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Slide 1
Hospital Nurses’ Perceptions of their role in Health Promotion
By
Victoria Oladimeji BA, MA, MBA, PhD RGN, RM
Lecturer in adult Nursing
City University; St Bartholomew School of Nursing
and Midwifery
Philpot St
Whitechapel London EC1 2EA
Tel: 020 7040 505 5800
020 7040 505 5887 Direct Line
Fax: 020 7040 505 5811.
Email V.I.Oladimeji@city.ac.uk
www.city.ac.uk
Slide 2
Abstract:
The aim of this paper is to present the findings of a small-scale research
into hospital nurses’ perceptions of their role in health promotion.
Sample: Two wards were selected for this study. A total of 10 trained
nurses were selected.
Findings
These four themes emerged.
1.
2.
3.
Nurses personal construct of health and health promotion.
Application of health promotion in clinical practice.
Nurses’ role in health promotion.
2
4.
Factors that impact on nurses’ health promotion role.
Conclusion: As this is a small-scale research, involving two wards in a
hospital, results cannot be generalized. However, there is a relationship
between this study and other studies in UK (Kendall, 1998; Whitehead,
1999; and Wass, 2000).
There is a need
for nurses to adopt a wider approach to Health
Promotion by embracing some of the principles of Ottawa Charter
1986(WHO 1986) such as Empowerment, Healthy Public Health Policieseg Public Involvement and tackling Inequalities.
Slide 3
INTRODUCTION
The significance of health promotion within hospital settings in the UK
has gained momentum within the last decade. Against a backdrop of recent
social, economic and demographic trends, and changes in morbidity and
mortality, health promotion has assumed increasing importance in today’s
society (Latter et al, 1992). In addition it has become increasingly prominent
following publication of the Government’s strategies for health (DOH, 1992,
1999) and changes in the mode of delivery of health services.
Slide 4
Research Methodology and Research Design
This research uses the phenomenology of Heidegger (1962) who stated
that phenomenology is based on an existential perspective, which
considers that an understanding of the person cannot occur in isolation
from the person’s world
Before exploring nurses’ role it was important to review these nurses’
understanding of the concepts Health and Health Promotion. The
research instrument was designed to provide these nurses an
opportunity to speak openly and individually with the researcher without
any feelings of betrayal of the organisation that they worked for. The
study was conducted on a medical unit that provided inpatient care for
adults.
Sample:
Two wards were selected for this study. A total of 10 trained nurses
were selected.
Slide 5
Findings
: Four themes emerged from the exploration of nurses’ knowledge and
understanding of the concepts health and health promotion in clinical
practice.
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These are:
1.
Nurses personal construct of health and health promotion.
2.
3.
Application of health promotion in clinical practice.
Nurses’ role in health promotion.
4.
Factors that impact on nurses’ health promotion role.
Slide 6
Discussion
Nurses personal construct of health and health promotion.
The nurses’ construction of health promotion centered
around education and teaching. Responses include the
following:
“ It is about teaching them about their illness”.
“We find out what is wrong with them and we teach them
about it”.
Their approach often centered on Patient Education regarding diseases
and lifestyle changes. Concepts such as public involvement in health
promotion, enablement and empowerment did not feature in these
nurses’ definition of Health or Health Promotion.
Slide 7
Factors, which Tones (1993) consider central to the concept of
empowerment are: consideration of environmental issues, possession
of competencies and skills, which enable individuals to control aspects
of their lives and possession of self-esteem.
Slide 8
Application of health promotion in clinical practice.
According to Towell and Beardshaw (1991) activities that engage clients
as active partners must be evident at all levels of the service from planning
decisions to specific domestic decisions about daily life, work or leisure.
These levels are:
Individual: commitment to empowering individuals
Local and service: local collective advocacy, encouraging access to
community resources, developing partnerships and networks.
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Strategic: political lobbying, representation and participatory policy
planning and implementation; promoting mutual aid; actively seeking
consumer views and funding of projects (Bunton 1992).
Slide 9
A ‘bottom-up’ strategy calls for different skills in the health promoter,
who becomes a facilitator instead of the expert (Naidoo and Wills 1994). The
empowerment model takes into consideration the subjective views of the
client and enables the nurse to build a trusting relationship with the patient
based on participatory approach and mutual goal setting (Gibson 1991).
