synthesis of art and science is lived by the nurse in the nursing act Art & science || The public acute care health

JOSEPHINE G PATERSON

EVERY NURSE HAS A DUTY TO MAKE EVERY CONTACT COUNT Sharon Graham highlights the simplicity and brevity of opportunistic interventions that health professionals can use to persuade children and their parents to consider positive lifestyle changes Correspondence [email protected] Sharon Graham is senior lecturer, faculty of health sciences, Staffordshire University Date of submission May 5 2014 Date of acceptance August 15 2014 Peer review This article has been subject to open peer review and checked using antiplagiarism software Author guidelines rcnpublishing.com/r/ ncyp-author-guidelines

Abstract Make Every Contact Count is a public health strategy and not entirely a new idea in nursing, but one that all nurses need to be more conscious of when dealing with patients and the public. The strategy is based on the fact that it is simple and easy to be tactful in delivering correct, brief health advice of any kind, in any setting, whether as nursing students or nurse consultants. Such opportunistic intervention may be opposed or ignored, but could be the trigger that encourages people to change their behaviour positively and take responsibility for their health. A sustained change can reduce the potential negative effect of adverse habits on people’s life or on the lives of their children, even in much later years. In this article, the author argues that it is every nurses’ duty to make every contact count for the health of the population now and for the future, and thereby reduce the burdens on the NHS and social services. Keywords Children and young people’s nursing, home care services, health promotion, health visiting, nursing training, public health MAKING EVERY Contact Count: is this something new? It sounds like a new buzzword being used to achieve a target or a new call to action. Is it a health or social care issue, or a job for all health practitioners, and what do we have to do?

16 December 2014 | Volume 26 | Number 10

Making Every Contact Count is a UK public health strategy that all healthcare organisations can deliver though the work of their healthcare professionals (NHS Yorkshire and Humber 2012a). It is a prevention strategy intended to reduce the effects of poor quality lifestyles at any socioeconomic level and promote healthy living. It encourages every health worker to use each and every opportunity to advise and enable service users to improve their health positively.

Background An independent report (Bernstein et al 2010) reviewed existing practice and also the barriers in the UK to achieving positive lifestyle-changing behaviour and therefore improving the health and wellbeing of the nation. The report focused on four risk behaviours: ■  Tobacco use. ■  Excess alcohol use. ■  Poor diet. ■  Physical inactivity. These areas are identified as having the greatest effect on preventable disease, supporting the premise that changing adverse health behaviours, particularly in younger healthy populations, will reduce the risk and delay onset of behaviour-associated life-limiting conditions. It is now well known that changing adverse health behaviour at whatever time of life improves the health and wellbeing of older populations, irrespective of pre-existing conditions. NURSING CHILDREN AND YOUNG PEOPLE

Nursing Children and Young People 2014.26:16-21. Downloaded from journals.rcni.com by National University of Singapore on 11/25/15. For personal use only.

Getty

NURSING CHILDREN AND YOUNG PEOPLE

Nurses have a responsibility to promote positive health change behaviour among Decemberand 2014 | carers Volume 26 | Number 10 clients and their families

Nursing Children and Young People 2014.26:16-21. Downloaded from journals.rcni.com by National University of Singapore on 11/25/15. For personal use only.

