Health Promotion and Disease Prevention: Considerations and Interventions

When developing health promotion and disease prevention strategies for a healthy peripheral vascular system (PVS), always select an appropriate intervention based on careful consideration of all collected data, both subjective and objective. Subjective data collection should include asking about risk factors, social determinants, and other considerations. 

This kind of inquiry should be integrated throughout the assessment. You will ask many probing questions during the subjective assessment phase, but you will also come up with some questions based on your critical reflection of all data collected during the subjective and objective assessments. All of these data will inform your clinical judgement and appropriate health promotion strategies for a specific patient.

Activity

Any activity, including general daily activity, aerobic exercise, and strength training, improves blood flow within the body, lowers blood pressure, and supports the transportation of oxygen throughout the PVS. An active lifestyle and regular exercise lower the risk of vascular diseases. Exercise and participating in social activities can also help reduce stress, which in turn can help lower blood pressure and decrease the risk of peripheral vascular disease (PVD); a sedentary lifestyle with limited activity increases the risk factors that contribute to PVD. Standing and sitting for sustained periods of time can increase venous stasis and risk of deep vein thrombosis (DVT). For example, DVT can be an issue for some people with lengthy air travel due to the sustained period of sitting and lack of activity.

Guidelines for activity vary based on age and health status. Most people should engage in about 30–60 minutes of aerobic activity, five to seven times per week.

Probing questions related to activity might include:

• Tell me about your daily exercise? What activities are you involved in? (Probe about the type and amount each day.)
• Do you have any concerns about your level of activity or exercise? Do you have any limitations to your mobility that affect your activity?
• Do you experience leg pain or cramps when walking? Do you experience a lack of sensation to heat or cold in the extremities?

Collaborate with the client to create an activity/exercise plan that is specific to their needs and goals. Be aware of your own biases related to activity/exercise with certain populations such as older clients or clients who may currently live sedentary lifestyles or have mobility issues. Also, recognize that some clients may have concerns about starting an exercise plan: these might include exacerbating pain, fear of falling, mobility issues, and/or a history of previous falls. Try to connect with the client and get to know them and their needs and fears. Start at a realistic and attainable level, depending on the client’s physical capabilities and energy level, and then begin to increase the time and duration of the physical activity. Many interventions are available to help clients achieve their activity goals: community walking groups, fitness apps, or joining a local gym or group activity. When appropriate, encourage clients to ask family and friends to get active with them: a strong support system can help clients stay active and achieve their health goals. The participACTION website is a helpful resource for activity guidelines: https://www.participaction.com/en-ca. Also, consider activity interventions from a structural health promotion approach: for example, consider the financial costs associated with many resources and the client’s financial ability to pay for them.

Diet

A healthy diet helps maintain healthy blood vessels of the PVS and decreases the risk of plaque buildup in the blood vessels. A heart-healthy diet of leafy greens, vegetable, fruits, whole grains, nuts, fish, lean meats, low-fat dairy, and monounsaturated fats (e.g., olive oil) helps the body function, controls blood pressure, lowers cholesterol and blood glucose levels, and helps maintain an ideal body weight. In contrast, an unhealthy diet of refined sugars, carbohydrates, saturated and trans fats, and high levels of cholesterol and salt can lead to buildup of plaque in the arteries, high blood pressure, obesity, and an increased risk of PVD.

Canada’s guidelines now suggest that there are health risks associated with any level of alcohol consumption, although negligible with two drinks or less weekly (Paradis et al., 2022). The current literature indicates that drinking alcohol of any kind does not decrease risks of heart disease, and high levels of consumption increase risk for coronary artery disease, myocardial infarction, heart failure, hypertension, and stroke (Paradis et al., 2022).

 Probing questions related to diet might include:

• Tell me about your typical diet? What sorts of food do you eat each day?
• What have you eaten in the last 24 hours? Is that your usual diet?
• Do you have enough money to buy healthy food? Do you pack a lunch or purchase your food when out?
• Tell me about your cultural practices related to diet?

Explore the client’s familiarity with Health Canada’s Food Guide (Government of Canada, 2021) and explain that it can help them guide their food choices: https://food-guide.canada.ca/en/. However, this guide still includes Eurocentric elements, so you should collaborate with the client about its relevance in the context of their cultural food practices. A snapshot of the food guide is now offered in dozens of languages: https://www.canada.ca/en/health-canada/services/canada-food-guide/resources/snapshot/languages.html and many resources have been developed for Indigenous populations: https://www.sac-isc.gc.ca/eng/1581522106156/1581522147811.

