Clinical Competencies for Community Health Nursing

Cost-containment strategies initiated in the early 1980s caused a major shift in site of care delivery for persons needing nursing care. Where once the majority of clients were cared for in the acute-care setting until they were self-sufficient, now most are discharged to the home environment still requiring acute-care nursing interventions as well as community health nursing skills. This rapid shift in practice sites has placed severe strain on community health nursing agencies. Not only are more nurses required to fill the increased demand for services, but the demand comes at a time when we are experiencing a severe nursing shortage. This has forced many agencies to hire acute care nurses who have little or no community health nursing experience. These nurses come to community health nursing expecting to use the same set of skills and knowledge base used in their acute-care practice; however, the skill levels and concepts required for community health nursing are quite different from the acute care setting. Educational preparation has not kept pace with this shift in practice. Consequently, many nurses are not adequately prepared to enter community health nursing. Preparation must include theoretical and experiential components that focus on assessment skills (of the community and individual), decision making, case management, health systems management, teaching, and leadership. Collaborative efforts between community health organizations and educational institutions would seem to be one solution that would ensure adequately prepared nurses for community health nursing. The establishment and maintenance of strong staff-development programs within community health nursing agencies are also required.     

Ethical issues in rural nursing practice in Botswana

The concern for ethical principles and values is not limited to health professionals alone. However, ethical principles in nursing act as safety valves for social control to prevent professional misconduct and abuse of the rights of clients. As a result of colonial experience, developing countries like Botswana usually follow the European lead, especially examples from the UK. This article examines the ethical problems and dilemmas associated with rural nursing practice in Botswana, a developing country in sub-Saharan Africa. The major ethical problems identified are related to the distribution of and access to health resources in rural communities. It is proposed that nurses must assume responsibility in the field of access and allocation by working collaboratively with governments and other professional bodies, and that nurses as a global community must work together as a team to support each other.     

Knowledge, skills and experiences for community health nursing practice: the perceptions of community nurses, administrators and educators

Nursing in Canada is committed to preparing all new graduates at the baccalaureate level for entry to nursing practice by the year 2000 This goal has major implications for community health nursing education and practice Health care reform is also expected to move care out of the hospital and into the community It was against this backdrop that the researchers mounted a study on the educational preparation needed for graduates to begin to practice community health nursing In this paper, the knowledge, professional and personal skills, and experiences that graduates need to begin community practice are reported The study was carried out within an action-research framework All major groups of stakeholders involved in community health nursing throughout the study province were involved in the project This included nurses and administrators from two public health agencies (provincial and municipal), home care nurses, home health nurses (l e non-governmental visiting nurses), community health centres, provincial health care and nursing consultants, and faculty from two universities In addition to the generation of relevant research findings for use by the educational institutions, the study was initiated to set the stage for future and ongoing interactions between the researchers and community experts to implement the findings from the project Data were collected from 118 participants by means of 27 focus groups of community nurses, administrators and educators Interviews were tape-recorded transcribed and analysed using latent content analysis and constant comparison techniques Findings indicated that qualified nurses from university programmes need a wide range of knowledge, skills and experiences to begin to practice community health nursing Detailed accounts of these requirements are outlined and the implications for practice and education put forward     

New curriculum for a new century: beyond repackaging

A plan to evaluate the effectiveness of the changes is in progress. Focus groups with health care agencies in the community validate the life skills as essential to nursing practice. Evaluation of students and graduates is ongoing to determine the overall effectiveness of this curriculum. Preparing nurses for a new century requires developing a new curriculum. But it requires much more than changing what is taught. The students who are recruited, the teaching methods used, and the academic policies must be rethought. These all are reflected in this model that allows students to learn and practice skills needed for a lifetime in nursing.     