Slide 10
Factors that impact on Nurses’ health promotion Role
According to Webb (1997) nurses perform their health promotion role
poorly, and sometimes not at all. Poor educational provision, lack of time, and
lack of health knowledge have all been suggested as reasons for this. WilsonBarnett and Latter (1993) identified factors influencing nurses’ health
promotion practice in acute ward areas. These include:
*
The nurses’ understanding of what the concept of health
promotion represented,
*
The structure and organisation of the work place, which
emphasizes curative measures.
*
Role of the ward manager, which relegates health education to
the junior nurses.
Skelton (1994) and Norton (1998) identified nursing, medical and
managerial hierarchies and indeed, in some circumstances patients.
Slide11
Ethical Dimensions
Gibson (1991) stated that in order to adopt an ‘empowerment model’, in
nursing, a radical paradigm shift is needed. In other words, nurses need to
re-examine the philosophies underlying their practice. Professional bodies for
nursing need to re-examine codes of practice and broad principles for the
practice of health promotion for nurses.
Facilitating empowerment in the clinical setting begins with helping
individuals develop a critical awareness of their situation and enabling them to
master their environment, achieve self-determination, responsible citizenship
and meet health care needs, if it is their desire to do so (Malin and
Teasdale1991; Tones 1997).
Slide12
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The current government strategy document Saving Lives (DOH, 1999)
acknowledged that some minority ethnic groups carry higher burden of poor
health, premature deaths and long-term disabilities than other groups in the
population and emphasized the need for addressing the health of these
groups of people. This commitment to tackle inequalities should transcend
race issues to encompass tackling ageism, sexism, and discrimination against
people with disabilities in the clinical setting.
Slide 13
Conclusion:
As this is a small-scale research, involving two wards in a hospital,
results cannot be generalized. These nurses need to rethink the values
that underpin their practice. There is a need to adopting a wider
approach by embracing some of the principles of Ottawa Charter 1986
such as Empowerment, Public Participation and tackling Inequalities
Educationalists and policy makers should aim to improve nurses’
knowledge and skills necessary for tackling wider issues in health and
health promotion.
References
Bunton R (1992) Health Promotion as Social Policy in Bunton R. and
McDonald G (ed) Health Promotion, Disciplines and Diversity, pp. 129-152.
London: Rutledge.
Department of Health (1992) Health of the Nation: A strategy for Health in
England. London: HMSO,
Department of Health (1999) Saving Lives; Our Healthier Nation A strategy
for Health in England. London: HMSO,
Gibson C.H. (1991) A concept of analysis of empowerment. Journal of
Advanced Nursing 16: 354-361.
Heideggger, M. (1962) Being and Time. Harper and Brothers. New York
MacQuarrie J. an Robinson E. Trans.)
Latter S. Health Promotion in acute setting: the case for empowering nurses
in Kendall S. (1998) Health and Empowerment. London Arnold.
Malin N. and Teasdale (1991) Caring versus empowerment: considerations
for nursing practice. Journal of Advanced Nursing 16: 657-662.
Naidoo J. and Wills J. (1994) Health Promotion: Foundations for practice:
London: Bailliere Tindall.
Norton, L (1998) Health Promotion and health Education: what role should
the nurse adopt in practice? Journal of Advanced Nursing. 28(6): 1269-1275
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Skelton R. (1994) Nursing and empowerment: concepts and strategies.
Journal of Advanced Nursing 19: 415-423.
Tones B.K. (1997) Health Education as empowerment in Sidell et al Debates
and Dilemmas in Promoting Health. London, Mcmillan Press.
Towell D. and Beardshaw V. (1991) Enabling Community Integration - the
role of public authorities in promoting an ordinary life for people with
learning disabilities in the 1990s. London: Kings Fund.
Walters A.J. (1995) The phenomenological movement: implications for
nursing research. Journal of Advanced Nursing 22, 791-799.
Webb P. (1997) Health Promotion and Patient Education, London, Stanley
Thornes.
WHO (1986) Ottawa Charter for Health Promotion. An International
Conference on Health promotion (17-21 November) Copenhagen: WHO
Regional Office. pp. 20