The purpose of this study was to investigate how routine, day-to-day public health nursing (PHN) practice in one BC health authority affected health outcomes related to breastfeeding initiation and duration, infant immunizations, and household tobacco use within the population of perinatal women who were a high priority for additional and ongoing PHN services. Using administrative data from the integrated public health information system (iPHIS), outcomes for the priority population were compared to those of the general population of new mothers receiving usual PHN services. Additionally, through semi-structured interviews with PHNs, this study explored how the context of the work environment influenced PHN practice, and ultimately the achievement of those outcomes. Based on a philosophical foundation of critical realism, and a theoretical framework of critical caring, a mixed methods case study design was used to study PHN practice, as it existed day-to-day, amidst the array of ever changing organizational influences. Results from the statistical analysis of administrative data and thematic analysis of PHN interviews and organizational guiding documents, showed that priority women, who received five or more postnatal contacts from PHNs initiated breastfeeding in higher proportions than non-priority women, and continued breastfeeding to 18 months in the same proportion as non-priority mothers. Rates of breastfeeding duration for priority women were higher than expected based on current literature. Children of priority mothers were fully immunized in a slightly higher, but not significantly different proportion than children of the non-priority population, also at rates higher than expected. Although high rates of household tobacco use among this group of priority women did not appear to be influenced by PHN contact, the relationships that developed between priority women and PHNs suggest that organizational support for tobacco cessation activities may be a missed opportunity. Thematic analysis of PHN interviews and guiding documents provided background context and clarification for the kinds of organizational factors and underlying mechanisms that may have influenced the ability of PHNs to provide additional and ongoing support to priority perinatal women in achieving these three outcomes of interest. Finally, the theory of critical caring was verified and extended through the experiences and explanations of PHNs, with the addition of “navigating organizational complexity” to the original seven carative health promoting processes. / Graduate

The findings of Nutrition Canada, a national nutrition survey, have emphasized the importance of nutrition education to the public. It is a fact that the health professional most often disseminating nutrition information to the public is the public health nurse. Thus there was a need to investigate the nutritional knowledge of public health nurses, as well as their attitudes toward nutrition, and the kind of nutrition information they are offering to the public. This study involved testing the dependent variables: nutrition knowledge, attitudes and practices of public health nurses and comparing these with the independent variables: educational background, recency of acquisition of nursing related degree, years of nursing experience, age, qualification of the educators who taught nutrition in the training curriculum, years of home economics studied in high school, number of nutrition related communications with a nutritionist, and other types of nutrition experience or education. The nature of the relationship of knowledge, attitudes, and practices, and the interrelationships of knowledge and attitudes with practices were determined. Data were collected by a mail questionnaire which yielded a response rate of 85.1%. Coding and computer analysis of data resulted in percentage mean scores for the tests of nutrition knowledge, attitudes, and practices of 75.79, 89.48, and 65.08 respectively. The areas of nutrition knowledge in which the public health nurses scored lowest were nutrition and pregnancy-related to requirements and supplementation, knowledge about nutrient requirements, nutrient composition of foods, and weight reduction. Tests of nutrition attitudes revealed that the nurses had poor attitudes toward the importance of meal planning. Public health nurses demonstrated poor practices in counselling the public in budgeting, vegetarian diets, and dietary manipulation of fats. Nurses showed poor personal nutrition practices in meal management and in adhering to the recommended cereal group intake of the B.C. Daily Food Guide. Regression analysis indicated that the factors related to nutrition knowledge were educational background, recency of acquisition of nursing related degree, and years of experience. Factors related to nutrition attitudes were age, home economics training in high school, number of consultations with a nutritionist, and attendance at nutrition courses in continuing education. Nutrition practices were related to opportunities for consultation with a nutritionist and attendance at nutrition conferences. Partial correlation analysis of the dependent variables revealed significant and direct relationships between knowledge and attitudes, practices and attitudes, and practices and knowledge. The weakest relationship was between knowledge and attitudes. The strongest relationship was between knowledge and practices. Recommendations for a more effective inservice nutrition education program for public health nurses were made. / Education, Faculty of / Curriculum and Pedagogy (EDCP), Department of / Graduate

