Mothers with mental illness are in need of support as they struggle to cope with competing demands of their illness and those of parenting. Health professionals’ attitudes and experiences have been shown to affect how clients with mental illness are assessed and what resources are provided. The purpose of this research was to explore and describe experiences of Public Health Nurses (PHNs) in Manitoba who visited families in the postpartum period. Qualitative data were collected via focus groups consisting of PHNs within the city of Winnipeg. Emerging themes, “Dealing with where they’re at”; “Treasure hunting”; “I kept wanting more”; “You can only do so much” together aimed at a common theme, “Helping Moms succeed”. Results suggested that PHNs wanted to provide the best resources for mothers to succeed at parenting. PHNs provided recommendations for the needs of families and changes in practice to help improve service to families.

Mothers with mental illness are in need of support as they struggle to cope with competing demands of their illness and those of parenting. Health professionals’ attitudes and experiences have been shown to affect how clients with mental illness are assessed and what resources are provided. The purpose of this research was to explore and describe experiences of Public Health Nurses (PHNs) in Manitoba who visited families in the postpartum period. Qualitative data were collected via focus groups consisting of PHNs within the city of Winnipeg. Emerging themes, “Dealing with where they’re at”; “Treasure hunting”; “I kept wanting more”; “You can only do so much” together aimed at a common theme, “Helping Moms succeed”. Results suggested that PHNs wanted to provide the best resources for mothers to succeed at parenting. PHNs provided recommendations for the needs of families and changes in practice to help improve service to families.

A public health workforce must be trained to react quickly, especially in the case of terrorist attack. Political leaders and emergency management experts have often cited inadequate emergency training as a contributing factor in the public health system's failed preparations for a bioterrorist event. As a result of these failures, billions of dollars have been allocated towards correcting infrastructure deficiencies including training for public health nurses (PHNs), who are critical to a communitywide medical response. This quantitative study used Pearson's correlation and a multivariate regression analysis to evaluate the most effective modality of bioterrorism training (BTT) for PHNs working in rural communities in North Carolina. Using a conceptual framework created by Handler, Issel, and Turnock, this study compared 3 modalities of instruction (MOI) to seek the best predictor of success in retaining learned bioterrorism skills. The research question focused on whether MOI for BTT/all-hazards training courses significantly predicted the degree of retention of emergency knowledge/skills for PHNs working in public health agencies in North Carolina. A multiple choice survey was used to test 103 PHNs' level of knowledge retention on a bioterrorism quiz. The results of this study were ultimately inconclusive in that no MOI was found to be a statistically significant predictor of retention. Factors such as age were found to be successful predictors of knowledge retention. The readiness issues identified in this study have a potential for positive social change if community decision makers use this information to prioritize future funding for public health professionals or enhance communitywide emergency preparedness education programs.

ADHD is one of the most common behavioral disorders diagnosed in children. These children have difficulties regarding the regulation of emotions, maintaining attention and impulse control, all of which influence family and social life. The aim of this study was to describe and explore the everyday life of families with a child with ADHD and public health nurses’ role in relation to these families. The parents were contending with- and adapting to the parental role and social network. The family attempted to safeguard a functioning family in managing their everyday life, tuning themselves in on the child’s shifting moods, using strict boundaries and developing special skills. The family fought for acceptance and inclusion when interacting with their social network and professionals. Parents with ADHD and families with non-medicated children reported more problems in family functioning. Characteristics in parents and the child with ADHD, as well as support from the social network and community health services, all influenced family functioning. The PHNs described their role as both a peripheral and collaborating partner, asking for guidelines and multidisciplinary collaboration. The public health nurse is in a unique position to support and supervise these families. / Aim: The overall aim of this thesis was to describe and explore everyday life in families with a child with ADHD and public health nurses’ role in relation to these families. Methods: An explorative and descriptive design with qualitative and quantitative methods was used. In Study I, data was collected with individual interviews with nine parents, and analyzed using phenomenology. In Study II, the data was collected with individual interviews with 17 family members, and analyzed with phenomenography. In Study III, data was collected with a questionnaire responded by 265 parents, and analyzed with statistics. In Study IV, data was collected with group- and individual interviews with 19 public health nurses, and analyzed with phenomenography.                                                                                                  Main findings: The families’ everyday life was influenced by living in unpredictability, though they were striving for predictability. The experience of being a parent was described as contending and adapting every day, like windsurfing in unpredictable waters (I). The family tried to safeguard a functioning family in managing their everyday life and developing special skills, within the family and the society. They fought for acceptance and inclusion in relation to the social network and professionals (II). Parents’ sense of coherence, children’s behavior, support from social networks and community health services had all an impact on family functioning (III). The PHNs described their role as both a peripheral and a collaborating partner and they asked for guidelines and multidisciplinary collaboration (IV). Conclusions: Everyday life in families with ADHD is both demanding and giving. Acceptance and support from the social network and supervision from the professionals are essential. The public health nurse is in a unique position to support and supervise these families.

