The purpose of this essay will to be to promote Molly’s health and wellbeing through evidence based theory and practice (Refer to appendix 1 for Molly scenario). Molly has various health needs that necessitate the need for health promotion such as the risk of postnatal depression. However, for the purpose of this essay, the focus will be her type 2 diabetes health need. There are several bio-psychosocial factors that contribute to Molly’s health and wellbeing such as genes, stress and low income.
The interventions that are designed to promote Molly’s health and wellbeing will include education and empowerment . These will address Molly’s determinants of health by using appropriate models and approaches to provide realistic and practical suggestions to Molly. The rationale upon promoting Molly’s diabetic health need is due to the fact that, type 2 diabetes can cause severe complications such as retinopathy, kidney failure and cardiovascular disease. What is more, type 2 diabetes continues to increase in the United Kingdom and it is estimated to affect more than 5 million people by 2015 (NHS choices 2013)
Historic overview of health promotion was first highlighted by Florence Nightingale (1860) who noted the biomedical care given to patients and suggested the need to provide holistic patient centred care to patients (Piper 2010).
Notably, she recognized the importance of environmental factors such as cleanliness and nutrition to promote the health of patients (Piper 2009). Health promotion is a plethora of contested definitions. Therefore, over the years there have been considerable attempts to define this concept. For (WHO 1986) Ottawa Charter, health promotion is defined as a process of educating and empowering people to make healthier choices (Hubley et al 2013).
This definition implies that, health promotion is a holistic concept that emphasizes on the physical, social and mental wellbeing (Piper 2010) The nurse is the health professional that will be involved in promoting Molly’s health and wellbeing through evidence based theory and practice in addition to using various models and approaches (Piper 2009). This strategy will enable Molly and the nurse to individually and holistically express themselves, develop innovative plans suited to Molly’s health needs and promote effective communication between Molly and the nurse (Bowden and Manning 2006).
Communication is an important principle in health promotion as not only does it underpin the basis of holistic care given to patients but it also builds therapeutic relationships between the nurse and the patient (Bowden 2006). Communication is a fundamental concept in nursing that is defined as a skill of information sharing between the patient and other health professionals (Yulli et al 2011). In these circumstances, the nurse will communicate with Molly through various modes of communication which will include verbal, non-verbal and written communication. She will discuss with Molly on shared values and beliefs that is relevant to Molly’s health needs. Most important, communication in Molly’s case will go beyond information sharing to involving Molly in her own care by supporting her to make positive healthier choices in her life (Hubley 2013). Significantly, the nurse will adhere to ethical principles of autonomy, non-maleficence, beneficence and justice (Whitewood 2010).
There are several bio bio-psychosocial factors that contribute to the health and wellbeing of Molly. These factors can be well understood by using the bio-psychosocial model. This is holistic model that combines major determinants of health such as social economic status, biological status and psychological status to give a holistic view of an individual mental, physical and social wellbeing (Baxter 2010). The biological factors that contribute to Molly diabetic health need are her genetic susceptibility due to her family history (NHS choices2013). Her unborn child is also at a risk of inheriting the illness from her mother. Type 2 diabetes tends to run in families largely due to similar unhealthy lifestyle (Bowden and Manning 2006). Whereas Molly might have inherited type 2 diabetes from her parents, the development of this illness is also influenced by lifestyle choices (NHS choices 2013). Psychologically, Molly is at the risk of suffering from postnatal depression and stress due to physical demands of work and taking care of her family. This can consequently lead to mental illnesses (Hobart and Frankel 2009).
Psychological illnesses can affect Molly’s ability to self-manage her blood glucose. Apart from this, psychological instability can cause Molly to lose control of her diabetes with fatal consequences (NHS choices 2013). Molly is on a low social economic status as she is only able to work part time. Green and Tones (2010) contends that, low income limits access to nutritional food and housing which can consequently lead to poor physical health and social exclusion. Furthermore, Hill et al 2013 s proposes that, type 2 diabetes disproportionately affects people with limited resources. Perhaps this is because, low income earners are more likely to indulge in unhealthy damaging behaviours such as eating unhealthy food and lack of physical activity (Hubley 2013). If this were the case, Molly might not able buy healthy food or accesses those activities that address her health needs such as the gym and other social networks in her community. All these factors might hinder positive health outcomes.
