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Fundamentals of Health Promotion for Nurses E-Book

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Fundamentals of Health Promotion for Nurses is a concise, accessible introduction to health promotion and public health for pre-registration nursing students and newly qualified nurses. Promoting the health and wellbeing of patients is a vital part of the nursing role, and the updated second edition of this user-friendly book discusses the foundations for health promotion practice using practical examples, activities and discussion points to encourage readers to reflect on their values, debate the issues and apply their knowledge and understanding to practice.

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Table of Contents

Cover

Titles of related interest

Qrcode

Title Page

Copyright

About the series

Preface

Acknowledgements

Glossary of key terms

Contributors

How to use your textbook

Features contained within your textbook

The anytime, anywhere textbook

About the companion website

Part One: Health Promotion and Public Health

Introduction

References

Chapter 1: Health and health promotion

Introduction

What is health?

Influences on health

What is health promotion?

Health promotion and public health

Health promotion and nursing practice

Further reading and resources

References

Chapter 2: The patient in their social context

Introduction

Inequalities in health

Explaining health inequalities

Tackling health inequalities

Global perspective on tackling health inequalities

The role of the nurse in tackling health inequalities

Further reading and resources

References

Chapter 3: Approaches to promoting health

Introduction

Perspectives of health

Approaches to health promotion

Models of health promotion

Further reading and resources

References

Chapter 4: Creating supportive environments for health

Introduction

Creating supportive environments

A health promoting health service

The hospital setting

The pharmacy setting

The school setting

The prison setting

Further reading and resources

References

Part Two: Public Health Priorities

Introduction

References

Chapter 5: Smoking

Introduction

Factors influencing smoking

Prevalence of smoking

Smoking as a public health priority

Addressing smoking: tobacco control

Addressing smoking: creating supportive environments

Addressing smoking: developing personal skills and stopping people from starting to smoke

Addressing smoking: developing personal skills and enabling people to quit

The role of the nurse in addressing smoking

Further reading and resources

References

Chapter 6: Alcohol

Introduction

The impact of alcohol on health

Defining alcohol-related harm

Alcohol as a public health priority

The prevalence of drinking

The policy context

The role of the nurse in health promotion

Further reading and resources

References

Chapter 7: Sexual health

Introduction

Defining sexual health

Why is sexual health a public health priority?

Sexual health inequalities in England

Factors contributing to sexual health

Addressing sexual ill health and promoting sexual health

The role of the nurse in health promotion

Further reading and resources

References

Chapter 8: Obesity

Introduction

Defining obesity

Prevalence of obesity

Causes of obesity

Obesity as a public health priority

Policy context

Addressing obesity

Addressing obesity and promoting a healthy diet: health education

Addressing obesity in children: using social support

Addressing obesity and promoting physical activity: creating a supportive environment

Addressing obesity through public policy

The role of the nurse in tackling obesity

Further reading and resources

References

Chapter 9: Long-term conditions

Introduction

Long-term conditions as a public health priority

Health policy context

Approaches to long-term conditions: developing personal skills and self-management

Approaches to long-term conditions: developing personal skills: telehealth and telecare

Approaches to long-term conditions: developing personal skills and health education

Approaches to long-term conditions: creating a supportive environment

Further reading and resources

References

Part Three: Skills for Health Promotion

Introduction

References

Chapter 10: Using health information and epidemiology

Introduction

Health information

Definitions and uses of epidemiology

Measuring health and disease in populations

Epidemiological studies

Health outcomes

Needs assessment

The role of the nurse in using health information

Further reading and resources

References

Chapter 11: Evidence-based practice

Introduction

Practice and decision-making

What do we need to know?

The rise of evidence-based practice

Evidence-based practice: what it is and what it isn't

Doing a review

Finding evidence

Looking for other information to help decision-making

Appraising evidence

Acting on evidence

Further reading and resources

References

Chapter 12: Health education and communication

Introduction

Approaches to changing lifestyles

The role of the nurse in promoting health behaviour and lifestyle change

Further reading and resources

References

Chapter 13: Protecting the health of the population

Introduction

The changing pattern of disease and ill health

Infection control

Protecting populations: the bigger picture

Vaccinations

Screening

The role of the nurse in health protection

Further reading and resources

References

Part Four: Health Promotion and the Nurse

Introduction

References

Chapter 14: Health promotion and people with learning disabilities

Introduction

The role of the nurse in promoting the health of people with learning disabilities

