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Health Promotion

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Health promotion empowers people to increase control over, and improve their own health (WHO, n.d.). This essay will highlight the importance of health promotion, particularly in the emergency department with regard to the trending topics discussed in the online forum. The primary focus will be on asthma and hand hygiene in relation to health promotion and the role of the nurse. A recurring theme on the forum was that the emergency department is no exception to holistic patient care, including patient education, which can lead to a decrease in avoidable presentations. Recommendations will be made for implementing these health promotion strategies in the emergency department.
Asthma is a chronic multifactorial inflammatory disease of the airways, affecting approximately 2 million Australians. Asthma was deemed a preventable presentation in emergency departments when high quality care and education was delivered (Newton, Osei-Akosa & Strunk, 2007). The Global Strategy for Asthma Management and Prevention Initiative designed a simple four C strategy of patient education - Choose, Check, Correct and Confirm. While the focus is based on inhaler use, the four C strategy can be altered to suit most presentations (Bateman, Hurd, Bames, Bousquet, et al, 2015).
One of the major causes associated with uncontrolled asthma and subsequent emergency department visits was improper inhaler technique (Tapp, Lasserson & Rowe, 2007). As patients can spend many hours in the emergency department receiving inhaled and nebulised medications, there is ample opportunity for nurses to provide appropriate and individualised education. I believe adoption of the four C process, if implemented correctly, can provide high quality education and care. In regards to asthma, the four Cs involve assisting the patient in choosing the correct inhaler, checking correct technique with the patient and caregiver, correct demonstration and confirming that correct use is maintained (Bateman, Hurd, Bames, Bousquet, et al, 2015). The incorporation of the four C strategy follows criteria for Practice Standard 2, communication of the emergency nursing standards (CENA, 2014).
Sufficient training in self management is associated with improved health and a decrease in emergency department visits (Newton, Osei-Akosa, Strunk & Krauss, 2013). Nurses in emergency can be involved in this training by encouraging the patient to use and update their action plan, detect deterioration and use medications correctly (Asthma Australia, n.d.). The latter two provide a guideline of a nurse’s focus at the bedside, probing education topics and appropriate resources (Tapp, Lasserson & Rowe 2007).
Current nursing practice in my clinical workplace is to manage mild to moderate asthma attacks with nebulised salbutamol. However, evidence shows that the use of metered dose inhalers (MDI) with a spacer is a preferred alternative, especially in children with decreased tachycardia and tremor (Cates, Rowe & Welsh, 2013). The use of MDIs with spacers gives emergency nurses the opportunity to provide education on correct inhaler technique. As such I believe it may be beneficial for emergency departments to adopt the MDI technique, particularly in paediatrics.
In my experience improper inhaler technique is common and greater health promotion could result in a decreased number of asthma presentations. I recommend empowering patients and families by providing access and awareness of resources. Asthma Australia’s website provides brochures, fact sheets and videos and the National Asthma Council Australia website provides asthma plans. The National Asthma Council has designed a phone application which provides information including medication management, demonstration videos and a symptom journal. These resources can be used to complement education given in emergency.
Hand hygiene is the primary measure in hospitals to reduce the spread of infections (White, Starfelt, Jimmieson, Campbell, et al, 2015). While hand hygiene is not the cause of presentation to emergency, non-compliance with hand hygiene can lead to adverse effects for the patient. Health care associated infection rate is increasing and can lead to many adverse outcomes for the patient and health system (White , Starfelt, Jimmieson, Campbell, et al, 2015).
The four C process can be easily adapted as a guideline for hand hygiene education. Choosing the correct solution, checking of technique, correctly demonstrating and confirming the technique is maintained. Patients must also be aware of when hand hygiene should be performed and feel comfortable to educate others (GINA, 2015).
Education, particularly formal education involving infection control has indicated a significant improvement in compliance of health care workers (WHO, 2009). This implies that providing formal training could improve the compliance of patients and visitors hand hygiene. After completing a formal hand hygiene auditing course I greatly improved my own compliance. Combining both evidence based practiced and personal experience I recommend greater access to formal education.
My current emergency department has a large number of computers in the department facing high traffic areas. With this in mind, I would suggest the use of Hand Hygiene Australia’s online resources. They provide a computer screen saver which displays the “5 moments of Hand Hygiene” videos (Hand Hygiene Australia, n.d.), providing a visual prompt and education to staff, patients and visitors. Promotion and encouraging the use of online learning modules as well as posters around sinks and bed spaces would also be a valuable tool.
The online discussion raised a variety of topics surrounding health promotion, to which many of the responses provided education and practical examples of health promotion used in different facilities. I believe the underlying message is that some of the best health promotion we as nurses can provide is addressing the topic with the patient and ensuring sufficient understanding and rationale. Health promotion is a vital part in illness and disease management, in which nurses play a key role. While the emergency department is often a busy environment, each nurse has the responsibility of providing patient education and achieving health promotion with every patient.…...

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