School-based youth health nurses: roles, responsibilities, challenges, and rewards

A case study and focus-group discussions were conducted with 10 youth health nurses (nurses) employed in the recently introduced School-Based Youth Health Nurse Program (SBYHNP) to identify their roles, responsibilities, and professional development needs. Major roles are support, referral, health promotion, and marketing. Clients include high school students, teachers, and parents; the majority of whom are female and aged 13-16 years. Health issues addressed during individual consultations are predominantly psychosocial but also include medical, sexual health and sexuality issues, health surveillance, and risk-taking behaviors. Nurses also provide clients with health information and promote enhanced personal skill development during these consultations. Health promotion strategies undertaken by nurses were predominantly health education and health information displays. Nurses reported marketing their role and function within the school to be an essential and often difficult aspect of their role. Professional development through the SBYHNP was excellent; however, there was concern relating to the availability of future educational opportunities. The SBYHNP provides nurses with a new, challenging, autonomous role within the school environment and the opportunity to expand their role to incorporate all aspects of the health-promoting schools' framework.     

Health promotion training needs analysis: an integral role for clinical nurses in Lanarkshire,Scotland*

Training needs analysis is considered essential to professional and organizational development, for continuing education and for incorporation into professional practice. Increasingly, nurses are encouraged to develop their health promotion role. Despite this there has been relatively little research in Scotland into the health promotion role of the hospital nurse. This study describes the results of a health promotion training needs analysis undertaken on qualified, hospital-based nurses in Lanarkshire, Scotland. Information on the nurses' current health promotion practices, their attitudes and beliefs, their views on role development and priorities for further training were collated, analysed and discussed within the framework of the Health Action Model. This model was originally designed to assist understanding of the gap that exists between an individual intention to act and the eventual health action. However, in this study the ways in which ‘cognitive factors’ (knowledge and beliefs) and ‘motivational factors’ (considering values, attitudes and drives) and pressures from social norms and significant others assisted in the understanding of the nurse's orientation to, and beliefs about, health promotion practice. Fifty-seven per cent of nurses in the study considered health promotion activities to be emerging in clinical care and 4% considered them to be advanced. The interest respondents have in role development and the further integration of health promotion activities into nursing practice was explored by ascertaining the nurses' attitudes and beliefs about their own health promotion role. Of 107 respondents, a majority 72 (67%) agreed health promotion interventions to be an important function of the nurse with 29 (27%) strongly agreeing (n=107). Sixty per cent stated they would be interested in developing their role and 30% were very strongly interested. Recommendations are therefore made for future planning and development strategies for the health promotion role of hospital nurses.     

A sociological approach to health promotion for nurses in an institutional setting

This paper sets out to examine health promotion practice in hospital settings from a sociological viewpoint It starts by tracing the development of health promotion among hospital and community nurses The influences that professional and institutional structures and agendas have in health promotion are explored and a model of operation is proposed The main emphasis is that health promotion is not an activity relying solely on skills acquisition by the nurse, but one that requires recognition of where power and control are located A model of working is proposed which takes account of the institutional and professional agendas and the need to balance these with the needs and rights of the patient     

Carondelet St. Mary's nursing enterprise.

We began our nursing enterprise believing that nurses could enhance their contribution to health care. Our first step was charging for nursing services within Carondelet St. Mary's hospital walls. Across the country, few nursing departments bill separately for service. We believed this change was a bold step, but given our professional practice foundation, we also felt prepared to take that step. Our enterprise has expanded to a nursing network linked by NCMs. We offer professional nursing services within and beyond the hospital walls. Our boldest step has been to create the nursing HMO, which enables nurses to design and implement a full range of community nursing service, be reimbursed on a capitation basis, and demonstrate high-quality and cost-effective service for people at risk in managing their health concerns. Reflecting on our experience in creating a nursing enterprise, we find ourselves rooted in the essence of nursing. True to our professional mandate, we based our endeavor on service, not on profiting as a business. At the same time, we honored our holistic underpinnings. We matched our services to health needs expressed by people in the hospital and community, not on what we thought they should need. Founded on a belief in health as an expression of body, mind, and spirit, we believe that our approach has helped people to assume greater responsibility for themselves. Bringing us full circle, from service to outcomes, we believe that our enterprise, overlaying the business of nursing on the service of nursing, has enabled us to orchestrate our professional nursing services with nurses as conductors, as well as players.     

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.     

Mental health nursing and the promotion of physical activity

Evidence and recent policy initiatives support the promotion of physical activity and exercise within acute inpatient settings. Mental health nurses may perform an important role in encouraging physical activity and legitimizing its incorporation within care planning. This exploratory study aimed to investigate perceptions of the role of exercise and physical activity as a therapeutic strategy within inpatient settings. Given the exploratory nature of the study, a qualitative design using semistructured interviews was considered most appropriate. As part of a larger study regarding the promotion of physical activity within one United Kingdom (UK) Mental Health Trust, 12 mental health nurses were interviewed. All participants identified a need for increasing opportunities for physical activity on inpatient wards. Three interrelated themes emerged that related to how physical activity and exercise was conceptualized by the participants. First, exercise and physical activity was seen as a potentially beneficial distracting strategy rather than an adjunctive strategy in its own right. Secondly, exercise was considered as a lifestyle choice and an individual responsibility. Thirdly, a difficulty in articulating a possible relationship between the 'physical' and the 'mental' was predominant. The implications of these perceptions are discussed in relation to developing a greater profile for physical activity and exercise on acute wards.     

