Naidoo and Wills (2009) identified five approaches to health promotion, these are medical, behavioural change, empowerment, educational and social policy. Each of the above approaches are important, relevant ways for a nurse to promote good health and healthy living for service users in their care. However, this assignment chooses to focus on three of the five approaches in particular, the Medical, Empowerment and Educational approaches. (Green and Kreuter, 1999) state that health promotion is “any combination of educational and environmental supports for actions and conditions of living conducive to health” and so this assignment will spend time discussing the meaning and effectiveness of each of the three approaches, and also how they relate to the work of a nurse in all disciplines, particularly mental health.
The medical approach to health promotion defines health as “a person being healthy because of a lack of physical symptoms”. This is apparent through the common social conception that one is healthy because of them never, or rarely attending the doctor. Over time, and due to research in this area, humans have learned that this isn’t necessarily the case. There are many symptomless and very dangerous diseases, including sexually transmitted diseases, and cancer. Another point to be made is that because one doesn’t feel the need to attend a doctor, or feel unwell, they may not necessarily be healthy. It is common for people to have a cold, and ignore it, as they can still carry out their activities of daily living, while taking over-the-counter medication. As a nurse, the medical approach would be the best known.
Making patients aware of the medication they are on, and helping them adhere to taking it as instructed, (Aslani, Rose, Chen, Whitehead, Krass, 2010) mention that “strategies that have been shown to increase adherence to medication include initiation of routine in hospital, clear and direct messages about importance of adherence, inclusion of patients in decision-making and use of reminder systems”. There are different reasons why someone mightn’t adhere to medication (Traynor, 2009) “a patient is nonadherant for “non intentional” reasons, such as forgetfulness, or “intentional” reasons, such as a belief that the cost of the medication outweighs its benefits”.Another very interesting side of the medical approach, that is particularly relevant to mental health nursing is motivational interviewing. (Laasko, 2012) “By using a patient-centered approach, Motivational Interviewing has been shown to enhance patients’ insight and attitudes toward treatment.” This method has proven very effective in service users with Bipolar Disorder. Research has shown that only about 50% of people with Bipolar Disorder adhere to medication, and it is through a directive and patient-centered approach that they are helped to resolve their ambivalence toward medication treatment.
Hokanson Hawks (1992) defines empowerment as “the interpersonal process of providing the proper tools, resources and environment to build, develop and increase the ability and effectiveness of others to set and reach goals for individual and social ends” Empowerment is a central aspect of health promotion. (Chambers&Thompson, 2009) Governments worldwide have advocated the use of empowerment in their public health policies and nurses are seen as essential in the delivery of this agenda using the empowerment model to engage patients in self-care and decision-making.gives the service user information and tools they require in order to help themselves, and has programs and policies in place for them. Through this system, they will have the support of the nurse and other necessary health care professionals the whole way through the process. (Marchinko & Clarke,2011)
“To work toward empowerment, not only must the client be at the center of service planning, but a shift in responsibility for some of the coordination of services to the client must also occur for self-management to be achieved This is seen widely in mental health nursing, and with the introduction of the Community Psychiatric Nurse (CPN) and Home Care nurses, service users are able to carry out their normal routines, and yet have the constant support and help of their nursing team. This type of nursing, and approach to health promotion means that consumers of mental health services are able to stay at home, and still able to maintain a healthy lifestyle. This suits people who are long enduring sufferers of illnesses, but are not experiencing a crisis particularly well. During these times, it is unnecessary for them to be admitted to hospital, therefore spending their time, at home or at work, as normal is more appropriate. It is also better for the service user themselves, as they feel that they have the power and the ability to do everything they need to do, but will always have support when things don’t go to plan, or they’re experiencing symptoms of their illness.
The educational approach to health promotion involves the teaching role of a nurse that Peplau (1988) spoke of, which “Gives instructions and provides training; involves analysis and synthesis of the learner’s experience”. This approach requires the Nurse to be aware and knowledgeable on required topics prior to speaking to service users. It is important that the service user believes and understands the nurse, as they are being taught how to independently look after themselves, along with learning information on their medication, illness, circumstances, etc. (Daniel & Green, 2002) state that “Health education is a systematically planned activity, and can thus be distinguished from incidental learning experiences”. It is vital that nurses keep up to date with training and education sessions throughout their career, as they can be called on to give information all the time. Education can also protect a nurse, a course such as manual handling is a prime example, as it teaches the nurse methods in which they can prevent themselves from straining and pulling muscles.
This assignment spoke about three of the five approaches to health promotion, Medical, Empowerment and Educational. It referred to journal articles and Irish policy documents in order to give detailed information on each of the approaches, it aimed to give a balanced argument for all approaches mentioned. As each approach differs, from the next, but all are relevant when looking at the holistic care of a person.
Aslani.P, Rose.G, Chen.T.F, Whitehead.P.A, Krass.I, 2010. A community pharmacist delivered adherence support service for dyslipidaemia. European Journal of Public Health, 21 (5), 567-572.
Chambers.D & Thompson.S. (2009) Empowerment and its application in health
promotion in acute care settings.
Daniel.M, & Green.L.W (2002) Health Promotion and Education, Encyclopedia of Public Health.
Department of Health and Children (2006) ‘A Vision for Change’ Report of the Expert Group on Mental Health Policy. Stationary Office, Dublin.
Hokanson Hawks.J.RN C MSN DNSc,(1992) Empowerment in nursing education: concept analysis and application to philosophy, learning and instruction Journal of Advanced Nursing, 17 (5), 609-618.
Laasko, L.J., RN, MSN., 2012. Motivational Interviewing: Addressing Ambivalence to Improve Medication Adherence in Patients with Bipolar Disorder. Issues in Mental Health Nursing, 33 (1), 8-14.
Marchinko.S & Clarke.D (2011) The Wellness Planner: Empowerment, Quality of Life, and Continuity of Care in Mental Illness, Science Direct:Archives of Psychiatric Nursing, 25 (4), 225-306.
Naidoo J. & Wills J. (2009) Foundations for Health Promotion. 3rd edn, Bailliere Tindall, Edinburgh.
Peplau.H, (1988) Interpersonal Relations in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing. Macmillan.UK.
Traynor.K, Improving medication adherence remains a challenge for provider, American Journal of Health-System Pharmacy, 2009 Jun 15; 66 (12): 1070- 1073