This assignment consists of defining the knowledge, skills, and attitudes that healthcare professionals use to apply to advance wellbeing. This will emphasis on quitting smoking in the adolescent (16-25 years old) population in the community environment, with particular reference to national NHS health guidelines. This assignment is aimed at this population because if adolescent individuals carry on smoking it would lead to a wide scope of health problems and the development of a serious disease in adulthood; for example, hearing loss (Dawes Piers, 2014). Smoking is a process where burning tobacco in cigarettes, pipes, and cigars is inhaled by an individual. Tobacco smoke contains over 5,000 chemicals including tar and nicotine (Saleem et al 2018).
The definition of health promotion is for individuals to have control over their health and make sufficient improvement (Ottawa Charter,1986). WHO (1946) states that ‘’ health promotions defined as the health state of complete, physical, mental and social well-being, and not simply the absence of disease or infirmity; this, therefore, means that physical, mental and social prosperity is part of health promotion as well as the nonattendance of illness or sickness’’. Health promotion helps individuals resolve their health issues via a holistic approach, allowing individuals to get involved in situations that they are comfortable with and therefore helps healthcare professionals to use health promotion to ensure that individuals have a positive outcome with their health (Kumar and Preetha, 2012). According to The Royal College of Nursing, health promotion has a relationship with nursing as it understands that nurses can reduce the impact of illnesses, promote health and help individuals to the best of their ability, regardless of whether it is in a community or hospital setting (RCN, 2019).
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Adult Nurses are required for health promotion as they get in contact with the public all the time, accordingly their insight and abilities can lessen sicknesses of patients and advance a more advantageous way of life for the patients as it would lead to a reduction of demands for healthcare professionals and financial pressure on NHS and private healthcare institutions (Kumar and Preetha, 2012), in spite of the fact that wellbeing nurses focus around health, infection, changing the conduct of the people education (Dombrowski et al, 2014). Subsequently, it has enhanced the accessibility of wellbeing administrations, decreased manifestations of perpetual ailment, expanded cost adequacy, upgraded personal satisfaction and encouraged self-administration (Stromberg et al, 2003). Health promotion has the thought of upstream and downstream aspects which underlines how social, cultural, cash related and characteristic components impact prosperity and wellbeing (Smith, 2015). The downstream idea tends to be why an individual turns out to be sick in any case, though the upstream idea centers around starting consideration for the anticipation of sickness, which is basically what health promotion means (Wills, 2014).
Knowledge
Health is most important as it is a source of everyday life. Therefore, health promotion is not just the responsibility of the health sector but it is for healthy lifestyles and wellbeing (Ottawa Charter, 1986). Health promotion is defined as having the understanding to be able to educate individuals, to make the individual mindful and enabling individuals to accomplish their well-being and lifestyle (Veras et al, 2015). This supports people in identifying their physical, mental and social well-being, and helps individuals realize their ambitions and satisfy needs which will help the individual to change or cope with the environment. On the other hand, this could also potentially be a disadvantage due to a minimal amount of understanding and time which is needed to continue health promotion (Veras et al, 2015).
Nurses need the experience to promote smoking in adolescent individuals (16-25 years old) because smoking can cause a wide range of illnesses which can decrease life expectancy (Dawes P, 2014).
Reducing health inequalities in the key to Public Health priority as a way of promoting health (Marmot, 2010). On the other hand, it may also be difficult for subcategories of the population to be in contact with health promotions as it may be ‘’hard-to-reach’’ for Public Health programs due to physical/geographical location or their social/economic situation (Flint, 2008). According to Professor Mike Kelly, director of the NICE Public Health Centre, states: ‘’over 79,000 deaths in England each year are due to smoking tobacco’’. Several health promotion techniques are being utilized for counteractive action and suspension. Evaluation of some of the health promotion intervention studies has appeared to have a positive effect on the decline in smoking. For instance, ‘’the ‘STOPTOBER’ 28-day campaign has helped over 1 million people quit smoking’’ (Stoptober, 2012). Another health promotion that was put in place for adolescent individuals was not being able to buy cigarettes as the minimum age for the legal purchase of tobacco increased from 16yrs to 18yrs in England, Scotland and Wales on 01/10/2007 (BMJ, 2018).
Smoking is a risk factor of chronic diseases such as lung cancer, ‘’with 90% of these cases being the result of smoking’’ (Cancer Research UK 2019). It is the biggest issue increasing particularly with people who live in a poorer society.