Assess the client’s lifestyle to understand how it affects their diet and how you can help them adapt to include healthier food choices when possible. Use a relational health promotion approach to learn what a healthy diet means to the client and how their environment and the people within it can influence their choices. For example, some clients may choose fast food vendors for lunch due to accessibility (e.g., school or work cafeteria options). Try to help the client find accessible food services or learn how to pack healthy lunches. Issues related to food security, and the increasing costs of food globally, has made it difficult to ensure everyone can have a healthy diet. As a nurse, you can advocate to ensure the particular needs of each client are being met using the available socioeconomic and environmental resources. Advocacy might include identifying and securing access to resources for clients, as well as political advocacy efforts related to food costs and geographical access to food. By working in partnership with clients, you can create effective interventions that help them achieve a healthy diet.

Smoking

Smoking tobacco has negative effects on the PVS because it can damage blood vessels and increase the risk of atherosclerosis and PVD. Smoking can cause the blood vessels to narrow, which reduces blood flow and the transportation of oxygen to the peripheral areas (e.g., limbs). There has been some recent interest in the health effects of cannabis use, but the literature remains inconclusive in terms of peripheral vascular and cardiovascular diseases (Page et al., 2020). Some have suggested that smoking cannabis may lead to arteritis and should be considered in adults younger than 50 years of age who are presenting with signs and symptoms associated with PVD (Cottencin et al., 2010 as cited in Page et al., 2020).

Always use a culturally inclusive and non-judgemental approach when you are asking about consuming tobacco and cannabis or providing health education. For example, be aware that tobacco plays an important part in traditional and spiritual practices in many communities, such as some Indigenous communities, where individuals may use it for ceremonial and medicinal purposes (CAN-ADAPTT, 2011). 

Probing questions related to smoking tobacco and cannabis might include:

• Do you smoke cigarettes or use any tobacco- or cannabis-related products? If affirmative, ask probing questions such as: How much per day? What type of product do you use (e.g., smoking, vaping, chewing)? For how long? Can you tell me the reasons you began smoking? Have you ever considered quitting smoking? 
• If you do not currently smoke, have you ever? If affirmative, ask similar probing questions, including the reason that the client quit.
• Are you exposed to second- or third-hand smoke? If affirmative, ask similar probing questions, including whether the client is still exposed and possible interventions to reduce the risk.

Health education should focus on the client’s lifestyle, living situation, and reasons for using tobacco. ​​Interventions related to using safely or quitting should be tailored to each client and could include counselling, cognitive-behavioural therapy, and support groups. You should also consider a relational approach. For example, a client’s smoking or second- and third-hand exposure can be influenced by their surrounding environment (e.g., family, friends, workplace). 

References

CAN-ADAPTT. (2011). Canadian Smoking Cessation Clinical Practice Guideline. Canadian Action Network for the Advancement, Dissemination and Adoption of Practice-informed Tobacco Treatment, Centre for Addiction and Mental Health. https://www.nicotinedependenceclinic.com/en/canadaptt/PublishingImages/Pages/CAN-ADAPTT-Guidelines/CAN-ADAPTT%20Canadian%20Smoking%20Cessation%20Guideline_website.pdf

FAO, IFAD, UNICEF, WFP and WHO. (2021). The State of Food Security and Nutrition in the World 2021. Transforming food systems for food security, improved nutrition and affordable healthy diets for all. Rome, FAO. https://doi.org/10.4060/cb4474en

Page, R., Allen, L., Kloner, R., Carriker, C., Martel, C., Morris, A., Piano, M., Rana, J., Saucedo, J, on behalf of American Heart Association Clinical Pharmacology Committee and Heart Failure and Transplantation Committee of the Council on Clinical Cardiology; Council on Basic Cardiovascular Sciences; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; Council on Lifestyle and Cardiometabolic Health; and Council on Quality of Care and Outcomes Research (2020). Medical marijuana, recreational cannabis, and cardiovascular health: A scientific statement from the American Heart Association. Circulation, 142(10), e131-e152. https://doi.org/10.1161/CIR.0000000000000883

Paradis, C., Butt, P., Shield, K., Poole, N., Wells, S., Naimi, T., Sherk, A., & the Low-Risk Alcohol Drinking Guidelines Scientific Expert Panels. (2022). Update of Canada’s Low-Risk Alcohol Drinking Guidelines: Final Report for Public Consultation. Ottawa, Ont.: Canadian Centre on Substance Use and Addiction.