Home > RNJ > 2008 > July/August > Editorial: Prevention Scorecard

Editorial: Prevention Scorecard
Elaine Tilka Miller, DNS RN CRRN FAHA FAAN Editor

Although many aspects of rehabilitation nursing are constantly changing, the prevention of health problems remains a cornerstone of our practice. Yet, despite the mounting evidence suggesting ways to specifically prevent major chronic diseases such as diabetes, heart disease, and stroke, few U.S. dollars are spent on these preventable conditions, which account for a majority of our morbidity and mortality compared with existing diseases (U.S. Department of Health and Human Services, 2003). In addition, within our various practice settings numerous other preventable conditions, such as skin breakdown, infections, and falls, could be reduced. If you had a scorecard to evaluate your professional and personal prevention activities, how would you rate yourself?

How often do you take advantage of prevention opportunities or advocate for resources that enhance the long-term health of your patients, your colleagues, and yourself? This issue of the journal focuses on essential preventive actions that can dramatically enhance quality of life and reduce healthcare costs. The skin, for instance, is our first line of defense against the outside world and constitutes a protective barrier that all nurses and healthcare professionals (HCPs) should monitor. Although practice standards and charting requirements dictate times for routine skin examination, it is important to do more. Many patients are at risk for skin problems including pressure ulcers, which can lead to sepsis and death (King, 2008; Ayello, 2007). So many skin problems could be prevented, or at least reduced in severity, if evidence-based guidelines were operationalized (e.g., proper positioning, turning, nutrition). As rehabilitation nurses, we frequently deal with instances of decubitus and contractures that limit mobility and quality of life, but could have been prevented with targeted interventions. If you are not achieving the desired outcomes in your practice setting or your preventive actions are limited by others, carefully examine the barriers as well as facilitators to fostering positive change (e.g., teachable moments with patients and HCPs, availability of evidence-based guidelines). Perhaps Ehrlich-Jones’s article, which pertains to conducting literature searches for evidence, will be helpful for identifying strategies or data to overcome these barriers.

My suggestion is not to create a laundry list of preventive actions that need to be enacted; rather, highlight the importance of daily activities that influence our patients and our own functional abilities and quality of life. Another example of prevention that can significantly affect long-term health is discussed in Hinkle’s article. When examining individuals at risk for stroke, it is crucial to be aware of modifiable and nonmodifiable risk factors. Although individuals cannot change their race, age, gender, or family history of stroke, there are modifiable risk factors such as hypertension, smoking, physical activity, and diet that have been demonstrated to significantly affect the incidence of stroke (American Heart Association [AHA], 2008; Miller, 2007). Data support that as many as 80% of ischemic strokes (accounting for approximately 85% of strokes) can be prevented if these modifiable risk factors are addressed using evidence-based parameters (AHA). Plus, other evidence illustrates how several major companies (e.g., Motorola, Caterpillar, Johnson and Johnson) instituted award-winning disease-prevention wellness programs (Health Project, 2006). So if you or your patients are at increased risk for stroke, what immediate preventive actions can be taken to diminish this risk?

Given our culture and lifestyle, prevention is something that most of us consider important, but somehow forget or underemphasize. It is imperative to revisit preventive actions directed at patients as well as yourself. Change is difficult and takes time, but small steps taken today to coordinate preventive practices can lead to greater ones tomorrow or next week. The information provided in this issue of the journal can serve as a first step in accomplishing your goals and achieving desired outcomes. The journal also encourages you to submit manuscripts that help advance our collective preventive actions.


Ayello, E. A. (2007). Predicting pressure ulcer risk. Try This, 5(1). Retrieved April 23, 2008, from http://www.hart fordign.org/publications/trythis/issue05.pdf.

American Heart Association. (2008). Heart disease and stroke statistics: 2008 update. Dallas, TX: Author.

Health Project. (2006). C. Everett Koop National Health Awards. Retrieved April 23, 2008, from http://health project.stanford.edu/koop/index.html.

King, R. B. (2008). Preventive skin care beliefs of people with spinal cord injury. Rehabilitation Nursing, 33(4), 154–162.

Miller, E. (2007). Prevention of transient ischemic attack and stroke in older adults: Implementing evidence-based interventions. Journal of Gerontological Nursing, 33(7), 26–37.

U.S. Department of Health and Human Services (2003). Prevention makes common “cents.” Retrieved April 23, 2008, from http://aspe.hhs.gov/health/prevention/.