A replication of Reilly's study (1980) was conducted in order to describe the attitudes of community health nurses who work with parents and children toward child abusers; to determine the relationship between the attitudes of the community health nurses and selected social and professional variables; to compare the attitudes of these nurses to the attitudes of the registered nurses studied by Reilly (1980); to compare the attitudes of the community health nurses in the randomly selected group with the attitudes of the community health nurses in the convenience group; and last, to describe the data presented by the community health nurses in regard to their experiences with child abuse. The population consisted of community health nurses. One sample population of one hundred and fifty-seven subjects was randomly selected from the community health nurses employed by the British Columbia Ministry of Health. A second sample population of fifteen subjects was self-selected from the community health nurses employed in two of the Health Units of Metropolitan Health Services of Greater Vancouver. The attitudes of the community health nurses toward child abusers were measured by a Likert-type Attitudinal Instrument developed by Reilly (1980). Information regarding the selected social and professional variables was obtained by a biographical data sheet also developed by Reilly (1980). Data regarding the community health nurses' experiences with child abuse were collected by open-ended questions. The correlated data from the attitude scores and the background data sheet were analyzed through the process of inferential analysis and descriptive statistics. Data regarding the subjects' experiences with child abuse were summarized by the process of content analysis and descriptive statistics. The results of the study revealed that the community health nurses' attitudes toward child abusers were more favorable than unfavorable. This finding substantiated Reilly's (1980) finding regarding registered nurses' attitudes toward child abusers. In addition, it was shown that the variable, whether the subjects have seen an abused child, significantly affected the attitude scores of the community health nurses in the randomly selected group. The study did not support Reilly's (1980) findings that the subjects' present level of education and whether the subjects have met an abusing parent or detected a case of child abuse significantly affected the attitude scores. The study also found that community health nurses experience a multitude of frustrations in the management of child abuse. In addition, it was found that a significant percentage of the nurses expressed a need for further instruction regarding the treatment of child abuse. / Applied Science, Faculty of / Nursing, School of / Graduate

Many communities across the United States, including those from low-income and racial and ethnic minority groups, have less access to quality, timely, and preventative primary healthcare services. One factor contributing to this disparity is the shortage of primary care providers to meet demands in underserved areas. Nurse practitioners (NPs), or advanced-practice registered nurses trained to diagnose, treat, and manage health conditions, are a solution to meeting the nation’s primary care needs. Over the past decade, the NP workforce has grown significantly, doubling its number between 2010 and 2017. NPs frequently care for individuals from medically underserved communities, including those receiving care in community health centers (CHCs). CHCs are a network of safety-net healthcare organizations delivering comprehensive primary care in many rural and inner-city areas. However, the NP workforce can be further optimized in CHCs. Despite the growing national NP supply, CHCs struggle with adequate NP staffing. Furthermore, providers working in CHCs and other safety-net settings report insufficient resources to care for patients, high workloads, and elevated staff turnover; these challenges may create poor practice environment and predispose CHC NPs to poor workforce outcomes, such as burnout and job dissatisfaction.Literature has demonstrated that poor clinician workforce outcomes, particularly burnout, negatively affect the safety and quality of care patients receive. Poor care and disease management may also result in disease exacerbation and, subsequently, preventable healthcare use by patients such as emergency department visits and hospital admissions. Preventable healthcare use increases the nation’s healthcare costs and may expose patients to harm. Despite the contributions of NPs to CHCs, little is known about how to optimize their staffing and workforce outcomes (e.g., reducing burnout, turnover intention, and improving job satisfaction) to assure positive patient outcomes. The overall purpose of this dissertation is to understand ways to optimize the NP workforce in CHCs to potentially improve outcomes for CHC patients. Specific aims include: 1) examining factors that influence the recruitment and retention of NPs in underserved areas; 2) assessing the practice environment and workforce outcomes of NPs in CHCs; and 3) understanding the consequences of NP burnout on CHC patient outcomes. Dissertation Chapters and Findings The first chapter of this dissertation summarizes the background on the NP workforce and CHCs and details the problem under investigation. The second chapter is a scoping review examining the factors influencing recruitment and retention of NPs in underserved areas. Factors influencing recruitment and retention of NPs in underserved areas exist at various levels, from individual (e.g., growing up in underserved areas) to policy factors (e.g., autonomous scope of practice). However, current literature lacks rigorous, up-to-date, and NP-focused studies. The third chapter is a cross-sectional analysis of survey data from 269 CHC NPs. This chapter assessed the practice environment, job satisfaction, burnout, and turnover intention of NPs working in CHCs to better understand the current workforce conditions of CHC NPs; this chapter also examined the relationship between CHC NPs’ practice environment and workforce outcomes. CHC NPs reported generally favorable practice environment and high job satisfaction. When CHC NPs report good relationships with their administration, they are more likely to report higher job satisfaction and lower intention to leave their jobs. The fourth chapter aimed to understand the implications of a negative workforce outcome (i.e., burnout) in the CHC setting. Through a cross-sectional analysis of merged NP survey and Medicare claims data, we examined the relationship between NP burnout and preventable hospitalization and emergency department use in patients. Patients receiving care in CHCs with higher NP burnout are more likely to use the emergency department for preventable reasons. The fifth and last chapter discusses the findings of this dissertation and its implications for policy, research, and practice.

