Primary health care theory to practice: experience of first-year nursing students in Hong Kong

In the past, nursing education in Hong Kong has focused on acute illness care, and institutions providing nursing education have been slow to modify the illness-focused curriculum to a health-based curriculum. The nursing curriculum at the University of Hong Kong is unique in that it focuses on primary health care, and these concepts are introduced in both theory and practice in the first year of the baccalaureate program. In the second semester of the first year, students are required to develop and implement a primary health care project in a community setting. This article outlines the process and outcomes of the experience of 8 first-year nursing students who developed and implemented a primary health care project with older adults in a Hong Kong community. The Generalized Model for Program Development (McKenzie & Smeltzer) was used to guide the students in their practicum activities. The students demonstrated a high degree of competency in relation to health assessment skills; analysis of individual and community needs; development of appropriate health promotion sessions in relation to coronary artery disease, diabetes mellitus, and arthritis; and evaluation strategies to demonstrate effectiveness of the intervention. This experience early in the program provided a strong foundation for the students in primary heath care and grounded their nursing practice in scientific-based evidence.     

A Paradigm for Baccalaureate Public Health Nursing Education

Abstract A national study was conducted to determine what constitutes baccalaureate public health nursing education. The primary focus of this article is the essential concepts in the education of public health nursing. The assumption was that an ideal curriculum represents a knowledge base that is acceptable to members of the profession based on an accepted paradigm. Data were collected using a mailed questionnaire distributed to all National League for Nursing-accredited baccalaureate programs and completed by the person responsible for the public health nursing curriculum. The questionnaire obtained information related to theory and practice objectives. A response rate of 82 percent (N= 275) was obtained after follow-up mailings and telephone calls. Content analysis of responses allowed us to identify 11 concept areas considered essential and receiving great or some emphasis by more than 90 percent of the respondents. There seems to be consensus that the concepts of family-centered care, health maintenance/promotion, community, levels of prevention, holism, continuity of care, epidemiology, self-care, population-based care, and home health care constitute the theoretical base of public health nursing education. These results were compared with results offered by the Consensus Conference report. Public health nursing educators are encouraged to continue to define what constitutes baccalaureate preparation for public health nursing.     

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.     

SARS--a perspective from a school of nursing in Hong Kong

Background. Severe acute respiratory syndrome (SARS) is a new infectious disease with significant morbidity and mortality that has had a major impact on health and health care services worldwide. Hong Kong has had a significant number of cases and deaths. Nurses, at the vanguard of the clinical health care team, have been particularly affected by it. The outbreak prompted the health authorities to implement a series of public health measures and hospital policies, including a guideline for the diagnosis and management of patients with SARS. Aims and objectives. This paper aims at providing an overview of what is known about SARS and the impact it has had in Hong Kong and to highlight from the perspective of a school of nursing the major clinical, educational and public health implications. Conclusions. The lack of understanding and uncertainty about the disease led to significant variation in the provision of information, contributing to the confusion and anxiety in the community. Therefore, there is a need to revise the nursing curriculum, to provide continuing education to all health care professionals, particularly with regard to infection control measures, and to revisit the range of public health policies to ensure the health of the community is protected by these policies. There also has been a reaffirmation of the importance of health promotion that highlights the importance of the partnership between nurses, health policy makers and public health personnel. It is evident that the organization and delivery of clinical practice, teaching and health promotion have to be flexible and responsive to a changing health scenario. Relevance to clinical practice. Nurses must play a crucial role in the prevention, detection and containment of SARS. They will need to implement and ensure strict adherence to infection control measures and, in some circumstances, isolation and quarantine may be warranted. Attention to the psychological state of patients and family members should not be overlooked. Paramount is education of patients, families and members of the public at large.     

