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Perceptions of public health nursing practice On borders and boundaries, visibility and voice
Nordic Council of Ministers, Nordic School of Public Health NHV.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The aim of this comprehensive thesis is to explore different perceptions of public health nursing practice. The intention being to contribute to developing the service, theoretically and practically, in throe with current and future public health needs.

Methods: The thesis comprises five studies. Public health nurses, young people, parents and decision makers are interviewed and share their perceptions of public health nursing practice (studies I, II, III and IV). Consultations at local child health clinics, clinics for young people and at school health services are observed (study III). A cross sectional study amongst a sample of doctors, public health nurses, midwives and child protection workers is carried out (study V). The first four studies have an explorative, descriptive design. Study V, with its focus on interprofessional collaboration, is based on the results of studies I, II, and IV.

Findings: Study I, a case study, provides a backdrop for the remaining four studies. It focuses on changes the nurses have faced during the period 1984-2005. The results point to issues of visibility and that respect is more important for the nurses than authority or status. Study II is a philosophical study based on interviews with public health nurses. It gives an introduction to the philosophy of Emmanuel Levinas and develops a novel theoretical and practical understanding of aspects of responsibility in public health nursing. Study III shows the importance of relationships with service users in public health nursing practice; and that not only pleasantness but also honesty and openness are important. This study has contributed to further developing models of public health nursing interventions. Decision makers in study IV point to the challenges public health nurses face regarding collaboration, visibility and boundaries. Study V is a cross sectional questionnaire study that focuses on interprofessional collaboration. The results show that size of municipality can influence frequency of meeting points and views on issues relating to collaboration; and that mental health services are those most missed in collaborative relationships. The findings warrant further research and should be of interest when organising municipal health- and social services in Norway.

Conclusions: The thesis concludes that service users and decision makers are satisfied with public health nursing services, but that public health nurses face challenges related to collaboration, to boundaries for knowledge and involvement, and in making their health promotive function visible

Abstract [no]

Denne doktorgradsavhandling: Perceptions of public health nursing practice - on borders and boundaries, visibility and voice, fokuserer på ulike oppfatninger av helsesøsters praksis. Helsesøstre, ungdom, foreldre, samt lokale politikere og administratorer er intervjuet om deres syn på helsesøstertjenesten. Konsultasjoner på helsestasjon for barn, ungdom og i skolehelsetjenesten er observert. Et utvalg av samarbeidspartnere har svart på et spørreskjema om samarbeidsforhold. Avhandlingen består av fem studier. De første fire studier har eksplorativ, deskriptiv design. Studie V er en tverrsnittsstudie som bygger på resultatene fra studiene I,II, og IV. Avhandlingen har til hensikt å løfte frem områder som respondentene mener fortjener oppmerksomhet og som kan ha praktiske og teoretiske implikasjoner for utvikling av tjenesten. Studie I, en case studie danner et bakteppe for de andre studiene. Den fokuserer på endringer i helsesøstertjenesten i perioden 1984-2005. Resultatene fra denne studien peker på helsesøstrenes opplevelse av usynlighet og at respekt er mer viktig for helsesøstrene i studien enn autoritet og status. Studie II er en filosofisk studie basert på intervjuer med helsesøstre. Den gir en introduksjon til Levinas’ filosofi og utvikler en dypere forståelse for teoretiske og praktiske aspekter av etisk ansvar i helsesøsters praksis. Studie III peker på betydningen av relasjoner i helsesøsters praksis. Det var viktig at konsultasjonene var hyggelige for helsesøstrene og brukerne, men ærlighet og åpenhet var også vesentlig for gode relasjoner. Beslutningstakere i studie IV peker på utfordringer helsesøstre har når det gjelder samarbeid, usynlighet, samt grenser for deres kunnskap og involvering. Studie V er en spørreskjemaundersøkelse som fokuserer på samarbeid. Resultatene viser at kommunestørrelse har betydning for hyppighet av møtepunkter og syn på samarbeid og at psykiske helsetjenester er savnet mest i samarbeidsrelasjoner. Disse funn burde være av interesse i fremtidig organisering av helse- og sosialtjenester. Avhandlingen konkluderer med at foreldre, ungdom og beslutningstakere er fornøyde med helsesøstertjenesten, men at helsesøstre står overfor viktige utfordringer i samarbeidsrelasjoner, i forhold til grenser for involvering og i å synliggjøre deres helsefremmende funksjon

Place, publisher, year, edition, pages
Nordic School of Public Health NHV Göteborg, Sweden , 2009. , 98 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Report 2010:7
Keyword [en]
boundaries; children; Emmanuel Levinas; interprofessional collaboration; interpersonal relationships; Norway; parents; perceptions; public health nursing; visibility; young people
Keyword [no]
barn; Emmanuel Levinas; familier; folkehelse; grenser: helsesøstertjenesten relasjoner; tverrfaglig samarbeid; synlighet, ungdom
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3704ISBN: 978-91-85721-90-0 (print)OAI: oai:DiVA.org:norden-3704DiVA: diva2:785734
Public defence
2010-06-10, Nordic School of Public Health NHV, Göteborg, Sweden, 13:00 (Norwegian)
Opponent
Supervisors
Available from: 2015-02-05 Created: 2015-02-03 Last updated: 2015-02-05Bibliographically approved
List of papers
1. A profession under threat? An exploratory case study of changes in Norwegian public health nursing.
Open this publication in new window or tab >>A profession under threat? An exploratory case study of changes in Norwegian public health nursing.
2007 (English)In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 54, no 2, 197-203 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The first courses for public health nurses in Norway were held in the 1920s-1930s. In 1957, the Act regulating public health nursing was passed. Norwegian public health nurses have a primary role in promoting health and preventing illnesses. Their role has changed with a changing society. This article shows some of the challenges the nurses have faced. It focuses on collaboration, tasks, leadership and authority/status.

AIMS: The study's intentions are exploratory. It looks into how the nurses experience their changing role.

METHODS: A single case with an embedded design is the method chosen; the case is 'Changes in the role of the Norwegian public health nurse during the period 1984-2005'. Document analysis and interviews are sources of evidence.

FINDINGS: The findings show that public health nurses' visibility seems to be an important issue. There are some divergences between relevant literature on the nurses' professional status and the views of the nurses in the study. Several other public health professionals have lost tasks and formal positions of authority.

CONCLUSION: The nurses interviewed still feel that they are a respected and trusted profession despite being less visible. A recent study among parents who frequent local clinics confirms their important role. Can the nurses' lack of visibility have undesired outcomes? A profession that is unassuming, not visible and that fights silent battles may have problems being heard when it tries to promote issues concerning family health. Further studies are indicated.

Keyword
Explorative Case Study; Health Professions; Norwegian Public Health Nurses; Organizational Change
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3700 (URN)10.1111/j.1466-7657.2007.00519.x (DOI)17492995 (PubMedID)
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2017-12-05Bibliographically approved
2. Public health nursing and interprofessional collaboration in Norwegian municipalities: a questionnaire study.
Open this publication in new window or tab >>Public health nursing and interprofessional collaboration in Norwegian municipalities: a questionnaire study.
2013 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 3, 659-68 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to examine collaboration relating to public health nursing in different sized Norwegian municipalities. It sought to gain insight into factors that are important for successful collaboration, frequency of meeting points for collaborating activities and missing professionals in different sized municipalities. A cross-sectional e-post questionnaire study was carried out on a national sample of public health nurses and their collaborators. A total of 849 public health nurses (43.64%), 113 doctors at clinics and school health services (54.8%), 519 child protection workers (16.34%) and 115 midwives (41.3%) returned the questionnaire. The data were analysed using descriptive and inferential statistics. Analysis of variance (anova), Kruskal-Wallis H and chi-square tests were used to tests differences between groups. Trust, respect and collaborative competence were ranked highest by all the respondents and formalised structures, economy and leadership ranked least important in collaborative activity. The majority of the respondents stated that they do not have fewer meeting points compared with 5 years ago. Collaboration with mental health services was missed most by all respondents. There were associations between frequency of meeting points and statements on collaboration related to municipality size. Norway is in the throes of a major coordination reform. The fact that relational factors were deemed most important for successful collaboration is an important finding at a time when focus is on structural change. The findings indicate the need for further in depth qualitative studies on reasons for 'missing collaborators,' on professional cultures in different sized municipalities and on interpersonal relationships. Qualitative enquiry is necessary to gain a greater understanding of how relational concepts of respect, trust and conflict are understood by municipal public health professionals.

Keyword
interprofessional collaboration; Norway; municipal health and social services; public health nursing; primary care; questionnaire study; relational factors; structural factors
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3703 (URN)10.1111/j.1471-6712.2012.01079.x (DOI)23088191 (PubMedID)
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2017-12-05Bibliographically approved
3. Perceptions of public health nursing consultations:: tacit understanding of the importance of relationships
Open this publication in new window or tab >>Perceptions of public health nursing consultations:: tacit understanding of the importance of relationships
2010 (English)In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 11, no 4Article in journal (Refereed) Published
Abstract [en]

Aim This study aims to describe and reflect upon how a sample of nurses, parents and young people experience consultations at local clinics and school health services. Central to the concept of health promotion is ensuring that focus is on the empowerment of clients through dialogue and participation. This study aims to explore public health nursing consultations with this in mind.

Background Norwegian public health nurses are in contact with almost all families at the child health clinic. They meet children and young people at school health services and youth clinics; putting them in an important position to promote health and prevent illnesses.

Methods Participant observations and in-depth interviews are the methods chosen. The data were analysed using qualitative content analysis.

Findings The study shows that good relationships are not only sustained by pleasantness but also by honesty and directness, provided that the relationship is based on trust and sincerity. Continuity and trust in services seem paramount to the service users’ satisfaction. Service users were not always able to put the reason for their appreciation into words, just as the nurses had difficulty verbalising their strategies. Words often fall short when attempts are made to capture the essence of caring, trust and other life phenomena. Openness on agenda and focus on feedback from service users are important in order to ensure empowering services. Further studies should address the interconnectedness of the service and the subtleties of public health nursing consultations

Keyword
interpersonal relationships; Norway; perceptions; public health nursing; qualitative content analysis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3699 (URN)
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2017-12-05Bibliographically approved
4. 'Faced' with responsibility: Levinasian ethics and the challenges of responsibility in Norwegian public health nursing.
Open this publication in new window or tab >>'Faced' with responsibility: Levinasian ethics and the challenges of responsibility in Norwegian public health nursing.
2007 (English)In: Nursing Philosophy, ISSN 1466-7681, E-ISSN 1466-769X, Vol. 8, no 3, 158-66 p.Article in journal (Refereed) Published
Abstract [en]

This paper is concerned with aspects of responsibility in Norwegian public health nursing. Public health nursing is an expansive profession with diffuse boundaries. The Norwegian public health nurse does not perform 'hands on' nursing, but focuses on the prevention of illness, injury, or disability, and the promotion of health. What is the essence of ethical responsibility in public health nursing? The aim of this article is to explore the phenomenon based on the ethics of responsibility as reflected upon by the philosopher Emanuel Levinas (1906-1995). From an ethical point of view, responsibility is about our duty towards the Other, a duty we have not always chosen, are prepared for, or can fully explain; but it is nevertheless a demand we have to live with. Interviews with five experienced Norwegian nurses provide the empirical base for reflection and interpretation. The nurses share stories from their practice. In interpreting the nurses' stories, the following themes emerge: personal responsibility; boundaries; temporality; worry, fear, and uncertainty; and a sense of satisfaction. As the themes are developed further, it becomes apparent that, despite their diversity, they are all interrelated aspects of ethical responsibility. Responsibility for the Other cannot be avoided, ignored, or transferred. The nurses' responsibility is personal and infinite. Levinasian ethics can help nurses understand the importance of accepting that being a responsive carer can involve not only contentment in the predictable, but also the fear, worry, and uncertainty of the unpredictable.

Keyword
Levinas; responsibility; public health nursing; ethics
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3701 (URN)10.1111/j.1466-769X.2007.00311.x (DOI)17581243 (PubMedID)
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2017-12-05Bibliographically approved
5. Perceptions of public health nursing practice by municipal health officials in Norway.
Open this publication in new window or tab >>Perceptions of public health nursing practice by municipal health officials in Norway.
2009 (English)In: Public Health Nursing, ISSN 0737-1209, E-ISSN 1525-1446, Vol. 26, no 5, 412-20 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The objective of this study was to describe and analyze municipal decision-maker's views on public health nursing and to reflect upon and discuss the relevance of those views to the future of public health nursing in Norway.

DESIGN: This explorative qualitative study using face-to-face interviews is part of a larger project, comprising 5 studies, that explores perceptions of public health nursing.

SAMPLE: A purposeful sample of 11 municipal decision-makers was selected for interview during 2006-2007 to reflect variation in community size and perspective.

RESULTS: Thematic content analysis of the transcribed interviews revealed 4 content categories: contribution, collaboration, challenges, and visibility. The decision-makers expressed satisfaction with the public health nursing services, showed concern about lack of visibility and clear boundaries, and some expressed irritation over lacking collaboration. The interviewees elaborated on their past experiences as the public health nurses coworkers, leaders, collaborators, and service users.

CONCLUSIONS: The respondents recognized public health nursing's contribution to public health but they lack sufficient knowledge of its content and tend to take services at local health clinics for granted. Dialogue between nurses and decision-makers is necessary in order to ensure updated evaluation and continued development of public health nursing services.

Keyword
interdisciplinary collaboration; municipal health officials; Norway; nurse visibility; public health nursing
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3702 (URN)10.1111/j.1525-1446.2009.00799.x (DOI)19706124 (PubMedID)
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2017-12-05Bibliographically approved

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