Roaming through Virginia with the public health nurse

Rural health nursing has long been considered a subspecialty within public health nursing, albeit one that required the nurse to be a generalist. In the excerpts of this article, Webb (1920) shares her observations as a State Supervising Nurse for the Red Cross in Virginia while traveling in rural areas of the state with the county public health nurses. Themes evident in these excerpts include the transportation issues associated with working in remote areas, as well as nursing work in the areas of maternal and child health, communicable diseases, case finding through health inspections, and health education. Additionally, there are themes specific to rural nursing, including distance and isolation, self-reliance, and development of trust among the rural population. In her 1922 book, The Evolution of Public Health Nursing, Annie M. Brainard identified many of these themes when she stated the ideal rural public health nurse needed to be a "school nurse, baby nurse, tuberculosis nurse, and a general visiting nurse", as well as tactful in dealing with "country people" who are "peculiarly independent and sensitive" (1985 edition, p. 303).     

The Black Bag

In the early‐ to mid‐twentieth century, stories about nursing practice submitted by nurses frequently appeared in Public Health Nursing. The article reprinted here is an example of this genre of publications. Originally published in April 1936, this article tells the story of a day in the work of one public health nurse as she moves about the city making home visits. In this article, Snow (1936) used personification of the iconic black bag to tell her story. Using this technique she brings to life the nuances of her day, the personalities of her patients, and the importance of the black bag to the work of public health nurses. What did nurses learn from stories such as this one? Themes embedded in this story reflect the role of the Public Health Nurse (PHN), as well as the environment in which she worked. For instance, in this story we learn that not only was the PHN a welcomed visitor in the homes of families struggling with health problems, but that she brought order out of chaos, as illustrated in “The New Arrival”. “The Black Bag” also highlights the humor nurses experienced in their encounters with families, as well as the pathos in other situations. Stories served as a vehicle for nurses to share and learn about both the common elements of their work, as well as the unique features related to location and environment, such as rural and urban locales.     

Reinstating district nursing: A UK perspective

As policy directives gather pace for service provision to be delivered in primary care, district nursing has not been recognised as a valuable asset to facilitate this agenda. Investment in district nursing and specialist district nursing education has fallen. This is concurrent with an ageing district nursing workforce, a lack of recruitment and growing caseloads, as district nursing adapts to meet the challenges of the complexities of contemporary healthcare in the community. The district nurse role is complex and multifaceted and includes working collaboratively and creatively to coordinate care. Redressing the shortages of specialist district nurse practitioners with increased numbers of health care support workers will not replace the skill, knowledge, experience required to meet the complex care needs of today's society. District nursing needs to be reinstated as the valuable asset it is, through renewed investment in the service, research development and in specialist practice education. To prevent extinction district nurses need to be able to demonstrate and articulate the complexities and dynamisms of the role to reinstate themselves to their commissioners as a valuable asset for contemporary practice that can meet current health and social care needs effectively.     

Promoting leadership and management in Australian general practice nursing: what will it take?

Aim This paper outlines the current state of Australian practice nursing, describes the context of general practice and establishes the importance of promoting leadership and management in this setting. Background Australian general practice nurses have emerged as key stakeholders in primary health care. However, their role in leadership and management has been largely invisible. The reasons for this are multifactorial, including the delay to establish a strong professional organization, their negative power relationships with general medical practitioners, limited nursing leadership and poorly defined roles. To date, the impetus for practice nurse growth has been largely external to the nursing profession. Growth has been driven by the increasing burden of chronic disease and workforce shortages. This has further weakened the control of nurse leaders over the development of the specialty. Conclusions The Australian practice nurse role is at a crossroads. While the practice nurse role is a viable force to improve health outcomes, the growing strength of the practice nurse challenges traditional professional roles and practice patterns. Implications for nursing management There is an urgent need to develop practice nurse leaders and managers to not only embrace the challenges of Australian general practice from an operational perspective, but also undertake a clinical leadership role. As clinical leaders, these nurses will need to develop a culture that not only optimizes health outcomes but also advances the status of the nursing profession.     