Preparation of community health nursing leaders for social action

Indiana University School of Nursing graduate Department of Community Health Nursing has been preparing community health nurses for primary health care practice, as defined by the World Health Organization since 1978. The faculty are committed to preparing community health nursing leaders for social action aimed at improving the health of the community in both the Department's major in the master's programme and its new major in the doctoral programme. The core curricula for these majors in both programmes are presented. The master's curricula is based on integrating public health principles with those of community development. The doctoral major builds on this base of primary health care practice with a curriculum focused on the contribution of community health nursing to public and health policy. The graduates of the master's programme are prepared to work with community groups as a social force in promoting the health of the community. The graduates of the new doctoral major entitled "Health Policy and the Health of the Community" are being prepared as community health nursing leaders with expertise in health care policy and the legislative process with a focus on issues related to nursing and community health. These graduates will be able to function within the broader community, including national and international settings. Based on experiences in graduate education in community health nursing recommendations are made for the response graduate nursing education must make in order to prepare appropriate leaders who can work toward the goal of improving the community's health.     

Partners in care: investigating community nurses’ understanding of an interdisciplinary team‐based approach to primary care

Aim. This study investigated community nurses understanding of teamwork in primary care. Background. Internationally trends indicate a movement towards the development of primary care as a key element in health service delivery. This will have implications for the organisation of community nursing services by creating the need for more coherent integrated structures for service delivery. In this context, teamwork is associated with a range of positive outcomes including higher levels of quality care and job satisfaction. Design. A research study was undertaken to investigate community nurses’ understanding of an interdisciplinary team‐based approach to primary care using a qualitative research design. Focus groups were held with community nurses working in the areas of public health nursing, general nursing and practice nursing. Methods. Three focus groups were established. Twenty seven participants were recruited to form three groups comprising public health nurses (n = 10), general nurses (n = 10) and practice nurses (n = 7). A sequenced‐questioning framework guided the systematic process of data collection. Data analysis engaged a thematic content analysis framework. Results. The analysis of the data revealed the following themes: teamwork, promoting community services, promoting health, professional roles and skills and knowledge for primary care. Conclusion. Nurses can contribute significantly to the re‐orientation and development of primary care services. There must be greater efforts to encourage interdisciplinary approaches. The outcomes of this study can inform strategies for effective team working in primary care. Collective team efforts enhance patient care and effective teamwork requires a greater understanding of group processes and team development. Relevance to clinical practice. Nurses clearly articulated their contribution to primary care, but recognised that there are many challenges to overcome. An enhanced primary care team has the potential to allow the public access to both the individual and collective skills and knowledge of team members.     

Family Nursing Practice in Public Health: Finland and Utah

Abstract This exploratory study of family nursing practice in public health care was conducted in Finland and Utah. Staff nurses were interviewed in focus groups and asked to describe their practice of family nursing, the factors promoting and restraining practice, and the impact of the changes in health care delivery on practice. Thirty-six Finnish and 30 Utah nurses participated. Pressure to do more activities with fewer nurses and resources, changes in family problems, and skill level of the nurses were common themes. However, differences were evident. Finnish public health nurses used emotional support and information to help families empower themselves to use resources and to strengthen their family unit. Utah nurses focused first on individual level goals and then family cohesion and health. Nurseinitiated referrals and direct physical care were the primary intervention strategies of Utah nurses. Unlike the U.S. health care system, access for all in maternal and child health care and school health allowed Finnish nurses to develop long-term relationships with families, thus advancing family nursing practice. This study identifies several potential variables for further study particularly related to the organization of health care and nurse-family relationships.     

Barriers and facilitators to the achievement of community-focused public health nursing practice: a UK perspective

Aim  To explore the extent to which Community Health Nurses (CHN) engage in community-focused public health practice and the facilitators and barriers to such practice.
Background  The government promotes the role of nurses in public health. However, there is confusion as to what constitutes public health; a lack of support to move from individual and family-focused practice to community-focused practice; and, inconsistency of the use of titles.
Method  A 15% quota sample ( n  = 409), drawn from a population of 2668 CHNs, participated in a quantitative survey.
Results  Response rate was 67% ( n  = 275). Over half of CHN time was spent with individuals and families, community level activity accounting for only 18%. Only 9% of respondents had completed a community needs assessment. Education was key to the promotion of community-focused practice with collection of individual activity data a major barrier.
Conclusions  There is a gap between the rhetoric and reality of community public health nursing.
Implications for Nursing Management  Development of a shared vision of public health nursing and commissioning of education to meet public health priorities is essential. Furthermore, strengthening public health nurse leadership to foster innovative practice and methods of measuring public health nursing outcomes is required.     

