门诊总护士长对社区护理工作的管理

总结了门诊总护士长在7年社区护理管理中的做法。做好社区护士的选拔和规范化培训,建立适应本医院、本地区实际的社区护理组织 体系,确立社区护理工作内容和运作方式,建立社区护理管理制度,做好社区护理质量控制工作,使社区护理高效优质运作,是社区护理管理者 思考、实践与努力的方向。     

Public Health Nurse Salaries: Associations with Nurse, Agency, and Community Characteristics

This study applied an economic framework to the analysis of public health nurse (PHN) salaries, assessing their relationships to nurse qualifications, agency resources, community economic base, and area competition for the nurse supply. Data were obtained through interviews with 125 Ohio health departments and from various state and local reports. Associations between salaries and explanatory variables were analyzed through correlations and stepwise regression models. The PHN salaries were significantly lower and more compressed than salaries for nurses in area hospitals. Agency and community characteristics were more important than nurse education and experience in explaining salary variations. Maximum PHN salary attainable was significantly related to level of health department funding and community unemployment rate. Health departments in rural locations paid lower salaries at both minimum and maximum levels. Evidence suggested the presence of entry-level wage competition by health departments with both area hospitals and other community nursing agencies. Each 1% increase in minimum hospital nurse salaries was linked to a 0.66% increase in PHN salaries. Findings support the need to improve competitive positions of health departments as nurse shortages intensify.     

Practice patterns of Finnish public health nurses

Koponen P, Kalkas H. International Journal of Nursing Practice 1997; 3 : 97–104
Practice patterns of Finnish public health nurses
The aim of this study was to: (i) describe the practice patterns of Finnish public health nurses during the development of primary health care based on the 'population responsibility' principle; and (ii) to identify the relation of public health nurses' task division models and types of community (rural/town) to their practice patterns. A detailed recording of public health nurses' home and clinic visits was developed and used during three annual study periods in 8–9 health centres by 93–118 public health nurses. The total number of recorded visits varied annually from 4842 to 6841. Statistical significance was determined by Chi-squared. Significant differences were found between the three study periods and also in the practice patterns of public health nurses (PHN) with different task division models and of PHN working in different types of community. However, the short study periods limited the practical importance of these findings.     

香港社区护理的概况及管理经验

从家庭健康、长者健康、学生健康、卫生防护中心、健康教育、诊所服务、普通科门诊 ,介绍了香港基层健康服务的范畴。从社康护理服务、精神科社康护理服务等方面介绍了香港社区护理的概况。从社区老人评估服务、个案管理、社康护理专科化及疾病护理规程、外展护士及私营安老院舍服务、出院后病人的支援计划、科技的运用 :社康护理信息系统及PDA系统、遥控录像和电话支持服务等方面介绍了香港社区健康服务的发展及科技的突破。以新界西社区护理模式为例介绍了联网社区的护理模式。论述了社区护士应具备的条件和社康护理服务的发展方向。     

Overcoming barriers and improving public health nursing practice

Public health nurses (PHN) are critical to ensuring the health of communities. Absent the most basic information on the PHN workforce in our state, we conducted interviews with 21 PHN and school health nurse (SHN) leaders and an online survey of PHNs and SHNs practicing in Maryland (N = 491). Our study identified an older, very experienced, and well-educated workforce. Both the interviews and survey identified similar barriers: low salaries, recruitment and hiring challenges, limited funding for public health programs, and no opportunities for education or career advancement. Survey participants also identified barriers of inadequate leadership, recognition, and communication including PHNs not being represented at decision-making tables or at the state leadership level. Strategies to promote public health nursing from leaders and survey participants were similar: increasing awareness about what public health and PHNs do and their value; improving advocacy and stakeholder engagement; improving access and availability of services; improving PHN leadership representation at the state level; a improving PHN salaries and benefits including tuition reimbursement. Although results were similar to national studies, comprehensive, granular workforce data is critical to ensure the public health workforce can meet current and emerging public health needs and that public health infrastructure and services are appropriately funded.     

