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Chapter 1

THE PROBLEM

INTRODUCTION

Nurses play an important role in promoting public health. Traditionally, the focus

of health promotion by nurses has been on disease prevention and changing the behaviour

of individuals with respect to their health. However, their role as promoters of health is

more complex, since they have multi-disciplinary knowledge and experience of health

promotion in their nursing practice.

The indispensable role of nurses in promoting health could not be taken for

granted but given emphasis since they are responsible in providing holistic care to the

patients. Nurses play a dynamic and crucial role in health care. A nurse is usually the

first person a patient interacts. Nurses are responsible for assessing patient’s needs and

diagnosing illnesses. As such, nurses are an integral part of the comprehensive standards

of care and health promotion. The World Health Organization (WHO) defines heath

promotion as the process of enabling people to increase control over the determinants of

health and thereby improving their health (Schaffer, 2012).

Health promotion strategies are directed toward promoting the welfare of the

patients with emphasis on provision of holistic care . Nurses are presented with the real

challenge to optimize health, such as nonprofit organizations and educational campaigns.

Nurses enable or empower their patients by striving for equal access to health care

services. Hence, the study is undertaken to assess the nurse promotion strategies in

University of the Visayas with the end view of coming up with proposed measures for

enhancement.
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An actual scenario in which oftentimes nurses are so busy and occupied with so

many things and would likely their ability to promote health among the patients with the

increase number of patients with the ratio of the hospital in which the hospital is under

staff and it affected the ability to promote health. Hospital management is trying its best

to provide the best care but at times affected by increasing number of patients.

It has been a common observation that nurses are faced with a lot of challenges

when it comes to health promotion strategies to promote or optimize health of the

patients. Such are there are many patients who suffered from poverty and they cannot

afford to go to the hospital knowing that it will incur a lot of costs and make them

dependent to the people significant to them to help them when it comes to hospitalization

and as well as medication. Nurses play an important role as catalysts in order that they

could be helped. The vitality of the role of nurses could not be taken for granted but

given emphasis in promoting optimum health.

The practical value of the study is that it reduces the health care costs and

promote a government that contributes to the promotion of the people and growth to the

country through getting rid of sickness and illness.

Theoretical Background

The study is primarily anchored on the Health Promotion Model (HPM) of Nola

Pender in 1987 and revised in 1996. The HPM was designed to be a complementary

counterpart to models of health protection. It defines health as a positive dynamic state

not merely the absence of disease. Health promotion is directed at increasing a client’s

level of well being. The health promotion model describes the multi dimensional nature

of persons as they interact within their environment to pursue health.

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The health promotion model notes that each person has unique personal

characteristics and experiences that affect subsequent actions. The set of variables for

behavioral specific knowledge and affect have important motivational significance. These

variables can be modified through nursing actions. Health promoting behavior is the

desired behavioral outcome and is the end point in the HPM. Health promoting behaviors

should result in improved health, enhanced functional ability and better quality of life at

all stages of development. The final behavioral demand is also influenced by the

immediate competing demand and preferences, which can derail an intended health

promoting actions.

There are subconcepts of this theory which are (1) Personal factors categorized

as biological, psychological and socio-cultural. These factors are predictive of a given

behavior and shaped by the nature of the target behavior being considered; (a) Personal

biological factors that include variable such as age gender body mass index pubertal

status, aerobic capacity, strength, agility, or balance, (b) Personal psychological factors

that include variables such as self esteem self motivation personal competence perceived

health status and definition of health, and (c) Personal socio-cultural factors that include

variables such as race ethnicity, acculturation, education and socioeconomic status.

Another subconcept is (2) Perceived Benefits of Action which are the anticipated

positive outcomes that will occur from health behavior. Next is the (3) Perceived

Barriers to Action which is the anticipated, imagined or real blocks and personal costs

of understanding a given behavior. The fourth subconcept is (4) Perceived Self Efficacy

defined as the judgment of personal capability to organize and execute a health-

promoting behavior. Perceived self efficacy influences perceived barriers to action so

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higher efficacy result in lowered perceptions of barriers to the performance of the

behavior. The fifth one is (5) Activity Related Affect which is the subjective positive or

negative feeling that occur before, during and following behavior based on the stimulus

properties of the behavior itself. Activity-related affect influences perceived self-efficacy,

which means the more positive the subjective feeling, the greater the feeling of efficacy.

In turn, increased feelings of efficacy can generate further positive affect. Next is the (6)

Interpersonal Influences which is the cognition concerning behaviors, beliefs, or

attitudes of the others. Interpersonal influences include: norms (expectations of

significant others), social support (instrumental and emotional encouragement) and

modeling (vicarious learning through observing others engaged in a particular behavior).

Primary sources of interpersonal influences are families, peers, and healthcare providers.

Following interpersonal influences is (7) Situational Influences which are personal

perceptions and cognitions of any given situation or context that can facilitate or impede

behavior. Include perceptions of options available, demand characteristics and aesthetic

features of the environment in which given health promoting is proposed to take place.

