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.

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.

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.

Health promoting hospitals: the role and function of nursing

BACKGROUND

In 1986, the World Health Organisation's (WHO) Ottawa Charter for Health Promotion sought to create a framework that conveyed the notion of capacity building, related to specific settings, and a structured process for health promotion action. It provided the platform from which the health promoting hospital movement was later launched. Nearly two decades on, the health promoting hospital (HPH) movement has grown considerably and continues to expand, against the backdrop of having to adapt to the changing needs and demands of clients and the evolving social context of their communities. Many nurses, it is argued here, are often unaware of health promoting hospitals concepts or, when they are, do little to contribute to them.

METHOD

A critical review of the available health promoting hospital and related literature has been conducted for discussion.

FINDINGS

The literature revealed that hospitals are being urged to reject practices based purely on health-limiting and limited biomedical frameworks, in favour of moving towards models based on health promoting hospitals and public health-orientated hospitals. This requires radical reform that focuses on the social and health policy context of organizations, the socio-political empowerment of its employers and clients, and the personal/collective positive health and welfare of its employers and clients. Many health service agencies are beginning to emphasize population health within communities as part of a concerted move away from an original primary focus on acute inpatient hospital-based service provision.

CONCLUSION

Hospitals need to adapt and expand their efforts to focus on health promotion activities, in collaboration with the ever-widening community networks of health and social agencies. This requires the commitment of all health care professional groups. Nurses who practice in the hospital setting should be aiming to initiate and promote radical health promotion reform as set out in the health promoting hospital movement. This paper argues that nursing per se could be making much larger inroads and efforts to affect and implement wide-ranging health promotion activities in hospital organizations. Nurses should view the HPH movement as another opportunity truly to embrace evolving broad-based health promotion concepts, as a means to forge and own their own health agenda, and also as a means to move beyond the traditional reliance of a limited health education role.

RELEVANCE TO CLINICAL PRACTICE

Hospitals and their employees must be seen to advocate, support and implement wide-reaching social and community-based reform, as part of a necessary commitment to 'seamless' health care provision. The health promoting hospital movement represents a collective vehicle for enabling such activities. If nurses wish to be at the forefront of current health service strategies they must be seen to embrace the radical health promotion reforms that are emerging from the current literature and put forward in this article.

Health promotion and health education: advancing the concepts

BACKGROUND

Health education and health promotion activities are a fundamental requirement for all health professionals. These two paradigms are closely related but are not inter-dependent. Despite this, it is known that many nurses confuse the terms and use them interchangeably. With this in mind, it is necessary to re-conceptualize the terms in an attempt to bring them to a current form of 'maturity'.

AIM

The aim of the paper is to provide an up-to-date analysis of health promotion and health education that serves as a conceptual and operational foundation for clinicians and researchers.

METHOD

A concept analysis following the criterion-based methods described by Morse and her colleagues was applied to the terms health education and health promotion, using generic and nursing-related literature.

RESULTS

The conceptual literature on health education is consistent between generic and nursing-related sources. On the contrary, earlier nursing literature on health promotion is now at odds with more recent socio-political and community action models of health promotion, in that it focuses on individualistic and behavioural forms of 'health promotion'. A significant proportion of later nursing-related literature, however, suggests a maturing of the concept that brings it further in line with a socio-political health promotion agenda.

CONCLUSION

While the theoretical and conceptual literature surrounding health education has remained relatively constant and unchanged over the last decade or so, the same cannot be said for the health promotion literature. The evolving dominance of socio-political action in health promotion has overtaken individualistic and behaviourally-related forms. While the recent nursing literature addresses and acknowledges the place of socio-political activity as the mainstay of health promotion interventions, this is largely from a theoretical stance and is not applied in practice.

Day surgery: patients' perceptions of a nurse-led preadmission clinic

BACKGROUND

Previous research studies have demonstrated that nursing intervention is often lacking in the provision of adequate information and psychological support, and fails to meet the holistic needs of patients in the preassessment for day surgery.

AIM

The aim of this study was to elicit patients' perceptions of the preassessment preparation they received prior to day surgery.

METHOD

A hermeneutic phenomenological research approach was utilized to elucidate the participants' experiences of the preassessment process and to collect data. Qualitative data were collected using face-to-face interviews and analysed thematically following procedures expounded by Colaizzi and van Manen.

SAMPLE

The sample included 30 patients undergoing day surgery in a large teaching hospital in the north of England. The day unit built for this purpose consisted of a preassessment unit, a seated preoperative area, three theatres, a six space first stage recovery area, a 24 space second stage recovery area and a separate seated recovery area. The patient groups focused on individuals scheduled for general surgery, gynaecology and urology procedures.

RESULTS

Findings suggest that the nurse-led clinic appeared to function effectively; most patients felt they were adequately assessed and prepared for day surgery. The majority reported receiving comprehensive information about procedures, appreciated health education interventions and had opportunity to ask questions. A few patients pointed to deficits in information giving, indicating that their individual needs were not met, leaving them feeling anxious. Others alluded to problems associated with unexpected cancellation of procedures, which threw them into states of disequilibrium.

RELEVANCE FOR CLINICAL PRACTICE

The findings indicate that information giving, psychological support and person-centred care could be strengthened in the preassessment preparation of patients undergoing day surgery.

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.

Health promotion and health education viewed as symbiotic paradigms: bridging the theory and practice gap between them

A recognized 'paradigm war' exists between the two distinct approaches of health education and health promotion practice. This tension is both unhealthy and unhelpful and is known to have a profound effect on nursing activity. Leading health promotionalists have begun to acknowledge the futility of the stated paradigm tension, realizing that health education and health promotion interventions are not that dissimilar in their origins and intentions. Progressive health education and health promotion programmes acknowledge the interrelatedness of both approaches and seek to incorporate favourable aspects of the two. The aim of this article is to present arguments and stances that help to diffuse/avoid the stated paradigm conflict, as a basis for health education and health promotion reform in nursing. It also seeks to clarify the nature of both health education and health promotion practice so as to avoid contextual confusion. In doing so, this article draws significantly from the author's previous work. This article concludes that the constructive review of any intended health education/health promotion programme lies in the consideration of each approach according to its own relative merits, what is required of the programme, and the nature of the setting in which the intervention takes place.

Incorporating socio-political health promotion activities in clinical practice

A criticism laid at the door of many nurses in relation to their health promotion activity is that they almost exclusively adopt a biomedical/preventative health education approach. When it comes to adopting socio-political health promotion approaches, there is scant evidence that nurses implement these activities in clinical practice. This article is designed to raise awareness and signpost the types of activities that nurses could be involved with if they wish to influence the broader social and political health promotion agenda. In doing so, it has developed an 'effect' programme model for socio-political health promotion practice as a framework for those practitioners who wish to review their current health-related activities and/or who are seeking to extend their range of health promotional practice. This article draws upon a critical review of the literature in order to develop an evolving theoretical perspective for health promotion practice. The proposed model was developed from this new perspective as were recommendations for practice.