Community health nurses, like all other health professionals, are being called to develop new clinical practices based on collaboration and are faced with the demands of working both interprofessionally and interorganizationally (D’Amour et al., 2008). In Capital Health, public health nurses (PHNs), family practice nurses (FPNs) and nurse practitioners (NPs) are all working in different aspects of breastfeeding support and promotion. However, there is no formal structure for collaboration of services, despite the strong desire of these nurses to work together to improve breastfeeding outcomes. The purpose of this study was to explore the roles of PHNs, FPNs and NPs who work in breastfeeding support and promotion in Capital Health and the structures and processes needed to support the development of collaboration amongst these groups of nurses. Through the analysis of semi-structured focus group interviews and follow-up focus group interviews with a purposeful sample (n=10) of four PHNs, four FPNs and two NPs, four major themes and sub themes were identified that represented the nurses experience with collaboration between public health and primary care in breastfeeding support and promotion. The data generated revealed that participants had not experienced active collaboration, rather developing or potential collaboration (D’Amour et al., 2008). The first theme, Establishing Interpersonal Relationships, provided an overview of the precipitators and barriers to forming relationships and the outcomes of interpersonal relationships between public health and primary care nurses. The second major theme, The Organizational Context: Structures and Processes in the Everyday Work Environment outlines the impact of the organizational context of the nurses work environment on the development of collaboration. Benefits of Collaboration was the third theme identified in the study. Consistent with other studies on collaboration between primary care and public health nurses, the nurses interviewed believed that the development of collaboration in breastfeeding support and promotion would benefit health care professionals and the clients that they serviced. The last theme, Development of New Practices Grounded in Collaboration, described new initiatives or innovations that the participants explained were needed for the development of collaboration between PHNs, FPNs and NPs. Implications for practice include organizational support for PHNs, FPNs and NPs to work to the full scope of their competencies and providing them with opportunities to meet and establish relationships to facilitate joint planning initiatives related to breastfeeding support and promotion. Additionally, exploration of flexible roles and funding structures as alternatives to fee-for-service should be explored in primary care organizations. The development of a communication infrastructure is necessary for future development of collaboration between public health and primary care in breastfeeding support and promotion. Future research is needed in this area with a broader, more diverse sample, exploring organizational structures needed to improve breastfeeding outcomes and optimize FPN and NP roles. PHNs, FPNs and NPs have the opportunity to impact the model of care for breastfeeding families in the Capital Health District of Nova Scotia, optimizing their capacity to address issues in practice and ensuring that breastfeeding support and promotion activities address the complex social factors that influence the breastfeeding experience.