Situational influences may have direct or indirect influences on health behavior. The

there is (8) Commitment to Plan of Action which is the concept of intention and

identification of a planned strategy leads to implementation of health behavior. This is

affected by the (9) Immediate Competing Demands and Preferences where competing

demands are those alternative behaviors over which individuals have low control because

there are environmental contingencies such as work or family care responsibilities.

Meanwhile competing preferences are alternative behaviors over which individuals exert

relatively high control, such as choice of ice cream or apple for a snack.
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In this study, health promotion is measured through an inventory of the health

promoting lifestyle profile II which practically revolves around six sub scales of health

promotion in terms of (1) health responsibility; (2) physical activity; (3) nutrition; (4)

spiritual growth; (5) interpersonal relations; and (6) stress management. These subscales

are essential elements of health promotion which does not only cover one aspect of self

but varied aspects enough to ensure that health promotion is done not only for physical

health but also for psychological, social, and spiritual wellness.

The Health-Promoting Lifestyle Profile II continues to measure health-promoting

behavior, conceptualized as a multidimensional pattern of self-initiated actions and

perceptions that serve to maintain or enhance the level of wellness, self-actualization and

fulfillment of the individual. The 52-item summated behavior rating scale employs a 4-

point response format to measure the frequency of self-reported health-promoting

behaviors in the domains of health responsibility, physical activity, nutrition, spiritual

growth, interpersonal relations and stress management. It is appropriate for use in

research within the framework of the Health Promotion Model (Pender, 1987), as well as

for a variety of other purposes.

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HEALTH PROMOTION MODEL

OF NOLA PENDER (1987)

NURSES IN UNIVERSITY OF
THE VISAYAS

PROFILE OF NURSES such as HEALTH PROMOTING

Age, Gender, Civil Status, LIFETYLE INVENTORY as
Highest Education Attainment, Health responsibility, physical
Years in Service and Number of activity, nutrition, spiritual
relevant trainings growth, interpersonal relations,
and stress management

PROPOSED MEASURES FOR

ENHANCEMENT

Figure 1. Schematic Diagram of Theoretical Framework

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THE PROBLEM

Statement of Purpose

The study determines the nurse promotion strategies in a private hospital. The

findings will serve as basis for proposed measures for enhancement.

Specifically, it seeks to answer the following inquiries:

1. What is the profile of the respondents in terms of the following:

1.1 age;

1.2 gender;

1.3 civil status;

1.4 highest educational attainment;

1.5 number of years and in service and

1.6 relevant trainings and seminars attended?

2. What is the extent of the nurse promotion strategies utilizing the health

promoting lifestyle profile inventory in terms of:

2.1 health responsibility;

2.2 physical activity;

2.3 nutrition;

2.4 spiritual growth;

2.5 interpersonal relations; and

2.6 stress management?

3. Is there a significant relationship between profile and the nurses’ health

promotion strategies in a private hospital?

4. From the findings, what proposed measures are envisioned for enhancement?
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Statement of Null Hypothesis

There is no significant relationship between profile and the nurses’ health-

promoting strategies in a private hospital.

Significance of the Study

Determining the nurse promotion strategies in a private hospital has a profound

impact to the following:

Nurses. They are the direct beneficiaries of the said undertaking through

supporting their promotion strategies in promoting the welfare of the patients.

Hospital Administrators. They are presented with the real challenge in

supporting the undertaking of these nurses on their promotion strategies that will enhance

health promotion.

Policy-makers. The Department of Health and the hospital concerned also

support the undertaking of these nurses through support given in the nurse promotion

strategies in the promotion of wellness to the patients emphasizing about the need for

independence.

Researcher. It will serve as an enlightenment and enrichment in understanding

more about nurse promotion strategies in a private hospital.

Future Researchers. This study will serve as an added reference if they make

researches similar in nature.

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Definition of Terms

Terms are operationally defined as how it is used in the study:

Nurse promotion strategies. This refers to the ways by which nurses promote

the well-being of the clients in a private hospital and guided by the health-promoting

lifestyle profile inventory which are as follows:

Health responsibility. This is one subscale of health- promoting lifestyle profile

that centers on how a person should handle health and do measures which will promote

optimum mind, body and spirit functioning.

Physical activity. This pertains to a subscale of health- promoting lifestyle profile

that focuses on how a person can maintain full locus of control in terms of physical

wellness and engagement in activities.

Nutrition. This refers to a subscale in health- promoting lifestyle profile which

revolves on ensuring that proper diet and appropriate nutritional activities are undertaken

to promote health.

Spiritual growth. This pertains to a subscale in health- promoting lifestyle which

caters items that complements physical and social health through the practice of one’s

beliefs and faith in his Almighty.

Interpersonal relations. This refers to one subscale of health- promoting lifestyle

profile which involves questions on how a person deals with other people and how he

interacts with the surroundings to help maintain optimal health and wellbeing.

