Unit 3: Health Promotion and Family Nursing Practice

3.1 Overview

Historically, the focus of health professionals' work with families has been in the areas of medical care and disease treatment. Only recently has increased attention been allocated to health promotion. Although health promotion may be the most complex and difficult area in which to intervene, the potential benefits are thought to justify the necessary efforts. (Bomar, 2004, p. 69)

Family has been identified as an important place for individuals to learn about health promotion, protection, and maintenance. Whereas disease prevention and health protection are oriented towards avoiding specific illnesses and disabling conditions, health promotion is more generally oriented toward growth and well-being, not merely avoiding disease. While health promotion involves "approach" behaviours, disease prevention addresses "avoidance" of risk behaviours (Friedman, 2003). The specific measures associated with disease prevention have been a more manageable focus than the compelling, yet complex, all-involving nature of health promotion measures.

Traditionally, family nursing models and family health assessment tools have been designed to measure both the strengths and deficits of the family. The information collected is analyzed and a nursing diagnosis is formulated usually around the problems and risks that face the family. With this determined, the plan that follows is usually driven by the health professional to 'fix' the problem and eliminate the risks.

Three commonly used family health assessment models are introduced in this unit because it is important to know 'what's out there.' A fourth model, the Allen Developmental Model of Health and Nursing is also introduced. Commonly called the McGill model, this approach is unique because it focuses both on health as a potential the family wants to attain and on ways that the strengths and resources of the family can be further developed so they can do what is important to them. No attention or language is given to the problems or health deficits of the family. While the other models give way to health protection and disease prevention measures, the McGill model is driven by health promotion alone.

3.2 Preliminary Reflection

If you asked someone in your family, a friend, or a co-worker to tell you what health meant to them what do you predict they would say? What would you say if someone asked you what health meant to you? Many Nursing 436 students who have asked families for their definition of health have discovered that many still speak about health as the absence of disease and illness. Almost sixty years ago the World Health Organization (1948) defined health as "a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity." (http://www.who.int/about/definition/en/).

Thirty years ago the Canadian government landmark position on health, A New Perspective on the Health of Canadians (Lalonde, 1974) claimed health was the result of a combination of variables including biology, lifestyle, environment, and health care services. Why do you think that after all these years health is still defined in terms of 'not being ill'?

3.3 Optional Conference Posting

Describe what you discovered when you asked someone in your family, a friend, or a co-worker for their definition of health. How many referred to what health is not, that is, 'the absence of illness'? How many tried to explain it in terms of something more?

Please Note: Your tutor may or may not read your postings in the optional conference forums. If you have questions that you would like your tutor to respond to, please send them to him/her in an e-mail using Course Mail.

3.4 Learning Outcomes

When you have completed this unit you should be able to:

describe the primary, secondary, and tertiary levels of prevention that constitute the major goals of family nursing.
explain the difference between health promotion and health protection/disease prevention measures within the primary prevention level.
explain how the nature of health outlined in Allen's Developmental Model of Health and Nursing serves as a basis for health promotion in family nursing practice.
compare the Situation-Responsive model of nursing practice to the a priori model of nursing practice outlined by Allen and Warner (2002) regarding the following points: focus (problem), unit of concern, perspective, assessment, plan, time frame, and evaluation.
describe how each of the five essential ingredients identified by Gottlieb and Feeley (2005) contribute to a collaborative partnership identified by Gottlieb and Feeley (2005).
compare the similarities, if any, and the important differences between a nursing stance with a focus on a health problem and the related risks, with one that looks at the potential(s) for health within a family that can be attained through the further development of their strengths and resources.

3.5 Learning Activities

The following activities are different and enriching ways to learn the content so you can attain the learning outcomes for this unit. The required reading is essential for your learning in this unit. The other activities are optional and have been suggested to make your learning more interesting and fun.

3.5.1. Go to Canada Health, Health Promotion Online http://www.hc-sc.gc.ca/english/for_you/hpo/index.html.What kind of focus, if any is given to the role of family in the health promotion resources described?