Aim: The overall aim of this thesis was to study mental distress, health and lifestyle habits, social factors and psychotropic drug use by young people, and how PHNs conceive their roles in relation to this. Methods: Quantitative and qualitative methods were used. Study I included data  from the Norwegian Youth Health Study (NYHS, 11 620 participants, aged 15-16 years) (2000–2003) linked to the Norwegian Prescription Database (NorPD) (2004–2009). Study II included prescription data on psychotropic drugs among 15-16 year olds from the NorPD (2006–2010). Eight young people were interviewed and qualitative content analysis was used to analyse the data (III). Study IV included interviews with 20 Public Health Nurses (PHN), and was analysed using a phenomenographic approach. Main results: Mental distress was reported among 15.5% of the adolescents non-users of psychotropic drugs, 75% of whom were girls. In both genders reporting mental distress, incident psychotropic use was higher one to nine years, up to 27.7% among girls, as compared with the rest of the participants. In addition, health, lifestyle habits and social factors were associated with incident use (I). Psychotropic drug use increased during 2006–2010, hypnotics and melatonin accounted for most of the increase. In total, 16.4% of all incident psychotropic drug users in 2007 were still having prescriptions dispensed in 2010 (II). Young people experience both beneficial and undesired effects from psychotropic drugs. Access to professional support and follow-up was experienced as insufficient. Life with family, friends, school and work was influenced by psychotropic drug use, and they were afraid of being lonely and stigmatized (III). The PHNs conceived their roles in relation to young people as; the discovering PHNs who became aware of psychotropic drug use in the health dialogues and chose either to act or not to act in relation to this. Those PHNs who took action continued to be the cooperating PHNs who cooperated with the young people, their families, schools, and others. If cooperation was established, the supporting PHNs teach and support the young people in relation to psychotropic drug use (IV). Conclusions: Attention must be paid to poor mental health and increasing psychotropic drug use by young people. Advances in knowledge, treatment and follow-up are needed. The prevalence of mental distress among young people, with differences between the genders, as well as between socioeconomic groups, should have consequences for health promotion strategies. PHNs in Norway, working in health centres and schools, have responsibility and opportunity to identify and follow-up young people with mental health problems. / Baksidestext International studies indicate an increase in mental distress and psychotropic drug use among young people. In this thesis mental distress is reported among 15.5 % of the young people. Of those reporting mental distress 75 % were girls. One quarter of the girls reporting mental distress at 15-16 years of age was incident users of psychotropic drugs one to nine years later. Psychotropic drug use, increase among young people, particularly hypnotic drugs. The young people experience beneficial and undesired effects of the psychotropic drugs. They miss out on professional availability and follow-up, and experience negative reactions related to their psychotropic drug use by their significant others. The public health nurse who discovers psychotropic drug use among young people chooses either to act or not to act in relation to this. Those who choose to act continue to cooperate with the young people and others. An established cooperation was followed by a public health nurse who supports and teaches the young people. The prevalence of mental distress, with a high frequency of initiation of psychotropic drug use among young people should have consequences for health promotion in the school health service. Public health nurses, working in health centers and schools, have a responsibility to promote health and prevent health problems. They have the responsibility and opportunity to identify young people struggling with mental health problems and psychotropic drug use as well as teach and support significant others.

Abstract The purpose of this research is to describe and comprehend the planning and realization of the Finnish Nurse Education from 1945 to 1957. The historical perspective of Nurse Education is examined from the Health Administration perspective, which utilizes the Intellectual and Administrative history research tradition. The phenomenon of education is studied holistically at macro and micro levels. At macro level the organizing of State Administration and the work of the leading nurses in development analysis is based on various documentation. At micro level the analysis concentrates on research knowledge based on memories of the contemporaries, i.e. experiences and conceptions of teachers and students of Nurse Education. The source materials are interpreted qualitatively. This approach structures the change in foundation and contents of education as well as the general nation-wide educational principles and the sympathies and frailties of human nature of the leading nurses that influenced the education. The research results present the changes in Nurse Education structure and content from 1945 to 1957, and the occurred change. The projecting of Nurse Education was effected by administrative and educational instructions. It was greatly influenced by the so-called Nurse Elite, which adopted an international perspective to nurse education supported by the Rockefeller foundation. The goal-oriented realization of education resulted in increase in theoretical education, concentration on social evaluation and holistic approach in teaching. Practical realizations intensified student guidance and systematic teaching, and also student independence and vocational education were intensified. The results structure research knowledge of Nurse Education, and present the identity of the current Nurse Education and the foundation for further development. / Tiivistelmä Tutkimuksen tarkoituksena on kuvailla ja ymmärtää sairaanhoitajien koulutuksen suunnittelua ja toteutusta Suomessa vuosina 1945 - 1957. Sairaanhoitajien koulutuksen historiankuvaa tarkastellaan terveyshallintotieteen näkökulmasta, jossa hyödynnetään aate- ja tapahtumahistoriallista tutkimusperinnettä. Koulutusta kokonaisuutena tutkitaan makro- ja mikrotasoilla. Makrotasolla analysoidaan erilaisten dokumenttien avulla valtionhallinnon organisointia sekä kehittämistoimintaa johtaneiden sairaanhoitajien työtä. Mikrotasolla analysoidaan aikalaisten muistitiedon avulla tuotettua tietoa eli opettajien ja sairaanhoitajaopiskelijoiden kokemuksia ja käsityksiä koulutuksesta. Lähdeaineiston tulkinnan perustana on aineistojen kvalitatiivinen lukutapa. Lukutapa auttaa ymmärtämään koulutuksen rakenteen ja sisällön muutoksen lisäksi myös koulukseen vaikuttaneiden kasvatusaatteiden ja sairaanhoitajien inhimillisen toiminnan merkitystä. Tutkimustuloksissa kuvaillaan sairaanhoitajien koulutuksen suunnittelua ja toteutusta vuosina 1945 - 1957 sekä siinä tapahtunutta muutosta. Suunnitteluun vaikuttivat sekä valtiohallinnolliset että kasvatusaatteelliset ohjeet. Sairaanhoitajien koulutuksen suunnittelua ohjasi erityisesti niin kutsuttu sairaanhoitajaeliitti, joka omaksui suunnitteluun Rockefeller-säätiön tukemana kansainvälisen ajattelun. Koulutuksen tavoitteellinen toteutus edisti sairaanhoidon opetusta siten, että teoriaopetus lisääntyi, yhteiskunnallinen painotus korostui ja opetuskokonaisuudet kehittyivät. Käytännöllisessä toteutuksessa tehostettiin opiskelijoiden ohjausta ja käytännön järjestelyjä sekä vahvistettiin opiskelijoiden itsenäisyyttä ja syvennettiin ammattikasvatusaatetta. Tutkimustulokset auttavat jäsentämään sairaanhoitajien koulutuksen tietoperustaa. Ne auttavat myös ymmärtämään nykyisen sairaanhoitajakoulutuksen identiteettiä ja ovat perusta sen edelleen kehittämiselle.