Stress management. This is a subscale of health- promoting lifestyle profile

which revolves around questions on maintain health by ensuring appropriate response

and interventions to stressors in the environment and in the self.

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Profile. This refers to the demographic characteristics of nurses of the University

of the Visayas which are further subcategorized as follows:

Age. This pertains to the number of years since birth the respondents have been

living by the time they answer the questionnaire.

Gender. This pertains to the sex of the respondents as either male or female based

on their biological identification.

Civil status. This refers to the social classification of the respondents with

reference to relationship outcomes and is sub-classified as single, married, and others.

Educational attainment. This pertains to the highest level of education that the

respondents have achieved so far by the time they answer the questionnaire.

Years in service. This refers to the tenure, measured in terms of years, that the

respondents have worked in the research environment.

Relevant trainings. This pertains to the number of related trainings and learning

development that the respondents have participated.

Proposed Measures. This refers to the steps or ways undertaken in the

enhancement of the nurse promotion strategies of the University of the Visayas.

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Chapter 2

REVIEW OF LITERATURE AND STUDIES

Chapter II gives the review of literature and studies that have direct bearings to

the present study.

Health Promotion

Health promotion measures focus on both individuals and on contextual factors

that shape the actions of individuals with the aim to prevent and reduce ill health and

improve well being. Health in this context not only refers to the traditional, objective and

biomedical view of the absence of infirmity or disease but to a holistic view that adds

mental resources and social well-being to physical health (McEwen, 2010).

Health promotion goes beyond health education and disease prevention, in as far

as it is based on the concept of salutogenesis and stresses the analysis and development of

the health potential of individuals. The scope of disease prevention has been defined in

the Health Promotion Glossary as measures not only to prevent the occurrence of disease,

such as risk factor reduction, but also to arrest its progress and reduce its consequences

once established. The same source defines the scope of health education as comprising

consciously constructed opportunities for learning involving some form of

communication designed to improve health literacy, including improving knowledge and

developing life skills which are conducive to individual and community health (McEwen,

2010).

Scope of Health Promotion

Given the scope of possible health promotion interventions in hospitals, the WHO

HPH (2010) movement focuses on four areas: promoting the health of patients,
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promoting the health of staff, changing the organization to a health promoting setting,

and promoting the health of the community in the catchment area of the hospital. These

four areas are reflected in the definition of a health promoting hospital: A health

promoting hospital does not only provide high quality comprehensive medical and

nursing services, but also develops a corporate identity that embraces the aims of health

promotion, develops a health promoting organizational structure and culture, including

active, participatory roles for patients and all members of staff, develops itself into a

health promoting physical environment, and actively cooperates with its community.

There is a large scope and public health impact for offering health promotion

strategies in health care settings. Hospitals consume between 40% and 70% of the

national health care expenditure and typically employ about 1% to 3% of the working

population. These working places, most of which are occupied by women, are

characterized by certain physical, chemical, biological and psychosocial risk factors.

Paradoxically, in hospitals organizations that aim to restore health – the

acknowledgement of factors that endanger the health of their staff is poorly developed.

Health promotion programmes can improve the health of staff, reduce absenteeism rates,

and improve productivity and quality (Downie, 2010).

Impact on Influencing the Behaviour of Patients and Relatives

Health professionals in hospitals can also have a lasting impact on influencing the

behaviour of patients and relatives, who are more responsive to health advice in situations

of experienced ill-health. This is of particular importance for two reasons: firstly, the

prevalence of chronic diseases is increasing in Europe and throughout the world.

Secondly, many hospital treatments today not only prevent premature death but improve
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the quality of life of patients. In order to maintain this quality, the patient’s own

behaviour after discharge and effective support from relatives are important variables

(Grossman, 2011).

Health Education and Health Promotion Activities

Health education and health promotion activities are a fundamental requirement

for all health professionals. These two paradigms are closely related but are not inter-

dependent. Despite this, it is known that many nurses confuse the terms and use them

interchangeably. With this in mind, it is necessary to re-conceptualize the terms in an

attempt to bring them to a current form of 'maturity'. The aim of the paper is to provide an

up-to-date analysis of health promotion and health education that serves as a conceptual

and operational foundation for clinicians and researchers. A concept analysis following

the criterion-based methods described by Morse and her colleagues was applied to the

terms health education and health promotion, using generic and nursing-related literature.

The conceptual literature on health education is consistent between generic and nursing-

related sources. On the contrary, earlier nursing literature on health promotion is now at

odds with more recent socio-political and community action models of health promotion,

in that it focuses on individualistic and behavioural forms of 'health promotion'. A

significant proportion of later nursing-related literature, however, suggests a maturing of

the concept that brings it further in line with a socio-political health promotion agenda.

While the theoretical and conceptual literature surrounding health education has remained

relatively constant and unchanged over the last decade or so, the same cannot be said for

the health promotion literature. The evolving dominance of socio-political action in

health promotion has overtaken individualistic and behaviourally-related forms. While

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the recent nursing literature addresses and acknowledges the place of socio-political

activity as the mainstay of health promotion interventions, this is largely from a

theoretical stance and is not applied in practice (Whitehead, 2014).

