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1. Strengths related to mentoring colleagues
Nursing as a profession is stressful and newly qualified nurses and nursing students require a strong support, advice and career guidance in order to cope up and be integrated successfully into the profession. For these reasons, a professional practicing nursing needs to have good mentoring qualities that will help the colleagues develop their profession. Some of the strengths needed to do this that are evident in my portfolio include:
Good interpersonal skills
Absolute confidentiality
Relevant professional skills
Mutual respect as professionals between the mentor and the mentee
Open mindedness and non-judgemental approach
Honesty and straightforwardness
Trustworthy
Desire to help other colleagues to develop their nursing profession
2. Evidence in my professional portfolio that contribute to the role of mentoring my health and wellbeing
Mentoring personal health and well-being plays a key role in demonstration of evidence that one is capable to mentor other colleagues. The evidence found in my professional portfolio include:
Ability to do health assessment and needs
Improved self esteem
Self-management
Good understanding of food and diets, including preparation of proper meals required by the body
Good understanding of the human body and its needs
Recognition of the need for prioritization of healthcare needs as a professional as well as opportunities for health promotion
Observation skills for a healthy lifestyle such as rest, diet, sleep, exercise etc.
Recognition of the importance of health and social care networks
Ability to do risk assessment, physical observations and nutritional needs assessment, and give advice or do the required referral by following the correct referral protocols.
Individual led change and action planning
3. Areas that need to be developed with regard to mentoring colleagues’ knowledge and practice and my health and well being
The following areas need to be well developed in order to ensure that the men tees gain in-depth knowledge in obstetrical and Women’s health, as well as to improve my health and well-being.
Food and diets and proper meal preparations
Pregnant mothers need a healthy, nutritious and well-balanced diet with enough minerals and vitamins. In fact, everyone else needs this, not only pregnant women. This calls for the need of good understanding of good diet because the body is a reflection of whatever diet one takes. This change will be implemented through consultation with an expert in foods, nutrition and diets, and in addition, through research.
Opportunities for health promotion
Advances achieved in areas such as medical research provide unprecedented opportunities in improvement of health. New approaches to diagnosis, healthcare and treatment have yielded a significant impact. Reduction of risk factors such as improper nutrition, lack of exercise, misuse of alcohol, smoking and other maladaptive behaviours can also produce substantial health benefits. This change will be implemented through education and motivation and prevention efforts that will be effectively applied at the point of patient risk assessment, health assessment and diagnosis, and treatment process.
References
Masters, K., 2009. Role Development in Professional Nursing Practice. 1st ed. London: Jones & Bartlett Publishers.
Susan M. Baxley, P., RN, K., Ibitayo, S. & Bond, M. L., 2013. Mentoring Today's Nurses: A Global Perspective for Success. 1st ed. London: Sigma Theta Tau.
Introduction
The discipline of health promotion has evolved over many decades, taking a number of forms on its journey. Contemporary health promotion approaches health from a socio-environmental or ecological perspective and encompasses a broad range of professionals from health and other sectors. All nurses have a key role to play in health promotion but these roles are varied depending upon the work environment and specific position of the nurse. Within this assignment health promotion will be defined and the evolution of its contemporary form explored and the scope of the paediatric nurse within the health promotion landscape will be examined.
What is health promotion and where do its contemporary origins lie?
Health promotion represents a multi-faceted process of empowering individuals, communities and societies to increase control over the determinants of health (e.g. social, environmental and economic conditions), thereby improving their physical, mental, social and spiritual health. One of its distinctive contemporary characteristics is the goal of reducing health inequalities through participation and social change while considering people within their specific social and cultural contexts (Eriksson & Lindstrom, 2007; Kickbush, 2007; Ridde, Guichard & Houeto, 2007; World Health Organisation [WHO], 1986; WHO, 1998).
