Concepts of health: implications for public health work

Exploring the contribution of district nurses to public health

To date the public health role of district nursing has been less well defined than in other branches of community nursing. A qualitative study examining the public health role of district nurses was undertaken in a West Yorkshire primary care trust. The study explored the range of public health activities currently undertaken by district nurses, the agendas perceived as most conducive to input and the organizational barriers that prevented greater involvement in public health from district nurses. Focus group and individual semi-structured interviews were undertaken with 21 members of the district nursing team and analysed using thematic content analysis. The findings suggest that district nurses were already undertaking a range of public health and health education activities but much of the work was opportunistic. District nurses perceived themselves as well placed to undertake locally based health action because of their profile in the local communities together with local intelligence. However, ineffective referral criteria were considered to be the most prohibitive barrier against making a greater contribution to health improvement.

A multidisciplinary team approach to public health working

For several years the government's health agenda has provided a strong directive for primary care professionals to work in a more public, health focused way. There remains, however, the constant challenge to incorporate a public health focus into existing clinical practice and caseload commitments in an achievable and manageable way, while at the same time impacting on ill health. This article explores a pragmatic public health approach to addressing some of the common health needs of people, as identified collectively in the national service frameworks for mental health, coronary heart disease, diabetes, older people and cancer. A practical example of facilitating collaborative working between disciplines and agencies is offered using the author's successful experiences form a review and modernization project of health visiting services in East Somerset (Dion, 2003).

The public health roles of health visitors and school nurses: a survey

This article describes a qualitative study that examined the family centre public health role of health visitors and the child-centre public health role of school nurses. A telephone survey of key health visitor and school nurse informants in the West Midlands was undertaken. Respondents to the survey were asked to give examples of practice that related to Holman's (1992) public health typology. A wealth of data were obtained, which included 344 different examples of practice interventions. The majority of examples of practice given by the respondents were categorized as primary preventive interventions. The least represented concerned community empowerment and health protection. The findings of the survey give evidence of the current transitional nature health visitor and school nurse practice. Identified is some reorientation in practice and adoption of currently advocated models of public health, which have community participation, empowerment, and health protection as essential features.

A literature review of the public health roles of health visitors and school nurses

This paper describes a two-stage review relating to the family-centred public health role of health visitors and the child-centred public health role of school nurses. During the first stage, literature was searched using CINAHL and Medline databases and two models were used to frame the literature analysis. The findings of this analysis were, however, disappointing. Although many policy documents advocate development of the family-centred public health role of health visitors and the child-centred public health role of school nurses, there was no overwhelming evidence of reports of these approaches in health visiting and school nursing practice. The second stage of the review comprised a content analysis of West Midlands community trusts' strategic development plans. Seventeen plans were analysed. Of these, only two were 'formal' plans, the remainder being fragmented documentation related to plans for the development of health visiting and school nursing services. It may be concluded from the analysis that NHS trusts are beginning to adopt ideas from the rhetoric of national policy documents. Additionally, public health practice initiatives form an integrated part of most of the trust strategic development plans that the researchers examined.

The role of district nurses in public health: a discussion

The government has challenged community nurses, through recent policy changes, to become more involved in improving the health of local populations. However, very little has been written about the role of district nurses within this agenda. This article explores these opportunities and discusses some of the challenges facing district nurses if they are to embrace this new agenda. A model is examined which details four approaches to public health in which district nurses could contribute: individual advice-giving, personal support, environmental control and community development. District nurses have many valuable skills and attributes that could be utilized within all four approaches; it is important that they use these skills in collaboration with others. There will be implications for the future education and leadership of district nurses.