Remote nursing certified practice: viewing nursing and nurse practitioner practice through a social justice lens

Remote Nursing Certified Practice (RNCP) was introduced in 2010 to regulate nursing practice in remote, largely First Nations communities in British Columbia, Canada. These are communities that often experience profound health and health-care inequities. Typically nurses are the main health-care providers. Using a critical social justice lens, the authors explore the clinical and ethical implications of RNCP in terms of access to equitable, high-quality primary health care.They examine the fit between the level and scope of health services provided by registered nurses working under RNCP and the health needs of remote First Nations communities. In doing so, they draw comparisons between nurse practitioners (NPs) and outpost nurses working in NP roles who historically were employed to provide health care in these communities.The authors conclude by calling for nursing regulations that support equitable, high-quality primary care for all British Columbians.     

Updating the Definition and Role of Public Health Nursing to Advance and Guide the Specialty

National changes in the context for public health services are influencing the nature of public health nursing practice. Despite this, the document that defines public health nursing as a specialty—The Definition and Role of Public Health Nursing—has remained in wide use since its publication in 1996 without a review or update. With support from the American Public Health Association (APHA) Public Health Nursing Section, a national Task Force, was formed in November 2012 to update the definition of public health nursing, using processes that reflected deliberative democratic principles. A yearlong process was employed that included a modified Delphi technique and various modes of engagement such as online discussion boards, questionnaires, and public comment to review. The resulting 2013 document consisted of a reaffirmation of the one‐sentence 1996 definition, while updating supporting documentation to align with the current social, economic, political, and health care context. The 2013 document was strongly endorsed by vote of the APHA Public Health Nursing Section elected leadership. The 2013 definition and document affirm the relevance of a population‐focused definition of public health nursing to complex systems addressed in current practice and articulate critical roles of public health nurses (PHN) in these settings.     

Vision for the Future of Public Health Nursing: A Case for Primary Health Care

Abstract Canada has embraced the goal of the World Health Organization to achieve health for all. This has created a paradigm shift from a focus on direct care to include health promotion and community development, consistent with a primary health care approach. Nevertheless, a clearly articulated vision for the role of public health nurses (PHNs) is lacking. Despite the fact that PHNs make up the largest group of health care workers in the community, their collective opinions and ideas regarding their own practice are seldom sought in a systematic manner. We conducted a survey of public health nurses in British Columbia. Using a two-wave Delphi approach, PHNs were asked to define issues for the future of public health nursing, and to state publicly their preferences for change and transformation. The responses were rank ordered, analyzed, and compared with recent nursing and health care literature to interpret their content. The PHNs' visions for tomorrow agree with concepts of primary health care and community development, and have implications for community health nursing's practice and education.     

Building Community Capacity for Health Promotion: A Challenge for Public Health Nurses

Abstract The centennial celebration of public health nursing is a strong reminder of the tradition and practice of public health nursing's commitment to communities. Partnerships with communities give public health nurses fiduciary responsibility to be actively involved in public health reform to advance health promotion and health protection. Public health nurses must rise to the challenge to build community capacity through facilitating community participation, enhancing community health services, and coordinating public policy to achieve core public health responsibilities of assessment, policy, and assurance. This paper explicates strategies for building community capacity for health promotion.     

The birthing experiences of rural Aboriginal women in context: implications for nursing

It has been established that the birthing experiences and outcomes of rural women are shaped by poverty, isolation, limited economic opportunities, and diminishing maternity services. We lack research into how these dynamics are compounded by intersecting forms of oppression faced by Aboriginal women, to impact on their birthing experiences and outcomes. The findings of this study of rural Aboriginal maternity care in 4 communities in British Columbia show how diminishing local birthing choices and women's struggles to exert power, choice, and control are influenced by centuries of colonization. The research questions focus on rural Aboriginal women's experiences of birthing and maternity care in this neocolonial context and their desire for supportive birthing environments. A community-based participatory and ethnographic design was employed. Individual interviews, focus groups, and participant observation were the primary data sources. Although the women's experiences in each community were shaped by distinct histories and traditions, economics, politics, and geographies, the impacts of colonization and medical paternalism and the struggle for control of women's bodies during birth intersect, placing additional stress on women. The implications for nurses of accounting for the intersecting dynamics that shape Aboriginal women's experiences and birth outcomes are discussed.     

