Empowerment and its application in health promotion in acute care settings: nurses' perceptions

Supporting patients to make lifestyle behaviour changes

The lifestyle choices that people make in relation to areas such as alcohol consumption, diet and smoking have the potential to seriously affect their health, with long-term conditions such as obesity, heart disease and diabetes mellitus potentially resulting in a suboptimal quality of life for individuals and incurring significant costs in terms of healthcare resources. Health promotion and preventing ill health are priorities for UK healthcare services. All nurses have a duty to continuously update their knowledge and expertise to support patients undertaking lifestyle behaviour change. This article considers practical methods that nurses can use to undertake this essential role, as well as discussing public health policy in this area.

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.

A case study approach to the examination of a telephone-based health coaching intervention in facilitating behaviour change for adults with Type 2 diabetes

AIMS AND OBJECTIVES

This study aims to examine the effectiveness of the use of telephone empowerment-based health coaching as a cost-effective alternative to changing health behaviours of adults with Type 2 diabetes.

BACKGROUND

Guidelines regarding lifestyle management to reduce the risk of complications in diabetes include changing patterns of eating, physical activity and smoking cessation. Traditional education/behavioural methods of support for behaviour change reveal mixed and mainly short-term effects.

DESIGN

A mixed method case study approach was used (n = 10).

METHODS

Data were collected by means of physiological measurements survey and focus group interview both before and after telephone a coaching intervention.

RESULTS

Participants took greater responsibility for health and revealed high self-efficacy scores. Short-term benefits were seen in physiological variables at three months but these deteriorated with the cessation of the intervention indicating the need for continuous support.

CONCLUSION

Telephone coaching is a cost-effective approach to supporting health behaviour change for those with diabetes. It embraces the principles of empowerment and warrants further evaluation in supporting long-term behavioural changes. As such coaching emerges as a suitable proposition for this cohort.

RELEVANCE TO CLINICAL PRACTICE

Health coaching has a positive impact on health behaviours for those with diabetes. Health coaching facilitates an increase in personal control of health and builds confidence in self-managing diabetes. Patients feel really supported and become motivated towards self-care.

Reflexivity and habitus: opportunities and constraints on transformative learning

This paper will explore the relationship between Mezirow's concept of reflexivity and Bourdieu's theory of habitus in order to develop a more robust framework within which critical reflection can take place. Nurse educators have sought to close the theory practice gap through the use of critical reflection. However, we are not convinced that this has produced the depth and quality of reflection required. Furthermore, the contexts in which critical reflection takes place is often sidelined or erased so that the whole impetus in the literature is to educate nurses in reflection rather than empower nurses to understand the complex circumstances and barriers that obstruct critical reflection. This paper argues that the reason for this position is that nurse education does not always acknowledge the role that personal and cultural values systems have on reflective practices. The literature search was undertaken using CINHAL and MEDLINE. Keywords included: values systems, habitus, and critical reflection. Inclusion criteria were determined by the theoretical approach and included seminal texts, from as far back as 1956, to identify key themes. Although critical reflection is a potentially powerful way of enhancing care it has often failed to do so. It is suggested that this is because nurse educators have frequently used models of reflection without considering the impact that student's personal values systems has on their perceptions of care and subsequently care delivery. The purpose of this paper is to promote deeper levels of reflection and is part of a programme of research aimed at developing a more robust approach to reflection in educational practice.

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.

Empowerment, patient centred care and self-management

BACKGROUND

Patient or person centred care is widely accepted as the philosophy and practice that underpins quality care. An examination of the Australian National Chronic Disease Strategy and literature in the field highlights assumptions about the self-manager as patient and a focus on clinical settings.

OBJECTIVE AND CONCLUSION

This paper considers patient or person centred care in the light of empowerment as it is understood in the health promotion charters first established in Alma Ata in 1977. We argue that patient or person centred care can be reconfigured within a social justice and rights framework and that doing so supports the creation of conditions for well-being in the broader context, one that impacts strongly on individuals. These arguments have broader implications for the practice of patient centred care as it occurs between patient and health professional and for creating shared responsibility for management of the self. It also has implications for those who manage their health outside of the health sector.

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.

Patient engagement with a diabetes self-management intervention

OBJECTIVES

To explore how people living with type 2 diabetes self-manage their condition in everyday life and the impact of the Diabetes Manual programme, a one-to-one structured educational intervention aiming to increase skills and confidence for self-management.

METHOD

Semi-structured interviews with 12 participants on the Diabetes Manual trial, sampled purposively according to baseline self-efficacy and educational attainment.

RESULTS

When describing their experience of living with diabetes, there was little difference between intervention and control participants, although those who had received the programme talked more about the use of blood glucose self-assessment. Programme users were grouped into three categories, Programme Engagers (n = 2), Programme Browsers (n = 4) and Information Seekers (n = 6). Of the two participants engaging with the programme, one described a very positive experience, the other felt unsupported by their practice. None noticed a difference in the approach used by their health professional. Participants' approach to the Diabetes Manual programme suggests they will continue to use it as a resource in the future.

CONCLUSION

Participants used the Diabetes Manual programme in different ways, choosing the timing and depth of engagement. Their experience suggests that the programme requires close communication and openness towards collaborative approaches to improve skills and confidence for self-management.