Catford (2007) asserts that the origins of contemporary health promotion as a discipline are complex and that no single driver is responsible. The promotion of health and prevention of disease have however, been a feature of public health since the 1850’s (Royal College of Nursing [RCN], 2012) and Ritchie (1991) advocates that health promotion sees its roots in the health education strategies that arose via public health in the early 20th century. A shift in thinking became apparent around the time of the ‘Declaration of Alma-Ata’ in 1978 when primary health care was formally adopted as the principle mechanism for global health care delivery. Following this, in 1981 the World Health Organisation presented a global initiative ‘Health for all by the Year 2000’ which contained a series of measurable targets and goals (WHO 1981). This initiative then became the driver for global health development during the proceeding two decades and was seen to provide an environment conducive to the cultivation of the contemporary health promotion concept. The ‘First International Conference on Health Promotion’ in Ottawa, Canada then followed in 1986 (Catford, 2007).
The Ottawa Charter (WHO, 1986), now considered by many to be the fundamental document in the field of health promotion, was discussed and constituted at this first conference. Here the focus of health promotion shifted from disease to health and was expanded from individuals and groups to communities and societies (Eriksson & Lindstrom, 2008; Ridde et al., 2007). The Charters’ primary goal was to legitimize the vision of health promotion by clarifying the key concepts, highlighting conditions and resources required for health and identifying the key actions and basic strategies required to pursue ‘health for all’ (Catford, 2007). (An expanded explanation of these resources, strategies and actions can be found in Appendices A & B). However, despite its centrality to the discipline of health promotion the Ottawa Charter appears to have attracted as much criticism as support.
In addition to the shift in focus of health promotion, the declaration is seen to have paved the way for a shift in power from the providers of healthcare services, to the consumers and wider community (Catford, 2007). Raeburn (2007) however, contends that the Ottawa Charter overemphasizes the top-down political aspects of health promotion at the expense of its more human and empowering features and displays remoteness from everyday life, particularly in developing countries.
Hills and McQueen (2007) view the Ottawa Charter as a call to embrace a broad vision of health promotion, with the goal of placing it at the centre of any work relating to the five action areas, rather than it being a prescriptive framework or planning tool. It is argued that the lack of a clear theoretical framework to support the principles contained in the Ottawa Charter and a paucity of clarity regarding exactly what action needs to be taken to achieve its goals, created problems for the health promotion movement (Eriksson & Lindstrom, 2007; Ridde et al., 2007). Kickbush (2007) asserts that the full potential and importance of the Ottawa Charter is yet to be recognized and that the Charter’s sub-title ‘the move towards a new public health’ (authors’ emphasis) is often overlooked.
Wise and Nutbeam (2007) and Catford (2007) expand that subsequent conferences on health promotion convened by the WHO and in partnership with national governments, have built upon the foundations of the Ottawa Charter by focusing on each of the five specific strategies contained within it; examined the application of the charter principle in developing countries and responded to the current challenges to health arising from globalisation. Raeburn (2007) acknowledges that despite its limitations, the Ottawa Charter has ensured that health promotion has become established on the world’s political agenda and highlights that despite its many criticisms the Ottawa Charter is popularly used as the key health promotion guidance document today.
The scope of the paediatric nurse in health promotion
Successful health promotion requires co-ordinated action by all parties: governments; health, social and economic sectors; non-governmental and voluntary organisations; local authorities; industry; the media; individuals, families and communities. The World Health Organization (1986) advocates that health personnel hold a major responsibility in mediating between the differing interests of society in the pursuit of health.
Nurses are the largest group of health professionals, have a high degree of credibility and visibility and all have a key role to play in health promotion. Nurses are in an ideal position to influence the people they interact with, empowering them to achieve positive health outcomes (Royal College of Nursing Australia [RCNA], 2000; RCN, 2012; Sourtzi, Nolan & Andrews, 1996). Nurses are also in the unique position of being able to contribute to a lifespan approach to health promotion through a continuum of activities, at a range of levels, from individuals to communities, and in a wide variety of settings (RCN 2012). The UK’s Department of Health [DoH] (2006) stress that placing practice within a population context enables children’s nurses to address health inequalities by seeking out and prioritizing those children and young people likely to experience the greatest health threats and poorest access to services.
