Nursing outside hospitals: the working experience of community nurses. Educational characteristics and job perceptions

Beyond the sick role: situating community health nursing practice

This grounded theory research into the role of the community health nurse in Australia identified that moving from the comfort and structure of an institutional setting to the client's turf results in profound changes to the purpose of nursing practice. Data were collected from 17 'excellent' community health nurses practising in a range of community health settings in three states of Australia. Data included transcripts from in-depth interviews, questionnaires, group discussions with participants, job descriptions, agency documentation, professional organisation documentation and focus groups. Data were analysed using constant comparative techniques. In community health nursing practice, the client's role changes from a sick role to a well role and there is a shift in responsibility for outcomes from the nurse to the client. The central purpose of the community health nursing role is to facilitate Situated Health Competence, which the client achieves within the context of going about their everyday life, including work, recreation, relationships and role responsibilities. Situated Health Competence requires families, groups and communities to address their own illnesses, health problems, health issues and health behaviours; have enough knowledge and power to make their own decisions; question matters that impact on their health; and seek out and access appropriate health resources on an ongoing basis. The findings of this study make the intangible motivations of the community health nurse more explicit. The aim of facilitating Situated Health Competence results in an expanded view of the boundaries of nursing practice. The traditional foci of nursing practice are still present, but are incorporated within a broader 'situated' role.

Preparing students for health promotion: the challenge for Australian nursing in the 90s

Health promotion is increasingly recognized as a role to be taken up by all health workers, and nurses, in particular, have been recognized for their potential contribution in this area. Nurse educators around Australia are currently grappling with how best to reorient nurses towards health promotion, and how to prepare nursing students for a health promotion role. In this discussion paper, one university's preparation of their undergraduate students will be examined, as a means of stimulating further debate about how health promotion can be effectively incorporated into undergraduate nursing education. The Health Education and Promotion unit at University of New England, Armidale is offered in the third year of the Bachelor of Nursing. It incorporates traditional teaching strategies and a specific health promotion practicum. The practicum is vital in developing students' health promotion skills and helping them to integrate their theoretical learning into practice. It is argued that education in health promotion is vital if nurses are to prepare themselves for the challenge of promoting the health of their communities.

Nursing outside hospitals: the working experience of community nurses: job characteristics

The Community Nursing Project reports the results of a mailed questionnaire survey of the working and educational experience of 689 nurses employed outside hospitals and nursing homes in Victoria in 1985. This paper reports that part of the study relevant to their practice settings, job titles, job content and working conditions. Confusion about titles for community nurses was evident given that subjects offered 281 separate job titles. A title with the general form 'Community Nurse--specialist designation' was acceptable to 88% of nurses. Eighteen (of 57) job activities were identified that were performed at least weekly by four of the six principal practice areas. Therefore while the concept of the generic community nurse is a meaningful one, it is only so when the differences in job content across practice areas are acknowledged. Medical clinic nurses however do not conform to this general pattern. Seventy-nine per cent of the nurses currently had a job description. However, only 45% had a statement of job conditions, 26% had a formal job orientation, 24% worked overtime unrewarded by payment or time in lieu and only 59% could reschedule their work times. These figures varied greatly between practice areas. It is suggested that the concept of the community nurse--specialist designation be promoted. Specifically this could be done by the adoption of this title and the development of appropriate post-basic educational courses. While these conclusions have most relevance for Australia, they will also be of interest to nurses of other countries where an increasing emphasis on primary health care has resulted in an expansion of community nursing practice.