The role of the public health nurse in a changing society

Sustainable Development Goals in Ireland: How Public Health Nurses Are Contributing Through Engagement in an Interagency Community Pediatric Clinic

Introduction

United Nations Sustainable Development Goals (SDGs) were adopted as a plan of action for people, planet, and prosperity by 2030. SDG 3 aims to ensure healthy lives and promote well-being for all ages, and other goals focus on reduction of inequality, abolition of poverty, decent work for all, and building effective, accountable, and inclusive institutions. A community pediatric clinic, Kidscope, was established in a vulnerable Irish community offering free developmental assessment and onward referral of children 0 to 6 years. The Kidscope model involves multiagency input with local public health nurses (PHNs) acting as fundamental partners in the provision of specialist early years support to vulnerable children and families. This study evaluates PHN involvement in Kidscope in the context of SDGs.

Objective

To record and understand PHN roles within Kidscope and to capture their contribution to achieving SDGs in a disadvantaged Irish community.

Methods

Qualitative stakeholder analysis and mapping design. Snowball sampling identified participants. Data collection involved scoping interviews, questionnaires, one-to-one interviews, and a focus group. A Stakeholder Matrix Table was developed in line with the guiding framework. Transcripts were thematically analyzed.

Results

PHNs are key stakeholders in Kidscope contributing to clinic development, delivery, and sustainability. Six themes were identified: lead referrers, in-clinic support, learning and education, child and family follow-up, specialist early years role, and partnership working. PHNs contribute to six SDGs through the Kidscope model.

Conclusion

PHNs are fundamental partners in achieving SDGs in a disadvantaged Irish community through ameliorating childhood developmental delay by intercepting the gap within Ireland's early intervention system and disrupting the impact exclusion to healthcare has on vulnerable children and their families. Findings underscore a shift from the current "cradle to grave" model of working toward a specialist early years PHN role.

Difficulties and countermeasures in implementing age-friendly policies in primary health centers in Taiwan

Background

Taiwan is predicted to become a super-aged society by 2025, and primary health centers (PHCs) are set to play a crucial role in the care of older adults. The Taiwanese government has developed an age-friendly verification framework for PHC. The aims of this study were to explore the difficulties faced by PHC staff in the implementation of age-friendly policies and their solution strategies.

Methods

This study adopted a qualitative research method. The first stage involved conducting five focus groups with the responsible staff of PHCs (n = 41) that have been certified “age-friendly.” The focus groups covered the effectiveness, difficulties, and resources of PHCs in regards to the introduction of age-friendly policies. In the second stage, in-depth interviews were conducted with executives of PHCs (n = 5), both certified and not certified as age-friendly, to further compare the difficulties faced by these two types of PHCs, thereby gaining perspectives for solution strategies. The principles of grounded theory were used for data analysis.

Results

Four major PHC strategies are employed in the promotion of age-friendliness. First, organizational management, through which managers apply management methods and analyze the present PHC-related health concerns; second, resource utilization, which refers to the tallying, linking, and integrating of resources; third, business operation process, in which work efficiency is improved through the combination of business operations and staff training; finally, hardware improvement, which is achieved through comprehensive cataloging of facility environments.

Conclusion

The implementation of age-friendliness in PHCs requires the efforts of both the service units and government. With resources provided by the government, PHCs can integrate management methods, businesses operations, and essential resources. Moreover, PHC executives can lead their teams in promoting age-friendly policies, and closely monitor their effectiveness.

Nursing Students' Intention to Work as Community Health Nurse in China and Its Predictors

PURPOSE

To identify nursing students' intention and the predictors of intention to work as a community health nurse in China.

DESIGN

A cross-sectional investigation was conducted.

METHODS

A questionnaire based on the Theory of Planned Behavior was delivered by Wechat to a convenience sample of 810 students.

FINDINGS

In the study, 345 students (42.6%) expressed the intention to be a community health nurse, and the program type, students' attitude, subjective norm and  perceived behavioral control were significant predictors of this intention.

CONCLUSION

The results highlight the necessity of community health nursing education reform in curriculum, teaching methods and nursing educators training, so as to improve students' ability and acceptance of community health nursing.

CLINICAL EVIDENCE

Working as community health nurse is not favored by students, and the current situation of community health nursing and nursing education system in China has not helped students recognize the attractive complexity in community care.

Community Health Nursing in Iran: A Review of Challenges and Solutions (An Integrative Review)

Background and Objective

In recent decades, nursing has witnessed many changes in Iran. Despite the numerous advances in nursing, the health system faces many challenges in community health nursing. This study aims to review the challenges in community health nursing in Iran and provide an evidence-based solution as well.

Materials and Methods

This article is an integrated review of the literature regarding the challenges in community health nursing published between 2000 and 2021 in the databases Scopus, Medline, Cochrane Database of Systematic Reviews, Science Direct, Google Scholar, Scientific Information Database (SID). After performing searches, 20 articles were selected and studied. Data analysis was done using Russell approach (2005).

