Health promotion is defined by Simnett (1995) to be “an umbrella term for a very wide range of activities which enhance good health and well-being and prevent ill-health, this includeincludes health education and health information, and preventative medical measures”.
In attempting to establish critical thoughts regarding defining mental health promotion it is first necessary to establish a shared understanding of what it is to be mentally healthy and to experience wellbeing. Presently most of the debates have focussed on mental illness rather than on mental health, being concerned with conditions such as anxiety, depression, and schizophrenia.
Less consideration has been given to issues of well-being, such as isolation, loneliness, low self-esteem, and fear, which are often deliberating and have a direct effect on the mental and physical health of individuals. Predisposition as well as the conditions in which individuals and communities live and interact, directly affects their mental health, according to Heer and Woodhead (2002).
To facilitate meaningful debates across professional and sector boundaries, there is a need to address the problem of language and conceptual frameworks in relatiaboutealth promotion.
This could be achieved by involving communities, and taking account of lay perspectives (The Sainsbury Centre for Mental Health and Mentality 2001) This essay focuses on the National Service Framework (NSF) for
Mental Health. This indicated seven standards of treatment and care that people will be entitled to expect throughout the country. Standard one addresses mental health promotion and tackles the social exclusion and discrimination aligned with mental health problems. This mental health promotion activity will be founded on ‘standard one’ because it was intended to combat discrimination against the patienpatient with mental health problems and to promote social inclusion.
Although standard one aims to ensure health anthe d social services reduce the discrimination and social exclusion associated with mental health problems, however,r there are countless incidents (as stated by the mass media recently) of individuals with mental health problems being sent to prison (for menial/insignificant crime) one wonder if this is a way of avoiding the problem.
For this account, the patient’s name will be altered and he shall be referred to as Alonzo, in keeping with the confidentiality clause of the Nursing and Midwifery Code of Professional Conduct, “to protect all confidential information regarding clients obtained during professional practice” (NMC 2002). Alonzo is a 28-year-old male with a psychiatric history of schizophrenia. He was recently discharged from the hospital and was maintained in the community by a four-weekly Flupentixol Decanoate depot injection, administered at home (his Parent’s home) by his community psychiatric nurse.
The health promotional activity that the qualified mental health nurse devised for Alonzo was an exercise that included walking and playing squash’. The walking consisted of walking (four blocks) a distance of 800 meters to the local Leisure Centre, this would take approximately 10 minutes, then they would engage in a game of squash for 1 hour, After which they would have light refreshment, then walk back to his home. The exercise activity would address not only Alonzo’s physical needs but also his cognitive and psycho-social emotional development. Alonzo would learn how to develop appropriate social behavior(i.e. self-inclusion, coping skills, improving competence, stress management, healthy competitiodevelopmentdevelop sself-confidence enjoyment, and success).
The rationale for using this health promotion activity was becauseAlonzos had become withdrawn his presentation was that of apathy, and sadness and he lacked emotional resilience. Therefore by engaging the patient in walking and exercise the nurse hoped to have participateating in activities outside his home, which also facilitated the patient in taking charge of his activities of daily living (i.e. getting out of bed, attending to personal care, adorning the appropriate clothing, having breakfast, managing time – to be ready when the nurse arrives). This strategy not only gives autonomy to Alonzo but also integrates the nurse’s major goal and action sequences into a cohesive whole Quinn (1992, in the Strategy process). By getting Alonzo outside his home the nurse had intended to re-integrate him with his social networks thereby addressing his psychosocial needs, and allowing him to develop efficient communication skills. Participation in the activity would aid in dismissing the stereotype and reduce the stigma associated with mental illness (i.e. mentally ill people are: – lunatics; likely to display movement disorders and dyskinesias, incoherent; zombies, addoesmentally individualsproviderdualsot behave like mentally stable individuals) because Alonzo would be integrating appropriately within the wider society, and therefore would allay concerns and fears that mentally ill individuals are a menace to society. The activity would also facilitate the reduction of stress and lift his mood. In supporting this recent research literature suggests that there is now ample evidence that a definite relationship exists between exercise and improved mental health. This is particularly evident in the case of a reduction of anxiety and depression. For these topics, there is now considerable evidence derived from hundreds of studies with thousands of subjects to support the claim that “exercise is related to a relief in symptoms of depression and anxiety” Craft (1997).
Regarding the concept of health promotion needs the nurse had defined Alonzo’s as normative. A normative need is defined by a professional or expert according to their standards; if a patient falls short of those standards it’s concluded that there is a need. However, there are limitations with this concept because the values and judgments of the professional experts dictate its basis. This could prove detrimental, because not all expert shares the same opinion regarding acceptable standards, and their values and standards may differ from that of their patients. This is how the nurse considered that limitation when she allowed the client to give some feedback following the explanation. Therefore the patient expressed by expressed agreement to an expressed need, and an assumption was made that an expressed need was also considered following on from the normative need assessed initially.
Standard one of the NSF was aimed at addressing Alonzo’s needs as stated. However, does it balance the need for skills, with the need to explore the purpose of the behavior, and the psychological or social needs of the client, rather than focusing solely on the development of skills for managing behavior? Is it culturally aware rather than conforming to a dominant culture, and do these national strategies improve the health of those worst off in our society?
The nurse used the assessment to ascertain the impact of Alonzo’s isolative behavior on his psycho/social wellbeing. The tool she used was the Hamilton Rating Scale of Depression (HRSD) it is appropriate for patients diagnosed with depression and is an observer-rated scale used to assess the presence and severity of depressive states where anxiety-related symptoms are prevalent. Following on from this, the type of prevention that was identified was a Tertiary intervention that aimed to reduce the deterioration of Alonzo’s mental illness through personal coping strategies.
