Wellness and disease prevention: This sphere emphasizes health promotion, as well as the treatment of minor uncomplicated diseases or injuries for those not experiencing chronic illness or life-limiting conditions. Prenatal care, screenings, immunizations, and health promotion are some examples of care in this sphere (AACN, 2021). Nursing knowledge and competency in disease prevention and addressing social determinants of health are vital to promoting wellness across populations.
Chronic disease management: This sphere encompasses caring for those with one or more chronic diseases and preventing adverse outcomes associated with them. Specialized nursing care is often needed for this population due to the complex needs, along with integrated interprofessional team-based care. Four in 10 Americans have two or more chronic diseases, and those diagnosed with multiple comorbidities are projected to increase.
Regenerative and restorative care: This sphere includes critical and trauma care, complex acute care, acute exacerbations of chronic disease, and care of unstable patients who are typically in acute care hospital settings (AACN, 2021). This sphere includes the acute management of illness, such as a stroke or mental health crisis, and progression through the rehabilitative phase. Nursing skills and management of these populations are resource-intensive and specialized.
Hospice and palliative care: The final sphere relates to competencies surrounding palliative care in advanced illness and hospice care at the end of life. All registered nurses provide generalist palliative care in compassionate and patient-centered care while managing pain and other symptoms associated with advanced, progressive illness. The End-of-Life Nursing Education Consortium has mapped its Competencies and Recommendations for Educating Nursing Students competencies to the new AACN Essentials to assist educators in this endeavor.
Reflection Questions
By the end of your practicum, make sure that you have answered each of these questions.
• Wellness and disease prevention: Reflect on the health promotion disease prevention interventions you witnessed in your practicum site, as it relates to the social determinants of health most prevalent in your community. What did you see? What does this time mean to you as a professional nurse in your role?
Sample Answer
This is a thoughtful reflection question based on the American Association of Colleges of Nursing (AACN) Essentials spheres of care. Since I don't know the specifics of your practicum site or community, I'll provide a framework to help you structure your answer.
When reflecting on the Wellness and Disease Prevention sphere, focus your answer on the connection between the interventions you observed and the specific Social Determinants of Health (SDOH) affecting your community.
Wellness and Disease Prevention: Practicum Reflection
What I Saw: Observed Interventions and SDOH
Reflect on the specific health promotion and disease prevention activities you witnessed during your practicum. Then, tie them directly to the prevailing SDOH in that community.
Identify the Interventions: Think about activities like:
Screenings: Blood pressure checks, A1c testing, cancer screenings, developmental screenings for children.
Immunizations: Flu shots, COVID-19 vaccines, routine childhood immunizations.
Health Education/Promotion: Group classes (e.g., nutrition, diabetes self-management), one-on-one counseling (e.g., smoking cessation, safe sex practices), distribution of educational materials.
Identify the Most Prevalent SDOH: What non-medical factors are most significantly impacting health in this community?
Economic Stability: High unemployment, food insecurity, poverty.
Neighborhood and Built Environment: Lack of safe parks/walkable areas, limited access to healthy food (food deserts), substandard housing.
Education Access and Quality: Low literacy levels, lack of health education in schools.
Social and Community Context: High rates of violence, lack of social support networks, discrimination.
Health Care Access and Quality: Lack of insurance, limited transportation to clinics, linguistic barriers.
Example Connection (You will use your own specific details): "I observed a community health fair (Intervention) that focused on providing free blood pressure and A1c screenings. This was a direct response to the community's prevalent SDOH of Economic Stability (many residents couldn't afford a regular primary care doctor) and Neighborhood and Built Environment (the area is a 'food desert' contributing to higher rates of hypertension and diabetes)."
What This Time Means to Me as a Professional Nurse
This section addresses your growth and realization of the importance of the Wellness and Disease Prevention role.
The Nurse's Role in SDOH: Your experience should solidify the idea that a nurse's job extends beyond the hospital bedside. Nurses are key figures in addressing the root causes of disease by intervening in the SDOH.
Advocacy: Realize the importance of advocating for policy changes or resources that address poverty, housing, or transportation barriers.
Holistic Assessment: Understanding that a comprehensive patient assessment must include questions about housing, food security, and social support.
Community Partnership: Recognizing that effective health promotion requires collaborating with non-healthcare entities like schools, food banks, and housing agencies.
Personal Meaning: Use strong, professional language to describe your takeaway:
"My time here illuminated the profound impact of Social Determinants of Health on wellness. It has reinforced my commitment to adopting a public health mindset in every patient interaction, knowing that simply diagnosing a condition is insufficient without addressing the context of the patient's life."
"I now see my role not just as a provider of care but as an essential connector—linking patients with the community resources they need to truly manage their health outside of the clinic walls."
This reflection demonstrates that you understand the AACN Essentials and the critical link between social factors and health outcomes.