3.5.2. Read about the most recent strengths-related research in the article entitled, No expiry on dreams by Dr. Laurie Gottlieb (2005). Dr. Gottlieb is a professor in the McGill School of Nursing and has helped develop and research the Developmental Model of Health and Nursing http://www.mcgill.ca/reporter/37/09/gottlieb/

3.6 Readings and References

Required Reading

* You might consider taking notes that relate to the learning outcomes for this unit as you read through these references.

Allen, M., & Warner, M. (2002). A developmental model of health and nursing. Journal of Family Nursing, 8(2), 96-135.

Feeley, N., & Gottlieb, L. (2000). Nursing approaches for working with family strengths and resources. Journal of Family Nursing, 6(1), 9-24.

Ford-Gilboe, M. (2002). Developing knowledge about family health promotion by testing the developmental model of health and nursing. Journal of Family Nursing, 8(2), 140-156.

Gottlieb, L., & Feeley, N., (2005). The collaborative partnership approach to care: A delicate balance. Toronto: Elsevier Canada. Chapter 1 & 2.

Optional Reading

Hartrick, G., Lindsey, E., & Hills, M. (1994). Family nursing assessment: Meeting the challenge of health promotion. Journal of Advanced Nursing, 20(1), 85-91.

Loveland-Cherry, C., & Bomar, P. J. (2004) Family health promotion and health protection. In P. J. Bomar (Ed.), Promoting health in families: Applying family research and theory to nursing practice. Philadelphia, PA: Saunders, Chapter 3. (Available as Athabasca University loan)

3.7 Optional Post-Reading Reflections

3.7.1. Consider the following situation:

Mrs. Jane Smith arrives in tears in the hospital emergency department. Her youngest child, two year old David Jones has burns to his upper chest and left arm after overturning a frying pan of bacon on the stove. David is crying, as is his three year old sister, Jessica who was not injured in the accident. While David is being examined by a physician, Mr. Robert Smith arrives in the examination room. There is a slight odour of alcohol on his breath. The tension between Mr. and Mrs. Smith is obvious. He tries to pick up Jessica to quiet her but she resists his attempts, crying for her mother to hold her instead. Mrs. Smith takes Jessica and says to her husband "You never wanted to be a father to these kids. If you did you would spend less time watching TV and drinking beer and more time with them. Maybe this wouldn't have happened then." Mr. Smith replies angrily "I wasn't even there. Don't blame me because you can't keep an eye on your own kids."

It is clear that David will need to be admitted for treatment. During the admission interview, Mr. Smith is visibly dejected. He has been unemployed for three months and states that their home life has gone 'downhill' ever since that happened. He and Mrs. Smith have been married for one year and Mr. Smith states that prior to his unemployment "things were going along quite well. We were getting along and the kids were really starting to like me. They are my kids now, too, you know. I can't believe this has happened."

Since her husband lost his job, Mrs. Smith has been able to work part-time as a sales clerk. As the interview continues, she blames herself for rushing supper and not paying enough attention to the children while they were underfoot. She looks at Mr. Smith and says "I didn't mean what I said earlier. I was just so upset. It wasn't your fault at all. I should have been more careful." Mr. Smith responds "Well, I could have been there helping you. I should have been watching them." Jessica has settled down a little and is sitting quietly now on Mr. Smith's lap. She looks up at Mr. Smith and asks if they can sit closer to David.

What concerns did you initially have for this family? What were the problems? What were the reasons for those problems? What was your initial response about what could be done about the problems?
What strengths become apparent in this family as the scenario unfolds? What hopes do you think they have for themselves as a family? What do you think they will most likely do to reach these hopes?
What happened when you switched from looking at the problems and what this family was doing wrong to looking at their potential as a family and what they were doing right?

3.8 Evaluation of Your Learning

The following is one of the options you can choose to complete the Critical Thinking Question Discussion (Assignment 2) in the course. If you have not already done so, review the guidelines for Assignment 2 outlined in the course Assessment.

You are asked to debate whether or not families are in the best position to determine their own health goals and to attain them through identifying and further developing their strengths as an egalitarian partner with a family nurse. Which side would you prefer to debate and what evidence would you use to support your position?

If you have any questions about your approach to this Critical Thinking Question, you are welcome to contact your tutor through Course Mail.