Since Hurricane Mitch there have been many humanitarian efforts to provide health care to the poor and needy of Honduras. Unfortunately there is little information available regarding the specific health needs in this country. The purpose of this project was to analyze data collected during a recent mission trip to Honduras for trends in health symptoms, diagnoses and health care practices to assist in the planning of future trips. Health Intake forms were created by Drs. Holcomb and Crigger and were filled out by 500 patients at the time of their visit to both rural and urban clinics. The forms included information on the patient's health history, current symptoms, diagnosis and treatment as well as their health habits and living conditions that might affect their health. Descriptive statistics revealed the clinic population to be primarily women and children. The most common presenting symptoms were gastrointestinal, non specific (i.e. fever, malaise . .. ) and pulmonary. Common diagnoses included intestinal parasites, arthritis and upper respiratory infections. The most frequently prescribed medications were over the counter medications (i.e. vitamins, and Tylenol) as well as antibiotics. Chi-square analysis revealed few differences between the urban and rural populations. It was discovered that many of the population continue to drink unpurified tap water, which may contribute to their gastrointestinal complaints and the frequent occurrence of intestinal parasites.

The World Health Organization (WHO) in 1979 declared a global goal of, "Health for all by the year 2000." Lesser-developed countries, including Honduras, struggle to meet the most basic health needs of their people. Problems of meeting health care needs in Honduras include uneven distribution of health services, inadequate numbers of trained health care workers, and lack or awareness of those in need of healthcare. Natural disasters such as Hurricane Mitch, which struck Honduras in November of 1998, have exacerbated the problems. The purpose of this educational project was to develop, implement, and evaluate an educational program taught by nurses to lay community health care workers in Tegucigalpa, Honduras. These lay health workers will be called 'Community Health Promotores' (CHP) The CHPs will voluntarily work with their neighbors to improve health promotion, increase self care abilities for minor health problems, monitor growth in children and identify serious health problems for referral to their nurse of physician supervisor. The CHP will assist to improve the self-care abilities of community members and finding those in need of health care. An instructional manual includes information on nutrition, hand-washing, first aide, disease states (hypertension, diabetes, heart disease, diarrhea, problems common in pregnancy and childhood, mental health), and skills in measuring blood pressure, temperature, pulse and respiration. Teaching strategies used in this project and pre and post course evaluation are discussed. The initial class was offered in March 1999. Eleven students completed the course and are volunteering in their communities.

No / By 2014 the NHS is expected to make �21 billion in efficiency savings and increase productivity by 6% per annum, while maintaining or improving the quality of care. Given that the cost of the 1.7 million strong workforce represents 60% of the NHS budget, changes are likely. This context of innovation and cost-effectiveness has resulted in an ever greater emphasis to fully engage and support community nursing.

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

Thesis (M.S.)--Yale. / "This study was supported in full by United States Public Health Service Grant 2T1 MH-7903." "Publication number 21-1386." Bibliography: p. 81-82.

Thesis (M.S.)--Yale. / "This study was supported in full by United States Public Health Service Grant 2T1 MH-7903." "Publication number 21-1386." Bibliography: p. 81-82.

M.Cur. / The purpose of the research study was to describe guidelines to improve the community health clinics as a learning context conducive to learning. The objectives of the study commenced by getting the perception of student nurses, community sisters and college tutors, to explore and describe the problems experienced in relation to community health clinics as a learning context for student nurses, especially when they are allocated for their clinical practicals to prepare them to become competent. The research design and method used, consisted of a qualitative approach to achieve the intended goal of the research study. The design was divided into two phases: Phase one consisted of a field/empirical study and phase two consisted of conceptualization. Phase one has three steps where each step indicates the research method, population and sampling, data collection and data analysis. Population and sampling for step I included all the fourth year students from a nursing college in Gauteng, who are in an educational programme leading to registration as a nurse (general, psychiatric and community) and midwife. Population and sampling for step II consisted of community sisters from ten community health clinics in the Southern Metropolitan Local Council. Population and sampling for step III consisted of community college tutors from a college in Gauteng; the sample size consisted of the whole population. In all the steps follow-up interviews were conducted to confirm the findings. To ensure trustworthiness Lincoln and Guba's (1985) model was implemented, and data analysis were according to Tesch's (1990 in Creswell, 1994:155) method, based on a qualitative approach. The major problems reflected in the research findings based on Step I, II, II indicate similarities and Step III only indicates some uniqueness. The conceptual framework was discussed, indicating a body of knowledge, based on the study and empirical findings from phase I, to give clear meaning and understanding regarding the research study. Problems from all the steps were used in an integrated manner as research findings and were compared with existing literature within the framework, to determine similarities and differences as literature control method. Guidelines were then formulated from phases I and II, to solve the indicated problems, based on the three different sample groups. Guidelines were supported by the conclusion statement from chapter four and the problem statement from chapter three. Essential actions were indicated for operationalisation. Ethical consideration was maintained throughout the research study. The study has been evaluated by means of positive and negative issues related to the actual research process. Recommendations related to nursing education, nursing practice and nursing research were indicated accordingly.

An exploratory, qualitative research design was used to explore the role, attitude, views and competence of the community nurse to integrate children with disabilities into the community of the Mafikeng district, in the North West Province. Barriers to the integration of children with disabilities into the community as well as strategies to address these barriers were identified. Focus group discussions were conducted to collect data from the community nurses and parents of children with disabilities. Interviews were also conducted to collect data from the clinic health managers. The findings of this study reveal that the community nurse is instrumental in integrating children with disabilities into the community. However, barriers related to the family, community and health system are challenges to the integration process. The recommendations of this study deal with addressing these barriers. / Health Studies / M. A. (Health Studies)