Nursing ethics in a developing country

Nursing is a true profession, distinguished by its philosophy of care, its full-time commitment to human wellbeing, its particular blend of knowledge and skills and its valuable service to the community (Curtin & Flaherty, 1982:92). Ethics is vital to nursing. Being a professional implies ethical behaviour and knowledge of what it means to be ethical (Pera & Van Tonder, 1996:v). Ethics is the foundation of committed service to humankind. When nurses practice is an ethical manner they should adhere to ethical principles like autonomy, beneficence, justice, veracity, fidelity, confidentiality and privacy. From this conceptual framework two questions can be asked, namely: Does the behaviour of nurses in health services in South Africa comply with the principles of ethics? How can ethical behaviour be facilitated in nurses in South Africa? The first question was answered by doing a critical analysis of thirty-two case studies of recent ethical phenomena in health services. The ethical principles will be used as criteria for this analysis. Some of the ethical case studies will be presented in this paper to indicate the problems in relation to autonomy, beneficence, justice, veracity and fidelity. It will be demonstrated that from deontological ethical theories nurses are not doing their duty as advocates for the vulnerable patient and from utilitarianism the poor and uneducated patients are being exploited. To empower patients in developing countries it is of vital importance for nurses to behave in an ethical manner. From a literature study a program for rational interaction for moral sensitivity (Rossouw, 1995) and virtue-based ethics in Nursing Education is identified to facilitate moral behaviour amongst nurses in developing countries.     

District and practice nurses' public health practice and training needs

In 2000, the UK government set out its plan to tackle poor health in 'Saving Lives: Our Healthier Nation'. Practice and district nurses were recognized as key health professionals in achieving the integration of health improvement into the local delivery of health care. In order to respond to these changes, North Tyneside PCT undertook a training needs and skills analysis of local practice and district nurses. Thirty practice nurses and 39 district nurses returned completed questionnaires. Practice and district nurses rated their competence as lower in public health skills than in clinical skills and also rated them of less importance. Senior practice and district nurses indicated that they perceived low value in skills required to move forward public health practice within community nursing. The findings of this study have been used to develop a 5-day training programme. The approach has relevance to those concerned with making public health a reality within community services.     

A population-based approach to pediculosis management

Pediculosis is a population-based problem that is a priority concern for many communities. Public health nurses in a county health department collaborated with epidemiologists, nursing students, and faculty to design and implement an effective population-based pediculosis management project. The focus of the project was the development of pediculosis treatment and prevention guidelines based on recognized best practices that were acceptable to both epidemiologists and practicing public health nurses. Public health nurses disseminated these guidelines to community providers and reinforced their use through consultation and educational sessions. Two critical changes occurred as a result of the project. First, community providers significantly changed their recommendations for the treatment of pediculosis after nursing intervention. Second, public health nurses increased their population-based practice skills, continued to use those skills to address pediculosis, and extended those skills to additional population-based initiatives.     

Ethical challenge in community health nursing

Community health nurses frequently face situations involving ethical conflicts, but little research has been carried out in this area. This paper, based on a study of dilemmas defined by 30 practising community health nurses in urban and rural British Columbia, Canada, presents an analysis of the situations that contain the most serious ethical conflicts for nurses working in the community. Although issues related to client's rights, nurses' interactions with colleagues and the system, and nurses' rights were explored, nurses in the study reported that situations involving high-risk parenting provided the most serious ethical challenges. Strategies to help nurses caring for such vulnerable clients are described. As well, this paper offers some discussion on implications for community health nursing practice and education in light of current changes and challenges.     

Does Advanced Community/Public Health Nursing Practice Have a Future?

Societal trends and predicted needs of the health care system indicate that there will be increasing demands for health care professionals who can effectively manage the health needs of populations and communities. Nurses who have master's degrees in community/public health nursing have the educational background to provide this expertise. Although the Association of Community Health Nursing Educators and many nursing leaders maintain that these nurses are advanced practice nurses, most leading nursing organizations and state nurse practice acts do not include population and community health management skills in their definitions of advanced practice nursing. These exclusions have produced a serious status problem for master's programs in community/public health nursing. This article examines issues affecting the current and future status of master's-level community/public health nursing. Solutions are suggested for ensuring the viability of this specialty area.     

