Development of a community health promotion center based on the World Health Organization's Ottawa Charter health promotion strategies

Aim: To describe the development process of nursing school‐led community health promotion centers (CHPC) to improve the health of the surrounding communities. Methods: This study design was a research and development study. (i) Assessment of health needs by interviewing 359 people in the community to select health programs for the community health promotion center. (ii) Five health promotion strategies from the Ottawa Charter were applied to develop the community health promotion center for a city community. Results: (i) The people in the community had higher socioeconomic status levels and better health behaviors compared to the general Korean population, and they also listed chronic health problem management as their first priority health service. (ii) Development of the community health promotion center was done based on the five World Health Organization's Ottawa Charter Health Promotion Strategies: build healthy public policy, create supportive environments, strengthen community actions, develop personal skills, and reorient health services. Conclusions: The present study showed that the WHO's five Ottawa Charter Health Promotion Strategies were useful for developing health promotion centers in the community.     

The Ottawa Charter--from nursing theory to practice: insights from the area of alcohol and other drugs

This article aims to assist nursing services to use the Ottawa Charter as a framework for nursing practice. Incorporation of the Ottawa Charter for Health Promotion into a nursing structure constitutes an innovation in nursing practice that was evaluated as a quality improvement exercise in a health-care organization responsible for providing services in the area of alcohol and other drugs. The evaluation consisted of two stages and sought to identify the degree to which the framework was effective in practice. This involved identifying issues surrounding the implementation of the Ottawa Charter as a framework for nursing practice as well as identifying the means by which quality improvements could occur. The evaluation involved an initial questionnaire to all nursing staff, followed by a series of focus groups. The data collected was both informative and enlightening and revealed a range of pertinent issues such as staff understanding and interpretation of the Ottawa Charter, expansion of the nurse's role and suggestions for organizational change. The Ottawa Charter strategies are discussed in relation to their relevance to the organization under evaluation and also expanded into recommendations to assist those contemplating using the Ottawa Charter as a framework for nursing practice. There was considerable agreement among the respondents that the Ottawa Charter provided a useful framework for nursing practice but was on occasions problematic.     

The Health Promoting Prison (HPP) and its imperative for nursing

The World Health Organisation's (WHO) Ottawa Charter for Health Promotion in 1986 provided the catalyst from which the Health Promoting Prison (HPP) movement emerged. Here, an extensive review of the available prison-related health literature provides the basis for critical discussion and recommendations for nursing services and prison-related health care. The findings suggest that current prison-based nursing services are seriously neglected and woefully lacking in structure and resources. This article recommends strategies for reform that includes nurses who practice in all settings, and not just prison-based nurses. If nurses wish to be at the forefront of future HPP strategies, they must first embrace the radical health promotion reforms that are emerging from the current literature. Building sustainable group capacity into prison-based health care, through developing social interaction, cohesion, participation and political action can only benefit the community at large and further emphasise the health promotion role of nursing.     

Evaluation of the health promotion activities of paediatric nurses: is the Ottawa Charter for Health Promotion a useful framework?

Researchers were involved in an evaluative approach to examine the health promotion activities of paediatric nurses from a paediatric tertiary hospital centre (N = 83) and five paediatric non-tertiary hospital centres (N = 48) from Sydney, Australia. The aims of this study were to understand the nature of heath promotion in paediatric nursing practice by examining nurses' attitudes, investigating paediatric nurses' involvement in the five action area of the Ottawa Charter, and identifying barriers to the implementation of health promotion in practice. The researchers developed a health promotion survey based around the Ottawa Charter for Health Promotion (World Health Organisation, 1986a), and a literature review of nurses' involvement in health promotion. Results showed that tertiary paediatric nurses undertook more varied health promotion activities such as creating supportive environments (CSE), reorienting health services (RHS) and building healthy public policy (BHPP) than did non-tertiary paediatric nurses who were involved in only one action area of the Charter, that of developing personal skills (DPS). This research revealed that within paediatric nursing practice the action areas of the Ottawa Charter of BHPP and CSE were important; and that there is support for the advocacy role of paediatric nurses. There is also evidence that paediatric nurses may have health promotion knowledge deficits associated with the Ottawa Charter, and that the environment of multidisciplinary allied health professionals in a tertiary paediatric centre may positively influence senior paediatric nurses and their capacity to be involved in varied health promotion activities associated with the Ottawa Charter.     