Challenges for Continuing Education of Public Health Nurses in Florida

Perceived continuing education needs among public health nurses at the staff and supervisory levels were investigated. A questionnaire was adapted for each and administered at participating county public health units. Results indicated a high level of agreement between staff nurses and supervisors. Further analysis of the data suggested a relationship between the nurses' perception of continuing education needs and the realities of their nursing practice. Public health nurses, educators, and administrators face the challenge of refocusing continuing education needs and activities on the broad scope of this area of specialty.     

Applying Marketing Concepts to Promote Health in Vulnerable Groups

Public health nurses must have a valid marketing orientation. Two marketing concepts, exchange relationships and channels of distribution and their application for public health nursing practice, have relevance in this context. In spite of the complexities inherent in applying them, they can be used to promote health in at-risk populations. By incorporating these concepts in planning and delivering public health nursing services, it is hoped that the health goals of a larger number of vulnerable individuals can be achieved.     

The Effects of Violence on Health and Adjustment of Southeast Asian Refugee Children: An Integrative Review

Abstract Public health nurses have historically been on the front line in meeting the needs of refugees in their practice communities. Little nursing research has been focused on the needs of refugees, however. The purpose of this integrative literature review was to clarify research focused on the needs of one refugee group, southeast Asians. The integrating factors reviewed were the instruments used, sampling procedures, statistical methods, and clarification of independent and dependent variables. Power analyses were computed on three of the studies to critique further the appropriateness of sample size. Findings indicate that premigration experiences, especially violence, play an important role in health status and adaptation after settling in the United States. Since health problems are often manifested in cultural ways different from Western norms, public health nurses would benefit from continued research clarifying the needs of individuals from other cultures.     

Ethical issues in public health nursing

This qualitative study was designed to explore ethical issues in public health nursing in the Canadian context, and to begin to identify strategies to support ethical practice. Twenty-two public health nurses, 11 in rural and 11 in urban settings, were asked to describe ethical problems they had experienced in the course of their work. These participants most often described situations that required a relational response rather than an active choice between options. Their goal was to optimize the good, while at the same time maintaining a supportive relationship. Analysis revealed five interrelated themes, each with several subthemes: relationships with health care professionals; systems issues; character of relationships; respect for persons; and putting self at risk. It was clear that all aspects of public health nursing have ethical components.     

"I'm a different kind of nurse": advice from nurses in rural and remote Canada

The sustainability of the rural and remote nursing workforce in Canada is increasingly at issue as the country becomes more urbanized and the nursing workforce ages. In order to support the retention of nurses in rural and remote communities and the recruitment of nurses to these communities, we require a better understanding of what is important to rural and remote nurses themselves. As part of the in-depth interviews conducted within The Nature of Nursing Practice in Rural and Remote Canada, a national research project, registered nurses (RNs) were asked what advice they would have for new nurses, educators, administrators and policy makers. This is the first of two papers describing that advice. It focuses on RNs in acute care, long-term care, home care, community health/public health and primary care roles in rural and remote communities across the country. The RNs were generous with their advice and gave many rich examples. While they were enthusiastic about their nursing practice and encouraging of other nurses to work in rural settings, they were intent that improvements be made in several key areas: education available to new practitioners and themselves, working conditions for rural and remote nurses, leadership, organizational supports and policies that better support rural and remote practice and communities.     

The role of public health nurses in bioterrorism preparedness.

