Moving Upstream: Becoming a Public Health Nurse, Part 2

SmithBattle, Lee; Diekemper, Margaret; Leander, Sheila

doi:10.1111/j.0737-1209.2004.021202.x

Cited by 12 publications

(10 citation statements)

References 15 publications

(21 reference statements)

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“…With this experience, PHNs were able to reflect on the journey their clients had taken over time. This ability to see the broader perspective was indicative of gains in the PHN’s relational and perceptual skills [16] allowing them to see achievement over time. Literature supports that discussion with experienced colleagues assist with the development of perspective and in identification of over-involvement [14,50].…”

Section: Discussionmentioning

confidence: 99%

“…Literature supports that discussion with experienced colleagues assist with the development of perspective and in identification of over-involvement [14,50]. As the impact of worry and doubt may stem from the gap between theory, or program guidelines, and the unpredictability of the practice environment, this is a significant area where supervisors need to focus their reflective supervision goals [16]. …”

Section: Discussionmentioning

confidence: 99%

“…Poverty and complex cyclical familial issues are only some of the overwhelming range of issues facing mothers on a daily basis; and the complexity and chronicity of issues in the lives of clients often stands in stark contrast to the public health nurses’ (PHN) own experiences in their typically middle-class backgrounds [16]. …”

Section: Introductionmentioning

confidence: 99%

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Long-term home visiting with vulnerable young mothers: an interpretive description of the impact on public health nurses

et al. 2015

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BackgroundThe Nurse-Family Partnership (NFP) is a targeted, nurse home visitation program for young, low-income, first-time mothers. While the effectiveness of the NFP has been established in the United States, and is currently being evaluated in the Canadian public health care system, we have minimal understanding of how work of this nature impacts public health nurses (PHNs), an essential component of this program delivery model, on both professional and personal levels.MethodsThis two-phase study consisted of a qualitative secondary analysis of data from five focus groups conducted with PHNs (N = 6) who delivered the NFP intervention as part of a pilot study assessing feasibility and acceptability conducted in Hamilton, Ontario. The second phase, an interpretive description of individual interviews with the PHNs (N = 10) who have delivered the NFP in this context, further explored themes identified in the first phase. A practice, problem and needs analysis was conducted to describe and understand the phenomenon and promote sustainability of PHNs in this practice environment. Conventional content analysis was used to code and categorize data in the two datasets.ResultsThe nurse-client relationship, the core elements and structure of the NFP program and support of NFP colleagues were described as rewarding factors, while workload and workplace factors were identified as significant contributors to stress. PHNs described transforming their nursing practice through redefining success and shifting to a philosophy where the client is the expert of her own life. PHNs described the personal impact of worry about clients and doubt about their effectiveness in addressing client concerns. High levels of satisfaction were described in relation to the depth and intensity of relationships with clients and seeing them succeed over time.ConclusionsPHNs are impacted in multiple ways by their work with vulnerable, young mothers. The study findings have implications for identification of strategies to support PHNs in reducing staff turnover, PHN burnout, secondary traumatic stress and compassion fatigue, and improving program delivery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Long-term home visiting with vulnerable young mothers: an interpretive description of the impact on public health nurses

et al. 2015

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“…Even in cases of child neglect or abuse, expert public health nurses often framed the situation in such a way that promoted the child's safety without excluding or blaming the family (SmithBattle et al, 1997, p. 82). That many nurses make the shift from a child focus to the person and family deserves further study, including its role in achieving positive outcomes and sensitizing the nurse to the bigger picture in which children and families are embedded (SmithBattle, Diekemper, & Leander, 2004).…”

Section: Discussionmentioning

confidence: 99%

Getting Your Feet Wet: Becoming a Public Health Nurse, Part 1

SmithBattle¹,

Diekemper²,

Leander³

2004

Public Health Nursing

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While the competencies and theory relevant to public health nursing (PHN) practice continue to be described, much less attention has been given to the knowledge derived from practice (clinical know-how) and the development of PHN expertise. A study was designed to address this gap by recruiting nurses with varied levels of experience and from various practice sites. A convenience sample of 28 public health nurses and seven administrators/supervisors were interviewed. A subsample, comprised of less-experienced public health nurses, were followed longitudinally over an 18-month period. Data included more than 130 clinical episodes and approximately 900 pages of transcripts and field notes. A series of interpretive sessions focused on identifying salient aspects of the text and comparing and contrasting what showed up as compelling, puzzling, and meaningful in public health nurses' descriptions. This interpretive analysis revealed changes in understanding of practice and captured the development of clinical know-how. In Part 1, we describe the sample, study design, and two aspects of clinical knowledge development--grappling with the unfamiliar and learning relational skills--that surfaced in nurses' descriptions of early clinical practice. In Part 2, which is to be published in the next issue of Public Health Nursing (SmithBattle, Diekemper, & Leander, 2004), we explore gradual shifts in public health nurses' understanding of practice that led to their engagement in upstream, population-focused activities. Implications of these findings for supporting the clinical learning of public health nurses and the development of expertise are described.

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“…The social determinants of early childbearing invite public health nurses (PHNs) to rethink and challenge ideological assumptions and shortsighted policies with upstream thinking, a concept familiar to PHNs from their practice (SmithBattle, Diekemper, & Leander, ) and from the health disparities literature (Reutter & Kushner, ; Whitehead & Popay, ). Moving upstream is consistent with Milio's () ecological framework and ontological views of the person (Bourdieu, ; Heidegger, ).…”

Section: Discussionmentioning

confidence: 99%

Moving Policies Upstream to Mitigate the Social Determinants of Early Childbearing

SmithBattle

2012

Public Health Nursing

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The teen birth rate in the United States is one of the highest in the post-industrialized world. International comparisons suggest that U.S. rates reflect high levels of social disadvantage and misguided policies that frame teen parenting as costly for mothers, children, and taxpayers. Studies that control for background factors that predispose teens to become parents highlight the social inequities that contribute to early childbearing and unfavorable maternal-child outcomes, regardless of maternal age. After reviewing these studies, federal policies that target and scrutinize teenage and single mothers are described and critiqued for the ways they disregard the social determinants of early childbearing and further the marginalization and social exclusion of low-income families. This review calls for public health nurses to challenge the ideological assumptions driving downstream policies and to advocate for comprehensive reforms that reduce the wide and growing inequities in education, income, and health among U.S. citizens. Building the public support and political will to move upstream will remain daunting in light of the pervasive stereotypes of teen parents and the ideological assumptions that early childbearing and poor maternal-child outcomes stem more from individual choices and lifestyles than from social inequities.

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Moving Upstream: Becoming a Public Health Nurse, Part 2

Cited by 12 publications

References 15 publications

Long-term home visiting with vulnerable young mothers: an interpretive description of the impact on public health nurses

Long-term home visiting with vulnerable young mothers: an interpretive description of the impact on public health nurses

Getting Your Feet Wet: Becoming a Public Health Nurse, Part 1

Moving Policies Upstream to Mitigate the Social Determinants of Early Childbearing

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