One of the fundamental roles of the nurse is the promotion and maintenance of health as declared by the Vienna Declaration on nursing (1988) and cited in Salvage (1993). This reflective account, will discuss the presentation of a health promotion initiative by a third year mental health nursing student.
The paper will highlight the effectiveness efficiency and economy of the health promotion and be critical in its evaluation. It follows a reflective model as described in the Gibbs model (1988), cited in Burns and Bulman (2000), .
The National Service Frame Work for Mental Health Department of Health standard one, (1999) declares that the health and social services should promote mental health for all, working with individuals and communities. It also declares that people with Drug and Alcohol problems have greater adverse factors associated with social exclusion. The policy is a working document with a view to promoting the health of the subject group.
Much research and objectives have been identified into many issues involving alcohol abuse. Almost 1 in 3 men and 1 in 5 women drink above safe levels, 8 million people drink at risky levels and 3 million of those are dependant on alcohol. Statistics verified by the British Beer and Pub Association (2004) Saitz, (2005), supports these finding in his recent articles. This risky behaviour is identified in the high level of alcohol related deaths on the road. Dramatically reported, by the Department of Transport (2000) casualty reports.
The Prime Ministers Strategy Unit,(2004) commissioned research into the interventions of effective health intervention in the health service. And a specific need for further education in the context of health promotion has been identified. Further more, the Assessment of need for alcohol treatment in England. National Treatment Agency (2005) Established that the area of the North West of England, as being the highest regions in United Kingdom with people in England with an Alcohol use disorder at almost 28 %
The health promotion initiative reflected here met all these identified issues and was conducted in a specialist Alcohol Clinic based in the North West of England and used service users already committed to an intensive programme of education and support, based around their drinking experiences.
A clearer education of the effects of dissipation rates and the calculation used to determine alcoholic units will provide the service user with a better informed choice regarding their drinking habits, and potential further harm to their health.
Identifying needs and priorities
The needs and priorities were clearly established by dedicated systematic reading regarding the effects of alcohol in many articles such as Rumph.Harke Meyer and John (2002) and a detailed evaluation of the current program for the service users attending a 3 week inpatient course based on challenging the behaviour of excessive alcohol abuse. Whilst the course was accredited and covered a wide range of issues around problem drinking, there was little emphasis on the area of alcohol dissipation rates. It was felt that an extra incentive of possibly loosing the independence of a driving licence may influence the behaviour of the group’s previous risky drinking behaviour. This change of behaviour would also contribute to the continued better health of the individuals concerned.
It was an important message to bring to the group as it further offered a contribution to the vast media coverage around drink driving at this time of year and would utilise the exposure given to this subject. It was anticipated therefore that the information being passed would remain identifiable and prevalent, after the presentation had taken place.
Setting Aims and Objectives.
The aims and objectives set by the initiative were clear for the subject group to focus on. They were made clear to the group before starting the presentation, but by doing so an atmosphere of a structured lesson was felt. It was apparent to me that by doing this, the client group felt that they were going to be lectured to. They were all aware that I was a university student and possibly felt that this presentation would be too academic.
It would have been better to be less formal at this stage of the presentation and add the question “Is there anything further that you would like to understand around this subject?” before I commenced the presentation. This would have created better warmth to the group. I also strongly believe that adults learn most effectively when they identify there own learning needs. Ewles and Simnet (2003) agree to this philosophy and go on to suggest that adult learners should be encouraged to carry out continuous evaluation of their own learning.
Deciding the best way of Achieving the Aims.
The project took the form of an educational approach which intended to provide sufficient knowledge and information to enable the user group to make an informed decision and included a presentation of the formula for calculating the alcohol unit measurement per drinks of choice. In addition it also produced a “ready rekoner” (Attached) that gave an estimation of time, how long the body may take to dissipate the alcohol in the system.
The educational approach was favoured as it was a process now familiar with the group and did not offer any additional complications of a different method. It also continued the message that the processes of change remains in the individuals own hands and a degree of responsibility still lay with them.
The process followed a cycle of change method as described by Prochaska and Di Clemente,(1992), Which is attached at Appendix B. This process is a preferred method of the placement area and is evidence based in its effectiveness with the chosen subject group. It was important to the effectiveness of the initiative that the clients were on the ready to change part of the cycle. This ensured that the message was being absorbed and enhanced the economy of the initiative. This initiative could be used for clients on different stages of the cycle but would require additional and more specific reasons to adopt a change in behaviour at its onset.
Clients participating in the group at an earlier stage would need a clear understanding of the process of change.