Priorities in health promotion and disease prevention

General health and life expectancy

Examples of health promotion strategies and activities

Further reading and resources

References

Chapter 15: Health promotion and people with mental health issues

Introduction

Defining mental health promotion

The role of mental health nursing and health promotion

Priorities for health promotion for people with mental health issues

Strategies for mental health promotion

Further reading and resources

References

Chapter 16: Health promotion and older adults

Introduction

Priorities for the health of older people

Strategies for health promotion with older adults

Further reading and resources

References

Chapter 17: Health promotion and nursing in the community

Introduction

Defining community

Defining community nursing

Priorities for health promotion in the community

Strategies for health promotion in the community

Further reading and resources

References

Chapter 18: Children's nursing and health promotion

Introduction

Priorities in health promotion for children

Strategies for health promotion with children

The role of the children's nurse in health promotion

Further reading and resources

References

Index

End User License Agreement

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Guide

Cover

Table of Contents

Preface

Part One: Health Promotion and Public Health

Begin Reading

List of Illustrations

Figure 1.1

Figure 1.2

Figure 1.3

Figure 2.1

Figure 2.2

Figure 2.3

Figure 2.4

Figure 3.1

Figure 3.2

Figure 4.1

Figure 4.2

Figure 0.1

Figure 5.1

Figure 5.2

Figure 5.3

Figure 6.1

Figure 6.2

Figure 6.3

Figure 6.4

Figure 7.1

Figure 7.2

Figure 8.1

Figure 8.2

Figure 8.3

Figure 8.4

Figure 8.5

Figure 9.1

Figure 10.1

Figure 10.2

Figure 10.3

Figure 10.4

Figure 10.5

Figure 11.1

Figure 12.1

Figure 12.2

Figure 12.3

Figure 13.1

Figure 13.2

Figure 13.3

Figure 15.1

Figure 16.1

Figure 16.2

Figure 18.1

Figure 18.2

Figure 18.3

Figure 18.4

List of Tables

Table 1.1

Table 1.2

Table 1.3

Table 1.4

Table 2.1

Table 2.2

Table 3.1

Table 3.2

Table 3.3

Table 4.1

Table 5.1

Table 6.1

Table 7.1

Table 7.2

Table 7.3

Table 8.2

Table 8.3

Table 9.1

Table 9.2

Table 9.3

Table 10.1

Table 10.2

Table 10.3

Table 10.4

Table 10.5

Table 11.1

Table 12.1

Table 12.2

Table 13.1

Table 13.2

Table 14.1

Table 15.1

Table 15.2

Table 15.3

Table 16.1

Table 17.1

Table 18.1

Table 18.2

This title is also available as an e-book. For more details, please see www.wiley.com/buy/9781118515778 or scan this QR code:

SECOND EDITION

Fundamentals of Health Promotion for Nurses

EDITED BY

JANE WILLS

Professor, Health Promotion

London South Bank University, London, UK

This edition first published 2014 © John Wiley & Sons Ltd

Registered Office

John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

Editorial Offices

350 Main Street, Malden, MA 02148-5020, USA

9600 Garsington Road, Oxford, OX4 2DQ, UK

The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

For details of our global editorial offices, for customer services, and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell.

The right of Jane Wills to be identified as the author of the editorial material in this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.

Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. It is sold on the understanding that the publisher is not engaged in rendering professional services and neither the publisher nor the author shall be liable for damages arising herefrom. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

Library of Congress Cataloging-in-Publication Data

Promoting health (Wills)

Fundamentals of health promotion for nurses / edited by Jane Wills. -- 2nd edition.

p. ; cm.

Preceded by Promoting health / edited by Jane Wills. 2007.

Includes bibliographical references and index.

ISBN 978-1-118-51577-8 (pbk.)

I. Wills, Jane, 1954- editor. II. Title.

[DNLM: 1. Health Promotion--Nurses’ Instruction. 2. Public Health Nursing--methods--Nurses’ Instruction. 3. Nurse’s Role--Nurses’ Instruction. 4. Nurse-Patient Relations--Nurses’ Instruction. 5. Patient Education as Topic--Nurses’ Instruction. WY 108]

RT97

613--dc23

2014005312

Cover image: Reproduced from iStock © alengo

Cover design by Grounded Design

1 2014

About the series

Wiley's Fundamentals series are a wide-ranging selection of textbooks written to support preregistration nursing and other health care students throughout their course. Packed full of useful features such as learning objectives, activities to test knowledge and understanding, and clinical scenarios, the titles are also highly illustrated and fully supported by interactive MCQs, and each one includes access to a Wiley E-Text: powered by VitalSource – an interactive digital version of the book including downloadable text and images and highlighting and note-taking facilities. Accessible on your laptop, mobile phone or tablet device, the Fundamentals series is the most flexible, supportive textbook series available for nursing and health care students today.

Preface

This book is intended to clarify for new nurses the importance of developing public health and health promotion skills. The Nursing and Midwifery Council (NMC) has established standards of competence and specific skills that student nurses must be able to perform (NMC, 2010). One of the NMC standards for pre-registration education states that:

All nurses must understand public health principles, priorities and practice in order to recognise and respond to the major causes and social determinants of health, illness and health inequalities. They must use. health screening, health promotion, and promote social inclusion.

(NMC, 2010)

Part of the reason why health promotion and public health have assumed increasing importance in nursing is a consequence of changing understandings of medicine and health care and the importance of reducing preventable illness and deaths. Infection-control measures, the modification of unhealthy lifestyles and the appropriate use of health services can offer a cheaper solution to demands for health care and threats to individual health. Health promotion and public health can seem a vast area of new knowledge and skills that may also be difficult to put into practice. The nurse needs to use a range of information and data to assess needs, promote access to services and identify effective ways to promote health. It is also expected that all nurses will use their communication and interpersonal skills to encourage patients to adopt healthier behaviours. Changing behaviour is a challenge for patients and may also be so for the nurse and this requires an understanding of the social and psychological dimensions of lifestyle change.

