The role of Project 2000 educated nurses in health promotion within the hospital setting

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.

A qualitative study exploring the relationship between nursing and health promotion language, theory and practice

The definitions and meaning qualified nurses employed in an acute NHS hospital setting in the UK gave to health education and health promotion practice and how these fitted established language and theory were investigated qualitatively. These concepts, and the concomitant frameworks and models of practice, have been the subject of considerable debate in the literature. While unresolved both in general and in nursing, a degree of theoretical convergence was established in the 1990s [Bunton, R., Macdonald, G., 1992. Health promotion: disciplines and diversity. Routledge, London; Maben, J.M., Macleod Clark, J. 1995. Health promotion: a concept analysis. Journal of Advanced Nursing 22, 1158-165] helped by The Ottawa Charter [WHO, 1986. Ottawa Charter for Health Promotion. http://www.who.int/hpr/archive/docs/ottawa.html]. For many of the participants in this study however, the meanings given to these concepts and the predominant use of health education were inconsistent with much of the language of the wider debate and this has potential implications for nurse education. For, if the findings are considered transferable then there is a need to develop education strategies and curricula that articulate the ideological foundations of policy and practice and to use mainstream terminology to assist nurses both to understand and contribute to the contemporary health promotion debate.

Do healthier nurses make better health promotors? A review of the literature

This discussion paper draws on a review of the literature to explore factors that might promote or inhibit healthier nursing practice. The term healthier nursing practice, used here, refers to the way commitment to health promoting practices at organisational, professional and personal levels is demonstrated and achieved. Health promotion is a holistic concept that calls for the creation of empowered relationships between self, others, and the environment to improve wellness. Nurses have often struggled to achieve this within their patient encounters and even more so within their own personal and professional life experiences. Two factors were identified in the literature review that appear to significantly impact on this situation, the organisational environment within which nurses practice and their educational exposure to health promoting opportunities. There are a number of parallel processes identified that illustrate the difficulties nurses have in their experiences of working with patients and with themselves in promoting healthier lives. Action learning is advocated as an effective way for nurses to address what are sometimes perceived as being insurmountable barriers to developing health promoting opportunities for patients and the individual nurse.

Reviewing health promotion in nursing education

The [World Health Organisation, 2000. Nurse and Midwives for Health: A WHO European Strategy for Nursing and Midwifery Education. WHO Regional Office for Europe, Copenhagen] European Strategy for Nursing and Midwifery Education calls for the explicit inclusion and application of health promotion in all nursing curricula. Prior to this strategy, and subsequently, studies have explored the nature and extent of health promotion in nursing education. This article extensively reviews this body of literature. Overall, the literature, both included in this review and its supporting discussion, presents a picture suggesting that the call for effective inclusion of health promotion has in many cases gone unheeded. The literature also identifies that the educational delivery of broader elements of health promotion is muted in comparison to the 'traditional' constructs of health education. Considerations for wider reform, born out of the literature, are presented.

Findings from non-participant observational data concerning health promoting nursing practice in the acute hospital setting focusing on generalist nurses

AIM

This paper reports on the non-participant observational findings from a study, which examined hospital-based nurses' health promoting nursing practice in an acute setting.

BACKGROUND

Nurses are considered to have a key role in health promotion. However, the development of the role of the generalist hospital-based nurse in health promotion has been slow and is not well-understood.

METHOD

The conceptual framework used was based on the Ottawa Charter (WHO 1986). A single qualitative embedded case study, employing data source and methodological triangulation was used. A framework for identifying nurse's use of health promotion methods was developed and used to collect non-participant observations on a purposive sample of eight nurses working on an acute hospital ward. Following the observations a semi structured one-to-one interview was conducted with each observed nurse. One randomly selected patient that the observed nurse had cared for during the observations was also interviewed. Qualitative data analysis based on the work of Miles and Huberman was employed.

RESULTS

Two categories were identified 'health promotion strategies and content' and 'patient participation'. The findings indicated that, overall, the strategies used by nurses to promote health were prescriptive and individualistic. The main strategy observed was information giving and the content was 'preparatory information'. Predominantly, nurses practised traditional health education. Overall, patient participation was limited to minor personal aspects of care as nurses focused on the routine and getting the tasks completed. There was no evidence of a ward culture which valued health promotion.

