Community health promotion nursing practice

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.

Analyzing the state of community health nursing: advancing from deficit to strengths-based practice using appreciative inquiry

In this article we critically analyze the disconnect between much of the contemporary discourse and practice in Canadian community health nursing (CHN) that has contributed to the slow progress of strengths-based, health-promoting nursing practice. Appreciative inquiry philosophy and methods are introduced as a bridge to traverse this disciplinary gap. Two exemplars show how appreciative, strengths-based CHN research and action can move policies and programs toward more socially just practices congruent with CHN values. Exciting potential for nursing knowledge may arise from incorporating more strengths-based approaches into practice, education, policy, and research.

Health Promotion in the Practice Setting: Findings from a Review of Clinical Issues

BACKGROUND

Many agencies over the last few decades have called for the explicit inclusion and application of health promotion in all aspects of nursing practice. This article reviews the body of empirical (research-based) and theoretical (conceptual) literature addressing health promotion in nursing clinical practice, to uncover its nature, intention, and impact.

APPROACH

The aim of this review was to identify from the nursing literature what is reported on in relation to health promotion activity, both theoretical and clinical in the practice setting. An extensive review identified that literature pertaining to these issues clustered around the categories of: theorising and conceptualising the meaning and purpose of health promotion in nursing practice, the development and testing of tools and models for practice, and the exploration of attitudes, behaviours, roles and functions of nurses and health professionals in practice.

FINDINGS

Against more recent trends in health promotion, the literature shows that broader and wide-ranging health promotion reform has yet to have universal impact, whereas conventional health education activities remain the mainstay for the majority of "health promotion" activities in nursing practice. Where nurses purport to be conducting "health promotion" they are often conducting behavioural, lifestyle, and risk-orientated health education. The findings of this review therefore support the notion that much of nursing-related health practice is firmly located in reactive ill health and disease risk-specific preventive locations, instead of incorporating and instilling broader societal, economic, ecological, and political dimensions of health promotion. Recommendations for wider reform, developed from personal opinion and supported by the literature, are presented.

CONCLUSIONS

It is argued that nursing bodies, as well as individual nurses themselves, should seek current health promotion locations in nursing practice, and find effective ways to implement health promotion strategies and, subsequently, equip practitioners with the necessary resources and skills to engage with other health promotion agencies. Future research should be aimed at implementing and evaluating broad health promotion processes.

Advancing nursing theory through theory-guided practice: the emergence of a critical caring perspective

Critical caring is proposed as a hybrid, midrange theory that builds on nursing science and critical feminist theories. As such, it has the potential to root public health nursing practice in an expanded nursing caring science that reincorporates the social justice agenda characteristic of early public health nursing practice but not featured prominently in contemporary nursing theories. Critical caring transforms the carative processes of Watson's theory into 7 carative health-promoting processes that form the "core" of public health nursing practice and reflect the legacy and reality of public health nursing practice.

From Miasma to Fractals: The Epidemiology Revolution and Public Health Nursing

If public health nursing is truly a synthesis of public health science and nursing science, then nurses must keep track of current developments in public health science. Unfortunately, the public health nursing literature has not kept pace with revolutionary developments in epidemiology, one of the sciences that informs population-focused nursing practice. Most epidemiology chapters in community health nursing texts do not reflect the intellectual development that has taken place in epidemiology over the past two decades. The purpose of this article therefore is to facilitate an updated synthesis by (a) reviewing the development of epidemiology and the focus of public health nursing practice through three historical eras, (b) discussing current controversies and tensions within epidemiology, (c) introducing an emerging paradigm in epidemiology based on an ecosocial perspective, and (d) discussing the congruence of this perspective with the evolving theory and practice of public health nursing.