Health Promotion Programmes

Health Promotion Programmes can encourage healthy behavior, prevent

readmission and maintain quality of life of patients. Hospitals also typically produce high

amounts of waste and hazardous substances. Introducing Health Promotion strategies in

hospitals can help reduce the pollution of the environment and cooperation with other

institutions and professionals can help achieve the highest possible coordination of care.

Furthermore, as research and teaching institutions hospital produce, accumulate and

disseminate a lot of knowledge and they can have an impact on the local health structures

and influence professional practice elsewhere (Nursing Online, 2018).

Nurses play a dynamic and crucial role in healthcare. A nurse is usually the first

person a patient interacts with. Nurses are responsible for assessing patients’ needs and

diagnosing illnesses. As such, nurses are an integral part of the comprehensive standards

of care and health promotion. The World Health Organization (WHO) 2010 defines

health promotion as the process of enabling people to increase control over the

determinants of health and thereby improving their health. Before they can examine the

role of nurses in health promotion, they must first assess the guiding principles of health

promotion.

The three main tenets of health promotion are advocate, enable and mediate.

Nurses advocate on behalf of their patients and the community at large by supporting

causes that help optimize health, such as nonprofit organizations and educational
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campaigns. Nurses enable or empower their patients by striving for equal access to

healthcare services. Race, gender and ethnicity are important factors to consider. Finally,

to promote health for all citizens, nurses play the role of mediator between healthcare

providers, governments, businesses and the media. A collaboration between various

institutions is the only way to ensure the health of a population (Nursing Online, 2018).

Strategies for Health Promotion

Strategies for health promotion should strive to reduce negative health outcomes

associated with health determinants by increasing knowledge through health education.

Therefore, a nurse’s role in health promotion includes various responsibilities related to

advocating, enabling and mediating activities to reduce poor health outcomes. Online RN

to BSN programs should be proactive in preparing nurses to meet this increased demand

for health promotion by incorporating courses and practical experiences related to health

promotion and education, theories to enhance health outcomes among diverse segments

of the population, and the development of leadership skills, into their curricula. Online

RN to BSN programs should also facilitate and support critical thinking to remove

barriers to health and well-being at all levels of patient interaction (Nursing Online,

2018).

Methods of standard practice in nursing now require nurses to actively engage in

health promotion strategies to maximize optimal health outcomes. Nurses should be able

to apply evidence-based concepts from research to implement effective strategies that

promote optional health. Additionally, they should be proficient in the skills and

competencies needed to influence health-related policy and empower communities to

take action toward improving health. Online RN to BSN programs that cultivate critical
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thinking skills and leadership and incorporate the tenets of health promotion into their

curricula are better able to prepare nurses for the increasingly important role of health

promotion to improve the health and well-being of the population at large (Nursing

Online, 2018).

Vital Component of Health Promotion

Health promotion is a complex activity and is difficult to define. Davies and

Macdowall (2010) describe health promotion as any strategy or intervention that is

designed to improve the health of individuals and its population. However perhaps one

of the most recognised definitions is that of the World Health Organization’s who

describes health promotion as “a process of enabling people to increase control over their

health and its determinants, and thereby improve their health.

A vital component of health promotion is health education which aims to change

behaviour by providing people with the knowledge and skills they require to make

healthier decisions and enable them to fulfil their potential. Healthy Lives Healthy

People (2010) highlight the vital role nurses play in the delivery of health promotion with

particular attention on prevention at primary and secondary levels. Nurses have a wealth

of skills and knowledge and use this knowledge to empower people to make lifestyle

changes and choices. This encourages people to take charge of their own health and to

increase feelings of personal autonomy. Smoking is one of the biggest threats to public

health, therefore nurses are in a prime position to help people to quit by offering

encouragement, provide information and refer to smoking cessation services. There are

various approaches to health promotion, each approach has a different aim but all share

the same desired goal, to promote good health and prevent or avoid ill health. The
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medical approach contains three levels of prevention as highlighted by Naidoo and Wills

(2000), primary, secondary and tertiary prevention. Primary health promotion aims to

reduce the exposure to the causes and risk factors of illness in order to prevent the onset

of disease. In this respect it is the abstinence of smoking and preventing the uptake

through health education and preventative measures.

Factors affecting the conception of health promotion orientation

The most common factor influencing the concept of health promotion orientation

was individual perspective. When nurses' health promotion activities were guided by

individual perspective nurses' exhibited a holistic approach in their health promotion

practice, they concentrated on activities such as helping individuals or families to make

health decisions or supporting people in their engagement with health promotion

activities. Nurses' strategies for health promotion included giving information to patients

and providing health education. However, patient participation was mainly limited to

personal aspects of care, such as letting patients decide on a menu, when to get out of bed

and what clothes they wanted to wear. The second common defining concept of health

promotion orientation was empowerment, which was related to collaboration with

individuals, groups and communities. Such orientation was described in these studies in

terms of nurse–patient communication and patient, group and community participation.

