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The Essence of Care benchmark for patient health promotion

VOL: 102, ISSUE: 14, PAGE NO: 23

Jason Beckford-Ball, BA, RMN, is assistant clinical editor, Nursing Times

A new benchmark for health promotion has been added to Essence of Care, the government’s strategy for improving the quality of fundamental aspects of nursing care (Department of Health, 2001). The benchmark focuses on a range of measures designed to help nurses provide effective advice on healthier lifestyle choices. Essence of Care came out of Making a Difference (DH, 1999) and uses best practice evidence to structure a patient-focused approach to care.

 

A new benchmark for health promotion has been added to Essence of Care, the government’s strategy for improving the quality of fundamental aspects of nursing care (Department of Health, 2001). The benchmark focuses on a range of measures designed to help nurses provide effective advice on healthier lifestyle choices. Essence of Care came out of Making a Difference (DH, 1999) and uses best practice evidence to structure a patient-focused approach to care.

 

 

Initially, Essence of Care covered areas including principles of self-care, food and nutrition, and personal and oral hygiene. Communication was added in 2003 and promoting health was included after the publication of Choosing Health: Making Healthy Choices Easier in 2004. This recommended that all health professionals should be able to provide evidence-based advice on issues such as smoking, nutrition, exercise, sexual health and alcohol.

 

 

The promoting health benchmark
The new promoting health benchmark states that: ‘Everyone will be supported to make healthier choices for themselves and others.’ It includes a number of factors (Box 1, p24), each of which states a target for best practice and a list of indicators identified by patients, carers and health professionals that give guidance towards achieving it.

 

 

The factors
Empowerment and informed choice

 

 

Following on from principles first outlined in The NHS Plan (DH, 2000), this factor recognises that it is important for individuals to be able to make informed decisions about their own health.

 

 

Among the indicators of best practice that health professionals are asked to consider are whether individuals and communities have the knowledge and skills to improve their own health and whether there is evidence of patients being referred to health-promoting services (DH, 2006).

 

 

Education for practitioners
This factor recognises that if health professionals are to deliver choice when promoting health, they have to possess the appropriate knowledge and skills to do so. They are asked to consider whether best practice is shared with colleagues and to look at issues around cultural diversity. For example, nurses providing health promotion leaflets need to consider whether the patient’s first language is English.

 

 

Assessment of health promotion needs
This factor encourages health professionals to ensure that patients can identify their own health requirements. As well as being able to assess health promotion needs, this factor recommends that the patient’s health promotion needs are recorded and that any assessment tools that are used are evidence based.

 

 

Opportunities to promote health
This is one of the most significant factors in that it signals a shift to health promotion being the responsibility of every health professional. It stresses that each patient contact should be an opportunity to promote health. To meet this target health professionals should try to ensure that every contact is person centred and that every opportunity is taken to minimise health inequalities.

 

 

Engagement
This factor states that health should be promoted by responding to a patient or a community’s identified needs as opposed to those needs being dictated purely by policy or by strategy. To ensure best practice the indicators encourage a person-centred plan for each patient and a commitment to making sure that all care pathways include health improvement measures.

 

 

Partnership
This target states that health promotion should be undertaken ‘using different expertise and experiences’ (DH, 2006). Health professionals are used to working as part of a multidisciplinary team and the indicators for partnership reassert some of these principles. These include: exploring all opportunities for partnership working across traditional boundaries; recognising partners’ contributions; and adequately signposting organisations providing health promoting services.

 

 

Access and accessibility
Choosing Health (2004) set out how the government wanted to provide ‘more of the opportunities, support and information people want to enable them to choose health’ (DH, 2004). Crucial to enabling people to make healthier lifestyle choices is access to health promotion services. When providing health promotion services, some of the indicators that health professionals should look at include ensuring services are equally accessible to all, for example, by providing disabled access and providing information in a patient-centred way. This factor also stresses that patients should be actively directed to specialist health promoting services, for example, prescription exercise or smoking cessation.

 

 

Environment
If health professionals are to be involved in promoting health, the environment in which they are operating needs to reflect this. This target stresses that ‘individuals, groups, communities and agencies influence and create environments which positively promote health and well-being’ (DH, 2006).

 

 

Among the indicators to look at when considering the environment in which health promotion services are provided is respect for every individual’s confidentiality. Issues that affect health, such as transport and housing, should also be considered.

 

 

Outcomes of promoting health
The best practice target for promoting health outcomes is to ensure that ‘health promotion activity has a sustainable effect that informs the ongoing public health agenda’ (DH, 2006). The original Essence of Care guidance stressed the need for good practice to be shared, ensuring that improvements would be passed on and that poor practice would continue to be identified (DH, 2001).

 

 

The indicators for this factor encourage health professionals to disseminate any examples of improvements in practice, undertake research into the success of initiatives and use the results to promote good practice.

 

 

Nursing implications
The purpose of the guidance is for health professionals to take a fresh look at their practice in the light of the best evidence for promoting health. For example, referring a smoker to cessation services or promoting healthy eating options in hospitals.

 

 

Essence of Care can have a beneficial effect on patient care if nurses are given enough support to implement the benchmarks as has been illustrated in many trusts around the country (Oxtoby, 2004).

 

 

However, the results of an NT survey illustrated that although trusts are implementing Essence of Care, many are choosing to tackle the benchmarks one at a time (Oxtoby, 2004). The survey also showed that trusts may choose to implement the more highly visible benchmarks such as nutrition before those that are less easy to quantify.

 

 

Based on the experience of implementing the other benchmarks, this new benchmark could have a significant effect on promoting health. However, its effectiveness will be dependent on nurses in all areas having the time and support to draw up and carry out a strategy for its implementation.

 

 

- This article has been double-blind peer-reviewed.

 

 

For related articles on this subject and links to relevant websites see www.nursingtimes.net

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