Using our strengths: The new health promotion

As a small child, I had terrible asthma. It was in the days of oral aminophylline, spinhalers and hope. My parents were often terrified by my nightly attacks of breathlessness. My mother retreated  into another room to be sick with fear and my father, another asthmatic, was left to sit and care for me.

Consequently, I was wrapped in cotton wool by my parents and the family GP, Dr V,  armed with few effective drugs but helpful practical tips , was sympathetic and responsive to our family’s plight.

bless you, Dr L, who, when faced with a sobbing student nurse with an acute exacerbation, persuaded the frightened me into inhaled steroids, despite my fear over the imagined side effects, drummed into me during my training.

One day the said good doctor diagnosed a  pneumothorax during a home visit to my student nurse hovel. My lung, weakened by attacks, had popped. The surgeon Mr B was calledwhen it failed to mend, and to my shock he said it wasn’t much good and removed two thirds of my right lung without so much as a ‘by-your-leave’.

Now, although Dr L had fixed my attacks, I couldn’t climb a hill without stopping for breath. My therapy was to choose cardiothoracics as a speciality, and look after others in the same position.

Skip forward to my forties. I’m looking at my reflected self – middle aged, a bit podgy, and unfit. My excuse of course is that I can’t make too much cardiovascular effort because of my lungs. But being somewhat vain, I decided to take up jogging, just to see what happened. My school friend, Mandy, knowing my history, was so utterly shocked by this that she took up jogging too and we’ve done a few 5k races together.

One day, something occurred to me as I puffed along the Bridgewater Canal. I had always equated breathlessness with illness, not wellness. Nobody had talked to me about what I could do, only what I couldn’t.

This week I went to see Donna Hinkson and Emmelynne Forman, who have recently founded a social enterprise  called People Point. They listen to the problems of local people and develop schemes which involve and support the community. At the moment they are developing a community cafe in a church – a place to be run by people with learning disability. Here, experienced mothers can pass on child care skills to younger women, and people can come and cook their food bank rations together and share a few tips.

Knowing that I am a nurse, Donna told me some tales of others like me with long term conditions. So terrified are these people about what they have been told about their diabetes that they dare not eat a Kitkat, for fear of losing their leg. Some are too scared to leave the house or, like I used to be,  take exercise. My colleague K, the local  lead nurse for primary care, took a sharp intake of breath as she sat beside me. In certain BME communities in the area, with standardised mortality ratios for cardivascular disease of one and a half times the national average, she knew that  some local practices use shock tactics, basically putting the fear of God into people to get them to control their diabetes.

Donna commented on how the messages that some health professionals give can turn the micro into macro – people with long term conditions can amplify the risks. She emphasised how People Point uses a  strengths-based approach, focusing on finding out and harnessing what residents are good at and what they are able to do. It avoids people seeing themselves as victims and encourages empowerment and self confidence.

In general, health services tend to be  health CARE services, we look after people and we fix weaknesses. But we may not find time or opportunity to identify the skills, talents and abilities that patients otherwise have. But other disciplines such as social work, youth services, training, education and family support have a strengths based approach built in.

Getting away from Parson’s sick role and illness behaviour must be built into our psyche as we go forward. As primary care professionals some of us understand and practice this, but we must now all take every opportunity to use a strengths-based approach. I know from bitter experience that long term illness can foster introspection and self pity. Asking what people are good at and finding ways to harness it is the new health promotion.

We know that ‘giving back’  is one of our five ways to wellbeing, so one approach might be to refer  patients to the local volunteers centre.

Here’s an example: I introduced myself to a Major in the Territorial Army at a community event last Thursday. He told me of his concerns for amputee war veterans who have returned to my home town with low self esteem and no hope. I asked if some of them could still drive or brew up. Yes, he said. I gave him the business card for our charity, CALLPlus,  which supports people with life limiting illness and asked him to speak to our manager about veterans, who have also experienced life-limiting situations, helping out. Our volunteers host fortnightly coffee mornings,  drive people to hospital and sit with them while they have their cancer treatment. His face brightened. ‘I’ll do just that’, he said.

The post was first published as a blog for the NHS Alliance on April 29th as part of a campaign on changing culture and behaviour in the NHS