La profession infirmière, ayant grandement évoluée depuis plusieurs années, place aujourd’hui les infirmières comme des acteurs clés dans l’amélioration des services de santé tant au niveau de l’accessibilité que de la qualité et de la sécurité des soins et des services offerts à la population. Au Québec, on estime que 15 à 20 % des enfants âgés entre 0 et 5 ans naissent et grandissent dans des familles vivant en contexte de vulnérabilité. Afin d’aider ces familles à améliorer leur santé, depuis 2003, tous les centres intégrés de santé et de services sociaux offrent des services intégrés en périnatalité et pour la petite enfance (SIPPE). Le contexte dans lequel vivent ces familles nécessite souvent une approche interdisciplinaire et une collaboration interprofessionnelle. Au cours de leur formation, les infirmières développent des compétences tant biomédicales que psychosociales. En raison de l’éventail de leurs champs de compétences, il appert que les infirmières occupent un rôle central dans l’équipe des SIPPE. Or, pour répondre à la complexité des besoins des familles, les infirmières doivent exercer à leur pleine étendue de pratique. Cependant, les résultats issus de plusieurs recherches menées dans divers milieux au cours des dernières années tendent vers une conclusion commune soit que les infirmières ne parviennent pas à déployer leur étendue de pratique de façon optimale. Puisqu’aucune étude n’a été menée dans le contexte spécifique des SIPPE, l’objectif de cette recherche qualitative consiste à explorer l’étendue effective de la pratique infirmière dans les SIPPE. Afin de mieux comprendre ce phénomène, les facteurs influençant le déploiement optimal de l’étendue de la pratique infirmière (ÉPI) dans les SIPPE ont également été explorés. Cette présente étude prend appui sur le modèle théorique Public health nursing practice de Smith et Bazini-Barakat (2003). Selon ce modèle, le rôle de l’infirmière dans un programme de santé publique, comme les SIPPE, repose principalement sur l’évaluation, la planification des soins, l’enseignement à la clientèle et aux familles ainsi que sur la communication et la coordination des soins avec l’équipe interprofessionnelle. En combinant les notions de ce modèle aux activités professionnelles de l’ÉPI de D’Amour et al. (2012), il a été possible de collecter des données sur l’étendue effective de la pratique infirmière dans les SIPPE. Des entrevues individuelles semi-structurées ont été menées auprès de quatre participantes soit trois infirmières œuvrant dans les SIPPE et leur assistante-infirmière chef. Les résultats démontrent que les infirmières occupent un rôle important auprès des familles vivant en contexte de vulnérabilité. Actuellement, elles semblent être en mesure de mettre en œuvre plusieurs activités professionnelles liées à l’évaluation et la planification des soins ainsi que pour l’enseignement à la clientèle et aux familles. Toutefois, les résultats sous-entendent que la pratique infirmière dans les SIPPE n’est pas optimale pour les activités professionnelles liées à la communication et la coordination des soins. Plusieurs facteurs semblent actuellement influencer la capacité des infirmières à mettre en œuvre les activités de leur étendue de pratique. / The nursing profession has evolved considerably over the past several years, and today nurses are key players in improving health services in terms of accessibility, quality and safety of care and services offered to the population. In Quebec, it is estimated that 15 to 20 % of children between the ages of 0 and 5 are born and grow up in families living in a vulnerable context. In order to help these families improve their health, since 2003, all the integrated health and social services centers have been offering integrated perinatal and early childhood services (IPECS). The context in which families live often requires an interdisciplinary approach and interprofessional collaboration. During their training, nurses develop both biomedical and psychosocial skills. Because of their wide range of knowledge and skills, nurses have a central role in the IPECS team. To meet the complexity of families’ need, nurses must practice to their full scope of practice. However, the results of several research studies conducted in recent years point to the common conclusion that nurses are not achieving optimal scope of practice. Since no studies have been conducted in the specific context of IPECS, the purpose of this qualitative research was to explore the actual scope of nursing practice in IPECS. To better understand this phenomenon, factor influencing the optimal deployment of scope of nursing practice (SNP) in IPECS were also explored. This study is based on Smith and Bazini-Barakat (2003) theoretical model of public health nursing practice. According to this model, the nurse’s role in a public health program, such as IPECS, is primarily based on assessment, care planning, client and family teaching, communication and coordination of care with the interprofessional team. By combining the concepts of this model with the professional activities of D’Amour et al. (2012), it was possible to collect data on the actual scope of nursing practice in IPECS. Semi-structured individual interviews were conducted with four participants: three nurses and their assistant nurse. The results show that nurses pay an important role with families living in a vulnerable context. Currently, they seem to be able to carry out several professional activities related to assessment and care planning as well as teaching clients and families. However, the results suggest that nursing practice in IEPCS is not optimal for professional activities related to communication and care coordination. Several factors currently appear to influence nurses ‘ability to implement their full scope of practice.

