1 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. 3 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. 4 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 5 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. 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(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