Health promotion health center project

OBJECTIVES: As part of a major government support for health promotion, a health promotion health center (HPHC) project was launched at the national level in Korea. The purpose of the study was to describe this 2-year HPHC project within the framework of the Ottawa Charter for Health Promotion and to evaluate the preliminary outcomes of the community residents. DESIGN: A cross-sectional design was used. SAMPLE: A total of 2,261 community residents participated in the survey, with 792 in HPHC sites and 1,469 in non-HPHC sites. MEASUREMENT: The instrument included questions on participants' demographic characteristics, awareness, participation, health behavior (smoking, exercise, meat consumption, and blood pressure checkup), and satisfaction with the health promotion programs. RESULTS: The 5 main health promotion strategies of the Ottawa Charter were evident in the HPHCs. HPHCs were successful in enhancing awareness, participation, and satisfaction through their health promotion programs, although health behaviors were not significantly different between the 2 groups, except exercise. CONCLUSION: Ottawa Charter strategies embedded within the practice of the community health promotion activities were effective in increasing the short-term outcomes (awareness, participation, and satisfaction with health promotion programs), which is a promising finding for the development of health promotion behaviors in the future.     

Autonomy of the volunteer sector in the evaluation of public health programs: an exploration from the perspective of an HIV/AIDS coalition

As recommended in the Ottawa Charter, Canadian government agencies are counting on the involvement of grassroots organizations to implement federal public health programs at the local level. At issue is the forced acceptance by community organizations of the predefined role of suppliers of services. Because of the top-down issues of health promotion practice, the problem is crucial for public health nursing.The author uses reflexive analysis, grounded in the internal colonization framework, to explore the case of a Canadian public health program and its relations with a provincial coalition of volunteer organizations working on AIDS issues. Implementing the Ottawa Charter highlights the challenges of the meanings and actions inherent in the notion of partnership between public agencies and community organizations of volunteers. Participation suggests more democratic and egalitarian social organizations, with hierarchical structures in a broader image of a modern society.     

A qualitative study exploring the relationship between nursing and health promotion language, theory and practice

The definitions and meaning qualified nurses employed in an acute NHS hospital setting in the UK gave to health education and health promotion practice and how these fitted established language and theory were investigated qualitatively. These concepts, and the concomitant frameworks and models of practice, have been the subject of considerable debate in the literature. While unresolved both in general and in nursing, a degree of theoretical convergence was established in the 1990s [Bunton, R., Macdonald, G., 1992. Health promotion: disciplines and diversity. Routledge, London; Maben, J.M., Macleod Clark, J. 1995. Health promotion: a concept analysis. Journal of Advanced Nursing 22, 1158-165] helped by The Ottawa Charter [WHO, 1986. Ottawa Charter for Health Promotion. http://www.who.int/hpr/archive/docs/ottawa.html]. For many of the participants in this study however, the meanings given to these concepts and the predominant use of health education were inconsistent with much of the language of the wider debate and this has potential implications for nurse education. For, if the findings are considered transferable then there is a need to develop education strategies and curricula that articulate the ideological foundations of policy and practice and to use mainstream terminology to assist nurses both to understand and contribute to the contemporary health promotion debate.     

