Helen Mulcahy

Primary Health Care: Comparing Public Health Nursing Models in Ireland and Norway

Health of populations is determined by a multitude of contextual factors. Primary Health Care Reform endeavors to meet the broad health needs of populations and remains on international health agendas. Public health nurses are key professionals in the delivery of primary health care, and it is important for them to learn from global experiences. International collaboration is often facilitated by academic exchanges. As a result of one such exchange, an international PHN collaboration took place. The aim of this paper is to analyse the similarities and differences in public health nursing in Ireland and Norway within the context of primary care.

Examining the breastfeeding support resources of the public health nursing services in Ireland

AIMS AND OBJECTIVES The aim of the study was to review breastfeeding support provided by Public Health Nurses in Ireland. The objectives were to identify the availability of appropriate guiding policies, educational preparation, attitude of Public Health Nurses and the availability and use of other supportive services. BACKGROUND Breastfeeding rates in Ireland are among the lowest in Europe. The main source of formal support for breastfeeding mothers in the community in Ireland is from Public Health Nurses who can make referral to other non-statutory resources. The nature of this support is determined by policies guiding clinical practice and education that increases breastfeeding confidence and competence of all personnel. Consequently, an assessment of breastfeeding resources requires an analysis of all these variables. DESIGN A large quantitative, cross-sectional study was conducted, involving Public Health Nurses and mothers. This paper represents the results from the perspective of Public Health Nurses. METHOD Directors of Public Health Nursing (n = 24) and Public Health Nurses (n = 204) completed self-report questionnaires by mail and online. Data were analysed using the Statistical Package for Social Sciences and reported using descriptive and inferential statistics. RESULTS Public Health Nurses are well educated to support breastfeeding and have a positive attitude and a high degree of self-assessed confidence and competence. A wide variety of non-statutory support exists for breastfeeding but is not always used to their full potential. CONCLUSION Standardising educational requirements for Public Health Nurses in supporting breastfeeding is an area that requires attention. Ultimately, service delivery in relation to supporting breastfeeding mothers would benefit from being more timely and responsive. RELEVANCE TO CLINICAL PRACTICE Awareness of support resources is necessary for Public Health Nurses to make appropriate referrals for breastfeeding mothers. Furthermore, Directors of Public Health Nursing need to encourage the breastfeeding supportive role of Public Health Nurses and facilitate continuing professional development.

Participatory nurse/client relationships: perceptions of public health nurses and mothers of vulnerable families

Public health nurses (PHNs) in Ireland are involved with all children and their families for health screening and health education. Nurse/client relationships with vulnerable families are important, yet there is evidence that they are not participatory. Participation in the context of this study implied PHN/client consensus in relation to the needs identified and provided, in conjunction with mutual satisfaction with the level of interpersonal involvement and responses. The primary purpose of this pilot study was to determine similarities in perceptions on participation between nurses and mothers of vulnerable families (n = 44 dyads). A cross-sectional quantitative design was used to investigate the needs identified and provided, as well as satisfaction with the level of involvement and response, from the perspective of both sides of the dyad. There were more similarities than differences in perception found in the dyads, indicating participatory relationships.

Uncertainty A little bit not sure. Parental concern about child growth or development

Delays in child growth or development are significant problems for children, their families and population health. Eliciting parental concerns as early as possible to promote child growth and development requires close collaborative working with parents. There is evidence that parents delay expressing concern and that health-care professionals are not always effective at eliciting and attending to parental concerns. The aim of this study was to understand the experiences of parents of preschool children who had expressed a child growth or development concern. An Interpretative Phenomenological Analysis (IPA) study design was used with a purposive sample of parents of 15 preschool children in Ireland. Data were collected by semi-structured interviews and analysed using IPA. One key superordinate theme – Uncertainty – ‘a little bit not sure’ captured how parents made sense of their concerns about their child’s growth and development. In addition to watching, comparing and wondering, parents assessed whether their child could ‘do other things’ or if something in particular could have caused the growth or development problem. Parents, particularly mothers, grapple with uncertainty associated with unfamiliar cues in the complex and multifaceted nature of child growth and development in their efforts to make sense of what is happening with their child.

Transitional care interventions: Relevance for nursing in the community

OBJECTIVES The coordination and integration of health care is compromised by complex challenges related to transitions between care settings, greater prevalence of chronic health conditions, and older individuals with increasing levels of dependency. Transitional care incorporates a broad range of services designed to provide care continuity. This systematic review aims to synthesize and present findings regarding the relevance of transitional care interventions to community nursing. DESIGN AND SAMPLE A systematic search of electronic databases was conducted as part of a larger review to identify evidence-based interventions to support a model to guide nursing and midwifery in the community in Ireland. All relevant empirical studies published in English between 2010 and 2015 were included. MEASURES Studies were assessed based on inclusion criteria. The Cochrane Risk of Bias and AMSTAR tools were used to assess the methodological quality of studies. Key themes and concepts were extracted and synthesized. RESULTS Transitional care interventions had significant positive effects in reducing all-cause readmissions, mortality, and heart failure-related rehospitalizations. CONCLUSION Effective transitional care requires excellent communication between acute and primary care providers. This has implications for integration and organization of care across settings and nursing competence.

