Health Promotion in Nursing: Child Obesity Interventions

This essay will explore the knowledge, skills and attitudes nurses need for health promotion.

In the last decade health promotion has been a significant part of health policy in the UK (Piper, 2009). For instance the Department of Health (DOH) policies: Choosing Health (DOH, 2004) and Better Information, Better Choices, Better Health (DOH, 2007), both highlight health promotion as a main concern in health service (Piper, 2009). Nurses have a significant part in reducing the effect of disease, promoting health and function (RCN, 2012). The NMC (2008) states that health promotion is a key aspect of the nursing profession and one they are required to undertake in practise. Health promotion is a procedure which helps people to enhance their health and have control over it (WHO, 1985). Tones (1987) describes health promotion as “any strategic measure which aids health or averts illness, disability and pre-mature death.”

Health promotion aims to enhance ones skills and abilities in order to take action, and in the volume of a group or community to work mutually to place control over determinants of health and attain positive change (WHO, 1978). Health promotion is essential in child nursing as anything which affects a child’s health during childhood may have an effect on adulthood (Moyse, 2009). In order to provide effective health promotion nurses must have the correct skills, knowledge and attitudes (Cole, 2008). Having the right knowledge, skills and attitude allows nurses to implement successful health promotion, consequently making a positive effect on the patients’ life, health and wellbeing (Cole & Porter, 2008).

Child nurses delivering public health are working to establish opportunities for children to live positive healthy lives, by influencing public policies and via health promotion (RCN, 2007). However to ensure this nurses need knowledge (Risjord, 2011). For example having knowledge on various health conditions is vital for nurses, as they spend a significant amount of time with service users, thus nurses are usually the first source for information when service users want find out about a certain health condition (Risjord, 2011). In relation to tackling child obesity nurses will need knowledge about obesity to carry out successful health promotion (Bagchi, 2010). Grimmet et al (2010) found that parents and children either have inadequate or no knowledge on obesity and the severity of it. This suggests that there is lack of awareness on child obesity. Moyse states that nurses must offer guidance and lifestyle education each time they are in contact with service users. Working with the child’s family is vital as it will allow nurses to identify misunderstandings families have about: exercise, food consumption, and health matters (Moyse, 2009).

This shows knowledge is vital when delivering health promotion as nurses can help both child and parent come to terms with health issues via education and advice. Having knowledge on health epidemiology will be vital for nurses in health promotion as if offers a depiction of current health conditions amid children thus highlighting areas which require priority. Currently in the UK 33% of boys and 30% of girls aged 2-15 years are obese (Health Survey for England, 2012). Since 1995-2006 the obesity rate has increased from 14% to 25% for boys and from 15% to 27% for girls. Obesity rates in boys aged 2-10 increased from 11% in 1995 to 17% in 2006 and girls 10% in girls to 12% in 2006 (Health Survey for England, 2012). Being aware of the prevalence and incidence of child obesity will allow nurses to identify: preventative approaches, monitor secular trends and allow nurses to recognise groups at risk (Naidoo & Willis, 2009).

Nurses need to have knowledge about a child’s psychological, social, physical and intellectual development. The Children Act (2004) states this as an obligation for all child practitioners involved in children’s health, protection and welfare. Being aware of child development is a significant step towardsunderstanding what establishes children’swellbeing, safety and promoting and maintaining wellbeing (DOH, 2012). This ensures that holistic care is given to the child as it considers all aspects of child’s health. In relation to childhood obesity child development is a vital aspect when delivering health promotion as it will help the nurse to identify how the child’s development is affected due to obesity and the implications caused by it, but most importantly it allows the nurse to identify how this can be altered to improve the child’s health (reference).

Having evidence based knowledge is vital in health promotion, the NMC (2008) states that nurses must use evidence based practise to deliver excellent care and to ensure patient needs are met. In relation to child obesity nurses can acquire evidence based knowledge about obesity by reviewing literature this will offer understanding of key research, initiatives, interventions, and policy which are all key in implementing care for obese children (Porter & Cole, 2008).

Having knowledge on health promotion theories and models will be beneficial for nurses as they underpin the application of health promotion. Theory can help implement health promotion in various ways (Nutbeam & Harris, 2010). Models and theories offer a better understanding of health problem being addressed. They also explain the needs and motivations of the target population and offer suggestions in how to alter health status, health behaviour and their detriments. Health promotion models and theories also offer approaches and measures utilised to monitor the programmes and problems (Nutbeam & Harris, 2010). In relation to child obesity nurses may use the nursing process, which has the following stages: assessment, diagnosis, planning, implementation and evaluation. For instance the child will be assessed to identify child’s health needs as basis for care implementation.

For the diagnosis the child’s weight and height may be measured, this will allow the nurse to identify if the child is obese by comparing the results to the national body mass index percentile, for children. Nurses may also have a consultation with parents to identify what may be contributing to child being obese. For planning nurses may devise a care plan for the child consisting of planned actions which are suitable for child’s needs i.e. regular exercise, balance diet or decreasing calorie intake to a sensible amount. For the implementation stage nurses will help the child to implement actions from the care plan e.g. food diary to help reduce calorie intake to recommended amount, encouraging the child and family to do 30 minutes of exercise per day or increasing healthier food choices. For the evaluation stage the nurse and child or family, will assess if the interventions were effective and if not how actions can be improved to ensure patients’ needs are met.

