Continuous Professional Education:
The Way for Public Health Nurses to Perform their
Health Educators' Role with Competence and Confidence
Ms. Georgina K. H. HO, RN(H), RM, BSN (Hons)
Senior Nursing Officer, Department of Health, Hong Kong
Public Health Nurses (PHN) working in the Department of Health (DH) form the bulk and first line of client contact in most of the services provided by the Department. They are privileged to perform health promotion and health education duties to their clients and other members of the community.
Health Promotion Vs Health Education
The Ottawa Charter for Health Promotion (WHO, 1986) defined health promotion as "the process of enabling people to increase control over, and to improve, their health". Since then there has been much debate over the use of the term health promotion and health education. Health promotion encompasses wider issues such as initiating political actions to change social policies, putting employee health on the agenda of employers, engaging in community development work for health while health education focuses on working towards changing the knowledge, attitude and behaviour of clients and members of the community conducive to adoption of healthy lifestyle (Ewles & Simnette, 1999). Although health education is not synonymous with health promotion, it is an important element in health promotion that contributes to the achievement of health promotion goals (Ewles & Simnette, 1999; Nutbeam, 1998; Tones, 1996).
Public Health Nurses' Scope of Practice
Health promotion and health education form a substantial part of the daily practice of PHN working in various services provided by DH. While a small proportion of them working in services such as District Health System and Central Health Education Unit concentrate on their health promoters role of community development for health, the majority of them are still performing their health educators role at the general out-patient clinics, family health, student health and other health service centers to empower individual clients and families to make informed health choices. Since majority of PHN are still engaged in health education activities, I shall focus my discussion on health education.
Small Group Health Education Programmes Conducted by Public Health Nurses for Hypertensive Patient Attending General Out-patient Clinics (GOPC)
In Hong Kong, 31.2% of patients who require long-term follow-up by doctors have hypertension (Census and Statistics Department, 1999). As health education and self-management support can bring about sustainable improvement in blood pressure control (Stroebel, Broers, Houle, Scott & Naessens, 2000), PHN working in GOPC in DH are conducting small group health education programmes for hypertensive patients attending their clinics for long-term follow-up. The programme includes four weekly sessions, each lasting for approximately two hours. There is a reunion session of one and a half hours four weeks after the fourth session. The content includes talks and discussions on hypertension knowledge, hypertension medication, blood pressure taking skill, healthy lifestyle, diet management, physical activity, stress management and community resources. In each group, there are 8-10 patients with a registered nurse acting as the facilitator. 188 such groups were held in the year 2000.
In addition to their own workload, members of the research team of the Public Health Nursing Division (PHND), DH had contributed their time and effort to complete a research project entitled 'An Outcome and Process Evaluation of a Small Group Health Education Programme Conducted by Nurses for Hypertensive Patients in General Out-patient Clinics'. The aim of the study was to evaluate the effectiveness of the small group hypertension health education programme (the HE Programme) and to explore the perceptions and experiences of nurses and clients with regard to the HE Programme. The findings were encouraging. Quantitative data indicated that the HE Programme was effective in terms of gains in clients' health literacy, self-efficacy and behaviours and qualitative data indicated that client-staff relationship was enhanced and both nurses and clients found the programme fruitful and enjoyable. While findings of the research were quite encouraging, emerged from the data were a few training needs for PHN to perform their health educators' role with competence and confidence.
Training Needs of PHN
The training needs were identified during individual interviews with clients, focus group discussions with the nurse facilitators and the observations of the research team members. Some of them involved either the knowledge or skill aspect while others involved both. On the list were knowledge on medication and sex issues, facilitation and collaboration skills and knowledge and skills in questionnaires development and testing. PHN have to update their knowledge on medication and sex issues to meet their clients' expressed needs for detailed information on their own anti-hypertensive drugs and the ways to cope with disturbance of sexual life caused by the associated side effects.
While the ultimate goal of health education is behaviour change, group dynamics play an important role in small group health education. It can help clients to change behaviours that may be self-limiting to that promote wellness (MacLaury, 2000). To establish true group dynamics in which the clients are able to discuss their own problems freely and engage in problem solving and decision making for their own health fully, PHN ought to possess fine facilitation skill. With holism as the guiding principle in service delivery (WHO, 1986), multi-disciplinary approach has become a trend in health promotion and health education. PHN need the collaboration skill that enables them to work in partnership with other health care team members and yet fully utilize their own nursing expertise to actualise holistic care.
When it comes to programme evaluation, pre-test and post-test measures are essential. Questionnaires are often used to measure health gains in clients in terms of health knowledge, attitudes and behaviours. PHN need the knowledge and skills to develop valid and reliable instruments that enable them to attribute health gains in their clients, if any, to their health education interventions.
Continuous Professional Education
The above-mentioned training needs are just to name, but a few that were identified by a small-scale study conducted by a group of nurse practitioners and administrators that comprised the PHND research team. To meet the clients' and community's ever changing health needs and rising aspiration for quality service, there are many more emergent training needs for PHN to perform their health educators' role with competence and confidence. Continuous professional education is the only way for PHN to meet their training needs and advance their profession. While many other healthcare disciplines are actively considering mandatory continuous professional education, nurses should not lag behind their partners in the multi-disciplinary team.
Census and Statistics Department (1999). Thematic household survey report no. 3. Hong Kong: Printing Department, Hong Kong SAR Government.
Ewles, L. & Simnett, I. (1999). Promoting health: a practical guide (4th ed.). London: Bailliere Tindall.
MacLaury, S. (2000). The hidden group: the role of group dynamics in teaching health education. Journal of Health Education 31 (3), 156-159.
Nutbeam, D. (1998). Evaluating health promotion. Health Promotion International, 13 (1), 27-43.
Stroebel, R.J., Broers, J.K., Houle, S.K., Scott C.G. & Naessens, J.M. (2000). Improving hypertension control: a team approach in a primary care setting. Journal on Quality Improvement, 26 (11), 623-632.
Tones, K. (1996). The anatomy and ideology of health promotion: empowerment in context. In A. Scriven & J. Orme (Ed.), Health promotion, professional perspectives (pp. 9-21). London: Macmillan.
World Health Organization (1986). Ottawa Charter for Health Promotion. Geneva.