Findings

The results of this study were summarized in 6 themes consisting of challenges in community health nursing education, practical challenges in community health nursing, policy-making challenges in community health nursing, management challenges in community health nursing, and infrastructural and cultural challenges. Solutions were also proposed to address each of the above issue.

Conclusions

The results of the study showed that diverse challenges exist in community health nursing in Iran, considering that community health nurses play an important role in providing primary health care and community-based care. In order to solve these challenges, the authors have some recommendations: modifying the structure of the health system with the aim of moving toward a community-oriented approach from a treatment-oriented one, developing laws to support community health nurses, creating an organizational chart for nurses at the community level, modifying nursing students' training through a community-based approach, and covering community-based services and care under insurance.

Scope of Iranian community health nurses 'services from the viewpoint of the managers and nurses: a content analysis study

BACKGROUND

Considering the need for nurses specializing in community health and in order to define professional duties for future planning towards creating the position of community health nurses in the primary health care system of Iran, this study aims to explain the range of services which can be provided by community health nurses from the perspective of the mangers and nurses.

METHODS

The present qualitative study was conducted with the approach of contract content analysis in Iran in 2020. This study was conducted through in-depth and semi-structured interviews with 22 participants, including community health nursing faculty members, health deputies and managers, community health nurses working in health centers, and the care seekers visiting comprehensive health centers. The samples were selected through purposeful sampling. The interviews continued until data saturation. Data analysis was performed simultaneously with data collection. The interviews were recorded, transcribed, and analyzed through Graneheim & Lundman's content analysis method, and data management was done using MAXQDA software. To achieve data trustworthiness, the criteria presented by Lincoln and Guba were used.

RESULTS

The obtained data were classified into the two main categories of service provision settings and service provision domains. The category service provision settings covered 7 subcategories including participation in the family physician plan, activities at the centers for vulnerable groups of the community, establishing private community health clinics, leading health promotion programs in the 3rd generation hospitals, activities in comprehensive health centers, follow-ups and home visits, and activities in schools' health units. Service provision domains consisted of 6 subcategories including participation in health planning, decision-making, and policymaking, research on the health system, health promotion, monitoring and coordination, providing care for the patients with non-communicable diseases and high-risk groups, and eldercare.

CONCLUSIONS

From the participants' perspective, important services that can be provided by the community health nurse are health promotion, the management of chronic patients and the elderly, follow-ups, and home visits. Therefore, it is recommended that health policy makers pay attention to the service provision areas and the services providable by the community health nurse in their macro-planning, and to provide primary health care in comprehensive health centers using inter-professional care models, integrating the community health nurse into the care team.

"They're very passionate about making sure that women stay healthy": a qualitative examination of women's experiences participating in a community paramedicine program

BACKGROUND

Community paramedicine programs (i.e., physician-directed preventive care by emergency medical services personnel embedded in communities) offer a novel approach to community-based health care. Project Swaddle, a community paramedicine program for mothers and their infants, seeks to address (directly or through referrals) the physical, mental, social, and economic needs of its participants. The objective of this process evaluation was to describe women's experiences in Project Swaddle. By understanding their experiences, our work begins to build the foundation for similar programs and future examinations of the efficacy and effectiveness of these approaches.

METHODS

We completed 21 interviews with women living in Indiana (July 2019-February 2020) who were currently participating in or had graduated from Project Swaddle. Interviews were audio-recorded, transcribed, and analyzed using a six-phase approach to thematic analysis.

RESULTS

Program enrollment was influenced by the community paramedics' experience and connections, as well as information received in the community from related clinics or organizations. Participants viewed the community paramedic as a trusted provider who supplied necessary health information and support and served as their advocate. In their role as physician extenders, the community paramedics enhanced patient care through monitoring critical situations, facilitating communication with other providers, and supporting routine healthcare. Women noted how community paramedics connected them to outside resources (i.e., other experts, tangible goods), which aimed to support their holistic health and wellbeing.

CONCLUSIONS

Results demonstrate Project Swaddle helped women connect with other healthcare providers, including increased access to mental health services. The community paramedics were able to help women establish care with primary care providers and pediatricians, then facilitate communication with these providers. Women were supported through their early motherhood experience, received education on parenting and taking control of their health, and gained access to resources that met their diverse needs.

Bibliometric analysis of the Doctor of Nursing Practice dissertations in the ProQuest Dissertations and Theses database

AIMS

To examine the distributed characteristics and explore the research themes of Doctor of Nursing Practice (DNP) dissertations during the past two decades.

DESIGN

A descriptive statistical and visualization bibliometric analysis was conducted.