17

Art & science | public acute care health The Marmot report (2010) discussed the association of poor socioeconomic status and ill health. Marmot showed that these four risk behaviours were associated with a higher incidence of reported poor physical and mental health among populations of higher social deprivation, and that this had effects across people’s lifespans. The World Health Organization (WHO) has repeatedly emphasised the importance of enabling people to increase control over and improve their health. Its policy, while retaining the focus on individual behaviour, is also moving towards a wide range of social and environmental interventions directed at whole populations. The WHO has its own health promotion unit with specific school and youth promotion areas that can be accessed on its website (www.who.int). It is now accepted that interventions to improve health in early life can have a positive effect on potential for disease prevention in later years (WHO 2014). Bernstein et al (2010) suggested that the health and wellbeing of children and young people should receive particular attention, emphasising early monitoring, intervention and intensive case management when necessary, and objective evaluation of health and wellbeing outcomes. They specified that the nursing workforce should be knowledgeable and skilled in discussing disease prevention, discerning challenges and supporting children and their families to access appropriate health and social care provision. In collaboration with all those involved, assertive intervention might be required, involving cross-agency co-ordination and expertise in early years support. Sadly, in the UK, in some instances, early intervention has been tried and failed. As reported in the media, a number of obese children have had to be taken into the care of social services when all early interventions to change their harmful lifestyles failed (Daily Mail 2011, Daily Express 2013, Daily Mirror 2014).

Why is this a nurse’s role? The Nursing and Midwifery Council’s (NMC) Code of Conduct (2008) instructs professionals to ‘work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community’. Therefore, it is clear that nurses, in whatever branch of the discipline, have a responsibility to promote positive health change behaviour among clients and their families and carers. However, what is not evident in any of the earlier publications is the consequent need to provide the training, supervision and support 18 December 2014 | Volume 26 | Number 10

to enable healthcare professionals to promote positive health change behaviour and responsibility among their clients. As someone with a practice nurse background, promoting health has been one of my duties in primary care settings since the 1990s, initially in response to the Health of the Nation (Department of Health (DH) 1992) report and subsequently to permutations of national policy documents, usually associated with payments for this service in general practice. As an educationist, health promotion has been the focus of many of the teaching sessions I have delivered to pre- and post-qualifying nursing students and allied health professionals. So I pose the question once again: what is new? To quote the Royal Society for Public Health (2012): ‘Good health is now everyone’s business, so it is vitally important that everyone understands how to communicate health messages effectively.’ What is new is the recognition that it is everyone’s business; no longer is it something carried out mainly in nursing settings. However, as nurses, we must each recognise that we are formally required to deliver health promotion effectively, supported by a sound evidence base for everything we say and do, and we must recognise that we are particularly well placed to do this. Furthermore, we need training and supervision in how to act and where to access appropriate further support or other services.

Nursing curricula Bernstein et al (2010) used the National Institute for Health and Care Excellence (NICE) (2006) Brief Interventions document to exemplify good practice among healthcare professionals to encourage lifestyle behaviour changes. They also observed that brief interventions are relatively cheap and cost-effective approaches that can be implemented across the health sector. More recently, NICE (2014) launched a new document, Behaviour Change: Individual Approaches. This publication states that it is the responsibility of everyone involved in health care to promote healthy lifestyle improvement among their clients. In addition to the four types of behaviour listed by Bernstein et al (2010), NICE (2014) cited sexual behaviour as an area to address. Ostensibly, this is a document for commissioners but, importantly, its 17 recommendations include points about the training of those who themselves train healthcare professionals (Box 1). Higher education institutes undergo a process of validation of all courses, and for those that teach nursing and midwifery there is a requirement that syllabuses and NURSING CHILDREN AND YOUNG PEOPLE

Nursing Children and Young People 2014.26:16-21. Downloaded from journals.rcni.com by National University of Singapore on 11/25/15. For personal use only.

programmes are reviewed and revalidated at regular intervals (NMC 2010). With this in mind, during the revalidation process for the prequalifying programme for child, adult and mental health nursing fields, Staffordshire University, formally incorporated the principles of Making Every Contact Count (NHS Yorkshire and Humber 2012b) in its curriculum. Teaching Making Every Contact Count was explored and developed throughout the next three years of the course. As the curriculum was implemented from September 2013, students have to date been exposed only to levels 1, 2 and 3 of the generic competencies outlined by NHS Yorkshire and Humber (2012b) (Box 2). However, some students with previous experience or opportunity have demonstrated the ability to step up a level. An initial module undertaken by child, adult and mental health nursing students, entitled Evidence in Contemporary Healthcare, introduces students to Making Every Contact Count in conjunction with discussion about a number of areas where Box 1 Recommendation 13: provide training for health and social care practitioners All those who train or accredit health and social care professionals should: ■  Ensure that behaviour change knowledge, skills and delivery techniques comprise a formal element of initial training, work placements and ongoing continuous professional development for all those who deliver health and social care services – see recommendation 12 for details of training content. ■  Ensure that all health and social care professionals can, as a minimum, deliver a very brief intervention. Training modules can be found online, for example, see the National Centre for Smoking Cessation and Training’s, www.ncsct.co.uk, very brief advice training module. (National Institute for Health and Care Excellence 2014)

