Nurses in all settings should promote public health, says Viv Bennett
There is a renewed interest in public health - improving and protecting the health of all. As a country, we face major challenges: health inequalities are widespread, risks like pandemics exist, and new health threats emerge. The white paper Healthy Lives, Healthy People sets out a mission to improve and protect the nation’s health, improve health fastest where it is poorest, and to do so through a “life course” approach - starting well, developing and growing up well, living and working well, and ageing well. There is also increased understanding that good mental health is central to wellbeing and there can be “no health without mental health”.
Trusted by the public regarding the provision of health information and advice; having knowledge ranging from biomedical to psychosocial care; working holistically; and skilled at building relationships with individuals, families and communities, nurses can help to greatly improve health and wellbeing throughout the life course. We are key to making “every encounter count” towards improved health and wellbeing; we have most contacts with patients, families and communities, many of which are at significant life events when people are receptive to health advice. These may be called “teachable moments” and we must ensure we recognise them and provide advice in sensitive and effective ways.
“We have most contacts with patients, families and communities, many of which are at significant life events when people are receptive to health advice.”
The nursing contribution can be split into three levels. The first is “all nurses” acting as health-promoting practitioners maximising health outcomes for individual patients and carers. Many nurses across a range of settings from surgery to learning disabilities are doing this. For example, the sister on a pre-operative unit who realised the impact this nurse led-service could have not only on the immediate surgery but also on the patient’s health into the future, and who is developing a shared approach with patients to do this.
The second level is those nurses whose roles include specific primary and secondary prevention as well as treatment responsibilities. This includes, for example, practice nurses with key roles in screening who enable people to remain healthy and support self-management when conditions do arise. Another example is sexual health nurses who have responsibilities to individuals and the wider community. Nurses can also make a significant impact on health inequalities. For example, a group of learning disability nurse consultants are currently working on individual and population approaches for those with mental health conditions and in learning disability services to close the unacceptable inequalities gap.
The third level is those nurses - such as health visitors, school nurses, nurse public practitioners and consultants - with specific training in public health and/or public health nursing with specific responsibilities for population health.
Improving health outcomes requires joined-up approaches between health services, local government and communities. Approaches based on assets (factors that develop resilience and promote positive health and wellbeing) are being promoted, and health visitors and school nurses are leading the way by piloting a programme to develop skills to support capacity building in local communities with the aim of improving health and wellbeing.
To measure the impact of the new approaches a Public Health Outcomes Framework is being developed across five domains: health protection and resilience (protecting the population’s health from major emergencies and remaining resilient to harm); tackling the wider determinants of health (factors that affect health and wellbeing and health inequalities); health improvement (helping people to live healthy lifestyles, make healthy choices and reduce health inequalities); preventing ill health (reducing the number of people living with preventable ill health and reducing health inequalities); and healthy life expectancy and preventable mortality (preventing people from dying prematurely and reducing health inequalities).
Nurses are central to achieving good outcomes in these domains and often lead care in areas that make vital differences, such as effectively managing long-term conditions, providing services for people marginalised from mainstream care, and leading public health programmes.
January is a time for resolutions - as nurses let’s make one of ours to make every nursing encounter count towards improved health and wellbeing.
Viv Bennett is director of nursing at the Department of Health and the government’s principal adviser on public health nursing