METHODS

Doctor of Nursing Practice dissertations submitted between January 2005 and June 2021 were collected from the ProQuest Dissertations and Theses database. A descriptive statistical analysis was conducted to calculate the distribution of the DNP dissertations by granting institution and the published year of publications. The VOSviewer 1.6.13 was used to explore the bibliometric networks and research priorities of the DNP dissertations.

RESULTS

A total of 4989 DNP dissertations from 90 universities were included in this study, all from the United States. The number of DNP dissertations showed an upward trend, with steady growth from 2005 to 2014 and rapid growth after 2015. The DNP studies focused on five areas: health care management in clinical nursing, advanced practice in nursing education and health education, public health problems, mental health care for adolescents and nurses and the older people care and long-term care.

CONCLUSION

Parallel to the numerical increase in DNP dissertations is a steady expansion in the range of research topics and scopes, which is aligned with specific specializations of the DNP. Many are interdisciplinary and employ techniques imported from the fields of public health, psychology and social sciences, resulting in nursing educators and practitioners continually broaden their subject perspectives.

IMPACT

Knowing where, when and why DNP research trends developed will help nursing educators to further develop DNP education and optimize DNP programs in the future, such as paying more attention to the nursing practice. Moreover, this study will inspire DNP students and researchers to expand their subject perspectives and broaden the research scope to solve nursing practice problems based on interdisciplinary theories and methods.

Intention to response, emergency preparedness and intention to leave among nurses during COVID-19

AIM

To comprehensively assess the current level and identify associated factors of intention to response and emergency preparedness of clinical nurses during COVID-19 outbreak.

DESIGN

A cross-sectional study was designed.

METHODS

Demographic and characteristic questionnaire, intention to response scale, emergency preparedness scale and a self-designed questionnaire related to effects of events and intention to leave were used in this study.

RESULTS

The mean scores of intention to response and emergency preparedness were 82.00 (SD = 18.17) and 64.99 (SD = 12.94), respectively. Moral consideration, engaged in COVID-19 protection training, had working experience in SARS, and the other eight factors were explained 34.6% of the total model variance in intention to response model (F = 80.05, p < .001). While, the level of IR, whether the pace of work was affected and above three same factors were explained 21.5% of the total model variance (F = 91.05, p < .001). Pathway analysis revealed that moral consideration, intention to leave and impacts on work and life mediate the relationship between EP and IR.

Being a real nurse: A secondary qualitative analysis of how public health nurses rework their work identities

Many Western nations are emphasizing the importance of population health across health care delivery organizations and education systems. Despite significant momentum to integrate population health into nursing practice, a parallel effort to examine how these efforts impact practicing nurses' views of their professional role and work identity has not occurred. This secondary qualitative analysis, employing an abductive approach, explored processes public health nurses use in creating and maintaining their work identity through three organizing themes: narrative self-identity, mandated identity, and identity as struggle. The analysis was based on interview data collected from 30 US public health nurses residing in 17 states. 'Being a real nurse' describes public health nurses' efforts to balance a contradictory work identity where at times they are expected to focus on populations and at other times, on individuals. The identity work revealed through this study should be further explicated and specific strategies developed for stabilizing a work identity for public health nurses, as well as for any nurse charged with a population health role.

Public health nurse perceptions of evolving work and how work is managed: A qualitative study

AIM

To explore public health nurse (PHN) perspectives of their evolving work and how public health nurse work is managed in a Canadian health region.

BACKGROUND

Professional and public health organisations describe public health nurse practice roles as population-focused work. Health care management directs public health nurse work to achieve specific goals.

METHODS

In this qualitative study, data were collected during focus groups with 42 public health nurse participants in one health region. Focus group data were analysed for meanings and themes.

RESULTS

Public health nurses perceived increasing immunizations and limited resources for public health nurse work meant that population-focused care for the public was rationed or missing. Participants perceived the health care organisation directed, managed and assigned public health nurse specialist work; however, public health nurses managed their client-focused practice with knowledge, reasoning and support from colleagues.

CONCLUSIONS

Evolving visible public health nurse work was managed by health organisational management directives to increase immunizations and disease control. Public health nurses managed their evolving visible and invisible work supported by their knowledge, practice values and public health nurse colleagues.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing management must lead and communicate the vision supporting better health, better population-focused care and health outcomes to public health nurse and stakeholders, while reviewing resources needed to optimize public health nursing and improve population health.

The Effects of a Training Program Based on the Health Promotion Model on Physical Activity in Women with Type 2 Diabetes: A Randomized Controlled Clinical Trial

BACKGROUND

Physical activity among women with type 2 Diabetes Mellitus (DM) is an undesirable level. This study aimed to determine the effect of a training program based on the Health Promotion Model (HPM) on physical activity in women with type 2 DM.