I believe that I chose the best approach by using this method, but would have benefited by not being so structured. The group had a wealth of experience and working knowledge of their previous drinking behaviour, and time should have been given for them to share their experience with the group. This would have contributed to the delivery of the message as being personal to them, and increased its effectiveness. I was conscience that the group were engaging and discussing my points as a team, but at times stopped them, possibly due to the fact that I was being assessed and felt that I needed to show control of the group. I have learnt from this that it is vital occasionally to allow the group to dictate the speed and content if it is aiding the message. It is of course important to have a control of a group but in the inpatient setting such as opportunities of good group interaction should be embraced. Strategies such as case studies, role playing, simulations, and self-evaluations are most useful, when considering adult learning. Cantor (1992) says Instructors adopt a role of facilitator or resource rather than lecturer or grader. It is also important that the group are acquiring knowledge for practical use; this adult learning criteria is defined well by Steinbach (1993).
Identifying resources.
The resource of the group of 30 service users for a control trial as discussed in the plan for this promotion was later reflected on as being un necessary in the effectiveness and efficiency of the project and was dismissed. It was felt that little new information obtained by the results of establishing that alcohol still remained in the system the day after a period of drinking was not a landmark discovery. The benefit would only be to the individual in realising how long it personally takes them to be fit to drive was un economic and this message could be delivered better by the subscription of joining the presentation. I also felt that the commitment to gain this knowledge was minimal to individuals who had not at this stage joined an enhanced behavioural change model and as such would not be subscribing to the cycle of change needed for the projects effectiveness.
To further enhance the message, I included numerous local press cuttings of drivers that had been prosecuted the day after drinking, including one incidence of a fatal accident at a school crossing caused by a driver over the limit at 9am. This article was enough to reiterate the importance of being aware how many units of alcohol remain in the system. It cost the life of a 5 year old child! This proved to be effective and made the message personal, many were parents. On further reflection I may have used this technique more to enhance the seriousness of not knowing the formula for calculating units and dissipation times.
The inpatients were a valued resource of the effectiveness of the promotion and responded well to the initiative. The PowerPoint presentation was professional in its delivery but appeared a little high tech at stages. The subject group seemed a little overwhelmed by the amount of equipment that I was using.
As this presentation was being assessed I felt the importance of demonstrating a professional delivery, this was not required as the importance of the message to the group was paramount. I feel as if I let the worries of being assessed override the needs of the patients. I have reflected further on my practise and intend to remain patient focussed at all times.
The Alco meter was not required as previously stated, due to the fact that the controlled trial was cancelled
A ready rekoner was produced and was so successful, It has been agreed in principal, to be adopted by Alcohol Concern and may be used for a national initiative. If the system is adopted, I believe that a valued message will be passed to an extended group of clients, and not reserved to those affected by alcohol addiction. In turn the consequences of the public greater appreciation of my promotion may save lives.
Plan Evaluation Methods.
I decided against the planned detailed questionnaire be given before and after the presentation. I had never met the group before and decided to have an ice breaking session by going around the room asking people to tell me their names and why they were here at an alcohol specialist clinic. The desired response was obtained and I was able to establish what they knew already about the chosen subject, what they wanted to know, why they wanted to know it and also by additional questions for clarification to some individuals at the end of the presentation, how effective it had been. One service user stated at the start of the session that he thought he was allowed to drink three pints of lager before he was unable to drive, and had done so for years and never been stopped. By clearly establishing to him the unit calculation for the strong lager he was drinking was in fact higher than the legal recommendation he intended now to lower his strength lager with a view to stopping his drinking completely. This appreciation was a reflection on the additional awareness shared by the group and the effectiveness of the message delivered.
I was further able to establish the effectiveness of the presentation by asking a few relevant questions at the start of the groups next session three days latter. I was delighted that the key points of my message were remembered by the vast majority of the group.
Action Plan
The action plan was effective in that it gave a good time schedule to work to. I tried to stick to the timings as far as possible but was unable to due the demands on the practise placement. The presentation was put back a week due to the fact that an incident had occurred during before my presentation. I was disappointed as I had prepared well and was conditioned for the experience of discussing my presentation with the group, however when I did present it was to an additional twenty five people,
So my subject group was infact better. It was more economic to give the presentation to more people and the message could be dissipated to a bigger group of clients.
The health promotion was a success. The presentation will be used as an addition to the units program and will provide an additional resource, with clients suffering from alcohol problems
I have learnt a tremendous amount about delivering a presentation during this initiative, and am enthused that the ready rekoner may be used for a national campaign. The biggest lesson learnt is that health promotion should be one of the primary interventions of a nurse. We need to convey knowledge and understanding to our clients in order to empower them to make considerable changes in their previous behaviour of health neglect.