According to (WHO 1986), health is defined as not only an absence of diseases but also a complete state of physical and mental wellbeing. In order to promote Molly’s health, a holistic approach is needed to address the bio-psychosocial the factors that affect her health and wellbeing. Therefore, various activities need to be undertaken by using appropriate theoretical approaches and models. Initially, the nurse should ensure that, Molly’s basic needs are meet first before moving up to the higher needs. Maslow (1943) proposed that, humans have hierarchies of needs. He believed that, needs such as food and water are meet first before reaching the level of self-actualisation (Hubley2013).
Having previously identified that Molly is on a low income which can affect her ability to access healthy food. The health promotion priority will be then to address this need before moving on to the other higher needs. The nurse should advice Molly on the help that is available for her to increase her earnings . For example, Molly would benefit from extended school that offer childcare and family support services (Larkin 2009). The importance of childcare would be that, Molly will be able to work more hours bringing in some extra income for her family. Consequently, she will be able to buy healthy food and engage in activities such as swimming or going to the gym. Significantly, this would reduce her risk of social exclusion and diabetes related complications (NHS choices 2013). However, it is important that Molly believes that, her positive health behaviours will prevent complications and help acquire good quality of life.
This will influence Molly’s willingness to take action (Yulli 2010). According to Health belief model by Rosenstock (1966), Molly will only take positive action if she believes that, she is susceptible to serious illnesses, believes that her type 2 diabetes is serious and believes that her positive actions will avoid the negative consequences of diabetes ( Yulli 2010). For instance, by doing physical activities it reduces her chance of her being obese and consequently reducing her risk the of cardiovascular diseases or even death (Coyle 2013). The Health belief model is useful in promoting Molly’s diabetic health need. This is because it organises the patients health status, views and points out the factors that that determines whether the patient will change their behaviour. Furthermore it provides a useful checklist that points out the issues that need to be addressed and the patient’s motivation to change their health ( Yuill et al 2010). Nevertheless, the Health belief model has not escaped criticism due to its individualistic way and ignores social influences (Hubley 2013).
For example, Molly low income status may influence her decision of whether or not she eats healthy food. Furthermore, it does not address psychological factors such as fear and denial that greatly influences human ability to take positive action towards their health (Hubley 2013) . For instance, Molly’s ability to engage in physical activities may be affected her pregnancy, emotions and social influences such as family and friends. Another activity that to be undertaken to promote Molly’s health is encouraging Molly to learn from positive role models that will motivate her to positively regulate her behaviour and reflect on her actions (Green 2010).
This can be learning from her family, friends or other people who have type 2diabetes but have successfully managed their diabetes through positive attitudes, behaviours and treatments. According Social learning theory by Bandura (1986), people actions are influenced by observing the behaviour of other people. He argued that, this promotes people self-esteem that in turn drives them to make positive changes (Green 2010). In these circumstances, the social learning theory is equally important in promoting Molly’s diabetic health need because it addresses the concept of self-esteem.
This is a key part of resisting negative influences and promotes self-efficacy and locus of control to do what is right by her health (Amdam 2012). Social learning theory importance should not be underestimated as it recognizes that, individuals do not exist in isolation (Amdam 2012). Despite this, it is criticised by biological theorists for its rejection of biological factors such as genes. Moreover, the biologist model challenges the social learning flawed assumption that, behaviours are learnt by contending that, behaviours are inherited but not learnt (Gyenscuico 2011).
Education is another activity that needs to be undertaken in order to promote Molly’s diabetic health need. The aim of education will be to teach Molly on self-management skills and to improve Molly’s knowledge on diabetic care (Bowden and Manning 2006). The nurse will use health educational model to modify Molly’s behaviour and actions through providing value-laden facts and information about type 2 diabetes . This may be done by giving Molly leaflets about type 2 diabetes, teaching Molly on how to control and monitor her glucose levels (Bowden and Manning 2006). According to education approach, if Molly have the necessary knowledge on diabetes, she is more likely to make positive decisions (Lawrence et al 2009). For Instance, by teaching Molly how her blood glucose is affected by food and exercise, she is more likely to eat more healthier food and be active in order to keep her blood glucose stable (NHS 2012).
