During my second student nurse community placement, I was caring for a 63-year elderly of Caribbean descent with a history of smoking addiction. For confidentiality to be upheld in accordance with the Nursing and Midwifery Council ‘The Code’ (NMC 2018), the patient has been given the pseudonym of Mr. Smith. He lived in a very cluttered terrace house in a poor condition which left him vulnerable, as he disclosed that the amount of money, he received from his pension could not accommodate the required renovations. Mr. Smith had recently undergone abdominal surgery and was transferred to the coronary care unit, for treatment following a minor myocardial infarction and was receiving administration of morphine to keep him comfortable. As a student nurse, and working under the supervision of my assessor, I was requested to calculate his body mass index. As well as recording a score as 32.6 kg/m2, which meant that he was classified as overweight, and his blood pressure was recorded at a steady 140/84mmHg. Mr. Smith disclosed that he had always been a heavy smoker, smoking around twenty cigarettes a day since the age of twenty. Through the assessment, it became obvious that smoking was affecting his family life negatively as his daughter refused to let him spend time with his grandchild. As a result of this, Mr. Smith revealed that he was motivated to change, however as he had attempted unsuccessfully to quit several times. However, he believed that with the support of the Multi-Disciplinary Team (MDT) he could stop. I informed my practice assessor and she decided to give Mr. Smith more information about smoking services because he had chosen not to do so independently. This included the National Health Service (NHS) applications and the stop smoking websites, which aims to provide equal support to patients using a variety of different methods. A decision was made by the nurse and suggested to Mr. Smith that, he would work in partnership with the MDT towards enabling this goal to happen. My assessor further made a referral to the local NHS stop smoking service for Mr. Smith and explained the positive impacts that smoking cessation would have on his health.
This essay incorporates a health promotion scenario I was involved in during practice. The essay will critically analyze and discuss the actions and roles of a nurse in health promotion. It will also intend to explore some relevant definitions of health, health promotion, and the lay perception of health. The essay will further explain the awareness and skills nurses are required when promoting the health of service users. The nurse aimed to focus on the autonomy model in promoting health. The scenario to this essay would be centered on the empowerment and educational approach to health promotion. It will also link and identify social determinants and the influence it had on the patient.
In order to understand this essay, one must first understand the terms related to health promotion. In the context of nursing practice, autonomy is vital as it is central to person-centered care. Flinch (2019) highlights autonomy as worthy of respect which relates to being human, thus autonomy incorporates the individual using health services to be involved in making informed decisions about the treatment and care he or she receives. In health promotion, empowerment is defined by Green et al (2019) as a procedure whereby individuals have greater self-control over actions and decisions regarding their health. Benbow et al (2019) emphasize that empowering people enables them to obtain knowledge, attitudes and skills to have control of their lives and adapt to the changing world and their life conditions.
Lundberg et al (2017) state that health is an integral part of a practitioner’s job role. The World Health Organisation (WHO 1948) defines health as a condition of whole physical, mental and social well-being and not simply the absence of infirmity and disease. Although, health can be understood inversely by some lay people as a person’s perspective of well-being centered on their daily experience of their body (Blaxter 2010). Polan and Taylor (2019) delineated health promotion as enabling service users to gain control of their health needs and being able to empower them to identify parts of their health that are most essential to them (Naidoo and Wills 2016). WHO (1948) further explains health promotion as the procedure designed of empowering people to increase and have greater control over their well-being and its determinants. Katz et al (2020) proposed that, health promotion is the skill of supporting individuals to alter their lifestyles to progress toward optimal health. The emphasis of this explanation is lifestyle and behavior because individuals only take action when their behaviors change, then they improve their health. This definition correlated to Mr. smith as it may be the reason why he decided to stop smoking, as his daughter refused him to spend time with his grandchild. Notably, it could be that, he was unsuccessful to quit smoking when his daughter banned him from seeing his grandchild. In contrast, if he had the chance to see his grandchild could motivate him to alter his behavior by successfully quitting smoking.