Box 2 Generic competencies in Making Every Contact Count

health promotion interventions may be focused to encourage changes in behaviour, particularly the five behaviours outlined by NICE (2014). For each topic, students are provided with an overview of the adverse health behaviour from global, national and local perspectives. As part of the summative assessment of the module, students are required to investigate what is available in their locality to address the topic of their choice. Discussions are supported and aligned to the effect of health-related inequalities, identifying how they may affect behaviour change. These include the psychological, social, cultural and economic factors that influence individuals’ choices. Also, where possible, there is a talk by a health professional working in the specialist field, for example smoking cessation or weight management advisers. The talks help students to gain an understanding of what is happening in the locality. Students are allocated self-directed learning time for reading the implementation guide and toolkit, and they then enrol online with Health Education West Midlands to complete their professional development tool and assessment. Students who pass, print the certificate which they present as evidence of completion of work and which they retain in their personal professional portfolio. Those wishing to pursue further information and expand their knowledge are offered a link to the NHS Yorkshire and Humber (2012a) online training and assessment tool. Proactive students have provided additional links and shared these with their peers via an online discussion forum. Based on NICE (2014), year one students are reminded of their role in Making Every Contact Count by following recommendation 9 in delivering very brief interventions (Box 3). To add a practical perspective to the learning experience, students undertake a one-week taster placement in a clinical area toward the end of the module, during which they are requested to make a brief mental note of every time they observed Box 3 Recommendation 9: delivering very brief interventions

Special Practice Level 4 Specialist/advanced lifestyle and behaviour change approaches.

A very brief intervention can take from 30 seconds to a couple of minutes. It is mainly about giving people information or directing them where to go for further help. It may also include other activities such as raising awareness of risks, or providing encouragement and support for change. It follows an ‘ask, advise, assist’ structure. For example, very brief advice on smoking would involve recording the person’s smoking status and advising them that stop-smoking services offer effective help to quit. Then, depending on the person’s response, they may be directed to these services for additional support.

(Adapted from NHS Yorkshire and Humber 2012b)

(National Institute for Health and Care Excellence 2014)

Level 1 Brief advice and signposting. Level 2 Behaviour change intervention. Level 3 Behaviour change intervention programme.

NURSING CHILDREN AND YOUNG PEOPLE

December 2014 | Volume 26 | Number 10 19

Nursing Children and Young People 2014.26:16-21. Downloaded from journals.rcni.com by National University of Singapore on 11/25/15. For personal use only.

