Public Health Nursing in Ireland: A Critical Overview*

Characteristics of Public Health Registered Nurses and Advanced Practice Registered Nurses: Lessons Learned From the 2018 National Sample Survey of Registered Nurses

OBJECTIVES

Little research has compared the demographic and practice characteristics of registered nurses (RNs) who work in public health (PH RNs) with other RNs and advanced practice registered nurses (APRNs) who work in public health (PH APRNs) with other APRNs. We examined differences in characteristics between PH RNs and other RNs and between PH APRNs and other APRNs.

METHODS

Using the 2018 National Sample Survey of Registered Nurses (N = 43 960), we examined demographic and practice characteristics, training needs, job satisfaction, and wages of PH RNs compared with other RNs and PH APRNs compared with other APRNs. We used independent sample t tests to determine significant differences between PH RNs and other RNs and between PH APRNs and other APRNs.

RESULTS

On average, PH RNs and PH APRNs earned significantly less than other RNs ($7082 difference) and APRNs ($16 362 difference) (both P < .001). However, their job satisfaction was comparable. PH RNs and PH APRNs were also significantly more likely than other RNs and APRNs to report the need for more training in social determinants of health (20 [P < .001] and 9 [P = .04] percentage points higher, respectively), working in medically underserved communities (25 and 23 percentage points higher, respectively [P < .001 for both]), population-based health (23 and 20 percentage points higher, respectively [P < .001 for both]), and mental health (13 and 8 percentage points higher, respectively [P < .001 for both]).

CONCLUSIONS

Efforts that expand public health infrastructure and workforce development must consider the value of a diverse public health nursing workforce to protect community health. Future studies should include more detailed analyses of PH RNs and PH APRNs and their roles.

Street-level bureaucracy and policy implementation in community public health nursing: a qualitative study of the experiences of student and novice health visitors

Aim To explore the experiences of student and novice health visitors in implementing health visiting policy reform pre- and post-qualification.

BACKGROUND

In England, public health nursing has been subject to major policy reform. The Health Visitor Implementation Plan (2011) set out a plan to recruit increasing numbers of nurses and midwives to the profession to deliver an expanded and refocussed health visiting service. Exploring this policy change from the viewpoint of those new to health visiting offers a unique perspective into how a specific policy vision is translated into nursing practice.

METHODS

A descriptive qualitative study in which participants were enrolled on a one-year post-graduate health visiting course at a University in South West of England. Qualitative data were collected pre- and post-qualification. A total of 16 interviews and a focus group were conducted with nine participants between September 2012 and March 2013. Findings Descriptive data were interpreted using Lipsky's theoretical framework of street-level bureaucracy. Three themes emerged which relate to this 'bottom-up' perspective on policy implementation; readiness to operationalise policy, challenges in delivering the service vision; and using discretion in delivering the vision. Community public health nurses operate as street-level bureaucrats in negotiating the demands of policy and practice, and by this means, attempt to reconcile professional values with institutional constraints. Barriers to policy implementation at a local level mediate the effects of policy reform, ultimately impacting upon outcomes for children and families.

Examining the Synergy of Practice: The Irish Public Health Nurse's Potential From the First Postnatal Visit and Beyond

Public health nurses in Ireland are charged with conducting a home visit to every postnatal mother within 48 hours of hospital discharge. This represents the beginning of a long-term relationship, not only with the mother and newborn child but also with the family. This article fundamentally demonstrates the essential work of the public health nurse in promoting the health of the baby within a family. In this article, the expertise the public health nurse uses in the first visit is examined in the context of 3 competencies: communication, partnerships with the family, and partnerships with individual family members. This expertise provides the foundation for a long-term therapeutic relationship with the family to the essential benefit of the baby’s early childhood growth and developmental milestones. Consequently, the first postnatal visit by public health nursing in Ireland represents a synergy of practice, which provides the foundation for enduring family relationships focused on potentializing both individual family members’ health and the family as a dynamic unit.

