This essay will discuss healthy start as a current healthcare initiative in the United Kingdom. It will also look at the historical overview of healthy start its aim and how the initiative is structured, problems associated with in adequate nutrition with relation to socioeconomic status and the effectiveness of health promotion/health education will be reviewed with its implication to health care delivery, finally this write up will discuss about different nursing theories and models, which promote healthy start and how the knowledge of transcultural nursing and reflective practise will promote nursing practice.
The history of a healthy start is as far as 2002 when similar initiatives were in place, namely National school fruit scheme, Five a day program, Promotion of breast feeding and Welfare food scheme (Department of Health DH, 2005) Welfare food scheme initiative focused on distribution of milk to schools, nurseries and low income families.
Upon scientific review it was understood that the beneficiaries where not getting adequate nutrition, vitamins and weaning diet was not included, as the focus is on milk distribution only and researchers fear that if it continues it will discourage breastfeeding, it was agreed that a new program be designed that will better meet the need of the people (DH 2005). Healthy start is a government initiative that replaced the food welfare scheme. The focus is on provision of fresh fruit, vegetables, milk, infant formulas and vitamins to children below 4years and pregnant women. (Robert et al. 005). This initiative is targeted towards supporting low income and disadvantaged families, pregnant women and children below age four.
Beneficiaries receive vouchers which will be utilised in purchasing vegetables, fresh fruits, milk or infant formulas. However, according to DH (2010) low income families still have difficulty providing their children with a healthy, balanced diet this includes varieties of fruit and vegetables daily. The intent of healthy start initiative is to improve the welfare food scheme to better meet the nutritional needs of beneficiaries within existing udget, improve the health and well being of young children and pregnant women from low income families, increase the flexibility of the welfare food scheme to better reflect current dietary guideline to low income family and to forge closer link between nurses, midwifes, health visitors and beneficiaries to enable them have access to information about breast feeding, healthy eating and living (DH 2006). It have been understood that most people do not get adequate nutrition for two reason firstly due to financial restrain and secondly lack of knowledge (DH 2006).
Healthy start have been structured in a way that it will take care of both issues with the effective participation of the nurse and other healthcare professionals (Robert et al. 2005). It is an evidence based government intervention in reducing inequality in healthcare. (Marmot 2010) Inadequate nutrition does not only pose a threat to the individual and family but also the society and the government at large. Among the pregnant women and children it increases the risk of morbidity and mortality from infectious disease and also it affects the rate of physical and cognitive development in unborn child (IMAJ 2000).
According to (Albon and Murkheji 2008), babies born in disadvantaged families are prone to having a weight at birth, malnourished or even die than those of families of higher income. Also, Blake (2006) supported this by saying that the strain on family resources with reference to purchasing power adversely affects the nutritional status of children from such family thereby increasing their exposures to infectious disease. Because it is assumed that the stable income families can afford healthy meals.
Marmot (2010) supported this by saying that people of higher socioeconomic standard have more chances leading to flourishing life and better health. Triches and Giuliani (2005) are of the opinion that in some cases it is a problem of unhealthy eating, life style or ignorance rather than unavailability of fund and nutritious meal. Apart from the physiological effect, not getting adequate nutrition and the necessary vitamins also have its psychological effect: in adult it could cause depression and self neglect.
Whereas in children it have been found to decrease their intelligence quotient levels, cognitive function and sometimes it could be associated with behavioural problems that last till adulthood (Gregory 2010) this in turn affects the society as this may increase the dependency ratio.. The chain of event is such that when immunity is reduced due to inadequate intake of nutritious meal the individual is predisposed to being sick often, prolonging the recovery time and encourages long hospital stay, (Holick and Chen, 2008) during hospitalisation they are predisposed to hospital acquired infections e. . meticillin resistance staphylococcus aureus (MRSA) (Kielmann, Powel, Sheikh, Price, Williams and Pinnach, 2009) Overall this piles up a high cost on the National Health Services. Information sourced from the British association for parenteral and enteral nutrition (2005) shows that malnutrition is costing the UK government 7. 3 billion pounds annually due to long hospital stay and frequent visiting to the GP.
These national problems can be tackled by making available nutritious diet to mothers and infant (Albon and Murkherji 2008). Because the effect of low income is exaggerated by lack of social support system hence Horton (2007) recommended healthy start initiative. Most importantly the nurse as the middle person between this programme and the beneficiaries, her effective participation in carrying out her legal and ethical responsibility as a health educator and a health promoter will enhance the success of the programme. Wong 1992) It is the nurse’s responsibility to encourage individuals to choose positive health behaviours Heath (2005). The nurses role in a healthy start government initiative is to health educate people on appropriate health and life style with emphasis on the role of fruit, vegetables ,milk and vitamins in diet (DH 2005) Nurses should also encourage eligible women and children to benefit from healthy start (DH 2005) as to discourage them from cheap food high in fat and sugar (Neumark 2003).
Nurses are well positioned for health promotion because of their education and access to the community (whitehead 2009) In most cases patients have acknowledged that nurses as their primary and most reliable source of accurate health information (Cortis and Lacey, 1996), it is important that they utilise these contact points, clinics, immunization sections in familiarising people about healthy start (Elia, 2006).
