Health Promotion

Issues within the implementation of health promotion will be discussed in relation to my field of nursing, adult nursing and my other field of choice, mental health nursing. A definition of health and health promotion will be identified, and why it is of significance to nursing practice in both of these fields of nursing. The impact of health promotion on nursing care will be considered in both fields, looking at examples of its implementation and its impact in the healthcare setting and the population at large. Similarities and differences that the issue raises between the two fields of nursing, as well as the importance of its implementation will be considered.

Crucial issues to be taken into account are diversity issues; such as economic status, background, environment, race, ethnicity, religious and cultural beliefs; and how these may have a significant effect on the assessment, evaluation, planning, implementation and communication of health practice and health promotion to the mainstream population. Another important concern is how the individual’s circumstances, background and lifestyle choices may have a significant affect the outcomes of health promotion. In defining nursing, the RCN outlines the importance if health promotion in nursing; “its purpose is to promote health, healing, growth and development, and to prevent disease, illness, injury and disability.” (Royal College of Nursing, 2004)

There are various definitions of health promotion in literature. McBride (1992, p.8) suggests that it is the process of “enabling people to increase control over and improve their health in physical, mental and social terms”, and that health promotion is one of the most basic concepts of nursing, ideologically and in the practice setting. (McBride, 1992) Tones and Tilford argue that health promotion is any planned intervention that “seeks to improve health and/or prevent disease.” (1994, p.18) The World Health Organization (WHO) redefined health from the original 1948 definition to “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” (WHO, 1986) The new definition included the components of intellectual, environmental, and spiritual health.

It emphasized concern for the individual as a whole person and placed health in the context of social environment, personal resources and physical capability. (Pender et al, 2001). In emphasizing wholeness it meant that the significance of mental health was also now being taken into account. A definition of mental health promotion involves “any action to enhance the mental well-being of individuals, families, organisations or communities” (DOH, p.27, 2001) The first core principle of the ‘NMC The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives’ outlines the importance of the patient as the nurse’s first concern, “treating them as individuals and respecting their dignity.” (NMC, p.2, 2008)

It states that the nurse should “act as an advocate to those in your care, helping them to access relevant health and social care, information and support.” (NMC, p.2, 2008) This implies that patients should be supported in caring for themselves so they are able to maintain and improve their health. It recognizes the importance of health promotion and the nurse’s role as an advocate to patients, in helping to improve patient autonomy by participating in their own healthcare and making their own decisions in order to restore or maintain their health. The NMC also states that patients should be provided with information and advice that is understandable so they are able to make their own choices regarding care. (NMC Guidance on Professional Conduct for Nursing and Midwifery Students, 2009)

Similar viewpoints are put forth by the Nursing Times, stating that the role of nurse as “informer” is central to practice. “Information given to patients to increase their knowledge and understanding of disease, diagnosis, prognosis and treatment, and assist with decision-making.” (Nursing Times) Another one of the four core principles that the NMC Code establishes is to “Work with others to protect and promote the health and well-being of those in your care, their families and carers, and the wider community.” (NMC, p.4, 2008); which again highlights the value of health promotion in nursing with an emphasis on teamwork. The Department of Health (p.5, 2001) outlines the implication of mental health promotion as crucial to the improvement of physical and mental health.

Its benefits include “increased emotional resilience, greater social inclusion and participation and higher productivity. It can also contribute to health improvement for people living with mental health problems and to challenging discrimination and increasing understanding of mental health issues.” Health promotion and its success is highly significant to both fields of nursing since it can be argued that more recently there has been a change of priority towards preventing illness and promoting good health. (POST, 2007) While in the past evidence suggests that nurse educators were preoccupied with teaching patients the management of illness, future nurse educators may teach and promote health maintenance. (McBride, 1995).