BACKGROUND: Public health nurses have a central function in the public health system. Nurses conduct disease surveillance, which is an important first step in recognizing diseases caused by bioterrorist agents. Unfortunately, the current public health infrastructure and expectations for public health nurses are not clearly defined and therefore pose serious difficulties for conducting disease surveillance. Increased surveillance activities for bioterrorism preparedness add more responsibilities to the work of public health nurses. METHODS: A qualitative study on disease surveillance was conducted with public health officials at regional and local levels, working in a variety of urban and rural settings in one large public health region in Texas. Data analysis was supported by qualitative research software, The Ethnograph. RESULTS: The study found that the nurses working at the local level were extremely dedicated to serving their communities, had formed informal partnerships that are essential for disease surveillance, and effectively used informal communication channels to obtain critical surveillance information. The study revealed that nurses had unmet needs and experienced multiple barriers to conducting disease surveillance. CONCLUSIONS: The study's findings could have implications for public policy and nursing leadership. Defining the structure of the public health system and the scope of public health nurses' responsibilities will serve as the cornerstone for improvement of bioterrorism preparedness.     

Are We Implementing Community Health Promotion in Nursing?

Abstract Promoting the health of communities has been the rallying cry (now renewed) from the nation's top public health officials. Public health nurses have always stressed community health promotion, not only in their work but also in the educating of future public health nurses. Facilitating the shift from focusing primarily upon secondary and tertiary prevention, individual, and disease-oriented processes is a constant challenge, given the current health care and reimbursement systems. The objectives of this paper are: to give a brief historical review of the nation's health objectives, other recent pertinent documents, and early public health nursing's emphases regarding community health promotion; to give a selected overview of recent community health promotion programs implemented by community and public health nurses in nursing education and practice; and to focus on present challenges to nursing in implementing community health promotion.     

Do women want women health workers? Women's views of the primary health care service

This paper sets out to explore key aspects of women's views of women GPs and practice nurses within primary health care settings The extent to which women actively seek female health workers for the provision of their primary health care needs, including preventive health care, is examined The findings presented m this paper are from a 3-year research project employing both quantitative and qualitative methods, which aimed to develop an understanding of the role women primary health care workers play in the construction and provision of primary health care services for women The findings indicate that for specific 'women's health issues' the gender of the worker is clearly important for women However, for other health needs factors such as the personal approach of the provider become paramount Consideration of the role of the practice nurse suggests that there is considerable potential for practice nurses to further develop a specific role with women Although lack of awareness among women of nursing skills and expertise raises issues for the presentation of the role of the practice nurse within the primary health care service In conclusion the paper highlights that women's views should be understood in terms of a complex range of preferences and needs     

Population-Based Public Health Nursing Interventions: A Model from Practice

Abstract In a changing and complex health care system, public health nurses face challenges to explain their work and contributions to health outcomes. In response to this need, the Minnesota Department of Health, Section of Public Health Nursing, initiated a process to describe public health nursing interventions. The Public Health Nursing Interventions (PHI) Model was developed through a collaborative process by public health nurses at the state and local levels. The purpose of the model was to define more clearly the practice of public health nursing and to describe better the work of public health nurses at the community and systems levels. The PHI model identifies 17 interventions and provides practice examples at the systems, community and individual/family levels. The model defines a broader view of the mission and scope of public health nursing. Practice examples are given for agency staff, administrators, educators, and policy makers.     

Enhancing the Role Public Health Nurses Play in Serving Children with Special Health Needs

Abstract Public Law 99-457 Part H supports the development of systems to identify infants and toddlers with special health needs and provide these children the comprehensive care they need. Although public health nurses traditionally provide many of the mandated services, Part H, with its roots in education, presents new terminology, conceptual models, and challenges to public health nurses. An interactive videoconference entitled "Public Health Nurses and Part H: Putting the Pieces Together" was broadcast to 525 public health nurses in 11 states. The program goals were to increase knowledge of Part H among public health nurses and to enhance their role in its implementation. An evaluation was conducted to assess knowledge change and satisfaction with the program format. Results revealed a high degree of satisfaction with distance learning and no difference across sites in knowledge acquisition or participant satisfaction. A need identified through this project is increased interdisciplinary communication among those who serve infants and toddlers with special needs. In an era when financial resources are dwindling, interactive videoconferencing is an innovative and cost-effective method for decreasing the isolation of many public health nurses by offering opportunities for education and networking from their local communities.     

