MODULE 4

Chapter 9: Nursing in Primary Health Care and Health Promotion

Themes Defining the roles and responsibilities of nurses in health promotion
Objectives - By the end of the chapter, you should be able to:
Understand your roles and responsibilities in promoting health
Identify obstacles for primary health care nursing
Discuss how nurses beliefs and attitudes could influence their practice of health promotion

CONTENT
Nurses roles and responsibilities in promoting health
About a decade ago, nursing literature that focused on the practical or applied aspects of health
promotion in nursing practice was scarce. Nursing texts and nursing curricula typically followed
the medical or disease model focusing on the treatment and diagnosis of disease. Most nurses
enter nursing schools that do not specifically educate them about health promotion. The skills
they acquire in nursing school are often related to acute care. Those who have not studied public
health nursing may find themselves particularly disadvantaged in the area of health promotion.
Nurses are in the ideal and best position to assume the role of health promoter as our expertise
and knowledge receives high credibility from the public. Nurses are often in close and frequent
contact with patients, families, caregivers and the community. However, our expertise is not
fully substantiated if we only confine ourselves to roles related to traditional patient care without
positively influencing the health-promoting behaviours of our clientele.
Today, nurses should never limit their nursing responsibilities to what was learned in nursing
school. Nurses need to work proactively to be sure that our roles are also seen as health
promoters and prevention specialists. Nurses need to see their roles as holistic and expand their
view of nursing. We must learn other new skills that are considered integral to contemporary
nurse practice. Nurses must be multi-disciplinary. The skills they need to acquire include
emergency care, illness assessment, psycho-social nursing, counselling, behavioural science,
health promotion, statistical analysis, advocacy, presentation skills, political activity and
knowledge, marketing, publicity, family intervention and community needs assessment. Today,
nurses should see themselves as prime movers for change. We need to be alert to trends and
changes in all sectors of society and understand how these could affect the health of the
population.
Nurses working in acute care often have the misconception that health promotion is the
responsibility of community health nurses. In fact, there are various avenues for health
promotion in hospitals. Examples are patient and caregiver education and counselling
services, clinical rehabilitation programmes, self-help groups and community wellness
services. Moreover, health promotion initiatives such as improving and encouraging
occupational and safety practices in hospitals and participating in staff wellness programmes are
considered extremely valuable.

Examples in Hong Kong

Traditionally, health promotion activities are an additional responsibility for most practitioners.
Recently, health promotion has been discussed as a concept that needs to form part of all nursing
activities with patients. For this to be successful, health promotion needs to be seen as a
complete strategy, not as a series of one-off activities. In Hong Kong, an acute regional hospital
in the New Territories collaborates with some schools in the cluster area to promote health. The
hospital nurses act as health advisors to the schools to impart health knowledge and assist in
organizing health promotion activities. This is considered a breakthrough, as the focus of
nursing is on health but not illness. Moreover, health is being recognized as multidimensional.
These hospital nurses cross the border between acute care and working with the community.

The School of Nursing of the Hong Kong Polytechnic University is the WHO collaborating
centre in health promotion.

Identify obstacles for primary health care nursing

Role complexity
We can no longer disagree about obstacles to primary health care nursing. First of all, the
designated role is complex and requires the provision of a high level of nursing care. The nurse
needs to be skillful in both technical and communication skills. However, it is unreasonable to
assume that all nurses are competent in this regard. It is important that nursing colleagues are
supported as they face changed situations. Importantly, we need to face the changed nursing
reality rather than resist it.
Special responsibilities
Laffrey & Page (1989) stated that despite recognition of the value of illness prevention and
health promotion, community nurses focus nursing care on individuals and families to solve
specific health problems. If nurses working in the community do not focus on total community
care, they are not considered to be fulfilling the potential of public health nursing to the
community. Besides, there is the impression that nurses working in specialty areas such as
intensive care units are more competent than nurses working in primary health care settings.
Role confusion
Since the traditional role of nurses is deeply rooted in the minds of everyone, role confusion is
considered a major obstacle for nurses when organizing health promotion activities. Nurses,
regardless of whether they work in the community or in hospitals, face challenges when
collaborating with other professional disciplines. Frustrations arise when members of the team
do not understand their new roles. Difficulties can emerge over role boundaries over the care
provided by the team. In this situation, nurses need to be flexible and flexibility causes
challenges and frustrations at the same time.
Lacks of skill training
There is a need to change nurses attitudes to enable them to work better with groups in the
community, with other professionals on the health care team and with members of society at
large. Opportunities should be provided for the development of professional autonomy, skills in

working with a diverse range of professionals and the community, managing uncertainty and
monitoring health gains from new nursing interventions. In addition, changes in nursing
education are needed. Nursing practice and management need to be able to cope with the everchanging professional roles. In order to bring about changes, nurses must seek ways to influence
governments in their own countries to take a series of actions.

How nurses beliefs and attitudes could influence their practice of health
promotion
Nurses serve as role models for many of the people with whom they come in contact. Through
their own behaviour, nurses influence the behaviour of others. The nurses role as a model is not
confined to influencing the health related behaviour of clients. Nurses also serve as role models
for other health care professionals. It is understandable that the role modeling function is of
primary importance. Therefore, the issue needs to be addressed in nursing curricula that prepare
nursing students for that special role in their careers.
Callaghan & colleagues (1997) stated that in order to meet their obligations as health exemplars,
nurses have a duty to engage in healthy lifestyle. There has been research evidence of a link
between the health practices of health professionals and their behaviour towards clients in their
care. It has been reported that patients who are non-compliant in their health promoting
behaviours may be influenced by the non-compliance of those caring for them. Moreover, there
is a link between nurses personal health habits and their tendency to counsel patients about
health issues. The study showed that in the areas of breast self-examination, cervical screening
and physical exercise, Hong Kong nurses might jeopardize their own health. This brings into
question their obligation to fulfill this important requirement in their nursing role.