Dear Editor,
We read Anne Mills' article exploring the concept of health responsibility in nursing with great interest (Mills, 2019). As final year medical students at Imperial College London, we feel strongly that health promotion is an invaluable part of health care. The way in which it is incorporated and taught during training, for both nurses and doctors, is therefore of the utmost importance and we wanted to share our thoughts on how this could be changed.
Evidence shows that the workplace environment and working conditions greatly affect doctors' mental health (Haoka et al, 2010). This is echoed in Mills' article, where she states that lack of breaks or availability of nutritious food can lead to a working environment that causes stress. As mental health deteriorates in health professionals, this is reflected in poor lifestyle choices and, ultimately, will have an impact on the individual's health outcome. Haoka et al (2010) also found that mental health is affected by attitudes towards working conditions.
Perhaps a solution to improving mental health in health professionals is to enhance their sense of satisfaction from work through rewards, such as recognition of achievements through certificates. This would reduce the mental challenge of working life, leading to better self-care and better health promotion.
Health promotion has always been a part of our medical education. However, we still feel that we are not being taught how to best implement it in practice. The style in which we are taught needs to be honed. To improve our skills in training, role play could be used. Situations could be created where real patients are recruited to assist in our training. Health professionals could practise identifying these patients' problems and counselling. Through this, one could identify what techniques work and receive feedback from patients on what they felt was most influential.
The Making Every Contact Count initiative discussed in Mills' article seems robust and useful (Public Health England et al, 2016). One area that particularly resonated with us was the use of reflection on one's own health behaviours. Another aspect to focus on would be ensuring that both nurses and doctors have a strong, genuine belief in health promotion and, if not, to adjust their attitudes. If attitudes towards health promotion are strengthened, this will encourage health practitioners to implement it in their own lives (Valente et al, 1986). This is difficult, however, as you cannot force a belief.
This situation could be improved if students were given the opportunity to attach themselves to a specific patient during their training, observe the counselling process carried out by their seniors and monitor the patient's progress themselves through follow-up to see the direct behavioural change that good health promotion can cause. Directly witnessing behavioural change over time would lead to a stronger belief in the importance of health promotion.
Another aspect that we feel needs to be focused on is confidence. To be a valuable health promoter while counselling patients, it is important to be confident in your delivery of the information and comfortable in your own lifestyle choices. Often patients have very distorted health beliefs or refuse to take any responsibility for their health. For health professionals, these situations require a tricky, fine balance of non-judgmental communication and firm advice—something that can only be achieved if one is confident. Pushing students in both nursing and medicine to counsel real patients about health beliefs from early on in their training, will lead to more capable and confident health promoters in practice.
To promote confidence, it might even be worth considering moving away from demanding that nurses and doctors change their own lifestyle choices, and focus more on ensuring they understand the genuine health outcomes that are possible from the information they are delivering, regardless of whether they have made that health choice in their own lives.
In conclusion, we recognise the importance of self-care and effective health promotion. To improve the actual skill of delivering health promotion, more teaching techniques during training need to be implemented, such as role play, feedback from patients and increasing one's confidence in delivering this information. As nurses and doctors so often work in unison, and health promotion works in the same way in both fields, combining this teaching could perhaps allow for better and more multifaceted learning.