Adult specific assignment relating to the use of health promotion in the acute setting

University Degree Subjects allied to Medicine

Throughout this assignment the author will consider the health promotion opportunities, and the nurses’ role within health promotion. In relation to women aged twenty to twenty-four who have undergone a surgical termination of an unwanted pregnancy, which was not the result of rape or sexual abuse. This will be achieved by defining the terms, termination of pregnancy and health promotion. The statistical data will be examined, recent trends identified, and legal aspects discussed. The nurses’ role within health promotion and the ethical implications will be identified, before going on to critique two models used to deliver health promotion, with the most appropriate being employed to demonstrate health promotion strategies and activities.

A termination of pregnancy can is defined as “the purposeful interruption of an intrauterine pregnancy with the intention of not giving birth to a liveborn infant” (Koch & Waterstraat, 2000, p90). Women have had the right to terminate pregnancy since the introduction of the abortion act in 1967. However, in order for a termination pregnancy to go ahead, two doctors must agree that it is necessary under the terms of the act.

The highest rate of termination in England and Wales was carried out in the twenty to twenty-four age group accounting for 55,340 of the total terminations in 2006 (Department of Health, 2006). However, it is important to note that the statistical data, relating to the termination of pregnancy may not be representative of the termination of unwanted pregnancies. Unwanted pregnancy is not grounds for a termination. Under these circumstances the doctors must consider whether it would be potentially, mentally or physically harmful to the woman, or her existing children for the pregnancy to continue as set out in section 1 (1) (a) of the abortion act. Thus meaning that it may be impossible to collect accurate statistical data relating soley to the termination of unwanted pregnancies, as terminations carried out for other reasons relating to the woman’s health may be included. In 2006 there were 193,737 terminations of pregnancy carried out in England and Wales. 190,493 of these were performed under section 1(1) (a) (Department of Health, 2006). Signalling a significant increase when compared to 2005 where 186,400 terminations were carried out in total and 182,654 of these were performed under section 1 (1) (a) of the abortion act (Department of Health, 2005).

In 2001 the government implemented the national strategy for sexual health and HIV, in an attempt to reverse this trend and improve sexual health. Included within this strategy free condoms and contraceptive pills have been introduced, the morning after pill has been made more widely available. Efforts have also been made to improve family planning services and sexual education in schools (Department of Health, 2001a). With the implementation of these strategies a growing emphasis has been placed on health promotion. The World Health Organisation (1984) defines health promotion as, ‘The process of enabling people to increase control over and to improve their health’ (WHO, 1984). More recently this definition was supported by Ewles and Simnett (2003), who state that, "health promotion is about raising the health status of individuals and communities” (p23). The emphasis on health promotion has meant that, all health care professionals have an increasingly important role, in assisting patients and clients to make and maintain lifestyle changes (Department of Health, 2004). The Nursing and midwifery council has stated that “you must promote the interests of patients and clients” (NMC, 2004, p4).

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When delivering health promotion in relation to termination of an unwanted pregnancy, the nurse will have a relatively small window of opportunity. Meaning that it is essential that an appropriate model of health promotion is utilised (Naidoo & Wills, 2000). Prochaska and DiClemente, (1984) Transtheoretical Stages of Change Model for example, is as lengthy model that requires health promotion to be carried out over a significant time period, involving ongoing contact and facilitating relapses (Lucas & Lloyd, 2005). Making the Transtheoretical Model an impractical model to use when providing health promotion after a termination of pregnancy, it may be more appropriate in long term strategies such as smoking citation. Becker’s (1974) Health Belief Model however, consists of only five stages. Incorporating an individual’s perceived susceptibility, perceived seriousness, perceived benefits, cues to action and self efficacy. Meaning that it may be completed in a much smaller timeframe, and it may be more appropriate where there is limited time available. However, this model has been criticised as it dose not account for habitual behaviours (Harari & Legge, 2001). At times it may also be useful for the nurse to utilise an eclectic approach, combining different aspects of several models, in order to tailor health promotion to best meet the individual needs of patients from a diverse society (Croghan, 2005).