Caseload management: an approach to making community needs visible

AIM

To explore the process employed in the development of a population health framework and documentation for managing community nursing caseloads.

BACKGROUND

No formal structure exists to validate and link local health information collected by Irish public health nurses to a wider epidemiological framework. Neglect of this bottom up information forfeits opportunities to resource and manage public health nursing services.

DESIGN

Action research methods guided the development of the framework in one geographic area in Dublin and 34 participants engaged in Stringer's (1996) Look, Think and Act cycle.

RESULTS

The framework identified four patient registers: family health, chronic sick/disability, older adults and acute care, which identify public health outcomes for discussion within the caseload analysis process and can predict risk factors in local populations.

CONCLUSIONS

The use of the developed documentation identified a framework that describes caseloads in primary care and provides nurse managers with an evidence base to allocate resources, match skill mix to need, and estimate future workforce requirements.

Factors associated with duration of breastfeeding in ireland: potential areas for improvement

There is a need to comprehensively examine why mothers in Ireland discontinue breastfeeding early and to explore the factors influencing duration of breastfeeding during the first 6 months postpartum. Findings from this study provide valuable direction for future strategies and interventions aimed at increasing breastfeeding duration rates in Ireland.

Community nurses working in piloted primary care teams: Irish Republic

Primary care health services in the Irish Republic have undergone fundamental transformation with the establishment of multidisciplinary primary care teams nationwide. Primary care teams provide a community-based health service delivered through a range of health professionals in an integrated way. As part of this initiative ten pilot teams were established in 2003. This research was undertaken in order to gain an understanding of nurse's experiences of working in a piloted primary care team. The methodology used was a focus group approach. The findings from this study illustrated how community nurse's roles and responsibilities have expanded within the team. The findings also highlighted the benefits and challenges of working as a team with various other community-based health-care disciplines.

Measuring self-perceived public health nursing competencies using a quantitative approach

BACKGROUND

The contribution of nurses to the public health agenda is acknowledged in all health care systems. To integrate public health into nursing curricula competency based models are being proposed. Despite general agreement on public health competencies, there has been limited research on how community nursing students self-assess their public health competencies and the impact of public health programmes on qualifying students' self-assessed competence.

AIM

The aim of this paper is to report on the development of a research tool to assess self-perceived public health competencies of community nursing students, pre and post studying on a community and public health nursing programme.

METHODS

A pre and post intervention quantitative survey was conducted with a non-probability sample of community nursing students (n=108) studying on a public health programme. The questionnaire was developed using public health competencies derived from a United Kingdom (UK) national consensus exercise and informed by international literature. Analysis used SPSS, generating descriptive and inferential statistics.

RESULTS

There were statistically significant improvements in students' self-perceived public health competencies following participation in the public health programme.

CONCLUSION

It is possible to assess self-perceived competency in public health skills using a validated measurement tool.

The Community Client Need Classification System - a dependency system for community nurses

AIM

The aim of this paper was to discuss the predictive validity and reliability of the Community Client Need Classification System (CCNCS), the results of using this tool and public health nurses' satisfaction with the system.

BACKGROUND

Public health nurses provide the majority of community nursing services in Ireland. The traditional method of measuring workload in the community is based on recording the number of visits. The revised Easley-Storfjell instrument for Caseload/Workload Analysis was modified for the Irish context and permission from the authors was sought to use it in this study and was thus named the CCNCS.

METHODS

A convenience sample of 29 public health nurses used the CCNCS to classify 1352 clients for 2 weeks.

RESULTS

The elderly and child health groups accounted for the majority of the nurses' direct and indirect time. Predictive validity analysis demonstrated a positive relationship between needs level and nursing time. Nurses reported that the CCNCS was useful in predicting the needs of new and existing clients.

CONCLUSIONS

This classification system, albeit in the first draft of its revised form, was perceived by the chosen sample of public health nurses as useful in measuring their workload. Further research is required to ascertain the reliability of the modified classification system with a larger sample size.