Student experiences of nursing health promotion practice in hospital settings

It has become evident that the current approaches to health care are inadequate for the changing needs of the world. Health promotion has gained recognition as a preferred option and many nursing programmes throughout the world have reoriented their curricula to incorporate this approach. This paper describes a study that was conducted to explicate student experiences of the practice of health promotion. Twenty-four students participated in the study; qualitative methods, narrative accounts and reflective journals were used to collect the data and the data was analysed using van Manen's recommendations for thematic analysis. Three major themes emerged: the centrality of caring; empowerment—power, participation and partnerships; and the primacy of people. Student narratives are used to illustrate the themes.     

Exploring views on Swedish district nurses' prescribing--a focus group study in primary health care

Since 1994 district nurses (DNs) in Sweden have been permitted to prescribe drugs from a limited list. This reform has met severe resistance from doctors and the opinions of general practitioners (GPs) and DNs have differed in many aspects. The aim of this study was to gain deeper understanding of the different opinions about DNs' prescribing and to explore the impact of the reform on primary care. Six focus group interviews were conducted, four with DNs and two with GPs. Data analysis revealed six categories, which were condensed into two dimensions. The dimensions were individual prerequisites, with the categories responsibility and knowledge, and organizational prerequisites, with the categories distribution of work, climate of co-operation, resistance and economic considerations. District nurses were very positive towards prescribing and had gained new knowledge through the compulsory training course and via discussions with pharmacists. Because of the responsibility required for prescribing, some nurses had introduced systems for self-monitoring. Prescribing was seen as a natural part of the nursing process. All interviewees could describe periods of resistance against the reform, and the head of the health centre was a key person for attitudes at the workplace. The DNs found the nurse prescribing reform very positive. They experienced a strengthening of professionalism and also thought that the reform was a natural development. Negative attitudes and opinions offset the positive feelings. The resistance that had appeared in the beginning had now turned into silent acceptance.     

Mental health nursing and physical health care: A cross‐sectional study of nurses' attitudes,practice, and perceived training needs for the physical health care of people with severe mental illness

Mental health nurses have a key role in improving the physical health of people with a serious mental illness, however, there have been few studies of their attitudes or the extent of their involvement in this work. The aim of this study was to examine mental health nurses' attitudes to physical health care and explore associations with their practice and training. A postal questionnaire survey including the Physical Health Attitude Scale for mental health nurses (PHASe) was used within a UK mental health trust. The 52% (n = 585) of staff who responded reported varying levels of physical health practice; this most frequently involved providing dietary and exercise advice and less frequently included advice regarding cancer screening and smoking cessation. Having received post‐registration physical health‐care training and working in inpatient settings was associated with greater reported involvement. More positive attitudes were also evident for nurses who had attended post‐registration physical health training or had an additional adult/general nursing qualification. Overall, the attitudes of mental health nurses towards physical health care appear positive and the willingness of nurses to take on these roles needs to be recognized. However, there are areas where nurses in our sample were more ambivalent such as cancer screening and smoking cessation.     

Finnish public health nurses' experiences of primary health care based on the population responsibility principle

Implementation of a 'population responsibility' principle in Finnish health centres began in the late 1980s. The aim of this study was to describe public health nurses'(PHNs') experiences of primary health care based on this principle and to identify contextual and personal factors related to their experiences. The sample consisted of PHNs in 10 health centres. A questionnaire was developed based on a qualitative study. The survey was conducted in 1990 and repeated in 1992. The response rate was 84% for the 1990 sample ( n =102) and 91% for the 1992 sample ( n =131). In the multivariate analysis of variance type of community (urban/rural), size of the target population, task division model and existence of regular teamwork between social and health care personnel were chosen as contextual factors studied. Age, length of professional experience and having specialist education in midwifery were chosen as personal factors. Dependent variables were subscales on: experiences of planning and implementation, perceived influence of population responsibility on nurse–client relationships, comparison with previous experiences, views and experiences on comprehensiveness of care and job satisfaction. The majority of the PHNs experienced only minor changes in their work after the implementation of population responsibility. They were most critical about the way these changes were planned and implemented. Changes were mainly perceived as positive. There were some differences in the two samples, reflecting a shift from both positive and negative responses towards more neutral or more positive responses. Several contextual factors were multi-dimensionally related to the PHNs' experiences.     

