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.     

Examining the correspondence of theoretical and real interpretations of health promotion

Aims and objectives. The aim of the research was to identify how the development of concept analyses have influenced practising nurses’ understanding of health promotion. More specifically the aim gives rise to the objective of establishing how they translate their understanding into practice. Background. The acknowledgement that nurses are confused about health promotion has led to attempts to define the term through the production of concept analyses, which aim to clarify the term for nursing education, research, policy and practice. Design and methods. A qualitative approach, using semi‐structured interviews was undertaken with a purposive sample of 21 district nurses, based throughout Wales. Thematic content analysis was used to order, describe and interpret the data. Results. Generally the respondents gave definitions of health promotion that were confined to the traditional conceptualization of health promotion, comprising actions aimed at changing the behaviour of individuals. These interpretations were translated into practice, where district nurses adopted a mainly reactive and individualistic approach to health promotion. Conclusions and relevance to clinical practice. The paper concludes that the more contemporary definitions of health promotion that focus on empowerment, community development and socio‐political action are yet to reach practising district nurses. Considerable effort is required from educationalists and practitioners if nurses are to include these ‘new paradigm’ approaches to health promotion in their practice.     

Implementing and evaluating the National Healthy School Program in England.

The purpose of this article is to trace development of the National Healthy School Program (NHSP) from a global concept to implementation at the local school level in England with a view toward clarifying and, more importantly, determining if implementation is proceeding as planned, as evidenced by the presence of process evaluation. The NHSP is designed to serve as a catalyst for health promotion in schools by identifying core health themes linked to evaluation principles in the whole-school approach. In this analysis, process evaluation of the NHSP whole-school approach indicates that program data are collected and recorded, but these data are not used to form an evidence-based program implementation strategy to transform the data into action. The NHSP brings valuable concepts to the global school health community that should be embraced because schools are increasingly being recognized as key settings for health promotion activities.     

Implementing health promoting nursing: the integration of interpersonal skills and health promotion

Health promoting nursing practice is seen as the way forward for the nursing profession. This paper outlines the meaning of health promotion and distinguishes between a traditional and new paradigm approach. The research examining the extent to which a new paradigm approach is practised demonstrates that, to date, nurses predominantly adopt the traditional approach to health promotion. It is argued that the integration of interpersonal skills and health promotion within nursing curricula is crucial in enabling the transfer of theoretical concepts into practice. The ways in which this integration has been approached within one college of nursing are described. The difficulties encountered in attempting this integration and accomplishing a philosophical shift from a traditional to a new paradigm approach to health promotion are discussed and critiqued. Specifically conflicts that occur at an interpersonal, organizational and societal level are identified and proposed as explanations for the slow implementation of health promoting nursing.     

From preventive health behavior to health promotion: advancing a positive construct of health.

A concept analysis of preventive health behavior provided the foundation for this review of current health promotion research in nursing. Studies selected for review described or explained behavior for health promotion, illness prevention, or preventive health behavior. The major focus of this critical review is on the conceptualization and measurement of health promotion behaviors being investigated. Despite nursing's claim to an holistic idea of health, the biomedical model continues to influence indicators of health behavior and the context for promotion of healthy life styles. Major issues for future health promotion research relate to the lack of attention to theoretical definitions and multidimensional aspects of health behavior, and the triad of national strategies for health promotion are discussed.     

In health visiting, a routine visit is one that has passed

Pressure on British health workers to be more explicit in articulating the function, purpose and outcome of their role has increased with the introduction of general management and shift to a market-place orientation, since implementation of the NHS and Community Care Act (1990) However, a recurring theme in the history of health visiting has been the difficulty which practitioners experience in trying to explain exactly what it is that they do This has often been portrayed as a major failing, and possibly even a reason to discontinue the service This paper will offer a potential explanation for this difficulty, and suggest that the management of uncertainty and ambiguity are central to the role It will draw on a grounded theory study which explored how health visitors choose which approach to use in any particular situation encountered in their work The analysis suggested that health visiting's central focus is on situations which are unpredictable, ambiguous or anomalous The study revealed an approach to health promotion which requires a highly developed ability to cope in a safe and therapeutic way with shifting, uncertain and ill-defined health needs, and to recognize and respond to complex, potentially risk-filled situations Drawing on examples which illustrate the implications of these concepts in practice, the paper suggests that, much as midwives have long claimed that a'normal delivery is one that is over, so in health visiting a'routine visit'can only be recognized as such once it has taken place Nevertheless, it will be contended that the particular approach to practice revealed in this study represents a valuable and necessary aspect of health promotion, which has the potential to ensure relevance and acceptability, and which maximizes unexpected opportunities for prevention     