M.Cur. / The researcher's occupation as medical services manager at a packaging company regularly brings her into contact with the occupational health nurses employed at the factories. She has become aware that the occupational health nurses often become involved in ethical dilemmas with regards to the handling of HIV -positive people at the workplace in that the interests of the HIV -positive conflict with the interests of the employer. The occupational health nurse finds him/herself acting as intermediary and advocate between the two parties, namely the employer and the HIV -positive person. In spite of the provision of legal norms and ethical standards to regulate the interests of the HN -positive person in the workplace, no guidelines exist as to how these norms and standards should be operasionalised during interaction between the HIV -positive person, the occupational health nurse and the employer. The occupational health nurse is therefore uncertain how to act professionally within laid-down ethical standards with the HIV -positive person at the workplace. The purpose of this study is to describe guidelines and criteria for the operasionalisation of ethical standards for the occupational health nurse regarding the HIV -positive person in the workplace. This objective is obtained through the following aims: • Researching and describing literature with specific reference to current legal and ethical frameworks within the occupational health context regarding interaction with the HNpositive person in the workplace in order to formulate these ethical standards; • Researching and describing problems and solutions for the following target groups regarding the ethical aspects regarding the HN -positive person in the workplace: Occupational health nurses The HN -positive person in the workplace. The design of the research is qualitative, explorative and descriptive. The research was carried out by studying the occupational health nurses and HN -positive people employed by the packaging company countrywide. The occupational health nurses who were involved were obtained from a purposive test sample. The HN -positive people were chosen by making use of a quota test sample. Data obtained from the occupational health nurses was gathered by means of a workshop, and the data from the HN -positive people was obtained through personal interviews. The results of the research identified certain problems and solutions which were experienced by both target groups. These problems and solutions are divided into four sub-categories to illustrate how individual, organisational, health and family-systems are influenced. In order to assist the occupational health nurses to ethically handle the HIV -positive person in the workplace, guidelines and criteria were drawn up for the operasionalisation of the ethical standards. Additional research themes were identified through the study, the goal being to further improve the ethical handling of the HIV-positive person in the workplace, and to give better support to the HIV positive person.

The purpose of this study was to explain how public health renewal has shaped public health nursing practice, how public health nurses have managed these changes, and the perceived impact of such changes on health outcomes. I used the grounded theory method to develop a theoretical explanation of how public health nurses navigated the changing organizational milieu in British Columbia. I interviewed 29 public health nurses and three public health nursing managers in three health authorities to explicate the impact of healthcare reform initiatives on public health nurses and public health nursing practice. Over the last few decades, there have been several organizational and policy changes in British Columbia, intended to strengthen the health system and health service delivery. These changes have eroded the nature of the public health nurse role and negatively influenced public health nursing practice, undermining the ability of public health nurses to improve population health and health equity. Many participants were concerned about changes in their practice and reported that leaders restricted their role, particularly in their broad health promotion and community development efforts. Nurses in this study highlighted specific organizational and policy changes that have undermined their effectiveness. For example, nurses talked about cuts to the public health budget, the disbanding of health unit structures, the appointment of leaders who lacked public health or public health nursing knowledge and experience, and the increase in mandated targeted public health nursing programs with a corresponding decrease in universal programs. As a result, participants engaged in the process of managing the eroding of the public health nurse role, which comprises five strategies. In standing tall, a number of nurses in this study advocated for their practice and pushed back against decisions that jeopardized the quality of public health nursing programs and services with varying degrees of force. Public health nurse participants also worked within organizational expectations and constraints in the process of getting by. In going underground, several public health nurses engaged in various activities in secret by harnessing their community connections and attended to community issues they believed went unaddressed. A number of nurses, dissatisfied by the state of their role, were contemplating getting out and considered other employment possibilities. Throughout the process of navigating external changes affecting practice, many nurses restored their dedication to the public health nurse role in reaffirming commitment. Given the limited research exploring the impact of healthcare reform and public health renewal on public health nursing practice, this research helps to provide an initial glimpse into the effects of such change on public health nurses in British Columbia. / Graduate

Thesis (M.A.)--Boston University

No description available.

