Chapter 21: Promoting health

Case study: Mr Patel

Wheatley, a small village in rural Oxfordshire has an amateur rugby team, comprised mainly of regulars from the Kings Arms public house. One evening, after practice, Mr Patel, the coach and some of the players start talking about men’s health in relation to prostate and testicular problems. There seems to be some confusion about the different disorders, the risk factors and ages at which these occur.

Mr Patel says he is worried because at 70 he is beginning to have trouble wanting to urinate but not being able to ‘go’ when he gets to the toilet. He thinks this means he has cancer. Jay Brown at 19 says he thinks he will not get testicular cancer because, like prostate problems, this is an ‘old man’s disease’. His friend Craig, who is 20, shyly reveals that he has had a swelling ‘on one side’ for three months and has told no one because he is afraid it might be cancer. Mr Patel tells him it is normal and nothing to worry about.

None of the men are correct in what they say.

  1. How could health promotion be used in this setting? What resources and methods would you suggest could be used to raise awareness of these conditions?
  2. What if these conversations were taking place in a residential home for men with learning disabilities. How would you adapt the health promotion project to raise awareness of these health issues in this setting?
  3. Imagine children having a similar conversation with various misunderstandings and inventions. How would you adapt a health promotion project to meet their needs?

No solution available for this case study

Case study: ‘Bugs’

Alisha is a 6 year-old, in hospital to have investigations of recurrent gastro-intestinal upsets. The last episode made her very ill and her mother has despaired of finding ways to protect her child.

The paediatric team have not been able to find any specific causes but Alisha’s named nurse wonders if it could be due to poor hand hygiene.

You are asked to think about how Alisha could be shown to prevent infection by washing her hands more effectively.

Firstly:

1. What does Alisha need to know?

2. How should Alisha be washing her hands?

​Secondly:

3. At 6 years of age how can you teach her about ‘bugs’?

4. How can you show her hand washing so that she will understand and remember?

As a student nurse you are also thinking about how your work with Alisha could be used on the ward generally. You suggest to your mentor that try out some ideas.

5. What could you do in the ward to improve the children’s hand washing?

› Solution

1. ‘Bugs’ stick to hands and objects, and are transferred. Wash hands after toilet and before eating. ‘Bugs’ cause sickness. ‘Bugs’ can be picked up from door handles, handrails etc.

2. Soap and water is effective. Drying is important. Wash hands all over (including backs and wrists). Take time.

3. At 6 she will not really understand consequences, so although you may think a couple of repetitions is enough, she will do the same wrong thing again. At this age using toys and cartoons works well as the children relate to them and remember – perhaps inventing a song to go with the toy.

Use bug toys and pictures. Reward learning with stickers.

4. Show her first, but don’t expect learning yet (this is not different in adults!). Make a game of who can get the soap all over both hands. Wash her hands with yours and let her feel the pressure needed to rub all over. Make a song or jingle of it, e.g. once around the garden (palms together), twice around each statue (fingers), etc.

5. Having done this with one youngster, you can think more broadly in terms of age groups – but older children like to have fun too, perhaps the song could become a ward song?! Think of simple (and available, cheap) ideas like colourful containers for the soap, home-made posters and notices near the toilets and hand basins. Making hand washing an essential part of the ward routine can also work. You will have read about giving ‘signals’ such as red trays for poor eaters – how about a green spot sticker on hands washed and ready for meals?

There are resources available:

  • Posters and colouring books, etc.
  • UV light lamps to show up where special soap has not been removed
  • Soft toys in the form of ‘bugs’

Some obviously cost money. So you request a budget for your project or rely on free online resources. Sponsorship from soap companies, or even just using brand name leaflets, etc. will need Trust permission and a very careful analysis of things like safety for children and what the product costs (nurses must not exclusively recommend a product anyway, but certainly not involve a family in unnecessary expense). Be really sure your resources are evidence-based and approved by NHS, and your manager.