MATERIALS AND METHODS

This randomized clinical trial was performed on 128 women with type 2 DM, who were randomly assigned to control and intervention groups. Data were collected using the Baecke Physical Activity Questionnaire (BPAQ) and a researcher-made questionnaire designed based on the HPM constructs before and 2 months after the intervention. The training was carried out in four sessions in the intervention group and the control group received regular education at the clinic. Data were analyzed using Chi-square, Fisher's exact test, paired t-test, independent t-test, and Mann-Whitney and Wilcoxon tests in Statistical Package for the Social Sciences (SPSS) software.

RESULTS

The findings showed that the mean [Standard Deviation (SD)] of physical activity in the intervention and control groups before the intervention was 6.52 (0.86) and 6.56 (1.07), respectively, and there was no significant difference between the groups (p = 0.95). However, after the intervention, the mean (SD) of physical activity in the intervention and control groups was 8.04 (0.92) and 6.33 (1.60), respectively, which showed a significant difference (t126= 9.71, p < 0.001).

CONCLUSIONS

The findings of this study revealed that the training program based on the HPM has a positive effect on improving physical activity in women with type 2 DM.

Developing a comprehensive career development scale for public health nurses in Japan

OBJECTIVES

This study aims to develop a scale that can comprehensively measure public health nurses'(PHNs) career development and to verify the validity and reliability of that scale.

DESIGN AND SAMPLES

This study is a cross-sectional investigation. The participants were 1,009 PHNs working in a government facility in Japan. A total of 586 participants who had been working for more than 3 years as PHNs were analyzed.

MEASUREMENTS

Anonymous self-response questionnaires included items on professional awareness, practical competency, and job satisfaction. We conducted exploratory factor analysis and confirmatory factor analysis to clarify the construct validity of the scale. The reliability was examined by the Cronbach's α coefficient. The validity was examined by an external reference relevant validity and the known-group method.

RESULTS

The scale was structured with 32 items covering three factors: "community activities, policy, and management," "PHN identity," and "foundations as a PHN." The Cronbach's α coefficients were all greater than 0.9. In confirmatory factor analysis, the scale showed acceptable goodness of fit.

CONCLUSIONS

The comprehensive career development scale for PHNs proved its reliability and validity. This scale may be useful to promote PHN identity and competency comprehensively in basic education and in-charge education.

A qualitative exploration of breastfeeding support groups in Ireland from the women's perspectives

OBJECTIVE

Volunteer breastfeeding support groups are deemed effective in promoting breastfeeding initiation and duration, but women's views are not well reported. The aim of this study was to explore women's experiences of Breastfeeding Support Groups in Ireland from their perspective.

DESIGN AND PARTICIPANTS

Semi-structured interviews with 15 breastfeeding mothers were conducted with participants recruited as part of a larger mixed-methods study.

METHODS

Interviews were conducted online. Interviews were audiorecorded, transcribed, and analysed using Thematic Analysis. Cultural Historical Activity Theory was used as the theoretical framework.

FINDINGS

Six key themes were identified: 'complexity of breastfeeding support', 'community and connection', 'impact of culture on breastfeeding needs', 'the journey', 'passing on', and 'what mothers want'. Mothers primarily attend in order to meet other mothers, and not necessarily with a problem, getting practical suggestions to meet their individual and changing needs. The social aspect of support groups fosters a sense of community and inclusion, long-standing friendships, a social outlet, and ongoing support.

CONCLUSIONS

Mothers attend breastfeeding support groups in order to meet other mothers and continue to attend for this reason to get mothering and breastfeeding support, as well as passing on their knowledge and experiences to other mothers, while meeting their social needs.

IMPLICATIONS FOR PRACTICE

More resources, acknowledgement and funding are needed to provide breastfeeding support groups in local communities. Breastfeeding support groups and health professionals need to emphasise the social aspects of the interactions at these group rather than attending for a breastfeeding problem.

The role of public health nurses in risk factor modification within a high-risk cardiovascular disease population in Ireland – a qualitative analysis

Background/aims:

Health promotion for cardiovascular disease risk factors management is essential to secondary prevention of cardiovascular disease events. In Ireland, post-cardiac rehabilitation patients are discharged into the care of community public health nurses, who have a health promotion role. Little is known of the public health nurses’ perceptions or knowledge surrounding their role in cardiovascular disease risk factor management. Underpinned by a constructivist viewpoint, this study aims to generate empirical evidence on the phenomenon directly from public health nurses’ encounters within the context of the current health service.

Methods:

This qualitative cross-sectional analysis involved face-to-face, semi-structured interviews with a purposeful sample of 17 public health nurses. Interviews were audio-recorded, transcribed, subjected to thematic content analysis and subsequently reported incorporating verbatim quotes.

Results:

A significant gap exists between evidence-based guidelines for cardiovascular disease prevention and current practices. Variations in public health nurses’ training, experience and knowledge result in inconsistent practices, and public health nurses feel this is specialised area for which they are not equipped. The changing public health nurse role and increasing workloads result in prioritisation of other nursing duties over health promotion. Ineffective systems for care delivery and a lack of community-based rehabilitation programmes also negatively impact on secondary prevention practices.