The study sought to explore professional nurses' perceptions of the roles of home and community-based carers in the Capricorn district of the Limpopo province as well as the problems they experienced and make recommendations to improve the quality of home and community-based care. A qualitative approach with non-probability, purposeful sampling was used in this study. The sample consisted of professional nurses serving as focal points for home-based care in the area of the study. The findings indicated that professional nurses believe that carers have a role in providing care to the community and serve as the extended hands of their services. However, challenges exist, which impact on the quality of service delivery. Recommendations included the strengthening of existing elements, such as improving relationships, communication, and the care of carer's programme, carer training, reporting, and monitoring and carer distribution. / Health Studies / M.A. (Health Studies)

The study sought to explore professional nurses' perceptions of the roles of home and community-based carers in the Capricorn district of the Limpopo province as well as the problems they experienced and make recommendations to improve the quality of home and community-based care. A qualitative approach with non-probability, purposeful sampling was used in this study. The sample consisted of professional nurses serving as focal points for home-based care in the area of the study. The findings indicated that professional nurses believe that carers have a role in providing care to the community and serve as the extended hands of their services. However, challenges exist, which impact on the quality of service delivery. Recommendations included the strengthening of existing elements, such as improving relationships, communication, and the care of carer's programme, carer training, reporting, and monitoring and carer distribution. / Health Studies / M.A. (Health Studies)

A needs assessment during 2000 guided the design of a buddy system in Botswana. Implementation of this care and support system for and by 39 HIV+ve female buddy-client pairs started in 2002. During April and November 2002, levels of disclosure, self-care, support and quality of life of buddy-client pairs and the controls (n = 38) were compared. Orem's self-care theory, Maslow's hierarchy of needs and Cohen and Syme's conceptualisation of social support formed the theoretical framework. By November 2002, clients' disclosure levels, self-care for TB, and antiretroviral therapy adherence had improved. Higher income, higher education and older age predicted higher levels of self-care for antiretroviral therapy. The social support survey reported satisfaction with types of support available in November 2002 (N = 112). Clients' scores for self-care for TB, antiretroviral therapy and social support improved more than those of controls over the study period. The personal resource questionnaire measured perceptions of support: buddies' scores increased more than those of clients. Women on antiretroviral therapy completed the adherence attitudes inventory in April and November 2002 and reported a downward trend in adherence. Findings of the quality of life (SF 36) instrument showed that during the six-month study period, physical and mental health component summary scores improved but remained low (N = 112). During 2003 Botswana's community-based buddy-support programme was adopted by four other countries in Southern Africa in an attempt to enhance the quality of life of HIV+ve women in these countries. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of the study was to investigate the services provided by the Bhambayi Drop-In Centre in Inanda, KwaZulu-Natal for orphans and vulnerable children (OVCs). Qualitative research design and in-depth interviews with key informants and foster parents of the OVCs were conducted. The study found that the services which are provided by the Centre enabled the orphans and vulnerable children to enjoy life as normally as possible and to experience life meaningfully. As beneficiaries of the Bhambayi Drop-In Centre the children had access to education and two meals per day. Beyond meeting such basic needs, the study also found that Centre instilled a sense of belonging and community in the children. Access to social grants enabled the children’s basic needs to be met. In addition foster parents played a crucial role in taking care of orphans and vulnerable children. / Health Studies / M.A. (Social Behaviour Studies in HIV/AIDS)

A needs assessment during 2000 guided the design of a buddy system in Botswana. Implementation of this care and support system for and by 39 HIV+ve female buddy-client pairs started in 2002. During April and November 2002, levels of disclosure, self-care, support and quality of life of buddy-client pairs and the controls (n = 38) were compared. Orem's self-care theory, Maslow's hierarchy of needs and Cohen and Syme's conceptualisation of social support formed the theoretical framework. By November 2002, clients' disclosure levels, self-care for TB, and antiretroviral therapy adherence had improved. Higher income, higher education and older age predicted higher levels of self-care for antiretroviral therapy. The social support survey reported satisfaction with types of support available in November 2002 (N = 112). Clients' scores for self-care for TB, antiretroviral therapy and social support improved more than those of controls over the study period. The personal resource questionnaire measured perceptions of support: buddies' scores increased more than those of clients. Women on antiretroviral therapy completed the adherence attitudes inventory in April and November 2002 and reported a downward trend in adherence. Findings of the quality of life (SF 36) instrument showed that during the six-month study period, physical and mental health component summary scores improved but remained low (N = 112). During 2003 Botswana's community-based buddy-support programme was adopted by four other countries in Southern Africa in an attempt to enhance the quality of life of HIV+ve women in these countries. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of the study was to investigate the services provided by the Bhambayi Drop-In Centre in Inanda, KwaZulu-Natal for orphans and vulnerable children (OVCs). Qualitative research design and in-depth interviews with key informants and foster parents of the OVCs were conducted. The study found that the services which are provided by the Centre enabled the orphans and vulnerable children to enjoy life as normally as possible and to experience life meaningfully. As beneficiaries of the Bhambayi Drop-In Centre the children had access to education and two meals per day. Beyond meeting such basic needs, the study also found that Centre instilled a sense of belonging and community in the children. Access to social grants enabled the children’s basic needs to be met. In addition foster parents played a crucial role in taking care of orphans and vulnerable children. / Health Studies / M.A. (Social Behaviour Studies in HIV/AIDS)