TM5528 Health Promotion
The scope of the
paediatric nurse in
Health Promotion
Assignment One
Samantha Leggett SN 12494652
4/14/2013
Word Count: 3044
SN: 12494652
Contents
3
Introduction
3-4
What is health promotion and where do its contemporary origins lie?
4-8
The scope of the paediatric nurses’ role in health promotion
9
Summary
10
Appendix A
11
Appendix B
12-14 References
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Introduction
The discipline of health promotion has evolved over many decades, taking a number of forms on its
journey. Contemporary health promotion approaches health from a socio-environmental or ecological
perspective and encompasses a broad range of professionals from health and other sectors. All nurses
have a key role to play in health promotion but these roles are varied depending upon the work
environment and specific position of the nurse. Within this assignment health promotion will be defined
and the evolution of its contemporary form explored and the scope of the paediatric nurse within the
health promotion landscape will be examined.
What is health promotion and where do its contemporary origins lie?
Health promotion represents a multi-faceted process of empowering individuals, communities and
societies to increase control over the determinants of health (e.g. social, environmental and economic
conditions), thereby improving their physical, mental, social and spiritual health. One of its distinctive
contemporary characteristics is the goal of reducing health inequalities through participation and social
change while considering people within their specific social and cultural contexts (Eriksson & Lindstrom,
2007; Kickbush, 2007; Ridde, Guichard & Houeto, 2007; World Health Organisation [WHO], 1986; WHO,
1998).
Catford (2007) asserts that the origins of contemporary health promotion as a discipline are complex
and that no single driver is responsible. The promotion of health and prevention of disease have
however, been a feature of public health since the 1850’s (Royal College of Nursing [RCN], 2012) and
Ritchie (1991) advocates that health promotion sees its roots in the health education strategies that
arose via public health in the early 20th century. A shift in thinking became apparent around the time of
the ‘Declaration of Alma-Ata’ in 1978 when primary health care was formally adopted as the principle
mechanism for global health care delivery. Following this, in 1981 the World Health Organisation
presented a global initiative ‘Health for all by the Year 2000’ which contained a series of measurable
targets and goals (WHO 1981). This initiative then became the driver for global health development
during the proceeding two decades and was seen to provide an environment conducive to the
cultivation of the contemporary health promotion concept. The ‘First International Conference on
Health Promotion’ in Ottawa, Canada then followed in 1986 (Catford, 2007).
The Ottawa Charter (WHO, 1986), now considered by many to be the fundamental document in the field
of health promotion, was discussed and constituted at this first conference. Here the focus of health
promotion shifted from disease to health and was expanded from individuals and groups to
communities and societies (Eriksson & Lindstrom, 2008; Ridde et al., 2007). The Charters’ primary goal
was to legitimize the vision of health promotion by clarifying the key concepts, highlighting conditions
and resources required for health and identifying the key actions and basic strategies required to pursue
‘health for all’ (Catford, 2007). (An expanded explanation of these resources, strategies and actions can
be found in Appendices A & B). However, despite its centrality to the discipline of health promotion the
Ottawa Charter appears to have attracted as much criticism as support.
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In addition to the shift in focus of health promotion, the declaration is seen to have paved the way for a
shift in power from the providers of healthcare services, to the consumers and wider community
(Catford, 2007). Raeburn (2007) however, contends that the Ottawa Charter overemphasizes the topdown political aspects of health promotion at the expense of its more human and empowering features
and displays remoteness from everyday life, particularly in developing countries.
Hills and McQueen (2007) view the Ottawa Charter as a call to embrace a broad vision of health
promotion, with the goal of placing it at the centre of any work relating to the five action areas, rather
than it being a prescriptive framework or planning tool. It is argued that the lack of a clear theoretical
framework to support the principles contained in the Ottawa Charter and a paucity of clarity regarding
exactly what action needs to be taken to achieve its goals, created problems for the health promotion
movement (Eriksson & Lindstrom, 2007; Ridde et al., 2007). Kickbush (2007) asserts that the full
potential and importance of the Ottawa Charter is yet to be recognized and that the Charter’s sub-title
‘the move towards a new public health’ (authors’ emphasis) is often overlooked.