Child health is considered to be a major determinant of health in adulthood. Further, health behaviours and lifestyle choices are formed in early childhood and are acknowledged as making a significant contribution not only to the health status of individuals, but to communities and societies also. Health promotion, must therefore, begin as early as possible in order to realise its maximum potential. Recent UK government policies have acknowledged the importance of investing in the health of children and young people, with health improvement and tackling inequalities high priorities within these policies. Paediatric nurses are therefore well-placed to deliver health promotion interventions across a range of areas including for example, obesity, mental health, sexual health, accidents and substance misuse. Within the scope of paediatric nursing, health visitors, school health nurses, registered children’s nurses, health promotion specialists, clinical nurse specialists and specialists in child and adolescent mental health, all have a vital role to play. Working with others offers the best opportunity for the mobilisation of all community resources to address needs and improve health (DoH, 2006; RCN, 2012).
As previously mentioned, health promotion is a multi-faceted process of empowerment. Kalnins, McQueen, Backett, Curtice and Currie (1992) explain that three principles may be seen as central to the notion of empowerment: the first is that health promotion must address problems that people themselves define as important in the context of their everyday lives; the second, that health promotion involves effective participation of the public, alongside experts, in problem solving and decision making and third is that health promotion must be in accord with healthy public policy to achieve the best outcomes.
Kalnins et al. (1992) assert that children’s health promotion has traditionally centred around problems identified as important from an adult perspective and has focused on children being protected from conditions that lead to unnecessary mortality and morbidity in childhood or later life. We, as adult health professionals know what health behaviours in childhood are a major player in adult morbidity and mortality and it would be irresponsible not to guide children and young people into what is considered good for their health based on a strong foundation of evidence. However, within an empowerment model of health promotion, Kalnins et al. (1992) stress that it is equally as important to acknowledge children’s own views and concerns about their health and accept these as valid also.
Taking teenage pregnancy as an example of a socio-ecological determinant of health and using the three core values of advocacy, enablement and mediation and five action areas: build healthy public policy; create supportive environments; strengthen community action; develop personal skills and reorientate health services of the Ottawa Charter as a guide, the scope of the paediatric nurse within an empowerment model of health promotion will now be explored.
The UK has the highest rate of teenage conceptions within Western Europe (DoH, 2006). The Health Development Agency [HDA], (2003) recognise that although parenthood can be a positive and life-enhancing experience for some young people, it may also bring a number of negative consequences for other young parents and their children. Teenage parents are more likely than their peers to be unemployed and be trapped in a perpetual cycle of poverty through a lack of educational achievement, childcare, encouragement and support. Early motherhood can also be associated with poor physical and mental health, social isolation, lone parenting, family conflict and their related factors (HDA, 2003).
The negative outcomes for babies and children of teenage mothers can also be significant determinants of health: Babies tend to have a lower than average birth weight; infant mortality is 60% higher in this group than for babies of older women; only 44% of mothers under 20 breastfeed compared to 64% of 20—24 year olds and up to 80% of older mothers; children of teenage mothers are generally at increased risk of poverty, poor housing and having bad nutrition and finally, daughters of teenage mothers may be more likely to become teenage parents themselves (HDA, 2003; Khashan, Baker & Kenny, 2010).
The scope of health promotion activities for the paediatric nurse within the realm of teenage pregnancy may encompass the following:
Build healthy public policy
Paediatric nurses may be involved in lobbying for policy change, e.g. to the paediatric nurses’ role within the provision of Sex and Relationships (SRE)
In secondary education PSHE helps young people to embrace change, feel positive about who they are and enjoy healthy, safe, responsible and fulfilled lives. Through active learning opportunities students recognize and manage risk, take increasing responsibility for themselves, their choices and behaviors and make positive contributions to their families, schools and communities in schools; they may be involved in strengthening data collection and research activities in order to raise awareness of local issues or be leading monitoring and evaluation programs.
Create supportive environments
Paediatric nurses can ensure that information and education is in place before young people become sexually active, explaining the possible consequences of early parenthood and promoting prevention of accidental pregnancies; encourage a local culture in which the discussion of sex, sexuality and contraception is permitted; provide and promote confidential drop-ins at school and community venues ensuring they are linked to wider primary health care, family planning and genito-urinary medicine services; fully engage in the use of new technologies such as texting or social media to improve access to services, and provide screening activities to help detect relevant issues as early as possible for appropriate referral and treatment if needed.