CONCLUSIONS

Ward managers are key in creating a culture for health promotion. A review of the methods of organizing nursing care is warranted.

RELEVANCE TO CLINICAL PRACTICE

Nursing programmes must highlight health promotion as integral to practice and emphasis the socio-political dimensions of health promotion.

Nurses' opportunistic interventions with patients in relation to smoking

AIM

This paper reports a study exploring nurses' provision of opportunistic health education on smoking for hospital patients.

BACKGROUND

Smoking cessation guidelines recommend assessment of patients' smoking habits and provision of smoking cessation advice when possible, and highlight the importance of the role of nurses in health promotion and health education. In the past, nurses have been criticized for lack of knowledge, skills and confidence in relation to health education and the perception that it is additional to, rather than integrated with, nursing care.

METHODS

A qualitative case study design was selected to explore the health education practice of 12 nurses working in acute wards in three general hospitals in Scotland. Data were collected in 2000 through non-participant observation, semi-structured interviews and the use of a radio-microphone to record nurse-patient interactions. The data analysis was guided by four key elements of health education practice: 'the teachable moment', 'readiness to learn', 'the provision of health information' and 'oral communication'.

FINDINGS

Smoking was part of the nurses' agenda, as most recognized opportunities to introduce health education on smoking during nursing care, suggesting a tentative move towards the integration of health education with nursing care. Evidence from patients' interactions indicated ample opportunity for nurses to provide smoking-related health information. However, the content of nurses' interactions on smoking was variable, with some limited by poor communication skills and inadequate knowledge of smoking and smoking cessation. The context of the interactions was also important in understanding some of the restrictions on conversational progress.

CONCLUSIONS

Nurses require the knowledge and skills to perform a health education role, and the inclusion of smoking cessation guidelines in nursing curricula would contribute to this. Where patients are in hospitals for short periods of time, opportunistic health education on smoking needs to be introduced as the basis for more specialist intervention.

The health-promoting nurse as a health policy career expert and entrepreneur

A plethora of literature suggests that many nurses struggle in their attempts to develop a political role that allows them to directly influence and implement health policy activity. Nursing curricula are an integral part of ensuring that nurses are capable of taking on a more active role in initiating and developing health policy processes, through a broadening of the health promotion curriculum that focuses on socio-political approaches to health care provision. Despite this, the available literature suggests that the majority of nursing curricula are yet to fulfil this role. Such a role could be supported by attempts to define and promote a specific career route that develops nurses as health policy experts and entrepreneurs early on in their careers. This article aims to put forward a rationale for developing such a position in nursing education.

Teachers' views on curriculum development in health promotion in two Finnish polytechnics

This study describes teachers' views on how to improve the health promotion element in the curricula of two health care polytechnics in Finland. The theoretical background of this study draws on curriculum development in nursing education and how to promote a human- or resource-centred approach in health promotion. The research data were collected by interviewing 10 teachers from both the schools involved in nursing or public health nursing education since August 1997. The data were analysed using content analysis. The findings showed that most of the teachers interviewed were involved in local curriculum development. This work was impeded by lack of time and real commitment, as well as the teachers' desire to protect their own teaching domains. In both polytechnics, they regarded the curriculum mainly as a document guiding their own and students' work. Teachers in one of the polytechnics emphasised the importance of national guidelines in ensuring professional competence, but no one stressed the importance of their school as a regional educational institution. Almost all agreed that health promotion was adequately included in their curriculum. The project "Health for all by year 2000" was taken as the basis for the curriculum in both schools, but some teachers expressed a need for an additional study unit. The findings revealed teachers' traditional views on health promotion in curricula and that there was no evidence of a new approach being adopted.

Health promotion in palliative care: the patients' perception of therapeutic interaction with the palliative nurse in the primary care setting

AIMS

To identify and describe palliative patients' perception of factors within the interaction with the community palliative care nurse that enhance feelings of health and well-being, and to begin to define health promotion in relation to palliative nursing in the primary care setting.

BACKGROUND

Health promotion may seem to be of little relevance in palliative care and for patients within its remit, and there is no definition of health promotion in relation to palliative care, yet therapeutic 'new' nursing, and its core elements of holism, egalitarianism and a humanistic approach accord with the philosophy of palliative care and are recognised as health promoting nursing practice.

