Public Health and Health Promotion for Nurses at a Glance

Karen Wild, Maureen McGrath

• Publisher: Wiley-Blackwell
• Year: 2018
• ISBN:
  9781119274230
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing Skills

Public Health and Health Promotion for Nurses at a Glance is the perfect companion for study and revision for nursing students and practitioners. Health promotion is a growing core component of nursing care, and this text combines superb illustrations with accessible information to make the key concepts of health promotion clear and easy to understand. It also provides guidance for how this can be applied in daily practice in all fields of nursing to promote the health of individual patients and communities.

Divided into six sections, the first looks at the relationship between the outcomes of public health and the outcomes of nursing, before going on to explore the definitions and different approaches of health promotion.This includes the causes and determinants of morbidity and mortality, and the skills and resources that can support nurses in promoting health with individual patients. It also examines strategies for working with communities to improve health, as well as the ethics of health promotion in nursing.

• The perfect revision and consolidation textbook
• Closely linked with the public health outcomes as represented by the NMC, the 6Cs of nursing, essential nursing skills clusters as well as the implications for nursing arising from recent inquiries.
• Highly visual colour presentation, with full colour illustrations throughout

Unit 1
What has public health to do with nursing?

Chapters

1. 1 What is public health and why is it relevant to nursing?
2. 2 Some historical points of public health
3. 3 Determinants of health
4. 4 Health improvement and the role of the nurse
5. 5 What people think about public health
6. 6 How public health is measured: epidemiology
7. 7 Public health outcomes and the role of the nurse
8. 8 The prevention of premature mortality: screening
9. 9 Health surveillance
10. 10 Inequalities in health
11. 11 Investigations into inequalities in health: reports and reviews
12. 12 The relationship between public health and competency standards for registered nurses

Thinking points for NMC Revalidation

Once you have completed Unit 1 you will have gained an insight into why public health nursing is such an important part of the NMC competencies. How does it relate to the work that you carry out in practice?

1
What is public health and why is it relevant to nursing?

Public health: definition

A number of definitions exist – probably the best is the one used by Acheson (1988):

the science and art of preventing disease, prolonging life, and promoting health through the organised efforts of society

Public health is generally thought of as those strategies that impact on population health such as screening programmes and vaccination programmes, but it is about much more than that (Figure 1.1.1).

The definition that is posted on the current GOV.UK Public Health page is:

Public health is about helping people to stay healthy, and protecting them from threats to their health. The government wants everyone to be able to make healthier choices, regardless of their circumstances, and to minimise the risk and impact of illness.

www.gov.uk/government/topics/public-health

The approach to public health of the current administration has been to place an emphasis on health improvement and prevention of ill health, largely through support for changing health behaviours, and this has been at the centre of its strategy for health in England (Department of Health, 2010), which has the overall aim of

helping people live longer, healthier and more fulfilling lives; and improving the health of the poorest, fastest. …tackling the wider social determinants of health. This new approach will aim to build people’s self-esteem, confidence and resilience right from infancy.

Department of Health, 2010, p. 4

The strategy is concerned with addressing the inequalities in health that were recognised in the Marmot Review (Marmot, 2010) into health equity and inequality. This review acknowledges that health outcomes are poorer in societies in which inequalities exist (socioeconomic inequalities, inequality of opportunity, inequality of provision of education, housing, green spaces. etc.).

For those of you interested in the link between wealth inequalities and health inequalities, you may wish to access the Equality Trust site (http://www.equalitytrust.org.uk/) and also a book, The Spirit Level (Wilkinson and Pickett, 2009).

In England there is as yet little evidence that the gap between the health (measured in terms of mortality and morbidity) of the poorest and the richest is narrowing. It is also the case that for many health indicators England fares worse than other developed countries. For example, although mortality rates for cardiovascular disease (CVD) have fallen they are still high compared with other developed countries (only Ireland and Finland have higher rates). Death rates due to CVD are six times higher in people from lower socioeconomic groups when compared with those from higher socioeconomic groups. Most premature deaths from CVD are preventable and the government’s strategy has been built on a belief that this is also the case for many other conditions – some cancers, respiratory diseases (particularly chronic obstructive pulmonary disease, or COPD), some mental health conditions, overweight and obesity. There has been a welcome acknowledgement of the impact of mental health and wellbeing on physical health, and vice versa.

Public health: relevance to nursing

So what does public health have to do with nursing? Most people spend a relatively small proportion of their overall lifespan in contact with nurses and in the main that contact occurs at a time of acute ill health when the emphasis is on ‘getting better’ or ‘recovery’. There is a recognition that nurses are ideally placed to support people to make healthier choices because of the nature of the therapeutic relationship that develops between a nurse and a patient/client/family and because that relationship develops at a time when people are facing their vulnerabilities to illness and other threats to their health.

The current Nursing and Midwifery Council (NMC) competency standards for registered nurses (Nursing and Midwifery Council, 2015) indicate the requirement for nurses to understand public health principles and be able to respond appropriately to support people in managing the many different factors that impact on health and wellbeing (Box 1.1.1). All nurses are required to be able to recognise the existence of and deterioration in mental health and wellbeing – this is of particular relevance when a nurse is engaging someone in behaviour change. There is also the requirement to recognise that different stages in people’s lives represent different challenges and vulnerabilities to ill health. They also represent different opportunities to improve health and wellbeing as nurses engage with patients in different contexts.

The Public Health Outcomes Framework 2013–2016 (Department of Health, 2012) has two domains that directly relate to the work that nurses engage in with patients (Table 1.1.1). The need for a focus on prevention of ill health is also outlined in the multi-agency five-year plan drawn together by the Chief Executive of NHS England, Simon Stevens, in order to ensure the sustainability of the National Health Service (NHS) as we know it.

It is important to note that the responsibility for public health – in the sense of improving health and wellbeing – was transferred from health trusts to local authorities following the Health and Social Care Act 2012. In July 2015 the Conservative government announced a 6.2% reduction in the funds that would be made available to local authorities for spending on public health. It is therefore imperative that nurses engage in every opportunity afforded to them to improve the health and wellbeing of patients/clients/families.

2
Some historical points of public health

Our understanding of contemporary public health is enhanced by viewing its historical context, and by building on our knowledge of the past it can be argued that we are better placed to appreciate current intervention within public health.

The convention of public health and people’s comprehension of the idea dates as early as pre-Christian times. Rosen (1993; cited in Costello and Haggart, 2003) identifies five important historical periods: the Graeco-Romans with an emphasis on water and sanitation; the medieval focus on endemics; the Enlightenment and a focus on disease prevalence; the industrial focus on working conditions; and a modern era with a focus on bacteriology and virology.

Our forefathers were of the notion that the environment had a huge influence on health and disease, and as such the quality or inadequacy of the air was important. Better to live in airy, well-ventilated places than to reside in the toxic environment of rotting debris, or humid environments. The agricultural revolution saw the expansion of the population, and consequently the development of settlements, villages and towns. The summer months were synonymous with the putrefaction of debris, when the smell was at its worse and the presence of disease was acutely observed. Belief systems supported this view, and the use of aromatic...