Life-style changes in a cardiac rehabilitation program: the client perspective

Major life-style changes are required after an acute coronary event, although the vast majority of patients are unsuccessful in maintaining these changes. This study examines factors clients view as enabling or disabling their life-style changes for health promotion. Ten patients in a cardiac rehabilitation program were interviewed using grounded theory methodology. Both health protection and health promotion stimulated life-style change, as did instructions from the physician and life enjoyment. Enabling and disabling factors affecting the process of repatterning were individually defined, but changes in beliefs, attitudes, and plans facilitated repatterning. Specific precipitants to change, forces influencing change, and methods of repatterning life style are discussed, as are nursing implications.     

Historic and Future Health Promotion Contexts for Nursing

Purpose: Health promotion in the United States has been narrowly defined focusing primarily on individual behaviors, risk factors, and lifestyle. This article traces the historic and conceptual roots of health promotion care in the United States and critically examines the direction nurses have taken in health promotion.
Scope: Health promotion care in Western ideology emphasizes the value of individuals and the importance of personal responsibility for success or failure.
Conclusions: Health promotion nursing interventions, based on the tenets of individual choice and knowledge, restrict the range of interventions. The complex nature of health promotion requires that nurses consider the economic, sociopolitical, and cultural context in which health care takes place. Recommendations are made for an expanded nursing role in health promotion, one that is consistent with nursing's underlying contextual focus and concern with environments.     

Minimal interventions for problem drinkers: a review of the literature

There is an increasing body of literature concerning the role in health promotion for nurses working in many health care settings. It has been argued that this role should include identifying those individuals whose life-style increases their risk of developing health problems, as well as providing appropriate advice and information. Life-style factors which may contribute to ill-health include problem drinking. This literature review presents a critique of studies of brief, or minimal, interventions for problem drinkers which have been conducted in both primary care and acute settings. The concept of minimal interventions is explored and the potential for nurses to assume a role in delivering such interventions is discussed.     

Health promotion ideology and nursing education

Nursing has been concerned primarily with the visible aspects of health promotion and has shown little regard for what is invisible. Yet the hidden ideology powerfully shapes current approaches to health promotion. This paper examines and makes visible the ideology of individual responsibility which is embedded in individualistic health promotion, the primary orientation to health promotion. Ways in which this ideology is perpetuated within nursing curricula are described. Concrete strategies are proposed that may be considered by nurse educators as they seek to prepare students in health promotion, with particular emphasis on strategies that highlight its ideological underpinnings.     

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.     

Revisiting the Health Belief Model: nurses applying it to young families and their health promotion needs

The Health Belief Model (HBM) was reviewed with the aim of modifying it so that it reflected a health promotion stance for young families. Since this model's inception, health professionals like nurses have been involved in using the HBM to guide their practice. It is argued that to assist families, nurses now need a model that is focused on "health." In support of this approach, reorienting the HBM and basing it on "positive" health definitions associated with health promotion, by modifying it through adding the constructs "perceived behavioral control" (representing health locus of control) and "behavioral intention" from Ajzen will provide nurses with a more appropriate and useful model for interacting with families and their preschool children. A summary of positive and negative aspects of the modification of the HBM is presented, followed by a strategy for the process of validating the revised HBM for young families.     

Evaluating health promotion: a model for nursing practice

AIMS: To investigate the place and validity of effective process in evaluating health promotion practice in nursing and, in doing so, develop a specific model for this purpose. BACKGROUND/RATIONALE: The failure of many nurses to provide successful health promotional programmes is underpinned by a distinct lack of evaluation research activity. Without this type of activity, health-related nursing practice remains limited in its scope and nature. This article seeks to redress this situation by proposing a specific evaluation model that assists the nurse in their attempts to include evaluative research activity in future health promotion practice. METHOD: This article draws on existing literature to develop an evolving theoretical perspective for health promotion practice in nursing. The proposed model was developed from this perspective. CONCLUSION: Evaluation is an essential activity for any health promotion programme. Failure to include it in practice ensures that attempts to conduct health promotion are usually rendered ineffective and unsuccessful. Evaluation models are valuable tools that nurses can incorporate routinely into existing frameworks of practice, alongside other models of health education/health promotion, such as planning models. The development of this model is intended to enable nurses to review their current practice and offer a further framework for those who wish to extend their current health promotion repertoire.     

