The educational and practice tensions in preparing pre-registration nurses to become future health promoters: A small scale explorative study

Workplace-based learning about health promotion in individual patient care: a scoping review

OBJECTIVE

To outline current knowledge regarding workplace-based learning about health promotion in individual patient care.

DESIGN

Scoping review.

DATA SOURCES

PubMed, ERIC, CINAHL and Web of Science from January 2000 to August 2023.

ELIGIBILITY CRITERIA

We included articles about learning (activities) for healthcare professionals (in training), about health promotion in individual patient care and in the context of workplace-based learning.

DATA EXTRACTION AND SYNTHESIS

The studies were evaluated using a charting template and were analysed thematically using a template based on Designable Elements of Learning Environments model.

RESULTS

From 7159 studies, we included 31 that described evaluations of workplace-based learning about health promotion, around a variety of health promotion topics, for different health professions. In the articles, health promotion was operationalised as knowledge, skills or attitudes related to specific lifestyle factors or more broadly, with concepts such as health literacy, advocacy and social determinants of health. We assembled an overview of spatial and instrumental, social, epistemic and temporal elements of learning environments in which health promotion is learnt.

CONCLUSIONS

The studies included in our analysis varied greatly in their approach to health promotion topics and the evaluation of learning outcomes. Our findings suggest the importance of providing opportunities for health profession learners to engage in authentic practice situations and address potential challenges they may experience translating related theory into practice. Additionally, our results highlight the need for conscious and articulated integration of health promotion in curricula and assessment structures. We recommend the exploration of opportunities for health profession students, professionals and patients to learn about health promotion together. Additionally, we see potential in using participatory research methods to study future health promotion learning.

STUDY REGISTRATION

Open Science Framework, https://doi.org/10.17605/OSF.IO/6QPTV.

Obesity and Diet Predict Attitudes towards Health Promotion in Pre-Registered Nurses and Midwives

Nurses and midwives are integral to public health promotion; in the UK, they are advised to act as role models by their governing body, but overweight or obesity rates are high. We explored whether obesity and dietary habits are related to attitudes towards healthy role modelling and health promotion practice. A total of 346 pre-registered UK nurses and midwives (92.6% female; 18–53 years) completed an online survey. Items included body composition, dietary habits assessed by the Lifestyle Behaviour Questionnaire (LBQ), attitudes towards being role models for health (RA: role attitudes) and attitudes toward health promotion practice (ATHPP): 33.8% of the sample self-reported as overweight or obese; 67.6% did not consume 5-a-day portions of fruit/veg; 31.5% reported a healthy diet; and 89.6% believed their diet could be healthier. Positive RA was significantly linked to health promotion engagement (HP) (ß = 0.33, p < 0.001). Positive ATHPP was significantly predicted by lower BMI (ß = −0.08, p = 0.078), positive RA (ß = 0.67, p < 0.001), lower HP (ß = −0.25, p < 0.001) and male gender (ß = 0.09, p = 0.02). Greater confidence in patients valuing healthcare professional’s advice was predicted by healthier diet (ß = 0.11, p = 0.03), lower BMI (ß = −0. 16, p < 0.01), more positive RA (ß = 0.14, p < 0.01) as well as HP engagement during training (ß = 0.20, p < 0.01). One’s own motivation to promote health, similarly to ATHPP, was predicted by RA (ß = 0.17, p = 0.001) and previous HP engagement (ß = 0.39, p < 0.001). Findings show that overweight and obesity are prevalent in pre-registered nurses and midwives; the majority did not consume a healthy diet. Individual’s body composition, diet and attitudes towards role modelling are positively associated with their attitudes towards, and confidence in, health promotion practice. Experiences of health promotion practice during training can have either a positive or a negative influence on attitudes. Mentors and educators could actively promote healthy lifestyles for pre-registered nurses and midwives and facilitate more opportunities for health promotion practice during placements, which includes time for reflection.