Support may be offered to young women to access services to make timely choices about emergency contraception, pregnancy or abortion; nurses can ensure that children and young people are clearly informed of their rights e.g. how to access confidential advice and services within the boundaries of safeguarding and support young mothers by working with education officers and health visitors to re-integrate teenage parents back into education.
Parenting classes for teenage parents may be set up and facilitated which encompass encouraging young men in their role as fathers and paediatric nurses may work collaboratively with or within family outreach programs for example the ‘Family Nurse Partnership Programme’ (FNP)[ Within the FNP program specially trained nurses (usually registered children’s nurses or midwives) provide an evidence-based early intervention program that sits at the intensive end of the prevention pathway for vulnerable first time mothers. It offers intensive and structured home visiting from early pregnancy until age two. FNP has three aims: to improve pregnancy outcomes; improve child health and development; improve parents’ economic self-sufficiency
Strengthen community action
Paediatric nurses can confront discrimination and challenge prejudice such as homophobia; provide and promote sessions for parents that will support and prepare them in their central role as educators; engage young people and their parents/carers in helping to identify their own problems and solutions and to help shape schools’ sex and relationships and personal, social, health and economic education policies. Nurses may also advocate and facilitate participatory methods to enable children and young people to have roles as evaluators in these services.
Another area in which paediatric nurses can be involved in strengthening community action is to become involved with advocacy groups such as the National Children’s Bureau[ The National Children’s Bureau is a charity that aims to improve the lives of children and young people. Working with and for children they influence government policy, act as a strong voice for young people and provide creative solutions on a range of social issues (Retrieved from http://www.ncb.org.uk/#).]. For example a campaign could be spearheaded that emphasises the joint responsibility of schools, parents, carers and communities in providing PSHE/SRE to children and young people and highlights what can be done to become involved. Further, nurses may encourage and facilitate the development of community support groups for young people; become involved in highly visible public health campaigns and encourage young people via either school or community groups to do so also. Their voice can then be given to campaign direction. The paediatric nurse must also ensure that interventions are sensitive to different cultures and needs at all times.
Develop personal Skills
Paediatric nurses, working in partnership with teachers and involving the wider health and social community (e.g. clinical nurse specialists; MP’s; members of an anti-bullying advocacy group) are in a unique position to take a participatory role in PSHE/SRE and to be able to deliver an accurate, factual and comprehensive range of information regarding sex, relationships, the law and sexual health to young people to facilitate them to make informed choices.
Additionally, they may also work in partnership with teachers, youth workers or health promotion specialists to help young people acquire a range of skills such as negotiation, decision making, assertiveness and listening. The opportunity to practice these skills and those of resisting pressure can be provided through role play, hot seating[ Hot seating is where people take on the role of characters from a story and other people ask them questions. The characters have to answer the questions in as much detail as possible
Reorient health services:
To become involved in reorienting health services, paediatric nurses might work in partnership with young people, their families, other professionals, agencies and teenage pregnancy co-ordinators to assess needs locally and plan integrated services; they can play a central role in ensuring that PSHE and SRE programmes and services meet the need of all young people, for example, they should encompass the needs of ethnic minority, disabled, bisexual, transgender, gay and lesbian young people.
Paediatric nurses can be influential in tackling the wider determinants of health through working in partnership with other members of health and social care organisations and be involved in integrated and multi-agency working to encompass children who are not in education, employment or training or who are in young offender institutions, in relevant health promotion initiatives. Nurses would also likely want to consider forging links with churches and other faith-based organisations in order to strengthen health promotion programmes.