Health promotion: a role for perioperative nurses

• ? British theatre nurses are reluctant to identify health promotion as part of their work and when asked if they are involved in health promotion the answer is likely to be an emphatic ‘no’.
• ? Many theatre nurses would be surprised by the shift of emphasis within nursing away from the medical model and towards a more holistic approach to care which encompasses the concept of health promotion.
• ? British perioperative nursing should draw on health promotion for the benefit of surgical patients and operating department staff.
• ? This paper outlines the contribution perioperative nurses can make to the creation of healthy life not only in their patients but also their co-workers using established health-promotion techniques. It is suggested that health promotion should be an essential part of the education of modern perioperative nurses.

     

A concept analysis of health promotion for women with urinary incontinence

Health promotion (HP) is a multi‐dimensional and complex phenomenon. However, the concept has not been well‐defined and researchers used it in different ways. The aims of this concept analysis are to clarify the meaning of an existing concept of HP and to develop a conceptual definition for the research on women with urinary incontinence. The method suggested by Walker and Avant guided this concept analysis. Health promotion is defined as an artistic science whose goal is to enable humans to enhance their health and well‐being through interaction with the environment. Critical attributes of health promotion include enabling and empowering process and activity, multi‐factoral and multi‐dimensional process, health behaviour and healthy lifestyle inseparable with self‐care and concerning disease prevention and health protection. Antecedents include previous decisions and responsibilities on health, beliefs, attitudes, behaviours, and perceptions, change of healthy lifestyle and health challenges. Health‐promoting behaviour, health and well‐being, self‐actualization, equity, change of healthy lifestyle, increased quality of life, self‐awareness, consciousness, balance and stability are the consequences of health promotion. It is recommended that further inquiry in this area should focus on the development of valid measures to accurately evaluate HP in women with urinary incontinence.     

An analysis of the concept of empowerment

This paper is an analysis of the concept of empowerment and its use in nursing practice, education, research and health promotion The paper adopts an eclectic approach to concept analysis, incorporating the methods advocated by Walker & Avant and Rodgers The concept is analysed and a theoretical definition given Defining attributes, related concepts, antecedents and consequences of empowerment are proposed and a model case presented The analysis demonstrates that empowerment is a helping process, a partnership valuing self and others, mutual decision making, and freedom to make choices and accept responsibility Implications for practice conclude the paper     

Mindfulness and the development of professional health competence in nursing

Health competence is not only a requirement for personal health action; it is also a condition for professionalisation of health promotion. Health promotion has meanwhile become a well recognised part of nursing. This is the reason why in this study the term "health competence", which is actually very much discussed in health sciences, is presented. This concept is knowledge based (health literacy). It is focused on the ability to read, understand and work with health information to be able to do decisions in daily life which are positive for the health. An experienced-based understanding, which focuses on the ability to feel and to perceive and which is regarded as a precondition of self care, is added to this knowledge-based understanding of "health competence". The concept for this interpretation is the "Leibkonzept" which has already been discussed as a fruitful concept in nursing science in other publications.     

Health promotion. Evolution of a concept

An examination of the concept of health promotion provides insight into the origins and developmental milestones that have brought us to our current level of application in health care. It is our view that health promotion can occur at any point on the continuum of health and illness. Perhaps it is a semantic struggle that keeps us from movement toward providing the highest quality of health care of which we are capable. The previous examination leads us to contend that there is indeed significant overlap in the intent of the concepts of health promotion and prevention. Further examination of the concept is redundant if our goal is to continue to improve the quality of care. After all, as Nightingale pointed out, our purpose is to do all we can to assist the body in taking care of itself.     

A holistic-existential approach to health promotion

Health promotion seems to be implicit in many nursing theories, but the theoretical and philosophical basis of health promotion in nursing is not always explicitly stated. The interpretation of health promotion is closely related to the interpretation of man, health, illness and nursing. There is a need to clarify, refine and redefine health promotion in nursing because the concept is partly nonspecific and has not been used to identify a distinctive nursing focus. The aim of this study was to formulate a stipulative definition of health promotive nursing with a holistic-existential approach. A philosophical frame of reference in combination with conceptual analysis and theoretical synthesis were used as the methodological approach. The philosophical framework served as a basis in selecting the nursing theories and influenced the analysis. Two nursing theories and one nursing model were selected due to their influence on Norwegian nursing and because of their philosophical basis. Through analysis and synthesis of the selected nursing theories, the concepts man, health, illness/disease and nursing were analysed. The paper proposes a stipulative definition of health promotion in nursing based on a holistic-existential approach, supported by five necessary conditions. The definition and conditions needs to be further investigated by both empirical studies and by comparing with other relevant nursing theories, in order to formulate theoretical statements. The proposed definition may be the first step in a process of developing a theoretical framework of health promotive nursing with a holistic-existential approach.     