‘’Responsible for 80,000 lives for each year, the immense budgetary burden on the NHS to treat sicknesses related to smoking is evaluated at £2.7 billion every year’’ (DH 2010). Research shows that mediations are progressively viable when joined with approaches, for example, campaigns and legislation (Edwards 2010). Having attention to campaigns and legislation is significant for the best practice and guaranteeing that the learning and abilities are cutting-edge, and medical caretakers know about the update arrangements and legislation so they are not giving mistaken data out to the people, a standard set by the Nursing and Midwifery Council (NMC 2008). The standard stated by the NMC Code (2008) was ‘’the standard of education, training, and conduct that nurses and midwives need to deliver high-quality healthcare consistently throughout their careers is done by ensuring that nurses and midwives keep their skills and knowledge up to date and uphold the standards of their professional code'' (NMC Code, 2008). Up-to-date data shows that ‘’in 2009, 6% of youngsters matured 11-15 years were consistent smokers’’ (Robinson 2007). However, even when individuals understand the health risk that tobacco smoking can cause, unfortunately, 1 in 5 people continue smoking (DH 2010). Nurses have the responsibility knowing all the information about smoking, the health promotion strategies in place for smoking, what kind of help the individual is getting and where changes could be made if the patient feels like the help they are currently receiving is not helping him or her. Nurses must process enough learning while at the same time utilizing evidence-based techniques as it enables them to support, encourage and share data with individuals to quit smoking. However, diminished learning, expanded feelings of anxiety, constrained data and absence of time are obstructions that prompt the weaknesses of promoting health (Chen et al, 2014).
Health promotion policies are important as they aim to support the country’s priorities with the real health needs of the population so that all people in all places have access to quality health care and live longer, healthier lives (WHO, 2016). There is a wide range of models of health promotions that develop from behavioral and social sciences and borrow from psychology, sociology, marketing, and consumer behavior; it also reflects not just the behavior of the individuals but influences of wider society. The reason why models are put in place is that it helps practitioners and nurses to understand health behaviors and guides the identification of health promotion strategies. The models which are used specifically for smoking in health promotions are:
Tannahill's model (1990) of health promotion consists of three overlapping circles. An example of this model would be when a nurse contributes to handing leaflets out which educates individuals or the wider community regarding the health risks of smoking and prevention. An example of the element of the model is that ‘’ in 2007 the legal age for selling tobacco increased from age 16 to 18 years to reduce the availability to young people and prevent them from starting to smoke’’ (DH 2008). Another model that can be used for behavior and promoting health would be Prochaska and DiClemente Stages of transformation model (1984). This works as individuals go through stages for them to improve behavior, which leads to maintaining a healthier lifestyle. The stage will depend on how much the patient is smoking and therefore this is when an effective assessment will take place. This model motivates patients to change and get involved in the changing process (Hove et al, 2002). Marmot (2010) stated that the lower social classes had the poorest health and identified social factors such as low income and deprivation as the root causes which affect health and wellbeing. Bilton, T (2002) suggests the environment an individual is at can harm health which can influence patterns of behavior. An example of this would be families who have deprived housing conditions, living in poverty or in an environment where no one socializes, this, therefore, can lead to psychological stress, which encourages people to enforce behaviors such as smoking (Blackburn et al 1991, Earle et al 2005).
Skills
Nurses are required to use various verbal and non-verbal communication methods considering sensitivities to appropriately respond to patients’ personal and health needs (NMC Code, 2015). Verbal communication is used by nurses for the nurse to choose their words carefully so the patients can understand what the nurse is trying to say (Lloyd and Craig 2007). Nonverbal communication is a message which is expressed without using any words. For example, this can be done via gesture, facial expression or touch (Renata et al, 2005). For successful communication between a nurse and the individual, the necessary skills are effective and respectful assertiveness and listening (Boynton, 2017). Overall, good communication skills are necessary for a therapeutic relationship between the nurse and individual, this can be verbal or non-verbal, however, would be seen by having the appropriate body language, posture, respecting the patients’ values and beliefs and allowing time to communicate with the patient (Tanz et al, 2018). Nurses would be active listeners and encourage the patient to talk, using open and closed questions which shows the individual that the nurse is listening and showing concerns for the person's conditions which therefore demonstrates respect and shows the individual that the nurse is willing to put the effort in and help them out (Peate 2006).