Developing such skills demands a wide range of knowledge, drawing from the scientific knowledge of epidemiology to communication skills. Such knowledge must then be applied to the needs of the individual, family, group, community or population and because the National Health Service (NHS) is not the only sector that affects and is concerned with health, the nurse must work in partnership with other professions and groups in public, private and voluntary sectors who have an impact on people's health and well-being.

This book is written for new student nurses whose placements may include working with children, adults, people with mental health issues or a learning disability and the community and who may in the future, work in many different contexts including health centres, primary care, walk-in centres, and specialist clinics such as Genitourinary Medicine and Sure Start areas as well as the acute hospital setting. While specialist community public health nurses are recognized as making a specific contribution to the promotion of health and are registered on Part 3 of the Nursing and Midwifery Council (NMC) register, many other nurses have an interest in, and responsibility for, enabling people to achieve optimum health.

The terms health promotion and public health are often used interchangeably. In this book we see these as complementary and overlapping areas of practice in which health promotion refers to efforts to prevent ill health and promote positive health, a central aim being to enable people to take control over their own health. This may range from a relatively narrow focus on changing people's behaviour to community action or public policy change reflective of tackling the wider determinants of health. Public health has traditionally been associated with public health medicine and its efforts to prevent disease. It takes a collective view of the health needs and health care of a population rather than an individual perspective. Its strategies thus include the assessment of the health of populations, formulating policies to prevent or manage health problems and signi¬ficant disease conditions such as immunization programmes and the promotion of healthy living environments and sustainable development.

Health promotion is a difficult concept because there are many different perspectives on health that underpin current approaches. For the nurse, promoting health means much more than the traditional role of addressing symptoms, experiences of pain, distress or discomfort. It means enabling people to increase control over their health though this may be at odds with the medical approach to care which may too often dismiss the patient's perspective and cast the patient's role as one which involves passivity, trust and a willingness to wait for medical help. This book tries to help the nurse understand health promotion activities by suggesting that these may relate to the following:

developing personal skills through health education;

strengthening community links and networks;

reorienting services to promote health;

creating environments that make the healthy choice easier;

working towards policies that support the public's health.

This book is a substantially revised second edition of a textbook published in 2007, Promoting Health: Vital Notes for Nurses. Many of the same authors have contributed to this volume but we have adopted a different structure for the book to enable new nurses to better orientate themselves to how they can be health promoting in practice. Part One is therefore a discussion of some of the core concepts in health promotion. Part Two outlines some of the major public health priorities and how they may be addressed by the nurse. Part Three is an introduction to some of the core skills of public health and health promotion including epidemiology, communication and health education, evidence-based practice and health protection and infection control. Part Four is a completely new addition to this book in which practising nurse educators explain how their branch of nursing can be health promoting. Although health promotion and/or public health are central aspects of the nurse's job description, part of their training and a core dimension in the NHS knowledge and skills framework for the competent nurse, these aspects of a nurse's role are not well understood and so this section is to make real health promotion as an approach and set of activities.

The book is organized consistently throughout to enable you to find your way. Each chapter has learning outcomes and a chapter summary. At the end of each chapter there are some suggestions to follow up in further reading or web resources. Each chapter also contains an ‘on placement: checklist’ of practice points for the new student nurse to take note of and assess whether health promotion is visible on placement.

Acknowledgements

Textbooks are an important but sometimes unrecognized part of the work of academics and I am grateful to my colleagues who have found time in their busy workloads to contribute their expertise to this book. Also to my family who had to forego their summer holiday to its production. Finally, I want to acknowledge the enormous assistance provided by Katrina Rimmer, the Development Editor in the Health Sciences team at Wiley, who was both patient and meticulous in preparing the manuscript.

Jane Wills

Glossary of key terms

You can download these key terms by visiting the companion website at: www.wileyfundamentalseries.com/healthpromotion

Chapter 1

Empowerment

Developing the capacity of people to make informed decisions by building self-efficacy and understanding.

Health education

Facilitating learning and behaviour change.

Health promotion

A range of activities to enable people to take greater control over their health that may be directed at individuals, families and communities or whole populations.

Holistic

Taking all the elements of a person's life into account – including physical, emotional, mental and spiritual elements.

Primary prevention

Interventions to avoid occurrence of a disease. Secondary prevention includes measures to diagnose before a disease causes morbidity.

Public health

The science and art of preventing disease and prolonging life through the identification of need and population actions such as screening

Chapter 2

Health inequality

The avoidable and unfair differences in health status between groups of people.

Social determinants

The economic and social conditions in which a person lives that influence their health.

Social exclusion

A term used to describe those who are unable to participate fully in life due to social and economic factors.

Chapter 3

Model

While the definition of health promotion has been universally adopted, there have been a number of different approaches to promoting health and these are described or analysed in models.

Preventative medical

Sometimes called biomedical approach which focuses on addressing risk behaviours and healthy lifestyles as the means by which health can be improved.