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.     

Advancing health policy in nursing education through service learning

Knowledge of health policy is an increasingly important aspect of nursing practice and education, especially as nurses strive to improve the rapidly changing health care delivery system. At the same time, many educators, researchers, foundations, and government officials are touting the benefits of service learning. In particular, service learning offers ways to enhance partnerships between academia and community agencies and to extend learning beyond the traditional classroom. We present a model for educating nurses as advanced practice nurses in health policy that links service learning with a framework for the political development of nurses. Under the rubric of service learning, the curriculum is based on the overlap among health policy, the role of the nurse as consultant, and community-based care. After discussing the importance of health policy for graduate nursing education and reviewing the essentials of service learning, we describe a three-semester graduate sequence in health policy service learning. The focus is on the clinical and classroom components of both individual and group practica and their relationship to stages of nursing's political development. The article concludes with evaluation considerations and the implications of our work for nursing theory, research, practice, and education.     

Community Health Clinical Experiences: The Primary Care Setting

Abstract Applying the nursing process to the health of populations is a challenge in undergraduate community health nursing education. We evaluated a method of applying the process in primary health care settings. Key factors were using case management and other means to assess systems from the client's perspective, assessing population needs, diagnosing community needs-service mismatch, planning in partnership with communities, and implementing and evaluating plans. Because these are difficult, if not impossible, to accomplish in a one-semester undergraduate course, students transferred projects and cases from one semester to another. Case management is the principal interface of students to individual and family clients.     

Theory-practice integration in selected clinical situations

The current changes in health care systems challenge knowledgeable, mature and independent practitioners to integrate theoretical content with practice. The aim of this study was to investigate the problems of integrating theory with practice in selected clinical nursing situations. The study focused on rendering of family planning services to clients as a component of Community Nursing Science. Structured observation schedules were used to observe the theoretical content of the curriculum as well as the practical application of what has been taught in the clinical area. The findings of the study revealed that there was a need for an integrated holistic curriculum, which would address the needs of the community. It was concluded that a problem-based and community-based curriculum, intersectoral collaboration between college and hospital managements and student involvement in all processes of teaching and learning would improve the integration of theory and practice. There also appeared to be a need for tutors to be more involved in clinical teaching and accompaniment.     

The effect of cardiovascular health promotion on health behaviors in elementary school children: an integrative review

This report provides on an integrative review of health promotion studies relevant to elementary school children published between 1986 and 1998. The 22 research articles represented several disciplines including public health and nursing. The studies varied in research design, sample characteristics, and approaches to health education. The most common interventions targeted behavioral risk factors for cardiovascular disease, but it also was evident from the literature that family and community involvement both played a significant role in health behaviors of children. Health promotion studies were under-represented in the nursing literature, a gap that creates an impetus to study children and families to identify the ways they learn primary preventive behaviors.     

Nursing practice in community child health: developing the nurse-client relationship

Community nursing services to parents with young children have been an established part of child health services in Australia for more than a century. Although the titles vary within states, community child health nurses provide support services for parents with infants and young children and typically their scope of practice includes public health functions such as health surveillance of the developing infant and child up to the age of 5 years and early intervention. More recently state health policies have instituted universal home visiting and emphasized the primacy of psychosocial support for parents. These policies are accompanied by education programs that propose a change in nursing practice to a more egalitarian partnership model of practice. As a consequence greater attention now has to be paid to the processes used in developing a working relationship with the client in the community setting. Whilst there has been little published in the Australian nursing literature on the methods used by community child health nurses to engage their clients, the international literature offers some insights into the nurses' practice. This paper describes the practices of community child health nurses in engaging the parent and developing a complementary and therapeutic relationship that enables the nurse to promote the health of the child and family. Published accounts of community child health nursing practice in the United Kingdom, Scandinavia and northern America are described and compared to the Australian context.     

