Nurses as role models and health educators

Nurses as role models in health promotion: a concept analysis

There are national and international expectations that nurses are healthy role models; however, there is a lack of clarity about what this concept means. This study used concept analysis methodology to provide theoretical clarity for the concept of role models in health promoting behaviour for registered nurses and students. The framework included analysis of literature and qualitative data from six focus groups and one interview. Participants (n=39) included pre-registration students (adult field), nurse lecturers and registered nurses (RNs), working in NHS Trusts across London and South East London. From the findings, being a role model in health promoting behaviour involves being an exemplar, portraying a healthy image (being fit and healthy), and championing health and wellness. Personal attributes of a role model in health promoting behaviour include being caring, non-judgemental, trustworthy, inspiring and motivating, self-caring, knowledgeable and self-confident, innovative, professional and having a deep sense of self.

Nurses as Imperfect Role Models for Health Promotion

The purpose of this qualitative study was to discover ways in which nurses describe themselves as health-promoting role models. Focus groups and individual interviews were conducted with nurses working in a variety of settings. Transcribed interviews were analyzed thematically. Nurses defined themselves as role models of health promotion according to the meaning they gave the term, their perceptions of societal expectations, and their self-constructed personal and professional domains. The term role model evoked diverse interpretations ranging from negative perceptions of the idealized image to a humanized, authentic representation. Nurses perceived that society expected them as role models to be informational resources and to practice what they preached. Nurses defined themselves independently of societal expectations according to personal and professional domains. Valuing health, accepting imperfections, and self-reflecting were aspects of the personal domain, whereas gaining trust, caring, and partnering were facets of the professional domain.

The self as role model in health promotion scale: development and testing

Historically, nurses have been expected to be role models of health promotion, conceptualized and operationalized narrowly and indirectly as the practice of healthy behaviors. The purpose of the current study was to develop and test an instrument (The Self as Role Model for Health Promotion [the SARMHEP]) to measure nurses' perceptions of themselves as role models. Data were collected from nurses working in public health, nursing education, and general practice with a 56% return rate. A series of exploratory factor analyses elicited a five-factor solution that accounted for 44% of the variance and approximated the theoretical dimensions that guided the instrument's development. Cronbach's alpha for the total scale was .91. The new multidimensional SARMHEP was shown to have beginning validity and reliability.

[Abuse and neglect of older care recipients in domestic settings - a survey among nurses of in-home care services]

Although some anecdotal evidence for the phenomenon of abuse and neglect of community-dwelling older care recipients by in-home care services exists, there is an almost complete lack of data on this topic. In order to determine extent and risk factors of abuse and neglect of older care recipients by nurses, we conducted a self-report study among in-home care workers in the German city of Hanover. A total of 503 nurses took part in the study; the response rate was 43.3%. Nearly 40% of all respondents reported having abused or neglected at least one patient within the last 12 months. Psychological abuse/verbal aggression and neglect were most common. Serious problem behavior could be predicted by patients' aggressive behavior, the number of clients suffering from dementia, subjects' use of alcohol as a means of alleviating work-related stress, and nurses' general judgments of quality of care delivered by the respective in-home service. The results of this study show that the problem of abuse and neglect of care recipients is not limited to nursing homes and care by family members. Findings point at opportunities for prevention and accentuate the need for further research in this field.

When are new graduate nurses competent in the intensive care unit?

Transitioning from the graduate nurse level to that of competent practitioner may be characterized as 5 distinct stages instead of 3 as previously thought. Educational and performance goals and challenges may be described for each stage to track a nurse's progress through a critical care nursing development program without the traditional prerequisite period of general ward service.

Nurses? perceptions, understanding and experiences of health promotion

AIM

This paper presents an account of nurses' perceptions and understanding of health promotion in an acute setting.

BACKGROUND

Health promotion is considered the remit of every nurse. To engage in health-promoting practice, however, nurses need to understand the term 'health promotion' clearly.

METHOD

A single qualitative embedded case study was used. Purposive sampling of eight nurses was employed. Initially, theses nurses were observed in practice and, following this, a semi-structured one-to-one interview was conducted with each observed nurse. Qualitative data analysis guided by work of Miles and Huberman was employed.

RESULTS

The data revealed one main theme: health-promoting nursing practice and this consisted of six categories and five subcategories. The findings indicated that nurses struggled to describe their understanding of health promotion, their understanding was limited and the strategies described to conduct health promotion were narrow and focused on the individual. Their perceptions and descriptions of health promotion were more in keeping with the traditional health education approach. Overall health promotion was reported to occur infrequently, being added on if the nurse had time. Factors relating to education, organizational and management issues were identified as key barriers prohibiting health-promoting nursing practice.

