Commentary on 'Child in hospital: family experiences of how nurses can promote family health

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On reading the title of Hopia et al. (2005) article, I was particularly looking forward to this account of their family- related health promotion study and, by the end, had enjoyed reading it and commend them for the intent of their research. However, I was disappointed by the feeling that this study represented an opportunity lost. Admittedly this study did achieve what it purported to do – namely investigate the perception of the child/family as they related their illness experience against their received nursing contribution during hospital admission – but it failed to apply this to a claimed health promotion context. Subsequently, the study’s reference to various domains of family health promotion is somewhat misplaced in their type of investigation. Hopia et al. (2005), in their article, claim that hospital- based nurses are in regular contact with the child and family and, therefore, are in a ‘better position’ to promote family health than other healthcare professionals. However, I would argue that this is only the case if these hospital-based nurses are in a position to step outside the ‘traditional’ boundaries of institutional-based health care – which does not appear to have been the case in this study. Its parameters indicate that this was more a localized ‘naval-gazing’ exercise to explore the role of hospital nurses as perceived by their charges. In essence, it had nothing to do with any mentioned health promotion intervention or programme. I have published several articles that aim to conceptualize what it is that nursing-related health promotion and health education activity is and is not (Whitehead 2001, 2003a, 2004a, Whitehead & Russell 2004). I have also published on the matter of the hospital as a health-promoting setting and offered guidelines against the efforts of the European Health Promoting Hospitals movement (Whitehead 2004b, 2005). I would conclude that this study is definitely not grounded within a health promotion context. To even categorize it within a health education context is doubtful as there is no implemented health-programme intervention or outcome to speak of. I believe that the study authors already have insight into this as the final concluding statement indicates that, following on from their study, new methods should be applied to similar proceedings – namely they suggest action research. Again, I and colleagues have published on the pretext that action research is perhaps the most suitable method for implementing and evaluating organisational-wide health promotion programme reform (Whitehead et al. 2003). What it is not useful for is localized investigative studies of this nature. My question is, if the authors recommend that future studies in this area should use such methods, why did they not seek to extend their research practices to do so themselves? This would have made for a far more involved study that would have benefited from much broader outcomes and further helped the families in question. This is what I mean by an ‘opportunity missed’. Family health promotion, or any other health promotion intervention for that matter, cannot be implemented and evaluated purely within a single-setting context, without extensive organizational-wide strategies. Health promotion strategies, within the hospital setting, can only be sustained as organizational-wide reform processes that seek to influence hospital-wide policy as it relates to the public health role of the setting and its commitment to the health structures of the surrounding community. What we are unaware of in this study is how its findings might have had an impact on local and hospital-wide policy-related structures and practices or, indeed, how such findings might have impacted on the families once they had left the hospital setting. Hartrick et al. (1994) and Hartrick (1997) has highlighted that the role of the nurse in family health promotion is as a client advocate in dealing with complex social systems, as an identifier of community-based resources and as a direct liaison between families and community systems. Bomar (2004) adds that this role has also been expanded to working directly towards family-related support structures that influence broad social, economic and policy change issues. This type of practice is in line with the World Health Organisation’s (2000) European Regional Office initiative to develop and implement the role of the Family Health Nurse (FHN). Macduff and West (2004, 2005) have evaluated the outcomes of a WHO-endorsed FHN curriculum and programme and identified a role definition that states: With their knowledge of public health and social issues and other social agencies, they can identify the effects of socio-economic factors on a family’s health and refer them to the appropriate agency. Without such intention or intervention I argue that any potential family-centred health promotion outcomes are severely limited in their scope and impact – especially if they exist as isolated investigations. Some might feel that my comments are merely a semantic exercise. Instead, however, I believe that such situations make for a dangerous precedence. The longer that the nursing profession continues to misapply the term health promotion to any health-related situation, the longer that nursing will fail to move on in relation to this important discipline. I do not want to detract from the useful contribution that this study makes to the nursing literature, but I do feel the need to pigeonhole it. Either it stands as a useful ‘non-health promotional’ exploratory nursing role study or it fails as a piece of ‘health promotion-based’ research. I personally would have preferred it to have made the leap of faith that would have been required to make a health promotion contribution – namely a wide-ranging socio-political-orientated multi-agency collaboration that addressed the issue of producing continuous and seamless community/hospital family-related health promotion support as an evaluated outcome (Whitehead 2003b,c). However, the reality is that there are still very few nursing-orientated programme interventions that can truly claim a health promotion context to them – family health or otherwise. References Bomar PJ (2004) Promoting Health in Families: Applying Family Research and Theory to Nursing Practice, 3rd edn. Saunders, Philadelphia, PA. Hartrick G (1997) Beyond the service model of care: health promo- tion and the enhancement of family capacity. Journal of Family Nursing 3, 57–70. Hartrick G, Lindsey AE & Hills M (1994) Family nursing assess- ment: meeting the challenge of health promotion. Journal of Advanced Nursing 20, 85–91. Macduff C & West BJM (2004) An evaluation of an educational programme to prepare family health nurses. Nurse Education Today 24, 575–583. Macduff C & West BJM (2005) An evaluation of the first year of family health nursing practice in Scotland. International Journal of Nursing Studies 42, 47–59. Whitehead D (2001) Health education, behavioural change and social psychology: nursing’s contribution to health promotion? Journal of Advanced Nursing 34, 822–832. Whitehead D (2003a) Viewing health promotion and health educa- tion as symbiotic paradigms: bridging the theory and practice gap between them. Journal of Clinical Nursing 12, 796–805. Whitehead D (2003b) Incorporating socio-political health promotion activities in nursing practice. Journal of Clinical Nursing 12, 668– 677. Whitehead D (2003c) The health-promoting nurse as a policy expert and entrepreneur. Nurse Education Today 23, 585–592. Whitehead D (2004a) Health promotion and health education: advancing the concepts. Journal of Advanced Nursing 47, 311–320. Whitehead D (2004b) The European Health Promoting Hospitals (HPH) Project: How far on? Health Promotion International 19, 259–267. Whitehead D (2005) Health Promoting Hospitals (HPH): the role and function of nursing. Journal of Clinical Nursing 14, 20–27. Whitehead D & Russell G (2004) How effective are health education programmes: resistance, reactance, rationality and risk? Recommendations for effective practice. International Journal of Nursing Studies 41, 163–172. Whitehead D, Taket A & Smith P (2003) Action research in health promotion. Health Education Journal 62, 5–22. World Health Organisation (2000) The Family Health Nurse: Context, Conceptual Framework and Curriculum. WHO, Copenhagen.

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