Questions and answers: Some questions discussed at one of the round tables held at Chicago Institute with public health nurses

There were a number of issues confronting public health nurses in 1919, including the differentiation of practice between visiting nurses and public health nurses, use of community partnerships when developing a new nursing service in a community, and standards of nursing work. Other issues included the focus of nursing work at the community/population versus individual level, how to balance the work load where there was only one nurse in a community, and educating the public about the value of public health nursing to the community. In this excerpt from the original publication, Ella Phillips Crandall responded to questions raised at a round table session held in Chicago in 1919 as a part of a Public Health Nursing Forum, and then published in the October 1919 issue of The Public Health Nurse. While the social context in which PHNs worked in 1919 were significantly different from those nurses face today, these insights are prescient to the issues faced by PHNs today as the profession continues to address issues related to standards of practice, role development, and educational preparation for both entry level and advanced practice.     

The nursing shortage. Past, present, and future

According to healthcare experts, the present nursing shortage is going to extend to 2020 with an estimated 400,000 RN vacancies. A number of factors are contributing to the shortage: an increase in the age of registered nurses, decreased school enrollment, increased career opportunities for women, changes in the healthcare delivery system, nurse "burn-out," and the public's misunderstanding of what nurses do. Additionally, a number of social and economic trends are going to affect the healthcare delivery system in the future, such as: aging of the population, increased technology, the increase of the health/wellness movement, changes in employee's work ethic, influence of Generation X and dot.com workers, and scarcity of entry-level and low-wage workers. If nursing is going to be a major player in the healthcare delivery system in 2020, nurses must take an active role in developing and implementing a strategic plan. We need to look beyond solutions used in the past, such as increasing compensation and modifying school curriculums.     

Public health nursing competencies 1953-1966: effective and efficient

The Quad Council of Public Health Nursing Organizations developed public health nursing competencies in 2003. They are guides for determining skills at two levels, and they identify public health nurses as providing care to individuals and families or to populations and systems with the nurse having proficiency, awareness, or knowledge. The primary purpose of this paper is to discuss historical nursing roles and qualifications as judged by the 2003 competencies, including educational preparation and experience for the administrative and staff nurse. The historical exemplar for the nursing roles is a combination public/private nursing association, referred to as the partnership, that took place in 1953-1966. Primary sources include archived material from the Instructive Visiting Nurse Association, Richmond, VA. Administrative responsibilities were divided between the chief nurse and the nursing supervisors. Staff nurse responsibilities included clinic activities, home visitation, and referral coordination between health care organizations. The delineation of nursing roles demonstrates nurses' meeting the 2003 competencies. Based on the Quad Council's 2003 public health nursing competencies, the partnership nurses were competent.     

Advanced nursing practice: an idea whose time has come

Aims and objectives. This paper aims to analyse the concept of advanced nursing practice critically and to demonstrate an appreciation of the development of the role of the advanced nurse practitioner in the Irish context. Background. The concept of advanced nursing practice has existed in the US since the 1960s and in the UK since the early 1980s. The first signs of the advanced nurse practitioner began to emerge in Ireland in the late 1990s as a result of increasing demands and changes occurring within nursing and health care. Currently, there are 31 advanced nurse practitioners in the country, many of whom practice in the general setting. Strategies are in place to introduce advanced nursing practice into other nursing disciplines in the future. Methods. A literature review was conducted to address the various issues inherent within this concept. Results. There is a body of evidence indicating that advanced nursing practice has brought about an improvement in patient outcomes. In light of this, the advanced nurse practitioner has a valuable role to play in providing a beneficial contribution and filling a gap in healthcare services. Conclusion. This paper has demonstrated that nursing continues to be a dynamic and ever‐changing phenomenon where the onus is firmly on the advanced nurse practitioner as expert, leader and collaborator, to capture the hearts and minds of nurses and healthcare workers, so as to challenge traditional values and transform clinical practice. Failure to do so may allow medicine or other interested parties to shape the future of nursing or even absorb it. Relevance to clinical practice. Nurses working at an advanced level are striving to develop their expertise, initiate nurse‐led services and practice, in collaboration with other professionals in an effort to provide the highest quality care to the patient. Although the idea of the advanced nurse practitioner is relatively new to nursing in Ireland, it is the result of an idea whose time has come and there is nothing more powerful than an idea whose time has come.     