Social model

Acknowledges the social determinants of health and the reciprocal relationship between health-related behaviours and the environments in which people live and work.

Chapter 4

Setting

A setting is the term used to describe environments which influence a person's health. Settings such as a school or workplace can also be used to promote health as they are vehicles to reach individuals.

Supportive environment

An environment that offers people protection from the factors that can threaten good health and makes healthy choices easier. It will also foster participation in health and enable people to control their health.

Chapter 5

Cessation

Also called quitting in relation to smoking. Four-week quit rates are taken as the measure of success and these are validated by testing smokers' carbon monoxide (CO) level.

Harm reduction

Strategies to reduce harm caused by continued tobacco/nicotine use, such as reducing the number of cigarettes smoked, or switching to different brands or products, e.g. e-cigarettes.

Pharmacotherapy

A treatment using pharmaceutical drugs, e.g. Nicotine Replacement Therapy (NRT), bupropion.

Second-hand smoke

Also called passive smoking or environmental tobacco smoke (ETS). A mixture of smoke exhaled by smokers and smoke released from smouldering cigarettes, cigars, pipes, bidis, etc. The smoke mixture contains gases and particulates, including nicotine, carcinogens and toxins.

Chapter 6

Binge drinking

The consumption of five or more alcoholic drinks on at least one occasion.

Dependent drinking

Dependent drinking means that a person feels that they are unable to function without alcohol. Withdrawal symptoms can be both physical and psychological and include a compulsion to drink. Sweating, shakiness, and anxiety occur when alcohol use is stopped after a period of heavy drinking.

Harmful drinking

When a person drinks over the recommended weekly amount of alcohol and experiences health problems that are directly related to alcohol, e.g. depression, pancreatitis, cirrhosis, some types of cancer, such as mouth cancer and bowel cancer.

Hazardous drinking

When a person drinks over the recommended weekly limit of alcohol (21 units for men and 14 units for women). It is also possible to drink hazardously by binge drinking.

Low risk drinking

Is called “lower-risk” rather than “safe” because drinking alcohol is never completely safe but there is lower risk of causing future harm. Low risk is men who drink less than 3–4 units a day and women who drink less than 2–3 units a day.

Chapter 7

Sexual rights

The basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so. The right to make decisions concerning reproduction and sexual activity free of discrimination, coercion and violence.

Sexual risk

Behaviours which can increase the chance of contracting or transmitting disease, or increase the chance of the occurrence of unwanted pregnancy.

Sexuality

Encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction.

Chapter 8

Bariatric surgery

Surgery on the stomach and/or intestines to help the patient with extreme obesity lose weight. Bariatric surgery is a weight-loss method used for people who have a body mass index (BMI) above 40.

Body mass index (BMI)

A measure of body weight relative to height. BMI can be used to determine if people are at a healthy weight, overweight, or obese.

Obesity

A person is considered obese if he or she has a body mass index (BMI) of 30 kg/m

2

or greater.

Overweight

Being too heavy for one's height: having a body mass index (BMI) of 25–30 kg/m

2

.

Chapter 9

Care pathway

The steps in the treatment and care of a patient with a particular condition. Care pathways set out the expected progress of the individual as their condition progresses.

Chronic condition

A disease, illness or injury which has one or more of the following characteristics: it needs ongoing or long-term monitoring; it needs ongoing or long-term control or relief of symptoms; it requires rehabilitation ; it continues indefinitely; it has no known cure; it comes back or is likely to come back.

Long-term condition

Those conditions that cannot, at present, be cured but can be controlled by medication and other therapies.

Self-management

Encouraging a patient to take responsibility for managing a condition.

Chapter 10

Epidemiology

The study of the distribution and determinants of disease and conditions in particular populations.

Incidence

Number of new cases of disease in a given time period.

Measures of deprivation

Ways of assessing levels of disadvantage in a population.

Prevalence

The total number of people in a given population with a disease at any given point in time.

Rate

The frequency with which an event occurs in a defined population. In whole populations, usually expressed as number per 100000.

Risk factor

An aspect of personal behaviour or lifestyle, an environmental exposure, that is associated with an increased occurrence of disease or other health-related event or condition.

Surveillance

The systematic collection and analysis of health data on an ongoing basis, in order to control and prevent disease or outbreaks in the community.

Chapter 11

Causality

is “

the relating of causes to the effects they produce

”.

Critical appraisal

standards that are used to evaluate research evidence.

Evidence

Facts or information to prove whether or not something is true.

Intervention

An action or programme that aims to bring about identifiable outcomes.

National Institute for Health and Clinical Excellence (NICE)

An independent organization responsible for providing national evidence-based guidance on the promotion of good health and the prevention and treatment of ill health.

RCT

Randomized controlled trial is an experimental research design.

Systematic review

A synthesis of available evidence usually collected from RCTs.

Chapter 12

Advocacy

Activities such as lobbying aimed at changing the policy of organizations or government.

Health literacy

The skills needed to function in a health care environment which includes basic reading and numerical skills.

Lifestyle

The behaviours that make up how we live.