(“Best beginnings mobile apps,” 2013; Bower, 2013; DoH, 2006; DoH, 2011; DoH, 2012; Halliday & Wilkinson, 2009; Kalnins et al., 1992; Khashan, Baker & Kenny, 2010; National Institute for Health and Clinical Excellence [NICE], 2009; O’Connor, 2012; Peterson, Atwood & Yates, 2002; RCNA, 2000; RCN, 2012; Reeves, Gale, Webb, Delaney & Cocklin, 2009)
Summary
As can be seen from the above example a broad range of primary, secondary and tertiary health promotion activities all fit within the Ottawa Charter framework. Although teenage pregnancy has been used as a specific example here, it is clear that the health promotion activities exemplified can be widely extrapolated within the paediatric nurses’ role. What is also highlighted is that, in contention with Raeburn’s (2007) view that the Ottawa Charter promotes a top down model of health promotion, the scope of the paediatric nurse within the field of health promotion heavily supports an ‘upstream’ approach, focusing first on young people and their communities.
Appendix A
Basic pre-requisites for health and the three core values of the Ottawa Charter explained
The basic pre-requisites for health:
An improvement in health requires a secure foundation in the following fundamental conditions and resources: peace; shelter; education; food; income; a stable ecosystem; sustainable resources; social justice and equity).
The three core values: advocacy, enablement and mediation
Advocacy: Good health is a major resource for social, economic and personal development and an important dimension of quality of life. Political, economic, social, cultural, environmental, behavioural and biological factors can all favour health or be harmful to it. Health promotion action aims to make these conditions favourable through advocacy for health.
Enablement: Health promotion focuses on achieving equity in health. Health promotion action aims at reducing differences in current health status and ensuring equal opportunities and resources to enable all people to achieve their fullest health potential. People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health. This must apply equally to all women and men.
Mediation: The prerequisites and prospects for health cannot be ensured by the health sector alone. Health promotion demands co-ordinated action by all concerned: governments, health and other social and economic sectors, non-governmental and voluntary organisations, local authorities, industry and the media. People in all walks of life are involved as individuals, families and communities. Professional, social groups and health personnel have a major responsibility to mediate between differing interests in society for the pursuit of health.
WHO, (1986)
Appendix B
The five key action areas of the Ottawa Charter explained
Build healthy public policy: health promotion activities should put health on the agenda of policy makers at all levels. This includes legislation, economic measures, taxation and organisational change. Health professionals must want policy makers to be aware of the health consequences of their decisions and to accept their health responsibilities.
Create supportive environments: health promotion should generate living and working conditions that are safe, stimulating, satisfying, enjoyable and provide a positive benefit to health. The protection of natural and built environments and the conservation of natural resources must also be addressed in any health promotion strategy. The inextricable links between people and their environment constitute the basis for a socio-ecological approach to health.
Strengthen community action: health promotion should empower communities to exert control, ownership and action over their own endeavours and destinies and enable them in setting priorities, making decisions, planning strategies and implementation to achieve better health. Systems for strengthening public participation in and the direction of health matters should be encouraged.
Develop personal skills: health promotion should provide information and education for enhancing health and life skills to support personal and social development. The options available to exercise more control over health and the environment and to make healthy choices would thereby be increased.
Reiterate health services: to focus beyond clinical treatment and curative services toward the promotion of health. The responsibility for health should be shared amongst individuals, governments, institutions etc. Health professionals must respect cultural needs, look towards the specific needs of communities and forge interdisciplinary collaboration. Stronger attention should also be given to health research and changes in education and training should be called for.
Queensland Government, 2007; WHO, 1986.
References
Best Beginnings mobile apps: the transition to parenthood. (2013). Community Practitioner, 86(4), 11.
Bower, P. (2013). Growing up in an online world: the impact of the internet on children and young people. Community Practitioner, 86(4), 38-40.
Catford, J. (2007). Ottawa 1986: The fulcrum of global health development. International Journal of Health Promotion and Education. Supplement 2, p6: The Ottawa Charter for Health Promotion: A critical reflection. Background to the 19th IUHPE World Conference on Health Promotion and Health Education, “Health Promotion Comes of Age: Research, Policy & Practice for the 21st Century”.
Department of Health (2006) School Nurse: practice development resource pack. Specialist community public health nurse.
Department of Health (2011) Health Visitor Implementation Plan 2011-15. A call to action.
Department of Health (2012) Children and Young People’s Health Outcomes Strategy. Report of the children and young people’s health outcomes forum.