The educational preparation of nursing staff undertaking pre-assessment of surgical patients--a discussion of the issues

This article discusses the education and training needs of nursing staff undertaking the pre-assessment of surgical patients in the context of role development within health care. The authors undertook this piece of work as part of a project to inform the development of a competency framework for use by registered nurses working in the field of pre-assessment screening and preparation of surgical patients. A selective review of the literature on the education and training needs of pre-assessment nurses, and nurses undertaking expanded roles has been undertaken and some of the emerging issues are debated. The nature of current preparation for these roles and the apparent lack of any consistent approach to education and training for staff adjusting their scope of professional practice is debated. A brief review of the nature of competence and some of the different models including occupational competence models are presented. Finally, the implications of these for the development of a strategy for the acquisition and demonstration of knowledge and skills in pre-assessment nursing staff are presented.     

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.     

Demands for religious care in the Taiwanese health system

In order to care ethically nurses need to care holistically; holistic care includes religious/spiritual care. This research attempted to answer the question: Do nurses have the resources to offer religious care? This article discusses only one aspect--the provision of religious care within the Taiwanese health care system. It is assumed that, if hospitals do not provide enough religious services, nurses working in these hospitals cannot be fully ethical beings or cannot respect patients' religious needs. The relevant literature was reviewed, followed by a survey study on the provision of religious facilities and services. Aspects considered are: the religions influences in and on Taiwanese society; the religious needs of patients and their families; strategies that patients use to enable them to cope with their health care problems; professional motives for attuning to patients' religious needs; and hospital provision for meeting the religious and spiritual needs of patients. A survey of nursing executives showed differences between religious service provision in hospitals with and without a hospice ward. The practical implications for hospital management and nursing practice are discussed.     

Governance education for nurses: Preparing nurses for the future

The complexities of today's health care environment require organizational governing boards to have deeper understanding of health needs, influences, and outcomes with diverse board leadership. Nurses understand the complexities and demands of health care, but few nurses are engaged on boards of directors and many nurses feel unprepared for the governance leadership role. The nurse of the future requires governance knowledge and competencies to influence organizational policies that will improve health care outcomes and advance health promotion. Governance education is a necessary component of preparing the nurse of the future to influence health care transformation. Until nurses can confidently embrace governance leadership as a part of their professional identity, convincing and expecting non-nurse board leaders to appoint nurses to boards will continue to be a challenge. This paper describes a strategy for incorporating governance competencies into nursing curricula across all education levels by leveraging the American Hospital Association Governance Core Competencies (2009) and the Massachusetts Nurse of the Future Core Competencies©-RN (Massachusetts Department of Higher Education Nursing Initiative, 2016).     

Promoting leadership: the development of a nurse executive team in an acute hospital trust

Aim The purpose of this study was to evaluate how an executive nursing team, within an acute hospital trust in the south of England, developed their leadership characteristics through the use of a professional development programme. Background This paper offers an insight into how this team worked together to clarify their views of their new role and how the role would be enacted. Method A questionnaire using quantitative and qualitative measures was used to explore the group’s leadership style and evaluate the professional development programme. Findings The findings show how the development programme worked and what clarity it afforded the group in terms of their leadership style. Group work, building on the findings, helped them define their particular characteristics, skills and leadership ability and what further work was needed to demonstrate this. Conclusions The issues raised, such as team‐working, mutual purpose and personal development, are discussed in terms of their function within an integrated executive team with vision and goals. Implications for nursing management In ensuring that the nursing service has positive purpose, direction and goals, there needs to be a strategic approach to corporate development; otherwise, nursing will struggle to lead itself within a fast changing health care system.     

Accident and Emergency nurses' attitudes towards health promotion

AIM: This paper presents a study exploring Accident and Emergency nurses' attitudes towards health promotion. BACKGROUND: Much has been written about nurses and health promotion. Research has focused mainly on community nurses, less on nurses working in acute hospital settings, and apparently not at all on those working in Accident and Emergency units. METHODS: Q methodology, a technique for extracting subjective opinions, was used. Eleven nurses working in Accident and Emergency departments completed 33-item Q-sorts and wrote personal definitions of health promotion. Based on published literature in the field, the Q sample was structured with reference to nurses' attitudes as they related to health promotion. Factor analysis was performed on the data, and the resulting factors were interpreted. The data were collected in 2003. RESULTS: Three alternative constructions emerged from the data, representing three alternate views about health promotion. The most widely held opinion (representing nine of the 11 nurses) was a positive view of health promotion and the nurses' role in health promotion in Accident and Emergency environments. CONCLUSIONS: It is not possible to generalize the findings of this study due to the small number of participants. However, their knowledge of, and commitment to, health promotion is encouraging. Recommendations for practice are that there is continued and increased post-registration education in health promotion for nurses and continuing exploration of the hospital nurses' health promotion role. Further research is needed to explore nurses' perceptions of barriers to effective health promotion and nurses' health promotion activities in Accident and Emergency environments.     