Family nursing education and family nursing practice in Nigeria

A survey of six Nigerian nursing program curricula was conducted to determine the extent to which family nursing theory was used as a reference for conceptualizing nursing care in Nigeria. In addition, 25 nurse clinicians were purposely selected from three levels of primary, secondary, and tertiary health care units in Ile-Ife, Nigeria, and were interviewed to determine the extent to which nurses in practice reported using family assessment tools in their practice. The survey of the postgraduate curricula showed that master's and doctorally prepared nurses specializing in community health nursing have a theoretical base in family nursing theory. The limited focus on family nursing theory in basic, postbasic, and first-degree nursing curricula was deemed inadequate to develop the knowledge and skills necessary for all practicing nurses to embrace family-focused care in Nigeria. In nursing practice, families were seen to be involved in nursing care only to the extent of meeting financial and physical care needs of their family members. Findings from this study point to the need for a reorientation of the nursing curricula in Nigeria to include more family nursing theory. Specialized education of family nurse practitioners who would function at all levels of care also is a desirable goal to provide holistic health care to Nigerian families.     

Primary care parish nursing: academic, service, and parish partnership

Health care providers who want to make a difference in today's health care environment must support the idea of collaboration. To address the concerns of a university, a major medical center, and the community, a collaborative group shared their vision and developed creative strategies to serve the community. The critical components of this project included gaining the services of a nurse practitioner and nurse case manager, establishing physician liaison, assessing congregational health care needs, providing for both primary health and continuity of care needs, and maintaining the spiritual component of the faith community. Essential to the success of this program was the achievement of pastor and congregational support, enthusiasm, and involvement.     

The Henry street consortium population-based competencies for educating public health nursing students

The Henry Street Consortium, a collaboration of nurse educators from universities and colleges and public health nurses (PHNs) from government, school, and community agencies, developed 11 population-based competencies for educating nursing students and the novice PHN. Although many organizations have developed competency lists for experts, the Consortium developed a set of competencies that clearly define expectations for the beginning PHN. The competencies are utilized by both education and practice. They guide nurse educators and PHNs in the creation of learning experiences that develop population-based knowledge and skills for baccalaureate nursing students. Public health nursing leaders use the competencies to frame their expectations and orientations for nurses who are new to public health nursing. This paper explains the meaning of each of the 11 population-based competencies and provides examples of student projects that demonstrate competency development. Strategies are suggested for nurse educators and PHNs to promote effective population-based student projects in public health agencies.     

Community assessment: a church community and the parish nurse

In central Massachusetts a large urban parish asked the University of Massachusetts, Amherst School of Nursing to conduct a community assessment for the church and newly employed parish nurse. The aims of the assessment were: to determine the health status of parishioners, identify their perceived health needs and perceived barriers in meeting those needs, and to assist the church and parish nurse in developing a health program for their faith community. Findings of the assessment are based on questionnaire and focus group data. Four hundred and twenty-one questionnaires were completed, and six focus groups were held to validate the data. Results showed most parishioners felt they were in good health (93%), believed faith and spiritual beliefs were important in maintaining health and well-being (91%), and thought that the church should play a role in helping parishioners meet their health needs (70%). In addition, focus group discussions revealed a need for respite care for primary caretakers of the ill and elderly, and health education programs for their teen and elderly populations. In conclusion, parishioners were positive and articulated support of the parish nurse and activities designed to address the physical, emotional, and spiritual needs of their community.     

Pregnancy-free club: a strategy to prevent repeat adolescent pregnancy

ABSTRACT Public health nurses (PHNs) implement interventions from the Public Health Intervention Wheel in a school-based program to prevent repeat adolescent pregnancy. The local health department, the school district, and a community hospital collaborated to develop the Pregnancy-Free Club (PFC) for adolescent mothers attending the school. Their goal was to prevent repeat adolescent pregnancy through a multifaceted approach. Strategies include the daily presence of PHNs in the school, monthly pregnancy tests and surveys, health counseling and referral, and group health education classes. The school also provides day care for participants' children. Following program initiation, the repeat adolescent pregnancy rate declined from 4.7% to a mean of 4.7% over 9 years of the program. Data from focus groups conducted with program participants suggested modifications that would increase participant satisfaction with the PFC. The daily presence of a PHN who was open and nonjudgmental paired with a supportive school environment, the availability of birth control counseling and referral, and affirmation of healthy choices to remain pregnancy free, were essential program components.     