Integrating education and research in an APRN mental health services program

The Mental Health Services Program (MHSP), using an advanced practice psychiatric nursing model of care, was developed in an effort to address the need for community mental health services for an underserved population in Bridgeport, Connecticut. Under the direction of an Advanced Practice Psychiatric Nurse (APRN), direct services were provided by contracted APRNs and graduate and undergraduate nursing students, under the supervision of APRNs. Services provided included screenings for mental health problems; individual, family, and group education and counseling; psychiatric assessments; and consultations. More than 1,500 individuals, the majority of whom were vulnerable or at risk, were provided services during the 3 years of this grant-funded project. Client satisfaction was measured using the Goal Attainment Scale. Results indicated a high level of satisfaction and served as an indirect measure of effectiveness of services. More than 95% of respondents indicated that their goals were met "much better than expected." Furthermore, responses from community agency personnel indicate a high level of satisfaction with the services offered. As a result of the MHSP, curriculum changes have been implemented to integrate student community involvement and collaboration, and to facilitate student projects in the community. These curriculum changes include a health promotion project, a group process project, a mental health group project, and a research project. The students who participated as part of the MHSP benefited from their work in the real world with an underserved population in a way that otherwise would not have been possible. Services to the community will continue through the significant curriculum enhancement for mental health projects.     

A service-learning experience to teach baccalaureate nursing students about health policy

Incorporating health promotion strategies in practice, and in particular within healthy public policy based on the Ottawa Charter, is widely recognized as within the mandate of nursing, although evidence suggests that nurses are reluctant to take on this role. An innovative strategy was developed to facilitate baccalaureate nursing students' learning about healthy public policy by immersing them in a real-world service-learning experience. Students partnered with a population, assessed the determinants of health, and implemented a population health promotion strategy that included attention to a health policy issue. Students identified strengths and weaknesses of the existing policy and were required to propose recommendations for change that addressed the social justice issues. Students presented their work to faculty, students, and community partners and developed a written position paper on the topic. Students evaluated the service-learning experience as an excellent experiential learning opportunity.     

Health promoting schools: a new era in school nursing

Health promotion schools, introduced by the World Health Organization in 1996, represent a new model for school health. They consist of six working areas, and reflect the spirit of the 1987 Ottawa Charter for Health Promotion, which aims to place the foundations of health promotion work in schools. This article introduces the development of health promotion schools, both in Taiwan and overseas, outlines their structure, and compares and contrasts the models represented by traditional school health, integrated school health, and the health promotion schools. The roles of school health nurses are summarized as follows: health service provider, health education initiator, health counselor, leader of health promotion activity and integrator of community resources. Suggestions are made for future development, including: (1) a need to conduct the research, in order to evaluate and provide evidence of outcome effectiveness, (2) a need to establish standardized indicators concerning school health nursing, and (3)Education and health should be integrated in the health promotion schools.     

Holism in nursing and health promotion: distinct or related perspectives? – A literature review

Scand J Caring Sci; 2011; 25; 798–805
Holism in nursing and health promotion: distinct or related perspectives? – A literature review Background: The concept of holism is central in health promotion as well as in nursing. Holism or a holistic view on health was identified as one of the key principles of the Ottawa Charter for Health Promotion and is linked to social ecology and the determinants of health. Aims: To explore how the term holism was defined and/or described in Nordic articles with a health‐promotion approach, and how holism aspects were related to nursing and health promotion, and to the other key principles of the Ottawa Charter. Methods: Abstracts were first identified by the search word ‘health promotion’ as a keyword. The search was limited to 1986–2008 and abstracts written in English by authors with a Nordic affiliation. Abstracts/articles for this study were subsequently selected from these abstracts using the search words ‘holism’ and ‘holistic’ and analysed by quantitative and manifest qualitative content analysis. Findings: The sample included 23 articles: one theoretical, two reviews and 20 empirical studies. Sixteen articles included a hospital setting or nursing perspective. A holistic perspective could be extracted from most articles. No larger but several minor differences were identified in the way holism aspects were related to nursing and health promotion respectively. Conclusion: There is a risk that the individual patient perspective of holism in nursing may result in less chance of reaching larger groups of patients with chronic diseases and mental health problems, not least the most vulnerable ones.     

The health‐promoting school: what role for nursing?