Motivation

Internal factors within a person that influence their actions.

Motivational interviewing

A discussion focusing on a key issues that encourages the patient to change by exploring cost and benefits.

Self efficacy

Feeling able to do or change something and having confidence and control.

Victim blaming

Blaming or judging someone for unhealthy behaviours without acknowledging the social factors that influence that behaviour.

Chapter 13

Communicable disease

A disease that can be communicated or transmitted from one person to another.

Health protection

Part of the Public Health function that includes safety and quality of food, water, air and the general environment; preventing the transmission of communicable diseases; managing outbreaks.

Non-communicable disease (NCD)

Disease or conditions that are non-infectious and non-transmissible among people. NCDs may be chronic diseases or they may result in more rapid death. Risk factors such as a person's lifestyle and socio-economic environment are known to increase the likelihood of certain NCDs.

Screening

Screening is a process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition.

Chapter 14

Complex needs

A person who has a range of “layered” issues that may include learning disability and other difficulties such as physical and sensory impairment, mental health problems or behavioural difficulties.

Learning disability

Everyone is individual, and will have individual needs, preferences and ambitions. Learning disabilities are a significant, lifelong experience in which there is a reduced ability to understand or learn new or complex information, a reduced ability to cope independently, and starts before adulthood with a lasting effect on the individual's development.

Chapter 15

Advocacy

Independent help to enable people to take control of their lives, explore and express their own needs and access the services and support they need to meet their needs.

Mental health

Mental health is a state of well-being in which an individual realizes their own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to their community.

Mental health promotion

Mental health promotion aims to promote mental health and well-being for all; prevent mental health problems for at-risk groups through increasing protective factors and reducing risk factors; promote mental health for people with mental health problems.

Mental illness

Severe and enduring mental health problems.

Well-being

A multidimensional concept that includes happiness, positive affect, low negative affect, and satisfaction with life as well as psychological functioning.

Chapter 16

Activities of Daily Living

Tasks that people carry out to look after their home, themselves, and their participation in work, social and leisure activities.

Carer

Someone, usually unpaid, and often a friend or family member who supports a person with social care needs, either full-time or part-time.

Older adult

In the developed world, the age of 60 or 65, roughly equivalent to retirement ages in most developed countries, is said to be the beginning of old age. In other countries, chronological age has less meaning and an elder is associated with wisdom and possibly accompanying physical decline.

Chapter 17

Community

People who share a set of characteristics that may relate to geography, interest, culture or family.

Community development

Problem solving approach whereby the community is empowered with knowledge and skills to identify and prioritize its needs and problems, harness its resources to deal with the problems and take action.

Community nurses

Registered nurses who work in the community: in people's homes, in schools and in local surgeries and health centres. Also called public health nurses.

Chapter 18

Children's nurses

Nurses who care for sick or injured children and young people in hospital or in the home.

Child Health Profile

These provide a snapshot of child health and well-being for each Local Authority in England using indicators such as infant death, dental health, immunisation rates.

Safeguarding

The responsibilities and actions taken to protect children from maltreatment and to prevent impairment of their health.

Contributors

Thomas J. Currid

Course Director, Mental Health

London South Bank University, London, UK

Joanne Delrée

Senior Lecturer, Learning Disability Nursing

London South Bank University, London, UK

Pat England

Faculty Information Adviser, Health and Social Care

London South Bank University, London, UK

Renee Francis

Senior Lecturer, Learning Disability Nursing

London South Bank University, London, UK

Amanda Hesman

Senior Lecturer, Adult Nursing

London South Bank University, London, UK

Sandra Horner

Senior Lecturer, Specialist Community Public Health Nursing

London South Bank University, London, UK

Jenny Husbands

Senior Lecturer, Adult Nursing

London South Bank University, London, UK

Linda Jackson

Senior Lecturer, Public Health and Health Promotion

London South Bank University, London, UK

Maxine Jameson

Senior Lecturer, Specialist Community Public Health Nursing

London South Bank University, London, UK

Muireann Kelly

Research Assistant

London South Bank University, London, UK

Matthew Lester

Senior Lecturer, Child Nursing

London South Bank University, London, UK

Susie Sykes

Senior Lecturer, Public Health and Health Promotion

London South Bank University, London, UK

Jane Wills

Professor, Health Promotion

London South Bank University, London, UK

Sandie Woods

Senior Lecturer, Occupational Therapy

London South Bank University, London, UK

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Part OneHealth Promotion and Public Health

Chapter 1 Health and health promotion

Chapter 2 The patient in their social context

Chapter 3 Approaches to promoting health

Chapter 4 Creating supportive environments for health

Introduction

Part One defines and illustrates what health promotion and public health mean in practice, including their multidisciplinary nature and complex and wide-ranging activities. It shows how nurses must look beyond traditional views: the biomedical mechanistic view of health in which patients present with a problem needing treatment and the expert-led approach to nursing in which patients are encouraged to adhere to advice. Instead, it suggests that a health promotion approach includes:

a holistic view of health;

a focus on participatory approaches that involve patients in decision-making;

a focus on the determinants of health, the social, behavioural, economic and environmental conditions that are the root causes of health and illness which influence why patients now present for treatment or care;

multiple, complementary strategies to promote health at the individual and community levels.