Background: There are professional expectations for public health nurses to engage in and develop competencies in evidence-informed decision-making (EIDM). The purpose of this research study was to develop and psychometrically test a measure to assess competence in EIDM among public health nurses. Methods: Guided by the Standards for Educational and Psychological Testing (American Educational Research Association, American Psychological Association, & National Council on Measurement in Education, 2014), a three stage study was employed to develop and psychometrically evaluate the new self-report EIDM Competence Measure: 1) Stage one: a systematic review of existing measures assessing four EIDM competence attributes of knowledge, skills, attitudes/beliefs, and behaviours; 2) Stage two: item development for the EIDM Competence Measure comprised of four subscales (knowledge, skills, attitudes/beliefs, and behaviours); and 3) Stage three: psychometric testing (reliability, validity, acceptability) which included item reduction from an original 40-item to a final 27-item tool. Results: The EIDM Competence Measure consists of 27 items aligning with a four-factor model of EIDM knowledge, skills, attitudes/beliefs, and behaviours establishing internal structure validity. Cronbach’s alpha for these four factors was 0.96, 0.93, 0.80, and 0.94, respectively. Significant associations between EIDM competence subscale scores and education, EIDM training/project involvement, and organizational culture established validity based on relationships to other variables. For the original 40-item tool, missing data was minimal as 93% of participants completed all items and mean completion time was 7 minutes and 20 seconds. Conclusions: The EIDM Competence Measure is a conceptually and psychometrically robust instrument that has potential for use in public health nursing practice. / Dissertation / Doctor of Philosophy (PhD) / Nurses who work in public health have professional expectations to participate in evidence-informed decision-making (EIDM). Because of this, it is important to measure how competent they are in EIDM. The purpose of this study was to develop and test a tool that measures EIDM competence among public health nurses using a three-stage study. The first stage involved reviewing literature on existing tools that measure different components of EIDM competence including EIDM knowledge, skills, attitudes/beliefs, and behaviours among nurses. The second stage involved using existing tool items and developing new items for a new tool named the EIDM Competence Measure. In the third stage, the EIDM Competence Measure was tested to assess its validity, reliability, and acceptability among public health nurses in Ontario. The EIDM Competence Measure was found to have strong validity, reliability, and acceptability, showing that there is potential for its use in public health nursing practice.