Wise and Nutbeam (2007) and Catford (2007) expand that subsequent conferences on health promotion
convened by the WHO and in partnership with national governments, have built upon the foundations
of the Ottawa Charter by focusing on each of the five specific strategies contained within it; examined
the application of the charter principle in developing countries and responded to the current challenges
to health arising from globalisation. Raeburn (2007) acknowledges that despite its limitations, the
Ottawa Charter has ensured that health promotion has become established on the world’s political
agenda and highlights that despite its many criticisms the Ottawa Charter is popularly used as the key
health promotion guidance document today.
The scope of the paediatric nurse in health promotion
Successful health promotion requires co-ordinated action by all parties: governments; health, social and
economic sectors; non-governmental and voluntary organisations; local authorities; industry; the media;
individuals, families and communities. The World Health Organization (1986) advocates that health
personnel hold a major responsibility in mediating between the differing interests of society in the
pursuit of health.
Nurses are the largest group of health professionals, have a high degree of credibility and visibility and
all have a key role to play in health promotion. Nurses are in an ideal position to influence the people
they interact with, empowering them to achieve positive health outcomes (Royal College of Nursing
Australia [RCNA], 2000; RCN, 2012; Sourtzi, Nolan & Andrews, 1996). Nurses are also in the unique
position of being able to contribute to a lifespan approach to health promotion through a continuum of
activities, at a range of levels, from individuals to communities, and in a wide variety of settings (RCN
2012). The UK’s Department of Health [DoH] (2006) stress that placing practice within a population
context enables children’s nurses to address health inequalities by seeking out and prioritising those
children and young people likely to experience the greatest health threats and poorest access to
services.
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Child health is considered to be a major determinant of health in adulthood. Further, health behaviours
and lifestyle choices are formed in early childhood and are acknowledged as making a significant
contribution not only to the health status of individuals, but to communities and societies also. Health
promotion, must therefore, begin as early as possible in order to realise its maximum potential. Recent
UK government policies have acknowledged the importance of investing in the health of children and
young people, with health improvement and tackling inequalities high priorities within these policies.
Paediatric nurses are therefore well-placed to deliver health promotion interventions across a range of
areas including for example, obesity, mental health, sexual health, accidents and substance misuse.
Within the scope of paediatric nursing, health visitors, school health nurses, registered children’s nurses,
health promotion specialists, clinical nurse specialists and specialists in child and adolescent mental
health, all have a vital role to play. Working with others offers the best opportunity for the mobilisation
of all community resources to address needs and improve health (DoH, 2006; RCN, 2012).
As previously mentioned, health promotion is a multi-faceted process of empowerment. Kalnins,
McQueen, Backett, Curtice and Currie (1992) explain that three principles may be seen as central to the
notion of empowerment: the first is that health promotion must address problems that people
themselves define as important in the context of their everyday lives; the second, that health promotion
involves effective participation of the public, alongside experts, in problem solving and decision making
and third is that health promotion must be in accord with healthy public policy to achieve the best
outcomes.
Kalnins et al. (1992) assert that children’s health promotion has traditionally centred around problems
identified as important from an adult perspective and has focused on children being protected from
conditions that lead to unnecessary mortality and morbidity in childhood or later life. We, as adult
health professionals know what health behaviours in childhood are a major player in adult morbidity
and mortality and it would be irresponsible not to guide children and young people into what is
considered good for their health based on a strong foundation of evidence. However, within an
empowerment model of health promotion, Kalnins et al. (1992) stress that it is equally as important to
acknowledge children’s own views and concerns about their health and accept these as valid also.
