The Nurse as a Role Model: Barriers that Impact on Health Promotion and Wellness

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Chapter 1: Introduction

Background

Three decades ago, Rosen and Ashley (1978) identified role modelling as an expected behaviour for all health professionals, including nurses (p. 401). Shortly thereafter, the United States Surgeon General's inaugural report (USDHEW, 1979, p. 12) introduced the Healthy People concept. In the current Healthy People 2010 (CDCP, 2005, p. 9), the expectation that nurses should be health promoting role models remains unchanged. Underlying this expectation is the assumption that to be effective in health promotion, nurses must be role models of the healthy behaviours they seek to promote. Empirical work premised on this assumption has been used to make inferences about the role model adequacy of nurses across several specialty areas; overall, however, nurses have been negatively judged as health role models (McElligott , 2009; Petch-Levine, 2003).

The difficulty with this negative judgment of nurses as role models is the narrow conceptualisation on which it is based so that validity is questionable. The shift in health promotion from a behaviouristic, lifestyle focus to broader determinants of health. Brenchley and Robinson (2001) reflect the need for reconceptualisation of what a health-promoting role model is (p. 1068). An expanded conceptual base is necessary for the development of a valid measure of nurses as health-promoting role models. A measure to identify nurses' self-perceptions as role models of health promotion is of heightened importance because of the influence one's self-regard as a role model has on health promotion practice (Strobl & Latter, 1998, p. 179).

Nurses Perception of themselves as Role Models of Health Promotion and Wellness

Few studies have explored nurses' perceptions of themselves as role models of health promotion, but findings are equivocal. Nurses view themselves as role models generally in terms of setting a good example by exhibiting healthy behaviours (Swenson, 1991, p. 27). According to a study conducted by Connolly and colleagues (1997), 70% of critical care nurses surveys agreed that they would recommend their lifestyle to others (in particular their patients) since they eat well, watch their weight and consider themselves as good role models. In another study, nurses, medical preceptors, and their students identified differences between their intentions and actual health behaviours (McWilliam, Spence-Laschinger, & Weston, 1999, p. 100). They expressed concern that they could not expect patients to practice healthy lifestyles when they themselves did not role-model this behaviour. Qualitative work showed that nurses perceived that being an imperfect, but humanistic and realistic, model of health promotion was just as valuable as being a perfect, ideal role model (Rush, Kee, & Rice, 2005, p. 172). They thought that this very imperfection could be used to great advantage with patients. Other investigators have shown that when nurses perceive themselves negatively as role models they are reluctant to teach and counsel patients about health-promoting behaviours, engage in policy development, or create healthy environments (Strobl & Latter, 1998, p. 181).

American Nurses Association (2012) defines healthy nurse as a nurse who takes extreme care about his/her health, wellness, ...