Runciman Phyllis
Formerly Senior Research Fellow, Glasgow Caledonian University, Glasgow, UK.
Prim Health Care Res Dev. 2014 Jan;15(1):15-25. doi: 10.1017/S1463423612000655. Epub 2013 Feb 4.
This article presents an interpretation of health promotion within the work of a district nurse (DN).
Literature supports the centrality of health promotion within nursing. It also presents debate about its meaning and suggests uncertainties for educators and practitioners about its relationship to nursing care. Two studies in Scotland on community nurses' health promotion work with older people suggested that health promotion was evident and recognisable in planned initiatives or projects but could be hidden and unrecognised in day-to-day nursing work with individual patients and their families.
An experienced DN's interpretation of health promotion embedded in her work with a patient with multiple sclerosis is presented. The case was one of a number derived from a study designed in the constructivist paradigm, which addressed health promotion in relation to community nurse education and practice for a range of community nursing roles, including district nursing. The case study data were derived from observation of practice, interviews with the DN and the patient and from field notes.
Health promotion emerged as embedded within day-to-day holistic nursing care. The DN illustrated an understanding of the dimensions of health and of the significance of core health promotion concepts such as education, prevention, advocacy, empowerment, self-esteem and self-efficacy. However, health promotion could be invisible, described as weaved into everything and on the back of other things, and therefore not normally acknowledged and clearly articulated. Embeddedness highlighted the challenge for evaluation, when nursing and health promotion activities are intrinsically related and can be argued as sharing certain principles, processes and outcomes.
Embeddedness is a significant issue for learning in practice. The ability of experienced community nurses to interpret and articulate the concept of health promotion clearly and to make tacit knowledge evident would be of benefit to students.
本文呈现了对社区护士工作中健康促进的一种解读。
文献支持健康促进在护理工作中的核心地位。它也引发了关于其含义的争论，并指出教育工作者和从业者对其与护理工作关系存在不确定性。苏格兰两项关于社区护士对老年人健康促进工作的研究表明，健康促进在有计划的举措或项目中是明显且可识别的，但在与个体患者及其家庭的日常护理工作中可能是隐藏且未被认识到的。
呈现了一位经验丰富的社区护士在照顾一名多发性硬化症患者工作中对健康促进的解读。该案例是从一项以建构主义范式设计的研究中选取的多个案例之一，该研究探讨了与包括社区护理在内的一系列社区护理角色的社区护士教育及实践相关的健康促进。案例研究数据来自实践观察、对社区护士和患者的访谈以及实地记录。
健康促进在日常整体护理中得以体现。该社区护士展示了对健康维度以及教育、预防、倡导、赋权、自尊和自我效能等核心健康促进概念重要性的理解。然而，健康促进可能是无形的，被描述为融入一切以及在其他事情的背后，因此通常未被认可和清晰阐明。当护理和健康促进活动内在相关且可被认为共享某些原则、过程和结果时，这种融入性凸显了评估的挑战。
融入性是实践学习中的一个重要问题。经验丰富的社区护士清晰解读和阐明健康促进概念并使隐性知识显性化的能力将对学生有益。