Although these studies found empowerment to be one of the most important theoretical

bases for health promotion activities by nurses, empowerment was not embedded in

nurses' health promotion activities (Irvine, 2010).

The third common defining concept of health promotion orientation was social

and health policy. These studies suggested that nurses' health promotion activities should
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be based on the recommendations in, for example, the World Health Organization's

(WHO) charters and declarations and directives and guidance from professional and

governmental organizations. However, the studies examined found that nurses were not

familiar with social and health policy documents and that they did not apply them to their

nursing practice. The last defining concept of health promotion orientation was

community orientation. It revealed that nurses had knowledge of community-orientated

health promotion: they were expected to use health surveillance strategies, work

collaboratively with other professionals and groups and respect and interact with different

cultures. In addition a health promotion orientation appeared to result in nurses working

more closely with members of communities, for example, being involved in voluntary

work and implementation of protective and preventive health measures (Irvene, 2010).

Classification of Nurses

Nurses can be classified into: general health is health education. General health

promoters are expected to have knowledge of health promotion, effective health

promotion actions, national health and social care policies and to have the ability to apply

these to their nursing practice. There is growing recognition that different patient groups,

such as the elderly or families with chronic diseases, have different health promotion

needs. In promoting the health of these different groups, nurses can be regarded as

patient-focused health promoters. These studies revealed that when health promotion for

patient groups who need high levels of care and treatment is required, nurses must have

the ability to include health promotion activities in their daily nursing practice (Irvene,

2010).
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Nurses should be able to plan, implement and evaluate health promotion

interventions and projects. Projects can facilitate the development of health promotion in

nursing practice. Thus, managers of health promotion projects should have advanced

clinical skills and take the responsibility in supervising and leading research and

development actions in nursing as well as having the ability to co-ordinate educational

and developmental interventions in health-care units and communities (Irvene, 2010).

Strategies used in Health Promotion

Strategies include, but are not limited to: provide nurses with “access to a rich

library with nursing and medical journals; provide nurses with opportunities for working

with a computer and for searching the Internet in the workplace; system support for

searching and reading professional literature; implementation of a virtual journal club;

provide nurses with access to evidence-based practice resources via mobile information

technologies; implement an EBP mentorship programme with EBP mentors who are

skilled in both EBP and organizational culture and change; support nurses to acquire the

skills needed to read, evaluate and critically appraise evidence; establish leadership, a

coherent change strategy, and relationships between point of care providers and managers

nurse managers act as role models; nurse managers provide the resources and the support

for the work and celebrate success with recognition of unit staff; designate a champion

who is “accessible to the nurses, along with other leaders and innovators who can answer

questions and reinforce the practice change and involve the clinical educator as a part of

the support system of the EBP change (Ezra, 2012).

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Nurse’s Role in Health Promotion Practice

The study of Kemppainenand Tossavainen (2013) on nurse’s role in health

promotion practice supports the contention of the present undertaking. Nurses play an

important role in promoting public health. Traditionally, the focus of health promotion by

nurses has been on disease prevention and changing the behaviour of individuals with

respect to their health. However, their role as promoters of health is more complex, since

they have multi-disciplinary knowledge and experience of health promotion in their

nursing practice. This paper presents an integrative review aimed at examining the

findings of existing research studies (1998–2011) of health promotion practice by nurses.

Data were analysed and the results are presented using the concept map method of Novak

and Gowin. The review found information on the theoretical basis of health promotion

practice by nurses, the range of their expertise, health promotion competencies and the

organizational culture associated with health promotion practice. Nurses consider health

promotion important but a number of obstacles associated with organizational culture

prevent effective delivery.

Job Satisfaction among Nurses working at Selected Tertiary Care Hospital

The study of Mohite, Shinde and Gulavani (2014) on job satisfaction among

nurses working at selected tertiary care hospitals supports the contention of the present

undertaking. The primary aim of the study was to assess job satisfaction among nurses

working at tertiary care hospital. job dissatisfaction is increasingly large disorder among

nurses job dissatisfaction has a cost for individual in term of health, wellbeing and for

organization in term of absenteeism and turnover which indirectly affect quality of

patient care. A descriptive research design was adapted and exploratory approach used to
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assess job satisfaction among nurses. Study was conducted on 100 staff nurses selected

by convenient sampling technique. Modified Minnesota job satisfaction scale was to

assess job satisfaction. It was self-reporting questionnaire and generally requires 15-30

minutes to solve questionnaire. Majority of nurses was highly satisfied in their job with

respect to all jobs reinforcing factor except independence and compensation where they

have reported only average satisfaction.

