In 2007, the Secretary of the U.S. Department of Health and Human Services published the 31st Annual Report on the Health Status of the Nation that identified that the health status of Americans is declining (Health, United States, 2007). The report recognized an increase in the prevalence of unhealthy lifestyles and behaviors, specifically physical inactivity and obesity. Physical inactivity and obesity are risk factors for the development of cardiovascular disease, metabolic syndrome, Type 2 diabetes, and some forms of cancer. The Centers for Disease Control and Prevention (CDC) estimated that 70% of all deaths and a majority of limitations of daily living activities in the United States are the results of chronic diseases. Many of these diseases are either preventable or manageable by adopting healthy living practices (CDC June 2, 2008). Never before has health promotion been more important than it is today. Nurses in education, practice, and research settings can participate in the advancement of health promotion not only to the mainstream but to the forefront of nursing practice (King, 1994). Historically, nurse educators have taught patients how to manage illness; in the future, the focus must be on teaching people how to remain healthy. Nurses must have an evidence-based understanding of the significant effect that can be made through health promotion interventions and communicate this understanding to the public at large. As more people grow in their awareness of activities that lead to good health and become knowledgeable about their own health status and the health of their families, the overall health of the population will improve (King, 1994). Health
Health is an elusive term. It is a term that many people think they understand until they are asked to define or describe it and then asked how they would measure it. It has been described as a value judgment, as an objective state, as a subjective state, as a continuum from illness to
wellness, and as a utopian state. Florence Nightingale wrote that health is “not only to be well, but to be able to use well every power we have to use.” Peplau defined health as “Forward movement of the personality that is promoted through interpersonal processes in the direction of creative, productive, and constructive living (Lyon, nd).” Health Promotion
A definition of health promotion is “any planned combination of educational, political, environmental, regulatory, or organizational mechanisms that supports actions and conditions of living conducive to health of individuals, groups and communities” (Joint Committee, 2001, p.24). Health promotion, disease prevention and chronic disease management are proactive approaches to health care that stress prevention at different points along the health care continuum. Health promotion and disease prevention strategies focus on keeping people well and preventing diseases from occurring. These strategies are referred to as primary prevention activities. Secondary and tertiary prevention activities focus on maintaining the health of individuals with chronic conditions, delaying progression of their conditions, and preventing complications (Maben & Clark, 1995).
Health Promotion Theories
In developing nursing a professional discipline, nursing educators and researchers have developed theoretical frameworks for the clinical practice of nursing that are used by clinical nurses as models for testing and validating applications of nursing knowledge and skills. The results are added to a body of knowledge commonly called the theory of nursing. Peplaus theory defines nursing as a “significant, therapeutic, interpersonal process.” Peplaus states that four components make up the main elements of the nurse-patient relationship: the orientation phase, the working phase, and the resolution phase. During encounters with patients, the nurse observes, interprets what he/she observes, and then decides what needs to be done (Watson & Foster, 2003). Another example of nursing theory is Watsons Theory of Caring. Caring is central to nursing, and most persons choosing nursing as a profession do so because they desire to care for others. Caring as a science has been defined by Jean Watson. She describes science of
caring as one that encompasses a humanitarian, human science orientation, human caring process, phenomena and experiences (Watson & Foster, 2003). Integrating Health Promotion Theory
Health promoting nursing practice is seen as the way forward for the nursing profession. St Joseph’s Regional Medical Center in Paterson, NJ has already integrated Jean Watsons Theory into their nursing practice. SJRMC integrates Watson’s theory in several ways beginning with the organizations core values represented by the acronym CARES: Compassion, Accountability, Respect, Excellence, and Service. Jean Watson’s theory has been woven into the job descriptions and the clinical ladder process. The nursing job descriptions now include a statement that the nurses must be competent in both technological skills and the curative factors of the caring theory. Her theory has also enhanced educational offerings. Nursing grand rounds are presented each month as part of the hospital educational offerings. Nursing theory is woven into these presentations. Components of the caring theory and/or specific carative factors are referenced as theoretic frameworks for these offerings. The educational offerings have also taken on a more holistic approach, addressing body-mind-spirit components of the health-illness experience.
Changes to the clinical documentation system have also been undertaken to better capture theory-based nursing practice. The clinical information system coordinators at SJRMC have revised the computerized documentation screens to link the carative factors with nursing diagnoses and interventions. Lastly, Nurse recruiters have brought the caring theory to the recruitment and selection processes of new nursing staff. Nurse recruiters are now informing prospective candidates that the nursing practice of this organization is based upon the caring theory. During the interview process, recruiters ask candidates to describe a caring moment from their past. New graduates may describe a situation from their student clinical rotation or a time when they perhaps cared for a family member or friend, or even a time when they were the recipient of someone else’s care. Barriers to Health Promotion Activities
The journey to integrate nursing theory has led this organization’s nursing practice to new vistas and new possibilities. While partaking in any journey, there are barriers to overcome and benefits to appreciate as new vistas are considered and new possibilities are realized. The barriers encountered proved to be nothing more than challenges that could be overcome. At times questions arose as to whether nurses had the time to truly enact the caring theory within the emergency room at SJRMC fast-paced environment. Discussions in brought forth the fact that nurses do enact the caring theory in their professional role every day despite the fast-paced environment. Other perceived possible barriers included a diverse nursing staff, many of whom had no previous exposure to nursing theoretical concepts. These perceived barriers did not at all hinder the progress of this initiative. Nurses realized that although they might have been from different cultures, with different educational backgrounds, working in different nursing specialties, they did share with other nurses a common mission and purpose as described by Watson’s theory.
SJRMC evaluates the effectiveness of its health promotion theory several ways, beginning with using a company called, HealthStream to manage patient satisfaction surveys. Upon discharge from the emergency room we explain their discharge instructions and follow it up with information about the survey, along with a pamphlet from HealthStream inside their discharge packet. This helps the hospital train, reward and recognize its staff. Conclusion
As health care evolves and changes, the roles of nurses in health promotion and prevention have expanded greatly. The goal is to prevent disease from occurring rather than taking a reactive position of treating the client once disease has already occurred. Theory is important because it helps us to decide what we know and what we need to know it helps to distinguish what should form the basis of practice by describing nursing. Additionally, by selecting and integrating one nursing theory like SJRMC did, it solidifies and strengthens the nursing practice as an integrated whole.
Center for disease control and prevention (2007). Health, United States, 2007. Retrieved from http://www.cdc.gov/nchs/data/hus/hus07.pdf.
Center for disease control and prevention (CDC) (June 2, 2008). Chronic Disease Prevention. Retrieved from http://www.cdc.gov/nccdphp/
King, P. (1994). Health promotion: the emerging frontier in nursing. Journal of Advanced Nursing, 20, 209-218.
Lyon, L.B. (n.d) Stress, Coping &Health. A Conceptual Overview. Retrieved from: http://www.sagepub.com/upm-data/44174_1.pdf Report of the 2011 Joint Committee on Health Education and Promotion Terminology. (2011). American Journal of Health Education, 43, 1-32. Maben, J. & Clark, J. (1995). Health promotion: a concept analysis. Journal of Advanced Nursing, 22, 1158-1165.
Watson, J.,& Foster, R (2003). The attending care model: Integrating theory, evidence, and advanced caring-healing therapies for transforming professional practice. Journal of Clinical Nursing,12, 360-365.