Managements' perspective on Canadian public health nurses' primary health care practice

Abstract

An interpretive qualitative study was conducted to examine public health nurses' (PHNs') practice in fostering citizen participation and collaborative practice and the impact of a decade (1992-2002) of health care restructuring. This article presents the perspectives of public health management and a public policy analysis as they relate to PHNs' primary health care practice in Nova Scotia, a province in Eastern Canada. Seven face-to-face interviews were conducted with public health management from across Nova Scotia and 26 relevant public policy documents were analyzed. Three major themes emerged from the coded transcripts and the document analysis: (1) opportunistic shifts in values: constraining structures, operations, and governance; (2) insufficient funding and infrastructure support; (3) opportunities and challenges to PHN capacity and competency. The emergent themes illustrate the unique population health perspective and day-today contested realities of public health and PHN practice. The study provides preliminary understanding of PHNs' primary health care practice in Nova Scotia that may resonate with other national and international settings. This knowledge can form a basis for more research to explore the PHNs' practice in the organizational context in which it is embedded. This study was undertaken at a pivotal time in Nova Scotia as the provincial government embarked on primary health care renewal to improve the health of Nova Scotians. The success of this study is in large part attributable to the collaborative effort of university researchers and public health decision makers.

The Role of Public Health Agencies in Addressing Child and Family Poverty: Public Health Nurses’ Perspectives

“…This finding is consistent with other literature that concludes that PHN participation and effectiveness in promoting population health is significantly enabled or constrained by organisational values, policies, support, standards, and funding [33, 52]. Factors that have been found to adversely affect PHNs’ scope of practice include a lack of philosophical, organisational, and managerial understanding of and commitment to PHN practice [52-55]. This study contributes to this literature by identifying organisational barriers to addressing CFP specifically.…”

“…FGI participants’ concerns about their loss of connection with the community also supports other sources who have noted that programme-based models of public health service delivery severs the PHNs’ integral connection with the communities that they work in, and erodes a population-based practice that formerly was the foundation of their work [52, 56, 57]. …”

“…Greater organisational understanding of and support for the potential role of PHNs is also necessary. Lack of philosophical, organisational, and managerial understanding and commitment to PHN practice, and the need for managers to demonstrate their respect for the full scope of the PHN role, has been noted in the literature [52, 69]. At the very least, public health managers require extensive orientation and, preferably, continuing education in principles of population health promotion, the SDOH, and public health nursing.…”

Building Nurses' Capacity in Community Health Services

“…Examples include: a) research on patient safety and home care in partnership with the Victorian Order of Nurses and several provincial Ministries (Lang, Edwards, & Benzies., 2006), b) an early childhood development initiative being undertaken with a community agency in Calgary (Benzies et al, 2009); c) a project examining nursing voices in primary health care undertaken in conjunction with the Nova Scotia Ministry of Health (Meagher-Stewart, Aston, Edwards, Young, & Smith, 2007), d) a program of research on HIV and AIDS stigma involving community partners in Edmonton and Ottawa (Mill, et al, in press); and e) a program of research with Aboriginal partner organizations that addresses improvements in prenatal care (Smith, Edwards, Martens, Varcoe, & Davies, 2008). This is reflected in the sustained partnership models that former interns and postdoctoral fellows have developed through their programs of research.…”

Public Health Nurses' Primary Health Care Practice: Strategies for Fostering Citizen Participation

“…This article presents findings from an interpretive qualitative study of public health nurses' perceptions of their role in fostering citizen participation. These findings are part of a larger study that examined public health nurses' primary health care practice at a time of significant health care restructuring (Meagher-Stewart, Aston, Edwards, Young, & Smith, 2007).…”