Developing an evening clinical experience for baccalaureate community health nursing students

With the ever-changing directions in health care delivery, baccalaureate nursing instructors are being challenged with the task of seeking out innovative approaches to community health nursing clinical experiences. With the focus on "community as client," an evening clinical program was designed and piloted for nontraditional nursing students who, because of daytime employment, were in need of evening courses to further their nursing education. The pilot project incorporated family nursing care, community-centered practice, and observational experiences. The evening community health nursing clinical experience was found to be mutually beneficial to clients and students and served to fill a gap in health teaching within the community.     

Public Health Nurses and the Prevention of and Intervention in Family Violence

Abstract This article seeks to describe the current efforts of public health nurses involved in family violence prevention while on home visits, participating in community groups, working on special projects, and developing innovative policies. Despite a dearth of outcomes research and data regarding public health nursing practice in this area, both strengths and weaknesses in public health nursing practice are evident. Improvements in nursing education related to family violence, an increase in multidisci-plinary collaboration by public health nurses, and improvements in the utilization of public health nurses in the public health infrastructure and in primary prevention efforts would remove many barriers to effective family violence prevention strategies.     

Maximizing an urban secondary and post-secondary partnership to align educational expectations and student success

Students from public urban secondary schools in the United States are often academically underprepared for post-secondary education. There are multiple social and structural factors contributing to this including living in communities where there are high rates of poverty, insufficient funding for public urban schools, and lack of rigor in their curriculum. Urban public post-secondary institutions struggle to bridge the gap to support students who are underprepared and in need of educational, financial, and social assistance. The purpose of this paper is to describe a partnership that was created between a public urban high school and a neighboring public urban university to address the issues underrepresented racially and ethnically (URE) diverse students encounter in order to not only better prepare them for the transition to post-secondary education, but to help them succeed once they arrive on campus. This partnership demonstrates that community cooperation to bridge the gap to support students who are underprepared is possible and benefits everyone involved. Preparing urban students for the successful transition to post-secondary education, particularly in the area of health professions can have a long-term impact on reducing racial inequities in health care.     

What is Good Mental Health Nursing? A Survey of Irish Nurses

The practice, theory, and preparation associated with nursing people with mental health issues has changed in profound ways in recent decades. This has in part been reflected by a shift in nurses identifying as being mental health rather than psychiatric nurses. Context, theory, and values shape what it means to be a mental health nurse. Thirty experienced mental health nurses in Ireland completed a survey on what good mental health nursing is and a definition induced from their responses. Mental health nursing is a professional, client-centered, goal-directed activity based on sound evidence, focused on the growth, development, and recovery of people with complex mental health needs. It involves caring, empathic, insightful, and respectful nurses using interpersonal skills to draw upon and develop the personal resources of individuals and to facilitate change in partnership with the individual and in collaboration with friends, family, and the health care team. This appears to encapsulate the best of what it meant to be a psychiatric nurse, but challenges remain regarding how to reconcile or whether to discard coercive practices incompatible with mental health nursing.     

Lessons learned: integrating a service learning community-based partnership into the curriculum

Auburn University School of Nursing (AUSON) has been in a partnership with the Auburn Housing Authority (AHA), a low-income public housing provider, for several years by providing a weekly nursing care clinic. AUSON was convinced expansion of the clinics would be beneficial to all. This article describes the process and lessons learned in expanding the scope and depth of the partnership and how this service learning experience was integrated throughout the nursing curriculum. Journaling by students revealed that interactions with a different culture over time changed their perceptions. Residents have been empowered to take control of their health. A community partnership takes persistence, perseverance, and consistency. This partnership has been beneficial to residents, students, and faculty. The university's land-grant mission of service and access is demonstrated through a partnership that offers opportunities for students and faculty to address the community's needs.     

Perceptions of public health nursing: views from the field

While there has been considerable debate about future roles for public health nurses, there is little research that explores public health nursing from the practitioner's perspective The findings reported in this paper are part of a larger study that explored public health nurses' perspectives and experiences of their practice what they do and how they feel about what they do Qualitative data were gathered through in-depth individual and focus group interviews with 28 female public health nurses (PHNs) in Alberta, Canada This paper describes how PHNs feel about their work The analysis revealed that public health nurses perceived that their work was valuable and worthwhile, enjoyable, demanding, and not well understood by others These perceptions are discussed in terms of their implications for the future role of public health nursing in a reformed health care system and for the quality of nursing work-life