Conclusions:

Findings support the need to develop a community cardiovascular disease specialist role to effectively support ongoing cardiovascular disease risk factor management. Evaluation of the mechanisms of current service delivery is required to ensure a quality-assured equitable service, in line with community needs and current evidence-based guidelines for practice. A quantitative triangulation study is recommended.

The challenges to public health nurse practice in rural Ireland

OBJECTIVES

The primary objective was to understand the contemporary public health nurse's (PHN) role and the issues that they face working in rural Ireland.

DESIGN AND SAMPLE

This study was based on an ethnographic approach with 13 PHNs working in rural areas in the South West of Ireland.

MEASUREMENTS

A combination of solicited diaries and semi-structured interviews referred to as the diary/interview method were employed. Diaries were used by the PHNs to record their working day on a staggered basis from February to April 2017 with the subsequent interviews carried out in June and July 2017.

RESULTS

Working as a PHN in a rural area presented a number of issues such as time spent on traveling as a result of geographical disparity & poor road networks; client transport issues; a sense of working in isolation; communication issues with respect to computer/tablet hardware availability, mobile phone and broadband connectivity and the availability of, and the physical access to services.

CONCLUSION

PHNs operating in rural communities face a distinct set of challenges that they have a limited ability to address. Legislators, health care providers and policymakers need to create a supportive environment that helps address these challenges in Ireland.

Public health nurses' activities at a time of specialization in nursing-A national study

OBJECTIVES

To provide a detailed, up-to-date account of the job description and practice areas of current public health nurses.

DESIGN AND SAMPLE

A cross-sectional study. A sample of 824 public health nurses, 80% of public health nurses in Israel, participated in a national structured survey.

MEASURES

A structured questionnaire eliciting self-reported public health nursing activities, priorities, perceived deficiencies, and job satisfaction was compiled.

RESULTS

Nearly 70% of surveyed public health nurses provided individual-level interventions and less population-health-focused activities such as community needs assessments and development and implementation of community-based projects.

CONCLUSIONS

Advanced training should be required in several areas of practice and the scope of public health nurses' practice should be expanded, with greater emphasis on population health.

Factors underlying perceptions of community care and other healthcare areas in first-year baccalaureate nursing students: A focus group study

BACKGROUND

Despite the increasing labour market shortage of well-educated community nurses, few baccalaureate nursing students choose for a career in community care. Obtaining knowledge of how students perceive healthcare areas early in their education is important to take meaningful steps in counteracting any existing misconceptions with targeted curriculum redesign.

OBJECTIVE

Determination of factors underlying perceptions of healthcare areas in first-year baccalaureate nursing students.

DESIGN

A descriptive qualitative study using focus group inquiry.

METHODS

This study follows up on a large-sample quantitative multicentre survey study. Fourteen first-year nursing students at a university of applied sciences in the Netherlands participated in focus group discussions in October 2014. Transcripts of the discussions were coded by two independent researchers at three levels - open, axial and selective coding - on the basis of two templates. The codes were sorted into categories and assigned to suitable main codes in the templates. The number of sub-codes per category and code were added together.

RESULTS

Eight main themes were formulated, to wit (1) variety and diversity, (2) challenges, (3) improving people's health, (4) collaboration, (5) role models, (6) patient- or environment-based perceptions, (7) self-efficacy and (8) immediate vicinity. Data suggest that first-year students have clear ideas about the characteristics which they consider important in professional practice. Their perceptions do not necessarily reflect the actual situation, as they expect the hospital to possess all desired characteristics while community nursing seems to be undervalued.

CONCLUSION

To remedy students' misperceptions, four recommendations are formulated for curriculum redesign strategies deriving from the eight themes. These recommendations are based on collaboration between school and care organisations as well as on themes related to in-depth knowledge within the educational programme. The interventions will potentially help to strengthen the focus on community care, which will foster a more optimistic and realistic career outlook on this field.

Tackling the workforce crisis in district nursing: can the Dutch Buurtzorg model offer a solution and a better patient experience? A mixed methods case study

Despite policy intentions for more healthcare out of hospital, district nursing services face multiple funding and staffing challenges, which compromise the care delivered and policy objectives.

OBJECTIVES

What is the impact of the adapted Buurtzorg model on feasibility, acceptability and effective outcomes in an English district nursing service?

DESIGN

Mixed methods case study.

SETTING

Primary care.

PARTICIPANTS

Neighbourhood nursing team (Buurtzorg model), patients and carers, general practitioners (GPs), other health professionals, managers and conventional district nurses.