O presente estudo tem como objetivos: desvelar percepções de enfermeiros acerca da acupuntura como prática assistencial de enfermagem; identificar fatores dificultadores/facilitadores para a implantação da acupuntura como técnica complementar à assistência de saúde; discutir aspectos contraditórios e os dilemas ético-legais que perpassam a prática da acupuntura pelo enfermeiro em serviços de saúde pública. Pesquisa de campo exploratória foi realizada com 33 enfermeiras, de 11 Unidades de Saúde, da Região Sudeste do Município de São Paulo, que oferecem atendimento de acupuntura por profissionais médicos. Os dados coletados nas entrevistas foram examinados com base na Análise de Conteúdo de Bardin (2004) e Minayo (2007) e distribuídos em quatro categorias principais: (1) percepções de enfermeiros acerca da acupuntura na assistência à saúde; (2) fatores dificultadores e (3) facilitadores da prática da acupuntura pelo enfermeiro em serviços de saúde pública e (4) dilemas ético-legais na prática da acupuntura vivenciados pelos enfermeiros. Debates sobre percepções referentes à acupuntura revelaram credibilidade de pacientes na eficácia da técnica em uma grande variedade de enfermidades, especialmente em doenças crônicas, dor e estresse. Foi considerada como uma terapêutica holística, agindo com menos efeitos colaterais em situações em que a alopatia é ineficiente. Como fatores dificultadores foram encontrados: sobrecarga de trabalho, falta de recursos materiais e humanos e uma política de saúde que não favorece a implantação da acupuntura pelo enfermeiro. Entre os fatores facilitadores foram indicados: possibilidade de capacitação técnica do enfermeiro e de implantação do serviço de acupuntura multiprofissional pela Secretaria de Saúde, além de mais e melhor informação para a população e para profissionais, com a vantagem da proximidade já existente entre enfermeiro e usuário. Quanto aos dilemas ético-legais, questionou-se a acupuntura como prática limitada à classe médica, o preconceito quanto ao que o enfermeiro faz e pode fazer, a necessidade de regulamentação pelas autoridades competentes e, por fim, qual o perfil do profissional que poderia exercer a acupuntura, segundo as enfermeiras entrevistadas. Face ao novo paradigma emergente da saúde, na busca de um cuidado menos biologicista, mais integral e holístico, a acupuntura como prática complementar à assistência na saúde pública emerge como uma nova/velha terapêutica, trazendo muitos benefícios à saúde da população. O desafio que se coloca ao enfermeiro é a conquista da acupuntura como saber e fazer do enfermeiro, participando da implantação responsável, ética e multiprofissional da acupuntura em benefício da população / The objective of the present study were to unveil nurses´ perceptions on acupuncture as a nursing care practice; to identify difficulting or facilitating factors for implementation of acupuncture as a complementary procedure for health care; and to discuss contradictory issues, ethical and legal dilemmas which carry through the acupuncture practice by nurses in public health services. An exploratory research on field was held with 33 nurses, from 11 Health Units, located in the south-east region of São Paulo city, where acupuncture is practiced by physicians. Collected data through interviews were analyzed based on Bardin (2004) Content Analysis and Minayo (2007), distributed within four main categories: (1) nurses´ perceptions on acupuncture in health care; (2) difficulting factors and (3) facilitating factors related to acupuncture felt by nurses in public health services and (4) ethical and legal dilemmas on acupuncture practice experienced by nurses. Debates on perceptions related to acupuncture showed credibility by patients on the procedure efficacy in a large variety of illness, particularly on chronicle ones, pain and stress. It was considered as a holistic therapy, acting with less collateral effects, when allopath is inefficient. Difficulting factors found were: working overload, lack of material and human resources and the health policy which is not favorable for implementation of acupuncture done by nurses. Among facilitating factors were indicated: possibility of enabling nurses with technical qualification as well as implementation of acupuncture services by a multi-professional team through the Secretariat of Health; more and better information for people and professionals and the advantage of existing closeness between nurses and patients. Regarding the ethical and legal dilemmas, the issue of acupuncture as a practice limited to the medical group was raised, as well as the prejudice related to what nurses do or may do, the need of regulation by competent authorities and also who would be the professionals to practice acupuncture according to the interviewed nurses. Considering this emerging new health paradigm and looking for a less biologist and more integral and holistic caring, acupuncture as a complementary practice to public health care comes forth as new/old therapy, bringing many benefices to the public health. The challenge imposed to nurses is the conquest of the acupuncture as the knowing and the doing of the nurse, participating in responsive, ethical and multi-professional implementation of acupuncture practice for the people benefit