DESIGN/METHODS

A qualitative methodology was used. Information was obtained from 12 patients by a qualitative semi-structured interview. Data were organised and analysed using recognised guidelines for phenomenological analysis.

FINDINGS

The patients identified two types of therapeutic interaction with the nurse, which enhanced feelings of health and well-being in different ways. Psychological well-being was enhanced by the humanistic and egalitarian personal interaction with the nurse, and the professional interaction focused on the disease and addressed physical problems. Although recognizing the nurses' role in the relief of physical symptoms, the patients' perception of 'feeling better' generally focussed on enhancement of psychological health and well-being.

CONCLUSION

For the patients, a combination of 'new' (therapeutic) nursing and a more traditional expert-led approach resulted in the promotion of an enhanced sense of physical and psychological health and well-being, and was an integral part of community palliative care nursing. Based on the study findings, the researcher offers a definition of health promotion relevant to palliative nursing in the primary care setting, which identifies that for the patients (but with caveats related to generalizability), the practice of holistically therapeutic palliative nursing is the ideal.

Complementary therapies and health promotion

Nurses have an important role to play in health promotions and it is important that they have a comprehensive knowledge and understanding of the theories of health promotion and conventional interventions. However, they are increasingly likely to be asked about the efficacy of non-conventional interventions and the likelihood of these interventions being of value to the client. This paper offers a review of the evidence to support the role of complementary therapies as adjunctive treatments to enable nurses to discuss their use with their clients as part of their health choice options.

The Breast Cancer Distance Education Program: development and evaluation of a course for specialist breast care nurses

The Breast Cancer Distance Education Program is the first tertiary-based education program for specialist breast care nurses in Australia. The program covers current treatment options, psychosocial issues, and professional development issues relating to breast cancer nursing. For the first two student intakes (n = 53), precourse, postcourse, and 3-month follow-up surveys were conducted to assess the perceived value of the course, identify any limitations, and note changes in practice that arose. Before taking the course, most of the students had experience in breast cancer nursing, but lacked confidence and hoped to learn more about responding effectively to psychosocial issues through communication, counseling, and provision of support to patients and their carers. After taking the course, the students were very positive about the course content, resources, and teaching support. They reported learning new skills for addressing psychosocial issues and symptom management arising from a diagnosis of breast cancer, stating a desire to implement these new skills. Comparison between results from the three surveys indicated that students' confidence in providing breast cancer support increased significantly in most areas of practice, and was maintained at 3-month follow-up survey. Results suggest that students met the course objectives successfully, and in most cases subsequently translated their knowledge into improved practice.

Health promotion in the curricula and teaching of two polytechnics in Finland

The purpose of this study was to examine the manifestation of health promotion in two Finnish health care and nursing polytechnic curricula for students starting their studies in August 1997. Another goal was to explore students' and their teachers' perceptions of which modules contained health promotion, as well as to find out which modules contained integrated health promotion. In this study, data and investigator triangulation were used. The data consisted of the curricula of two polytechnics of health care and of interviews with 20 student nurses and their teachers. The data were analysed using content analysis. Health promotion studies were integrated with other studies in the curriculum of the first polytechnic, whereas the second polytechnic had two separate health promotion modules. While most students were in favour of separate health promotion modules, teachers supported integrated modules. Students also reported that their teachers integrated health promotion in modules which were not named as such, for example, in language modules. The results represent a major challenge concerning the content of health promotion in the curricula and, also, the methods for teaching health promotion. More cooperation between teachers during the process of planning curricula is recommended.

Developing an audit tool for health promotion learning opportunities in clinical placements

Education audit has proved to be an effective way of reviewing current activities and learning opportunities available to health-care students during clinical placements. Despite the importance attributed to education audit in highlighting good practice, identifying where there is a need for change as well as providing information for future planning, there is no evidence in the literature to support its specific application to health-promotion learning opportunities. This paper describes a two-part study in which an education audit tool for use in evaluating health-promotion learning opportunities for students in clinical placements was successfully developed. This tool can be utilized by multiple stakeholders in a variety of clinical settings. Following a discussion of the background literature, the methodology (which involved the development of a series of dynamic relationships between researchers, commissioners and participants) is described. The aim of this article is to discuss the lessons learned from the process of developing the tool, including the problems that were encountered and how they were addressed. The authors conclude that their experiences in developing this tool can be usefully transferred to other educational and clinical settings.