Health promotion by nurses for older persons in hospitals

Introduction: For many years, health promotion and its aim to enable people to control and improve their health situation, has been a recommended task throughout the different health professions. This dissertation describes the actual situation with regards to health promotion (HP) by nurses of older persons’ aged 65+ in acute hospitals in Switzerland. Described are the theoretical and practical expectations of health care experts with regards to nurses’ HP for older persons in acute hospitals. Furthermore, the clinical nurses’ experiences and the hospitalised older persons’ perceptions of the performed HP activities in the daily clinical life have been recorded. Additionally, older persons were asked to explain their needs and requirements concerning HP performed by nurses at the hospital. Aims: The objective of this study is to answer the question: do the competences of nurses’ HP, which are required by health care experts’, meet the older persons’ needs and do they correlate to the actual situation of the daily clinical work of nurses at the acute hospital setting. Material and Methods: For this dissertation, the mixed method research (MMR) design was selected. The multiphase design consisted of two phases; phase 1 was guided by the explanatory sequential design and phase 2 by the convergent parallel design. Each new approach was developed on the results of the previous phase of the study. Phase 1 included two separate interactive strands. The first strand consisted of a Delphi survey, identifying the opinion of health care experts on the HP by nurses for older persons 65+ in an acute hospital setting. The data collected from round one was analysed and adapted using a qualitative content analysis. The results from the questionnaires in the following two rounds were analysed using descriptive statistics. The second strand included two focus group discussions with bedside nurses working in an acute hospital setting. In this strand, the data collected was qualitatively analysed using the documentary method by Ralf Bohnsack. Phase 2 included face-to-face interviews with older persons, during their hospitalisation and after discharge. In strand 3 the open-ended interviews were evaluated using the concept of qualitative content analysis developed by Mayring. In strand 4, the interviews conducted using a structured questionnaire were analysed separately again using descriptive statistics. The overall analysis was performed deductively, using a part of the PRECEDEPROCEED model as defined by Green & Kreuter. Findings: The nurses’ studies described the ‘expected’ and the ‘experienced’ nurses’ role in HP of older persons in an acute hospital. The summary of the findings from both studies defined that; health promoting nurses support older patients by assessing their needs and resources, they further enable the patients through counselling and health education, thus improving their autonomy and ability to cope with the changing circumstances associated with their ill-health and daily life situation. The healthcare experts participating in the Delphi survey described the knowledge, skills and attitudes required by a HP nurse in more detail. Although the health care experts declared HP was an integral part of nursing for all patients at any age, the findings from the bedside nurses’ study clearly indicated the minor relevance of nurses’ HP in daily clinical life. Furthermore, the bedside nurses identified the additional challenge of integrating HP interventions with the patient and their relatives. The bedside nurses stated that nurses act as an intermediary and delegate the responsibility of identified HP problems to experts. The findings from the older persons study show that the patients appreciated the HP advice given by the nurses, but their relatives did not receive the joint HP counselling as expected. The findings of the study confirm that HP by nurses in acute hospitals was important and meant a lot to the participating older persons. The majority of the elderly acted upon the HP advice given and added that further counselling by nurses’ would have been appreciated. Discussion: The actual situation of nurses’ HP for older persons at the hospital has to be considered in relation to the commitment given to, and by, the nurses practising HP. This includes the defined competences of nurses’ HP, the shared decision making and the integration of the older persons’ family, the interprofessional collaboration, including the hospital management, nursing education and further research. Due to methodological limitations of this study, the findings have not been generalised but do indicate further directions to follow up on. Conclusions: The findings clearly indicated that there is a gap between the theory and the practice of nurses’ HP. If HP is to be an integrated part of professional nursing, as expected by the older persons and as required by the health care experts, the commitment to HP has to be improved and reinforced by all of the concerned parties. This is of upmost importance as the findings of this study clearly indicated that the daily clinical practice does not fulfil expectations. Specifically, there needs to be a clearly defined and agreed upon framework of nursing HP so that all the engaged parties, involved in the interprofessional collaboration know and understand what their objectives are; that they are able to discuss any issues or challenges and can be rewarded appropriately. Finally, it is essential that the nurses and older persons along with their families make shared decisions during the planning, performing and analysing of health promotion activities. This is an absolute requirement to improve the quality of health promotion and quality of health in general.