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Getting the message out there

Community nurses, especially those working in cities, may be neglecting their health promotional role. Fiona Cassie reports.

Nurses can get confused between health promotion and just one of its aspects, health education, according to new research.

Dr Janet Roden, nurse academic at the University of Tasmania recently presented her findings into the health promotion practice of community nurses at the recent Australasian Nurse Educators Conference in New Zealand. She found that community nurses were focused on providing health education and developing people’s personal health skills, rather than the wider advocacy role of health promotion. “But there are other parts of health promotion that are also important,” she told the conference.

During her research, Roden surveyed and interviewed nearly 150 community nurses working in urban NSW and rural and remote communities. She designed a survey partly based on the 1986 Ottawa Charter for Health Promotion’s five action areas to assess whether community nurses were carrying out health promotion. Roden became concerned that nurses were focusing more on health education, rather than the other action areas of the Charter.

What she had not expected was finding that rural and remote nurses were more likely to be carrying out charter recommendations than their urban counterparts. For example, they were creating supportive environments by providing satellite broadcasts at RSL clubs about cancer support for people in isolated communities. Another group of nurses were “reorienting” or modifying services so they could reach a bigger proportion of their target population.

Roden said despite the rural and remote nurse feeling disempowered by isolation and having to service a huge area, they were actually more effective health promoters. She considered that possibly the isolation meant they had more autonomy and had to take more initiatives than city nurses.

Meanwhile, their urban colleagues were concerned about their limited health promotion roles and felt they should be doing more, but were frustrated by a lack of time and resources. She said the growth in the chronically ill and early hospital discharges meant the generalist community nurses were managing more seriously ill people at home. “I think it’s getting harder and harder for them – they try and do health education but find it difficult to do more because of the constraints of the environment.”

Roden said some might ask whether the Ottawa Charter was still relevant 25 years on, but she believed its aims and primary health focus meant it was still relevant to all nurses – particularly nurses whose role, like community nurses, specifically includes health promotion.

She believed New Zealand’s primary healthcare strategy meant nurses were more proactive but believed nurses internationally could be more active in the area of health promotion. “I think all community nurses need to be more proactive politically. They need to develop a higher profile and work towards having more nurse practitioners [in the workforce].”

Fiona Cassie is the editor of New Zealand Nursing Review.

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