Empowerment in Nursing Practice

Health Promotion is an essential part of nursing, The World Health Organisation, 1986 defines health promotion as ‘Enabling people to increase control over and improve their health’.

I think that as health promotion has developed over the years and people are learning more about how to effectively promote health, it has become about, still using interventions but going further by helping to support the public, making them believe that they can succeed, as they choose to change their behaviour for the better. This is made clearer by Ewles and Simnett 1993, who define it as;

‘raising the health status of individuals and communities. Too often the word promotion, when used in the context of health promotion, is associated with sales and advertising, and taken to ment propaganda approach dominated by the use of mass media. This is a misunderstanding: by promotion in the health context we mean improving health: advancing, supporting, encouraging, and placing it higher on personal and public agendas’.

A similarity between these two definitions is that they can both be seen as providing information to allow the person to make the necessary choices to improve their lives. This can be linked to Ewles and Simnetts’ definition regarding empowerment, about helping people change how they feel about themselves by supporting and encouraging them to change their behaviour to increase their chance of living a healthier and more fulfilled and extended life. They go on to define empowerment as ‘modifying the way people feel about themselves through improving their self-awareness and self-esteem. It involves helping them to think critically about their values and beliefs and build up their own values and beliefs system’.

The relationship between empowerment and health promotion is discussed in the World Health Organisation Health Report by Nutbeam, 1998 ‘In health promotion, empowerment is a process through which people gain greater control over decisions and actions affecting their health’ he goes on to define the link between empowerment and health promotion as ‘a process of increasing the capacity of individuals to make choices’.

Nurses are constantly empowering people, which is important because people are more likely to change their behaviour with support and encouragement. Naidoo and Wills 1998, discuss that nurses are responsible for collecting information on patient’s health status and the potential for nurses to also work in community settings to empower and support clients.

The rationale for this assignment is to analyse and support an artefact which I have produced to empower people aged 20-35years, to take control of their health and stop smoking. To achieve this I have produced a poster to inspire people to think about the implications that smoking has on their health. The NHS Resource Centre 2012, states that ‘advertising has proved to be a highly powerful trigger in helping smokers decide to quit for good’.

Whilst working on an acute thoracic surgical ward, I met many patients who had been diagnosed with lung cancer and I found out many of them had smoked for the majority of their lives. I also found that most of them had not thought of the consequences of smoking until the reality was that they had cancer. This is when I decided I wanted to create a poster aimed at younger people in the hope that it will empower them to stop smoking so they never get to the same stage.

In a recent online research paper by Cancer Research UK, 2012 I found that around 86% of lung cancer deaths in the UK are caused by tobacco smoking. Tobacco consumption is recognised as the UK’s single greatest cause of preventable illness and early death. An estimated 102,000 people dying in 2009 from smoking related diseases including cancers.

My posters’ main function is to focus people’s attention on taking control of their own smoking habit and encourage them to change to a healthier lifestyle. I want to make people aware that help and support is waiting for them if they chose to quit but they must rely on themselves to initiate a change and realise the risk to their health.

I have also looked at other antismoking campaigns and the most effective has been the change in law regarding where people could smoke. I feel this changed some people’s behaviour for example not wanting to go outside to smoke and not making it so easy to be a ‘social smoker’. Making cigarette sales less accessible and printing pictures on packets, has proven a good idea in shock tactics that this could happen to them if they do not quit.

To make my poster successful I looked into some different approaches to health promotion that can be used as a useful way of analysing, to help clarify my aims and values. Ewles and Simnett, 1993 identify a framework of five approaches to health promotion; Medical – to notify the health issue and to be free from medically defined disease and disability. Behavioural change – to change people’s previous behaviour conducive to freedom from disease. Educational – give information to ensure knowledge and understanding enabling well informed decisions to be made and acted upon. Client Centred – identify what they want to take action on and working on the clients own terms. Societal Change – looking at physical and social environment which enables the choice of a healthier lifestyle.

Three aspects of this approach are important in helping my poster succeed in its aim. Behavioural – I aim to change people’s previous behaviour though persuasive education. Educational – I am giving the public information about cause and effects of health-demoting factors. From this the clients have an understanding of cause and effects to make the decision whether to smoke or not. Societal Change – I aim to change both the views and the behaviour of society as a whole. Changing the behavioural pattern and making the promotion of non-smoking a societal norm.