As mudanças sociais ocorridas nas últimas três décadas fizeram com que o respeito à autonomia do usuário e o direito ao consentimento livre e esclarecido assumissem posição de destaque na ética em saúde e fossem incorporados aos Códigos de Ética Médica e de Enfermagem vigentes no país. Estudos desenvolvidos em serviços de saúde, mormente os hospitalares, têm evidenciado que os usuários obtêm poucas informações sobre suas condições de saúde, tratamento, cuidado e que a prática profissional tem oscilado entre o paternalismo, o autoritarismo e o respeito à autonomia. Esta investigação foi realizada com o objetivo verificar como o consentimento esclarecido é concebido na prática das enfermeiras de quatro Centros de Saúde Escola (CSE) de São Paulo. A análise do material empírico, obtido através de entrevistas junto a essas profissionais foi feita à luz da ética principialista. O resultados demonstram que essas profissionais, apesar de desconhecerem o termo consentimento esclarecido, respeitam as suas normas básicas, reconhecem o direito dos usuários em participar de decisões que digam respeito à sua saúde, oferecem informações para subsidiar essas decisões. O padrão de informação é personalizado, porém, alternativas de decisão, além daquelas estipuladas em programas e protocolos, raramente são apresentadas. Assim, o consentimento esclarecido na prática das enfermeiras em CSE é limitado por esses programas e protocolos. As enfermeiras têm como preocupação o benefício do usuário, o estímulo às participação dos usuários no seu cuidado e a prevenção ou remoção de riscos e danos. No geral, estas enfermeiras acatam a decisão tomada pelo usuário, mesmo quando há recusa em seguir a orientação dada, mas por vezes demonstram dificuldade em aceitá-la quando a mesma põe em risco a saúde de terceiros. Enquanto profissionais que participam na implementação políticas de saúde demonstram preocupação com sua \"missão\", sentem-se impotentes e demonstram desconhecer aliados e instrumentos que poderiam ser utilizados nessa situação. / The social changes occurred in the last three decades were instrumental for causing the customers\' autonomy and right to free-informed consent to be respected assuming a leading rank in the health ethics as well as being incorporated into the Nursing and Medical Ethical Codes in force in the country. Studies carried out in health services, moreover in hospital facilities, disclosed that the customers usually obtain few information on their health condition, treatment and, care and that the professional practice has been oscillating among being either paternalistic, authoritarian or respecttul regarding the patient\'s autonomy. The purpose of this investigation was to ascertain how the informed consent is conceived by the nurses\' practice in four School/Health Centers in São Paulo, State of São Paulo. Brazil. The empirical material obtained in interviews along with these professionals was analyzed in the light of Bioethics principles. Results were as follows: these professionals do not know the term informed consent; however, they act in accordance with its basic norms, recognizing the customers\' right to participate in the decision-making regarding their health, besides providing information in order to subside these decisions: the pattern of the information provided is personalized, although decision alternatives other than those stipulated in programs and protocols are rarely presented. Informed consent, in nursing practice in School/Health Centers is restricted within these programs and protocols. These nurses are concerned about users\' beneficence, their participation in self care and about preventing or removig risks or harm. In general, these nurses respect the decision taken by the customers, even when they refuse to comply with the orientation provided, however showing sometimes difficulties in accepting it when the health of a third-part is in jeopardy; while professionals participating in the implementation of health policies, they demonstrate being concerned with their \"mission\", sometimes feeling themselves impotent to deal with this situation, disclosing therefore a lack of knowledge concerning allied institutions and instruments which might be used to face these kind of circumstances.

