococcus. However, the disease burden still thrives in developing countries, immigrants and older populations in the developed countries. Several countries that have been able to significantly reduce mortality and morbidity associated with rheumatic heart disease and rheumatic heart fever can attribute their success to planning and implementation of policies and control programs which have led to major improvements in the health system (Watkins et al., 2017). Therefore, policies and funds need to be directed towards improving the socio-economic conditions and increasing the awareness about rheumatic heart disease. Rheumatic heart disease has a prolonged subclinical presentation and there is a lack of information regarding the same. The nurses can be made the vectors who spread information, precautions, as well as, help increase the use of penicillin G benzathine. Currently, there are no policies that focus on this, hence a paradigm shift is essential, especially in developing countries, to combat rheumatic heart disease. The nursing can help in development of such policies where they can provide evidence based information to policymakers for implementing in community settings in order to prevent rheumatic heart disease. 

Creating a supportive environment: Untreated streptococcal pharyngitis has been identified as a precursor of rheumatic heart diseases and its prevention is associated with access to better health care and understanding the influence of the social determinants of health on its occurrence. However, the lack of progress in addressing the social determinants has been strongly associated with mortality and morbidity due to rheumatic heart disease especially in the low and middle-income countries (Dougherty et al., 2018). There are many reasons for this ongoing discrepancy worldwide which includes poverty, ineffective advocacy and frail health systems. A supportive environment can be constructed by strengthening the healthcare system, better policies as well as strategies and enhancing the provision of healthcare across the various economic strata. Community healthcare services should be underpinned and community nurses trained in health-promoting activities to fight the chain of infection and spread better hygiene habits as well as ways of prevention against streptococcal infections, acute rheumatic fever and rheumatic heart disease. Apart from this, the nurses can help understand the various social determinants and help work on them to ensure improved healthcare delivery for all.

Reorienting health services: To develop better healthcare provision, improve and sustain the quality of health as well as life, it is essential to reorient the hospital and health services towards health promotion (Read et al., 2018). At primary health care centres, the strengthening of the healthcare system activities can fail if the strategies and activities are unable to positively engage and offer self-management care and support to the community, especially for chronic diseases. It is vital to perform a qualitative assessment of the outcomes to understand the areas that need improvement and to check if the strategies that have been implemented are a success or failure. Since the nurses work in close association with the patients and have a better reach with them, they can help in both engaging the community as well as evaluating the outcome of the policies and strategies and eventually bring about modifications according to the outcome.

The healthcare system needs to be enhanced to support health education and improvement of the quality of health services on a continuous basis for better patient engagement and outcome. Community driven models of healthcare are being created and support tools for improved treatment adherence being brought into practice to enable compliance to the treatment for the sick and prevention for the healthy.

Conclusion on Role of The Nurse in Health Promotion

Health promotion nursing can be implemented through various strategies and can help improve prevention, awareness and detection of rheumatic heart disease. Rheumatic heart disease has been identified to have a major disease burden due to its morbidity and mortality as well as prolonged subclinical presentation. The nurses who work in close association with the patients can be used as a medium to strengthen the action of the community as they work on the frontline of the healthcare system. Nurses need to develop personal skills through education and training in health promotion. Policies and strategies need to be planned and implemented to train the nurses and enable them to perform health-promoting activities to the different socio-economic groups. The nurses can enhance the understanding as well as help work past the social determinants of the society to help create a supportive environment for health promotion. Healthcare system needs to be re-oriented to enable the nurses to evaluate and act on the outcomes of the various implementations of health policies and strategies as well as to successfully engage the community in the prevention and eradication of rheumatic heart disease.

References for Role of The Nurse in Health Promotion

Calderon, C., Balague, L., Cortada, J. & Sánchez, A. (2011). Health promotion in primary care: How should we intervene? A qualitative study involving both physicians and patients. BMC Health Services Research, 11(62), 1-11.

Coffey, P. M., Ralph, A. P. & Krause, V. L. (2018). The role of social determinants of health in the risk and prevention of group A streptococcal infection, acute rheumatic fever and rheumatic heart disease: A systematic review. PLOS Neglected Tropical Diseases, 12(6), 1-22. doi: 10.1371/journal.pntd.0006577 

Common Wealth of Australia. (2010). National Primary Health Care Strategic Framework. Retrieved from:

Dougherty, S., Beaton, A., Nascimento, B.R., Zühlke, L.J., Khorsandi, M. & Wilson, N. (2018). Prevention and control of rheumatic heart disease: Overcoming core challenges in resource-poor environments. Annals of Pediatric Cardiology, 11(1), 68-78.

Engelman, D., Kado, J. H., Reményi, B., Colquhoun, S. M., Carapetis, J. R., Wilson, N. J., Donath, S. & Steer, A. C. (2016). Screening for rheumatic heart disease: quality and agreement of focused cardiac ultrasound by briefly trained health workers. BMC Cardiovascular Disorders, 16(1), 1-9. doi:10.1186/s12872-016-0205-7 

Maceno, P. R. & Heidemann, I. T. S. B. (2016). Unveiling the actions of nurses in primary health care groups. Texto & Contexto-Enfermagem, 25(4), 1-9.

Read, C., Mitchell, A. G., de Dassel, J. L., Scrine, C., Hendrickx, D., Bailie, R. S., Johnston, V., Maguire, G.P., Schultz, R., Carapetis, J.R. & Ralph, A. P. (2018). Qualitative evaluation of a complex intervention to improve rheumatic heart disease secondary prophylaxis. Journal of the American Heart Association, 7(14), 1-15. doi:10.1161/jaha.118.009376 

Roden, J., Jarvis, L., Campbell-Crofts, S. & Whitehead, D. (2016). Australian rural, remote and urban community nurses' health promotion role and function. Health Promotion International, 31(3), 704–714.

Victorian Government Department of Health and Human Services. (2020). Ottawa Charter for health promotion. Retrieved from:

Watkins, D. A., Johnson, C. O., Colquhoun, S. M., Karthikeyan, G., Beaton, A., Bukhman, G., Forouzanfar, M. H., Longenecker, C.T., Mayosi, B.M., Mensah, G.A., Nascimento, B.R., Ribeiro, A.L.P., Sable, C.A., Steer, A.C., Naghavi, M., Mokdad, A.H., Murray, C.J.L., Vos, T., Carapetis, J.R. & Roth, G. A. (2017). Global, regional, and national burden of rheumatic heart disease, 1990–2015. New England Journal of Medicine, 377(8), 713–722.

World Health Organization. (2020). The Ottawa Charter for health promotion. Retrieved from:

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