Aim. To review the existing literature on health‐promoting schools and put forward recommendations for continuing progress. Background. The World Health Organisation's Ottawa Charter for Health Promotion in 1986 sought to create a framework for health promotion action that conveyed the notion of capacity building as it related to specific settings. It provided the catalyst from which the health‐promoting school movement emerged, against the backdrop of health professionals adapting to the changing needs and demands of clients and the evolving social context of the communities in which they live. Since then, the international health‐promoting school movement has been one of the most successful of the settings‐based projects and has expanded considerably over recent years. Method. An extensive review of available health‐promoting school‐related literature provides the basis for critical discussion and recommendations. Findings. Traditionally, the school nursing movement has provided the backbone of nursing‐related health promotion activity in the school setting. The literature, however, is generally critical of its contribution over the years – especially as its role is mainly confined to a ‘conventional’ health education function and has little to do with health‐promoting school projects. There are more and more calls now for the school nursing service to either re‐evaluate its function and processes or be devolved back into a broader primary health care practitioner role. Conclusion. Nurses should view the health‐promoting school movement as another opportunity to embrace evolving broad‐based health promotion concepts truly, as a means to forge and own their own health agenda and also as a means to move beyond a traditional reliance on a limited health education role. Schools also 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 healthcare professional groups. Nurses who practice in all settings, and not just school nurses, should be aiming to initiate and promote radical health promotion reform as set out in the health‐promoting school movement. Relevance to clinical practice. If health professionals wish to be at the forefront of current health‐promoting school strategies they must embrace the radical health promotion reforms that are emerging from the current literature and put forward in this article. Building such group capacity, through developing social interaction, cohesion, participation and political action can only benefit the community at large and further emphasize the health promotion role of nursing. The health‐promoting school movement is truly an international concept and, as such, deserves a concerted nursing representation and resourcing well beyond its current commitment.     

The Kids Into Health Careers (KIHC) initiative: innovative approaches to help solve the nursing shortage

In 2001, the Northern Illinois University School of Nursing was awarded a grant from the Division of Nursing of the Bureau of Health Professions, Health Resources and Services Administration, U.S. Department of Health and Human Services, to enhance the School's advanced practice nursing program. As a recipient of this grant, the School of Nursing was required to incorporate activities to meet the goals of the "Kids Into Health Careers (KIHC) Initiative" to encourage children into health care careers. This article describes the strategies developed by the School of Nursing to meet the KIHC goals and encourage children, especially those from minorities, into health care careers. The School's approach was multifaceted and included collaboration with a variety of community organizations and groups. While there is a tremendous amount of work to be accomplished in encouraging middle and high school students to consider nursing as a career, creative strategies through which nurses take an active role in helping resolve the problem are suggested.     

A public health nursing practice model: melding public health principles with the nursing process

There has been a shift in emphasis in public health from the provision of personal health services for individuals to efforts targeted at improving the health of the whole community. Many in public health nursing (PHN) have welcomed this shift, recognizing the important role PHN can play in promoting health and preventing disease for all. There continues to be a need to redefine PHN roles and practice so that public health nurses can participate more effectively. Los Angeles County Department of Health Services Public Health Nursing (LAC PHN) has developed a practice model grounded in nationally recognized components: the public health team, PHN standards of practice, the 10 Essential Public Health Services, Healthy People 2010's 10 Leading Health Indicators and additional local indicators, and the Minnesota Public Health Nursing Interventions Model. The LAC PHN Practice Model provides a conceptual framework that assists in clarifying the role of the public health nurse and presents a guide for public health practice applicable to all public health disciplines.     

School nursing in an underserved multiethnic Asian community: experiences and outcomes

Based on an Asian faculty's previous work, University of South Alabama College of Nursing conducted a project targeting the Asian population in Bayou La Batre, Alabama. The Helene Fuld Health Trust, HSBC, Trustee funded the project to demonstrate effective models for involving nursing students and faculty members in community-based practice. This project provided health services and developed educational programs for this underserved population. To facilitate entry into the Asian community, the College established clinical sites at 2 schools in Bayou La Batre that had the highest concentration of Asians in Mobile County's public school system. The purpose of the project was to develop a new curriculum, to involve nursing students in community-based practice, and to provide health care services in the community. The health services, educational programs, and community instructional activities generated substantial outcomes for the targeted population as well as nursing students. Nursing students learned to assess aggregates, plan, and evaluate interventions. The learning outcomes of the nursing students were evaluated using objectives developed in accordance with Bloom's (1956) Taxonomy. The project not only complemented and expanded existing school health services and programs but also filled the void in some health service and program areas. Preliminary evaluation of the project revealed overwhelmingly positive feedback from both the nursing students and Bayou La Batre school teachers. This article also explores the implications of the newly issued "National Standards for Culturally and Linguistically Appropriate Services in Health Care" for nursing education in the contexts of the Census 2000 and the megatrend of globalization.     

