Health professionals, particularly those working in primary care, have an important part to play in promoting good health. Therefore it is the intention of this essay to explain the theoretical base that underpins the nurse’s health promotion practice. Reference will be made specifically to promoting good nutritional intake and healthy lives for children. The essay will identify how evidence-based research concerning the subject of health promotion can be used to inform the practice of the nurse. The essay will highlight the priority given to the promotion of healthy eating by use of examining current government guidelines and healthcare strategies.
This part of the essay will examine potential definitions of health. Health is not just about physical health but also about mental and social well-being. It may be most effective when meeting basic needs, accessing relevant information and relying on family or community support (Bury 2005). The World Health Organisation (WHO) defines health promotion as “the process of enabling people to increase control over, and to improve their health” (WHO 1998). The growth of interest and activity in health promotion over recent years must also attempt to develop some methods of prevention to ill-health (Downie et al. 2000). Factors surrounding the nutritional health of children has many elements; some of which include their genetic make-up, environmental influences and the stage of development of the child (Holden and MacDonald 2000). Erikson’s (1968) established the psychosocial theory of development which took into consideration the effect of external aspects, parents and society on personality development from childhood to adulthood (Erikson 1968). According to Erikson’s (1968) theory every person must pass through a series of eight inter-related stages of their life cycle. Stage number four is school-age child where children are learning and developing new skills and it is also a very social stage of development (Erikson 1968). Social issues will be discussed in more depth later in this essay.
According to the Scottish Government “nurses and midwives play a dynamic and vital role in improving health and delivering health services to the people of Scotland” (Scottish Government 2001). Therefore in terms of promoting the health of children through healthy nutrition, nurses are encouraged to educate children through visits to schools, attending youth groups, giving advice to new parents and offering advice at clinics and so on. The school nurse works in cooperation with the school to produce an environment that promotes healthy living as well as looking after the needs of individual children (School Nurse 2010). Health education is important for preparing the social, practical and emotional knowledge of children and providing them with social skills. It also helps to protect and promote the health of children through an environment and culture which is safe, healthy and beneficial to learning (Department of Health 2004). Holden and MacDonald (2000) identified that nutritional education is essential to enable children to make informed choices about food and understand the relationship between diet and health. Nurses are often available to give advice and guidance on good diet and nutrition and regularly give health talks at school assemblies. The next part of the essay will look at some of the legislation surrounding health promotion for children.
School meals in Scotland have undergone a transformation over the past few years due to the Hungry for Success Initiative which introduced nutritional guidelines for school lunches (Fife Council 2010). The Schools Health Promotion and Nutrition Scotland Act (2007) encourages the Hungry for Success programme and requires all local authorities to ensure that food and drink provided in schools comply with the nutritional requirements specified in the regulations. This act places health promotion at the centre of school activities. It encourages local authorities to provide school pupils with healthy drinks and snacks either free of charge or at a reduced cost. It also requires local authorities to promote school meals and to also reduce the stigma attached for pupils having free school meals. Another project that was initiated was the Hygiene, Healthy Eating and Activity in Primary Schools Initiative (HHEAPS) (Food Standards Agency 2009). This was devised for schools to raise children’s awareness of food hygiene, healthy eating and physical activity and the main concept was to link the three together, providing children with a basic understanding of how colds and flu viruses spread, how they can feel mentally and physically better about themselves, as well as enjoy fun activities with their peers. The importance of health promotion in schools is a key part of the role of the school nurse and often concentrates on exercise and healthy eating which can include fighting obesity and perhaps even eating disorders (School Nurse 2010).
The Scottish Government (in partnership with Learning Teaching Scotland and NHS Health Scotland), have produced a leaflet called Healthy at Schools: Healthy for Life which acts as a guide for parents to explain why schools are promoting health (Scottish Government 2009), so as to keep parents involved. Pupils are giving the opportunity to take part in a physical activity or sport and they learn about health in many different subjects. The social, mental, emotional and physical health of school pupils are the responsibility of all teaching and non-teaching staff in schools. Good nutrition has a positive influence on child development and any health promotion involvement that focus on children and young people can be the basis for a healthy lifestyle that may be continued into adulthood (Licence 2004). Therefore the priority of health promotion and nutrition education is directed mainly at changing diet and lifestyles, with the aim of reducing chronic diseases (Webb 2002). According to The Scottish Government (2008), 20% of primary one school children are classed as overweight, some even categorised as being obese. Childhood obesity can lead to childhood diabetes, early puberty in girls and can lead to some types of cancers and heart disease later in life (Kozier 2008). It is therefore vital to begin health promotion in children as early as possible, to allow them to make their own choices about their health as they become older.