The three perspectives on health that influence health promotion practice (Naidoo and Wills, 2009) are as follows:

the

biomedical

views health as the absence of diseases or disorders;

the

behavioural

views health as the product of making healthy lifestyle choices;

the

socio-environmental

views health as the product of social, economic and environmental determinants that provide incentives and barriers to the health of individuals and communities.

These perspectives represent three different ways of looking at health and influence the ways in which health issues are defined. They also influence the choice of strategies and actions for addressing health issues. If health is viewed simply as the absence of disease, then health promotion is seen as preventing disease principally through treatment and drug regimes. If health is viewed as the consequence of healthy lifestyles, then health promotion is seen as education, communication of health messages, giving information and facilitating self help and mutual aid programmes. If, on the other hand, health is seen as a consequence of the socio-economic and environmental circumstances in which people live, then health promotion becomes a matter of tackling these issues to make healthy choices easier. The first two perspectives are much in evidence in nursing practice. A socio-economic and environmental perspective is more challenging for a setting which still emphasizes one-to-one care.

Chapter 1 introduces the fundamental features of health promotion and details the broad range of activities that can come under the umbrella of health promotion, and describes the health promotion role of the individual nurse.

Chapter 2 summarizes some of the evidence showing how social factors can affect health. Inequalities in health status exist across geographical areas, social class, ethnicity and gender. People may also not have equal access to health services and often those most in need have least access or the worst services. The delivery of care may be discriminatory, making it harder for individuals because of their language, race, age or disability. Material disadvantage has been shown to be a major factor not only directly in restricting opportunities for a healthy life but also indirectly in educational attainment and employment options. There is also emerging evidence of psychosocial risk factors for poor health especially weak social networks and stress in early life.

Current health policy (DH, 2010) is committed to tackling inequalities in health and a raft of government legislation is designed to: address areas of deprivation, increase the opportunities for disadvantaged and marginalized groups, and take children out of poverty. Public health thus reflects ideological debates about the rights and responsibilities of individuals and the state for the nation's health. Throughout this book we challenge the individualistic model which focuses on the presenting patient's problems alone and encourage the nurse to be aware of significant economic or social circumstances that might make it difficult for individuals, families and communities to adopt or experience healthier lifestyles despite being informed and offered advice. We urge the nurse to avoid victim blaming in which individuals are encouraged to feel responsible and guilty for their own health status. This sort of approach runs the risk of increasing inequalities by which only the most educated, articulate and confident individuals will be able to accept and adopt health messages.

Chapter 3 discusses the various models of health promotion which have attempted to describe approaches to a health issue. Many practitioners do not use theory when planning health promotion and work far more from intuition or existing practice wisdom, which is often rooted in a traditional health education approach. Health promotion models are not, by and large, planning models but attempts to ‘scope’ the broad field of health promotion. Nevertheless an awareness of health promotion models and models of behaviour change encourages much more rigour in planning, making the practitioner be more explicit about what they are trying to do and articulating those determinants that are thought to influence behavioural or clinical outcomes and which they think can be changed. An effective project or intervention, even if it is simply a one-to-one education session, will benefit from explicitly stated goals, methods and means of evaluation showing how any change following the intervention can be demonstrated.

The task-oriented culture of hospitals and little time for extended patient contact mean health promotion is often a peripheral activity, even though episodes of acute illness or injury can be seen as windows of opportunity for advice and education on disease self-management, rehabilitation and to empower patients to make better use of health services. Chapter 4 discusses how the hospital can be a more health-promoting setting. As the hospital is part of the community, so creating supportive environments for health means integrating the hospital with wider health concerns such as sustainable development and environmental management. Within the hospital itself, promoting health would mean closer relationships of different disciplines such as occupational health, infection control, catering managers and new structures for patient and public involvement. The chapter describes the World Health Organization Health Promoting Hospital movement and its call for hospitals to be at the heart of their communities and part of a seamless service that addresses health services across the whole health and social care continuum. The modern nurse, whatever their context, recognizes that they work in partnership with others in a multi-agency, multi-professional team to improve health and well-being.

Most hospital nurses have close and continuous contact with patients and at a time when they have a heightened awareness of their health. In the past, many nurses would employ a prescriptive approach to their practice, reassuring patients but intent on giving information usually about minor events such as the type of medication or a procedure. In order to be fulfilling their role, many felt they needed to be doing something to patients. Health promotion then was often characterized as “nannying”, due to the nurse assuming an expert role and telling patients what to do, ignoring the knowledge and experience that patients may already have about their own condition or lifestyle. Yet many nurses are taught that a basic principle underpinning practice should be to “empower” patients. So what does it mean to foster empowerment? Empowerment in health promotion can be defined as a process through which people gain greater control over decisions and actions affecting their health (Nutbeam, 1998). To do this, the nurse needs to be able to clarify the individual's beliefs and values about health, health risks and health behaviours and help the patient to become aware of the factors that negatively and positively contribute to their health. Activities and interactions are characterized by participation – starting from the patient's health situation, to setting realistic goals and increasing their motivation and confidence, to taking action to improve their health. We see this as a health-promoting way of working. But health promotion is far more than just developed interpersonal or counselling skills of active listening and open questioning.