This approach links in with the Stages of Change Model by Prochaska and DiClemente (cited in Ewles, 2005). The model looks at the beneficial change in behaviour for the client but it also takes into consideration encouraging change in addictive behaviours by going through a process of stages. They describe people going from ‘precontemplation’ into four stages of change: contemplation, preparation, action and maintenance including the regular occurrence of ‘relapse’ when the person reverts back to old ways.

I felt this model would be an excellent basis for my artefact because it shows that any change in behaviour that a client makes is not an ending but one of a whole series. It shows that it is hard to quit an addiction that it is acceptable to relapse and try again. My artefact links into two aspects of this model, Precontemplation because smokers probably won’t be thinking about giving up but the poster may make them start to think about it. Then, Contemplation because when smokers are deciding whether to quit or not, they could look at the artefact weigh up the benefits such as improved heath and more money.

I have aimed my artefact at people aged between 20-34 years smoking among this age group is at its highest. I found that 35% of men and women in this age group smoke (UK student information and resource portal, 2012). People within this age group should be aware of the health risks and the high cost involved with smoking. I hope that this will help them understand the future health issues they might face and therefor initiate a change.

Ewles, 2005 discussed that ‘strong smoke free policies and enforcement of bans on tobacco promotion will help create an environment that encourage smokers to stop, in turn reinforcing a smoke free norm that will discourage uptake by young people’.

Although I can’t make people give up smoking with my poster, I hope that it will make people put into perspective just how bad it is for your health and that it can kill you. Ewles, 2005 also states that ‘smoking causes around a fifth of all deaths in the UK, approximately 114,000 each year, most of them premature (on average, 21 years early)’ .This could be decreased immensely by people realising the facts.

I also looked at some of the excuses people use to continue smoking and NHS Choices (2011) discuss many possible excuses but I found the most common was ‘I will get stressed’ and they offer supportive responses to overcome these problems.

My poster is A3 in size, based on the danger to people’s health and the high cost of cigarettes. The NHS Toolkit, 2003 states that communication should be clear, straightforward, honest, and respectful whilst avoiding the use of jargon. I have tried my best to keep my poster within these guidelines. The Toolkit also expresses that lower-case letters should be used, with short sentences and small blocks of text. I have followed these guidelines for the facts and information on my poster except the main title because I wanted this to stand out. The NHS Toolkit, 2003 also states a white background should be used with a font size no less than twelve. All of which I have stuck to when designing my poster also that you should ‘let people know if the information in available in other formats’ which I have written at the bottom of my poster. I have designed my post to enable those who do not understand English can still interpret my message by the three pictures. I have used real images to ensure keeping within the Toolkit guidelines. I have included a number and website details where people can get more support and information if they chose to quit.

To develop my idea further it could be turned into an advert for the television or even the radio. As a poster it is much more cost effective ‘In 1998 smoking cessation interventions were calculated to have a cost effectiveness range of £212-£873, per life year gained’ (Ewles, 2005).

My poster could be displayed in GP surgery waiting rooms, in pubs or restaurants, designated smoking areas and on the sides of bus shelters. If the poster is put up in surgery waiting rooms, I believe this is more likely to change people’s behaviour because whilst waiting for their appointment there is an opportunity to read it. If it is displayed in a pub I think it will aim more at social smokers and may subconsciously change their perception about smoking effects. On the side of a bus shelter would be most effective because a variety of people walking past or waiting for the bus again have the opportunity to read it, including teenagers which may prevent them starting. By displaying the poster in a number of different places it will mean as many people see it as possible and hopefully have an effect on the behaviour of society and the number of smokers will decrease.

To evaluate the effectiveness of my poster I could look at statistics after my poster had been out in the public for a while. I could send out surveys or put surveys in doctor’s surgery’s or clinics for clients to fill in. Another idea would be to have group discussions with previous smokers and ask them how effective they thought the artefact is. The only criticism I have about my artefact is that I could have put more facts on it to deter people; however I think that keeping it simple and straight to the point is probably more effective in the long term.

In conclusion, I believe that I made the right decision by producing a poster which is simple and effective. My artefact is bold, colourful including pictures facts and information to target the attention of smokers to make an empowering decision by making a positive change to their health by giving up smoking.

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