Community and public health nursing practice: two new studies sound the alarm.

Richard, Lucie ; Beaudet, Nicole ; Gendron, Sylvie 等

Dear Editor,

The National Community Health Nursing Study (1) findings presented in the September/October 2009 issue of the CJPH offer an original and significant contribution in the realm of public health nursing in Canada. The analysis by Underwood et al. involves a threefold research approach (analyses of manpower data banks, questionnaire survey and discussion groups) that pinpoints several crucial issues, including the aging labour force; scarce replacement staff; inconsistency in the definition of work environments, services and occupational titles; and shortcomings in information systems. The study also highlights several factors that affect nursing practices, especially for nurses working in public health, such as government policies and programs, organizational culture and management practices.

The article is based on a nationwide sampling and does not present provincial and territorial profiles. A study conducted in Quebec at more or less the same time (the Pratiques infirmieres en prevention et promotion Project [PPP Project]) among nurses working in CLSC components of the recent CSSS corroborates several observations made by Underwood et al., at least from the standpoint of professional and contextual factors that affect nursing practices in community and public health. (2) Without undertaking a detailed comparative analysis, it appears that both studies underscore the need for continuing education initiatives to enhance professional development as well as increased networking opportunities between nurses and other professionals through various forums to further expand their practice. However, the PPP Project highlights additional conditions that are not reported by Underwood et al.: shortcomings in initial training in the domains of community and public health nursing, paucity of knowledge and competency with regards to the new public health and population-based approaches, (3) and nurses' mitigated roles in terms of programme planning and evaluation.

The past two decades have witnessed striking changes in public health practice with the emergence of new conceptual models and intervention approaches. (4,5) These changes have sweeping implications for public health workers and a number of initiatives are underway to ensure that professionals are fully able to assume the roles inherent in this new paradigm. (4,6-8) Nurses are working against a backdrop of staff shortages and appear to enjoy fewer opportunities to develop their practice in relation to the new public health as they are increasingly called upon to give clinical care to individuals and families. (4,9) However, in absolute numbers and proportionally, nurses represent the most prevalent workforce among public health professionals. (10) It is thus crucial to initiate broader research as well as policy and organizational interventions so that nurses in community and public health are fully able to contribute to the health of Canadians. The National Community Health Nursing Study and the PPP Project shed new light on unresolved issues and suggest concrete avenues for research and intervention.

REFERENCES

(1.) Underwood JM, Mowat DL, Meagher-Stewart DM, Deber RB, Baumann AO, MacDonald MB, et al. Building community and public health capacity: A synthesis report of the National Community Health Nursing Study. Can J Public Health 2009;100(5):I1-I11.

(2.) Beaudet N, Bisaillon A, Boisvert N, Boyer D, DeVilers L, Garceau-Brodeur MH, et al. Les pratiques infirmieres de promotion de la sante et de prevention dans une perspective de sante publique/populationnelle en CSSS: de la volonte a la realite...[Disease prevention and health promotion practices with a populational perspective in CSSS], 2008. Sur Internet : http://www.santepubmtl.qc.ca/ Publication/synthese/rapv11no2.pdf (Consulte le 4 janvier 2010).

(3.) Richard L, Gendron S, Beaudet N, Boisvert N, Garceau-Brodeur MH, Sauve MS. Health promotion and disease prevention among nurses working in local public health organizations in Montreal, Quebec. Public Health Nurs, in press.

(4.) Gebbie KM, Hwang I. Preparing currently employed public health nurses for changes in the health system. Am J Public Health 2000;90(5):716-21.

(5.) Kickbusch I. The move towards a new public health. Promotion et Education 2007;Suppl 2 (9):40-41.

(6.) Public Health Agency of Canada. Core Competencies for Public Health in Canada: Release 1.0, 2007. Available at: http://www.phac-aspc.gc.ca/ ccphcesp/pdfs/cc-manual-eng090407.pdf (Accessed January 25, 2010).

(7.) Community Health Nurses Association of Canada (CHNAC). Public Health Nursing Discipline Specific Competencies Version 1.0, 2009. Available at: http://www.chnc.ca/documents/competencies_june_2009_english.pdf (Accessed January 25, 2010).

(8.) Tilson H, Berkowitz B. The public health enterprise: Examining our twenty-first-century policy challenges. Health Affair 2006;25(4):900-10.

(9.) Grumbach K, Miller J, Mertz E, Finocchio L. How much public health in public health nursing practice? Public Health Nurs 2004;21(3):266-76.

(10.) Naylor D. Learning from SARS: Renewal of Public Health in Canada. Ottawa, ON: Health Canada, National Advisory Committee on SARS, 2003.

Lucie Richard, PhD *([dagger])

Nicole Beaudet, MSc *([double dagger])

Sylvie Gendron, PhD *([dagger])

E-mail: Lucie.Richard@umontreal.ca

* Faculte des sciences infirmieres, Universite de Montreal, Montreal, QC

([dagger]) IRSPUM (Institut de recherche en sante publique de l'Universite de Montreal), Universite de Montreal, Montreal, QC

([double dagger]) Agence de la sante et des services sociaux de Montreal, Direction de la sante publique, Montreal, QC