Health Promotion in Nursing Practice:

Health Promotion in Nursing Practice: An Overview of the Current Literature Primary Feinstein, Alvan. (Jan 2005) "Does 'health promotion' really promote health? American Journal of Economics and Sociology.

Retrieved 11 Dec 2006 at http://findarticles.com/p/articles/mi_m0254/is_1_64/ai_n13798793/pg According to Alvan Feinstein of The American Journal of Economics and Sociology, because of the success of "prophylactic" health promotion activities during the early 20th century, such as improved sanitation in cities and vaccination for infectious diseases, the attention of the medical profession has been turned towards encouraging other forms of health promotion. "Prevention has been subclassified into primary, secondary, and tertiary activities.

The primary activities include not only the old 'one-shot' types of vaccination, but the short-term use of antibiotics in healthy persons, such as college students, to prevent the spread of small epidemics, such as meningitis. In primary prophylaxis, individual healthy persons are encouraged to eliminate or reduce 'risk factors' in diet, smoking, or physical sloth. Secondary prophylaxis involves efforts to reduce an asymptomatic physiologic abnormality, such as an elevated blood pressure or serum cholesterol, to prevent future diseases such as heart attacks or stroke.

Tertiary prophylaxis, for diseases that already exist, is given with the hope of keeping them [sick or admitted patients] from getting worse," often in a hosptial or controlled health care setting like a nursing home. (Feinstein, 2005, p.1) However well-intended such health promotion activties may be, Fienstein contends, they are often quite problematic when viewed in terms of their measurable positive effects. Feinstein is especially concerned with primary interventions in so-called healthy persons.

Although dietary, pharmaceutical, and exercise interventions for asymptomatic people with the appropriate risk factors for heart disease, for example, may be a good thing, quite often they are not accompanied by psychological counseling and motivation to change behaviors that contribute to obesity.

Lifestyle issues, unlike one-shot medications, require additional psychological support from nursing staff or other medical personnel, else they do little else but create a sense of guilt, and do not fundamentally alter behavior, especially if the effects of obesity, smoking, and sedentary behavior are currently not being 'felt,' and seem like far-off rather than real risks. (Feinstein, 2005, p.2) Article 2: Secondary Dyson, Pam. (Apr 2004) "Diet and diabetes -- the new recommendations." Journal of Diabetes Nursing.

Retrieved 11 Dec 2006 at http://findarticles.com/p/articles/mi_m0MDR/is_4_8/ai_n6180372 Even for patients who have already developed diabetes as a result of poor lifestyle choices, however, "diet remains a contentious issue," and while it has been shown that "nutritional therapy is an integral part of effective management of diabetes and has a vital role in helping people with diabetes achieve and maintain optimal glycaemic control," often there is little or conflicting media information about what constitutes the "best diet," and how to help diabetics follow such a diet.

(Dyson, 2004, p.1) This can be frustrating from the point-of-view of the nursing practitioner, becase quite often, even expert advice may vary, which can make patient compliance even more problematic, as Type II Diabetes patients may find it difficult to agree to monitor their sugar or caloric intake. Sugar is a particularly controversial issue in diabetes treatment. Limiting sugar consumption is often seen as a way to mitigate the potential for the condition to spiral out of control. Traditionally, sugar is supposed to be limited for persons with diabetes.

However, some current research suggests that in health promotion for diabetics, sugar-containing foods in and of themselves are not the primary culprit, rather the problem is that sugar results in overall caloric increase, causing further weight gain, and weight gain is often at the heart of the reason that the patient developed Type II Diabetes in the first place.

Theoretically, sucrose can provide up to 10% of total energy intake for a diabetic without compromising glycaemic control, but it can be difficult for patients who have a problem limiting calories and foods that are energy dense such as chocolate, cookies, and cakes to stop at 'just one.' It is important to remember the role of weight loss in diabetes health promotion and maintaining a healthy lifestyle.

A nurse must stress the need for caloric limitation, as well as merely monitoring blood sugar and consumption of high-sugar foods, as fat-dense, high calorie foods that contribute to obesity can be equally dangerous. (Dyson, 2004, p.1) This can be difficult when patients do not experience complications from their condition, but merely have diabetes as a silent presence in their lives.

Nurses must provide support to making lifestyle changes, and accomodating cultural tastes and needs, as well understanding as psychological conflicts over conflicting media advice when ensuring that the secondary health promotion intervention is effective. Article 3: Tertiary Jensen, Gordon L. & Janet M. Friedman, Donna Henry K, Annalynn Skipper, et.al. (Jan/Feb 2003). "Noncompliance with body weight measurement in tertiary care teaching hospitals." JPEN: Journal of Parenteral and Enteral Nutrition. Retrieved 11 Dec 2006 at http://findarticles.com/p/articles/mi_qa3762/is_200301/ai_n9171099 Information is key to providing advice for patients.

However, weight is often a sensitive issue. A study of 300 patients, aged >=18 years that were admitted to general medicine and surgery services of 3 tertiary care teaching hospitals in Nashville, Chicago, and San Francisco, at 24 to 36 hours after admission, participants were asked if they had been weighed, and if not, they were asked whether they had been questioned by nursing personnel about their weight. It was found, unsurprisingly that patients were often unwilling or innacurate in the weight they volunteered to nurses, as opposed to patients weighed in hosptial gowns.

Overall, the conclusions of the study suggested the importance of understanding the psychological accuracy of weight, and also volunteered information in regards to daily eating and exercise habits, when attempting to mitigate the damage of patients with unhealthy lifestyles admitted to the hospital for health complications related to lifestyle issues.

Conclusion In all of these articles, health promotion is defined as enabling the individual to engage in more effective self-monitoring and self-care, not simply on a physical level, but on a psychological level, as away from the nurse's immediate supervison, the patient must continue to monitor his or her exercise, diet, and other aspects of health. The purpose of health promotion in nursing.