The Role of the Nurse in Health Promotion

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Edward Bracher        0917308 09b (Masters)

The Role of the Nurse in Promoting Health


Over the last few decades the promotion of a healthy lifestyle has attracted a huge amount of attention.  Health has obviously been a well discussed issue politically and culturally (Bunton et al., 1995).  This paper offers a history of the development of the idea of promoting health in order to properly understand what is meant by the term.  The role of the nurse in health promotion is explored with specific reference to a patient undergoing bowel surgery.  In order to do this a health promotion model is chosen by critically comparing two different models, and a health promotion strategy for the patient is developed using this model.  

For the purpose of this paper The World Health Organisation (WHO) definition of health will be used.  WHO describe health as not just about ones physical condition or absence of disease but encompasses a persons mental and emotional state, their social and societal position and their spiritual and sexual condition (WHO, 2010a).

Health Promotion

Health promotion is a phrase that can be used on a global, national or individual scale. Its exact meanings and the action taken to promote health can be different at different levels.  For example a government will promote health in a very different way to a nation or community than a nurse will promote health to an individual or family on a hospital ward.

It was not until the end of the 70’s that the term health promotion became popular, however in under 10 years it became a powerful factor on the formation of national policy (Parish, 1995).  The WHO defines health promotion as a process of empowerment.  That is giving people the power to take control of and improve their own health.  It does not just involve intervention in the behaviour of individuals but must include societal and environmental considerations (WHO, 2010b)”.  The development of this definition by WHO will now be explored.

In 1977 the WHO started its Health for All (HFA) Campaign, this concept was introduced at the 1978 International Conference on Primary Healthcare where the Declaration of Alma-Ata was signed (WHO, 2003).  This declaration noted that good health and the ability to participate in the planning of one's own healthcare was a fundamental right of all people.  It also stated that the difference between the health of those in developed and developing countries, specifically the poor nutritional status of those in developing countries, was unacceptable and that it was the responsibility of all governments to cooperate and address this issue.  The declaration suggests that primary healthcare is the key to achieving these goals and that primary healthcare is not just limited to the health sector but requires the coordinated efforts of the agricultural, food, industrial, educational and housing sectors.  (International Conference on Primary Health Care, 1978).  At the same time the Health Education Council in the UK was realising that previous approaches to improving the health of the nation were not adequate to noticeably improve the nation's health (Health Education Council, 1983).  By 1985 HFA had 38 targets set for countries in the WHO European region.  The UK signed this agreement and so agreed towards the HFA ideal.  

This new awareness in the political arena led to a series of 7 global conferences on health promotion hosted by the WHO over the next 2 decades in order to achieve the targets set down in the 1985 HFA agreement.  This started with the 1986 Ottawa Charter for Health Promotion (WHO, 1986) and ended with the 7th Global Conference on Health Promotion in 2009 (WHO, 2009a).  These conferences first built upon the declaration at Alma-Ata and subsequently built upon each other.  

They aimed to set down strategies on how to improve the health of the world.  These strategies involved promoting the idea that health is the responsibility of all and that those writing health policy should be accountable for the health of those it affects.  They also argue that our health is intrinsically linked to our environment and therefore a sociological approach to health is required and not just a clinical one and that in order to promote health we should create healthy working and living environments and educate the population on how to look after their own health. They build upon the idea that it is not just the health sector that is responsible for improving health but also that of social and economic sectors, non-governmental and voluntary organisations, local authorities, industry and the media (WHO, 1986, 1988, 1991, 1997, 2000, 2005, 2009a, 2009b).  

The trend that can be seen through the history of the WHO conferences is that health promotion is about raising the quality of living and working environments and improving health education.  This, alongside high quality healthcare, creates choices for individuals and communities about their health and empowers people to raise their health status.  It is interesting to note that the role of the nurse in promoting health is not directly mentioned in the WHO health promotion conferences.

Models of Health Promotion

Tannahill’s Seven Domains of Health Promotion (1996)

Tannahill’s seven domains contains seven aspects of health promotion formed from combinations of three main activity groups.

Disease prevention applies to any measures that directly prevent disease, immunization is a good example.  Health education activities involve educating people about maintaining their own health.  An example of this could be teaching a diabetic to self administer their insulin.  Health protection represents legal or legislative measures to protect health from negative influences.  Legislation for food hygiene in restaurants is an example.  The three main spheres then overlap forming combined forms of health promotion.  Disease prevention and health education combine to form preventative health education.  This is education aimed at preventing the onset or spread of disease.  Educating on the use of effective contraception to combat sexually transmitted infections could be fitted into this category.  A combination of health education and health protection is named education for health protection.  This domain characterises activities that educate with an aim to increase awareness of health promotion.  Preventative health protection is when disease prevention and health protection activities merge.  This includes policy aimed at reducing the incidence of disease.  A combination of all three main domains is named health education for preventative health protection.  Educating policy makers on the benefits of providing a service for the prevention of a disease is an example.

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Beatties Model of Health Promotion (1991) 

Adapted from Beattie’s model of health promotion (Beattie, 1991).

Beattie’s model of health promotion places health promotion activities on a dual axis (see diagram below).  One axis represents an authoritative or negotiated approach.  The second represents health promotion to an individual or to a collective.  The authoritative verses negotiated axis represents the method used to promote health.  It can be either “authoritative”, meaning the activity relies on decisions being made for those that are affected by said activity.  Alternatively the method could be “Negotiated”, meaning to undertake action with the input of those affected ...

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