Art & science | public acute care health the use of Making Every Contact Count by health and social care professionals (Box 4). Students are encouraged to consider the importance of Making Every Contact Count, and many will comment on it in the summative profiles they produce. The theme of health promotion, and with it Making Every Contact Count, will be taken forward into years two and three of the nursing curriculum. In year two, child, adult and mental health nursing students will undertake a generic module entitled community-based care, which will enable them to enhance their skills and knowledge about public health in a community setting and develop their practice in delivering health-change behaviour. This also enables learners to evaluate critically the appropriateness and application of established health promotion approaches and their effectiveness in community health settings. By revisiting the issue of Making Every Contact Count in year two it will be a reminder to continue to use opportunities in the practice setting. In the final year, students will undertake two primary modules. The first, the graduate nurse, maintains a focus on nationally and locally driven health and social care policies, strategies and guidelines. It has a particular emphasis on the application of Making Every Contact Count to nursing children and young people in primary, Box 4 Examples reported ■  A nursing student, working alongside her mentor in a hospital setting, attends the bedside of a two year old admitted with respiratory problems. The student, having recorded the child’s vital signs, was asked by the parent if she would sit with the child while ‘I pop out for a cigarette’. Recognising this as a potential cause of the child’s admission, the student was confident enough to ask if the parent had considered the effect of smoking on the child and offered to find out if there was some help available if the parent wanted to quit. ■  Several students reported applying the principle of Making Every Contact Count to family members, such as advising siblings and partners about the overuse of alcohol, or encouraging them and their children to adopt a healthy diet or take more exercise. Box 5 Examples of Making Every Contact Count brief interventions School nurse Used the opportunity to talk about alcohol during a consultation review at a school base drop-in clinic. Nursery nurse Provided advice to a young person about effective tooth brushing during a health education lesson at preschool club. Ward nurse When preparing a young patient for discharge used the opportunity to raise awareness of support services that can be accessed post-discharge, by asking the parent of an overweight child: ‘Are you aware of the healthy eating support group for young people?’ Health visitor Used the opportunity during a home visit to check the health status of the children and remind a parent of the importance of immunisations, by asking: ‘Let us check and ensure that the children are up to date with their immunisations.’ 20 December 2014 | Volume 26 | Number 10

secondary and tertiary care settings. The second, more clinically focused module, competent children’s nursing practice, incorporates the ethos of Making Every Contact Count. The second, more clinically focused module – competent children’s nursing practice – incorporates the ethos of Making Every Contact Count by reminding students that this is something that will be applicable to their practice once they begin working as qualified nurses. As Making Every Contact Count came to the fore at the time when a pre-registration curriculum was being delivered, students on that programme were introduced to the concept and made aware of the resources in existing modules, but they have not undertaken any formal assessment of their learning as this was not a requirement of the 2013 curriculum. Making Every Contact Count has also been added to many post-qualifying modules and programmes that are accessed by qualified nurses from child, adult and mental health branches, as well as colleagues from allied health professions.

In practice Discussion with first-year students on return to the classroom after a ‘taster’ week that exposed them to Making Every Contact Count in the clinical setting revealed a significant number of missed opportunities and some positive examples where students initiated the Making Every Contact Count brief intervention ahead of the mentor supervising their practice (Box 5). There are many areas of nursing that could follow the simple approach promoted by Making Every Contact Count to encourage lifestyle changes in a child or parent. In 2011, Sampson et al reported on parental opinions about why there was low uptake of influenza vaccine in the young who were designated at risk. They also discussed the positive effect healthcare professionals can have on uptake of immunisations by, for example, using every contact as an opportunity to advise parents and young people about the potential benefits of flu vaccination, and using the occasion to infer that this can be extrapolated to other vaccinations. In addition, particularly on a ward, it is important to be aware of a child’s or young person’s immunisation status to protect the person and those they may encounter to vaccine-preventable diseases. Berling et al (2012) reported on a study looking at the often missed opportunity for vaccination of children and young people in emergency departments, concluding that every health-service presentation of a child should be considered an opportunity to ensure optimal immunisation in accordance with national scheduling. NURSING CHILDREN AND YOUNG PEOPLE

Nursing Children and Young People 2014.26:16-21. Downloaded from journals.rcni.com by National University of Singapore on 11/25/15. For personal use only.

Some hospitals – such as Alder Hey in Liverpool – focus on different health promotion topics each month: for example, April 2014 was the ‘Change4Life’ month. This involved delivering healthy lifestyle promotion messages in various hospital settings, the local community, in schools and at fun-day events. Led by healthcare professionals, the topics covered included smoking, dental health, exercise, healthy eating, and drug and alcohol misuse (Alder Hey Children’s Hospital 2014).