Eriksson, M. & Lindstrom, B. 2008. A salutogenic interpretation of the Ottawa Charter. Health Promotion International 23(2) doi: 10.1093/heapro/dan014.
Halliday, J. & Wilkinson, T. (2009). Young, vulnerable and pregnant: family support in practice. Community Practitioner 82(10), 27-30.
Health Development Agency (2003). Teenage pregnancy and parenthood. A review of reviews.
Hills, M. & McQueen, D.V. (2007). At issue: two decades of the Ottawa Charter. International Journal of Health Promotion and Education. Supplement 2, p5. The Ottawa Charter for Health Promotion: A critical reflection. Background to the 19th IUHPE World Conference on Health Promotion and Health Education, “Health Promotion Comes of Age: Research, Policy & Practice for the 21st Century”.
Kalnins, I., McQueen, D., Backett, K., Curtice, L., and Currie, C. (1992). Children, empowerment and health promotion: some new directions in research and practice. Health Promotion International 7(1), 53-59.
Khashan, A.S., Baker, P.N., & Kenny, L.C. (2010). Preterm birth and reduced birthweight in first and second teenage pregnancies: a register-based cohort study. BMC Pregnancy and Childbirth, 10, 36.
Kickbush, I. (2007). The move towards a new public health. International Journal of Health Promotion and Education. Supplement 2, p9: The Ottawa Charter for Health Promotion: A critical reflection. Background to the 19th IUHPE World Conference on Health Promotion and Health Education, “Health Promotion Comes of Age: Research, Policy & Practice for the 21st Century”.
National Institute for Health and Clinical Excellence. (2009). Social and emotional wellbeing in secondary education.
Peterson, J., Atwood, J., Yates, B. (2002). Key elements for church-based health promotion programs: outcome-based literature review. Public Health Nursing 19(6), 401-411.
Queensland Government. (2007). Ottawa Charter.
Raeburn, J. (2007). Ottawa Charter: reflections from down under. International Journal of Health Promotion and Education. Supplement 2, p10: The Ottawa Charter for Health Promotion: A critical reflection. Background to the 19th IUHPE World Conference on Health Promotion and Health Education, “Health Promotion Comes of Age: Research, Policy & Practice for the 21st Century”.
Reeves, J., Gale, L., Webb, J., Delaney R., Cocklin, N. (2009). Focusing on young men: developing integrated services for young fathers. Community Practitioner 82(9), 18-21.
Ridde, V., Guichard, A,. & Houeto, D. (2007). Social inequalities in health from Ottawa to Vancouver: action for fair equality of opportunity. International Journal of Health Promotion and Education. Supplement 2, p12-16: The Ottawa Charter for Health Promotion: A critical reflection. Background to the 19th IUHPE World Conference on Health Promotion and Health Education, “Health Promotion Comes of Age: Research, Policy & Practice for the 21st Century”.
Ritchie, J. (1991). From health education to education for health in Australia: a historical perspective. Health Promotion International 6(2), 157-163.
Royal College of Nursing Australia. (2000). Position Statement on Health Promotion.
Royal College of Nursing. (2008). RCN toolkit for school nurses. Developing your practice to support children and young people in educational settings.
Royal College of Nursing. (2012). Going upstream: nursing’s contribution to public health. Prevent, promote and protect. RCN guidance for nurses.
Sourtzi, P., Nolan, P., & Andrews, R. (1996). Evaluation of health promotion activities in community nursing practice. Journal of Advanced Nursing 24, 1214-1223.
Wise, M., & Nutbeam, D. (2007). Enabling health systems transformation: what progress has been made in re-orienting health services? International Journal of Health Promotion and Education. Supplement 2, p23-27: The Ottawa Charter for Health Promotion: A critical reflection. Background to the 19th IUHPE World Conference on Health Promotion and Health Education, “Health Promotion Comes of Age: Research, Policy & Practice for the 21st Century”.
World Health Organization. (1981). Global Strategy for Health for All by the Year 2000.
World Health Organisation. (1986). The Ottawa Charter for Health Promotion.
World Health Organisation. (1998). Health Promotion Glossary.
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