Health promotion and health education practice: nurses' perceptions

AIM: This paper is a report of a study to explore nurses' perceptions of health promotion and health education practice in a Chinese provincial hospital. BACKGROUND: Health promotion and health education practices are based on universal constructs. Therefore, such practices should share common principles. To date, most nursing-related studies have been conducted in Europe or in North America. METHOD: A Husserlian phenomenological approach was adopted. Interviews were conducted in 2006 with a sample of eight nursing students and eight senior nurses. The interviews were audio-recorded and transcribed from Mandarin to English. Data analysis adhered to the framework developed by Giorgi. RESULTS: Reported health education and health promotion-related practices showed results similar to those reported in Europe and North America. Hospital-based nurses were often aware of what health promotion is, but did not have the scope or opportunity to implement it in practice. Instead, they were likely to conduct more limited forms of health education. Actual understanding of health promotion and health education constructs was high with most participants, underpinned by active clinical-based educational support. Some participants were able to conduct broader health promotion activities on a voluntary basis in their own communities. CONCLUSION: Health education and health promotion are universal health-related constructs. Thus, there is an expectation that all nurses will implement these in a similar fashion. Where possible, hospital-based nurses should strive to improve their health education practices and further embrace wider perspectives of health promotion practice.     

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.     

Health promotion and health education: what role should the nurse adopt in practice?

Health promotion and health education: what role should the nurse adopt in practice? ¶ Health promotion is widely accepted as part of the role of the nurse, midwife and health visitor. Theoretical definitions of health promotion and health education are presented. The author suggests that a variety of different approaches to health promotion can be adopted by nurses in practice, including education, persuasion, manipulation and attempts to promote an environment where healthy decisions about lifestyle can be made. Each strategy is examined and the advantages and the ethical limitations are explored. It is suggested that nurses may theoretically accept the notion of being a health promoter, but that in the reality of practice, their role may be primarily that of the health educator. The importance of recognizing that there are a variety of determinants of health, including social and environmental factors, as well as individual lifestyle, is emphasized throughout the paper.     

A stage planning programme model for health education/health promotion practice

AIM: To investigate the validity of a stage planning programme model for health education/health promotion practice in nursing settings and to develop a specific model for this purpose. Background/rationale. The last decade or so has seen a marked increase in the amount of health educational/health promotional activities that nurses are expected to undertake. This has followed concerted calls to make health promotion a familiar and recognized part of nursing practice. Despite this, however, current health-related practices are still unstructured, haphazard and under-evaluated. This state of affairs is further compounded by the lack of any generic and systematic nursing planning process model by which health education/health promotion programmes are applied in practice. This paper puts forward the case for such a model, develops it, and demonstrates its possible application in clinical settings. METHOD: A systematic literature review was conducted in order to develop a new theoretical perspective for health promotion/health education nursing practice. The proposed model has evolved from this new perspective. The process of developing this model has drawn on existing contemporary planning models--using them as a means to develop a conceptual framework. Consequently, the proposed model seeks to critique, adapt and adopt some of their components within a nursing context. CONCLUSION: If the current situation continues, in which planning process models are not adopted as a routine part of practice, then nursing may well remain a "bystander" in health promotion/health education.     

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.     

The theory and practice of health education applied to nursing: a bi-polar approach

The authors contend that health education is an intrinsic part of nursing practice. The paper outlines two models of health education each with different aims, methods and outcomes and these are related explicitly to nursing practice. The tensions between the two approaches are discussed and whilst the authors acknowledge that both models constitute legitimate health education activity within nursing, it is argued that emphasis should be given, where practically possible, to the patient empowerment model. In addition the authors argue that the social determinants of health and health-related behaviour need to be considered by nurses as a powerful factor in the formation of health lifestyles. Therefore a range of approaches should form part of a repertoire of nursing health promotion interventions.     