Conclusion Making Every Contact Count is not a new concept, but is something we, as nurses, need to be more conscious of in our encounters with the general public and patients. It is based on the premise that it is simple and easy to deliver brief health advice tactfully, whether you are a nursing student or a consultant. Taking the opportunity to do so could turn out to be the trigger that encourages a person to change his or behaviour which, in turn, can

reduce the potential negative effect of adverse habits on the person’s life in later years. It may not be so easy to encourage an individual to take genuine responsibility for their health, but it is our duty to make every contact count, for the health of the population now and in the future.

Points for practice ■  Nurses should be trained and supported to discuss disease prevention and lifestyle changes, discern challenges and assist children and families to access appropriate health and social care provision. ■  Delivering these messages may involve multidisciplinary co-ordination. ■  The five areas to focus on are diet, exercise, alcohol use tobacco use and sexual behaviour. ■  Making Every Contact Count can be practised in any setting.

Online archive For related information, visit our online archive and search using the keywords

Conflict of interest None declared

References Alder Hey Children’s Hospital (2014) Health Promotion Campaigns – Improving Health Promotion by Participating in Regional and National Initiatives. tinyurl.com/ Alderhey-health-prom (Last accessed: November 19 2014.) Berling I et al (2012) Opportunistic childhood vaccination in emergency – are we really missing anyone? Australasian Emergency Nursing Journal. 1, 1, 437-445. Bernstein H et al (2010) Enabling Effective Delivery of Health and Wellbeing. Department of Health, London. Daily Express (2013) Social Workers Take Children from Families Who Overfeed Them. tinyurl.com/express-obese-children (Last accessed: November 17 2014.)

Daily Mail (2011) Children Taken From Parents for Being Fat: Outrage as Social Workers Break Up ‘Loving’ Family. tinyurl.com/mail-fat-outrage (Last accessed: November 17 2014.) Daily Mirror (2014) Seventy-four Kids Taken into Care for Their Own Protection as They Are Too Fat. tinyurl.com/mirror-protection-fat (Last accessed: November 17 2014.) Department of Health (1992) Health of the Nation. A Strategy for Health in England. DH, London. Marmot M (2010) Fair Society, Healthy Lives: The Marmot Review. tinyurl. com/ihe-marmot-review (Last accessed: November 17 2014.)

NURSING CHILDREN AND YOUNG PEOPLE

National Institute for Health and Care Excellence (2006) Brief Interventions and Referral for Smoking Cessation. NICE, London.

Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. NMC, London.

National Institute for Health and Care Excellence (2014) Behaviour Change: Individual Approaches. NICE, London.

Nursing and Midwifery Council (2010) Standards for Pre-Registration Nursing Education. NMC, London.

NHS Yorkshire and Humber (2012a) Prevention and Lifestyle Behaviour Change: A Competence Framework Mapped to the Public Health Responsibility Deal. tinyurl.com/ york-humb-lifestyle (Last accessed: November 17 2014.)

Royal Society for Public Health (2012) Paving the Way; A Closer Look at What the Changing Policy Landscape Means for Public Health Improvement, Education and Learning. RSPH, London.

NHS Yorkshire and Humber (2012b) Making Every Contact Count. Training and Resources. tinyurl.com/mecc-training-res (Last accessed: November 17 2014.)

Sampson R et al (2011) Parental reasons for non-uptake of influenza vaccination in young at-risk groups: a qualitative study. British Journal of General Practice. 61, 588, e386-e391. World Health Organization (2014) Health Topics – Health Promotion. WHO, Geneva.

December 2014 | Volume 26 | Number 10 21

Nursing Children and Young People 2014.26:16-21. Downloaded from journals.rcni.com by National University of Singapore on 11/25/15. For personal use only.

Every nurse has a duty to make every contact count.

Make Every Contact Count is a public health strategy and not entirely a new idea in nursing, but one that all nurses need to be more conscious of when...
1MB Sizes 3 Downloads 10 Views