Skip to 0 minutes and 9 secondsWhen I hear the phrase public health, what comes to my mind as a healthcare professional is looking at the broader determinants of health, how economic factors influence health, why that leads to people possibly making poor lifestyle choices with adverse healthcare outcomes. So, smoking, obesity, alcoholism, are choices which are determined by the broader determinants of health. When I hear the phrase public health erm I think of a huge umbrella that encompasses a huge number of health related issues. That could be something from as simple as a vaccination programme, right through to a healthy lifestyle. But its also about ensuring that people are educated around public health issues and have access to public health services.

Skip to 1 minute and 5 secondsOne of the main public health issues that we see at BPAS is in relation to obesity and the reason that that is an issue for us is because we have freestanding clinics at BPAS where we don’t have the support services of say intensive care units and that means that we are unable to provide surgical services for patients with a BMI over 40 because of the morbidity and mortality risks that that surgery would make. That means that we would need to refer them into the NHS for treatment where support services will be available. Another public health issue that we often see at BPAS is around mental health issues.

Skip to 1 minute and 44 secondsThis can for some women be quite a traumatic time for them, going through a termination of pregnancy and often if they have got underlying mental health conditions then sometimes it can exacerbate the issues for them. When I hear the word public health what comes to my mind is about health improvement, health promotion, health protection. There are many issues I believe where I work things around sedentary lifestyle, smoking is predominant in the area that I work, alcohol and drug misuse. Obesity, equally, is predominant in the area that I work. I was talking to one of the patients who actually thought being big was good for her but its possible that that is something that would develop diabetes.

Skip to 2 minutes and 42 secondsThe public health issues that you hear about may cause people to have to come to hospital with problems such as obesity and diabetes erm and various infectious diseases like TB, HIV, those patients present to acute medicine in an unplanned way, so we can’t divorce public health from acute medicine because they are interlinked. I think patient’s expectations are different. I mean I started nursing back in 1981 and at the time patients didn’t question anything that the doctor said. If the doctor said they had to do something they did it. If the doctor said the nurse had to do something they did it.

Skip to 3 minutes and 27 secondsThings are very different from that perspective which is much better because patients are much better informed, and nurses are much better aware of how they can help. I think the most important thing you can do is actually listen to the patient and understand what their perspective is and make sure that you work within that sort of framework. Its about working with people to make sure that they do make the choices that are better for them.

Public health in nursing

To start with, we’ll consider the role of public health in today’s nursing environment.

Watch the video in which Peter Zeh, Senior Practice Diabetes Nurse, Helen Pickard, Consultant Nurse – Acute Medicine, Dee Power, Nurse Consultant Public Health England and Michael Nevill, Director of Nursing – British Pregnancy Advisory Service talk about their perceptions of public health and what public health in nursing means to them in their daily practice.

The World Health Organization (WHO) (2000) pledged that public health should be at the core of all nursing practice and declared that nurses today should redefine their role beyond caring for the sick, in hospital and the community, and reclaim their public health roots.

This suggests that nurses should play an equally important role in improving people’s health and well-being, but what does this actually mean when the overall focus of practice is on the delivery of clinically rooted individualised healthcare tailored to the needs of each particular patient or client?

Thinking about where to begin with this aspect of care can be a challenge and can be viewed in a number of different ways, ranging from whether a nursing contribution to public health can be made at all to a consideration of what level of contribution to public health different practitioners can make, with the distinction being: public health in nursing, nurses working in public health and public health specialists.

Nurses working in public health and nursing public health specialists can be employed in a range of different roles and organisations. They have often undergone additional training in public health and the focus of their practice is on promoting and protecting the public’s health. However, all nurses have a part to play in promoting health and well-being, regardless of their role, area of practice or place of work, so how do they view their involvement in public health? Is public health a visible and integral feature of everyday nursing practice or is it considered an ‘add-on’ or the domain of specialist practice? How can nurses demonstrate they can make a positive impact on the health of communities and play a part in influencing the health and well-being of the wider population?


Your task

Share how and where public health is reflected in your own practice and locality.


References

Nursing and Midwifery Council Royal College of Nursing (2016) Nurse 4 Public Health: Promote, Prevent and Protect. The Value and Contribution of Nursing to Public Health in the UK: Final Report. London: Royal College of Nursing

World Health Organization (2000) Munich Declaration: Nurses and Midwives: a Force for Health 2000. Copenhagen: WHO Regional Office for Europe

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This video is from the free online course:

Could You Be the Next Florence Nightingale?

Coventry University