Taking teenage pregnancy as an example of a socio-ecological determinant of health and using the three
core values of advocacy, enablement and mediation and five action areas: build healthy public policy;
create supportive environments; strengthen community action; develop personal skills and reorientate
health services of the Ottawa Charter as a guide, the scope of the paediatric nurse within an
empowerment model of health promotion will now be explored.
The UK has the highest rate of teenage conceptions within Western Europe (DoH, 2006). The Health
Development Agency [HDA], (2003) recognise that although parenthood can be a positive and lifeenhancing experience for some young people, it may also bring a number of negative consequences for
other young parents and their children. Teenage parents are more likely than their peers to be
unemployed and be trapped in a perpetual cycle of poverty through a lack of educational achievement,
childcare, encouragement and support. Early motherhood can also be associated with poor physical and
mental health, social isolation, lone parenting, family conflict and their related factors (HDA, 2003).
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The negative outcomes for babies and children of teenage mothers can also be significant determinants
of health: Babies tend to have a lower than average birth weight; infant mortality is 60% higher in this
group than for babies of older women; only 44% of mothers under 20 breastfeed compared to 64% of
20—24 year olds and up to 80% of older mothers; children of teenage mothers are generally at
increased risk of poverty, poor housing and having bad nutrition and finally, daughters of teenage
mothers may be more likely to become teenage parents themselves (HDA, 2003; Khashan, Baker &
Kenny, 2010).
The scope of health promotion activities for the paediatric nurse within the realm of teenage pregnancy
may encompass the following:
Build healthy public policy
Paediatric nurses may be involved in lobbying for policy change, e.g. to the paediatric nurses’ role within
the provision of Sex and Relationships (SRE)1 and Personal, Social, Health and Economic Education
(PSHE)2 in schools; they may be involved in strengthening data collection and research activities in order
to raise awareness of local issues or be leading monitoring and evaluation programmes.
Create supportive environments
Paediatric nurses can ensure that information and education is in place before young people become
sexually active, explaining the possible consequences of early parenthood and promoting prevention of
accidental pregnancies; encourage a local culture in which the discussion of sex, sexuality and
contraception is permitted; provide and promote confidential drop-ins at school and community venues
ensuring they are linked to wider primary health care, family planning and genito-urinary medicine
services; fully engage in the use of new technologies such as texting or social media to improve access to
services, and provide screening activities to help detect relevant issues as early as possible for
appropriate referral and treatment if needed.
1
SRE is integral to the national educational curriculum in the UK and involves learning about the emotional, social and physical aspects of
growing up, relationships, sex, human sexuality and sexual health. It should equip children and young people with the information, skills and
values to have safe, fulfilling and enjoyable relationships and to take responsibility for their sexual health and well-being (National Children’s
Bureau. (2013). What is sex and relationships education? Retrieved from http://ncb.org.uk/media/461792/sefr_mktf_3.pdf).
2
In primary education PSHE aims to help children to: develop confidence and responsibility and making the most of their abilities; prepare to
take an active role as citizens; develop healthy, safer lifestyles, develop good relationships and respect differences between people
(Department for Education. (2011). (primary national curriculum until 2014) Personal, social and health education (PSHE). Retrieved from
http://www.education.gov.uk/schools/teachingandlearning/curriculum/primary/b00199209/pshe/ks1).
In secondary education PSHE helps young people to embrace change, feel positive about who they are and enjoy healthy, safe, responsible and
fulfilled lives. Through active learning opportunities students recognise and manage risk, take increasing responsibility for themselves, their
choices and behaviours and make positive contributions to their families, schools and communities (Department for Education. (2012).
(Secondary school national curriculum until 2014) Personal, social, health and economic education (PSHEE): Programme of study. Retrieved
from http://www.education.gov.uk/schools/teachingandlearning/curriculum/secondary/b00198880/pshee/ks4/personal/programme).