RESULTS

The adapted Buurtzorg model of community nursing demonstrated feasibility and acceptability to patients, carers, GPs and other health professionals. For many patients, it was preferable to previous experiences of district nursing in terms of continuity in care, improved support of multiple long-term conditions (encompassing physical, mental and social factors) and proactive care. For the neighbourhood nurses, the ability to make operational and clinical decisions at team level meant adopting practices that made the service more responsive, accessible and efficient and offered a more attractive working environment. Challenges were reported by nurses and managers in relation to the recognition and support of the concept of self-managing teams within a large bureaucratic healthcare organisation. While there were some reports of clinical effectiveness and efficiency, this was not possible to quantify, cost or compare with the standard district nursing service.

CONCLUSIONS

The adapted Buurtzorg model of neighbourhood nursing holds potential for addressing issues of concern to patients, carers and staff in the community. The two interacting innovations, that is, a renewed focus on patient and carer-centred care and the self-managing team, were implemented in ways that patients, carers, other health professionals and nurses could identify difference for both the nursing care and also the nurses' working lives. It now requires longer term investigation to understand both the mechanism for change and also the sustainability.

The Scale on COmmunity care PErceptions (SCOPE) for nursing students: A development and psychometric validation study

The aim of this study was to develop a valid instrument to measure student nurses' perceptions of community care (SCOPE). DeVellis' staged model for instrument development and validation was used. Scale construction of SCOPE was based on existing literature. Evaluation of its psychometric properties included exploratory factor analysis and reliability analysis. After pilot-testing, 1062 bachelor nursing students from six institutions in the Netherlands (response rate 81%) took part in the study. SCOPE is a 35-item scale containing: background variables, 11 measuring the affective component, 5 measuring community care perception as a placement, 17 as a future profession, and 2 on the reasons underlying student preference. Principal axis factoring yielded two factors in the affective component scale reflecting 'enjoyment' and 'utility', two in the placement scale reflecting 'learning possibilities' and 'personal satisfaction', and four in the profession scale: 'professional development', 'collaboration', 'caregiving', and 'complexity and workload'. Cronbach's α of the complete scale was 0.892 and of the subscales 0.862, 0.696, and 0.810 respectively. SCOPE is a psychometrically sound instrument for measuring students' perceptions of community care. By determining these perceptions, it becomes possible to positively influence them with targeted curriculum redesign, eventually contributing to decreasing the workforce shortage in community nursing.

A falls case summary: Application of the public health nursing intervention wheel

BACKGROUND

The Public Health Intervention Wheel (PHIW) is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. Public health nurses (PHNs) provide care at the three levels of practice. Prevention of falls is a public health issue and the majority of falls happen at home. Therefore, prevention and management of falls in the community could benefit from a public health systems approach by PHNs underpinned by the PHIW.

CASE PRESENTATION

A hypothetical case is presented of a 78-year-old gentleman who had a fall which resulted in a fractured right acetabulum and surgery before being discharged home.

METHODS

The aim of this paper was to use a case summary to illustrate PHN practice in the context of the PHIW as applied to falls management and prevention. This paper focuses on fall incidence and PHN response in Ireland and Norway. The PHIW is described and relevant interventions from the PHIW are applied to PHN practice in managing the case.

CONCLUSIONS

The PHIW model provides insight into the potential scope of public health nursing in falls, articulating PHN practice in the community.

Identity of primary health care nurses: perception of "doing everything"

ABSTRACT Objective: To analyze, in the speeches of nurses, the habitus that conforms their professional identity in the primary health care area. Method: Qualitative study, carried out from March to October 2015, with nurses of primary healthcare units in the cities of Cajazeiras, in the state of Paraíba, and Maracanaú, in the state of Ceará. Data were collected by means of semi-structured interviews, and analyzed through discourse analysis. Results: Nurses, in their practice and perception, perceive that professional identity is linked to the meaning that involves the word "everything". This situation constitutes a habitus that directs the range of daily actions, often distant from the profession's core of knowledge. Final considerations: Trying to be and do everything in primary health care involves negative repercussions in the professional identity of nurses. Strategic guidance is necessary in order to achieve and embrace elements that reflect the essence of this category.

Examining the context of community nursing in Ireland and the impact of missed care

As populations rise and many global health policies point towards community care, it is important that health care delivery meets demand. In Ireland, a study was undertaken on the level and context of missed care in community nursing. The study used a survey to identify the quantity of, and reasons for, missed care; a reference group to develop possible health economic implications for missed care, and a small sample of semi-structured interviews to consider the macro-environment within which missed care occurred. This paper presents the findings of the health economics and qualitative data, and the study's implications for community nursing.

Perceptions of community care and placement preferences in first-year nursing students: A multicentre, cross-sectional study

BACKGROUND

Despite increasing shortages of highly educated community nurses, far too few nursing students choose community care. This means that a strong societal problem is emerging that desperately needs resolution.

OBJECTIVES

To acquire a solid understanding of the causes for the low popularity of community care by exploring first-year baccalaureate nursing students' perceptions of community care, their placement preferences, and the assumptions underlying these preferences.