Edna Dell Weinel, Champion of Public Health Nursing— Excerpts from an Oral History

ABSTRACT Edna Dell Weinel is a former executive director (1980–1991) of the Family Care Center, a federally funded neighborhood health center in St. Louis, Missouri; this position capped her career as a county public health nurse, state maternal-child nursing consultant, and educator. In all her positions, Weinel lived her values: working at one's highest level of skill, social justice, and teamwork, and used political skills to build alliances for the improvement of community health. Her many contributions to public health and public health nursing were recognized by the Public Health Nursing Section of the American Public Health Association in 1993 with the Ruth B. Freeman Distinguished Career award. In interviews conducted early in 2007, Weinel spoke of her pride in being a public health nurse, her unchanging belief that health care can best be delivered by teams, and that public health nurses are an essential part of any effective team.     

Friday at Frontier Nursing Service

ABSTRACT The Frontier Nursing Service (FNS) was founded in 1925 in eastern Kentucky by Mary Breckinridge, a nurse whose interest in improving rural health and midwifery changed the course of rural public health nursing and improved health outcomes for some of the most isolated and poorest people in 20^th century America. The visual image of Breckinridge on horseback visiting her scattered rural patients is imprinted on the minds of most public health nurses in the United States and has, perhaps, been the wellspring of many nursing career aspirations. The daily life of FNS nurses was one of hardship, uncertainty and variey, as is evidenced in this tale of one day; nonetheless, the experiment of a rural nursing service combining midwifery and generalized nursing was ultimately a tremendous success. The following historical reprint recounts a singular day in the life of Anna January, a nurse midwife at the FNS in Confluence, Kentucky. She captures the dialect and earthiness of the region and the period in her story, but the events she relates also illustrate how interconnected life events can be in rural communities. The original article appeared in the December 1948 issue of Public Health Nursing [Volume 40 (12), 601–602].     

Concepts of health: implications for public health work

This article explores the health concepts of community health care (CHC) nurses in relation to their potential roles as public health workers. On examining Ewen's (1998) study of CHC nurses' role perceptions, it is evident that an individualized, person-centred, holistic approach to care continues to dominate practice. The public health role within CHC nursing remains underdeveloped and is equated with primary prevention with the well population. A 'community-as-foreground' model is proposed as a useful way of redefining CHC nursing practice to incorporate public health. The discussion revolves around the need for a broader view of health to include a political and social dimension, and considers the role of education and practice in achieving this.     

Graduate education for advanced practice public health nursing: at the crossroads

The complexity of public health problems and advancement of science framing public health demand an expansion of traditional educational approaches and curriculum to prepare a futuristic advanced practice public health nursing (APPHN) workforce. This position paper sponsored by the Association of Community Health Nursing Educators challenges nurse educators to apply innovative strategies in preparing public health nursing (PHN) professionals and to expand curriculum paradigms to promote PHN's ecological approach to solving problems. To meet the challenges of ensuring public health in the 21st century, advanced practice public health nurses must have greater foundational knowledge in critical content areas discussed in this document. Competence in these areas will enable advanced practice public health nurses to address future health care challenges such as rapidly changing social structures, escalating knowledge explosion, globalization, and growth of new technologies. This education will prepare nurses to forge new knowledge and establish health care teams to create effective solutions.     

Cardiovascular disease in China: an urgent need to enhance the nursing role to improve health outcomes