Public health: a new nursing role for community practitioners

This article discusses the six key activities identified by the Royal College of Nursing (1994) as essential ingredients for public health nursing. Examples of public health practice and community nurse involvement are given to illustrate each activity. Public health skills such as health profiling, building healthy alliances and policy development are outlined. Current barriers to community nurses participating in these activities are identified and models of public health practice are reviewed. The potential for a radical transformation of community nursing practice is discussed in the context of an expanding public health role of community nurses in Scotland. Options for future practice are presented and discussed.     

护理人员循证护理知识、态度、行为、技能调查研究

目的；调查了解护理人员循证护理知识、态度、行为、技能状况，为临床开展护理人员的相关培训和循证护理教育的方向及管理灾践提供理论依据。方法：在参考国内外文献基础上自行设计调查问卷，对广州市5所医院的101名护理人员进行循证护理知识、态度、行为、技能状况调查。结果：63．7％的护理人员熟悉循证护理知识（人群集中在本科学历以上的护理人员），31．5％的护理人员对循证护理知识有一定的了解，只有4.8％的护理人员对循证护理一无所知；97．5％的护理人员对循证护理具有正向态度；护理人员的循证护理技能掌握较好的占18.4％，大部分人（58．3％）对检索知识、在实施循证护理过程与患者的沟通能力掌握较好，但在评价研究质量的优劣、决策能力技能方面能力不自信；20．80％的护理人员具有主动寻找解决问题的行为，而且集中在职称较高的人群；56．1％的护理人员会利用业余时间通过互联网获取需求知识，但有23．1％的护理人员墨守成规。结论：护理人员均对开展循证护理具有支持与正向的态度，但相当一部分护理人员对循证护理知识缺乏。     

From rhetoric to reality: the changing face of public health nursing in southern Ontario

A feminist, postmodern oral history was undertaken to make visible the work and struggles of public health nurses in Southern Ontario in the midst of drastic cutbacks and dramatic changes in public health. The study focused on the period between 1980 and 1996, during which time two distinct practice modalities were apparent: district nursing and program-focused practice. The narrators' stories describe the nature of their work in both those modalities, the skills and expertise they demonstrated, and the often conflicting influences of medicine and the health promotion movement that dramatically changed their practice. District nursing was characterized by the public health nurse's integral connection with the community; program-focused practice, occurring at a time when political and economic factors also impacted on practice, was characterized by a loss of that integrality. Narrators saw many positive aspects to the changes in public health but identified problems as well. They articulated a preferred vision for the future as one in which "nurses should be nursing." To do that, public health nurses are challenged to return their practice to a nursing center rather than struggling to conform to dominant paradigms in public health.     

The impact of economic recession on health‐care and the contribution by nurses to promote individuals' dignity

The health sector is facing many challenges, and there is a need to maintain the delivery of high‐quality health‐care. Issues related to equity and access to health‐care have emerged in a context of an economic recession in which the sustainability of the health system depends on everyone, including the actions and decisions of professionals. Therefore, nurses and their skills may be the answer to ethical, professional and community health management, but this recession could lead to major problems in the education of nurses in daily health‐care practice. Due to the limited availability of resources, nurses are increasingly taking leadership positions, continuing to develop their critical abilities and thinking skills, and considering sciences such as deontology and ethics. The main goals of this study were to reflect on the economic recession and its impact on health‐care and to demonstrate the contribution of nursing to the sustainability of health‐care and in the promotion of individuals' dignity. The authors conclude that health‐care depends on economic redistribution and, in this context, needs to be equitable and fair. Nurses have the responsibility to develop their profession according to the underlying sciences and can therefore strategically help the healthcare system.     

