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Opinion

'Every nursing contact counts for improving public health'

  • 16 Comments

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

  • 16 Comments

Readers' comments (16)

  • Lecturing patients about their life-styles is fine, provided one is willing to accept the consequences: an obese clinician explaining the dangers of obesity, must expect to be asked 'So how come you are no stick insect yourself ?'. Etc.

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  • "The white paper Healthy Lives, Healthy People..."

    why are the government still referring to 'white' papers?

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  • Will healthy advice extend to those undergoing dangerous pursuits and sports? How we drive, cross a road, stop kids playing some games, I think not. We will have to be careful bombarding people with health advice.

    'we have most contacts with patients, families and communities, many of which are at significant life events when people are receptive to health advice'.....and at their most vulnerable

    Lets not forget people should still be allowed choice, without being victimised. Something about this notion is very idealistic and also very controlling. Life should be about fun too, not thinking about everything you do and put in your mouth 24/7.

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  • "We will have to be careful bombarding people with health advice."

    I think the contradictory reports on health issues in the daily news papers are proof of this, peppered with what the public should and shouldn't do!

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  • michael stone

    Anonymous | 14-Jan-2012 1:03 am

    'Lets not forget people should still be allowed choice, without being victimised. Something about this notion is very idealistic and also very controlling. Life should be about fun too, not thinking about everything you do and put in your mouth 24/7.'

    I'm strongly with you there !

    This 'approach', of course, is all about an attempt to prod people into adopting 'healthier behaviour', so that they need less NHS resources. Although I'm not entirely clear whether that is true, even if it works - everyone eventually dies, and most people degenerate before their death, so this might only be delaying those costs.

    And if a person is stopped from doing all of the things they enjoy, is living longer worth it ? And if people believe these messages, but struggle to follow the advice, isn't there an extra 'worry and stress' factor which probaly makes those people less 'helathy' ? When I was at university in the 70s, and there were IRA bombing campaigns, some students were paranoid about being blown up on trains, etc - if you had no choice but to get the train, you couldn't affect your chance of being blown up, so why worry ?!

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  • raised level of guilt complex =

    raised level of depression =

    greater need for psychological support and counselling =

    demand outstrips supply =

    increases in staffing and facilities

    =

    rising costs of treatments

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  • I run a bowel cancer screening clinic. when asking the mandatory questions about alcohol intake and smoking and weighing them I take the opportunity to offer help if there is a problem. 9 times out of ten the help is refused but now and again i have been able to refer patients on to smoking cessation/ dietician /addiction support. I don't consider that lecturing, being hypocritical, or taking away peoples choices. After all they can choose to say no thanks.

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  • sensitive questioning whilst showing attention and genuine interest in the answers is fine but leaving adults feeling they are being bombarded with invasive questions from a standard tick box questionnaire subjected to a set of algorithms to find solutions is an entirely different matter and to many, and especially the older generation, may be totally unacceptable and pointless.

    This is about people and showing that health care professionals care for them, not meeting some hypothetical targets and government directives!

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  • Anon 15 Jan 4:10

    Come on lets give ourselves a little credit for intelligence! Why assume peolpe are going to bombard patients or make them feel threatened / uncomfortable. The idea is sound it's up to the healthcare professionals to interpret it appropriately.

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  • Sarah Stanley | 15-Jan-2012 5:24 pm

    Anon 15 Jan 4:10

    the idea is sound if it is delivered, as i said, with sensitivity and is left to the discretion of individual nurses to discern the needs of their patients

    it is not sound if it functions as I describe above and there are no guarantees that this will not happen in some cases.

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