Having examined some of the policies surrounding health promotion, it is now appropriate to examine the role of the nurse as a health promoter in greater depth. The nurse’s role in health promotion and health education involves taking into account all of the processes involved from assessing, planning, implementing and evaluating, as these are all essential elements of a health promotion programme (Whitehead 2002). According to Kemm and Close (1995), health promotion is an activity that intends to prevent disease or promote health. One of the key aspects of health promotion is attitude and to suggest ways to change attitude and its associated behaviour is of the main objectives in health promotion (Downie et al. 2000). It is vital to adopt the most important approach to health promotion and Ewles and Simnett (2005) suggest five approaches to health promotion: medical, behavioural change, educational, empowerment and social change. In terms of health promotion for children the educational approach and the behavioural change can be linked together as school education programmes can help pupils to learn the skills of healthy living thus aiming to change their attitudes and behaviour with the hope of them adopting a healthier lifestyle (Ewles and Simnett 2005).
To provide structure for health promotion, several health promotion models have been developed. One of the better known and most popular one is Tannahill’s model of health promotion (1995) which describes health promotion as three interlinked circles that include health education, health prevention and health protection. As the circles overlap they form the seven components of health, and number five on the list – positive health education – is aimed at changing behaviour and encouraging beneficial use of leisure time as in exercise and fitness (Downie et al. 2000). Changing behaviour could be done by either educating parents in positive health or by showing the consequences of poor health. Health education is described as an activity aimed at informing people about the prevention of disease, and according to Naidoo and Wills (2000) health prevention can be divided into three categories. Primary prevention is aimed at prevention of the start of the disease, secondary is aimed at preventing the development of the disease and tertiary is aimed to reduce any further suffering for those who are already ill (Naidoo and Wills 2000). The Ottawa Charter for Health Promotion (WHO 1986) outlines the key principles for health promotion which include strengthening individual’s personal skills and capacities, empowerment and because society is forever changing, be able to create a healthy working and living environment.
Dahlgren and Whitehead (1991) established the Determinants of Health model which explained how health is shaped by a variety of factors either positively or negatively. Economic, social and environmental conditions can determine the health of people and populations and also included in this model are the essential changes in the circumstances of daily life. Such factors can decide whether or not a person is in the right position, either physically, socially or personally to meet their requirements, succeed and be able to cope with changes in their situations (Local Government 2010).
In terms of social issues, it is vital to highlight that promoting good health amongst children is virtually impossible unless parents are also targeted. Since parents and carers make most decisions regarding what a child eats, perhaps whether they can go out to play and whether they can join organised sporting activities, it is important that parents also have appropriate information on how to keep their child healthy (NHS Scotland 2010). Healthy families are better equipped to deal with challenges such as illness as they have developed effective coping strategies. Midwives can begin the process by giving targeted information to expectant parents on initiatives such as breast feeding, childhood immunisations and different activities to nurture happy, healthy babies. Some of these activities may include toddler swimming lessons or attending baby rhyme time classes (Netmums East of Scotland 2010). Nurses could then reinforce this by providing further information and advice during clinics, nursery classes and through school-based drop-in advice services (Advice Guide 2010).
Nurses can use their role as a liaison between health and education by working in partnership with members of the teaching profession to promote good health to young children. This might be by providing training for school-based staff to support children with healthcare needs such as asthma or diabetes or working with physical education teachers to encourage all children to take part in sports and other activities (The Scottish Government 2003). It is important that nurses show children why good nutritional intake is so important, by focusing on how it will not only prevent future illnesses, but it will help them to feel better and be more alert and active. It is also important to include how environmental issues such as poor housing, poor income and low levels of education can all affect the health of children (The Scottish Government 2003). Children can only follow through by choosing the healthy options they have been taught if they understand the importance of why they should choose a healthy diet (Frey and Barrett 2006). Fast food chains can also target children, and although many of them offer healthy choices, it is vital that children and parents understand the consequences of always choosing the unhealthy options, such as fatty foods potentially leading to heart disease, or sugary drinks leading to tooth decay (Food Standards Agency 2005). It might be possible to use educational aids such as pictures and videos to highlight to slightly older children and their parents of what could happen if they continually choose unhealthy foods (Brown and Ogden 2004).