The aim as stated by the nurse was to reestablish Alonzo’s social networks and communication through education on the benefits of exercise and its impact on his self-confidence.
Ewles and Simnett (2003), stated that “objectives are the desired end state (for result, or outcome) to be achieved within a specified period. They are not tasks or activities”. The strength of an objective is that; it increases the patient’s knowledge, and facilitates the acquisition of practical skills thereby enabling the patient to do a specific task; is concerned with attitudes, beliefs, values,s, and opinions – how people feel. Objectives should be written specific, measurable, attainable, realistic, and within a specific timescale. Therefore the objective is for Alonzo to develop self-confidence, and be able to discuss with the nurse his feelings and views of how having been engaged in the exercise, has helped his self-image and self-confidence during the four weeks time frame.
The resources that were used during the activity were;- the local leisure center Alonzo was escorted by the nurse and the student to the local sports department store to procure jogging gear (trainers, jogging pants, and sweat-shirt) funding came from his unemployment and disability benefits entitlements. The nurse and the student had aan ppropriate change of attire to participate in the exercise on the specified days.
In the implementation and planning stages, incorporation of the educational and clicking-centeredproaches was used, this was justifiable because they both ensured that Alonzo had knowledge and understanding of his health issue, and helped him in making an independent decision according to his own choices, values, and interests. Ethically they promoted his autonomy and self-empowerment, which aided in the development of hispsychosociall wellbeing, i.e. his fears and worries were consoled by the nurse whose intervention aided in the maintenance of coping strategies. The weakness in using these models could vary from differences in approach to incompatible between a patient withaprowith a provider withwith a health promotion provider the, i.e. a patient wanting to be told what to do, and a health promoter who is adamant about empowering the patient with information to make his own decision. While the model was useful in providing information, and knowledge, and encouraging independdecision-makingking on the other hand it was questionable because it gave the patient too much autonomy, and the possibility exists that the client could manipulate the situation.
The student noted that during the implementation of the activity the nurse had included some principles of adult learning, based on research by Malcolm Knowles and many others, which emphasized that “adult learners do best when they are involved and are treated with respect and dignity.” (Ewles and Simnett, 2003: 231). This approach indicated the importance of the participative learning method. As stated by Carl Rogers.
Observations were made as to difficulties that were encountered during the inception of the health promotion activity; initially, Alonzo was hesitant about leaving home; he awoke late; tried to give various excuses for not being able to engageHoweverve,r the nurse was very tactful in her response, being aware of his limitations she utilized the first two ‘planned’ days by informing Alonzo of the need to get back to his former social interacting ways – to start communicating with his friends and colleague, and that by doing so it would set the stage for reintroducing him back to his community, during her conversation the student noted that the nurse had used aspects of the health action model, devised by Tones to support the educational approach, in using Alonzo’s self-esteem to influence his behavior. An important comment by the nurse “that Alonzo could help protect her when they go out to jog” made an impression on him, and aided in his participation. The exercise activity entails meeting Alonzo at his home every Tuesday and Thursday for four weeks, from 10:00 am to 11:30 pm. They would then do a power walk (walking briskly to promote aerobics qualities, and good cardiovascular activity) to the local Leisure Centre – located 800meters from his home (the squash session would have been pre-booked) on arriving there they would engage in games of squash for approximately one hour, after which they would have light refreshment, then back leisurely to his home (engaging cooling down techniques after the exercise session)
Regarding evaluating the activity; – evaluation is the process of assessing what has been achieved (whether the specific objective hahaseen met) and how it has been achieved. This means critically assessing the intervention, stating the good and the bad issues, and how to improve such. This could either address the process (how was it achieved) or the outcome what was achieved). (Simnett 1995). In the process evaluation, it was observed that the nurse had used a modest method of evaluating Alonzo, she had arbitrarily elicited how Alonzo felt, what he would do better, and if there were anything that he would like to state, thereby linking the educational and client-centered approach regarding working with psychosocial and health issues, the choices and actions that Alonzo identifies; exploring his attitudes (if he felt confident) and the development of skills required to develop self-confide nce. Concerning the outcome evaluation, at the end of the fourth week, Alonzo stated “the exercise activity had helped me go to sleep more quickly, I sleep longer, and I have a more restful sleep. It had also aided in my self-confidence, I feel more involved and I am no longer having panicky feelings. My head had become clear and I no longer suspected nor avoid others”. Therefore can state that the aims and objectives of the initial assessment were achieved progressively, comparing Alonzo’s ideation before engaging in the health promotion activity. If however, Alonzo had decided that did not want to actively participate in the activity, he would not have had the setting to permit self-disclosure, reflection, encouraged feedback, and the development of his perceptions, which is evidence of his personal growth and development.
On reflection, I learned that it is crucial for educators to use the principles of adult learning when working withadultst and to appreciate the importance of participative learning. Regarding the assessment; planning; implementation; a working partnership between the nurse, patient, and myself, I believe the nurse had used her skills expertly and creatively, and that the tools and approaches used were relevant and appropriate for the promotpromomentaltionthein wmentalntal health of the cliche ent.
In conclusion, the essay looked at the health promotion activity relevant to mental health nursing, which involved a client who had become withdrawn and lacked emotional resilience. A key point highlighted in the essay was the need to use the principles of adult learning and the importance of participative learning methods when addressing adults. The essay was based on a combination of the educational and client cantered approaches.