Health Promotion

Funding for disease prevention and health promotion nationally is highly dependent on government funding through Medicare (Australian Government, 2014). This is largely out of our control. We, as nurses, can still do our part to promote public health in every ward, department or other setting we work in. Chronic diseases are associated with economic, social and health burdens. They cause premature deaths due to diseases which have risk factors that are highly preventable. They are affected by social determinants of health (Australian Institute of Health and Welfare (AIWH), 2014), factors that Medicare need to take in to consideration when allocating funding in the annual budget (Fry, 2010). Chronic diseases are mostly managed through a community-based

program that requires the nurse to use evidence-based practice to fill in the role of nurse, psychologist, therapist, physician, social worker, educator and healer amongst many others (Edelman, Mandle, & Kudzma, 2013). Gordon’s 11 functional health patterns can be used as a guideline to help nurses identify areas in a person’s life that could benefit from health education or a screening program (Gordon, 2014).

The National Competency Standards for the Registered Nurse describes patient education as a primary nursing responsibility (Australian Nursing and Midwifery Accreditation Council (ANMAC), 2006). Health education encourages less dependence on the health care system by promoting a change in an individual’s health behaviours ultimately leading to self-care and self-empowerment (Newsom et al., 2012). Investment in prevention should not only be directed at consumers but also at healthcare staff. Constraints on nursing staff are drive up economic costs, affecting care and service delivery and compromising patient safety. Misplaced efforts to cut costs and achieve financial savings is seeing adverse events cost up to $4 billion annually, the occurrences of which can be reduced significantly by addressing and increasing awareness of known causes through education and increased staffing (Armstrong,

2009).
A study conducted in 2013 examined 13 years of research that looked at a nurse’s role in health promotion. Twenty five papers during this time suggested that nurses worked from two theoretical bases - a patient-orientated and holistic basis or a medical-orientated and chronic disease basis (Kemppainen, Tossavainen, & Turunen, 2013). Studies conducted in the past 5 years have suggested that a holistic style to health promotion is exhibited when nurses are guided by an individualistic approach rather than overall patient data. This allowed nurses to concentrate on activities best suited to the individuals and their families (Kemppainen et al., 2013; Povlsen & Borup, 2011). It was found that patients responded to health promotion when they felt empowered to make a difference in their lives. This is developed through nurse-patient communication and community participation (Whitehead, 2011). Nurses were also found to be well informed about community-orientated health promotion. They work closely with the associated professionals or groups to form a multi-disciplinary team to address their patient’s needs (Witt & Almeida, 2008). The medical-orientated model suggests that nurses need to have an authoritative approach to change a patient’s behaviour in order to relieve them of the physical symptoms of a disease. This forms part of a public health-orientated prevention program for chronic diseases rather than an individualistic approach to health promotion (Chambers & Thompson, 2009; Fagerström, 2009; Richard et al., 2010).
Delivery of safe and effective quality of care is an element of good clinical governance in a healthcare organisation (The Royal Australian College of General Practitioners, 2010).

The Australian Commission on Safety and Quality in Health Care argue that effective clinical governance includes transparency about responsibility and maintenance of high standards of care with a constant emphasis on quality improvement (Australian Commission on Safety and Quality in Health Care, 2015). A study in 2010 found seven key areas to support clinical governance which included education for both staff and patients (Phillips et al., 2010). Nurses are required to undergo continuous professional development to improve their clinical skills (Phillips, Piza, & Ingham, 2012). Today’s healthcare is multifaceted, specialised and technologically advanced. Education and training provided to staff need to reflect these norms so that they can provide specialised evidence-based care and educate consumers (Australian Commission for Safety and Quality in Health Care, 2005, 2012). This forms part of Standard 1: Governance for Safety and Quality in Health Service Organisations (Australian Commission for Safety and Quality in Health Care, 2012). The same should be done for the public in terms of being educated about their health, the systems and practices in place that can help them lead a healthier life as well as support from those higher up in the hierarchy - the Federal Government, that want to see the

people they are representing live a well and long life. A decrease in funding by Medicare is seeing nurses work long hours with high rates of exhaustion that are trying their best to provide safe patient care- a job they were trained to do. However, inadequate staffing due to funding cuts has a direct negative impact on the consumer, their safety, and quality of healthcare being provided (Armstrong, 2009). A study in 2003 calculated that 7.4 hours per working day (1773 hours annually) by a single healthcare professional is needed to provide satisfactory preventative services to a varied population seen in a healthcare facility daily (Yarnall, Pollak, Østbye, Krause, & Michener, 2003). Regardless of the systems in place such as risk management, legalities, guidelines and standard operating procedures, medical errors are bound to occur (Armstrong, 2009; Kemppainen et al., 2013). Funding for preventative health should also see increased staffing for nurses and educators whose main focus is to promote health to inpatients and outpatients in a community setting resulting in lower presentations to hospitals. This will improve the standard of care and help nurses with their workload thereby reducing medical errors and preventable adverse events. Health promotion is a process that is presently being conducted to the best of its abilities but can only be improved by funding, a resource that is currently scarce (Armstrong, 2009).
Nurses involved in health promotion require four competencies as suggested in a 2013 study (Kemppainen et al., 2013). 1) They need to have multidisciplinary knowledge relating to the health condition, 2) skill-related competence mainly in the form of communication and dealing with changes in patient’s behaviours, 3) respect and the right attitude towards their patients, acting as an advocate for their patients and having a proactive attitude, and 4) personal characteristics that allow them to be confident and flexible with the many patients that they help (Kemppainen et al., 2013; Wilhelmsson & Lindberg, 2009; Witt & Almeida, 2008). The development of a nurse’s skill to fit the mentioned criteria needs funding to aid education programs to make sure that the population is receiving safe and quality care (Kemppainen et al., 2013).
Although nursing is a fitting profession to deliver health promotion, it has its disadvantages. This includes organisational culture that limits the individualistic approach in an inpatient setting due to workload and time constraints along with educating patients at a vulnerable time, the particular population that their health promotion reaches which sees education occurring post-disease onset, and the lack of funding by Medicare to expand research and implementation of preventative strategies that are aimed at the general population and nursing staff to reduce the load on the public health system (Judd, Frankish, & Moulton, 2001; Kemppainen et al., 2013; Tengland, 2012). This results in preventable admissions, increased length of stay, increased demand for hospital beds and an unhealthy population (Armstrong, 2009). Patient safety and quality incidents are recognised, reported and analysed, and this information is used to increase safety daily in Australian hospitals (Australian Commission on Safety and Quality in Health Care 2015). The evidence should also be used ‘upstream’ to increase funding for preventable health to increase patient health, safety, and quality of care being provided nationally (Armstrong, 2009).
Better quality of life and increased life expectancy have resulted from well-planned prevention programs that reduce the risk of disease, injury and disability (Davis & Chapa, 2015). This in turn allows for better usage of public health funds to produce a healthier workforce which will boost economic productivity and ensure the delivery of safe and improved quality of care (Armstrong, 2009). Australia’s aging population and the prevalence of chronic diseases provides bountiful opportunity for preventative research, policy and action in the future (Australian Institute of Health and Welfare (AIWH), 2014) which need funding from Medicare to make a difference in the population. Where health organizations are required to provide a level of clinical governance, accounting for the quality of care for consumers, the Australian Government itself is below par in providing the best possible care for the people they govern which is unlike their belief that all Australians enjoy the highest possible standards of health (Liberal Party of Australia, 2015).