Nurses need knowledge on health inequalities as the UK government has identified health inequalities as a key public health issue (DOH, 2013). Child obesity can be considered as a health inequality, as the National Child Measurement Programme, found high obesity rates amid 5 and 12 year olds were linked to increased socioeconomic deprivation (NCMP, 2010). The Healthy Lives Healthy People policy (DOH, 2010) aims to reduce health inequalities and increase opportunities by offering various services for both family and children. The policy stresses the significance of giving children a healthy start in life, it sets goals for the Healthy Child Programme, health visitors, and the Family Nurse Partnership and demonstrates how this contributes to the public health priority of promoting good health and wellbeing (DOH, 2010).

Nurses play a key role in this policy by improving health and opportunities for children and young people via health promoting initiatives. For instance it aims to tackle child obesity by educating parents on healthy eating, and exercise. To achieve this nurses will need knowledge on the factors of health inequalities and health promotion methods which can be utilised to aid children and their parents to avert infirmity, injury and mortality (Moyse, 2009).

Skills

There is a vast range of skills used in health promotion to tackle public health issues. One of them is having the skill to collaborate with others. Brammer, (2007) states that effective support for families and children cannot be attained by a sole agency. Thus nurses must cooperate with others when delivering health promotion, to meet child’s needs. The DOH, states that NHS staff collaborate with each other in effective teams and that partnership is vital in implementing care to patients (DOH, 2006). Acheson suggests that in order to help people lead independent lives inter-professional collaboration is required to encourage public agencies to adapt services to individual’s needs and to promote choice along with independence (Acheson, 1999).

In relation child obesity nurses can collaborate with others to tackle environmental challenges, as it’s an area where nurses have less input. The environment consists of: physical, cultural, social and economic environment which are needed for one to make lifestyle modifications (Davis, 2007).

Via inter-professional collaboration within multidisciplinary team or with agencies for example with nutritionists, schools, religious representatives, fitness and leisure centres and community food personnel environment barriers can be tackled (Mosytn, 2005). Family culture and social life can be modified by motivating the family to embrace a healthier lifestyle, hence resulting in a positive environment for modification (Davis, 2007).

Having communications skills is crucial in health promotion (Webb, 2011). Wills et al (2007) found that nurses had to recognise how individuals acquire information, how information is exchanged effectively, how individuals make choices regarding their health and understand the way in which communities alter. In relation to child obesity, communicating with parents creates cornerstone of intervention to address the issue of child being obese. When communication is carried out correctly the foundation for working in partnership with obese children and their family can be formed and nurtured (Mikhailovich & Morrison, 2007).

Having the skill to deliver family centred care is a key aspect in health promotion, as families have a crucial part in ensuring the health and well-being of children and young people (Moyse, 2009). The National Service Framework (DOH, 2004) has guidelines which emphasis on health promotion and assisting families with education and resources from birth to adulthood. The guidelines ask for high quality care to promote and safeguard children and young people.

By implementing family centred care nurses allow the formation of partnership with the child’s family in the pursuit of being amenable to the priorities and necessities of the family and child (Bowden & Greenberg, 2011). Family centred care beneficial in delivery of health promotion as it improves care, allows successful distribution of resources, and satisfies both family and patient (Bowden & Greenberg, 2011). In relation to child obesity optimal care is delivered by adopting family centred care, where care and advice is offered to both family and child to allow concordance.

Having the skill to empower patients is vital, Tones & Tilford (2001) argue that empowerment is most crucial feature of health promotion. In relation to child obesity empowering the young person to manage their health while satisfying their needs is vital. Empowerment has been recognised as key concept in encouraging healthy eating and exercise (Cochran, 2008).

Attitudes

To achieve effective health promotion nurses must encompass health promoting attitudes and demonstrate respect for all patients.

Empathy is a crucial attitude in health promotion, McQueen (2005) states that empathy refers to being able to understand the patient’s behaviour and feelings. Malloch (2001) suggests that empathy forms trust and allows care to be negotiated, implemented and evaluated efficiently. The NMC, (2008) also states nurses need to be able deliver care with empathy. In relation to child obesity empathy is a key attitude as the DOH (2010) states that nurses must be empathetic with families when dealing with sensitive issue like child obesity.

Being compassionate is vital when delivering health promotion as the DOH (2010) states that compassion forms the basis of care via through relationships formed on respect, dignity and empathy.

Being non-judgmental is vital in health promotion, as the NMC (2008) states that care must be given in a universal, non-judgmental, kind and sensitive manner that avoids assumptions.

Being a motivational is a key attitude nurses will require as it helps patients feel confident, thus making a desired health action more achievable Fisher, (2013). Harter suggests that patients will be motivated when they perceive themselves as being confident however if one feels they are not capable of fulfilling an action they are less likely to do it. Thus having a motivational attitude is vital as it increases patient’s self-esteem and prompts patients to take action on their health.

Conclusion

This essay has explored why nurses need skills, knowledge and attitude to deliver health promotion and how this can be used to tackle child obesity.