The Precautionary Principle, public health, and public health nursing

ABSTRACT The Precautionary Principle posits that, in the absence of certainty, the appropriate course of action is to err on the side of caution. The Principle has been applied to decision making and policy development related to environmental health issues both internationally and in the United States. The American Public Health Association and the American Nurses Association (ANA) have issued policy statements that invoke the Precautionary Principle, and the Principle has been incorporated into statements that describe the practice of public health nursing. Nursing has always recognized the relationship of the environment with the health of humans—individuals, families, populations, and communities (ANA). The increasing attention to the Precautionary Principle comes at a time of redefinition of the field of public health, environmental public health, and the practice of public health nursing. Thus, it is crucial that practicing public health nurses understand the Precautionary Principle and its relevance to the practice of public health, public health nursing, and the current and future health individuals, families, populations, and communities.     

‘Maybe what I do know is wrong…’: Reframing educator roles and professional development for teaching Indigenous health

Settler colonisation continues to cause much damage across the globe. It has particularly impacted negatively on Indigenous peoples’ health and wellbeing causing great inequity. Health professional education is a critical vehicle to assist in addressing this; however, non-Indigenous educators often feel unprepared and lack skill in this regard. In this qualitative study, 20 non-Indigenous nursing, physiotherapy and occupational therapy educators in Australia were interviewed about their experiences and perspectives of teaching Indigenous health. Findings from the inductive thematic analysis suggest educators require skill development to: identify their discomfort in teaching cultural safety; contextualise the sources of this discomfort and; reflect on how this understanding can improve their teaching. Additionally, educators require professional training to become practitioners of cultural humility and to be facilitators and colearners (rather than experts) of the Aboriginal-led curriculum. Of relevance to this is educator training in how to decentre non-Indigenous needs and perspectives. Educators can also renew their teaching practices by understanding what a dominant settler paradigm is, identifying if this is problematically present in their teaching and knowing how to remedy this. Crucial to improved cultural safety teaching is institutional support, which includes Indigenous leadership, institutional commitment, relevant policies, and well-designed professional development.     

Health promotion and health education viewed as symbiotic paradigms: bridging the theory and practice gap between them

A recognized 'paradigm war' exists between the two distinct approaches of health education and health promotion practice. This tension is both unhealthy and unhelpful and is known to have a profound effect on nursing activity. Leading health promotionalists have begun to acknowledge the futility of the stated paradigm tension, realizing that health education and health promotion interventions are not that dissimilar in their origins and intentions. Progressive health education and health promotion programmes acknowledge the interrelatedness of both approaches and seek to incorporate favourable aspects of the two. The aim of this article is to present arguments and stances that help to diffuse/avoid the stated paradigm conflict, as a basis for health education and health promotion reform in nursing. It also seeks to clarify the nature of both health education and health promotion practice so as to avoid contextual confusion. In doing so, this article draws significantly from the author's previous work. This article concludes that the constructive review of any intended health education/health promotion programme lies in the consideration of each approach according to its own relative merits, what is required of the programme, and the nature of the setting in which the intervention takes place.     

Health promoting hospitals: the role and function of nursing

Background. In 1986, the World Health Organisation's (WHO) Ottawa Charter for Health Promotion sought to create a framework that conveyed the notion of capacity building, related to specific settings, and a structured process for health promotion action. It provided the platform from which the health promoting hospital movement was later launched. Nearly two decades on, the health promoting hospital (HPH) movement has grown considerably and continues to expand, against the backdrop of having to adapt to the changing needs and demands of clients and the evolving social context of their communities. Many nurses, it is argued here, are often unaware of health promoting hospitals concepts or, when they are, do little to contribute to them. Method. A critical review of the available health promoting hospital and related literature has been conducted for discussion. Findings. The literature revealed that hospitals are being urged to reject practices based purely on health‐limiting and limited biomedical frameworks, in favour of moving towards models based on health promoting hospitals and public health‐orientated hospitals. This requires radical reform that focuses on the social and health policy context of organizations, the socio‐political empowerment of its employers and clients, and the personal/collective positive health and welfare of its employers and clients. Many health service agencies are beginning to emphasize population health within communities as part of a concerted move away from an original primary focus on acute inpatient hospital‐based service provision. Conclusion. Hospitals need to adapt and expand their efforts to focus on health promotion activities, in collaboration with the ever‐widening community networks of health and social agencies. This requires the commitment of all health care professional groups. Nurses who practice in the hospital setting should be aiming to initiate and promote radical health promotion reform as set out in the health promoting hospital movement. This paper argues that nursing per se could be making much larger inroads and efforts to affect and implement wide‐ranging health promotion activities in hospital organizations. Nurses should view the HPH movement as another opportunity truly to embrace evolving broad‐based health promotion concepts, as a means to forge and own their own health agenda, and also as a means to move beyond the traditional reliance of a limited health education role. Relevance to clinical practice. Hospitals and their employees must be seen to advocate, support and implement wide‐reaching social and community‐based reform, as part of a necessary commitment to ‘seamless’ health care provision. The health promoting hospital movement represents a collective vehicle for enabling such activities. If nurses wish to be at the forefront of current health service strategies they must be seen to embrace the radical health promotion reforms that are emerging from the current literature and put forward in this article.     