Another skill that is used is motivational interviewing. Motivational interviewing is a counseling method that helps people with their insecurities to find a motivation that they need to change their behavior. Motivational interviewing evolved from Carl Roger's person-centered, or client-centered, approach to counseling and therapy to allow to help people who find it difficult to change a bad habit e.g. smoking (Rogers 1957). ‘’Smoking cessation is the most effective intervention to prevent deterioration’’ (Aggarwal and Agarwal 2007). Motivational interviewing is often applied in smoking cessation, together with self-efficacy (Bandura 2001) and the trans-theoretical model of change (TTM) (Prochaska and Dicemente 1984).
Motivational interviewing is portrayed as joined, suggestive and humane about the people's self-governance to support 'change talk', where the patients talk about how they will acknowledge change (Miller and Rose, 2009). Now the patients ought to be sure to express their very own inspiration and indecision for conduct changes (Rollnick et al, 2008). Motivational Interviewing has four rules:
- To oppose the correcting reflex,
- To comprehend and investigate the patients' very own inspiration,
- To tune in with sympathy
- To engage the patients and empower expectation and idealism (Rollnick et al. 2008).
Results appeared ''that experts' self-detailed aptitudes in the inspirational meeting were inconsequential to capability levels in watched practice'' (Miller et al, 2004). According to Lundahl and burke (2009), motivational interviewing showed better results compared to non-intervention.
Another skill for promoting health is Health Education. Health Education promotes an understanding of how to maintain personal health. This skill is necessary for this assignment because, at the moment, there is a lot of health education in place to help people quit smoking. The National Institute for Health and Care Excellent (NICE) guidelines shows that nurses should help individual stop smoking as soon as possible by maybe determining the level of interest in smoking cessation and discuss quitting options. The National Association of School Nurses Standards for Professional School Nursing Practice (NASN, 1998) includes a standard related to health education. Health education aims to change behavior by providing the person with the knowledge they require which allows them to make healthier decisions and ables them to fulfill their potential. Healthy Lives Healthy People (2010) ensure that nurses play an important role when delivering health promotion with attention to the prevention of primary and secondary levels. Nurses have a wide range of skills and knowledge which is used to empower people to make lifestyle changes and choices. This, therefore, underpins people to make changes in their wellbeing and increment sentiments of individual self-sufficiency (Christensen 2006).
Nonetheless, one national strategy which was viable of this intervention was the ‘’ Smoke-Free England’’ campaign which was presented in 2007 ‘’controlling smoking in work environments and encompassed open spots’’. At the point when this arrangement came into spot, ‘'the law smoking discontinuance administrations saw an expansion request by 20%, as smokers felt the environment was conducive to them having the option to stop'' (DH, 2008). This policy is also set up on emergency clinic ground, and medical attendants need to guarantee. Health education is important in nursing as there are nursing education programs in place which are given in the classroom and in the clinical practice setting about the importance of patients or individuals understanding their health care conditions to restore, maintain and promote health. The final skill which could be used by nurses to promote health is clinical skills. Clinical skills are needed as part of promoting health, this can be taken up when promoting health by doing a full psychological observation of the individuals which could include HR, RR, BP, Saturations and Temperature, once this procedure is done nurses must always ensure that the observations are recorded and monitored (NICE, 2008).
Attitudes
Nurses have an important role in nursing to show non-smoking behaviors for the individual. there needs to be a consistency between personal and professional beliefs for nurses to engage in smoking health promotion. evidence show in Sue Halls (2005) short report for the survey of practice nurses’ attitudes towards giving smoking cessation advice results showed that nurses had positive attitudes towards this short report for individuals to reduce smoking. For instance, ‘'36% wanted to go for smokers as they felt that the people would react to their recommendation, 28% did not trust that talking about smoking with all smokers was a reasonable and felt like this was tedious, 23% felt that examining smoking with all smokers were probably going to accomplish more mischief than anything lastly 23% did not trust that their recommendation was compelling'' (Hall, 2005).
This report was carried out in January 2003 via a cross-sectional survey, it consists of a population of 200 registered nurses. It was a random determination from the Medical Research Council General Practice Research Framework. Practical preparing in smoking suspension for enlisted medical professionals is relied upon to have an expansion rate, therefore along these lines implies that people will tune in to the smoking end encouragement given.
Conclusion
To conclude, wellbeing advancement concerning counteractive action of ailment and sickness, the job of the medical professional is significant as they should bring issues to light and give instruction and counsel to people who need to change their conduct. The difficulties of health promotions specify the extensive competences a nurse must have to empower and encourage individuals. On the other hand, governments have the responsibility to promote and protect health and are essential in presenting the national policy to build ‘'healthy publics'' an atmosphere beneficial to health.
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