Combining health promotion classroom lessons with health fair activities.

This article focuses on the important role of the school nurse in promoting healthy lifestyle choices through networking, resource identification, and working with community partners. "Everyone Is Healthy at Northeast" was a health promotion program designed and presented in two ways: classroom lessons and a health fair. There were interactive health promotion classroom lessons on topics such as proper hand washing, the effects of tobacco, and keeping one's heart healthy. These lessons were enhanced by community partners in delivering the healthy lifestyle message through a variety of teaching methods: music, interactive games, and hands-on visuals. The health promotion education program culminated in a schoolwide health fair that showcased the healthy lifestyle choice information at various stations. "Everyone Is Healthy at Northeast" was a success and promoted healthy lifestyle choices through creativity, collaboration, and support from the entire school community.     

Health-promoting life styles of older adults: comparisons with young and middle-aged adults, correlates and patterns

The purposes of the study presented were to compare the health-promoting behaviors of older adults with those of young and middle-aged adults, to examine the relationship of age and other sociodemographic characteristics to life style throughout adulthood, and to identify differing life-style patterns among older adults. Six dimensions of life style were measured by the Health-Promoting Lifestyle Profile in 452 adults aged 18 to 88. Older adults had higher scores in overall health-promoting life style and in the dimensions of health responsibility, nutrition, and stress management than both young and middle-aged adults. Sociodemographic variables accounted for only 13.4% of the variance in life style and for 5.2% to 18.6% in its six dimensions. Five major health-promoting life-style patterns were identified among older adults, depicting a heterogeneous group with varying needs for health promotion programming.     

Health promotion: the emerging frontier in nursing

Health promotion is gaining recognition as a health care strategy The major premise of this paper is that the nature of health promotion is emerging Rising into view, health promotion offers many challenges and opportunities to all health care professionals Many of the influences that health promotion will have on nursing have not yet been fully explored What is health promotion? What concepts are inherent in health promotion? Are there models of health promotion that are specific to nursing7 What will be nursing's role in health promotion? What changes are required by the nursing profession to enable nurses to emerge within this new frontier? These are central questions for nurses as health promotion professionals to ponder, and attempts are made in this paper to answer these questions     

Intensive management of type II diabetes

The goals of intensive treatment of type II diabetes are to restore blood glucose levels to normal; correct hyperlipidemia, hypertension, and other cardiovascular risk factors; and prevent hyperinsulinemia. Treatment should begin with attempts to reduce weight through diet and exercise. In fact, diet and exercise should be stressed as vital components of a diabetic patient's life-style no matter what treatment method is used. Drug treatment may consist of a sulfonylurea to increase insulin secretion and improve insulin resistance or of exogenous insulin to achieve glucose control and avoid the dangers of chronic hyperglycemia. A combination of the two appears attractive but is still under investigation. Control of hypertension is mandatory and may require use of an angiotensin-converting enzyme inhibitor or calcium channel blocker. Normalization of serum lipid levels is also important in these patients, and agents that adversely affect glucose levels must be avoided.     

From health promoting school perspectives to discuss the building of school-community partnership

In the wake of the WHO's health promotion campaign health promotion schools have gained currency in Europe and the United States. The Department of Education in Taiwan has proposed a "school health promotion program" and the Department of Health a "program to build healthy schools" The goal of these programs was to create a holistic environment for school health and put the concepts of "school-family-community partnership" into practice. Although difficulties, such as school-centered perspectives, ambiguous definitions of "community" and shortage of funding, human resources and long-term planning impeded the program, this article, based on literature and practical experience, presents the "school-community model" and the strategies that it applied to organize the school-community health promotion committee to plan long-term programs and to assess the needs and resources of schools and communities on a collaborative basis. It contends, furthermore, that integrating community services into curriculums in order to enable students to appreciate the meaning of partnership, and involving the community in the planning process, can achieve the goal of effectively promoting the health of both the school and the community.     