DESIGN

A quantitative cross-sectional design.

SETTINGS

Six universities of applied sciences in the Netherlands.

PARTICIPANTS

Nursing students in the first semester of their 4-year programme (n=1058).

METHODS

Data were collected in September-December 2014. The students completed the 'Scale on Community Care Perceptions' (SCOPE), consisting of demographic data and three subscales measuring the affective component of community care perception, perceptions of a placement and a profession in community care, and students' current placement preferences. Descriptive statistics were used.

RESULTS

For a practice placement, 71.2% of first-year students prefer the general hospital and 5.4% community care, whereas 23.4% opt for another healthcare area. Students consider opportunities for advancement and enjoyable relationships with patients as most important for choosing a placement. Community care is perceived as a 'low-status-field' with many elderly patients, where students expect to find little variety in caregiving and few opportunities for advancement. Students' perceptions of the field are at odds with things they believe to be important for their placement.

CONCLUSION

Due to misconceptions, students perceive community care as offering them few challenges. Strategies to positively influence students' perceptions of community nursing are urgently required to halt the dissonance between students' preference for the hospital and society's need for highly educated community nurses.

Public health nurses’ experience, involvement and attitude concerning mental health issues in a school setting

The aim of the study was to describe and explore public health nurses’ perceptions of involvement and their attitudes concerning the mental health aspects of their work in schools. Furthermore, we wished to explore their need for useful approaches and training topics. The teenage years in particular are associated with an incidence of mental health problems such as depression. Public health nurses in schools have an extensive role in relation to health promotion and the prevention of both physical and mental health. A cross-sectional study with 284 public health nurses from 163 municipalities in Norway was carried out, using the Depression Attitude Questionnaire. The public health nurses reported various degrees of confidence and time spent working with mental health issues. Confidence was found to be related to further education and courses.

Evaluating the impact of a quality care-metric on public health nursing practice: protocol for a mixed methods study

AIM

To establish, implement and evaluate the impact of a quality care-metric developed to measure public health nursing practice.

BACKGROUND

Measurement of care practices plays an integral role in quality improvement and promotes positive change in healthcare delivery. Quality care-metrics has been identified as a means of effectively measuring public health nursing practice. Public health nurses in Ireland are 'all-purpose' generalist community-based nurses caring for people across the lifespan, in defined geographical areas, employed by the Health Service Executive. In the public health nurse's child and maternal health role, the 'primary visit' (postnatal visit) has been identified as the most important contact a public health nurse has with a mother and her new baby.

DESIGN

Mixed methods using a sequential multiphase design.

METHODS

This study involves three phases. The first phase will include focus group and individual interviews with key healthcare professionals and new mothers, using purposively chosen sampling. Thematic analysis of data will identify key components for the development of a quality care-metric. Phase two will be a RAND appropriateness survey with a panel of experts, to develop and validate the quality care-metric. The third phase will involve implementation and evaluation of the quality care-metric. Descriptive and inferential statistics will be completed using SPSS version 21. Funding for this research study was approved in December 2013.

CONCLUSION

This study will evaluate the impact of introducing a quality care-metric into public health nursing practice. Results will illuminate the quality of public health nursing practice in relation to the primary visit.

WELCOMING AND NURSING CARE: A PHENOMENOLOGICAL STUDY

The objective of this study was to identify the acknowledgement of welcoming as a form of nursing care in the experience of primary care nurses. This is a qualitative research, guided by Alfred Schutz' social phenomenology. The participants were nine nurses working in health centers in the city of Campinas-SP, Brazil. The fieldwork took place through interviews in 2013 and data were analyzed according to the steps of social phenomenology researchers. It was identified in the research that the nurses were capable of recognizing the translation of welcoming into qualified listening, humanization, accountability and commitment to the needs of the other. In practice, however, welcoming was not acknowledged as nursing care and was characterized by occasional, fragmented and complaint-oriented visits. For this action to be acknowledged as nursing care, the nurses need to focus on relational care.

Self-neglect: a case study and implications for clinical practice

Self-neglect is a worldwide and serious public health issue that can have serious adverse outcomes and is more common in older people. Cases can vary in presentation, but typically present as poor self-care, poor care of the environment and service refusal. Community nurses frequently encounter self-neglect cases and health and social care professionals play a key role in the identification, management and prevention of self-neglect. Self-neglect cases can give rise to ethical, personal and professional challenges. The aim of this article is to create a greater understanding of the concept of self-neglect among community nurses.