One cannot ignore that education model is evidence based and not only does it educate the patient but it also gives skills to the patient. However, this model fails to consider environmental, psychological and economic constraints which affect individual’s ability to make choices (Lawrence et al 2009). Another limitation of this model is its simplistic view of cost-benefit analysis. It assumes that, if Molly is given the knowledge she will accept it unconditionally, weigh up the cost and then make a positive health choices for her best interest (Bowden and Manning 2006). What is more, its deterministic view point that, education is a must does and its top down approach does not give Molly much free will to make her own choices which the self-empowerment does (Bowden and Manning). The empowerment model gives the patient the free will through it advocacy of the individual concept of locus of control and self-efficacy to take control of their own health (Lawrence et al 2013). This model links to the activity of empowerment which is another activity that needs to be undertaken in in order to promote Molly’s health and well being .
This will be through Molly participating and taking part in all areas of decision making (Piper 2009). This model shifts the balance of power from the health professionals to the patient (Piper 2010). The empowerment model bottom up approach is a vital factor in empowering the patient (Bowden and Manning 2006). The empowerment will mean that , Molly is acknowledged as being a part of her health promotion and she will work alongside the nurse and other multi-agency teams involved in her own care (Yulli et al 2010). Perhaps this might raise her confidence and influence her ability to make healthier choices by taking responsibilities on her type 2 diabetes management (Hanlon et al 2012). The advantage of using the self-empowerment model in Molly’s scenario will be that, Molly will gain more control of her life and confidence to move towards healthier existence (Hanlon 2012). However, it fails to consider influences of power that may prevent Molly from making healthier choices (Hanlon 2012). For example, Molly’s husband might influence her ability to make choices. Moreover, it does not address social economic factors such as low income that can mean that, Molly’s primacies may be at odd with the priorities of the health promoting professionals (Bowden and manning 2006).
Finally, its acknowledgment of the self-determination means that, Molly might exercise her free will and choose unhealthy eating behaviours that might place her at risk or even death (Dean and Irvine 2010) One cannot ignore the benefits of health promotion in Molly’s scenario is a useful tool to educate, motivate and empower Molly to make positive changes towards her health. However, health promotion can be problematic at times. This is due to the dangerous assumptions of the health promoters focus on health issues ignoring that, people have various motives to change their behaviours and health might not be one of them (Scrive 2010). For instance, for Molly diabetic health need might not be her prime motivator to change her lifestyle. Another criticism of health promotion is the ever changing health advice for patients due to research that is always finding new evidence (Amdam 2011). In these circumstances, patients have barely enough time try one treatment or advice before they can adapt to another. This affects the efficacy of health promotion (Scriven 2010).
Evidently, the media contradicts the health promotion advice which is based on facts due to its focus on controversy rather than facts which can be confusing for the patients (Amdam 2011). Furthermore, the health promotion in Molly’s scenario raises this question. If Molly decides not to change, does it mean that the health promotion in her case has failed? The challenges of effective health promotion require actions at all levels starting at an individual, community and at a government level (Scriven 2011). Therefore, to successfully, promote the health of an individual, it is necessary to have an approach that combines all these levels together as they all influence the effectiveness of health promotion ( Amdam 2011). To conclude, health promotion is defined as a process of educating and empowering people to make healthier choices.
Molly’s health is influenced by various determinants of health that are linked to her social, biological and environmental conditions. The health promotion emphasis is to tackle such determinants of health through evidence based practices that combines various theories and approaches. These theories and approaches are tied up with practical activities that are aimed at changing Molly’s lifestyle and behaviour to promote her health.
The importance of health promotion should not be underestimated at it educates and empowers the patients to make positive actions towards their health. Nevertheless, health promotion is plagued with challenges such as contradicting health advice that affects the efficacy of health promotion. These challenges affect the most vulnerable people such as Molly. It is therefore important that the health promoters recognizes these difficulties and address them accordingly. Finally, it is recommended that, future health promotion professionals address the deficit of the lack of an approach that tackles health promotion at an individual, community, government level to ensure the effectiveness of health promotion.
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