Investigating Health Promotion Practice at an NHS Foundation Trust Hospital

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Investigating Health Promotion Practice at an NHS
Foundation Trust Hospital

• Current Practice and Implications for the
  Future

Charlotte Haynes, Stockport NHS Foundation
Trust Gary Cook, Stockport NHS Foundation
Trust Richard Edwards, University of Manchester
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Plan

• Brief Introduction
• Hospitals responsibility
• Research project
• Aim
• Method
• Preliminary findings
• Conclusions

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Public Health Policies
1. Health inequalities 2. Smoking 3. Obesity 4.
Drinking 5. Sexual health 6. Mental health
SUPPORTING INFORMED CHOICE for all PERSONALISATION
of support working in PARTNERSHIP
Every member of NHS staff has the potential to
increase their role in raising peoples awareness
of the benefits of healthy living
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• Stockport NHS Foundation Trusts commitment to
  health promotion
• Healthy Hospitals Project
• Improving working lives
• Health Information project
• Healthy Wards Scheme (HWS)
• Current health promotion practice
• Health Education and Patient Information form
  assess lifestyles and advise/offer interventions

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Health Education and Patient Information (HP Form) Health Education and Patient Information (HP Form)
Weight Height .. BMI Advice required ? Leaflet given (list below)
Diet Normal Vegetarian Special requirements Explain to patient that it is advisable to eat ? Less fatty/fried foods, less sugary foods ? More starchy foods e.g. potatoes, pasta, bread, cereals ? 5 portions of fruit or vegetables a day ? balance of good health card given if appropriate ?
BMI gt 30 Patient advised to contact their practice nurse for comprehensive health check and advice, patient self-referral form given ? Confirm with surgeon if patient suitable for operation at this weight ?
Alcohol Intake None ? Occasional ? Yes ? (units per week) .. Patient aware daily benchmarks are 3-4 units for men, 2-3 units for women ? If intake gt benchmark, give Think about drink flyer ? If intake gt 50 units per week men or gt 35 units per week women offer referral to hospital alcohol liaison worker ?
Smoking Never smoked ? Ex-smoker ? Current smoker ? Amount per day . Patient advised to stop before operation If not possible, advised not to smoke on day of operation ? Inform of smoke-free NHS policy ? Asked if would like to give up smoking ? If yes, give stopping smoking made easier leaflet ? Patient advised to contact GP/Link nurse for further advice ?
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Aims

• Insight into health professionals beliefs,
  attitudes, and current practice of health
  promotion at a UK hospital.
• What do patients expect?
• Inform health promotion practice and policy
  within secondary care.

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Method

• Review patient case notes pre and post HWS
• Validation case notes and patient questionnaire
  data
• Patient interviews ? patient questionnaires
• Staff interviews ? staff questionnaires

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Results 1 - Case Notes

• n 54, females, n 25, males, n 29
• Age range 7 - 92yrs mean 60 2.9yrs
• Females 69 3.8yrs Males 58 3.0yrs
• (1 tailed t-test p lt 0.02)
• LoS range 1 - 81 days mean 11 3 days

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Results 1 - Case Notes
Alcohol Smoking Diet Exercise BMI
screened 43/54 (80) 40/54 (74) 1/54 1/54 1/54
HP needed 4/43 (9) 13/40 (33) 3/54
treatment 3/4 2/13
advice 3/13 1/3
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Results 2 Patient Interviews
Yes. Oh it does definitely. When you know you
cant smoke and you are not meant to, you
dont smoker

• Do you think the hospitals no-smoking policy
  helped you/others stop smoking or reduce the
  amount smoked?

I think it does but I still think its wrong
that when you come in through the doors in
reception that you see people stood there smoking
all the time. It drives me a bit potty at
times! ex-smoker
Do you think the no-smoking policy works?

Its definitely working smoker
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If drinking is bad for you I would want the
advice (gt21 units/week)

• Do you have any ideas for improving alcohol
  related HP?

Im not sure that anyone would take much notice
I think most people dont see the amount they
drink as a problem
12
Not really. I manage ok

• Would you have liked to have been offered HP on
  a healthy diet?

Im more interested in getting better than what
I am eating
I dont think they try and influence you at all
... sometimes perhaps it would be a good idea to
have the advice on ... you could do with more
fruit or whatever.
Do you have any ideas for improving diet related
HP?
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• Do you have any ideas for improving exercise
  related health promotion at the hospital or
  things you would like to see offered?

Anybody that can walk should be offered a bit
of exercise, a slow treadmill or something
similar. Some sort of equipment in the ward or a
room they can be taken to and supervised. You
should be able to go into a room with equipment
in it and sit down and do the exercise that way
rather than in the ward
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General Issues

• Should all patients be asked about their risk
  behaviours?
• Yes, they should be. Everybody should be
• It would be useful if the info is spread to
  someone who can help. Someone who is an expert in
  smoking or diet or whatever. Now is a good time
  to re-evaluate things

• Which hospital staff would you prefer HP from?
• I dont
• think it would make any difference really.
  Providing it was somebody that you felt was
  talking to you, I dont think it would matter
• I dont care as long as they are experts in the
  area. Training is the most important not their
  position

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Should HP be provided in hospitals, and when?

• Patient responses
• Yes, it is a good time but not at the beginning
  because I was just worried about what was wrong
  with me
• When you are admitted all you are interested in
  is getting help with what you have come in with.
  At the end all you are interested in is getting
  home

• Staff responses
• Its about making a judgement about when to
  seize the opportunities with patients to give
  them health promotion
• When they are ill the most important thing is to
  get them better but also reinforce the health
  education messages
• I think it should start as soon as the
  admission

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Results 3 Staff Interviews
Who is responsible for providing HP?
Obstacles
Solutions?
Screen 1st level advice/info ? Refer to
specialist
All staff
Time
Government Targets
Hospital environment
Consistency of message
Resources
Readily available info
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Tentative Conclusions

• Smoking and alcohol are well assessed but HP is
  more limited.
• Diet and exercise are not well assessed. No HP
  provided.
• Patients show less concern for alcohol and
  dietary advice than for smoking.
• Patients want exercise facilities at the
  hospital.
• Health professionals want clear, consistent,
  readily available information/pathways for HP.