"You have to be okay with okay": experiences of flourishing among university students transitioning directly from high school

Mental health is central to overall wellbeing and, for students attending university, mental health is critical for learning and academic success. A wealth of research has focused on young people who experience psychosocial declines during academic and developmental transitions, but little is known about how young people flourish in this transition. The first to explore the experiences of flourishing among first-year Canadian university students making the transition directly from high school, this study sought to develop an understanding of: 1) the factors that promote flourishing amidst this academic and developmental transition, and 2) how first-year students define and experience flourishing. An interpretive phenomenological approach underpinned by Gadamerian hermeneutic philosophy was used to explore experiences of flourishing, using semi-structured interviews, in a sample of nine full-time, first-year university students, ages 18-20 years. What it meant to flourish amidst this developmental and academic transition and how participants defined flourishing offer new understandings of the concept associated with: 1) personal/individual aspects of flourishing, 2) contextual nature of flourishing, 3) temporality of flourishing, 4) dialectic aspects of flourishing. Implications for practice, policy, and research in light of these new understandings are discussed.

Preparing student nurses to be healthy role models: A qualitative study

There are national and international expectations for nurses to be healthy role models. This study aimed to investigate student nurses', nurse educators' and registered nurses' experiences and perceptions about being healthy role models and to explore whether nurse education prepares students to become healthy role models. The study used an exploratory qualitative design and was based in the south of England. Participants (n = 39) included student nurses, nurse lecturers and registered nurses. Data collection was conducted through focus groups and data were analysed using thematic analysis. The themes highlighted nurses' understanding of the key features of being a healthy role model, and perceptions that working as nurses does not support individuals to be healthy. Participants had varied views about whether they should be healthy role models or mirror society and share the same struggles with their health. Students and registered nurses reported inadequate understanding of health promotion and that there was a lack of healthy lifestyle content within undergraduate nurse education. Participants also considered that role modelling healthy behaviour would not in itself influence behaviour change. In conclusion, there needs to be preparation and support for student nurses to be healthy role models from the outset of nurse education.

Challenges and demands in the population-based work of public health nurses

AIMS

Government programs and the Norwegian Directorate of Health give public health nurses in Norway an explicit role in population-based health promotion and disease-prevention work. The aim of this paper is to explore Norwegian public health nurses' experiences with population-based work.

METHODS

A phenomenological hermeneutic approach was adopted, involving face-to-face interviews with a purposeful sample of 23 public health nurses from urban and rural districts in two counties in Norway.

RESULTS

Three themes were identified: the predominance of work at the individual level, a lack of resources, and adherence to administrative directives. The interviews revealed that the public health nurses were mostly occupied with individual problem-solving activities. Population-based work was hardly prioritized, mostly because of a lack of resources and a lack of recognition of the population-based role of public health nurses.

CONCLUSIONS

The study indicates contradictions between the public health nursing practice related to population-based work and the direction outlined by the government and the public health nursing curriculum, which may mean that the public health nursing role is not sufficiently clarified. The implementation of practice models and administrative directives and resources, as well as an explicit emphasis on population health in public health nursing education, can contribute to increased population-based interventions. Greater knowledge of and emphasis on population-based work in public health nursing are needed.

Nurse training in self-management of patients with cardiovascular diseases: a multicentre observational study

BACKGROUND AND AIM

The therapeutic education and self-management carried out by nurses, are winning elements in cardiovascular secondary prevention, but because they are complex matters, they require special training by the professionals. The target of the study has been to assess the effects in clinical practice of a training program for nurses in the management of patients with cardiovascular diseases, leaning towards a self-oriented patient management and therapeutic patient education.

METHOD

The research utilized a quali-quantitative study to compare the responses of 53 trained nurses (experimental group) and 101 untrained nurses (control group). The instrument used was a self-report structured in two sections: the first, a qualitative kind, was used to investigate the portrayal of nurses regarding self-management; the second, a quantitative kind, included a Likert scale based on 5 points (1=never, 5=always) that investigated the professional nurse's action in its bio-psycho-socio-relational and clinical activities (La Sala, 2012).

RESULTS

The trained nurses' approach is more oriented towards the psycho-socio-relational dimension, compared to the untrained nurses. A difference also emerged regarding activities of a bio clinical nature, which are performed much more by untrained nurses compared to trained professionals.

CONCLUSIONS

The health education and self-management skills were used by trained nurses during their care of patients with cardiovascular diseases, stressing the importance for professional nurses to develop an integrated competence, using narrative talks as the main tool in a patient-centred approach.

