Health Promotion In this reflection essay I will discuss about health promotion activity which took place during my placement in St’Clare Centre ,Glassnevin, Ballymun. Health promotion allows one to empower and educate individuals to make lifestyle choices and changes to promote their health and help prevent disease (Naidoo and Wills 2000). This can be challenging when individual health beliefs differ. According to Whitehead (2004) the concept changes with demands, it is delivered by health workers but has become politically driven as the nation’s health changes.
As a consequence strategies for health promotion can be influenced by the financial demands . According to Irish cancer society(2000) , seven thousand deaths annually are attributed to smoking related diseases in Ireland, as a result healthcare professionals are tasked with motivating and assisting every smoker to quit were possible . I was working as a student nurse on a day care ward when this health promotion activity occurred. The patient, Charles(name changed to protect patient’s identity) was a 74 year old gentleman who resided with his 67 year old wife and sole carer Sharon.
They lived in a densely populated council estate, which was known to be one of the towns more deprived areas. Their only source of income was their government pension. Charles has bad cough and his diagnosis was a chronic obstructive pulmonary disease (COPD). Charles had suffered from COPD for 6 years, a combined chronic lung disease which damages the airway passages, reducing the lungs’ capacity to inhale and exhale air (Haas & Sperber 2000). According to Gibson (2003) the risk of developing COPD is significantly increased in active and passive smoking.
Charles ad a 30 year history of smoking and had been informed this was the probable cause of his COPD. He had previously refused smoking cessation advice, agreeing to give up in his own time, however since commencing long term oxygen therapy 10 months ago he confirmed that he had felt isolated and unable to give up. I studied Charles admission paperwork and his smoking history. I offered Charles the opportunity to speak with our smoking cessation team which is in line with service centre policy when identifying a patient smoker, however he was defensive and declined the offer again advising that he would quit in his own time.
I began to build a good rapport with Charles, he apologised for his defensive response when I had offered him the services of the smoking cessation team. Using this as my cue I commented that he had abstained from smoking for two days and praised him for doing so. He agreed that it was not easy to smoke in service centre as his illness made it impossible for him to go outside. He confided that at home he rarely went out and found that smoking helped relieve the stress he felt under, he added that since he already had COPD he didn’t see the point in stopping now.
I asked if he felt comfortable talking bout the subject, he nodded his head so I continued to enquire about his previous attempts to stop, as he explained that his wife had continued to smoke. I asked if it would have been more successful if his wife had also stopped, but he had not wanted to ask this from her as this was ‘his disease’. He had also found the excessive sputum production difficult to manage when he had tried to stop. I explained that it his COPD. I explained that sputum production and cough are affected on cessation but this would eventually pass.
Later that day I gave Charles some literature on smoking cessation to read in his own time. The literature detailed support services available, a diary to plan his Journey, tips on managing triggers to smoking, coping with withdrawal symptoms and an explanation regarding systemic effects on the body during cessation. Both health and financial benefits were detailed depending on how much the individual smoked. Charles smiled and winked which reassured me that I had not upset him with my actions.
The following day Charles expressed he would like to attempt smoking cessation again, I informed the nurse in charge, she knew of his smoking on his last admission and had offered the service which was declined. During the start I had felt uncomfortable when Charles adamantly declined advice. I gave consideration to his situation, he was removed from his usual surroundings, feeling unwell and being asked personal questions by a complete stranger, I concluded it would not be unusual for a resident to be negative in this situation.
I was surprised that Charles had not given up when he was first diagnosed, but as an ex smoker I understood the difficulties one can encounter. Charles initially felt guilty about his inability to stop smoking, but was more able to communicate after a couple of days once a good relation had been established. Charles had low expectations and was originally resistant to change however Rollnick et al. (2001) suggest that this could be linked to past failed attempts. Once he had considered the benefits to his health, Charles felt reassured the support and advice given would help him and his wife.
