Raising Awareness for Tuberculosis ror People Migrating to the UK - Essay Example

Name of Writer] [Name of Professor] [Course Title] [Date] Health Promotion Activities Introduction Health promotion as a term became popular in the early 80s and, although there is a debate about what it encompasses, it is generally accepted that it expresses a movement towards better health and well-being. It mainly the result of the post-war developments in human health, as well as social and economic changes worldwide, especially in the developed countries (Herberg 246). The Fourth International Conference on Health Promotion, held in Jakarta in 1997, reiterated and expanded the concept. The Jakarta Declaration on Health Promotion into the 21st Century declared that “...health is a basic human right and essential for social and economic development” (p. 112), and the report noted that trends such as urbanization threatened “the health and well-being of millions of people”. In 1986, the World Health Organization’s Ottawa Charter for Health Promotion defined health promotion as “the process of enabling people to increase control over, and to improve their health” (p. 2). It identified five goals for health promotion: a reorientation of health services, development of personal skills for health, creation of health-promoting public policy, development of supportive environments, and strengthening of community action for health. In 1985, the Alma-Ata Declaration on Primary Health Care and subsequent documents on health promotion (WHO 5) stated that health promotion is not only a medical service but also a wider movement, which includes health care, social services and policy making. However, the significance of the health care professions was stressed in these documents and health promotion as a concept was included in their everyday practice, alongside health education and disease prevention. As a result of these developments, a considerable amount of literature relating to the role of community nurses (CNs) in health promotion exists. The bulk of this literature is from North America, but increasingly relevant literature is being produced in the United Kingdom (UK), especially after the recent changes in health care. Most of it, however, refers to the theory and content of health promotion in community nursing (Doucette 92). The term community nurse (CN) includes any nurse working within primary health care (PHC) but the present study refers only to health visitors (HVs), district nurses (DNs) and practice nurses (PNs). The reasons that only these three groups of CNs were chosen were; 1) They work in PHC, and very often from the same premises, which are a general practice surgery or a health centre, 2) they have the possibility of contact with individuals of all ages through their every day practice, 3) and they entire accessible to everyone in the general population for first contact. Theoretical Focus The individualistic approach and client education have been seen as central in the role of nurses in health promotion. However, the individualistic approach assumes that clients have control over then- health choices, and therefore it has been criticized heavily as 'blaming the victim' and restricting individual freedom. It should be used, therefore, with a lot of thought within the context of social and environmental circumstances (Dines 220). However, other authors have debated whether or not nurses are paid to educate clients concerning the social and economic causes of ill-health, or to teach them to reach an accommodation with their social and economic circumstances (Caraher 468). The trend of criticism of the individual approach in health promotion activities is not restricted in one country or specialty. In 1986 the discussion of greater involvement of nurses in health promotion activities in a wider context, such as community based activities and participation in healthy public policy formulation, is becoming the centre of attention (WHO 3). This is not; however, the case in research-related literature, where examination of health promotion in its wider context was found in only two studies (McBride 94). For the purpose of the present study, health promotion was defined as 'any activity aiming at improving the health of individuals or the community at large through empowerment. These activities include social, political, economical and organizational measures in practice these activities are translated into health education, ill-health prevention and health protection measures, not as three separate areas of activity, hut as overlapping ones' (Tannahill 67). Research Study Based on this literature review, it was concluded that health promotion activities provided by CNs have been limited to health education and ill-health prevention mainly on a one-to-one basis. In addition, there is no clear evidence from existing literature that clients are aware of health promotion activities provided by CNs, or that existing services are appropriate for their needs: • To examine the form and content of health promotion activities provided by CNs, and • To ascertain if the health promotion activities provided were relevant to the needs of their clients. A cross-sectional survey was chosen as the most appropriate research design for this study. Triangulation of methods (questionnaires, interviews and non-participant observation) and sources (CNs, their clients and records) were used for data collection. Population Due to restrictions of tune and cost, CNs and their clients from four District Health authorities (DHAs) and the corresponding family health service authorities (FHSAs) from the same region, were included in the study. Stratified random samples of CNs (100 HVs, 100 DNs and 100 PNs) from each of these DHAs were included in the questionnaire study. The total sample was 300 (75 from each DHA). Their job seniority (grade) was considered as a stratification characteristic. A smaller convenience sample of CNs (20 HVs, 20 DNs and 20 PNs, 15 from each DHA) was observed in practice, during either organized health promotion climes or their usual work, for identification of the range of health promotion activities used. The clients' sample was also a convenience one and was selected from those attending the clinics or from those that the CNs were visiting at home on the day of observation. Instruments The instruments prepared for the present study were a self-completed questionnaire for CNs and an interview schedule for CNs' clients. Notes were kept during the observation on the content of opportunistic health promotion activities and on how CNs were recording health promotion information. The CNs' questionnaire The questionnaire included (a) personal data, which included closed and open questions related to CNs' demographic characteristics, educational and training background, work and previous experience, and (b) current health promotion activities, which included closed and open questions Answering patterns were (a) dichotomous (yes/no), (b) ordinal with four-point scales (always-often-rarely never), (c) categorical, including exploratory lists with an open category, and (d) open questions. Clients' interview A semi-structured interview schedule was designed specifically for CNs' clients in order to elicit their awareness of health promotion activities and their perceptions of current CNs health promotion practices. The questionnaires were distributed and collected by the researcher. Results and Discussion Data for the main study were collected between October 1993 and May 1994. Three hundred questionnaires were distributed and 251 (83.67%), 92 from HVs, 81 from DNs and 78 from PNs, were returned completed. and 78 from PNs, were returned completed, from the clients the final Number interviewed was 249 (83 0%). The main reason for failing to achieve the initially planned number of interviews was the difficulty in finding adequate numbers of DNs' clients eligible to be interviewed during the half-day observation. Only 74 DNs' clients were asked to be interviewed and 66 (89.2%) of them accepted. Sixty sessions with HVs, DNs and PNs, 20 in each group of CNs, were planned and completed. The mean duration of observation was 3.17 hours and it was performed either in the morning or afternoon. The majority of the subjects (98.4%) were female and their age was accumulated in the categories 35-54 years (66.93%) in all three groups of CNs. The majority of CNs employed by the DHAs (60.87% of the HVs and 66.67% of the DNs) were working full time, while only 21.79% of the PNs were working full time. The mean duration in their present job was 6.86 years for HVs, 8.71 years for DNs and 4.80 years for PNs. From the 249 interviews conducted with CNs' clients, 76 (30.5%) were men, and 173 (69.5%) women. The mean age of male and female was similar for HVs and DNs clients PNs' male clients were much older (xbar = 55.6 years) than the female (xbar = 43.3 years), the difference was significant (t (89 d.f) = 3.30, P Read More