The role of nursing in public health/health promotion--attempt at a systematic approach

Public health and nursing meet mainly in the fields of care managing processes and health promotion. Since there is a new development of Public Health in the German speaking countries also the role of nurses in health education and health promotion has become more important. But traditional fields and new conceptions of public health nursing are still unmethodical. I present a systematic approach of different fields and different strategies of health promotion in nursing which has to be discussed further on. Health promotion in nursing is differentiated in a behavioural approach (empowerment of patients on different levels of nursing) and an approach which focuses on the conditions for health, mainly those for better social support, for better health in the community and in other settings.     

Health-as-process: a health visiting perspective

Health visitors are community nurses who define their role specifically in terms of health promotion, although they have often found difficulty in explaining how their seemingly diffuse and unfocused practice achieves this The grounded theory study reported here set out to uncover some of the hidden processes and features embedded within health visiting, so the practice might be more clearly articulated This paper reports one aspect of that study, which suggests that health visitors treat health as a lifelong process, involving the accumulation and use of 'resources for health' The relevance of approaches which appeared both caring and educational will be set in the context of therapeutic nursing and adult education theories Historically, health visitors have links with both nursing and health education, the analysis presented here helps to clarify the relationships between these different areas of work The paper will explain how treating health as a process allows multiple competing views and ideas about health and health promotion to be integrated into a manageable form, thus allowing positive health to be promoted within a broad, acceptable socio-cultural context However, the analysis also highlighted various points at which treating health as a process contradicts the firmly measurable requirements of the market-orientated health service Nevertheless, where health visitors are sufficiently skilled, and are permitted by their employing authorities to use this approach, it may serve to protect clients from intrusive and accusing interventions, made in the name of health promotion     

Health literacy: concept analysis

AIM: This paper reports an analysis of the concept of health literacy in order to clarify its meaning, reduce ambiguities associated with references to it, and promote consistency in using the concept in nursing dialogue and research. BACKGROUND: Health literacy is a relatively new concept in health promotion research. Only within the last decade have researchers identified the problems associated with health literacy, the role it plays in an individual's ability to comprehend health and self-care information, and its relationship to health outcomes. Clarifying the concept is essential so that nurses develop an awareness of the phenomenon and its relationship to the outcomes of their communication and health education efforts. METHOD: The method used for this concept analysis was that of Walker and Avant (1995). FINDINGS: Health literacy empowers people to act appropriately in new and changing health-related circumstances through the use of advanced cognitive and social skills. The defining attributes of health literacy are reading and numeracy skills, comprehension, the capacity to use information in health care decision-making, and successful functioning as a healthcare consumer. Antecedents of health literacy are literacy and a health-related experience. Consequences of health literacy include improved self-reported health status, lower health care costs, increased health knowledge, shorter hospitalizations, and less frequent use of health care services. Empirical referents of the concept are the Test of Functional Health Literacy in Adults and the health literacy component of the National Assessment of Adult Literacy. CONCLUSIONS: An analysis of the concept of health literacy enhances nurses' ability to assess more accurately their clients' levels of health literacy, thus identifying those at risk for misunderstanding health care instructions, shame associated with inadequate reading skills, and inability to adhere to health care recommendations.     

Organizational health in health organizations: towards a conceptualization

This article is introducing a new concept of organizational health and discussing its possible implications for health organizations and health management. The concept is developed against the background of New Public Management, which has coincided with increasing workplace health problems in health organizations. It is based on research mainly in health promotion and health management. Organizational health is defined in terms of how an organization is able to deal with the tensions of diverse and competing values. This requires a dialectical perspective, integration as well as disintegration, and a tricultural approach to value tensions. The concept of organizational health is pointing towards an inverse value pyramid and a hybrid‐ and value‐based form of management in health organizations. An application of this concept may clarify competing values and help managers to deal with the value tensions underlying workplace health problems on an organizational as well as an individual and group level. More empirical research is required, however, to link more closely the different aspects of organizational health in health organizations.