Background and Significance: Severe childhood obesity, the fastest growing subcategory of childhood obesity, affects 4-6% of youth. Children from racial/ethnic minority groups and low income households are disproportionately affected. Severe obesity increases risk for metabolic syndrome, cardiovascular disease, non-alcoholic fatty liver disease, musculoskeletal problems, poor health-related quality of life, bullying, low self-worth, absenteeism, and adult obesity. One method of addressing childhood obesity is through school-based interventions. School nurses may be well-suited to lead obesity interventions because of their healthcare expertise, long-term relationships with students and families, and availability to students without financial burden. Purpose: The overarching aim of this mixed methods dissertation was to evaluate the implementation and efficacy of the Healthy Options and Physical Activity Program, a school nurse-led intervention for children with severe obesity attending New York City schools. This evaluation focused on the 2012/2013 school year, the first full year of program implementation. Methods: Aims 1 and 2 were conducted to prepare for the Healthy Options and Physical Activity Program evaluation. Aim 1 included conduct of a systematic review and meta-analysis of existing literature to examine the role and impact of nurses in school-based obesity interventions. Aim 2 studied application of 3 propensity score methods to the observational Healthy Options and Physical Activity Program data set to determine which best removed significant differences in 11 potential confounders between the 1,054 kindergarten through fifth grade children who participated in the program in 2012/2013 and the 19,464 children who were eligible but did not participate. Aims 3-6 comprised the Healthy Options and Physical Activity Program evaluation. Aims 3, 4, and 5, utilized a retrospective cohort design to examine program implementation and its one year impact on body mass index percentile, school absences, and walk-in school nurse visits. Analytic methods included descriptive statistics, Wilcoxon signed rank tests, McNemar’s test, and logistic regression. Aim 6 qualitatively explored perceived barriers to and facilitators of implementing the Healthy Options and Physical Activity Program from the perspective of school nurses, using individual semi-structured interviews. Interview data were analyzed using content analysis. Results/findings: Of 11 studies eligible for systematic review, 8 met inclusion for meta-analysis. Pooled findings suggest that school nurse led interventions decreased BMI percentile by -0.41 (95%CI: -0.60, -0.21; I2=0, Cochrane Q=2.0). The comparison of propensity score methods demonstrated that only propensity score matching removed all significant differences between children who received the Healthy Options and Physical Activity Program and children who were eligible for but did not receive the program. The program evaluation demonstrated that the program had limited reach (5% of eligible children) and low intensity (median 1 session/year, parent attendance at 3.2% of sessions). Factors associated with selection for program enrollment included attending a school with low school nurse workload (OR 2.4, 95%CI 2.0-2.8), low school poverty (OR 1.6, 95%CI 1.3-1.9), and lack of chronic illness comorbidity (OR 0.5, 95%CI 0.5-0.6). After propensity score matching, program participants failed to decrease body measures, school absences, or school nurse visits at 1 year. Themes of interviews with 19 school nurses suggest that nurses encountered barriers to program implementation: parental and administrative resistance, heavy workload, and obesogenic environments. Despite barriers, nurses implemented the program to the best of their ability using creativity and teamwork. Conclusion: As implemented, the Healthy Options and Physical Activity Program was not effective in reducing body mass index percentile, absences or school nurse visits in youth with severe obesity. Barriers such as limited time and lack of parental and administrative support prevented nurses from fully implementing the program. However, school nurses with their clinical knowledge base, cost-free accessibility to children and families, and long-term relationship with students may be able to successfully employ other school-based obesity interventions. Therefore future research should use rigorous methods to develop and test school-based interventions implemented by school nurses, with a focus on intervention feasibility and sustainability. Implications for the Profession: This dissertation has implications for nursing practice, health policy, and nursing science. Findings of this mixed methods evaluation suggests that nurses may not have the resources necessary to implement intensive school-based obesity interventions. Nurses who are planning to implement such an intervention may want to carefully consider program intensity and feasibility. In addition, careful attention to increasing parent buy-in and ensuring administrator support are key. In addition, policy that supports adequate school nurse staffing can support appropriate nursing workload and may allow nurses time to implement health promotion programs and obesity interventions. During the qualitative portion of this dissertation, nurses reported the obesogenic environment as a barrier to healthful living that impacted the program’s effectiveness; obesogenic environmental factors (e.g., unhealthy school meals) will need to be addressed via legislation. Lastly, nurse scientists can work to increase the literature surrounding school-based obesity interventions, particularly with randomized controlled trials of interventions and qualitative work with nurses, parents, school administrators, and children. In addition, school-based obesity interventions must be developed and tested that consider the challenges faced by vulnerable children such as children living and attending school in high poverty neighborhoods.