The concept of health promotion focuses on social, socioeconomic and environmental determinants of health which contains the narrower thought of health education (Linsley et al 2011). Health education includes providing individuals and their communities with the understanding and awareness to achieve better health. Added to the above, health promotion aims to enable people and communities to advance the skills and abilities they need to obtain to have control over everyday life conditions (WHO 2016). Therefore, health education pursues to motivate people to accept a method of behavioral change by directly impacting their beliefs and morals to enable them to achieve their potential (Dixey 2012). Notwithstanding of which definition of nursing is used, we see that health is the fundamental concept and that health promotion is a key element of nursing practice. Naidoo and Wills (2016) suggested that, nurses promote the health of people, communities and their families by educating the needed lifestyle modifications and advocating for the conditions that encourage health. This paragraph relates to Mr. Smith’s scenario and helps to understand that, educating individuals about their lifestyle conditions such as smoking can have a positive impact on patients' values, hence encouraging them through education to enhance the skills needed for a healthy lifestyle.
WHO (1986) identified three important roles that nurses could use to develop health-promoting skills. They introduced what they called ‘advocating’, ‘enabling’, and ‘meditating’. The advocating skill relates to standing up for the desires and wants of patients and endeavoring to deliver a healthy atmosphere, by involving patients' social upbringing or economic situations (Choi 2015). They also recognized enabling, a view providing patients with what they need to be successful by focusing at ensuring that, patients have access to resources equally by utilising a mixture of dissimilar health approaches which permit patients to follow their elite health (Hubley and Copperman 2018). This was evident when Mr. Smith was signposted to the NHS applications and through the booking referral by the nurse to the local NHS stop smoking service, which tracks development and suggests specialized advice using websites and applications (Public Health England (PHE 2016). This may have further enhanced Mr. Smith's success with his smoking addiction as he had tried several times, however, had been unsuccessful. On the other hand, it could be that, accessing local cessation may be difficult due to a lack of motivation and knowledge as he was not reluctant to do so independently. Finally, mediating focuses on knowledge for health promotion to be positive, it needs the support of the government and other healthcare sectors (WHO 1986).
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In the scenario, a positive professional relationship was demonstrated with Mr. Smith. This was done by actively listening to him to build up a rapport to establish trust and maintain a social bond. Undeniably, Deville-Almond (2013) discovered that creating a relationship with a patient could be an effective means for nurses to facilitate health promotion. Notably, trust is essential in health promotion thereby influencing the service users to experience overall (Hemmingway et al 2012). Furthermore, Stickley (2011) reports that listening is one of the most significant humane actions for healthcare professionals in health promotion. This was evident when the patient felt confident and empowered to express his needs and share information concerning his smoking addiction. This is further supported by Kitson et al (2013) who deduced that listening to patients can enhance effective health promotion and build relationships between nurses and patients. They also suggested that without listening, positive health promotion cannot be achieved to promote health efficiently. Therefore, the fact that time was spent to listen to the patient’s response demonstrates active listening and communication skills which are required to effectively promote health and wellbeing. This may be accredited to sufficient self-awareness because health promoters who have emotional intelligence and self-awareness regularly appear sensitive to the patient’s condition (Curtis 2014).
The aspect of health promotion the nurse sought to promote in Mr. Smith’s scenario was focused on autonomy. In recent literature, the partnership remains prevalent (Gregory et al 2018). The objective of the partnership is to ensure that service users views and opinions should be contributed concerning their healthcare. This applies directly to Mr. Smith as he expresses his own wishes and thoughts surrounding his aims around smoking cessation, thus improving his own locus of control. For instance, Mr. Smith was given excess information about smoking services to help him with health-promoting ideas as he had decided not to do so autonomously. Adult learners are particularly unresponsive to learning health promotion approaches that are not perceived for them. However, using small bite-sized pieces of knowledge is likely to be understood rather than overloaded information.