A public health nursing practice model: melding public health principles with the nursing process

There has been a shift in emphasis in public health from the provision of personal health services for individuals to efforts targeted at improving the health of the whole community. Many in public health nursing (PHN) have welcomed this shift, recognizing the important role PHN can play in promoting health and preventing disease for all. There continues to be a need to redefine PHN roles and practice so that public health nurses can participate more effectively. Los Angeles County Department of Health Services Public Health Nursing (LAC PHN) has developed a practice model grounded in nationally recognized components: the public health team, PHN standards of practice, the 10 Essential Public Health Services, Healthy People 2010's 10 Leading Health Indicators and additional local indicators, and the Minnesota Public Health Nursing Interventions Model. The LAC PHN Practice Model provides a conceptual framework that assists in clarifying the role of the public health nurse and presents a guide for public health practice applicable to all public health disciplines.     

Public Health Nurses' Vision of their Future Reflects Changing Paradigms

Health care over the past decade has undergone important changes that have implications for public health nursing. The focus of public health has expanded, as a result of the World Health Organization establishing the goal of "Health for All by the Year 2000," with its strategy of primary health care. To be active participants in this expansion, public health nurses must be more explicit about their current contributions to health care systems; develop nursing frameworks consistent with the systems' changing goals; and articulate their visions of the future. It is clear that the medical paradigm of health care services needs to change to one of primary health care. Based on results of a recent public health nursing research study, a conceptual framework for the future practice of public health nursing was developed .     

The nurse as a social worker

In the early twentieth century the role of the public health nurse (PHN) was expanding to meet the needs of individuals, families, and communities. Among the ideas discussed in the early nursing literature was that of the social nurse. This role was conceptualized as a combined nurse and social worker. Much of the PHNs work was with people of the poorer classes who needed assistance with both the medical aspects of their disease, as well as help with social needs such as food, rent money, and bedding. In this reprint from The Visiting Nurse Quarterly (1911), Ellen La Motte, Nurse-in-Chief with the Tuberculosis Division of the Baltimore Health Department, argued for this combined role based on economic efficiency. As she pointed out, it was "economic waste" to have two sets of workers going into homes when the nurse was capable, with additional education, of carrying out both roles. Additionally, from La Motte's perspective the only way the nurse could move beyond her role as the "physician's handmaiden" was through "social training" that prepared her for a broader scope of practice than that received in the hospital-based nursing schools. In the end, however, she left it open to nurses as "reasonable beings" to determine the direction the profession would take on this issue. La Motte's words provide historical context for issues contemporary public health nursing leaders are addressing, such as inter-professional boundaries between nurses and public health workers, reductions in the public health workforce, and economic constraints faced by the healthcare system. The Institute of Medicine mandate for inter-professional practice within the healthcare system, however, presents opportunities for exploring new roles and practice models for nurses in conjunction with our partners in public health.     

The management of infant developmental needs by community nurses. Part 1: description of the responsibilities of community nurses with regard to the management of infant developmental needs

This article is one of two that describes the responsibilities of community nurses, according to their legal scope of practice, with regard to the management of developmental needs of infants in primary health care clinics in South Africa. A subsequent article describes the development of guidelines for the support of community nurses to address the developmental needs of infants 0-2 years. While evidence confirms that developmental surveillance should be incorporated into the ongoing health care of the infant, such services are not consistently provided in health care settings and, if provided, the delivery thereof suffers from significant inadequacies. A case study strategy was used to investigate the phenomenon and content analysis utilised to analyze the data. The Transactional Model of Development was selected to interpret the data obtained in the study. Findings of the study show that infant developmental care is not included to its fullest potential in the health care delivered to infants and their families, thereby indicating that community nurses do not meet the standards of the profession with regard to the management of infant developmental needs. Health service managers need to review their commitment and type of support to community nurses, if infant developmental care, as part of community nurses' responsibilities, is to be effective and of high quality. Furthermore, community nurses and other health care professionals must recognize the nature and potential of inter-professional collaboration to ensure positive outcomes for infants with developmental delays and disabilities.