CONCLUSIONS

Nurses must recognize that health promotion is a broad concept that does not exclusively focus on the individual or lifestyle factors. Nurses must be educated to recognize health-promoting opportunities in the acute setting, as well as how to plan for and conduct health promotion so that it becomes integral to practice. A review of the methods of organizing and delivering nursing care is also advocated.

RELEVANCE TO CLINICAL PRACTICE

Ward managers have an important role in supporting nurses, creating a culture for health promotion and sharing power in decision-making processes, so that nurses feel valued and empowered.

Health Behaviors of Nursing Students: A Longitudinal Study

To ascertain the degree to which a health science curriculum may influence health-related behaviors among students, nine selected health behaviors of 52 undergraduate nursing students were studied for 3 consecutive years and compared to those of a similar group of education students. In addition, the health behaviors of both student groups were compared to those of the general population. During the study, the nursing students had no significant alterations in the observed health behaviors, and no significant differences were observed between the health behaviors of the two groups of students. Both groups manifested certain health behaviors that were significantly different from the general population. However, nursing students were observed more frequently to be significantly different from the general population. A 3-year nursing curriculum may have facilitated the adoption of some personal health behaviors, but the time demands of academic life may have induced students to reduce time-consuming health behaviors, such as getting enough sleep, eating breakfast, and exercising.

The health-promoting lifestyles of undergraduate nurses in Hong Kong

Based on Pender's health promotion model in 1987, this descriptive study of 169 undergraduate nurses in Hong Kong was undertaken to determine any differences in their health-promoting lifestyles, as measured by the Health Promoting Lifestyle Profile II (HPLP II) among different age groups, gender, income, employment status, and levels in undergraduate nursing education. The student nurses performed best in interpersonal relations but worst in physical activity. There were significant differences among the various classes in stress management and spiritual growth, with senior classes (Years 3 and 4) reporting worse in both areas. This was particularly remarkable among the students of the final year, who would soon be graduating as staff nurses and were expected to inspire patients to practice health-promotive behaviors by their example. The older age group also had lower scores in stress management and exercise practice. Because most of the students in the senior classes were older, the findings further reinforce the earlier results. It was also identified that more than half of the students were supported on low parental income with many of them working a part-time job. These outcomes were explored with future recommendations made to improve the weaknesses in the students' health-promoting lifestyles.

Outpatient nurses: from handmaiden to autonomous practitioner

Little seems to have been written about health promotion in outpatients' departments. This article argues that outpatient nurses have the potential to play a significant part in promoting people's health. Outpatient nurses may be the first hospital nurses that an individual meets. What people observe and how they are treated may make a difference to both their experience of hospital care and their health. Outpatient nurses may have been perceived as the doctors' handmaidens of yesterday, but today they are evolving into an effective force for change. For example, evaluation of nurse-led outpatients' clinics is showing that they have the potential to complement doctor-led clinics and improve the healthcare experience of patients. It is argued that the health-promoting role of the outpatient nurse can be enhanced by a department that is a health-promoting environment.

Predictors of tobacco control among nursing students

As the most numerous health care providers, nurses could reduce tobacco-related morbidity and mortality. A cross-sectional survey of 476 junior and senior students at 12 schools of nursing in the New York metropolitan area was conducted, to determine nurse knowledge of tobacco control, their attitudes, beliefs, and practices. Overall, 76% of all nursing students reported that they practiced tobacco control. Current smokers were less likely to participate in tobacco control with targets ranging from the nurse herself to the community than either never or ex-smokers. Nurses were more likely to engage in tobacco control among individual, family, or group clients than to advocate for changes in the community. Student nurses who were African American or Hispanic, had never smoked or were ex-smokers, those who had better knowledge of cessation approaches, and those who tended to have more confidence in their cessation counseling skills were more likely to engage in multi-target tobacco control than other similar nurses. Tailored interventions that emphasize discrete counseling skills are suggested.

Developing an audit tool for health promotion learning opportunities in clinical placements

Education audit has proved to be an effective way of reviewing current activities and learning opportunities available to health-care students during clinical placements. Despite the importance attributed to education audit in highlighting good practice, identifying where there is a need for change as well as providing information for future planning, there is no evidence in the literature to support its specific application to health-promotion learning opportunities. This paper describes a two-part study in which an education audit tool for use in evaluating health-promotion learning opportunities for students in clinical placements was successfully developed. This tool can be utilized by multiple stakeholders in a variety of clinical settings. Following a discussion of the background literature, the methodology (which involved the development of a series of dynamic relationships between researchers, commissioners and participants) is described. The aim of this article is to discuss the lessons learned from the process of developing the tool, including the problems that were encountered and how they were addressed. The authors conclude that their experiences in developing this tool can be usefully transferred to other educational and clinical settings.

