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Not just health education needed

Nurses can get confused between health promotion and just one of its aspects, health education, says an Australian nurse researcher.

Dr Janet Roden presented her research into the health promotion practice of community nurses (public health or district nurses in New Zealand) at the recent Australasian Nurse Educators Conference in Hamilton.

She found that community nurses were focused on providing health education and developing people’s personal health skills, rather than the wider advocacy role of health promotion. “But there are other parts of health promotion that are also important.”

During her research, Roden surveyed and interviewed nearly 150 community nurses working in urban New South Wales and rural/remote communities.

She used the 1986 Ottawa Charter for Health Promotion’s five areas (see below) to assess whether community nurses were carrying out health promotion and became concerned that nurses were focusing just on health education.

What she had not expected was finding that rural and remote nurses were more likely to be carrying out charter recommendations than their urban counterparts. For example, they were creating supportive environments by providing satellite broadcasts at RSL (Returned Service League) clubs about cancer support for people in isolated communities. Another group of nurses were ‘reorienting’ or modifying services so they could reach a bigger proportion of their target population.

Roden said despite the rural and remote nurse feeling disempowered by isolation and having to service a huge area, they were actually more effective health promoters. She believed that possibly the isolation meant they had more autonomy and had to take more initiatives than city nurses.

Meanwhile, their urban colleagues were concerned about their limited health promotion roles and felt they should be doing more, but were frustrated by a lack of time and resources. She said the growth in the chronically ill and early hospital discharges meant the generalist community nurses were managing more seriously ill people at home.

“I think its getting harder and harder for them­ – they try and do health education but find it difficult to do more because of the constraints of the environment.”

Roden said some might ask whether the Ottawa Charter was still relevant 25 years on, but she believed its aims and primary health focus meant it was still relevant to all nurses but particularly nurses whose role, like community nurses, specifically includes health promotion.

She believed New Zealand’s primary health care strategy meant nurses were more pro-active but believed nurses internationally could be more active in the area of health promotion. “I think all community nurses need to be more pro-active politically, need to develop a higher profile and to be working towards having NPs (in the workforce).” ?hed research on mental health services’ responses to families.