In order for nurses to guide and direct client in the area of their nutrition and about a healthy start a proper understanding of factors that affect individual health illness behaviour is required and this understanding can only be achieved with knowledge of transcultural nursing. Transcultural nursing is an aspect of nursing that takes into consideration the particular values, beliefs and ways of life of people of diverse or similar culture with the aim of applying the knowledge in creative ways in provide culturally acceptable care (Mashaba 2007).
Cultural values are unique expressions of particular culture that have been accepted as appropriate overtime (Gigar and Davidhizer 2003). In other word, individual cultural value affects his preferred way of acting, and choice of food, and as the United Kingdom being a multicultural society nurses practicing in this area come in contact with people from different cultural background (Gigar and Davidhizer, 2003) thus it’s very important they a braise themselves with culturally appropriate technique in order to access properly and provide interventions that are culturally appropriate.
Campinha (2010) in his cultural competence model described cultural competence a stage when a health care professional strives continuously to gain the ability and availability to practice effectively within the cultural context of a client. This role is a challenging one for the practicing nurses and therefore needs flexible ways of responding to and learning from the situation, in order to advance their professional expertise this process is known as reflection.
It be defined as the act of throwing back of thoughts and memories a cognitive act of thinking contemplation (Tailor, 2000) or as a process of internally evaluating and appraising issues of concern which is triggered by an experience, causing a clarification of meaning in terms of self resulting to a changed perception of concept Boyd and False (1983). Reflection is a tool for learning and improving ones practice which is very vital to becoming a competent nurse practitioner.
Currently it is now part of nursing and midwifery requirement for every nurse to maintain a portfolio of evidence of learning activity (NMC 2002). It is very vital that nurses reflect to improve on themselves and the quality of care they give (Gibbs, 1988). It can be done in two ways reflection in action and secondly reflection on action (Schon, 1987). In action where the nurse thinks about information gotten from skill sharpening tools like history taken and physical observation while acting and use the knowledge in making a clinical decision on intervention strategy.
On action after the event had taken place, and involves a retrospective analysis and interpretation of the decision and care given in order to reveal the knowledge used and the feelings that follows. (Jones, 2010). Although some researchers have argued the possibility of reflection in action Gustafsson (2007) as event takes place in a very high speed, nevertheless it does not seem impossible as nurses are expected to function at optimal technical level Scrivener (2000).
Reflection occur in stages starting from the onset of the experience, “the experience of surprise” (Schon 1992) or a sense of inner discomfort (Boyd and Fales 1983). Gibbs (1998) included action plan as his final stage of reflection where the nurse decides on how to adapt her practice in the light of her new understanding and what should be done differently should the situation arise again. (Jasper, 2003) According to Pearson, et al (2005) the services that nurses offer are being influenced by nursing theories and models of care . hey account for disillusionment at the heart of modern nursing (Littlejohn, 2002). In a recent study carried out to find out the opinion of United kingdom and Taiwan nurses about the use of models in practise, information gathered showed that a higher number of them where of the opinion that it is a useful tool.
These theories have brought about focus in practice area and professionalism. For instance peplaus interpersonal theory exposed nurses on the need for nurse client relationship, Orlando nursing process theory taught nurses on making diagnoses upon which their care will be based. Alligood and Mariner, 2006). Some people are of the opinion that nursing models are too generalised, which by human nature it is impossible to apply generalised assumptions to all individuals (Cooley, 2003). Erickson (2006) refuted this in his theory of modelling and role modelling which appreciated the uniqueness of each individual as well as their similarities. Freund, McGuire, podhurst, (2003) and NMC (2008) suggested that in the absent of theories and models the nurse can still provide care for the patient based on skills, knowledge and experience notwithstanding.
Frisch (2003) urged nurses to use theories as foundation for practice. The benefit of healthy start initiative is enormous. Adequate intake of fruit and vegetable and vitamin supplement will improve people’s immunity says Holicks and Chan (2008),hospital stays will shorten and people will return back to work quickly resulting to increase in work productivity (DH 2007) and a reduction in Government expenditure on healthcare provision. Sokol et al 2005) Fruits vegetables, milk and multivitamin are very essential in life. Maslow is his Motivational theory classified them as basic needs (Kennon et al 2001). Consequently a well met basic needs increases motivation and performance at other levels in the hierarchy. Thus the numbers of well-adjusted individuals in the society will increase.
In relation to nursing practice it will increases the response to nursing care and intimate nurse patient relationship owing to the fact that nurses are involved in their getting access to healthy start initiative Many nurses have accepted the role of health promotion as part of their job yet some are not clear on how to implement and relate the health education principles to their practice area (Jackson, 2007). Harm (2001) suggested that they should integrate it into their routine curative function. Check (2004) adds that using health promotion frameworks in practice will also helps.
In summary the healthy start initiative will bring about a reduction in complications associated with inadequate nutrition to individuals and, families and the government. It will also equalise health care provision and distribution among all economic classes. Applications of models of nursing, knowledge of transcultural nursing as well as incorporating health promotion/education strategies in practice areas will advance nursing profession. Government in other countries apart from United Kingdom should embark on similar initiative to rule out inequality in provision of Health care.