Improving the physical health of people with severe mental illness in a low secure forensic unit: An uncontrolled evaluation study of staff training and physical health care plans

The life expectancy of people with severe mental illnesses is substantially reduced, and monitoring and screening for physical health problems is a key part of addressing this health inequality. Inpatient admission presents a window of opportunity for this health‐care activity. The present study was conducted in a forensic mental health unit in England. A personal physical health plan incorporating clearly‐presented and easily‐understood values and targets for health status in different domains was developed. Alongside this, a brief physical education session was delivered to health‐care staff (n = 63). Printed learning materials and pedometers and paper tape measures were also provided. The impact was evaluated by a single‐group pretest post‐test design; follow‐up measures were 4 months’ post‐intervention. The feasibility and acceptability of personal health plans and associated resources were examined by free‐text questionnaire responses. Fifty‐seven staff provided measures of attitudes and knowledge before training and implementation of the physical health plans. Matched‐pairs analysis indicated a modest but statistically‐significant improvement in staff knowledge scores and attitudes to involvement in physical health care. Qualitative feedback indicated limited uptake of the care plans and perceived need for additional support for better adoption of this initiative. Inpatient admission is a key setting for assessing physical health and promoting improved management of health problems. Staff training and purpose‐designed personalized care plans hold potential to improve practice and outcomes in this area, but further support for such innovations appears necessary for their uptake in inpatient mental health settings.     

Working with team midwifery: health visitors' views of one team midwifery scheme

The fragmented nature of maternity services in the UK has led to the introduction of various forms of team midwifery scheme. The aim of such schemes is usually to increase continuity through the provision of antenatal, intrapartum and postnatal care to women by a small team of midwives. Few published studies of this organization of midwifery care exist, and even fewer consider the impact of such schemes on related health professionals. This paper presents the results of an independent survey of health visitors working alongside one team midwifery scheme in the south-east of England. Eighty per cent of the health visitors thought that team midwifery was a good idea in theory; however, just 27% thought it was working well locally and 70% reported that they would like to go back to working in the way they did before the introduction of team midwifery. The survey highlighted the health visitors' concerns in relation to team midwifery locally. Two issues were paramount: firstly a reported deterioration in interdisciplinary communications, and secondly a perceived loss of continuity for the women. Thus team midwifery, as implemented in this locality, may not attain the goals aimed at by the organization of care in this way.     

Patients bringing information to primary care consultations: a cross-sectional (questionnaire) study of doctors' and nurses' views of its impact

Objectives  To explore the perceived frequency and impact of patients bringing health information from the Internet to primary care consultations.
Method  A questionnaire was sent to all general practitioners (GPs) and practice nurses (nurses) in a primary care trust in the North-west of England.
Results  The response was 52.3%, more nurses responding than GPs (61.2% vs 46.8%). A substantial majority (93.9% and 78.0%) had experienced patients bringing such information in the last 6 months, which often lengthened the consultations. Significantly more nurses than GPs felt that the information helped the consultation (87.1% vs 37.7%), but also reported that patients bringing such information was off-putting (21.9% vs 6.3%).
Conclusions  Both GPs and nurses experienced patients bringing health information to consultations and significantly differed in their views about whether it helped or hindered. Primary care staff should anticipate patients' use of the Internet for health information and should actively manage patients introducing it into the consultation.     

