In response to the striking health and social inequalities existing across communities within a large Southern Ontario City the McMaster University School of Nursing has partnered with the local family health team, municipal government, and other community partners to evaluate a pilot program designed to enhance health and social outcomes within a specific priority neighbourhood. The innovative pilot program is a nursing-based system navigation role, grounded concurrently in the community and a local Primary Care Practice. The role is uniquely designed as the nurse provides navigation for individuals and families while functioning as a networker to facilitate improved service integration at a systems level. This study serves as a narrative person-centered evaluation of the program, emphasizing the impact on the lives of community members. This study employed the Three-Dimensional Narrative Inquiry Space method as described by Clandinin and Connelly (2000) to explore the experience of nine community residents utilizing navigation services through the Community Nurse Navigator/Networker (CNN). Programs tell a story; therefore, the collection and analysis of participants’ life stories, in conjunction with field notes, observations, and documents, created a common narrative of the experience of navigation in a community setting. A thematic analysis of participants’ life stories was conducted to present a common narrative of community members’ experience of navigation. The major finding of this study was the positive experience residents shared interacting with the CNN. Participants valued the development of a therapeutic relationship through social interactions, the significance of place on the impact of the CNN role, and the effect of the navigation role to address health disparities over time. Study findings have implications for continued development of the CNN role and other community-based nurse navigation roles in priority neighbourhoods to address health inequities. / Thesis / Master of Science in Nursing (MSN)

The Community Nurse Networker (CNN) pilot project represents an innovative collaboration between primary care, public health and municipal stakeholders, including a local neighbourhood resident planning team in a priority neighbourhood in Hamilton, Ontario. This pilot linked primary care to ongoing community development work. The goal of the CNN pilot was to address issues beyond physical health, and to consider issues related to the social determinants of health, or where people, live, work, and play. This developmental evaluation study used a qualitative descriptive approach (Sandelowski, 2000, 2010). Multiple perspectives and sources were used to describe the implementation of the CNN pilot, the following were collected and analyzed: Interviews (N=5), a focus group (participants = 11), documents (N=90), and a survey (N=1). The implementation of the pilot was described by the following foci: (a) conceptualization of the CNN’s roles and activities, (b) perceived barriers and enablers in implementing the CNN pilot, (c) perceived impacts of the intervention, and (d) perceptions surrounding the value of a nurse in the CNN position. The CNN pilot is a unique intervention, demonstrating how primary care can be a leader within the community, engaging with health and social services organizations and hard to reach populations. The findings of this study supported the ongoing development of the CNN position. It provided an example of a nurse-led intervention, with an integrative approach to primary care, community development, social, and health services. This study illustrates the potential for strengthened partnerships between primary care and the community within priority neighbourhoods. / Thesis / Master of Science (MSc)