Aims. This paper reviews the role of cardiac nursing in China and the potential of this professional group to take an important role in secondary and tertiary prevention initiatives. Background. China is undergoing unprecedented economic growth, yet globalisation of Chinese society has caused an increase in the prevalence of chronic conditions, particularly cardiovascular disease. Studies recognise that health providers and members of the public are not fully aware of the risks associated with cardiovascular disease and consequently are not equipped to deal with this looming epidemic. Design. Position paper. Method. This position paper summarises and discusses the burden of cardiovascular disease in China within the context of evidence for nurse‐coordinated interventions. Barriers and facilitators to developing the nursing role in contemporary China are discussed. Conclusions. A key strategy for promoting the role of nurse‐led programmes in China is increasing research skills among Chinese nurses to promote independent, collaborative interdisciplinary research. Promoting doctoral education in China, increasing the status of nursing in interdisciplinary teams, collaborating with cardiovascular nurses internationally and increasing the public’s awareness of cardiovascular disease are critical steps in promoting nurse‐led programmes to improve the health and well‐being of the community. Relevance to clinical practice. Given the positive relationship between knowledge and skill levels of nurses and clinical outcomes, China’s investment in the education and training of its nursing workforce is critical in improving practice and outcomes in cardiovascular disease.     

Innovations in United States genetics nursing: Practice and research

Aim: Clinical and research applications from human genome discoveries are growing and creating both opportunities and challenges to the integration of genetic concepts into practice and research. Nurses have a long history of caring for individuals, families, and groups with genetic conditions. In the past two decades, a small group of nurses in the USA have used a variety of strategies to further develop the field of genetics nursing. In this paper we identify innovative approaches to identifying genetics‐related nursing roles and opportunities, as well as successful collaborative efforts beyond nursing to address the emerging health and societal challenges related to human genetics discoveries. Methods: The information presented here comes from a variety of sources where the authors or genetics nurses directly participated, including: (i) a systematic literature review of genetics nursing; (ii) a comprehensive research study of models of delivering clinical genetics services and the roles of health professionals; and (iii) participation in numerous national research, planning, programmatic, and advisory groups involved with clinical genetics‐related health services, research, education, and public policy. Results: Genetics nurses in the US have developed innovative responses to genetics‐related challenges within and beyond the profession of nursing. These include: (i) establishing an organization for nurses in genetics and gaining formal recognition of genetics as a specialty of nursing; (ii) defining the scope of genetics nursing practice and developing a new genetics nursing credential; (iii) establishing a multiprofessional genetics education coalition and defining genetic competency for health‐care practice; (iv) creating new clinical practice roles for nurses that integrate emerging genetics concepts and skills into diverse clinical practice areas; (v) expanding nursing involvement in genetics‐related research; and (vi) participation in high‐level genetics advisory groups. Conclusions: The US experience shows that nurses have made substantial progress in expanding their involvement in genetic services through visionary leadership, innovative approaches to challenges, establishing support with nurse colleagues, and engaging in multiprofessional efforts. The most important first step is developing a supportive environment for nurse advancement. In the US, the genetics nurses’ organization known as the International Society of Nurses in Genetics (ISONG) has provided this base.     

Articulating nursing in an interprofessional world

It is essential that nurses in practice clearly articulate their role in interprofessional clinical settings. Assumptions, stereotypes, power differentials and miscommunication can complicate the interaction of healthcare professionals when clarity does not exist about nurses' knowledge, skills and roles. Conflicting views among nurse scholars as to the nature of nursing knowledge and its relationship to practice complicate the task of nurses in explaining their performance and role to others in interprofessional environments. Interprofessionality is potentially misunderstood by nurse leaders, practitioners and educators, isolating nurses in an increasingly inter-disciplinary healthcare system. The theorization of contemporary nursing is explored through the views and perspectives of current nurse scholars. The ability to explain nursing knowledge, skills and roles to others in interprofessional interactions is a nursing competency, as well as an interprofessional one. Nurses, nurse leaders and nurse educators are challenged to engage in interprofessionalism so as to have an influence in the evolution of healthcare education and practice environments.     

Ethics in critical care in nursing

The ANA Code for Nurses requires ethical behavior from all practitioners of nursing. As such, it serves to safeguard the public from unethical nurses. However, the code cannot and does not give direction in all situations nurses encounter in practice. Nurses require more assistance to meet the ethical requirements of professional practice. Careful exploration of moral principles and theories affords the nurse a broad background and some specific insights into morality and moral decision making. However, even this knowledge does not allow any nurse to put her ethical self "on automatic" while she appeals to one or another of these principles to support what she decides to do. No moral theory or principle is absolute. None can be used exclusively to resolve the many ethical questions nurses face. A nurse must use the process of reflective equilibrium to balance her own moral convictions and her background beliefs with accepted moral theories and principles, in order to reach sound moral judgements.     