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Support may be offered to young women to access services to make timely choices about emergency
contraception, pregnancy or abortion; nurses can ensure that children and young people are clearly
informed of their rights e.g. how to access confidential advice and services within the boundaries of
safeguarding and support young mothers by working with education officers and health visitors to reintegrate teenage parents back into education.
Parenting classes for teenage parents may be set up and facilitated which encompass encouraging
young men in their role as fathers and paediatric nurses may work collaboratively with or within family
outreach programmes for example the ‘Family Nurse Partnership Programme’ (FNP)3.
Strengthen community action
Paediatric nurses can confront discrimination and challenge prejudice such as homophobia; provide and
promote sessions for parents that will support and prepare them in their central role as educators;
engage young people and their parents/carers in helping to identify their own problems and solutions
and to help shape schools’ sex and relationships and personal, social, health and economic education
policies. Nurses may also advocate and facilitate participatory methods to enable children and young
people to have roles as evaluators in these services.
Another area in which paediatric nurses can be involved in strengthening community action is to
become involved with advocacy groups such as the National Children’s Bureau4. For example a campaign
could be spearheaded that emphasises the joint responsibility of schools, parents, carers and
communities in providing PSHE/SRE to children and young people and highlights what can be done to
become involved. Further, nurses may encourage and facilitate the development of community support
groups for young people; become involved in highly visible public health campaigns and encourage
young people via either school or community groups to do so also. Their voice can then be given to
campaign direction. The paediatric nurse must also ensure that interventions are sensitive to different
cultures and needs at all times.
Develop personal Skills
Paediatric nurses, working in partnership with teachers and involving the wider health and social
community (e.g. clinical nurse specialists; MP’s; members of an anti-bullying advocacy group) are in a
unique position to take a participatory role in PSHE/SRE and to be able to deliver an accurate, factual
3
Within the FNP programme specially trained nurses (usually registered children’s nurses or midwives) provide an evidence-based early
intervention programme that sits at the intensive end of the prevention pathway for vulnerable first time mothers. It offers intensive and
structured home visiting from early pregnancy until age two. FNP has three aims: to improve pregnancy outcomes; improve child health and
development; improve parents’ economic self-sufficiency (Department of Health. (2012). The Family Nurse Partnership Programme.
Information Leaflet. Retrieved from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/156074/The-FamilyNurse-Partnership-Programme-Information-leaflet.pdf.pdf).
4
The National Children’s Bureau is a charity that aims to improve the lives of children and young people. Working with and for children they
influence government policy, act as a strong voice for young people and provide creative solutions on a range of social issues (Retrieved from
http://www.ncb.org.uk/#).
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and comprehensive range of information regarding sex, relationships, the law and sexual health to
young people to facilitate them to make informed choices.
Additionally, they may also work in partnership with teachers, youth workers or health promotion
specialists to help young people acquire a range of skills such as negotiation, decision making,
assertiveness and listening. The opportunity to practice these skills and those of resisting pressure can
be provided through role play, hot seating5 or scenario discussion.
Reorient health services:
To become involved in reorienting health services, paediatric nurses might work in partnership with
young people, their families, other professionals, agencies and teenage pregnancy co-ordinators to
assess needs locally and plan integrated services; they can play a central role in ensuring that PSHE and
SRE programmes and services meet the need of all young people, for example, they should encompass
the needs of ethnic minority, disabled, bisexual, transgender, gay and lesbian young people.
Paediatric nurses can be influential in tackling the wider determinants of health through working in
partnership with other members of health and social care organisations and be involved in integrated
and multi-agency working to encompass children who are not in education, employment or training or
who are in young offender institutions, in relevant health promotion initiatives. Nurses would also likely
want to consider forging links with churches and other faith-based organisations in order to strengthen
health promotion programmes.