Strategies to Promote Practice Nurse Capacity

The study of Dadich (2015) on strategies to promote practice nurse capacity to

deliver evidence-based care supports the contention of the present undertaking. ven the

central role of primary care in many healthcare systems, it is important to identify

strategies that bolster clinician-capacity to promote evidence-based care. The

purpose of this paper is to identify strategies to increase Practice Nurse capacity to

promote evidence-based sexual healthcare within general practice. A survey of 217

Practice Nurses in an Australian state and ten respondent-interviews regarding two

resources to promote evidence-based sexual healthcare – namely, a clinical aide and

online training. The perceived impact of both resources was determined by views on

relevance and design particularly for the clinical aide. Resource-use was influenced

by role and responsibilities within the workplace, accessibility, and support from

patients and colleagues.

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Integrating Health Promotion into Nursing Practice

The study of Bastani, Karmalani and Petrucka (2016) on integrating health

promotion into nursing practice supports the contention of the present undertaking. The

purpose of this study was to understand the concept of health promotion and perceptions

related to the integration of health promotion in nursing practice in Pakistan. The study

utilized the qualitative single case study approach to explore and describe the concept of

health promotion, its significance and ways to integrate health promotion strategies in

nursing practice. The data were collected from three different sources; focus group

discussion among final year Post-RN BScN students, key informant interviews of

practicing nurses, faculty, and MScN students, as well as a document review of the Post-

RN BScN curriculum. Data analysis included a content and thematic analysis, yielding

four major themes: Health Promotion as Diverse, Health Promotion as Necessary, Health

Promotion as Nursing Role, and Health Promotion as a Strategic Imperative. Further, the

findings highlighted the competencies, support mechanisms, and barriers which select

nurses faced while integrating the health promotion strategies in practice.

Nurse Delivered Lifestyle Interventions in Primary Health Care

The study of Sargent, Forrest and Parker (2012) on nurse delivered lifestyle

interventions in primary health care to treat chronic disease risk factors associated with

obesity which is a systematic review supports the contention of the present undertaking.

Nurses in primary health care (PHC) provide an increasing proportion of chronic disease

management and preventive lifestyle advice. The databases MEDLINE, CINAHL,

EMBASE and PsychINFO were searched and the articles were systematically reviewed

for articles describing controlled adult lifestyle intervention studies delivered by a PHC
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nurse, in a PHC setting. Thirty-one articles describing 28 studies were analysed by

comparison group which revealed: (i) no difference of effect when the same intervention

was delivered by a PHC nurse compared to other health professionals in PHC (n = 2); (ii)

the provision of counselling delivered by a PHC nurse was more effective than health

screening (n = 10); (iii) counselling based on behaviour change theory was more effective

than the same dose of non-behavioural counselling when at least three counselling

sessions were delivered (n = 3). The evidence supports the effectiveness of lifestyle

interventions delivered by nurses in PHC to affect positive changes on outcomes

associated with the prevention of chronic disease including: weight, blood pressure,

cholesterol, dietary and physical activity behaviours, patient satisfaction, readiness for

change and quality of life. The strength of recommendations is limited by the small

number of studies within each comparison group and the high risk of bias of the majority

of studies.

Synthesis

The study is a synthesis of significant literatures and studies that have direct

bearings to the presents study since it discuss on the role of health promotion strategies

and the nurses role in health promotion. The vitality of the rule of the nurses could not be

taken for granted but given importance. The thrust of the health care industry is

emphasizing the importance or the benefits of health promotion strategies and the need to

ensure lifestyle profile inventory to protect the patient and the hospital. It is the concern

of the hospital to settle issues, problems and barriers that would likely arise.
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Chapter III
RESEARCH METHODOLOGY

This chapter provides the procedure and the methods that will be used in the

study-research. It presents specifically the research design, research environment,

research respondents, instrumentation, data gathering procedures, and data analysis.

Design

This paper will make use of the descriptive method of research specifically

correlational design with the use of the modified standardized questionnaire on nurse

promotion strategies in a private hospital. This correlational method will be utilized to

determine if the profile of the respondents has any bearing on their health- promotion

strategies utilizing the six subscales of the health- promoting lifestyle profile inventory as

guided by the theory of Nola Pender. Correlational studies help in establishing the

relationship of two or more variables in order to determine their co-existence and the

value that each of these variables hold true with each other.

Environment

The research environment of the study is University of the Visayas. Located at

Colon Street, Cebu City. The University of the Visayas was founded by the late Don

Vicente Gullas in 1919 as the Visayan Institute (V.I.) in Cebu City. The VI was renamed

as the University of the Visayas. From that time on, the expansion in its baccalaureate

and post graduate course offerings and its physical facilities has been phenomenal. From

an initial enrollment of 37 students and only a high school department the VI evolved

into a University with an enrollment which at one time in the 1980’s peaked at 29, 000

distributed throughout its various campuses. (Abinuman, 2012).

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This is the research environment chosen since the researcher is affiliated with the

said hospital.

Respondents

The respondents of the study are the nurses. All nurses enrolled at graduate school

in University of the Visayas taken as respondents in the study. They will be taken

through the use of non-random purposive sampling. The inclusion criteria are as follows:

a) that they are nurses in University of the Visayas enrolled at graduate school; b) that

they have been working more than one year and c) that they are willing to participate and

cooperate in the said undertaking. The exclusion criteria are as follows: a) that they are

nurses from other hospital; b) that they have been working for less than a year; c) that

they are not willing to participate and cooperate in the said undertaking; and d) nurses

who are resigning or retiring at the time of study.