Nurses as role models in health promotion: a concept analysis

There are national and international expectations that nurses are healthy role models; however, there is a lack of clarity about what this concept means. This study used concept analysis methodology to provide theoretical clarity for the concept of role models in health promoting behaviour for registered nurses and students. The framework included analysis of literature and qualitative data from six focus groups and one interview. Participants (n=39) included pre-registration students (adult field), nurse lecturers and registered nurses (RNs), working in NHS Trusts across London and South East London. From the findings, being a role model in health promoting behaviour involves being an exemplar, portraying a healthy image (being fit and healthy), and championing health and wellness. Personal attributes of a role model in health promoting behaviour include being caring, non-judgemental, trustworthy, inspiring and motivating, self-caring, knowledgeable and self-confident, innovative, professional and having a deep sense of self.

Australian rural, remote and urban community nurses' health promotion role and function

Community nurses have often been 'touted' as potential major contributors to health promotion. Critical literature, however, often states that this has not been the case. Furthermore, most studies examining nurses' role and function have occurred mainly in hospital settings. This is a sequential mixed-methods study of two groups of community nurses from a Sydney urban area (n = 100) and from rural and remote areas (n = 49) within New South Wales, Australia. A piloted questionnaire survey was developed based on the five action areas of the Ottawa Charter for Health Promotion. Following this, 10 qualitative interviews were conducted for both groups, plus a focus group to support or refute survey results. Findings showed that rural and remote nurses had more positive attitudes towards health promotion and its clinical implementation. Survey and interview data confirmed that urban community nurses had a narrower focus on caring for individuals rather than groups, agreeing that time constraints impacted on their limited health promotion role. There was agreement about lack of resources (material and people) to update health promotion knowledge and skills. Rural and remote nurses were more likely to have limited educational opportunities. All nurses undertook more development of personal skills (DPS, health education) than any other action area. The findings highlight the need for more education and resources for community nurses to assist their understanding of health promotion concepts. It is hoped that community nurse leaders will collectively become more effective health promoters and contribute to healthy reform in primary health care sectors.

Conceptions of health promotion held by pre-registration student nurses in four schools of nursing in New Zealand

A research project conducted in four nursing schools in New Zealand presents an account of student nurses' conceptions of health promotion. Focus groups of six to ten pre-registration nursing students were conducted in each of the schools of nursing. The findings indicated that the student nurses had difficulty clearly articulating the concept of health education and health promotion. The student nurses focused on individuals. The main strategy they used was the giving of information. This strategy was in keeping with a traditional approach to health promotion. However a number of students did include empowering interpersonal strategies in their health promotion activities. Many of the students demonstrated an awareness of the impact of economic determinants on health but did not have the support or opportunity to address these. None of the students included addressing the political determinants of health in their discussion of the health promoting role of the nurse.

Nursing students' attitudes to health promotion to: implications for teaching practice

For several decades now the World Health Organization has indicated the need for a reorientation of the health services away from focusing solely on illness and disease to one that considers both disease prevention and health promotion. Successive publications that guide public health policy both nationally and internationally reiterate the need for health promotion and the principles of health for all to become integral to the fabric of health care delivery. The role of the nurse as health promoters is well recognized. However despite acknowledgement by professional nursing bodies and nurse educators that health promotion forms a central tenet of undergraduate nurse education curricula, there are varied approaches to teaching and learning and little formal evaluation of the consequences of approaches taken. The aims of this study are to identify current health promotion curricular content within the Irish undergraduate nursing programme context; to measure nursing students' attitudes towards health promotion and to examine nursing students' reported lifestyle behaviours.

Real mental health promotion requires a reorientation of nursing education, practice and research

The evidence for the individual, social and economic benefits of mental health promotion is now well established. The indication is that a broader public health approach that addresses social and environmental factors related to mental health and well-being is required. Mainstream mental health services, however, continue to operate in relative isolation, allocating the greatest proportion of funding and resources to the treatment of mental illness and disorder. Relevant to health promotion, this paper explores the bidirectional link between physical and mental health and the social determinants of mental health. The growing interest in the positive aspects of health and well-being which focuses on wellness rather than illness is also discussed. One example of how mental health nurses can adopt principles of positive mental health to education, practice and research is presented. The author proposes that as the largest professional group in health care, nurses must become more actively involved in initiatives that reorientate practices and services away from an illness culture towards the adoption of wider mental health promotion principles.