培养社区护理人才的设想

为担负起社区内人们的健康保健工作，培养社区护士势在必行。可将已取得中专、大专文凭，并具有２年以上护理临床工作经验的护士，进行为期两年的社区护理理论学习和实践能力培养之后进入社区中心工作，以推动我国社区护理的发展。     

Ethical implications for living with adversity: the ever-present experience in the global nursing community

The discipline of nursing is experiencing the ever-present phenomenon of living with adversity or opposition. As a global nursing community, what are the possible ethical implications for global health in view of professional nursing practice and education? Professional nurses worldwide struggle with choosing and doing what is right while abiding with contexts or situations incarnated with conflict. With a global shortage of nursing faculty and practitioners, this column begins a nursing ethical discussion for pondering the need for community change. Ethical implications for the possibilities of faithfulness in adversity will be discussed from a human becoming nursing theoretical perspective.     

Perceptions and expectations of Baccalaureate-prepared nurses in Jordan: Community survey

The overall purpose of this paper is to describe the process of utilizing community participation for curriculum design to develop a new school of nursing. A brief Community Needs Assessment Survey was carried out in order to explore community perceptions and expectations of Baccalaureate-prepared nurses in Jordan. The sample consisted of 152 participants who were staff nurses, nurse administrators, nurse supervisors, nurse educators, physicians, pharmacists and consumers of services. Data were collected through a self-administered survey form using open-ended questions. Participants were asked to describe their perceptions of nursing and nurses, the desired professional skills and personal characteristics of the Baccalaureate-prepared nurse, important curriculum contents and to provide suggestions or comments for improving the preparation of Bachelor of Science in Nursing (BSN) nurses. The findings indicated that nursing was viewed as a caring profession where nurses care for the person both in sickness and health. Several professional skills and personal characteristics emerged as being important for the BSN nurse, including clinical competence, the desire to continue learning, communication skills, ethical and moral character, critical thinking, assessment skills, and computer and English-language skills. The participants provided the desired curriculum contents and suggestions related to the expected skills. Implications for nursing education were discussed.     

Starting from a blank page: discovering and creating community health nursing in post-Soviet Latvia

Nurses discovering the practice and creating the tradition of community health nursing without mentors or forerunners have to learn from the practice itself and from each other. Data in the phenomenologic study of 17 Latvian community health nurses (CHNs) consisted of group and individual interviews and observation of practice with families. The focus of this article is the situated practice of nurses in the new role of primary care CHN, revealed through clinical stories that give voice to nurses in a particular historical and social context. The stories of the nurses in this article provide evidence of a growing ability to practice from a health promotion/prevention focus and engage with families and neighborhoods. The practice is still developing, and at this point nurses are not drawing on experience with families to identify and care for vulnerable populations.     

Generating ideas for teaching mental health nursing

University teachers who prepare mental health nurses require a variety of teaching techniques to encourage students to engage with the subject matter and to prepare for unknown future problems and dilemmas that they must resolve. Mental health nursing requires the development of specific discipline knowledge, intellectual skills, such as the ability to think laterally and make ethical decisions, and personal attributes, such as maturity and tolerance, as well as practical experience in collaborative care. This article offers a number of strategies that teachers may use in their classes to promote the development of these mental health nursing skills. Other teachers might use these examples to trigger the development of their own repertoire of teaching skills for beginning mental health nurses.     

Impact of a course on community nurses' practice: an evaluation

An evaluation of a community course for nurses working in primary care was undertaken to ascertain whether it made an impact on the students' clinical practice. The course was undertaken by 16 nurses working within community nursing teams that included intermediate care, health visiting, school nursing and district nursing. Three quarters of the nurses had worked in the community for less than one year and half of these were newly qualified nurses. The evaluation consisted of semi-structured questionnaires, which were completed after the course and by the student and their mentor after 3 months. The assessment of practice document submitted by the students for assessment was also scrutinized for examples of changes students had made to their practice. The results demonstrate that the students felt that the community course made an impact on their practice and encouraged them to develop some of the key skills identified for community nurses.