published_or_final_version / abstract / toc / Nursing Studies / Master / Master of Nursing in Advanced Practice

背景: 公共健康護理在香港的演變可以追溯到二十世紀三十年代，但公共衛生護士的培訓卻自一九五四年才正式開始。由於在此領域工作的護士人數相對比醫院護士少，因而令公共衛生護士的貢獻較不明顯。本研究旨在揭示公共衛生護士於一九五四年至二零一零年期間經歷了文化，社會，經濟和政治的變化後在母嬰健康院的發展。研究目的: 檢視公共健康護理的特點，並對公共健康護理在母嬰健康院的工作和改變進行分析，以確定對公共健康護理在母嬰健康院的發展有重大影響的事件和原因。研究方法: 使用研究歷史的方法，重新審視公共衛生護士的經驗。主要研究數據來源是收集退休公共衛生護士和醫療及護理行政人員的口述歷史。輔助數據來源則包括政府文件，個人筆記，照片和剪報。共有37名受訪者同意接受訪問，其中包括六名行政人員和三十一名退休公共衛生護士，年齡由五十多歲到九十歲。研究員以面對面訪談方法收集口述歷史。並以內容分析法處理所得資料。研究結果: 研究結果描繪公共健康護理有六大特點，包括其分類，護理文化，服務重點，健康教育和健康促進的功能，以及展現出護理的藝術和科學。研究結果表明，文化，社會，經濟，政治因素和社會上的重大事件影響了公共健康護理。其中不明顯和被貶值的公共健康護理服務，醫療優勢和行政影響，公共衛生和公共健康護理的意識形態，作為政府人員和公共健康護士的培訓等專業問題影響了公共衛生護士在香港的地位和護理專業。在這項研究中收集的數據也揭露了香港公共健康護理的發展是密切跟隨公共健康的變化，其發展可分為三個階段:從一九五四年到一九七零年是公共健康護理的演化期一九七零年至一九八零年間是靜態期，而一九九零年至二零一零年則是變化期。研究結論和含義: 公共健康護士需要擴大知識和技能，促進專業自主，推行以實證為基礎的護理並記錄護理成果。歷史研究可以幫助解釋過去和加強理解現狀；而歷史對護理亦提供了重大貢獻。 / Background: The evolution of public health nursing in Hong Kong can be traced back to the 1930s but formal training of public health nurses only commenced in 1954. However, as the number of nurses working in this field was small in comparison with hospital nurses, their practice and contribution is largely unknown. Aim: This study aims to reveal the developments in public health nursing practice in Maternal and Child Health Centres (MCHC) from 1954 to 2010. Objectives of this study include examining the characteristics of public health nursing practice and analysing the changes in public health nursing practice in MCHC, as well as identifying the significant events and factors that influenced its development. Methods: The historical research method was adopted to examine the public health nurses’ experiences. The primary data source was derived from the collected oral histories of retired public health nurses and medical and nursing administrators. The secondary data source was obtained from a review of government documents, personal notes, photographs and newspaper cuttings. In total, thirty-seven informants, including six administrators and thirty-one retired public health nurses were interviewed, ranging in age from late 50s to early 90s. Oral histories were taken from face-to-face interviews with these informants. Content analysis was used to analyse the collected information. Results: The study findings depict six characteristics of public health nursing, including its category, nursing culture, focus of service, health education and health promotion function, and the presentation of art and science in practice. Findings also demonstrate the developments and practice of the public health nursing was influenced by cultural, social, economical and political factors and events. In addition, several important professional issues affect the status and professional identity of public health nurses, among them the invisibility of the service and its devalued status, medical dominance and administrative influence, the ideology of public health and public health nursing in Hong Kong, the impact of working for the government and the preparation of public health nurses. Data collected in this study also disclose how developments in public health nursing in Hong Kong closely followed the changes in public health in which the development can be divided in three phases: the evolution of public health nursing from 1954 to 1970s, the static period from 1970s to 1980s and the period of changes from 1990s to 2010. Implications and Conclusions: Public health nurses are suggested to expand their knowledge and skills to further their autonomy, promote evidence-based practice and document nursing outcomes. The study also demonstrates that historical study can help to interpret the past and enhance understanding of the present. History has much to contribute to nursing. / Detailed summary in vernacular field only. / Foong, Mary. / Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 293-310). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts also in Chinese; appendix H in Chinese. / APPENDICES --- p.xiii / LIST OF TABLES --- p.xiv / LIST OF FIGURES --- p.xv / CHAPTER ONE / INTRODUCTION --- p.1 / Chapter 1.1 --- Aims and objectives of the study --- p.3 / Chapter 1.2 --- Significance of the study --- p.3 / Chapter 1.3 --- Overview of this thesis --- p.4 / CHAPTER TWO / LITERATURE REVIEW --- p.7 / Chapter 2.1 --- Literature search --- p.8 / Chapter 2.2 --- Public health and related terms --- p.9 / Chapter 2.2.1 --- Definition of public health --- p.9 / Chapter 2.2.1.1 --- Characteristics of public health --- p.10 / Chapter 2.2.2 --- Public health in Hong Kong --- p.11 / Chapter 2.2.3 --- Definition of community health --- p.11 / Chapter 2.3 --- Public health nursing and related terms --- p.12 / Chapter 2.3.1 --- Definition and characteristics of public health nursing --- p.12 / Chapter 2.3.2 --- Definition of community health nursing --- p.13 / Chapter 2.3.3 --- Public health nursing versus community health nursing --- p.13 / Chapter 2.3.3.1 --- Differentiation from setting of practice --- p.15 / Chapter 2.3.3.2 --- Differentiation from focus of practice --- p.15 / Chapter 2.3.3.3 --- Differentiation from context --- p.16 / Chapter 2.4 --- Public health nursing and community health nursing in different countries --- p.17 / Chapter 2.4.1 --- Public health nursing and community health nursing in the United States --- p.18 / Chapter 2.4.2 --- Public health nursing and community health nursing in Canada --- p.19 / Chapter 2.4.3 --- Public health nursing and community health nursing in the United Kingdom --- p.19 / Chapter 2.4.4 --- Public health nursing and community health nursing in Asia --- p.20 / Chapter 2.4.5 --- Public health nursing in Hong Kong --- p.23 / Chapter 2.4.6 --- Lesson learned from the differences of public health nursing practice around the world --- p.24 / Chapter 2.5 --- Nursing, history and the history of nursing --- p.25 / Chapter 2.5.1 --- The value of history and nursing history --- p.26 / Chapter 2.5.2 --- The general value of history --- p.26 / Chapter 2.5.3 --- The general value of nursing history --- p.27 / Chapter 2.5.4 --- The value of studying nursing history --- p.27 / Chapter 2.5.5 --- The value of nursing history as suggested by scholars --- p.28 / Chapter 2.5.6 --- The tools to study history --- p.29 / Chapter 2.5.6.1 --- The use of historical research to study history --- p.30 / Chapter 2.5.6.2 --- Standard of historical research --- p.31 / Chapter 2.6 --- Literature review and critique of the previous historical studies --- p.32 / Chapter 2.6.1 --- Summary of the review --- p.45 / Chapter 2.7 --- Conclusion of this chapter --- p.48 / CHAPTER THREE / METHODOLOGY --- p.50 / Chapter 3.1 --- Rationale of selecting a qualitative research method --- p.50 / Chapter 3.2 --- The choice of qualitative method historical research --- p.51 / Chapter 3.3 --- The importance of primary and secondary data sources --- p.52 / Chapter 3.4 --- The relevancy of adopting oral history as the main research strategy and its issues --- p.52 / Chapter 3.4.1 --- An overview of oral history --- p.53 / Chapter 3.4.2 --- Definitions on oral history --- p.53 / Chapter 3.4.3 --- Virtues of oral history --- p.54 / Chapter 3.4.4 --- Issues related to oral history --- p.55 / Chapter 3.4.5 --- Differences between oral history and other qualitative studies --- p.58 / Chapter 3.5 --- Secondary data sources --- p.59 / Chapter 3.6 --- Research procedures --- p.61 / Chapter 3.6.1 --- Ethical consideration and ethical review --- p.61 / Chapter 3.6.2 --- Informed consent --- p.61 / Chapter 3.6.3 --- Sampling method --- p.62 / Chapter 3.6.3.1 --- The use of purposive sampling in qualitative research --- p.63 / Chapter 3.6.3.2 --- The determination of sample size and sample units --- p.63 / Chapter 3.6.3.3 --- Selection of participants --- p.65 / Chapter 3.6.3.3.1 --- Consideration of choosing the retired participants. --- p.66 / Chapter 3.6.3.4 --- Recruitment of participants --- p.66 / Chapter 3.6.3.4.1 --- The sampling process --- p.67 / Chapter 3.6.4 --- Data collection method --- p.67 / Chapter 3.6.4.1 --- Collection of primary data --- p.67 / Chapter 3.6.4.1.1 --- Sequence of interview --- p.68 / Chapter 3.6.4.1.2 --- Setting for interview --- p.68 / Chapter 3.6.4.1.3 --- The process of collecting oral histories --- p.69 / Chapter 3.6.4.1.4 --- Strategies for avoiding personal bias --- p.72 / Chapter 3.6.4.2 --- Collection of secondary data --- p.72 / Chapter 3.6.4.3 --- Data handling and record keeping --- p.73 / Chapter 3.6.4.3.1 --- Handling of primary data --- p.74 / Chapter 3.6.4.3.2 --- Handling of secondary data --- p.74 / Chapter 3.6.5 --- Data analysis --- p.75 / Chapter 3.6.5.1 --- The adoption of content analysis --- p.75 / Chapter 3.6.5.2 --- Process of content analysis --- p.76 / Chapter 3.6.5.2.1 --- Analysis of the primary data --- p.76 / Chapter 3.6.5.2.2 --- Analysis of secondary data --- p.78 / Chapter 3.6.5.2.3 --- Linking the primary and secondary data --- p.79 / Chapter 3.7 --- Rigour of the study --- p.80 / Chapter 3.7.1 --- Quality issues related to qualitative research --- p.80 / Chapter 3.7.2 --- Strategies to enhance the rigour of the study --- p.81 / Chapter 3.7.2.1 --- Strategies applied to ensure credibility --- p.82 / Chapter 3.7.2.2 --- Strategies applied to ensure confirmability --- p.83 / Chapter 3.7.2.3 --- Strategies applied to ensure dependability --- p.84 / Chapter 3.7.2.4 --- Strategies applied to ensure transferability --- p.85 / Chapter 3.8 --- The pilot study --- p.85 / Chapter 3.9 --- Conclusion of this chapter --- p.87 / CHAPTER FOUR / FINDINGS --- p.89 / Chapter 4.1 --- Framework of data handling and presentation --- p.90 / Chapter 4.2 --- Characteristics of the participants --- p.93 / Chapter 4.3 --- The evolution of public health nurses - 1950s --- p.96 / Chapter 4.3.1 --- Data collected from secondary data source --- p.97 / Chapter 4.3.1.1 --- Significant events in the community --- p.97 / Chapter 4.3.1.2 --- The MCHC service --- p.97 / Chapter 4.3.1.3 --- The public health nurses --- p.98 / Chapter 4.3.2 --- Oral histories from the public health nurses --- p.102 / Chapter 4.3.2.1 --- Training of public health nurses --- p.103 / Chapter 4.3.2.1.1 --- Scope of training --- p.103 / Chapter 4.3.2.2 --- Selection of the public health field --- p.105 / Chapter 4.3.2.3 --- Perception of public health nursing duties --- p.106 / Chapter 4.3.2.4 --- Public health nursing practice in IWC --- p.108 / Chapter 4.3.2.5 --- Identifying factors which influenced public health nursing development --- p.112 / Chapter 4.3.2.6 --- Qualities of good public health nurses --- p.114 / Chapter 4.4 --- Challenges from socio-cultural and economical influences 1960 -1969 --- p.114 / Chapter 4.4.1 --- Data collected from secondary data source --- p.114 / Chapter 4.4.1.1 --- Significant events in the community --- p.116 / Chapter 4.4.1.2 --- The MCHC service --- p.117 / Chapter 4.4.1.3 --- The public health nurses --- p.118 / Chapter 4.4.2 --- Oral histories from the public health nurses --- p.119 / Chapter 4.4.2.1 --- Training of public health nurses --- p.119 / Chapter 4.4.2.1.1 --- Scope of training --- p.120 / Chapter 4.4.2.2 --- Selection of the public health field --- p.121 / Chapter 4.4.2.3 --- Perception of public health nursing duties --- p.121 / Chapter 4.4.2.4 --- Public health nursing practice in MCHC --- p.122 / Chapter 4.4.2.5 --- Identifying factors which influenced public health nursing development --- p.125 / Chapter 4.4.2.6 --- Qualities of good public health nurses --- p.129 / Chapter 4.5 --- The increasingly affluent period 1970 -1979 --- p.130 / Chapter 4.5.1 --- Data collected from secondary data source --- p.130 / Chapter 4.5.1.1 --- Significant events in the community --- p.132 / Chapter 4.5.1.2 --- The MCHC service --- p.133 / Chapter 4.5.1.3 --- The public health nurses --- p.134 / Chapter 4.5.2 --- Oral histories from the public health nurses --- p.134 / Chapter 4.5.2.1 --- Training of public health nurses --- p.135 / Chapter 4.5.2.1.1 --- Scope of training --- p.135 / Chapter 4.5.2.2 --- Selection of the public health field --- p.136 / Chapter 4.5.2.3 --- Perception of public health nursing duties --- p.136 / Chapter 4.5.2.4 --- Public health nursing practice in MCHC --- p.139 / Chapter 4.5.2.4.1 --- Health education activities --- p.139 / Chapter 