Community health nursing vision for 2020: shaping the future

As health care is shifting from hospital to community, community health nurses (CHNs) are directly affected. This descriptive qualitative study sought to understand priority issues currently facing CHNs, explore development of a national vision for community health nursing, and develop recommendations to shape the future of the profession moving toward the year 2020. Focus groups and key informant interviews were conducted across Canada. Five key themes were identified: community health nursing in crisis now, a flawed health care system, responding to the public, vision for the future, and CHNs as solution makers. Key recommendations include developing a common definition and vision of community health nursing, collaborating on an aggressive plan to shift to a primary health care system, developing a comprehensive social marketing strategy, refocusing basic baccalaureate education, enhancing the capacity of community health researchers and knowledge in community health nursing, and establishing a community health nursing center of excellence.

The preparation of child health nurses in sexual health education: an exploratory study

There are very high rates of pregnancy and sexually transmitted infections in the teenage population in Scotland. The Scottish Government recommends that child health nurses working alongside education professionals should be addressing these issues. The aim of this study was to explore the nature, type and experience of educational provision student nurses gain during their undergraduate programme to help them deal effectively with the sexual health needs of children and young people with whom they are involved. Thirteen students from two third year cohorts of a child health pre-registration nursing programme took part in this qualitative, phenomenological study. Focus groups (n=2) were undertaken to gather data and to develop emerging themes. Four themes are reported: "greater knowledge and expectations" "variation in practice affects the variety of experience" "sexual health should be part of the role" and "need to be better prepared". The students reported on their previous experiences of sex education and about differences in practice whilst out on a variety of placements. Most of the students believed that delivering sexual health education to young people was the nurse's role however there appeared to be a consensus that they did not have sufficient knowledge of sexual health to achieve this.

An international Delphi study examining health promotion and health education in nursing practice, education and policy

AIM

To arrive at an expert consensus in relation to health promotion and health education constructs as they apply to nursing practice, education and policy.

BACKGROUND

Nursing has often been maligned and criticized, both inside and outside of the profession, for its ability to understand and conduct effective health promotion and health education-related activities. In the absence of an expert-based consensus, nurses may find it difficult to progress beyond the current situation. In the absence of any previously published nursing-related consensus research, this study seeks to fill that knowledge-gap.

DESIGN

A two-round Delphi technique via email correspondence.

METHODS

A first-round qualitative questionnaire used open-ended questions for defining health promotion and health education. This was both in general terms and as participants believed these concepts related to the clinical, theoretical (academic/educational) and the policy (political) setting in nursing. Line-by-line qualitative content and thematic analysis of the first-round data generated 13 specific categories. These categories contained 134 statement items. The second-round questionnaire comprised the identified 134 statements. Using a five-point Likert scale (ranging from 1 = strongly disagree to 5 = strongly agree) participants scored and rated their level of agreement/disagreement against the listed items. Data from the second-round was descriptively analysed according to distribution and central tendency measures.

RESULTS

An expert consensus was reached on 65 of the original 134 statements. While some minor contradiction was demonstrated, strong consensus emerged around the issues of defining health promotion and health education and the emergence of a wider health promotion and health education role for nursing. No consensus was reached on only one of the 13 identified topic categories - that of 'nurses working with other disciplines and agencies in a health education and health promotion role.'

CONCLUSIONS

This study provides a hitherto previously absent expert consensus on the current position of health promotion and health education, in nursing and predictions for their future course. Its findings represent an important step for nurses as they seek to become increasingly active and influential within wider health promotion and health education arenas. Relevance to clinical practice. Delphi studies do not necessarily offer indisputable fact. This study, however, with its strong consensus on the majority of original statements is a good indicator as to how nursing experts currently view health promotion and health education constructs. Expert consensus offers a useful form of measure against current and future clinical practice and helps to build a firm foundation for change. Nurses, then, are advised here to refer to the findings presented, that they remain contextually and conceptually clear, as they embark on current and future health promotion-related activities.