References

DH (Department of Health) (2010)

Healthy Live, Healthy People: Our Strategy for Public Health in Englands

. DH, London.

Naidoo, J. and Wills, J. (2009)

Health Promotion: Foundations for Practice,

3rd edn. Ballière Tindall, London.

Nutbeam, D. (1998) Health promotion glossary.

Health Promotion International

,

13

, 349–364.

Chapter 1Health and health promotion

Jane Wills

Professor of Health Promotion and London South Bank University, London, UK

Linda Jackson

Previously Senior Lecturer, Public Health and Health Promotion, London South Bank University, London, UK

Learning outcomes

By the end of this chapter you will be able to:

1. Define health and well-being2. Analyse the difference between a medical and social model of health and identify how these apply to nursing practice3. Define and discuss the concepts of public health and health promotion and how they apply to nursing practice

Introduction

This chapter considers the concepts of health and well-being and why they are central to the practice of all health care professionals. There are many ways that the concept of health can be understood. The traditional medical model, where health is seen as the absence of disease and illness, has led to the perception that health is an individual phenomenon for which each person is responsible. A social model of health focuses on social and political determinants and the unequal access that people may have to health. This chapter will look at the definitions for health, holistic health, health promotion, and public health, as well as describing the medical and social models of health. As these are basic and commonly used terms, it is important to clearly define and examine what is meant by them and how they are applied to nursing practice. By exploring these other concepts of health, it will challenge nursing students to consider whether, in addition to the more reactive nursing role of responding to disease and illness, they also will have a proactive role in promoting health.

What is health?

Health can be hard to define, as it is one of those words that can mean many different things to different people. It is often looked at in two main ways:

a positive or wellness approach, where health is viewed as an asset or the ability to do something, or

a more negative approach, which focuses on the absence of illness and diseases.

The medical model of health sees health as being about illness and disease and ill health pertains to the individual patient or person. The nurse's role is thus seen as treatment and cure.

Activity 1.1

For me, being healthy means …

Tick whichever apply:

Taking regular exercise. Getting enough sleep. Eating fruit and vegetables. Enjoying life. Bouncing back when things are tough. Being safe. Having plenty of friends. Being the right weight for my height. Having a job. Feeling at peace with myself. Not smoking. Not getting sick. Drinking in moderation. Enjoying work and study with not too much stress.

Yet people interpret what “being healthy” means in different ways. For many people, it means not being sick or having any diagnosed condition, a view which can be described as a biomedical viewpoint. Others see health as having a lifestyle that contributes to health, such as not drinking too much and not smoking. But health may also be seen positively as a sense of well-being that includes a person's mental health and feeling of control over their life and their social relationships. The World Health Organization (WHO) defined health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1948). The WHO's definition of health is both holistic and positive and reflects more accurately how ordinary people view their health than the more medical perspective. Health encompasses many aspects, as shown in Figure 1.1.

Mental health

: being able to think clearly and adapt to different situations and have a resilience to cope.

Emotional health

: being able to recognize, express and manage emotions such as anger and fear

Social health

: being able to form and maintain relationships.

Physical health

: having energy and vitality and feeling well.

Spiritual health

: being able to be at peace with oneself and find calm.

Figure 1.1 The dimensions of health.

Because health may be viewed differently, nurses need to recognize individual needs and priorities. Younger people, for example, tend to see being healthy as being fit while older people see health as being able to fulfil their daily activities such as getting to the shops.

Activity 1.2

Consider the following case studies – which of these patients would you regard as healthy?

Mr A is 46 and has been living with HIV for 20 years, has a long-standing relationship and works for a computer company. Mrs B is a new widow, aged 80, who has been admitted following a fall.

Discussion

While individuals may regard themselves as healthy even when having a diagnosed condition such as Mr A, health care professionals tend to view health as the absence of disease or illness and that this is essential to fulfil life's functions.The nurse might be looking more at his physical health in terms of his medication and viral load counts. It would be important to first ask the patient how he is coping and what he considers to be the most important aspect of living with his disease as opposed to focusing on monitoring physical signs and symptoms and getting blood work done.

The nurse might take a functional view of Mrs B's health and may focus on her ability to perform selected duties of everyday life, e.g. dressing, cooking, climbing stairs and moving about unaided. Her mental health may or may not be assessed, however, though this may be the most important issue for this woman. Her major concern may be depression, social isolation and anxiety all of which impact on her health and well-being. The health promotion role could involve listening to the patient and trying to identify her needs as she sees them and offering emotional support.

The medical model of health is based on knowledge about the physical and biological causes of disease. It sees health as the absence of disease. It developed with the growth of the medical profession and tends to take a curative approach.

The social model of health focuses on the social distribution of health and illness between different groups (e.g. death rates vary between social classes). The social model is interested in the environmental and social causes of ill health. It tends to take a preventive approach.