Academic nursing education guidelines: tool for bridging the gap between theory,research and practice

Abstract The aim of the present study was to develop educational guidelines to be used as a tool for the integration of theory, research and practice to ensure that nursing knowledge and practical skills form the basis of academic nursing education. An additional aim was to describe the nursing competence expected of the students at four academic levels: introductory, intermediate and advanced levels I and II. Clinical nursing education plays a crucial role in assisting nursing students to integrate the theory and practice of nursing at the baccalaureate level, as well as in further specialization and in‐depth nursing studies at the advanced level. A research group consisting of lecturers from the Institute of Nursing, Göteborg University, Sweden, was given the objective to formulate educational guidelines for clinical practice within nursing education. The study took the form of a literature search. In addition, the Delphi method, aimed at reaching a consensus of opinion among colleagues, was used. Based on the literature review and the collegial discussions, four core concepts emerged: professional stance, reflective processes, problem‐solving processes, and practical skills, from which the educational guidelines were developed. Guidelines were formulated both in general and abstract form. They were not connected to a specific care context, specific patient group or specific nursing problems. The most important objective of academic education is that the student develops abilities and techniques necessary for life‐long learning. Students will, in their professional life as nurses, continuously meet situations where they are challenged to take appropriate decisions and actions. This demands training in problem‐solving, reflection, decision‐making and the ability to use both deductive and inductive learning strategies. The guidelines describe what is expected of the students in terms of nursing competence and personal qualifications to ensure that they will be ready to meet the demands of their future profession.     

Incorporating socio-political health promotion activities in clinical practice

A criticism laid at the door of many nurses in relation to their health promotion activity is that they almost exclusively adopt a biomedical/preventative health education approach. When it comes to adopting socio-political health promotion approaches, there is scant evidence that nurses implement these activities in clinical practice. This article is designed to raise awareness and signpost the types of activities that nurses could be involved with if they wish to influence the broader social and political health promotion agenda. In doing so, it has developed an 'effect' programme model for socio-political health promotion practice as a framework for those practitioners who wish to review their current health-related activities and/or who are seeking to extend their range of health promotional practice. This article draws upon a critical review of the literature in order to develop an evolving theoretical perspective for health promotion practice. The proposed model was developed from this new perspective as were recommendations for practice.     

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.     

Real mental health promotion requires a reorientation of nursing education, practice and research

The evidence for the individual, social and economic benefits of mental health promotion is now well established. The indication is that a broader public health approach that addresses social and environmental factors related to mental health and well-being is required. Mainstream mental health services, however, continue to operate in relative isolation, allocating the greatest proportion of funding and resources to the treatment of mental illness and disorder. Relevant to health promotion, this paper explores the bidirectional link between physical and mental health and the social determinants of mental health. The growing interest in the positive aspects of health and well-being which focuses on wellness rather than illness is also discussed. One example of how mental health nurses can adopt principles of positive mental health to education, practice and research is presented. The author proposes that as the largest professional group in health care, nurses must become more actively involved in initiatives that reorientate practices and services away from an illness culture towards the adoption of wider mental health promotion principles.     

Health promotion as a systems science and practice

Rationale  Health promotion is where clinical practice and prevention science intersect to address complex or 'wicked' problems that have multiple sources and require a broad perspective to address. This means focusing on the social determinants of health and the complex individual, community and environmental interactions that influence health and wellbeing. Health promotion research and practice recognizes that social change is not linear and involves multiple communities of interest working together in a coordinated manner in order to address health problems. An approach that acknowledges this non-linear system of interaction in its data gathering, strategic planning, and program implementation is necessary to addressing this complexity in practice.
Methods  Concepts such as chaos theory, self-organization, social emergence can inform how health promotion is practiced at multiple levels. Evaluation approaches such as social network analysis, system dynamics modeling combined with social organizing strategies like communities of practice and unconferences provide opportunities to leverage social capital effectively to promote health in complex environments with diverse populations.
Conclusion  Health promotion's focus on the multi-layered, complex interactions that create or limit health and wellbeing require knowledge and action that match this complexity. Approaches to engagement and evaluation that are based on systems theories and methodologies provide the means of addressing this complexity, while framing health promotion as a systems science and practice.     

Health,health promotion and the elderly

• ? Health promotion is a mode of practice which is being increasingly examined by policymakers (DHSS, 1987; DoH, 1992).
• ? Although practitioners are being required to screen people over 75 years of age and are exhorted to reduce accidents in the elderly by 33% between 1990 and 2005 (DoH, 1992), there is evidence that they do not value this sort of work (Pursey & Luker, 1993).
• ? This paper looks at the findings from 178 interviews with people aged over 75 years, examining the importance of health and health promotion to the elderly.
• ? Further to the work of Cox et al. (1987), it is clear that people aged over 75 years continue to engage in a wide variety of activities which are designed to keep or improve their health.
• ? Elderly people's accounts of their health suggest that the real influence of social circumstances and environment must be assessed and planned for if health promotion activity is to have relevance and meaning to this group of people.
• ? Evidence is presented which indicates that the elderly are a group of people who would welcome health-promotion activity provided it is given in easily accessible forms.
• ? The notion of client participation is highlighted as a difficult area, which is likely to require particular skill in working with elderly clients. In the light of these findings, practitioners may need to examine their own attitudes to their work with the elderly.

