According to The World Organization [WHO] (1946), “health is the state of complete physical, social, and mental welfare and merely the absence of disease”. WHO’s definition, however, does not reflect on the importance of spiritual health and wellbeing, and as evident in a research study by Olson (2015), spirituality whether practised through religion or secular means has a positive effect on patients toward managing and coping with health outcomes or recovery. Thus, the public health in New Zealand emphasises the need for holistic models of health such as Te Whare Tapa Whā model or Fonofale model for health promotion and disease prevention. Nurses are one of the largest regulated health workforces in Aotearoa New Zealand that embrace a holistic view of health (Clendon and Munns, 2018). Thus, nursing consists of maintaining individual and whanau’s health and wellbeing of all ages, ill or healthy and in all environmental and cultural setting. Nursing also includes but not limited to concepts such as the prevention of illness (WHO, 1984). Prevention of disease consists of three different levels of preventions and aims to maintain health and wellbeing by removing the causes and determinant of ill health, such as unhealthy nutrition, or environmental factors (Clendon and Munns, 2018). Therefore, the essay aims to address the role of nurses in maintaining individual and whanau health and explain how it fits with the prevention concept with supporting evidence using Mrs Siosiana K wellness check.
According to the Nursing Council New Zealand [NCNZ] (2018), nurse’s role is to assess health-related obligations and promote care, advice and support individuals to maintain their health. International Council of Nurses’ [ICN] (2012, p. 2) also states that nurses are to practice in “an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected”. Therefore, nursing consists of sustaining individual, whanau and community’s wellbeing, ill or healthy, at any age, in any emotional, physical, or social state and in all environmental and cultural setting, thus nurses integrate a holistic view of health into their practice (Clendon& Munns, 2018). A study by Olson (2015) also highlights the power of integrating client’s spiritual status and needs in the nursing practice, as it provides hope, sense of identity and purpose in their life, which become a powerful tool with the healing process. Moreover, a report by Auckland District Health Board [ADHB] (2016) highlights the importance of whanau, family, or friend’s involvement in the patient’s healthcare and is particularly significant to Maori and Pacifica patients. The ADHB (2010) report indicates that one in twenty patients (5%) and with twice as many Maori and Pacifica patients (11%) declared that allowing support is one of the significant factors toward their recovery, quality of care and treatment. Therefore, it is indeed fundamental to use a holistic approach in nursing to maintain a better understanding of the client’s health and wellbeing education level, to increase control of the factors of health, encourages self-care and thereby improves their health, and prevents the occurrence of a disorder or disease such as type II diabetes. For instance, as Mrs Siosiana K is Tongan, as a nurse, when assessing her, I would use a pacific holistic model such as the Fonofale model. The model was constructed as a Pacific Island model of health and wellbeing in New Zealand and bases on the resemblance of a fale/house. The roof represents Mrs Siosiana K strong cultural values as a Tongan; the foundation is her family support; and the Pou are the four dimensions of life: her strong spiritual faith as a Christian, along with her physical, emotional and social health such as education level, occupation or income level (Puloyu-Endemann, 2001). Using the Fonofale model will also provide a more profound understanding of my client’s knowledge and motivations that may aid her to a healthier life as well as an understanding of the lifestyle and living condition to determine Mrs K health status. However, the wellness check provided lacked inquiries about social, cultural, and spiritual beliefs, which as discussed are fundamental to gain a comprehensive understanding of the client.