The educational needs of non-specialist breast care nurses

AIMS: To provide an indicative occupational profile and identify the educational needs of non-specialist nurses working with breast cancer patients. DESIGN: A postal questionnaire survey, using a modified, but psychometrically validated, training needs analysis instrument. SETTING: The acute and community sectors of three large trusts. PARTICIPANTS: 119 general nurses working with breast cancer patients. FINDINGS: Significant educational needs were identified for all 30 items of the questionnaire, thereby indicating that participants had both general and cancer-specific training needs. However, 13 of the 14 cancer-related items were among the top 19 training needs, suggesting that these should be a priority focus for targeted educational programmes. No differences were found between acute and community nurses, although D grade (newly qualified) nurses had significantly greater educational needs than E grade nurses (with around 2 years' experience post-qualifying). The indicative occupational profile suggested that the most important tasks were perceived to be communication/team-work, self-management, awareness of special psycho-social problems, knowledge of specific clinical issues, and management of the care package; the least relevant tasks were seen to be specific health promotion activities, supervision, using technical equipment and research/audit. CONCLUSION: This sample of general nurses working with breast cancer patients reported both general and specific educational needs. The information yielded by the current survey could be used to inform continuing educational development for this group, and in this way, could inform the content and mode of delivery of its provision. Continuing professional development (CPD) courses which are based on empirical studies of workforce educational needs could rationalise resources and ultimately enhance patient care. The indicative occupational profile could be used as a competency indicator and might also inform CPD provision.     

The educational and practice tensions in preparing pre-registration nurses to become future health promoters: a small scale explorative study

Over the past three decades health policy within the United Kingdom (UK) has consistently acknowledged the potential for nurses to contribute to the health of individuals and communities. The educational curricular of pre and post registration nursing programmes has responded to such health policies by placing greater emphasis on the role of the nurse in health promotion and ill health prevention.

Aim

This paper explores how pre-registration student nurses in one university experience the impact of these factors on their preparation for practice.

Design

This small scale explorative study used a convenience sample of second year pre-registration student nurses (n = 100) studying at one university. Data were collected via four focus groups, and from student evaluations of practice placement experiences and self-reported learning outcomes relating to health promotion practice.

Findings

The findings suggest a dichotomy between what is espoused in the underpinning theory of the curriculum and what the student nurses actually experience in practice. It highlights some of the difficulties that student nurses have in effecting the professional and policy objectives and argues if nurses are to turn health promotion rhetoric into reality then health promotion practice needs to be more effectively actualised.     

Empowerment and its application in health promotion in acute care settings: nurses' perceptions

Title.  Empowerment and its application in health promotion in acute care settings: nurses' perceptions.
Background.  Empowerment has long been a central tenet of health promotion theory. Globally, governments have advocated the use of empowerment in their public health policies. Nurses are seen as essential in the delivery of this agenda using the empowerment model to engage patients in self-care and decision-making.
Method.  Six different vignettes requiring a health promotion intervention were shown to a convenience sample of 20 Registered Nurses in a United Kingdom acute care hospital. The nurses were asked to describe how they would meet the health promotion needs of the patients described in the vignettes. The data were collected between 2005 and 2006 and analysed using thematic analysis.
Findings.  Two types of practitioner were identified: Type I divergent nurse health promotion practitioner and Type II convergent nurse health promotion practitioner. The main factor distinguishing the two types was the way in which they conceptualized the verb 'to empower'.
Conclusion.  The theory of health promotion taught to participants does not seem to be applied in acute care settings. This raises the possibility that Registered Nurses acting as mentors and role models are convergent rather than divergent thinkers.     

The developing role of children's nurses in community palliative care

This article addresses some of the contemporary issues in relation to providing palliative care for children in Ireland, particularly focusing on the creation of the specialist palliative care nursing outreach posts. The recent publication of an Irish national policy on palliative care for children with life-limiting illness is welcome news for paediatric nurses in Ireland. Children are valued members of society and have a right to receive quality health care and support appropriate to meet both children and the families' precise needs. However, community services for children with life-limiting illnesses remain inadequate, with many parents and families struggling to provide palliative care for children in the home. Currently, community nurses, who are not always registered children's nurses, are providing palliative care for children at the end of life. These nurses may not fully understand the specific needs of critically or chronically ill children and their families. In addition, there are no specific palliative care educational programmes in Ireland with regard to end-of-life care for children. The challenges of providing palliative care to children and their families in relation to symptom control, controversial ethical and legal issues, and emotional and practical support, mean that advanced knowledge is required in order to progress the agenda and thus provide excellence in children's palliative care in Ireland. It is important that the agenda is moved forward so that children and their families requiring palliative care and nursing support do not suffer from a lack of professional provision for their needs.