     

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.     

国内外城市社区健康教育与健康促进的现状与展望

介绍了国内外城市社区健康教育与健康促进成功的经验和存在的问题,对我国今后社区健康教育与健康促进的发展方向提出建议。     

国内外城市社区健康教育与健康促进的现状与展望

介绍了国内外城市社区健康教育与健康促进成功的经验和存在的问题，对我国今后社区健康教育与健康促进的发展方向提出建议。     

A social cognitive model for health education/health promotion practice

AIM: To investigate the place and validity of contemporary social cognitive models for health education practice in nursing settings and, in doing so, develop and put forward a specific model for this purpose. BACKGROUND/RATIONALE: The last decade or so has seen a marked increase in the amount of health educational/health promotional activities that nurses are expected to undertake. This has followed on from concerted calls to make health education a familiar and recognized part of nursing practice. Despite this, past and current evidence identifies that nurses have been, and continue to be, ineffective and inconsistent health education practitioners. Where health education activity does take place it tends to centre specifically on social cognitive behavioural change strategies. Subsequently, it is argued here that any failure on the part of nurses successfully to apply health educational initiatives into practice has been compounded by the lack of any nursing-specific social cognitive model process. This paper seeks to redress this imbalance by putting forward the case for such a model, developing it, and demonstrating how it can be incorporated into the practice setting. METHOD: A systematic review of the literature has been conducted and the article draws upon this in order to develop an evolving theoretical perspective for health education practice. The proposed model has evolved from this new perspective. Development of this model has drawn on contemporary social cognitive behavioural models--using them as a means to develop a further conceptual framework for nursing. CONCLUSION: Social cognitive behavioural models are valuable tools that nurses can incorporate routinely into existing frameworks of practice. The proposed model is designed to make the adoption of health-related behavioural change in clients easier and more realistic. If the current situation continues whereby social cognitive behavioural models are not adopted as a concerted and routine part of nursing practice, then nursing may well continue to fall behind other health professions in the discipline of health education.     

Reconciling the differences between health promotion in nursing and ‘general’ health promotion

In the light of the fact that it is known that much of nursing-related health promotion practice is ‘out-of-step’ with the wider health promotion community, it seems sensible to explore to what extent this is the case and the reasons why. This article examines the key issues related to both camps. In doing so, and in noting any differences, it is possible to put forward recommendations for any needed reform - so that, where differences can be reconciled, nursing health promotion is seen to be in alignment with other health professions and the general health promotion community at large.     

The development of reflective learning in the context of health counselling and health promotion during nurse education

AIMS AND BACKGROUND: The purpose of this follow-up study was to describe the development of reflective learning of 16 student nurses in the context of health counselling and promotion during clinical training of a 3-year nursing education programme in two Finnish polytechnics. The first aim was to analyse the levels of reflectivity in the student nurses' reflections on their videotaped counselling situations. The second aim was to explore the qualitative features of the reflective health counselling learning process in the context of health promotion. The theoretical background of the study was based on a transformative learning theory. METHODS: The data consisted of stimulated recall interviews with 16 student nurses conducted once a year between 1998 and 2000. The data were analysed using categorization and thematic analysis. FINDINGS: The findings of the study showed that half of the students in the research group reached the level of critical consciousness during their nursing education. The others remained at the level of consciousness. Two students who represented thoughtful action without reflection in the first study year were able to reach reflection and even critical reflection later during their education. The meaning schemas of counselling developed and were enriched when the students moved into the higher stages of reflection. There were features of an empowerment approach to health promotion only in the meaning schemas and perspectives of critical reflectors. CONCLUSIONS: These results may indicate that the empowerment approach to health promotion within the modern health promoting role of nurses requires critical reflection. Therefore, effective methods and evaluation tools of reflective learning are needed to support learning from practice via critical reflection.