Smoking behavior and desire to quit among low-income female caregivers

The purpose of this study was to examine smoking behavior and the desire to quit among low-income women. Two hundred and eight women caregivers were surveyed about their smoking status, exposure to environmental tobacco smoke in the home, and desire to quit smoking. Most of the smokers (74%) wanted to quit smoking. With a logistic regression model, the number of years smoked was the only significant predictor variable for the dependent variable of thoughts about quitting when age, years of smoking, number of children, marital status, number of smokers in the home, cigarettes smoked per day, and money spent per week on cigarettes were entered as independent variables. The fewer years smoked the more likely the women wanted to quit.

"The people know what they want": an empowerment process of sustainable, ecological community health

Community-focused nurses routinely confront issues of environmental hazards in the context of the community. Limits to disciplinary knowledge about health, environment, and community constrain practice for many who are interested in ways to promote community health across a spectrum of diverse needs and contexts, including the context of the environment. The purpose of the reported critical ethnography was to explore the relationships among health, environment, and culture from the cultural context of one community. Findings highlight the emancipatory, yet ambiguous, process through which this community transformed individual symptoms of illness into an experience and examination of community environment and community health. The significance of this work lies in inductively building knowledge and theory about these relationships and community empowerment for community-focused nursing.

Latvian community nurses practising in a time of turmoil: a thin line of defence for children at risk

Recent World Health Organization (WHO) statistics rank Latvia below average on a number of health indicators, compared to other European Union (EU) candidate countries. Nurses who visit children in the home see a close-up view of the decline in health. This exploratory study was designed to understand the day-to-day experience of a representative sample of 17 Latvian nurses visiting infants and children in 1999, almost 10 years after the collapse of the Soviet Union. Analysis of practice reports from group and individual interviews, using interpretive phenomenologic methods, revealed three consistently emerging themes: the negative impact of societal change and dislocation on clients and nurses; clinical reasoning concerning degree of risk to children and priorities for intervention; and the physical and emotional burden of caring for increasingly vulnerable children. Risk assessment was expressed in the classification of families as 'good little family, a family that was 'simply poor, or a family that was a 'social risk.' With the first two types of families, concern about children was balanced with concern about the family as a whole. With 'social risk' families, the primary concern of the nurses was safeguarding the child. The findings cannot be generalized, but may imbue family health and welfare statistics with a human face, and suggest directions for education, practice and further research.

Examining the process of community development

AIM OF THE STUDY

To present the results of evaluation research investigating a successful community development project.

RATIONALE

Many governments, health care agencies, and organizations require community participation in health care. As a result, nurses and other health professionals are often required to practice using a philosophy of community development. Although the theoretical, philosophical, and practical components of community development are well articulated, there is little evidence that exemplifies the experience of initiating and participating in a community development project. This paper provides evidence of how one organization successfully engaged the broader community on a respite care project.

METHOD

Using qualitative research methods and guided by the principles and practices of participatory action research, this evaluation engaged with the community in data collection, analysis, dissemination of finding, and in promoting effective change.

RESULTS

Four themes emerged that provide insight into how one HIV/AIDS organization successfully undertook community development. These themes include: (a) identifying a community need; (b) addressing the various components identified in the community development process; (c) highlighting the strategies used to engage in successful community development; and (d) attending to factors that influence community development.

CONCLUSION

The results of this research contribute to the body of knowledge related to engaging in the process of community development. By highlighting the experiences of one community group, it is hoped that nurses can learn and incorporate this knowledge into practice.

Empowerment and Australian community health nurses' work with aboriginal clients: the sociopolitical context

A portion of a study designed to explore community health nurses' (CHNs) perceptions of the concept of empowerment in their work with Australian Aboriginal clients is discussed in this article. The 12 study participants were identified through purposive convenience sampling. During this exploration, contentions regarding the concept of empowerment emerged, revealing the sociopolitical context of CHN's work with Aboriginal people that shaped their practice in crucial ways. These issues emerged from the participants' discussions regarding the meaning of empowerment in their work with Aboriginal clients and the strategies for and challenges to working in empowering ways within the context of Aboriginal health. Selected components of Habermas's works provided a useful framework to facilitate an understanding of the forces that underpin community health nursing practice.