focusing upstream - fzab vsznj_merrell.pdf · upstream thinking and health promotion ......
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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