Lessons Learned: Public Health Nurses Practice in Safeguarding Children in the Republic of Ireland

The public health nurses’ scope of practice explicitly includes child protection within their role, which places them in a prime position to identify child protection concerns. This role compliments that of other professions and voluntary agenices who work with children. Public health nurses are in a privileged position as they form a relationship with the child’s parent(s)/guardian(s) and are able to see the child in its own environment, which many professionals cannot. Child protection in Ireland, while influenced by other countries, has progressed through a distinct pathway that streamlined protocols and procedures. However, despite the above serious failures have occurred in the Irish system, and inquiries over the past 20 years persistently present similar contributing factors, namely, the lack of standardized and comprehensive service responses. Moreover, poor practice is compounded by the lack of recognition of the various interactional processes taking place within and between the different agencies of child protection, leading to psychological barriers in communication. This article will explore the lessons learned for public health nurses practice in safeguarding children in the Republic of Ireland.

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.

Graduates from dual qualification courses, registered nurse and health visitor: a career history study

BACKGROUND

Educationalists and managers internationally are challenged to find ways of preparing, recruiting early in their careers, and retaining nurses into public health roles in primary care. Public health nursing qualifications are post-initial nurse registration in the United Kingdom as in some other countries. In the mid twentieth century there were a number of innovative programmes of dual qualification: registered nurse and health visitor (the United Kingdom term for public health nurse).

OBJECTIVE

To investigate the career histories of graduates from courses integrating both nursing and health visitor qualifications.

DESIGN

An observational, survey study.

SETTING

The United Kingdom.

PARTICIPANTS

A purposive sample of graduates from integrated registered nurse and health visitor programmes, 1959-1995, from one University.

METHODS

Self completed, anonymous, survey sent to graduates, with contact details known to the University and through snowballing techniques, in 2011.

FINDINGS

Forty five women (56%), graduates in all four decades, returned the survey. A significant majority (82%) had taken up health visitor posts on completing the course. Over their careers, 42% of all jobs held were as health visitors. Only four never worked in a post that required a health visiting qualification. Most had undertaken paid work throughout their careers that focused on aspects of public health, often linked to child, maternal and/or family wellbeing. Many held teaching/lecturing and management posts at some point in their career. Those holding management posts were more likely to report leaving them as a result of organisational re-structuring or redundancy than those in non-management posts.

CONCLUSIONS

Courses that prepare students to be both nurses and health visitors result in a majority of graduates who take up posts as health visitors on qualification and subsequently. Nurse education planners may find this evidence of value in determining ways of providing a future workforce for public health nursing.

Job satisfaction among public health nurses: a national survey

BACKGROUND

Despite increasing interest in nurses' job satisfaction relatively few studies have investigated job satisfaction among public health nurses.

AIM

To establish current level of job satisfaction among public health nurses and identify the main contributing variables/factors to job satisfaction among this population.

DESIGN

Quantitative descriptive design. A simple random sample of 1000 public health nurses was conducted yielding a response rate of 35.1% (n = 351). Data was collected using the Index of Work Satisfaction Questionnaire. Descriptive and inferential statistics were deployed.

RESULTS

Low levels of job satisfaction among public health nurses emerged. Professional status, interaction and autonomy contributed most to job satisfaction while pay and task-related activities contributed least. Age and tenure were the only biographic factors that correlated significantly with job satisfaction.

CONCLUSION

Public health nurse managers/leaders need to find creative ways of improving the factors that contribute to job satisfaction and address robustly those factors that result in low job satisfaction.

IMPLICATIONS FOR NURSING MANAGEMENT

The critical issue for public health nurse managers is to determine how job satisfaction can be improved. Greater collaboration and consultation between managers and public health nurses can be regarded as a useful way to begin this process, especially if contemporary nursing is to embrace a responsive approach within the profession.

Professional boundary work in the face of change to generalist working in community nursing in Scotland

AIM

The present study explored how community nurses and managers constituted changes towards generalist working.

BACKGROUND

Following international trends moving from acute care towards community care, changes within community nursing in the United Kingdom have been subject to debate in recent years. Sociological insights into 'boundary work' in professional disciplines are informative for understandings about proposed new roles in community nursing. Recently, radical changes to the role of the community nurse from specialist disciplines to a generalist community health nurse model were proposed in Scotland and tested in four health boards.

METHODS

Focus group discussions were held with 27 community nurses and semi-structured interviews with three managers during January-March 2009 in a purposive sample from one health board. Discussions were audio-recorded and transcribed verbatim. Initial thematic analysis was used to highlight key themes from the data and later a discursive analysis focused on the rhetorical strategies used by participants.

FINDINGS

Four key themes were identified along with the rhetorical devices associated with these including: the undermining of the generalist model through the 'jack of all trades, master of none' metaphor through associations of loss of specialisms; how the re-establishment of specialist discipline boundaries occurred; how current roles were validated and how managers and nurses accounted for future changes to the profession.

CONCLUSION

The qualitative study explored here has implications for discussions about future role change debates within community nursing as well as the specialist-generalist debate internationally. Managers and policy-makers involved in organizational changes are required to give greater credence to the perceived professional status of community nursing.

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.