Focusing Upstream:

Nurses’ Role in Health

PromotionProfessor Joy Merrell

16th September 2010,

Ljubljana, Slovenia

Background and underlying principles of

health promotion

Role of nurses in promoting health and

preventing ill health

Bridging the Gap project- hospital discharge

scheme

Outline

Health of European Population

Of the six WHO regions, the European Region is the most affected by non-communicable diseases.

Cardiovascular diseases are the number-one killer, causing more than half of all deaths across the Region.

Mental health problems and cancer are other leading contributors to the disease burden (WHO 2006).

Slovenia and UK

Mortality and Morbidity Statistics

In 2004 the age standardised

death rate (per 100,000) for

cardiovascular diseases was:

279.2 for males

161.4 for females

216.5 for males

139.2 for females in the UK

The European country with the lowest rates is Monaco:

142.6 for males

90.6 for females

Highest rates in Turkmenistan

(https://apps.who.int/infobase ).

Obesity

In 2010, BMI of 30Kg/m2 or more

(aged 15+):

Slovenia

Males: 13.9% (Ranked 26/52)

Females: 27.6% (7th in Europe)

UK

Males: 23.7% (ranked 3rd)

Females: 26.3% (ranked 9th)

Highest & Lowest Rates

Males: 30.3% (Greece), 3.6% Tajikistan

Females: 36.5% (Malta), 7.6% Francehttps://apps.who.int/infobase

Smoking

In 2006, the prevalence of daily cigarette

smoking (aged 15+):

Slovenia

Males: 28% (ranked 30/45)

Females: 18% (ranked 24/46)

UK

Males: 18% (ranked 43/45)

Females: 17% (ranked 26/46)

Highest & Lowest Rates

Males: 65% (Russia Federation),

12% (Sweden)

Females: 41% (Austria),0.4% (Azerbaijan)

https://apps.who.int/infobase

Changing Lifestyles

By changing lifestyle behaviors 80% of premature deaths from heart attacks and strokes can be avoided and most importantly people’s quality of life will also be improved, thus reducing the burden of health care costs.

Focusing Upstream

Upstream Thinking

`….You know, I’m so busy jumping in, pulling

them to shore, applying artificial respiration,

that I have no time to see who the hell is

upstream pushing them all in’.

(Zola, 1970, as cited in McKinley, 1979).

Upstream Thinking and Health

Promotion

Health promotion is `the process of enabling people to increase control over and to improve their health’ (WHO, 1984).

`the promotion of health and social development is a central duty and responsibility of governments that all sectors of society share’ and concluded that ‘health promotion must be a fundamental component of public policies and programmes in all countries in the pursuit of equity and health for all’ (cited by Tones and Green 2004, p16).

Principles of Health Promotion

Building healthy public policy

Creating supportive environments

Developing personal skills & coping strategies

Strengthening community action

Re-orientating health services away from treatment and care and improving access to health services

(WHO 1986).

Nurses’ Role in Health Promotion

Direct and close contact with patients, individuals, families and communities

Often at times when individuals may be more receptive and motivated to make changes in their lifestyles and health behaviours

All settings

Integrate health promotion into everyday practice

Levels of Prevention

Primary: Preventing an illness/disease occurring, reducing incidence.

Secondary: Early detection and identification of a health problem, preventing development of existing disease, minimise its severity, reduce prevalence.

Tertiary: Helping people who have had a health problem such as a heart attack to make lifestyle changes to reduce the risk of further heart attacks and aid rehabilitation- or for those people with chronic health conditions helping them to cope with their condition to achieve their maximum potential for health.

(Adapted from Tones and Tilford 2001 and Naidoo and Wills 2009).

Health Promoting

Environments

The Health Promoting Hospital Network.

Aims to:

Make the hospital a healthy working and living environment for the workforce and patients

Enhance recovery and rehabilitation programmes

Provide information and advice on health issues

Shift the hospital from being solely a place of treatment to one where prevention and health gain are also valued and seen as part of its purpose.

(Naidoo and Wills, 2009, p335).

Focus on Primary Health Care

In the UK, shift in focus to:

Enable people to remain as independent as possible

within their own homes,

Provide more services in the primary care setting

Reduce the number of hospital beds

Development of intermediate care schemes which

encompass cross boundary working between health

and social care and the voluntary sector to promote

independence by providing more choice and care at

home (WAG 2003).

Bridging the Gap

Developed from an existing Hospital Discharge Scheme provided by Age Concern (Charity).

Project’s purpose: to facilitate safe and sustainable discharge from hospital for older people aged 55 and over who have low level needs, by providing multi-agency support extending over 6 weeks.

Involves district/community nurses, social worker, benefits advisor, visiting assistants, trained volunteers, volunteer co-ordinators and a project manager.

Methods

Focus groups with volunteers (n=14) and paid workers (n=3)

Individual interviews with:

- managers and co-ordinators (n=4)

- referrers to the Project (n=3)

- partners (n=3)

Secondary analysis of data from a client satisfaction questionnaire (n=70) and clients’ letters (n=14)

Documentary analysis, e.g. workers’ job descriptions

Findings - Key Themes

Strengths of the Project

Challenges of Collaborative

Working

Roles and Boundaries

Support and Training

Benefits for Clients

81% (57) of clients reported

that the service was

excellent, 6% (4) stated that

it was good, and none were

dissatisfied with the service:

When I left hospital I was more or less housebound. To have a friendly face to come and see you, have a chat, do a bit of shopping and help out with the housework, ironing etc, it has helped me to get back into life again (Pt12).

Number of Clients Referred

Year

(Jan-Dec)

No. of

Clients

Referred

2002 272

2003 254

2004 459

Of the 459 referrals 1%

(4) were inappropriate

In 2004, 12 clients re-

admitted to hospital, 3

for terminal care

2% (9) potentially

avoidable re-

admissions

Role of the Nurses

The nurses’ role included:

reviewing clients’ medication and concordance,

expediting referrals, for example, to general practitioners as required,

ensuring clients had appropriate aids and adaptations in the home,

conducting risk assessments, for example, for falls prevention,

facilitating the completion of welfare benefits applications and

providing appropriate health promotion tailored to the individual client’s needs.

Benefits for Paid Workers

Working in a multi-disciplinary team

Job satisfaction

New challenges, new ways of

working

Autonomous decision making

Benefits for Paid Workers

We can challenge and

as long as we’ve got a

good rationale and a

good basis for what

we’re doing then go

ahead and have a go,

um I think...the nurses

can, they bridge the

gap in lots of ways

(P3,p7).

Challenges of Collaborative Working

Multi-agency working

Team working

Managing change

Conclusion

Many of the current health concerns require individuals to adapt and modify their health behaviours.

Policy makers need to make the healthy choice the easier choice.

Nurses can make a significant contribution to promoting health and preventing ill health, especially in view of their direct and close contact with individuals, families and communities.

Health promotion should be viewed as integral to the work of all nurses and other healthcare professionals. Indeed health promotion is everybody’s business.

Re-focus to upstream thinking.

THANK YOU