The health-promoting nurse as a health policy career expert and entrepreneur

A plethora of literature suggests that many nurses struggle in their attempts to develop a political role that allows them to directly influence and implement health policy activity. Nursing curricula are an integral part of ensuring that nurses are capable of taking on a more active role in initiating and developing health policy processes, through a broadening of the health promotion curriculum that focuses on socio-political approaches to health care provision. Despite this, the available literature suggests that the majority of nursing curricula are yet to fulfil this role. Such a role could be supported by attempts to define and promote a specific career route that develops nurses as health policy experts and entrepreneurs early on in their careers. This article aims to put forward a rationale for developing such a position in nursing education.     

Health promotion and health education: advancing the concepts

BACKGROUND: Health education and health promotion activities are a fundamental requirement for all health professionals. These two paradigms are closely related but are not inter-dependent. Despite this, it is known that many nurses confuse the terms and use them interchangeably. With this in mind, it is necessary to re-conceptualize the terms in an attempt to bring them to a current form of 'maturity'. AIM: The aim of the paper is to provide an up-to-date analysis of health promotion and health education that serves as a conceptual and operational foundation for clinicians and researchers. METHOD: A concept analysis following the criterion-based methods described by Morse and her colleagues was applied to the terms health education and health promotion, using generic and nursing-related literature. RESULTS: The conceptual literature on health education is consistent between generic and nursing-related sources. On the contrary, earlier nursing literature on health promotion is now at odds with more recent socio-political and community action models of health promotion, in that it focuses on individualistic and behavioural forms of 'health promotion'. A significant proportion of later nursing-related literature, however, suggests a maturing of the concept that brings it further in line with a socio-political health promotion agenda. CONCLUSION: While the theoretical and conceptual literature surrounding health education has remained relatively constant and unchanged over the last decade or so, the same cannot be said for the health promotion literature. The evolving dominance of socio-political action in health promotion has overtaken individualistic and behaviourally-related forms. While the recent nursing literature addresses and acknowledges the place of socio-political activity as the mainstay of health promotion interventions, this is largely from a theoretical stance and is not applied in practice.     

Reflections on the differences between religion and culture

Culture may be thought of as a causal agent that affects the evolutionary process by uniquely human means. Religion, on the other hand, is considered a process of revelation and contains the concept of the "faithful" who receive the message of revelation. Culture permits the "self-conscious evaluation of human possibilities" and therefore presents a device for increasing human control over species change. There are dangers, however, in accepting cultural relativism without any constraint, such as respect for human life and dignity. In this article, the author attempts to clarify the boundaries between religion and culture and acknowledges that further research is needed on the religion/culture dichotomy.     

Newspaper representations of mental illness and the impact of the reporting of "events" on social policy: the "framing" of Isabel Schwarz and Jonathan Zito

Concerns have been raised internationally about the role of the media in influencing public opinion and by implication, social policy on mental health issues. In particular, anxieties have been expressed that an "excessive" focus by the news media on violence in association with mental illness may reinforce pre-existing stereotypes and by escalating public concerns lead to the adoption of policies which place a high priority on the safety of the public. Such assertions are often contained in the numerous studies that record a seemingly disproportionate number of stories featuring violence in association with mental health. What is, however, almost invariably lacking is a developed theory of agency that explains how or why such depictions of mental illness might exert an influence on social policy. This paper critically examines the potential significance of the way in which responsibility for events is constructed for social policy by means of a discourse analysis, inspired by the genealogical work of Michel Foucault. It uses the device of "frames" originally developed by Goffman to explore the nature of newspaper coverage of two deaths to which causal responsibility for changes in the nature of English social policy in mental health has been attributed. Results presented suggest that attempts to assert a causal influence between media coverage and changes in the nature of social policy must engage with the question of agency.     

A student health advocate program.

School nurses are in a unique position to influence health education in the school system. However, it is likely that school nurses have varying opportunity, due to staffing patterns, to effectively use their health education background to reach large numbers of students. This article explores the benefits of providing a school nurse-facilitated student health advocate program. The student health advocate program is a creative approach, designed to access a greater audience of students for health education and health promotion activities. It also cites research supporting the choice of peer education as a health education/health promotion strategy. The initiation of a student health advocate program, the role of the school nurse, student activities, program evaluation, and nursing implications are discussed. Positive benefits accrued for both the student health advocate and the mentored student.