Registered nurses' perceptions of teaching: constraints to the teaching moment

Nursing literature indicates that patient teaching is an integral role function of the nurse. While some authors suggest that patient teaching is an essential part of nursing care, others argue that nurses are not adequately prepared to assume the role of teacher. This study explores the context within which nurses engage in patient teaching, revealing tensions experienced on a day to day basis within the practice setting. The principles of teaching and learning are also explored, raising questions about the extent to which nurses utilize these principles to guide the teaching moment. It is asserted that nurses find it difficult to engage in activities which are pivotal to the provision of quality patient education. Whether this is because they have little awareness or understanding of the principles of education, or whether this is related to the milieu in which teaching takes place, is explored.

Lifestyle practices and the health promoting environment of hospital nurses

Lifestyle practices and the health promoting environment of hospital nurses This paper examined the lifestyle practices of hospital nurses and the impact of specific interventions in the hospital environment. The perception of nurse as health promoter and as carer of AIDS patients was also examined. A self-administered questionnaire was used to collect data at two different time periods. The sample represented 729 nurses (at pre- and post-time periods), both qualified and student nurses. Qualified nurses reported the highest stress levels while student nurses reported more negative lifestyle practices such as smoking, alcohol consumption and drug use. A greater number of current smokers (29%) consumed alcohol and used drugs than non-smokers. The impact of intervention strategies around compliance with smoking policy and work-site walk routes reduced exposure to passive smoking at work for qualified nurses and increased exercise participation for both groups of nurses. Workplace was identified as the main source of stress which included relationships at work and demands of the job. Hospital nurses experiencing high work stress were more likely to use professional support and personal coping (discuss problems with friends/family, have a good cry and eat more) than others. Nurses believed in the importance of health promotion as part of their work; however, qualified nurses felt more confident and gave more health related information than student nurses. Student nurses perceived a lower risk of contacting AIDS through work and a higher concern/worry in caring for AIDS patients than qualified nurses.

The role of Project 2000 educated nurses in health promotion within the hospital setting

This study is concerned with the role of Project 2000-educated nurses in health promotion within the hospital setting. Historically nurses have been viewed as having a role to play in promoting the health of the people for whom they care. More recently, with the advent of the Health For All Movement initiated by the World Health Organization in 1978, the attention has again been focused on what nurses can do towards attainment of this goal, although most of the research has been carried out in relation to community nurses and primary care. Changes in nurse education, specifically that of Project 2000 nurse education, have been hailed as the opportunity to equip nurses with knowledge and skills appropriate to the task, which have been seen as lacking from many nurse educational programmes. Early work on this issue has produced conflicting findings as to the success of these educational changes. This study used an exploratory, qualitative approach to investigate what aspects of health promotion in the hospital setting are being carried out by nurses who have undergone Project 2000 nurse education within a college of nursing and midwifery in Scotland, and whether these nurses feel that they have been adequately prepared for this role during their educational programme. Findings suggest that the nurses interviewed were working with very wide perceptions of health promotion which included the more radical aspects of health promotion such as negotiation, collaboration and empowerment. Health promotion was also seen to include psychosocial factors that influence the health of individuals. The nurses interviewed in general felt that their education had prepared them for a role in health promotion. The value of clinical placements in facilitating the developing the skills for health promotion was established.

Evaluation of health promotion activities in community nursing practice

The purpose of this research was to study the extent to which community nurses (CNs) were involved in health promotion activities and to investigate whether these activities were meeting the needs of their clients. A cross-sectional survey by multiple methods was designed and carried out in four district health authorities (DHAs) in one regional health authority in England. Two hundred and fifty-one (83.67%) completed questionnaires were returned by CNs working in primary health care (PHC). Sixty sessions with CNs were observed and 249 interviews were conducted with clients. Additionally, as part of the observation 155 clinical records were examined. CNs reported involvement in a wide range of opportunistic and organized health promotion activities. Lifestyle advice and ill-health prevention were most frequently used by all groups. Health visitors (HVs) were involved significantly more in group and community wide activities. District nurses (DNs) were mainly involved in opportunistic health promotion. Practice nurses (PNs) were found to be involved significantly more in health promotion activities organized on an individual basis. Observation revealed that opportunistic health promotion was carried out in almost half of the consultations observed, of which lifestyle advice was the most frequent. Records however showed that this information was rarely recorded. The clients of PNs were mostly aware of other health promotion activities available within the general practice, while almost half of the HVs' clients knew what other health promotion activities were available to them and few DNs' clients were aware of any.

The role of the nurse in high-quality patient care: a review of the literature

A review of the literature reveals a range of the nurse's subroles within the service of nursing. Competence in psychomotor, cognitive and affective skills is required for performance within each of these subroles to achieve the delivery of high-quality nursing care.