For the purpose of this assignment the author will employ Becker’s (1974) Health Belief Model, to demonstrate the strategies and activities used to promote health following the termination of an unwanted pregnancy. This model has been selected as following a termination of pregnancy the woman may have a heighten awareness of susceptibility.

Following a termination of an unwanted pregnancy there are several areas that the nurse will need to discuss with the patient, such as, support and counselling, future contraception and the risk of sexually transmitted infections (STI’S). When addressing these issues it is imperative that the nurse dose not make assumptions about the patient, or her circumstances. Any interaction must be conducted in a non judgmental way, to benefit the patient and support her autonomy (Hinchliff Etal, 2003). As termination of pregnancy is such a sensitive area, it is preferable for the nurse to initiate health promotion after the procedure has been performed and the patient has recovered adequately from the anaesthesia. All discussion must take place in a suitably private area to allow confidentiality, privacy and dignity to be maintained the nurse must also gain the patients consent before initiating any health promotion (NMC, 2004). Once consent has been gained, the nurse can initiate a structured discussion using the Health Belief Model as a guide. The patients’ perceptions regarding her susceptibility, the seriousness of unprotected sexual intercourse, and the benefits of changing her behaviour should be ascertained (Browes, 2006). Throughout the discussion the nurse will need to take a problem solving approach in advising and educating the patient regarding the costs and benefits of behaviour change (McGough, 2004). Taking into account perceived barriers to behaviour change including social, environmental and cultural factors. For the Health Belief Model to be successful the patient must, believe that it is feasible for them to make and maintain the changes needed and that the benefits of the new behaviour out weigh the costs (Tones & Green, 2004). All information that is given during the discussion should be clear, up to date and evidence based (Department of Health, 2003). The nurse must not impose personal views regarding sexual behaviour on the patient (Malin, 2000). All information give should be tailored to meet the needs of the individual (The Department of health, 2001b). It is also important to take into account the circumstances that have lead to the unwanted pregnancy and adjust discussions and counselling accordingly. For example, if the pregnancy was the result of contraception failure the woman may need counselling with regards to her current method of contraception and advise about alternative methods if necessary (World Health Organization, 1997).

It is difficult to discuss all of the factors that contribute to sexual health in one consultation but the Health Belief Model can be used to springboard an ongoing program of care, allowing the nurse to direct the patient to services where further support, advice, counselling and contraception may be obtained such as the family planning association (Browes, 2006). Information given during the discussion should be supported by written information, to allow the patient to contemplate the information at a later date and provide cues for action (Department of Health, 2003). For example, of the types of written information that can be given please see the enclosed leaflet. All information should be made available in alternative languages, audio, large print and brail if required to meet the needs of the individual.

Following a termination of pregnancy it would not be appropriate for the nurse to contact the patient to evaluate the effectiveness of the health promotion. Instead the nurse would need to review, national and local statistical data relating to termination rates and STI’S, in order to measure the effectiveness of the interventions (Jones, 2004).

In conclusion the author has discussed the nurses role in health promotion, in relation to women aged 20 to 24, who have undergone a surgical termination of an unwanted pregnancy, which was not the result of rape or sexual abuse. The terms, termination of pregnancy, and health promotion have been defined and legal and ethical issues considered. Within the discussion the author has highlighted that; the available statistical data may not represent the number of terminations of unwanted pregnancies in the England and Wales. However, the data does show a significant increase in terminations overall, despite strategies implemented by the government to reverse the trend. There has also been a focus on the health promotion models employed by nurses and other professional groups, with Becker’s Health Belief Model being applied to demonstrate, the strategies and activates used to promote health following the termination of an unwanted pregnancy. The application of this model would only result in a positive outcome, if the woman feels that a behaviour change is necessary and that the benefits of behaviour change outweigh the cost. However, it is important to note that health promotion is not about the professional changing the patients social and personal attitudes, but about enabling people to live there lives as they chooses, by their own values and make informed decisions regarding their health. Meaning that regardless of the model used the nurse must respect the patients’ autonomy at all times, using a problem solving approach to support patients, in making individual lifestyle choices bases on their social circumstances and cultural beliefs.

Reference list

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