AS WE BEGIN another year, many of us go through the traditional ritual of making New Year's resolutions, and it always seems that many of our resolutions are directed toward improving our health. It is always an interesting phenomenon that gyms are so crowded the first two weeks of January and diet centers tend to have an overflow of people enrolling in various programs to lose weight. I'm sure that sales of pedometers and walking shoes skyrocket too, as we all try to take better care of ourselves and, for many of us, as we try to undo some of the negative health behaviors in which we engaged at the end of the previous year. This is an all too human phenomenon: We know what we should do to keep healthy, but we don't always do it. The New Year becomes a symbol of hope in once again trying to actually do what we should for our health. I know that as I put another piece of chocolate in my mouth in December, I comfort myself by saying I will “start my diet in the New Year.”
These musings have led me to think about one of the very important roles that nurses have in contributing to the health of individuals and communities. Health promotion is a critical role for nurses, and nurses are the most appropriate health professionals to address health promotion. We have many excellent role models within our profession. Nola Pender has developed the Health Promotion Model, taking a perspective of nursing that focuses on holistic human behavior (Pender, 1996). The International Council of Nurses (ICN) has developed a fact sheet on nursing and its important role in health promotion. The ICN refers to the fact that the term health promotion has become a “buzz word” (International Council of Nurses, 2000) and we need to truly understand what this term means. This organization goes on to clearly define health promotion as including strategies for people to be able to maintain health by making healthy choices through taking action through communities, specifically through collaborative efforts among communities, health professionals, and other groups. Ultimately, the goal is to positively influence the various determinants of health (ICN, 2000). Murray and Zentner (1997)) emphasize that health promotion is influenced by several factors, including sociocultural, environmental, and spiritual/religious.
The complex and multifaceted nature of health promotion reveals that the work of nurses in promoting health is more than simply advising people to go on a diet or start an exercise regimen. Health promotion involves understanding the social determinants of health, the social context, individual situations and perspectives, and all the complexities that influence one's motivation and ability to engage in health promotion activities. Promoting health is much more complicated than simply advising people on what they should and should not do. As noted above, we often know what we should do, but we don't do it. Some of us don't do it because of lack of willpower, but some of us don't do it because we may not have the resources or we may not be in an environment conducive to doing it. Advising a person to go to a gym to exercise may not be feasible if that person cannot afford the cost of joining the gym. In fact, what is advised for someone's health can vary from person to person. What is appropriate for one person may be less so for another person. Thus, nurses who work to promote health must not only understand the complexities of health promotion, but also the individual differences and needs across individuals and communities. Sometimes, too, the evidence for what is considered healthy and what is not can be ambiguous or misleading. Is a glass of red wine healthy? If so, what about three glasses? Where's the jury on caffeine?
Nurses, therefore, have a critical and very complex role in working to promote the health of the public. We must apply our skills of actively listening to individuals, getting a sense of their individual needs, constraints, and desires. We must actively involve individuals in their own care, encouraging them to take responsibility for their health while also being sensitive to the areas in which it may be difficult for a person to do so. In other words, we cannot assume that resources are equally available to all. We must work individually to promote health within the boundaries of an individual's capacity. For example, a person with limited mobility due to a chronic disorder will have different goals and will define health within the limits of this mobility, but this person can be encouraged to achieve an appropriate and attainable level of health. Edelman and Mandle (1994)) describe nursing's role in health promotion as encompassing an understanding of various settings, including social, work, and family, while recognizing the individual contextual differences within each of these settings in which health is influenced.
Nurses need to embrace a strong health promotion approach that includes being sensitive to health disparities that reflect some of the inequalities in access to health promotion. Although it is important to empower others to take responsibility for their own health, we need to simultaneously work at a societal level to mitigate the health disparities that may influence lack of health promotion. It is clear that our complex nursing roles involve a complex understanding of all that is involved in promoting the health of the public. We need to work hard on many fronts. Nursing's role is unique and invaluable in this arena.