Commentary on Whitehead D (2004) Health‐promoting hospitals: the role and function of nursing. Journal of Clinical Nursing 14, 20–27

Abstract

Dean Whitehead provides a comprehensive review of the published literature related to health-promoting hospitals and the role and function of nursing. While he makes many important and relevant comments, his central argument is that nurses should be taking leadership roles in radical health promotion reform, an activity that to date they have failed to grasp. While a leadership role might be desirable, the realities of working in a hospital environment make creating such opportunities extremely difficult. Despite this, there is some evidence that nurses in hospitals undertake activities consistent with a health-promoting hospital approach. Given the environment nurses in hospitals work in, these initiatives should be commended and the effort involved in such change, even though it is relatively small, not underestimated. That nursing could contribute more extensively to the health promotion activities in hospital is surely both desirable and, at least in theory, possible but is not likely to occur without strong support and leadership from the organization as a whole. Whitehead suggests that nurses must accept the blame for failing to take the lead with the health-promoting hospital concept. Nurses have been highlighted by Whitehead as the most important group to lead the change to health-promoting hospitals because of their large numbers. Unfortunately, while nurses may work in hospitals in large numbers, their power base – and thus capacity to make change – is limited. Higher acuity, increased use of technology, increased consumer demands, ever-tighter budgets and increased medical specialization are all areas where nurses often lack significant influence. Therefore, the expectation that nurses could reorient the health system away from medicine and disease towards health is likely to be highly problematic. If many hospitals have been reluctant to take on the health-promoting hospital concept, as Whitehead suggests, how can nurses then be held responsible for failing to reform the system when it is well articulated that an essential component for a successful health-promoting hospital is strong organizational support on multiple levels (Johnson & Baum 2001)? In addition, health promotion activities do not tend to be funded within the hospital setting (World Health Organization 2004). Absence of funding makes system wide change, particularly in major hospitals, less likely. Nurses alone are unlikely to change this situation. Reorientation will only occur if strong policy direction and support are implemented across the organization from the Hospital Board level down. For nurses to be in a position to implement significant change within the hospital, they need to be both competent and confident in the area of health promotion. It needs to be recognized that radical health promotion reform is new to nurses and many other health professionals and that organizational policy support that provides for adequate funding, education and initiative development, staff support and assistance are required to realize and legitimize the nurses role in proactively undertaking health promotion. It is clear that, if nurses are to undertake a significant health promotion role, strong nursing leadership is essential. The importance of leadership from within the nursing division must be recognized as a key initiative in promoting, supporting and directing nurses to undertake health promotion activities and to introduce the language into their organizational culture. Without support at every level of nursing management, change will not occur. While strong nursing leadership will make some impact on changing the health services approach to health promotion, it will not be sufficient for major institutional change. This requires a genuine commitment from all areas of the organization. Correspondence: Lynette Cusack, Director, Community Services, Drug and Alcohol Services, South Australia, 161 Greenhill Road, Parkside, South Australia 5063. E-mail: morgan.smith@unisa.edu.au