Tag Archives: health_promotion

Time to think about my own HP….. again!

Restarted back at the gym this morning – having been a serial gym joiner at least returning to the same one is a step in the right direction I feel! It’s amazing: -I know the evidence; understand the links between exercise and health; teach patients  and nurses about the wonders of exercise (notably with regard to fatigue management); have set up exercise rehab clinics for patients on treatment and post bone marrow transplant; even feel great and energetic when in a ‘must go the gym everyday’ phase of life ….. yet why is it so hard? and, why can’t i remember how great I feel when in the phase! Somehow sloth and icecream takes over. I blame the Magnum Gold for much of my downfall, although some of the sloth may be self induced! But … this is it …. this phase is THE ONE. I plan to lose a few kilos, run 15 km, take a spin class (without making a complete fool of myself or requiring an ambulance) and be able to lift 30kg (this is so that I can change a wheel on the fourbie! It’s all very well having terrific butch all terrain tyres but one has to able to deal with the flat versions of them). We’ll see …. ahhhh, already slipping!

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Is health promotion always healthy?

I have been thinking more about the notion and practice of ‘health promotion'(HP). When thinking about health promotion do we need to be mindful that the ‘good’ in HP sits within a spectrum (all  be it a wide spectrum) and there are limits beyond which HP becomes a risk to health? I was discussing HP with students yesterday and one of  talked about a recent clinical event which caused me to ponder this idea of limits. Within the last month two teenagers had presented to the student’s (Mental Health) unit – both suicidal and both citing the extreme demands of maintaining a healthy lifestyle and body. I know that this is a much more complex issue than the inference I am alluding to but i think that it relevant. How difficult (and sometimes for some people read stressful) is it to find time to fit in a visit to the gym 5 days a week for 30-60 minutes or to fit in walking 10,000 steps, or even to try and measure 10,000 steps? What impact does it have if you can’t afford or source five vegetables a day and two fruit? Is it a paradox to undertake major and potentially high risk surgery as a  health promotion activity? Recently a study revealed that loneliness is one of the greatest risks to health – are the social implications of the non acceptability of smoking  implicated? I wonder if  Talcott Parson’s rights and responsibilities of the sick role underpin some of our societal beliefs about HP and by this I mean; to have the right to be a member of society do people have a responsibility to seek and pursue HP activities? In other words, are smokers, drinkers and couch potatoes deviants?
I am being devil’s advocate here and, of course am cognisant of the the evidence and various strengths of evidence linking environment, lifestyle and disease and death but I think that we must remain open to question and critique blanket assumptions that can glaze over the complex detail.

Reconsidering the "art of nursing" through the lens of health promotion

Florrie (& you know who I mean), in 1893, proposed that there are two kinds of nursing. One  is “the art of nursing the sick. We shall call that art nursing proper” and the other kind, health nursing, was not so much a priority in her tented world at that time. I came across this idea as i was critiquing our notions of health promotion and it’s  basis in the 17th century liberal ideologies of individual responsibility, itself based upon the assumptions that individualism, rationalism and egoism are  good. The health promotion movement, built on  public health and health education work, really began in the USA in the 1940s and Maslow’s theory of ‘self actualisation’ (1943) really entrenched the notions of the individual responsibility as a member of society  and the demand to overcome lower level needs and achieve, achieve, achieve. Talcott Parson’s classic sick role theory in 1951 emphasised this individual responsibility by outline the rights and responsibilities of the sick person. Since then health promotion models have been built on these basic assumptions within a bio-medical paradigm. Health promotion tends to make claims; one that HP (as an entity) knows what constitutes health behaviour ;and two, HP knows the best way to go about it. This sits, as a separate practice to sick nursing. Health promotion is becoming/is a separate discipline.
However, if we reconsider the notion of health nursing as part and parcel of clinical practice – an approach rather than a discrete task, it may shift the idea that HP is something else and separate to being about the way that we practice not what we do. I think of  HP as being a component of every therapeutic interaction as it is related to how we practice not what we practice. I think that we do/can/maybe could do more practice through the lens of HP.
I guess what I am also saying is that the models of HP and the world, national and local programmes (macro, meso and micro levels of interventions) are only one part of the picture. Health nursing as a holsitic, relational, collaborative and situational approach to nursing where priorities, interventions and understandings are worked through together with the participant everyday rather than a more top down approach dominated by health care professionals, focused on disease and something seperate.