Instrument

The instrument that will be used in the study is the modified standardized

questionnaire consisting of three parts. The first part deals with the profile of the

respondents as to age, gender, civil status, highest educational attainment, number of

years in service and relevant trainings and seminars attended. The second part deals with

The Health-Promoting Lifestyle Profile II continues to measure healthpromoting

behavior, conceptualized as a multidimensional pattern of self-initiated actions and

perceptions that serve to maintain or enhance the level of wellness, self-actualization and

fulfillment of the individual. The 52-item summated behavior rating scale employs a 4-

point response format to measure the frequency of self-reported health-promoting

behaviors in the domains of health responsibility, physical activity, nutrition, spiritual

 26

growth, interpersonal relations and stress management. It is appropriate for use in

research within the framework of the Health Promotion Model (Pender, 1987), as well as

for a variety of other purposes.

Items are scored as Never (N) = 1 ; Sometimes (S)= 2; Often (O) = 3 ; and

Routinely (R) = 4 where the score for overall health-promoting lifestyle is obtained by

calculating a mean of the individual's responses to all 52 items; six subscale scores are

obtained similarly by calculating a mean of the responses to subscale items. The use of

means rather than sums of scale items is recommended to retain the 1 to 4 metric of item

responses and to allow meaningful comparisons of scores across subscales. The items

included on each scale are as follows: Health-Promoting Lifestyle 1 to 52; for Health

Responsibility items are 3, 9, 15, 21, 27, 33, 39, 45, and 51. For subscale on Physical

Activity the items are 4, 10, 16, 22, 28, 34, 40, and 46. As for Nutrition, the following

items cover: 2, 8, 14, 20, 26, 32, 38, 44, and 50. In terms of Spiritual Growth, these are

the corresponding items: 6, 12, 18, 24, 30, 36, 42, 48, and 52. Meanwhile for

Interpersonal Relations they are items 1, 7, 13, 19, 25, 31, 37, 43, and 49. Finally for

Stress Management the items are 5, 11, 17, 23, 29, 35, 41, and 47.

The parameter limits in interpreting the questionnaire shall be as follows: 1.00-

1.75 Never and interpreted as Not Practiced; 1.76- 2.50 Sometimes and interpreted as

Fairly Practiced; 2.51- 3.25 as Often and interpreted as Moderately Practiced; and 3.26-

4.00 as Routinely and interpreted as Highly Practiced.

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Data Gathering Procedures

The researchers followed a systematic process in the gathering of data. First, the

researchers will make letters addressed to the Dean of the Graduate School and Hospital

Director of Vicente Gullas Memorial Hospital asking permission that the researcher be

allowed to conduct the study. After which, the researcher will make a research paper and

to be submitted to the Institutional Review Board (IRB) for the clearance and survey on

determining nurse promotion strategies in a private hospital.. After which, the researchers

will administer the questionnaires to the respondents and the respondents and they will be

given ample time preferably 15-20 minutes to answer the questionnaire. After which, the

questionnaires will be collected and subjected to further presentation, analysis and

interpretation of data. Then, a final draft will be submitted for finalization.

Data Analysis

The data gathered will be tallied, tabulated, interpreted, analyzed, categorized and

organized. The parametric measure that will be used to determine the profile of the nurses

in terms of age, gender, civil status, highest educational attainment, number of years in

service and relevant trainings and seminars attended is simple percentage.

The parametric measure that will be used to determine the extent of the nurse

promotion strategies in Vicente Gullas Memorial Hospital is weighted mean while Eta

statistics will be used to determine the relationship between the profile of the respondents

and the nurses’ health promotion strategies.

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ETHICAL CONSIDERATION

Ethical Consideration

Protection of human rights. Three basic principles were observed in the conduct

of the study. First is the principle of respect of persons. In observing this principle, two

ethical convictions will be further be observed: (a) those people ought to be dealt with as

self-sufficient specialists and (b) that people with lessened self-rule are qualified for

security. Second is the rule of beneficence. The subjects was dealt with in a moral way

not just by regarding their choices and shielding them from harm, yet in addition by

endeavoring to secure their well-being. Two general rules were observed in the observing

beneficence: (a) try not to mischief and (b) expand conceivable advantages and limit

conceivable damages. In conclusion, the standard of justice. This principle was based on

the principle of "fairness in distribution" or "what is deserved”. To observe justice, the

following principles will apply: (a) to every individual an equivalent offer, (b) to every

individual as per singular need, (c) to every individual as indicated by singular exertion,

(d) to every individual as per societal commitment, and (e) to every individual as per

merit.

Risk-Benefit Assessment.