Den psykosociala arbetsmiljön är något som berör och påverkar alla distriktssköterskor oberoende av arbetsplats. Under en längre period har det skett neddragningar inom vården samtidigt som patienterna varken blir färre eller mindre sjuka. Att arbeta under tidspress en längre period påverkar individen negativt både fysiskt och psykiskt och kan leda till sjukskrivningar eller att distriktssköterskor lämnar yrket. Syftet med studien var att undersöka om det finns skillnader i den psykosociala arbetsmiljön utifrån antalet yrkesverksamma år som distriktssköterska eller beroende på arbetsplats. Finns det skillnader inom de åtta områden som i enkäten utgör den psykosociala arbetsmiljön utifrån antalet yrkesverksamma år som distriktssköterska eller beroende på arbetsplats? Finns det någon enskild utmärkande fråga inom de åtta områdena? Studien utfördes som en tvärsnittsstudie med kvantitativ ansats. Datan samlades in i form av en webbenkät med 143 svar från distriktssköterskor runt om i landet. Resultatet visar inga signifikanta skillnader utifrån yrkesverksamma år som distriktssköterska, däremot finns det signifikans på frågeområdena handlingsutrymme och återhämtning utifrån vilken arbetsplats deltagarna jobbade på. Störst skillnad förekommer mellan skola och vårdcentral. Slutsatsen är att många distriktssköterskor är nöjda med sin psykosociala arbetsmiljö men att det troligen är andra faktorer som i högre grad är påverkande. Mot bakgrund av stickprovets begränsade storlek, så bör föreliggande studie betraktas som en pilotstudie. Det är önskvärt att den följs upp av en mer omfattande studie där en större del av landet täcks in. Man kan trots detta slå fast att det är av vikt att den psykosociala arbetsmiljön ständigt beaktas och förbättras då ett sunt arbetsliv ger förutsättningar för en hållbar utveckling både på individnivå och samhällsnivå. / All public health nurses are affected by the psychosocial work environment. Public health care has suffered budget cuts for several years while the patients have neither become healthier nor fewer. Working under pressure for an extended period has negative effects on employees’ physical and mental state and can lead to increased sick leave or nurses choosing different career paths. The aim of the study was to investigate if there are differences in the psychosocial work environment in regard to the workplace or how many years one has been working as a public health nurse? Are there differences concerning the eight areas that were studied, regarding the psychosocial work environment in relation to the workplace as well as how many years one has been working as a public health nurse? Are there particular questions in these eight areas that deviate? The method used was a quantitative cross-sectional study. Data was gathered using a web enquiry including 143 public health nurses from all across Sweden. The result did not show any significant difference in regard to years of experience as a public health nurse, but it did show that the working place was a significant factor where two of the eight areas deviated from the other in “freedom of action” and “recovery”. The biggest differences were found between schools and health centrals.The conclusion is that many public health nurses are satisfied with their psychosocial work environment and that there are probably other factors that are more influential. In view of the limited size of the sample, the present study should be considered as a pilot study. It is desirable that it be followed up by a more comprehensive study covering a larger part of the country. Nevertheless, it can be stated that it is still important to highlight that more efforts are needed to improve the psychosocial work environment considering that a healthy working life is the key behind a sustainable development of both individuals and society.