(“Best beginnings mobile apps,” 2013; Bower, 2013; DoH, 2006; DoH, 2011; DoH, 2012; Halliday &
Wilkinson, 2009; Kalnins et al., 1992; Khashan, Baker & Kenny, 2010; National Institute for Health and
Clinical Excellence [NICE], 2009; O’Connor, 2012; Peterson, Atwood & Yates, 2002; RCNA, 2000; RCN,
2012; Reeves, Gale, Webb, Delaney & Cocklin, 2009)
5
Hot seating is where people take on the role of characters from a story and other people ask them questions. The characters have to answer
the questions in as much detail as possible (Women’s Aid. (2010). The Expect Respect Educational Toolkit. Section 4: supporting resources 4.
Hot Seating. Retrieved from http://www.womensaid.org.uk/page.asp?section=0001000100280001&sectionTitle=Education+Toolkit).
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Summary
As can be seen from the above example a broad range of primary, secondary and tertiary health
promotion activities all fit within the Ottawa Charter framework. Although teenage pregnancy has been
used as a specific example here, it is clear that the health promotion activities exemplified can be widely
extrapolated within the paediatric nurses’ role. What is also highlighted is that, in contention with
Raeburn’s (2007) view that the Ottawa Charter promotes a top down model of health promotion, the
scope of the paediatric nurse within the field of health promotion heavily supports an ‘upstream’
approach, focusing first on young people and their communities.
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Appendix A
Basic pre-requisites for health and the three core values of the Ottawa Charter explained
The basic pre-requisites for health:
An improvement in health requires a secure foundation in the following fundamental conditions and
resources: peace; shelter; education; food; income; a stable ecosystem; sustainable resources; social
justice and equity).
The three core values: advocacy, enablement and mediation
Advocacy: Good health is a major resource for social, economic and personal development and an
important dimension of quality of life. Political, economic, social, cultural, environmental, behavioural
and biological factors can all favour health or be harmful to it. Health promotion action aims to make
these conditions favourable through advocacy for health.
Enablement: Health promotion focuses on achieving equity in health. Health promotion action aims at
reducing differences in current health status and ensuring equal opportunities and resources to enable
all people to achieve their fullest health potential. People cannot achieve their fullest health potential
unless they are able to take control of those things which determine their health. This must apply
equally to all women and men.
Mediation: The prerequisites and prospects for health cannot be ensured by the health sector alone.
Health promotion demands co-ordinated action by all concerned: governments, health and other social
and economic sectors, non-governmental and voluntary organisations, local authorities, industry and
the media. People in all walks of life are involved as individuals, families and communities. Professional,
social groups and health personnel have a major responsibility to mediate between differing interests in
society for the pursuit of health.
WHO, (1986)
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Appendix B
The five key action areas of the Ottawa Charter explained
Build healthy public policy: health promotion activities should put health on the agenda of policy
makers at all levels. This includes legislation, economic measures, taxation and organisational change.
Health professionals must want policy makers to be aware of the health consequences of their decisions
and to accept their health responsibilities.
Create supportive environments: health promotion should generate living and working conditions that
are safe, stimulating, satisfying, enjoyable and provide a positive benefit to health. The protection of
natural and built environments and the conservation of natural resources must also be addressed in any
health promotion strategy. The inextricable links between people and their environment constitute the
basis for a socio-ecological approach to health.
Strengthen community action: health promotion should empower communities to exert control,
ownership and action over their own endeavours and destinies and enable them in setting priorities,
making decisions, planning strategies and implementation to achieve better health. Systems for
strengthening public participation in and the direction of health matters should be encouraged.
Develop personal skills: health promotion should provide information and education for enhancing
health and life skills to support personal and social development. The options available to exercise more
control over health and the environment and to make healthy choices would thereby be increased.
Reorientate health services: to focus beyond clinical treatment and curative services toward the
promotion of health. The responsibility for health should be shared amongst individuals, governments,
institutions etc. Health professionals must respect cultural needs, look towards the specific needs of
communities and forge interdisciplinary collaboration. Stronger attention should also be given to health
research and changes in education and training should be called for.
Queensland Government, 2007; WHO, 1986.
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