In order to decrease risks and maximize benefits in the study the following major

potential benefits to participants will be afforded: (a) access to a conceivably

advantageous mediation that may somehow or another be inaccessible to them; (b)

comfort in having the capacity to talk about their circumstance or issue with a friendly,

target individual; (c) Improved knowledge on their character or conditions, either through

direct association with analysts or through open door for contemplation and self-
 29

reflection or; (d) escape from the thought of being a piece of an examination and typical

schedule; and (e) fulfilment that data they give may help other people comparable issues

or conditions.

Risks. There is little to no risk involved in this study since this will only employ a

data mining process of gathering data. No actual human subjects will be involved in the

same manner that the researcher will not be getting information directly from any human

participant.

Informed Consent. Fully informed consent involves communication of the

following pieces of information to respondents:

1. Participant status. The respondents understand what the researcher will research.

They will be guided in answering the modified standardized questionnaire and

informed where the study will be addressed. They are the nurses of Vicente

Gullas Memorial Hospital.

2. Study goals. The study goal is to determine health promotion lifestyle profile

inventory which is an assessment among nurses in a private hospital.

3. Type of data. The type of data is the quantitative data of research with the use of

the survey questionnaire in determining health promotion lifestyle profile

inventory which is an assessment among nurses in a private hospital.

4. Procedures. Foremost the researcher considers a member of procedures that will

be followed before implementing study. First, the researcher will ask verbal and

written permission from the good office of the Dean of the Graduate School that

allow the researcher to conduct the study as requirement for the degree. After

some process as the permission will be granted, researcher will submit such
 30

documents to the Institutional Review Board (IRB) for the clearance and survey

among the nurses on nurse promotion strategies in a private hospital. Fourth, the

researcher will take time in determining health promotion lifestyle inventory in a

private hospital. Fifth, the researcher will gather or collect data that will be

calculated statistically so that the result will be derived by appropriate statistical

tools. Sixth, the researcher undergoes analysis for the possible outcome or finding

that will appear from the study. At last every collected data from the respondents

and any documents that have something to do with the respondents will be burned

by the researchers just for the security of the respondent’s identity as well as its

privacy.

5. Nature of Commitment. The researcher gives at least 30 minutes in answering the

modified standardized questionnaire.

6. Sponsorship. The research has no sponsor whatsoever and this study determines

the health promotion lifestyle profile inventory.

7. Participants’ selection. The respondents will be selected through purposive

sampling technique where the participants will be selected on the basis of the

inclusion criteria.

8. Potential risks. The respondents may lose their time when the researcher will

conduct the research and it will take time and patience before collecting data from

the respondent as it depends upon availability of the respondents.

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9. Potential benefits. The respondents can help in the enhancement of health

promotion lifestyle in Alternatives. There is no other advantageous procedure

than purposive sampling technique.

10. Compensation. No payments for the treatments, when researcher gives such

monetary benefits it equals to all respondents.

11. Confidentiality pledge. There is no any personal information from the respondents

that is being asked in the questionnaire. The data or documents from the

respondents will be considered as confidential that will keep their privacy.

12. Voluntary consent. The participants voluntarily answer the modified-standardized

questionnaires and they will be freed if ever they refuse to give answer or

response to the given questionnaires.

13. Right to withdraw and withhold information. The respondents in the study have

the right to withdraw and withhold the information they will offer or give if ever they

do not like the study. Otherwise if the respondent refuses the response to the given

question the researcher respect their decision.

14. Contact Information. To prevent bias and conflict of interest, you can contact UV-

IRB through telephone number 416-8607 or you can email through

uvirb2015@[Link].

Authorization to access private information. The study had involved accessing

records of the clients. The researcher shall secure consent and permission from the rural

health nurse who is in-charge of keeping the clients’ files for their medical care needs.

Confidentiality procedures. The researcher ensures that all information gathered

from the records of the clients shall only be used for the purpose of this study and will
 32

only be known by the researcher. There will also be no mention of personal information

in the data collection and anonymity shall be observed at all times.

Debriefing, communication and referrals. The researcher will not need

debriefing, communication, and referral since this is a data mining or archival study and

no actual human involvement shall be done.

Incentives or compensation. No motivating forces or pay were stood to the

subjects of the investigation, considering that the examination involves just noting a

survey and deliberate in nature. Expressions of appreciation were the methods for saying

thanks to the stakeholders in taking an interest in the investigation.

Conflict of interest. The researcher declares no conflict of interest in the conduct

of the study. Even if the researcher is currently connected with the data source, she will

only be using the client’s data from the existing files. However, should there be a conflict

of interest, a third party was requested in the distribution of the questionnaires. The

researcher also had it in mind that his study might be of used to future and aspiring

researchers with that the researcher emphasizes that if his study will be of great help to

someone that would be a privilege and honor.

Collaborative study terms of reference. The study was not in collaboration with

any institution or organization. This study was purely done, in compliance with the

requirements for the researcher’s master’s degree program. The licensed innovation

rights and additionally the distribution rights and data and duty sharing was solely owned

by the University and the researcher. Thus, terms of reference were not applicable in the

study.