Education is one of the strongest predictors of health, and well-being. Early termination of education can lead to poorer health, shorter lifespans, and increased stress on the healthcare system. Improving overall high school graduation rates has been debated and discussed by the Toronto District School Board (TDSB) and the Ministry of Education, however, there is a paucity of research on increased graduation rates as they relate to public health in the Canadian context. The purpose of this phenomenological qualitative study was to explore the perceptions of liaison public health nurses (PHNs) who worked directly with the TDSB regarding their roles in terms of influencing students in Toronto, Ontario to complete high school. Bronfenbrenner’s ecological model was the underlying conceptual framework for the study.Purposive sampling was used to select 10 PHNs who were interviewed regarding their role and involvement in high schools. The data was subjected to triangulation and analyzed to identify commonalities, trends and patterns. Findings from this study indicated that liaison PHNs believe that high school dropout rates are a public health issue and collaboration between the Ministry of Education and Public Health is needed to take action. Recommendations include more Canadian research that explores connections between health and school achievements and the expanded role of PHNs in Canadian high schools. Social change implications for this research include highlighting high school dropout rates as a public health concern in Canadian schools, particularly in communities of lower socioeconomic status. With increased research and resources, the Toronto public health system may work toward making improving graduation rates among their core mandate.

Hensikten med studien var å forstå hvordan helsesøstre jobber for å finne og hjelpe kvinnermed fødselsdepresjon, hvor effektivt dette arbeidet oppleves og deres holdning til ny kunnskap og til å ta nye metoder i bruk i arbeidet. Fødselsdepresjon er hyppig i barselperioden og flere studier viser at tilstanden ofte oversees. Fødselsdepresjon kan føre til forstyrrelser i ”bonding” mellom mor og barn som kan hanegativ innflytelse på barnets utvikling og helse. Hjelp og støtte til kvinnene vil ha betydning for mors- og barns fremtidige helse. I en kvalitativ studie ble 14 helsesøstre påhelsestasjoner i Oslo intervjuet om hvordan de finner frem til disse kvinnene og om de finner alle, samt deres holdning til å ta i bruk Edinburgh Postnatal Depression Scale (EPDS), som er et spørreskjema utviklet til bruk i primærhelsetjenesten for å oppdage kvinner med fødselsdepresjon. Det er benyttet en hermeneutisk/fenomenologisk tilnærming. Resultatet viser at helsesøstrene mangler en klar metode for å finne kvinner med fødselsdepresjon. De baserer seg på egen erfaring, personlighet og intuisjon og innser at de ikke finner alle. De er gjennomgående positive til å få mere kunnskap og ta i bruk EPDS . Denne studien bør følgesopp med en bred debatt om hvorvidt man ønsker en screening for fødselsdepresjon og hvordan man ser for seg organisering av oppfølging for kvinnene / The aim of this study was to understand how public health nurses work to trace women with postnatal depression, how effective they find their work and their attitude towards new knowledge and methods. Postnatal depression is common in the postnatal period and studies show that the conditionoften is not detected. Postnatal depression may lead to disturbances in the bonding between mother and child which can have a negative influence on the child’s development and health. Help and support given to these women will have a positive impact on both the mothers’ and the children’s future health. In a qualitative study 14 public health nurses wereinterviewed and asked how they trace these women, whether they miss some and their attitude towards using Edinburgh Postnatal Depression Scale (EPDS), which is aquestionnaire validated for use in primary health care to detect women with postnataldepression. The design had a hermeneutical/phenomenological approach. The results showed that the public health nurses do not have a method to trace women with postnatal depression. They rely on their experience, personality and intuition and are aware that they do not trace all.They are positive towards getting more knowledge about postnatal depression and to start using EPDS. Further research should include discussions about whether screening for postnatal depression is desired and how the follow-up for the women should be organized / <p>ISBN 91-7997-116-4</p>