Developmental Dysplasia of the Hip: A Case Study to Illustrate Public Health Nursing practice

Developmental Dysplasia of the Hip (DDH) captures a range of hip disorders which requires early identification and management and as such is a significant public health and primary care issue. The incidence of late diagnosis is higher in Ireland that other countries. Hip ultrasound is not widely practiced in Ireland. After birth, Public Health Nurses (PHNs) practitioners in Ireland may be the first health professional to be alerted to a missed case of DDH. The aim of this paper is to use a case study to illustrate the complexities of public health nursing practice with parents to screen, intervene and manage DDH. The paper highlights the way in which PHNs fulfil their public health role by implementing interventions, at the level of individuals, communities and systems, to address public health issues, informed by the Public Health intervention Wheel (The Wheel). Implications for education and practice are also discussed.

Self-neglect: a case study and implications for clinical practice.

Self-neglect is a worldwide and serious public health issue that can have serious adverse outcomes and is more common in older people. Cases can vary in presentation, but typically present as poor self-care, poor care of the environment and service refusal. Community nurses frequently encounter self-neglect cases and health and social care professionals play a key role in the identification, management and prevention of self-neglect. Self-neglect cases can give rise to ethical, personal and professional challenges. The aim of this article is to create a greater understanding of the concept of self-neglect among community nurses.

A falls case summary: Application of the public health nursing intervention wheel

BACKGROUND The Public Health Intervention Wheel (PHIW) is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. Public health nurses (PHNs) provide care at the three levels of practice. Prevention of falls is a public health issue and the majority of falls happen at home. Therefore, prevention and management of falls in the community could benefit from a public health systems approach by PHNs underpinned by the PHIW. CASE PRESENTATION A hypothetical case is presented of a 78-year-old gentleman who had a fall which resulted in a fractured right acetabulum and surgery before being discharged home. METHODS The aim of this paper was to use a case summary to illustrate PHN practice in the context of the PHIW as applied to falls management and prevention. This paper focuses on fall incidence and PHN response in Ireland and Norway. The PHIW is described and relevant interventions from the PHIW are applied to PHN practice in managing the case. CONCLUSIONS The PHIW model provides insight into the potential scope of public health nursing in falls, articulating PHN practice in the community.

Conceptualising a model to guide nursing and midwifery in the community guided by an evidence review

BackgroundSuccessful models of nursing and midwifery in the community delivering healthcare throughout the lifespan and across a health and illness continuum are limited, yet necessary to guide global health services. Primary and community health services are the typical points of access for most people and the location where most care is delivered. The scope of primary healthcare is complex and multifaceted and therefore requires a practice framework with sound conceptual and theoretical underpinnings.The aim of this paper is to present a conceptual model informed by a scoping evidence review of the literature.MethodsA scoping evidence review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Databases included CINAHL, MEDLINE, PsycINFO and SocINDEX using the EBSCO platform and the Cochrane Library using the keywords: model, nursing, midwifery, community, primary care. Grey literature for selected countries was searched using the Google ‘advanced’ search interface. Data extraction and quality appraisal for both empirical and grey literature were conducted independently by two reviewers. From 127 empirical and 24 non-empirical papers, data extraction parameters, in addition to the usual methodological features, included: the nature of nursing and midwifery; the population group; interventions and main outcomes; components of effective nursing and midwifery outcomes.ResultsThe evidence was categorised into six broad areas and subsequently synthesised into four themes. These were not mutually exclusive: (1) Integrated and Collaborative Care; (2) Organisation and Delivery of Nursing and Midwifery Care in the Community; (3) Adjuncts to Nursing Care and (4) Overarching Conceptual Model. It is the latter theme that is the focus of this paper. In essence, the model depicts a person/client on a lifespan and preventative-curative trajectory. The health related needs of the client, commensurate with their point position, relative to both trajectories, determines the nurse or midwife intervention. Consequently, it is this need, that determines the discipline or speciality of the nurse or midwife with the most appropriate competencies.ConclusionUse of a conceptual model of nursing and midwifery to inform decision-making in primary/community based care ensures clinical outcomes are meaningful and more sustainable. Operationalising this model for nursing and midwifery in the community demands strong leadership and effective clinical governance.