Nurse’s who work with children and young people also have an important role in identifying children who may be at risk of malnutrition. It is important for nurses to be able to recognise health problems that may be related to poor nutrition, for example, tiredness, slow growth, delayed puberty, pale skin and poor hair condition. The Royal College of Nursing (2006) suggests that basic screening of a child’s nutritional status contributes significantly to identifying children at risk (RCN 2003). The Scottish Intercollegiate Guidelines Network (SIGN) have specific guidelines developed on evidence based clinical practice for the National Health Service (NHS) and they suggest that children whose families live in a deprived area should be considered as an increased risk of developing tooth decay (SIGN 2005). Parents and carers should receive oral hygiene education from the local dental team and health professionals should ensure that oral health messages are relevant and applicable to lifestyles and communities (SIGN 2005).
Nurses need to take into account the ‘social world’ of their patients and to understand their social situations. Factors within the social and maternal environment can influence health and development (Bromley and Cunningham-Burley 2010). The nurses role is to recognise the relationship between social issues and health and to be aware of cultural differences with regards to nutrition (Food Standards Agency 2002). According to Save the Children Scotland (2009) 240,000 children in Scotland live in poverty; that is one in four young people in families that struggle to get by every day. Families on low incomes find it hard to provide the basic necessities like decent, healthy food so therefore poverty affects the way that people eat (Save the Children Scotland 2009). Circumstances and the environment determine whether families are healthy or not. Genetics, relationships, education levels and income all have a huge impact on health (Anon. 2010). The nurse’s role in health promotion also includes health psychology which is the understanding of psychological influences on how people stay healthy. Health care professionals deal with problems identified by behaviours, attitudes, diet, exercise and so on (Ogden 2003). Some socially excluded families may not have the communication skills to identify and utilise what is available in terms of health promotion and disadvantaged families may have difficulty in taking up healthy options. Parent’s perceptions of healthy eating and exercising need to change and parent’s need to be more aware of the outcomes of an unhealthy diet. Children follow in their parent’s footsteps and do what they are brought up to think is correct.
According to Nursing and Midwifery Council (2008), nurses are bound by and must adhere to the NMC Code of Conduct which states that it is the nurse’s duty to care for their patients and they must try and do what they think is best for them (NMC 2008). Nurses need to make people more aware of their role in promoting health and well-being of children and young people. Nurses need to work together with other health professionals including social care and local councils to change families attitudes and behaviours (Moyse 2009). Overall families are resilient and resourceful but they may need extra support and outside help to adapt successfully. Families cannot be forced to change but nurses can give them enough information and offer support to help them to change. Families need to believe that they can change and that changes will be good for them and that they will benefit from changing their lifestyles. Nurses need to influence the health of communities and problem areas. The Scottish Government published a paper which provided a framework to support a programme which could help to deliver a policy for health improvement (The Scottish Government 2003). The main objectives in this paper for health improvement are that by 2010 -2012 life expectancy for people living in all areas of Scotland should be improved and it is also expected that inequalities between the most deprived and most comfortable groups should be reduced (Scottish Government 2003).
In conclusion, this essay has examined some of the issues surrounding health promotion in children, focusing specifically on nutritional intake. It has firstly explained the knowledge base that underpins the nurses health promotion practice. The essay has looked at some of the legislation and government policies surrounding health promotion, and then also looked at the role of the nurse as a health promoter, and how a nurse must take into account social and educational issues when attempting to implement any health promotion initiative. The essay looked at a health promotion model and one component of this was discussed in more detail. Having examined current government guidelines and healthcare strategies, the essay then looked at guidelines that were developed on evidence based clinical research. Nurse’s should try to encourage people to take responsibility for their health and to make them more aware of the long term affects an unhealthy diet can have on younger children. Bad nutrition affects skin, hair, nails and teeth. The essay has also discussed factors within the social and maternal environment which can influence health and development. It has also looked at why nurses must work together effectively with other health professionals to change family attitudes and behaviours. This essay has also discussed why people struggle to change, the effect of social class and health inequalities. Throughout completion of this essay it has become apparent that health promotion of children and young people is a vital part of the role of the nurse and the nurse can influence health improvement through health promotion.
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