某银行571名职工健康体检结果分析及健康指导

目的了解合肥市某银行职工的健康状况,以便有针对性的制定健康教育对策,积极预防疾病发生。方法 2012年5月～7月对合肥市某银行571名职工集中进行健康体检,将体检结果采用顺位及构比法,按各年龄段主要异常结果检出率、部分异常结果男女检出率进行综合分析。结果571人体检其合格率为18.21%,检出有异常者467人,阳性病征检出率较高的为幽门螺旋杆菌(Hp)抗体阳性205人(35.90%),高脂血症137人(23.99%),脂肪肝123人(21.54%),颈椎退行性变117人(20.49%),心电图异常96人(16.81%),甲状腺疾病87人(15.24%),高血压71人(12.43%),肝功能异常60人(10.51%),高尿酸51人(8.93%),胆囊疾病49人(8.58%),血糖升高(包括糖尿病)44人(7.71%),泌尿系结石32人(5.60%)。各年龄段Hp抗体阳性、高脂血症、脂肪肝、高血压、血糖升高的检出率随着年龄的增长而增加。高脂血症、脂肪肝、高血压、高尿酸血症、血糖升高、肝功能异常的检出率男性明显高于女性,而甲状腺疾病的检出率女性高于男性。结论本调查对象的健康状况较差,加强职工的健康教育,指导建立良好的生活方式,对预防疾病发生,改善健康状况,提高生活质量意义重大。     

Using a community-based outreach program to improve breast health awareness among women in Hong Kong

OBJECTIVE: To evaluate the effectiveness of a community-based health education program via a mobile van to promote the awareness of breast cancer and breast self-examination (BSE) practice among women in Hong Kong. DESIGN: One group pretest/posttest design. SAMPLE AND MEASUREMENTS: Seven hundred and seventy-seven women in Hong Kong completed a self-administered questionnaire before and after a breast health education program from May 2002 to March 2003. RESULTS: About half were aware of breast health and breast diseases (53.7%) and breast screening methods (48.6%) before the intervention. It was found that women who had received instruction on BSE practice, and those who were aware of breast screening methods, breast health, and breast diseases were more likely to have had prior BSE practice. Most indicated their willingness to practice BSE regularly (93.3%) and to pass on the BSE knowledge to their relatives and friends (92%) in the posttest. CONCLUSIONS: The outreach health education program has successfully reached women living in the 18 districts in Hong Kong. It appears to be useful in raising the awareness of breast health and BSE practice among the women, but longer term follow-up is required to ascertain its sustainability.     

顺义区南法信镇居民健康状况及卫生服务利用情况分析

目的：了解农村社区居民健康状况和对社区卫生服务的利用情况。方法：采用分层系统抽样方法，调查了顺义区南法信镇15岁及以上居民606人。结果：农村居民的两周患病率为12．73％；居民的心脑血管病和糖尿病患病率较高，自感病轻占居民未就诊原因的55．71%，自我医疗的占27．14％；一年内，居民经常去看病的医疗机构中社区卫生服务中心（站）占77．53％。结论：自感病轻和自我医疗成为居民未就诊的主要原因，农村居民获得的卫生服务大部分来自社区卫生服务机构，政府应该加大对农村社区卫生服务的支持和投入。     

顺义区南法信镇居民健康状况及卫生服务利用情况分析

目的：了解农村社区居民健康状况和对社区卫生服务的利用情况。方法：采用分层系统抽样方法，调查了顺义区南法信镇15岁及以上居民606人。结果农村居民的两周患病率为12．73％；居民的心脑血管病和糖尿病患病率较高，自感病轻占居民未就诊原因的55．71％。自我医疗的占27．14％；一年内，居民经常去看病的医疗机构中社区卫生服务中心（站）占77．53％。结论自感病轻和自我医疗成为居民未就诊的主要原因，农村居民获得的卫生服务大部分来自社区卫生服务机构，政府应该加大对农村社区卫生服务的支持和投入。     

Documentation of Health Risks and Health Promotion Counseling by Emergency Department Nurse Practitioners and Physicians

Purpose: The purpose of this study was to examine medical record documentation of health risk factors and health promotion discharge counseling by nurse practitioners and physicians practicing in an emergency department in the U.S. midwest.
Methods: In this two-group comparative study researchers examined random-stratified medical records 305 nonacute ambulatory patients for selected health risk factors, including smoking, alcohol use, elevated blood pressure, obesity, and dental caries.
Results: Fifty-nine percent of this sample of relatively young adults (mean age = 33) had one or more health-risk factors. According to medical record documentation, only 22% of these adults, with nonacute problems, received health promotion counseling. Multivariate analyses indicated that nurse practitioners were slightly more likely to provide smoking cessation counseling than were physicians.
Conclusions: Many opportunities for identification of health risks and follow-up counseling, as recommended in Healthy People 2000 and by the U.S. Preventive Services Task Force, were not documented. To meet the new goals of Healthy People 2010, health care providers in all settings should identify health risk factors and document health promotion counseling during every patient encounter.     

Do nurses working in adult psychiatry take into consideration the support network of families affected by parental mental disorder?

The aim of this study was to gain information about registered and practical mental health nurses' activities concerning support network of families affected by parental mental illness. Data were collected using a structured questionnaire distributed to all 608 practical and registered mental health nurses working in adult psychiatric units in five Finnish university hospitals. A total of 311 nurses returned completed questionnaires (response rate 51%). Sixty per cent (n = 222) of registered nurses and 36% (n = 88) of practical mental health nurses responded. Information about family relationships and socio-economic situation was gathered regularly by all nurses. The nurses' individual characteristics, such as being a parent, further family education and use of family-centred care, were significantly related to their activeness in discussing the family's support network with the parents. Discussing family relationships and families support networks forms part of patient care in adult psychiatric nursing with families with dependent children (under 18 years of age). Nurses can work directly with the parents to aid them to strengthen their support network for themselves and their children.