Understanding health across different settings: a nursing journey

Holt, Maxine Lily (2015) Understanding health across different settings: a nursing journey. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

Introduction and Background This thesis presents ten published papers linked by the need to come to a better understanding of health across different settings and contexts. Central to the concept of health is the principle that settings play a pivotal role in shaping positive health outcomes for people and populations. The introduction of the concept of a settings approach to better health is usually attributed to the World Health Organisation (WHO), since its first mention in the Ottawa Charter (1986). I have used the concept of a settings approach (WHO 1986) to understanding health in order to draw the papers in this thesis together. Helping Nurses Understand Health to Promote Health in Practice. The idea that nurses are well placed to contribute to positive health in practice settings is well versed within the literature and it is in this context that the first published papers (1-5) and two book chapters are presented. As the publications in this thesis around nursing and its role in promoting health took shape, public health policy drivers from Government and from nursing’s professional body continued to emerge (e.g. DoH 1999, 2000, 2004, 2006, 2010, HEE 2015, NMC 2010, RCN, 2012). The papers in this section of the thesis demonstrate the challenge for nurse educators, in particular responding to an ever-changing NHS and the demands and expectations from those we nurse. Health in University Settings My work within the UK Healthy Universities Network led to external work for Papers 6 and 7. These focus on student health in universities, and the wider needs of students in such settings. It presents universities as settings for health, which can support students (and staff) using a whole systems approach. This section of the thesis provides the reader with glimpses of how health and, what creates health, is intrinsically linked across different settings and, how nurses can use settings such as universities to explore health and what creates health. Health in Work Place Settings Health and wellbeing in the workplace is a concept that is understood as a fundamental business case for a productive, happy, and healthy workforce. The workplace is also a setting by which knowledge and skills about health can be disseminated to assist people, in improving their health and wellbeing. The final paper in this thesis (paper 8), explores the main health and wellbeing needs of a sample of Small and Medium sized Enterprises (SMEs) across Greater Manchester. This work resulted in some unanticipated findings in terms of what creates health for people in SMEs, in particular that of quick fix public health interventions. It provides the reader with, an alternative lens in which to view health and health needs in the workplace. Summary The papers within this thesis and the contribution of the work that enabled their development, is intrinsically linked by the ideology of settings as places where people experience health and, what creates health for them in those settings. Being a nurse is at the heart of this thesis, it is where it begins, and this is where the thesis returns to at the end. Within this thesis, I have explored health in different settings through a research lens. From this, I am able to propose that by taking a settings approach to understanding health through the undergraduate nursing curriculum, alongside the use of non-traditional settings (e.g. universities and workplaces) for student nursing placements, nurses may then truly understand health and what creates health, for those they work with and care for. The papers, and subsequent work that has resulted from them, have enabled me to be at the cutting edge of nurse education. I have represented these within the thesis as a timeline linked to how these changes influenced my work and, my contribution to nurse education, workplace health, and health within universities.