4.5.2.4.2 --- Home visiting --- p.140 / Chapter 4.5.2.4.3 --- Serving clients with different backgrounds --- p.141 / Chapter 4.5.2.5 --- Identifying factors which influenced public health nursing development --- p.145 / Chapter 4.5.2.6 --- Qualities of good public health nurses --- p.145 / Chapter 4.6 --- The impact of the political scenes 1980 1989 --- p.147 / Chapter 4.6.1 --- Data collected from secondary data source --- p.147 / Chapter 4.6.1.1 --- Significant events in the community --- p.147 / Chapter 4.6.1.2 --- The MCHC service --- p.148 / Chapter 4.6.1.3 --- The public health nurses --- p.149 / Chapter 4.6.2 --- Oral histories from the public health nurses --- p.150 / Chapter 4.6.2.1 --- Training of public health nurses --- p.150 / Chapter 4.6.2.1.1 --- Scope of training --- p.151 / Chapter 4.6.2.2 --- Selection of the public health field --- p.152 / Chapter 4.6.2.3 --- Perception of public health nursing duties --- p.153 / Chapter 4.6.2.4 --- Public health nursing practice in MCHC --- p.154 / Chapter 4.6.2.5 --- Identifying factors which influenced public health nursing development --- p.156 / Chapter 4.6.2.5.1 --- Factors not influencing public health nursing --- p.156 / Chapter 4.6.2.5.2 --- Factors influencing public health nursing --- p.157 / Chapter 4.6.2.6 --- Qualities of good public health nurses --- p.161 / Chapter 4.7 --- 1990- 1999 Before and after the new era; the transition of political parties --- p.162 / Chapter 4.7.1 --- Data collected from secondary data source --- p.162 / Chapter 4.7.1.1 --- Significant events in the community --- p.162 / Chapter 4.7.1.2 --- The MCHC Service --- p.164 / Chapter 4.7.1.3 --- The public health nurses --- p.164 / Chapter 4.7.2 --- Oral histories from the public health nurses --- p.166 / Chapter 4.7.2.1 --- Training of public health nurses --- p.166 / Chapter 4.7.2.1.1 --- Scope of training --- p.167 / Chapter 4.7.2.2 --- Selection of the public health field --- p.168 / Chapter 4.7.2.3 --- Perception of public health nursing duties --- p.170 / Chapter 4.7.2.4 --- Public health nursing practice in MCHC --- p.172 / Chapter 4.7.2.4.1 --- Health education activities --- p.172 / Chapter 4.7.2.4.2 --- Home visiting --- p.173 / Chapter 4.7.2.4.3 --- Serving clients with different backgrounds --- p.175 / Chapter 4.7.2.4.4 --- Child developmental screening service --- p.176 / Chapter 4.7.2.4.5 --- Trail of various service delivery approaches --- p.177 / Chapter 4.7.2.5 --- Identifying factors which influenced public health nursing development --- p.178 / Chapter 4.7.2.5.1 --- Factors not influencing public health nursing --- p.178 / Chapter 4.7.2.5.2 --- Factors influencing public health nursing --- p.179 / Chapter 4.7.2.6 --- Qualities of good public health nurses --- p.184 / Chapter 4.8 --- Years of change after 2000 --- p.185 / Chapter 4.8.1 --- Data collected from secondary data source --- p.185 / Chapter 4.8.1.1 --- Significant events in the community --- p.185 / Chapter 4.8.1.2 --- The MCHC service --- p.188 / Chapter 4.8.1.3 --- The public health nurses --- p.190 / Chapter 4.8.2 --- Oral histories from the public health nurses --- p.193 / Chapter 4.8.2.1 --- Training of public health nurses --- p.193 / Chapter 4.8.2.1.1 --- Scope of training --- p.194 / Chapter 4.8.2.2 --- Selection of the public health field --- p.194 / Chapter 4.8.2.3 --- Perception of public health nursing duties --- p.195 / Chapter 4.8.2.4 --- Public health nursing practice in MCHC --- p.196 / Chapter 4.8.2.5 --- Identifying factors which influenced public health nursing development --- p.198 / Chapter 4.8.2.5.1 --- Factors not influencing public health nursing --- p.198 / Chapter 4.8.2.5.2 --- Factors influencing public health nursing --- p.199 / Chapter 4.8.2.6 --- Qualities of good public health nurses --- p.206 / Chapter 4.9 --- Oral histories from the administrators --- p.207 / Chapter 4.9.1 --- Training of public health nurses --- p.207 / Chapter 4.9.1.1 --- Scope of training --- p.209 / Chapter 4.9.1.2 --- Perception of public health nursing duties --- p.211 / Chapter 4.9.1.3 --- Public health nursing practice in MCHC --- p.213 / Chapter 4.9.1.4 --- Identifying factors which influenced public health nursing development --- p.216 / Chapter 4.9.1.5 --- Qualities of good public health nurses --- p.221 / Chapter 4.10 --- Conclusion of this chapter --- p.222 / CHAPTER FIVE / DISCUSSION --- p.225 / Chapter 5.1 --- A sketch of the working life of public health nurses --- p.225 / Chapter 5.2 --- The three research objectives --- p.227 / Chapter 5.2.1 --- Research objective one: The characteristics of public health nursing in Hong Kong --- p.229 / Chapter 5.2.1.1 --- Categories of public health nurses in Hong Kong --- p.229 / Chapter 5.2.1.1.1 --- Public health nurse title as defined by organisation --- p.229 / Chapter 5.2.1.1.2 --- Public health nurse title as defined from training --- p.231 / Chapter 5.2.1.1.3 --- Ranking of public health nurses --- p.232 / Chapter 5.2.1.2 --- Nursing culture --- p.233 / Chapter 5.2.1.3 --- Population-focused service in MCHC --- p.234 / Chapter 5.2.1.4 --- Nursing practice on health education, health promotion and direct care --- p.237 / Chapter 5.2.1.5 --- The invisible service --- p.238 / Chapter 5.2.1.6 --- The presentation of art and science in public health nursing --- p.239 / Chapter 5.2.2 --- Research objectives two: the changes of public health nursing practice during the study period --- p.241 / Chapter 5.2.2.1 --- The delineation of the development of public health nursing practice in MCHC from 1954 to 2010 --- p.241 / Chapter 5.2.2.1.1 --- The first phase of development: 1954 to the 1970s and the evolution of public health nurses --- p.242 / Chapter 5.2.2.1.2 --- The second phase of development: 1970s to 1980s a static period in the public health nursing service --- p.243 / Chapter 5.2.2.1.3 --- The third phase of development: 1990s to 2010s a period of changes --- p.244 / Chapter 5.2.2.2 --- Predominant features in the development --- p.246 / Chapter 5.2.2.2.1 --- Perceived decrease of autonomy --- p.246 / Chapter 5.2.2.2.2 --- Generational differences among nurses influence job satisfaction --- p.247 / Chapter 5.2.2.2.3 --- The cessation of home visits --- p.248 / Chapter 5.2.3 --- Research objective three: significant events and factors influencing public health nursing development --- p.250 / Chapter 5.2.3.1 --- The influence of significant events happened in the community --- p.251 / Chapter 5.2.3.2 --- Devaluation of the service and the invisibility of the practice --- p.254 / Chapter 5.2.3.3 --- Medical dominance, administrative influences and manpower factors --- p.257 / Chapter 5.2.3.4 --- Impact of working for a government organisation --- p.260 / Chapter 5.2.3.5 --- The ideology of public health and public health nurses in Hong Kong --- p.262 / Chapter 5.2.3.6 --- The good practice model initiated by the earlier public health nurses --- p.265 / Chapter 5.2.3.7 --- Training of public health nurses --- p.267 / Chapter 5.3 --- History, historical research and nursing --- p.271 / Chapter 5.4 --- Conclusion of this chapter --- p.276 / CHAPTER SIX / CONCLUSIONS --- p.278 / Chapter 6.1 --- Strengths of the study --- p.278 / Chapter 6.2 --- Limitations of the study --- p.279 / Chapter 6.2.1 --- Shortcomings of historical research --- p.280 / Chapter 6.2.2 --- Threats to internal and external criticism --- p.280 / Chapter 6.3 --- Implications for nursing research, practice and education --- p.282 / Chapter 6.3.1 --- Research --- p.282 / Chapter 6.3.1.1 --- Methodology --- p.282 / Chapter 6.3.1.2 --- Further research questions and new interpretations on history --- p.284 / Chapter 6.3.2 --- Education --- p.287 / Chapter 6.3.2.1 --- Content of nursing curricula related to nursing history --- p.287 / Chapter 6.3.2.2 --- Teaching historical research methodology --- p.288 / Chapter 6.3.2.3 --- Strengthen training on public health nursing --- p.288 / Chapter 6.3.3 --- Practice --- p.289 / Chapter 6.4 --- Conclusion of this chapter --- p.291 / REFERENCES --- p.293

Fong, Hildy Felicia. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 221-234). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract and appendix also in Chinese.