Reducing harmful traditional practices in Adjibar, Ethiopia: lessons learned from the Adjibar Safe Motherhood Project

This paper assesses the impact of the Adjibar Safe Motherhood Project and derives lessons of value to future interventions. Amongst the participatory qualitative methods used were 15 group discussions, eight semi-structured interviews, a number of opportunistic informal discussions and observation. The information gathering was complemented by a detailed review of project documents. Field visits for data collection took place over a six day period in March 2005. The project was effective in raising awareness about maternal health, and the social, economic and health consequences of various harmful traditional practices (HTPs). It has also mobilised the community to monitor and report HTPs and has strengthened referral systems for counselling, support and treatment. A number of effective strategies were identified as having contributed to project success. These are presented using the framework offered by the Ottawa Charter for Health Promotion which presents five areas of public health action: developing personal skills; strengthening community action; building healthy public policy; re-orienting health services; and, creating supportive environments. This evaluation contributes to and strengthens the expanding body of literature about effective development practices to reduce HTPs. It demonstrates that addressing HTPs takes time and long term investment; both are necessary to enable better understanding of the social and cultural reasons for HTPs before attempting to address them, and to build the community trust necessary to overcome the natural resistance to challenging such deeply entrenched practices. The project also highlighted the importance of developing a multi pronged strategy based on engagement with a broad range of stakeholders and supportive legislation.     

Meanings of community in a community health center

As health care organizations make communities the targets for their interventions, connections between "community" as theory for practice and community as setting for practice require examination. This study s purpose was to explore meanings given to community in a newly formed community health center, with particular emphasis on the relationship among women, community, and health. Using interpretive and emancipatory methodologies, interviews were conducted with clinic administrators and staff, and women who used the clinic. Data analysis revealed discrepancies in meanings of community. Clinic personnel referred to community as the target for their services, while clinic users spoke about community as the process that made feeling connected with others possible. Health center staff and administrators described the community they were serving as having limited economic, educational, physical, and psychological resources and saw little which could be labeled a community strength. Health center users however, spoke primarily of their abilities to support each other. These contradictory understandings of the meaning of community rendered different expectations regarding health care services. Meanings given to community may de-personalize, homogenize, and objectify, and ultimately distance nursing from those intended to be served.     

Workplace health promotion: the role and responsibility of health care managers

The World Health Organization's (WHO) Ottawa Charter for Health Promotion in 1986 provided the catalyst from which the Health Promoting Workplace movement emerged. Here, an extensive review of the available workplace-related health literature provides the basis for critical discussion and recommendations for health care managers. The findings suggest that health care managers, who practice in all health service settings, should be aiming to initiate and promote radical health promotion reform as set out in the WHO settings-based movement. Developing and implementing sustainable health promotion-orientated and organization-wide healthy workplace policy initiatives represent the most effective way for health care managers to directly benefit from the desirable outcomes that come from creating and maintaining a healthy workforce.     

Strengthening an academic nursing center through partnership

Nurse-managed health centers offer holistic health care and patient-centered health promotion and disease prevention. These goals are particularly well suited to the needs of children and their families. Few reports in the literature, however, have described such practices. The purpose of this paper is to describe one practice, Valencia Health Services (VHS), a nurse-managed, academic health center providing primary care to pediatric and adolescent patients. Valencia Health Services offers interdisciplinary, comprehensive health services to ethnically diverse children and their families through an inter-university partnership and provides clinical experiences and research opportunities, under the supervision of expert faculty-clinicians, to students of nursing (advanced practice, public health, and case management), social work and psychology. Valencia Health Services is the rare nurse-managed academic health center that provides comprehensive health care to children and adolescents. The multifaceted demands of such a health center, however, present both unique opportunities for quality care and service and considerable ongoing challenges.