This interpretive study examined the expertise that is often unrecognized in the everyday practice of community health nurses. Twenty-five nurses participated in the study and were asked to describe meaningful clinical situations during group and individual interviews. Field notes of observations of clinical situations and transcribed interviews were analyzed as a text. A major finding of the study involved the nurse's responsive use of self. Responsiveness to the other enabled the nurse to gain a situated understanding of clients' lives and to cultivate clients' strengths and connections to a responsive community.

BackgroundWith decreasing global resources, a pervasive critical shortage of skilled health workers, and a growing disease burden in many countries, the need to maximize the effectiveness and efficiency of pre-service education in low-and middle-income countries has never been greater.MethodsWe performed an integrative review of the literature to analyse factors contributing to quality pre-service education and created a conceptual model that shows the links between essential elements of quality pre-service education and desired outcomes.ResultsThe literature contains a rich discussion of factors that contribute to quality pre-service education, including the following: (1) targeted recruitment of qualified students from rural and low-resource settings appears to be a particularly effective strategy for retaining students in vulnerable communities after graduation; (2) evidence supports a competency-based curriculum, but there is no clear evidence supporting specific curricular models such as problem-based learning; (3) the health workforce must be well prepared to address national health priorities; (4) the role of the preceptor and preceptors’ skills in clinical teaching, identifying student learning needs, assessing student learning, and prioritizing and time management are particularly important; (5) modern, Internet-enabled medical libraries, skills and simulation laboratories, and computer laboratories to support computer-aided instruction are elements of infrastructure meriting strong consideration; and (6) all students must receive sufficient clinical practice opportunities in high-quality clinical learning environments in order to graduate with the competencies required for effective practice. Few studies make a link between PSE and impact on the health system. Nevertheless, it is logical that the production of a trained and competent staff through high-quality pre-service education and continuing professional development activities is the foundation required to achieve the desired health outcomes. Professional regulation, deployment practices, workplace environment upon graduation and other service delivery contextual factors were analysed as influencing factors that affect educational outcomes and health impact.ConclusionsOur model for pre-service education reflects the investments that must be made by countries into programmes capable of leading to graduates who are competent for the health occupations and professions at the time of their entry into the workforce.

An interpretive study conducted in a Midwestern metropolitan area was designed to examine expertise in everyday community health nursing (CHN) practice. Twenty‐five nurses from three practice areas (traditional, nontraditional, and program development) participated in group and individual interviews and field observations, sharing stories of their practice. Transcribed interviews and field observation notes were analyzed as a text. One of the major findings of the study focused on experiences of the nurses as they developed the population aspects of their everyday practice. Part I describes the natural development of a population focus of CHN generalists whose care most often targeted individuals and families. The stories of how their practices evolved and were supported by their institutions provided insights into how nurses develop a broad population‐focused practice perspective. Part II examines the practice of those CHN specialists who nurse their target populations from an intentional perspective. Their population‐focused practice, in which they repeatedly displayed what the research team terms multilingual and multiperspectival skills, was solidly based in their prior individual and family‐focused experience and expertise in program planning and evaluation.

An interpretive study conducted in a Midwestern metropolitan area was designed to examine expertise in everyday community health nursing (CHN) practice. Twenty-five nurses from three practice areas (traditional, nontraditional, and program development) participated in group and individual interviews and field observations, sharing stories of their practice. Transcribed interviews and field observation notes were analyzed as a text. One of the major findings of the study focused on experiences of the nurses as they developed the population aspects of their everyday practice. Part I describes the natural development of a population focus of CHN generalists whose care most often targeted individuals and families. The stories of how their practices evolved and were supported by their institutions provided insights into how nurses develop a broad population-focused practice perspective. Part II examines the practice of those CHN specialists who nurse their target populations from an intentional perspective. Their population-focused practice, in which they repeatedly displayed what the research team terms multilingual and multiperspectival skills, was solidly based in their prior individual and family-focused experience and expertise in program planning and evaluation.

While community health nursing (CHN) leaders speculate about the future, nurses on the front lines care for vulnerable families and populations in the midst of diminishing resources, radical changes in health care delivery systems, and unwieldy bureaucracies. Narrative data from a recent interpretive study provided an unexpected opportunity to explore how CHN practice in diverse settings is evolving in response to such changes. Data consisted of interviews and observations of 25 nurses in their practice setting. Several clinical stories or exemplars are selected to highlight how the "culture" of agency settings shapes public health nursing (PHN) practice in ways that need to be recognized and strengthened or affirmed. Clinical storytelling can play a crucial role in preserving the PHN tradition and restoring and transforming local cultures when PHNs, administrators, educators, and researchers commit to PHN excellence.