The changing division of labour between nurses and nursing assistants in New Brunswick

BACKGROUND: In 1989, the professional nursing organization that represents nurses in New Brunswick adopted baccalaureate entry to practice in nursing. This decision coincided with a major restructuring of provincial health care. Consequently, there has been a reorganization of health care worker roles which affects nurses and nursing assistants. AIM: This paper explores the changing division of labour between nurses and nursing assistants in the province of New Brunswick, Canada. METHODS: The study used archival material, from the period 1978-1990, of three nursing organizations that played a significant role in initiating baccalaureate entry to practice. Interviews with 19 key people involved in the decision to upgrade nurse education were conducted. Data from the archival material and interviews were analysed jointly. FINDINGS: There are ongoing tensions between nurses and nursing assistants. Although nurses would like a support worker, they remain ambiguous about the role of nursing assistants in health care and which tasks should be delegated to this group. Nursing leaders are concerned about the ease with which some patient-related tasks are moved to nursing assistants. In the past, these concerns have led nursing leaders to attempt to limit nursing assistant responsibilities through both legislative means and ways of organizing nursing labour (primary nursing). As a result of health care reforms and baccalaureate entry to practice for nurses, nursing assistant responsibilities are currently expanding. CONCLUSION: Upgrading nurse education, which came into effect in 1996 with the closure of diploma schools in New Brunswick, is likely to entrench the role of nursing assistants in health care because of the economic value of their work during a period of restructuring and rationalization of health care.     

Illuminating the clinical nurse specialist role of advanced practice nursing: a qualitative study

As the advanced practice nursing initiative in Canada gains momentum, effort is being directed towards clarifying and defining advanced practice roles. A qualitative study was undertaken to increase understanding of the clinical nurse specialist role of advanced practice. Sixteen nurses who worked in advanced practice roles, organizing and providing healthcare for children with complex health needs and their families across the continuum of care, participated in in-depth conversations about the nature of their practice, the knowledge that informs it and the factors that influence it. Findings suggest that clinical nurse specialists have a unique role in the organization and delivery of healthcare for specialized populations with complex health needs in their dual focus on the system level of healthcare and on population health needs. Initiatives directed to children and families within the study participants' specialties included program development, consultation and educational outreach and the development of clinical guidelines and policies. Although the nurses described their practice as focusing both on individual children and families and on the population of children and families within their specialty, it is at the population level that they see their greatest potential for contributing to the delivery of high-quality, cost-effective healthcare.     

Nursing work in Jordan: an example of nursing work in the Middle East

Aim. The study aimed to investigate Jordanian nurses’ perceptions of their role in clinical practice. Background. The lack of regulation of nursing practice by the profession across the Middle East until now has led to each institution setting its own policies regarding the role of the nurse and the practice of nursing. No study to date has examined the role of the nurse working in the acute hospital environment nor explored the practice of nursing in this region. Design and methods. A cross‐sectional questionnaire survey was conducted using a quota sample. A total of 348 medical‐surgical staff nurses and practical nurses from the three healthcare sectors in Jordan participated in the study with a response rate of 77%. The results were analysed by constructing multiple response tables, chi‐square test, anova and log‐linear analysis. Results. Staff nurses in Jordan were expected to carry out the majority of nursing care activities. The role of the practical nurse was limited to the physical and professional domains of nursing care. Activities requiring higher levels of emotional or intellectual labour and interdisciplinary communication were attributed only to the staff nurse. The majority of the respondents reported nursing had not been their first choice of career. Male nurses had a higher intention to leave the nursing profession. The predominant method of care delivery used by nurses was task‐oriented. Conclusion. There was a general consensus regarding what constituted the nurse's work in the clinical area across the three healthcare sectors in Jordan. Role delineation between the two levels of nurses was also clear. There is a need to move from task‐oriented to patient‐centred care to promote quality patient care. Relevance to clinical practice. This study explores the role of the nurse working in the acute hospital environment in Jordan.     

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.