Prevention concept consists of measures and strategies applied to prevent the occurrence of a disease and aims towards eliminating or reducing the impact of disease and disability (Clendon and Munns, 2018). WHO (1984) defines prevention concept as “the process of enabling people to increase control over the health and its detriments, and thereby improve their health”. According to Clendon and Munns (2018), public health in New Zealand classifies prevention in three groups: primary, secondary, and tertiary prevention. The focus of the primary level is to improve the health of an individual, whanau or community and have the client avoid or reduce high-risk determinants of ill health. For instance, according to George (2013), Pacific people have one of the most severe health indicators in NZ and experience a high number of preventable deaths mainly due to chronic non-communicable diseases (NCDs) such as diabetes and heart disease. Type II diabetes is more common among Pacific people and rates 2-3 times higher compared with the total NZ population (George, 2013). Survey also indicated that one of the leading causes of diabetes and heart-related disease among the Pacific people is obesity, with a rate of 90 percent in comparison with 60 percent of the total NZ population (Tapaleao, 2017). Some factors that affect their health, are low health literacy toward nutrients, or low physical activity and a lack of awareness of health care services available (Tapaleao, 2017). Therefore, primary prevention is preventing obesity, particularly in Pacific people, to gain quality health and wellbeing. Secondary prevention, on the other hand, relates to early diagnosis, and the goal is to persuade the client to have an early screening to reduce or prevent the progression of the disease. For example, according to George (2013), Pacific people are known to have little knowledge of primary health care services available, such as cervical and breast screening and also have low immunisation coverage rate. Thus, secondary prevention is to address this gap in knowledge to prevent the occurrence of disease such as cervical cancer. Lastly, tertiary prevention focuses on supporting the client in disease management and preventing further physical deterioration in order for the client to have the best quality of life possible, such as access to renal dialysis services as a result of renal failure due to diabetes (Hill, Ward, Grace and Gleadle, 2017).
Nurses play an essential role in disease prevention with the client, family, and community (Kemppainen, Tassavainen, and Turunen, 2012). According to Kemppainen et al. (2012), nurses educate clients on the benefits of a healthy lifestyle, such as eating healthy, exercising, obtaining an adequate amount of sleep, and ensure the client is participating in early detection diagnostic tests and screenings, thus preventing diseases. For instance, as a nurse, doing a wellness check such as Mrs Siosiana K’s check allows evaluation of Mrs K knowledge of health management and screening services available, such as breast screening and smear test, and confirms they done regularly. The wellness checks also provide a slight indication of Mrs K eating habits, sleeping patterns, and highlighted evidence that Mrs K is heading toward obesity with a BMI of 41.22. According to the wellness check, one factor of the weight gain could be due to sleep deprivation, as Mrs K stated a sleep of only 5 hours a night. A research study by Hanlon and Knutson (2013) states that sleep deficiency contributes to the increasing occurrence of overweight and obesity along with obesity related diseases such as type II diabetes and heart disease. Hanlon and Knutson’s (2013) findings prove that lack of sleep indeed weaken glucose metabolism and interferes with the central nervous system, leading to excessive food intake. Thus a further assessment of Mrs K sleep and rest patterns and the causes to her lack of sleep along with physical assessment is necessary in order to intervene based on the needs specific to Mrs K, such as planning activities and routines that may enhance the duration of sleep. The wellness check, however, failed to identify any other factors to Mrs K’s weight gain, such as whether it is lack of education toward healthy eating, her understanding toward risks of obesity or if it is stress or emotional related weight gain. Therefore, to prevent the occurrence of obesity related disease, it is vital in this case to gain more information about Mrs K using Fonfale holistic model as well as the wellness check, thus encourage self-care and thereby improve health.
In conclusion, the role of nursing range from simple to complex duties and includes but not limited to physical examination, prevention of disease and promotion of health for the individual along with the whanau, and community. Therefore, nursing act in the interest of the people of Aotearoa New Zealand, and work in partnership with individuals, whānau, and communities along with other health and social care providers in order to achieve optimal health outcomes. It was evident in the wellness check, some of the responsibility and quality of nurse’s role is disease prevention by interpreting information and factors that influence a client and develop a plan of care to treat an illness or simply improve quality of life, health and wellbeing. Moreover, the major need of using a holistic approach in nursing was apparent in order to maintain a more profound understanding of the client’s lifestyle and living condition, to best determine the health needs and thus provide the intervention required that is explicit for the client.
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