Wanless (2004) also suggests that the NHS should shift the focus from treating disease to the prevention of illness. The nature of health services is constantly changing and there is a greater need for the development of evidence-based practice within the nurse’s role. (Tod et al, 2008) Nurses in both fields and all settings, including education, practice and research have an important contribution to make to the advancement of health promotion, both in practice and mainstream society. (Ellis, P. 2010) They are the largest group of healthcare providers and often spend the most time with patients, so their position as role models in health promotion is vital (Pender et al, 2001)

It could be argued that it is the responsibility of all nurses to incorporate health promotion into their nursing role and philosophy since they have a professional accountability in promoting good health and well being. (Webb, P 1997) Their role as health educators may be viewed as a fundamental part of their care that should be carried out as part of their work on a daily basis. In both fields of nursing, evidence suggests that in assessing the patient and implementing health promotion it is important that the patient is viewed holistically. This means as a whole and focuses on the physical, psychological, social, sexual and spiritual well-being of an individual not only the diagnosed disease. (Macleod, A, 2006)

It also takes into account the individual’s environment, socio-economic status and lifestyle choices that may affect their health. Such lifestyle choices include smoking, alcoholism and drug taking and nutrition and exercise. These are an important factor in the success of the implementation of health promotion. Culture, ethnicity, race, religion and also matters such as social depravity, environment and crime are also crucial factors in the communication of health to patients and the public since they can have a vast impact on people’s lifestyle choices and their perception, views, beliefs and understanding of good health and how easy it is to access this assistance. Health promotion in nursing practice allows service users to make healthy choices, but matters of individuality must be taken into account when evaluating or assessing the service user.

Pender et al (2001) argues that health promotion should be geared towards not only individuals on a holistic basis, but the families (and communities) that they live in also. Becker (p. 1296, 1985) argues that while the nurses role in health promotion is pivotal in improving health behaviour, success is partly dependant on the acknowledgement of health care professionals that all individuals are “influenced by their perceptions, beliefs and values (attitudes) about health and illness.” Therefore it seems that it is crucial that any educating should take into account the individual’s beliefs about what is achievable and important. And the individual’s beliefs are influenced by a variety of factors such as background and perceptions of health.

While health education enables adults to make well-informed decisions regarding their health like eating better and exercising, it may be that changing long term habits such as smoking may not succeed due to the various beliefs and perceptions of the individual. (Becker, 1985) Another issue to consider is how the achievement of health may be measured in assessing the success of health promotion interventions. Pender et al (2001) argue that morbidity and mortality rates may be evaluated to assess the achievement of such interventions. Since mental health promotion has more recently become “centre stage” (DOH, p.5,2001) with the inclusion of Standard One in the National Service Framework for Mental Health, there has been an advancement in the promotion of mental health with hope that individuals will experience less discrimination because of their problems. (DOH, 2001)

Research carried out in promoting mental health suggests that more initiatives need to be carried out in reducing stigma and discrimination associated with mental health problems so that it is easier for individual’s to seek help. Personal experience or contact with people with mental health problems is associated with more favourable attitudes, Angermeyer & Matschinger (1996) found. Like with Adult Nursing and health promotion, many issues affecting mental health lies outside the remit of the health and social service, such as employment, social inclusion and neighbourhood renewal and health at work. (DOH, 2001)

Like health promotion in adult nursing, mental health is influenced by various factors, such as environment, social depravity, past experiences, and factors such as financial status, employment, life events and appropriate healthcare. Therefore it would seem diversity is a very important factor to consider in the implementation of health promotion in both fields. Research suggests that the advancement of health promotion has been found and can be mostly beneficial to both areas of nursing since everyone has mental health needs and physical health needs. Pender et al (2001) argues that nurses will continue to play a vital role in health promotion since they are the largest group of healthcare providers in offering available health promotion and illness prevention services to various population groups including the vulnerable and socially deprived in both fields of nursing.

“Most work towards distributing these services so they are available to all” (Pender et al, p.12, 2001) In the RCN and The Public Health Agenda Event advertisement, RCN fittingly points out that “The nursing profession is established as a key facilitator for the health of future populations” (RCN, 2012) It would seem that evidence suggests that this is true on both fields of nursing.