A qualitative study of nurses' attitudes and practices regarding brief alcohol intervention in primary health care

BACKGROUND: Excessive alcohol consumption causes significant mortality, morbidity, economic and social problems in the United Kingdom (UK). Despite strong evidence for the effectiveness of brief intervention to reduce excessive drinking in primary health care, there is little indication that such intervention routinely occurs. AIMS: This study aimed to explore primary health care nurses' attitudes and practices regarding brief alcohol intervention in order to understand why it is underexploited. METHODS: The study design was qualitative, using a grounded theory approach to data collection and analysis. Semi-structured in-depth interviews were conducted with 24 nurses from practices that had previously been involved in a General Practitioner (GP) led brief alcohol intervention trial in the North-east of England. A combination of convenience and purposive sampling was used to recruit subjects and gain a broad range of perspectives on issues emerging from ongoing data-analysis until data saturation occurred. RESULTS: It was clear that although primary health care nurses have many opportunities to engage in alcohol intervention, most have received little or no preparation for this work. This has left nurses at a disadvantage as alcohol consumption is a confusing and emotive area for both health professionals and patients. An analysis of factors influencing nurse involvement in alcohol intervention outlined a requirement for clear health messages about alcohol, training in intervention skills, facilitation to enhance confidence regarding intervention and support to help deal with negative patient reactions. CONCLUSIONS: As current health policy is to encourage, sustain and extend the health promotion and public health role of primary care nurses, more attention should be given to providing them with better preparation and support to carry out such work.     

Registered nurses' everyday activities in municipal health care: A study of diaries

This study described the work content of registered nurses (RNs) employed in municipal health care. Diary notes of three working days from 34 RNs were analysed using content analysis, and a total of 3185 activities were identified. Of these, 2807 were analysed further and grouped by comparing similarities and differences. The content of the RNs' nursing activities consisted of assessing health, giving treatments and conducting check‐ups, handling pharmaceuticals and teaching. In the administration category, the content comprised planning and reporting, followed by documentation. The RNs' role in municipal health care is consultative, which reinforces their need for competence in advanced nursing, as well as in leadership and pedagogy. RNs mostly work without colleagues and they are responsible for many seriously ill patients. In order to be confident in providing qualified nursing, specialist nursing education in elderly care is needed.     

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.     

Recognizing and reporting child physical abuse: a survey of primary healthcare professionals

AIM: This paper reports a study of the self-reported ability and behaviours of primary healthcare professionals in Northern Ireland to recognise child physical abuse. A secondary aim was to assess the educational and training needs of these professionals. BACKGROUND: In the United Kingdom, 7% of children suffer serious physical abuse by a parent or carer, and two children aged under 15 years die from abuse each week. Recognizing child physical abuse depends on the knowledge and skills of a variety of healthcare professionals. METHODS: A stratified random sample of 979 nurses, doctors, and dentists working in primary care in Northern Ireland were sent a postal questionnaire; 419 responded, giving a 43% response rate. The data were collected in 2002-2003. FINDINGS: In their working lives 60% (251) said that they had seen a suspicious child physical abuse case; however, only 47% (201) had reported a suspicious case to the authorities, leaving a 13% gap in reporting. Although 74% (310) of respondents were aware of some of the mechanisms for reporting child physical abuse, 79% (332) requested further education on this topic. Ability to recognize and willingness to report abuse cases discriminated between the three professional groups. Compared with doctors or dentists, community nurses were statistically significantly more likely to recognize and report suspicions of child physical abuse, and were the group most aware of child abuse issues and the most willing to become involved in abuse cases. CONCLUSIONS: The findings suggest that professional fears and anxieties and lack of knowledge act as barriers to recognizing and reporting abuse and that more specific education and support for primary care professionals is required.     

Placing physical activity in mental health care: a leadership role for mental health nurses

The wide-ranging benefits of physical activity for consumers with mental illness are acknowledged within the mental health nursing field; however, this is not commonly translated to practice. The primary aim of this paper is to argue that mental health nurses are well positioned to, and should, provide leadership in promoting physical activity to improve the quality of care for people with mental illness. Topics addressed in this paper include the relationship between physical activity and both physical and mental health, the views and experiences of consumers with physical activity, the efficacy of physical activity interventions, the attitudes of nurses to physical activity as a component of care, barriers to a physical activity focus in care for mental illness, and the role of mental health nurses in promoting physical activity. There is a clear and important relationship between physical activity and mental health. Mental health nurses are well positioned to encourage and assist consumers to engage in physical activity, although they might lack the educational preparation to perform this role effectively.