Health Promotion in Realtion to a Midwife

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In 1946 the World Health Organisation (WHO) defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. This definition integrates the main concepts of health and identifies that health can be viewed differently by individuals and groups (Bowden, 2006). Health and well-being are the result of a combination of physical, social, intellectual and emotional factors (Dunkley, 2000a). The concept of health promotion has emerged with the increasing realisation in society that our health is one of our most valuable personal assets, as well as an asset for society (Crafter, 1997). The Health Promotion Agency (2008) describes health promotion as a process enabling people to exert control over the determinants of health and thereby improve their health. Similarly, the WHO identifies that health promotion involves equipping people to have more power, enabling them to make choices in regard to improving their well-being (WHO, 1984). Ewles and Simnett (2003) determine from this that the fundamental elements of health promotion are improving health, empowerment and education. Breastfeeding is the best form of nutrition for infants and so is an important topic in the context of health promotion (Dearling, 1999). Health promotion is not an extended role of the midwife but a core competency. In its Code of Professional Conduct (2008), the Nursing and Midwifery Council (NMC) outlines the role of the midwife to include supporting people in caring for themselves to improve and maintain their health. Midwives must work with others to protect and promote the health and well-being of those in their care (NMC, 2008). Midwives meet and influence individual women and their families on a day-to-day basis, and can make real differences to how those people deal with health issues during their childbearing years and beyond (Crafter, 1997). Davis (2002) points out that every interaction with a woman is an opportunity to improve long-term health as midwives are trusted as authoritative figures in the delivery of health promotion. The Royal College of Midwives’ “Vision 2000” describes the midwife as a public health practitioner, and relevant models and approaches can enhance the way that midwives deliver care. A health promotion approach can be described as the vehicle used to achieve the desired aim (Dunkley-Bent, 2004). Ewles and Simnett (2003) suggest that health promotion is commonly characterised as having five different approaches: the medical approach; the behaviour change approach; the educational approach; the empowerment approach; and the societal change approach. A summary of these approaches can be found in Appendix One. A model of health promotion seeks to represent reality and demonstrates how these different approaches connect in practice (Dearling, 1999). This assignment applies Beatties (1991) model of health promotion to breastfeeding; analyses the challenges midwives may encounter when promoting breastfeeding and evaluates the effectiveness of the midwife in promoting breastfeeding. Beattie’s (1991) model is appropriate as it provides a structured framework to guide, map and contextualise health promotion intervention related to breastfeeding (Seedhouse, 2003). Beattie’s (1991) model has two dimensions; “mode of intervention” and “focus of intervention”. The “mode of intervention” ranges from authoritative which is top-down and expert-led; to negotiated, which is bottom-up and values individuals autonomy. The “focus of intervention” ranges from a focus on the individual to a focus on the collective. The model uses these dimensions to generate four strategies for health promotion – health persuasion technique, legislative action, personal counselling and community development (Tonnes and Tilford, 2001). The health persuasion technique utilises the medical and educational approaches to inform women of the research-based health benefits of breastfeeding. This...
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