Todres et al (2009) expressed that, patients' autonomy should be strengthened by nurses through sharing the responsibility for decisions to patients and acknowledging them to have a better choice. However, there will always be circumstances where this may be impossible. For instance, though accessible to health promotion advice and support, Mr. Smith had a prolonged record of repetitively trying to quit smoking without success. Varley and Murfin (2014) also stated that, service users should only be approached on occasions when they are receptive and prepared to amend, and that nurses should not impose their own recommendations of change onto service users (PHE 2016). Evidence suggests that patients want health information, but some have a problem in understanding and memorizing what they have been told by their nurse or other MDT. Evidently, McNaughton and Shucksmith (2015) suggested that checking understanding by asking the patient to repeat what was been expressed could promote health promotion. Complications that prevent understanding and action on health information include literacy, culture, language, age and physiological barriers (Beagley 2011). Patients who feel unhappy with the communications aspect of their encounters with health professionals may be unwilling to ask for more information and or may not conform with the advice and treatment prescribed for them (McNaughton and Shucksmith 2015).
Looking at the nurse’s role in health promotion, Mr. Smith was given advice in relation to smoking cessation, this could be perceived as an encouraging concept with the availability of information together with referral support, Mr. Smith is then capable to make an informed decision, thereby establishing empowerment and an aspect of self-control. Chen and Thomas (2016) proposed that empowerment is established when detailed information and well-informed advice is provided, as a result supporting the growth of self-esteem and personal skills. Castledine (2013) recommends that, the approach of an effective health promoter is to motivate people to aid them to make better choices; this involves the knowledge of participating individuals at all aspects completely. On the contrary, it is unlikely to succeed in health promotion when individuals are not motivated (Naidoo and Wills 2016).
Empowerment has been well explained by many specialists through the years as giving service users control over their personal behavioral change (Prochaska et al 2015, Yeh et al 2018). In health promotion, the use of empowerment has been stimulated to give individual autonomy. By allowing an individual to have some accountability, they advance in education and skills linking to their personal health (Powers et al 2012). Notwithstanding this, the use of empowerment has been criticized in health promotion. England (2012) argued that the empowerment approach is time-consuming in health promotion and as a result could cost the health service. Although government funds may build up if extra time with service users are not spent and they are not empowered, this could have a small positive influence for Mr. Smith, directly opposing the goals of health promotion. There is a possibility that service users, such as Mr. Smith, who are not empowered to improve their health behaviors will progress more lifestyle-correlated difficulties, consequently escalating the weight on health promoters. These ideas are directly applicable to Mr. Smith’s care as the nurse was determined to support him to be in charge of his own health. However, Mr. Smith was provided with a considerable amount of time by explaining research-based information about the effects of smoking on his health centered on education and knowledge. Relatively, he was signposted to other important information but instead tried to motivate Mr. Smith to be the advocate for his personal health. Although, if Mr. Smith had been instantly supported with extra information, he would possibly have been more successful in making decisions that were best suited for him rather than deciding his needs.
‘Making Every Contact Count’ well-known as (MECC) is a current standard viewed as an ultimate structure for health promoters to promote health (PHE 2016). MECC is related to the approach of empowerment and is outlined as health and social care experts being self-assured to empower an individual to amend their health behaviors by providing healthy lifestyle information (PHE 2016). MECC is relevant in health promotion as it is fundamentally about prevention and focuses on helping people live heathier longer lives by decreasing the effect of long-term disorders that can result from lifestyle habits and behaviors (Chisholm et al 2018). Nevertheless, MECC has been established as the perfect model for promoting health. In nursing, it is not simple for all health workers to adopt MECC in addition to their usual busy working responsibility and workloads. The use of MECC has some limitations. Nelson et al (2013) discovered that one of the obstacles to its achievement is clinicians' perspective that involving this model would upsurge workload. Despite its barriers, MECC as a method of promoting health has been acclaimed as being a constructive and valuable method (Chisholm et al 2018). Believably, understanding and knowledge of MECC still require an increase. A survey by Keyworth et al (2018) report that, about 41% of practitioners and health professionals acknowledged the MECC consensus report.
The nurse utilized an educational approach in promoting health when providing knowledge and information to Mr. Smith, in this case, this is an example of Mr. Smith making informed choices about his own care (Naidoo and Wills 2016). According to Prochaska et al (2015), there is the possibility that in using such a method, Mr. Smith would be motivated further in wanting to change his behavior. Hinchliff (2009) recommended that placing a service user in an optimal learning environment builds a trusting rapport with the health promoter. In Mr. Smith’s case, this meant that he would have felt more capable to express himself as he felt safe psychologically.
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