A public health nursing initiative to promote antenatal health

At least one in 10 pregnant women experiences depression. Other health risks during pregnancy include family violence, substance abuse, inadequate nutrition, financial challenges, environmental hazards and lack of social support. Public health nurses are in a unique position to enhance perinatal health by assessing for antenatal psychosocial risk factors. During 2005-06 in a suburban/rural community near Edmonton, Alberta, public health nurses initiated a one-year demonstration project with the goal of increasing the number of health and community services accessed by pregnant women as a result of an interactive appointment with a public health nurse. Eight family physicians in WestView Primary Care Network and three midwives from WestView's Shared Care Maternity Program referred local pregnant clients to the public health nursing unit at WestView Health Centre in Stony Plain. Each woman was assessed by a public health nurse for a variety of psychosocial risk factors. Results of the assessment determined the type of additional health services to which the pregnant women were referred. Care providers were unanimous in their support for public health nurses' continuing to provide antenatal assessments to an expanded population of suburban/rural communities in the Capital Health region.     

Community Empowerment in Rural Health Care

Abstract The Healthy Communities 2000 mandate calls for public health leaders to involve community members in setting health priorities and implementing programs in response to the national health objectives for the year 2000 (American Public Health Association, 1991). This paper describes community involvement through a community empowerment nursing intervention and evaluates its application in a rural community. A community health nursing project (AHCPR, Grant No. HS06801) with three interventions, one of which was community empowerment, was designed to address the health needs of small, rural, underserved, primarily Mexican American communities in Arizona. Community empowerment in this project was based on the community-development approach to community organization, and involved community health nurses and lay health workers, called promotoras , who are key persons in community development. The implementation of two health fairs, one the result of the community-empowerment intervention, is described and evaluated in relation to community health. The community-empowerment intervention was based on community participation and responsibility, hallmarks of the second health fair, reflecting lay expertise and cooperation among various levels of the community. Successes and limitations of the health fairs provide feedback for developing a community-empowerment intervention.     

Mental Health Nursing Practice and Indigenous Australians: A Multi-Sited Ethnography

Criticism of public mental services provided to Indigenous Australians have persisted over the last two decades, despite several national reports and policies that have attempted to promote positive service change. Mental health nurses represent the largest professional group practising within these services. This paper reports on a multi-sited ethnography of mental health nursing practice as it relates to this group of mental health service users. It explores the beliefs and ideas that nurses identified about specialist mental health nursing practice and Indigenous Australians. The study found a disunited approach to practice during the fieldwork. Practice was expressed as a series of individual constructions built upon the nurses’ beliefs about Indigenous Australians and their experiences in practice with these peoples. The criticism of mental health services from Indigenous communities was understandable to the mental health nurses, but how they could address this through their individual practices was not always clear to them. The actions by public mental health services to improve cultural safety through generic training related to the broad area of Indigenous health and health service needs, does not appear to evolve into informed specialist mental health nursing practice for Indigenous Australian service users.     

The Interprofessional Rural Program of British Columbia (IRPbc)

The Interprofessional Rural Program of British Columbia IRPbc was established in 2003 as an important first step for the Province of British Columbia, Canada, in creating a collaborative interprofessional education initiative that engages numerous communities, health authorities and post-secondary institutions in working toward a common goal. Designed to foster interprofessional education and promote rural recruitment of health professionals, the program places teams of students from a number of health professional programs into rural and remote British Columbia communities. In addition to meeting their discipline specific learning objectives, the student teams are provided with the opportunity to experience the challenges of rural life and practice and advance their interprofessional competence. To date, 62 students have participated in the program from nursing, social work, medicine, physical therapy, occupational therapy, pharmaceutical sciences, speech language pathology, audiology, laboratory technology, and counseling psychology. While not without numerous struggles and challenges, IRPbc has been successful in meeting the program mandate. It has also had a number of positive outcomes not anticipated at the time the program was established.