The episode of health promotion was positive, action was taken despite reservations in resident acceptance the service was offered. Carlebach (2009) suggest that a previous decline of cessation advice should not be a barrier to offering services again. Charles had refused help in the past despite his disease, the National Institute of Clinical Excellence (NICE) (2010) advise patients with COPD who continue to smoke should be encouraged to stop, furthermore smoking cessation decelerates the disease progression (WHO 2006).
The use of good communication and rapport building skills built trust between resident and me in facilitating further smoking cessation discussion. Owens (2001) stated that nurses who invested in building a nurse patient relationship often picked up cues which could be crucial for their health and holistic care. The non Judgemental approach and use of literature ave Charles the option to educate himself in smoking cessation, Rollnick et al. 2001) stated that patients prefer autonomy when making decisions, although there was a risk he would not read the information as I was asking him to examine a subject he had initially not wanted to discuss. However, empowering Charles to make his own choices had a desirable outcome in this case. Charles may have felt responsible for his disease. According to Sines et al. (2009) health promotion advice given when a patient is already suffering adds resistance to change, this may explain his defensive manner.
By holistic assessment it was clear that social isolation had increased Charles desire to smoke, suggesting ways of resuming social activities demonstrated to Charles how his quality of life could be improved. A combination of health promotion approaches were being used in the centre. An educational approach gave the resident the information to discover health benefits for himself . Not all health asked to change long term habits, from which they are already suffering the effects of. For this reason health education should start at an early age to encourage health enhancing behaviours.
By process of reflection on this episode of health promotion I have learnt that reflection can take place during an event which can influence the outcome. Before this event I many times think that there is no need of health promotion activities. On reflection I can see how my involvement positively changed the outcome for the residents, leading me to appreciate the value a nurse’s role can add, this is a skill I will work on and incorporate into practice with future patients. References Irish Cancer Society 2000. [online]. Available from:http://www. irishcancersociety. ie [Accessed 24 Febuary 2012] Carlebach S.
Hamilton J. (2009) Understanding the nurse’s role in smoking cessation. British Journal of Nursing 18 (1 1), pp. 672-676. Department of Health (DH) (2004) Choosing Health; Making healthy choices easier[online] Department of Health, London. Available from: http://webarchive. nationalarchives. gov. uk/+/www. dh. gov. uk/ en/Publichealth/Choosinghealth/index. htm [Accessed 27th February 2012] Gibbs G. 1988. Learning by doing: a guide to teaching and learning methods. Oxford Further Education Unit, Oxford. Haas F. & S. Sperber Haas (2000) The Chronic Bronchitis and Emphysema Handbook. John Wiley & Sons Inc.
New York. Naidoo J. & Wills J. (2000) Health Promotion Foundations for Practice. Balli?©re Tindall, London. Owens J. (2001). A critical incident study of Nurses’ responses to the spiritual needs of their Patients. The Journal of Advanced Nursing 33 (4), pp. 446-455. National Emphysema Foundation (2006). COPD – What is it? [online] Available from: http://emphysema foundation. org/copdcbro. Jsp#COPDWhatNational [Accessed February 28th ,2012]. National Institute for Health and Clinical Excellence (NICE) (2010) Management of Adults with chronic obstructive pulmonary disease in primary and secondary care. nline] Available from: http://www. nice. org. uk/nicemedia/live/ 10938/29302/29302. pdf [Accessed 24th febuary 2012].. Rollntck S. , Mason P. & Butler C. (2001) Health Behaviour Change. Churchill Livingstone, London. Sines D. , Saunders M. & Forbes-Burford J. (2009) Community Health Care Nursing. Blackwell Publishing Ltd, Oxford. Whitehead D. (2004) Health promotion and health education: advancing the concepts. Journal of Advanced Nursing 47, pp. 311-320. WHO (2006) COPD: Causes. [online] Available from: http://www. who. int/repiratory/copd/causes/en/ index. html [Accessed 21 th Febuary 2012]. Perceptor Signature:
