Community Nursing Award winner – Anne Thomas

An outpatient department staff nurse has transformed health education for men of all ages with a range of targeted initiatives throughout her rural community

Anne Thomas, with a team of two healthcare assistants, has developed a range of proactive and preventative projects and harnessed support from the voluntary sector, to address health inequalities for men living around Dolgellau Hospital in Wales.

Anne’s drive, commitment and achievements won her the Superdrug-sponsored Community Nursing Award category of the RCNi Nurse Awards, the profession’s top accolade.

Anne says: ‘Health outcomes for men are substantially worse than women with a lower life expectancy of 79 compared to 83 for women. This gap is partly accounted for by premature death from cancer and more deaths from cardiac disease. Men are also three times more likely to die from suicide, with the highest incidence in farmers.

‘We knew that if you approach health promotion in the wrong way, you will not reach the people you want to target'

‘There is a health behaviour paradigm of masculinity, particularly in farming communities, with men not accessing services as often or as soon as women, leading to later presentation of disease and poorer outcomes.’

Accessing health education

Anne's own research identified barriers in the rural community to accessing health education. In response, the team developed a concerted approach that was accessible and acceptable to men – and effective.

She says: ‘We are passionate about health education and work hard to ensure that promoting health is central to all care. However, we needed to reach out to men and this required our staff to go into the community and provide support and information where the men work, study and socialise.

‘Health education that is acceptable and appropriate to men, where men are is one strategy for closing the health inequality gap. For example, advising men on the symptoms of skin cancer in a cattle market during summer is more effective.’

Working round the clock

Managers liked the idea, but could not provide any resources. ‘We overcame this by designating one afternoon on the rota every week when each staff member could dedicate time to their own health education projects,’ Anne explains. ‘The staff back in the hospital work harder to cover the person out in the community. We fundraised for equipment and materials.

‘We knew that if you approach health promotion in the wrong way, you will not reach the people you want to target. So we did our research before we started out, talking to men in the community, individually and in groups. We held focus groups, conducted surveys and distributed questionnaires.’

The result was a raft of initiatives including sun awareness campaigns in farmers markets and delivering prostate awareness sessions to community groups in pubs. Health promotion boards have been put up in police stations.

Plans were developed with colleges, workplaces and GPs. Anne has built strong links with the British Heart Foundation, Macmillan, the Alzheimer’s Society and Carers Outreach. ‘Each organisation has provided training, materials and support,’ says Anne.

One HCA trained as an ambassador for men's health with the Orchid Charity enabling the team to provide testicular awareness for students in colleges. ‘Following a presentation, two young men are being investigated for worrying symptoms,’ says Anne. ‘We have supported them by arranging appointments.’

Support for lifestyle change is often not 'male friendly', said Anne, so the team offers a Healthy Hearts Programme that provides six private, individual sessions of advice and encouragement to encourage heart health.

At one college, the team worked with people who have special educational needs. ‘We talked to them regarding what would happen if they came in with an arm injury’ Anne says.

Proud

Anne is proud of the team’s achievements. ‘GPs report that the prostate drop in service ensures early referral and audit shows our Healthy Hearts Programme has significantly reduced risk factors. Farmers report that advice on recognising skin cancers increases their use of sun protection and a construction college tutor said that students have a better understanding of testicular awareness.’

Anne is looking to extend her team’s reach. The hardest-to-reach people in the community, she said, are those who do not leave the house. ‘If a patient has a BMI of 60, smokes 60 a day, has leg ulcers and poor mobility, he is unlikely to go out to access smoking cessation or weight loss support.

To address this, the team is joining forces with district nurses to provide a health education service in people’s homes. ‘I’ve been a district nurse and I understand it is not always easy to offer health education,’ says Anne.

‘If district nurses identify a patient who may benefit from lifestyle change, the outpatient team will visit them and offer support. We will have a laptop and DVDs that we watch with them to encourage discussion.’

The team has been asked to extend its programme to other schools and colleges. Another priority is increasing listening support services for men’s mental health.

‘We provide drop-in carers support but we are introducing Cruse for bereavement counselling and Time to Talk sessions,’ says Anne.

The team is also making links with the farmers’ helpline to offer mental health support.

‘It makes us proud when we have feedback from the community telling us our approach is working,’ says Anne. ‘It is often difficult to audit the effectiveness of health education but when we hear from college tutors that the construction and farming students are more willing to talk about their health, we know that the hard work involved in breaking down the barriers of embarrassment and reticence have been worth it’

The Community Nursing Award is sponsored by Superdrug