Influences on health

A person's health is inextricably linked to everything around that person.

Activity 1.3

Would you describe yourself as healthy?

Write down a list of factors, e.g. personal, medical, external, that you think have a bearing on your health.

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Discussion

Many things affect your health – your family history, where you live, where you work, what you can afford to eat, whether your friends are active, and so on.

Poor health, illness, disease and early death have many causes. Some are genetic, some may be the consequence of age and degeneration and some may be due to people's lifestyle choices but it is also known that some social groups have much higher rates of illness and early death than others. The causes of these inequalities lie in wider structures in society. These factors are termed the social determinants of health and include:

living conditions;

employment (or unemployment);

education;

housing.

These influences are well illustrated in the model in Figure 1.2 by Barton and Grant (2006), that adapts an earlier model by Dahlgren and Whitehead (1991). It clearly shows the difference between individual and social factors, with an onion likeness, where each layer can be peeled away. The core consists of inherited factors that are fixed. The inner layer suggests that health is partly determined by lifestyle factors such as smoking, physical activity and diet. Moving outwards, Figure 1.2 draws attention to relationships with family, friends and others in the community. The next layer focuses on living and working conditions – housing, transport, workplaces among other factors. The outer layers show the importance of the built, natural and global environment and their impact on health. Chapter 2 discusses how the social context of a patient affects their health.

Figure 1.2 The social determinants of health.

Source: Barton, H. and Grant, Figure 1. Copyright © 2006 by SAGE Publications on behalf of the Royal Society for Public Health. Reprinted by Permission of SAGE, and Dahlgren and Whitehead, 1991.

Many people live with chronic conditions such as diabetes or heart disease (see Chapter 9). The factors that predispose to these conditions are often seen as related to lifestyle choices such as obesity or smoking. The links between a chronic health condition like coronary heart disease and social and environmental factors that impact on the condition may be less recognized.

While a medical model of health works towards the absence of disease and is focused on diagnosis and treatment, the social model of health acknowledges the wide range of factors (determinants) that influence health, and focuses on empowering people and communities and influencing policy so that people can have greater control of their health.

Evidence 1.1

Housing and coronary heart disease (Hicks and Crowther, 2000)

Why is housing relevant to health?

When room temperatures fall below 12 °C, cardiovascular changes can be seen that increase the risk of myocardial infarction and stroke.

There is excess mortality in Britain in the winter. Approximately 40 000 more people die in Britain in winter than in summer, and most of these are older people. These excess deaths are mostly due to respiratory and cardiovascular diseases, not hypothermia. Therefore, the risk to health increases as the temperature decreases.

What action/intervention is needed?

Standards need to be set so than an acceptable indoor temperature, e.g. 20 °C, can be achieved at no more than 10% of the household income. Any excess should be paid for by social benefits.

Who will benefit?

The poorest people in society: the unemployed, the chronically ill, older people. “Fuel poverty” describes those with least to spend on heating but living in houses that are hard to heat. Many low-cost houses are prone to damp and cold.

What are the key targets?

The indoor temperature of local authority housing stock to be kept to a minimum of 20 °C.

What is health promotion?

Much of nursing is about treatment and restoring a patient to health. Sometimes this is referred to as “downstream” actions as they do not address why a person has become ill in the first place. Health promotion is principally about “going upstream” and initiating care to prevent people becoming ill in the first place. Nurses have a key role in minimising the impact of illness, promoting health and function (capabilities), and helping people maintain their roles at home, at work, at leisure and in their communities. Figure 1.3 shows the key areas for nurse involvement in public health and health promotion: promotion of health and health education; protection from harm; and the prevention of ill health underpinned by the assessment of health needs (RCN, 2012).

Figure 1.3 A framework for nursing and public health and health promotion.

Source: adapted from Royal College of Nursing, 2012, Figure 3, p. 14. Reproduced under the Open Government Licence.

Part of the nursing role is to promote the health of patients and clients. This can take place at three different levels: primary, secondary or tertiary prevention:

Primary prevention

seeks to prevent the onset of specific diseases via risk reduction: by altering behaviours or exposure that can lead to disease through education or protection. For example, respiratory disease might be reduced through smoking cessation and through state actions to restrict smoking in public places.

Secondary prevention

includes procedures that detect and treat pre-clinical pathological changes and thereby control disease progression. Screening procedures (such as mammography to detect early stage breast cancer) or routine blood sugar testing for people over 45 can lead to early interventions.

Tertiary prevention

seeks to reduce the disability or complications arising from a condition and improve a patient's function, longevity, and quality of life. Cardiac rehabilitation following a myocardial infarction can seek to alter behaviours to reduce the likelihood of a re-infarction by encouraging a patient to lose weight.

Activity 1.4

Table 1.1 shows the levels of prevention applied to bowel cancer. Fill in the same table to show the activities at each level relevant to coronary heart disease.

Table 1.1 Levels of prevention.
DiseaseIntervention levelPrimary preventionSecondaryTertiaryColorectal cancerIndividualHealth education advice on healthy diet, smoking cessation and alcohol reductionHemoccult stool testing to detect colorectal cancer early