Showing papers in "Public Health Nursing in 1988"
TL;DR: A beginning theory of independence through self-care and client involvement emerged from the data analysis, and it was suggested that to promote healthy aging, nursing interventions should be directed toward aggregate populations.
Abstract: In this research project we explored beliefs about healthy aging in an Appalachian community. A major goal was to develop theory for community health nursing interventions that promote and maintain health during the aging process. A convenience sample of 105 community informants responded to an open-ended interview schedule that elicited beliefs and values of health and aging. The data were analyzed for the purpose of producing grounded theory; a major category that emerged portrayed the aging process as a collection of attitudes about oneself. Health was described as feeling good and being able to enjoy life. The informants reported that health is maintained by good nutrition, exercise, and an environment that is safe and promotes individual growth and development. A beginning theory of independence through self-care and client involvement emerged from the data analysis. A second component of the theory suggested that to promote healthy aging, nursing interventions should be directed toward aggregate populations. Nursing interventions that are grounded in the understanding of cultural beliefs and practices are likely to be more beneficial to clients than those that ignore or displace such beliefs and practices. This theory has the potential of being extended to a variety of settings.
19 citations
TL;DR: Survey research was designed to measure the job satisfaction of the public health nurses, and high levels of job satisfaction were associated with increased educational preparation, increased age and longevity, administrative positions, and program assignment in tuberculosis or child health.
Abstract: To provide empirical data for dealing with problems of low morale and high turnover in a few districts of a state public health nursing department, survey research was designed to measure the job satisfaction of the public health nurses. Questionnaires that measured satisfaction with 12 job components were received from 741 nurses for a 68 percent response rate. Top-ranked satisriers were job importance, interpersonal relations, and achievement. Lowest-ranked satisfiers were job mechanics, recognition, and salary/benefits; administrative interventions were developed to deal with these areas. High levels of job satisfaction were associated with increased educational preparation, increased age and longevity, administrative positions, and program assignment in tuberculosis or child health.
17 citations
TL;DR: A more comprehensive view of elder abuse is possible when this problem is placed in the context of a family caregiving paradigm.
Abstract: Elder abuse is one of the most complex, difficult, and frustrating problems that practicing public health nurses face. In part this frustration is related to the lack of fit between the family violence paradigm (the explanatory base most commonly used to guide case identification and intervention) and the types of abuse most commonly encountered. Several issues are raised when this paradigm serves as the exclusive basis for concepts about elder abuse. A more comprehensive view is possible when this problem is placed in the context of a family caregiving paradigm.
16 citations
TL;DR: Difficulties include confusion about the domain of community health nursing, inadequate definition of key concepts, inappropriate competition among research methodologies, unpredictable collegial and financial support, and inattention to the dissemination of research findings in practice environments.
Abstract: Assessing the impact of community nursing services is critically important. It is, however, problematic. Difficulties, some germane to the general assessment of the impact of nursing service and others specific to community-oriented nursing practice, include confusion about the domain of community health nursing, inadequate definition of key concepts, inappropriate competition among research methodologies, unpredictable collegial and financial support, and inattention to the dissemination of research findings in practice environments.
16 citations
TL;DR: Reformulation of concepts from public health to be consistent with concepts of person and environment, replacing the concept of illness with that of health, and using methods for study of aggregates are strategies for achieving a synthesis of these two bodies of knowledge.
Abstract: The American Public Health Association (APHA) and the American Nurses' Association (ANA) have gone on record to define public health nursing as a synthesis of knowledge (APHA) and practice (ANA) from nursing and public health. If this synthesis is to be consistent with nursing, knowledge will have to be congruent with the concepts of nursing's metaparadigm. Disease is not included within the concepts of person, environment, health, and nursing. The focus of the public health tradition is reflected in the concepts of the epidemiologic model (agent, host, environment). Disease and its prevention are the focus of public health science. Reformulation of concepts from public health to be consistent with concepts of person and environment, replacing the concept of illness with that of health, and using methods for study of aggregates are strategies for achieving a synthesis of these two bodies of knowledge.
16 citations
TL;DR: The discrepancy in number of mothers receiving help from fathers with infant care and household tasks and mothers perceiving help from them as supportive was significant in the last three study periods, and with time fathers' supportive help with household tasks decreased.
Abstract: This study explored help with infant care and with household tasks from the infant's father and grandparents that mothers reported throughout their infant's first quarter-year, the extent to which help was perceived as a support and its lack as a stressor, and the difference that maternal experience made in holding this view. Participating mothers were interviewed biweekly concerning sources of help with infant care and household tasks (received help), and kept a daily log for the first 90 days after their healthy infant's birth that included supportive (e.g., help with infant care) and stressor (e.g., lack of help with household tasks) events. Received help varied by type (infant care or household help) and by source (father or grandparent). Help with infant care was more frequent than help with household tasks, and help from fathers was more frequent than help from grandparents for all six 15-day study periods. Lack of help was infrequently reported as a stressor, and only in the first 30 days. The discrepancy in number of mothers receiving help from fathers with infant care and household tasks and mothers perceiving help from them as supportive was significant in the last three study periods. Parity did not significantly affect either received or supportive help from fathers; however, with time fathers' supportive help with household tasks decreased. Study of mothers' expectations for help with infant care and household tasks from fathers and grandparents is needed to clarify these findings.
16 citations
16 citations
13 citations
TL;DR: Study findings pointed to a high frequency of health-promotion activities, with 98 percent of the respondents reporting this type of care delivered during the reporting day, including health screening, nutrition information, exercise counseling, family planning, education, and risk factor analysis.
Abstract: The evolution of advanced nursing practice over the past several decades has stimulated a number of studies of the activities of nurses specializing in the area of primary health care. These studies have ignored the nursing component of nurse practitioners' role in the areas of health care coordination, health promotion, health education, and counseling. We examined the extent to which nurse practitioners reported involvement in these areas in their practices. Study findings pointed to a high frequency of health-promotion activities, with 98 percent of the respondents reporting this type of care delivered during the reporting day, including health screening, nutrition information, exercise counseling, family planning, education, and risk factor analysis. The most common coordination activities were referrals for mental health, social work or drug rehabilitation, vision services, alcohol problems, and hearing services. Overall, study results supported the assertion that nurse practitioners considered that they provide their clients with a wide array of coordination, health-promotion, health-education, and counseling services within a nursing framework.
13 citations
TL;DR: A patient-classification system was developed by the authors to meet the need for a means of quantifying nursing care requirements in a home health setting and is currently undergoing further field testing in the agency.
Abstract: Home health agency nurses are caring for greater numbers of acutely ill patients than ever. Because patient requirements are so diverse, it has become difficult to predict the amounts and types of nursing care specific patients must have. To meet the need for a means of quantifying nursing care requirements in a home health setting, a patient-classification system was developed by the authors. The purpose of the present study was to test the reliability and validity of the system in actual use. Staff nurses in the Visiting Nurse Association of Los Angeles, Inc, completed patient classification forms for 408 home visits. Seventy-five of these visits were then scored by a second nurse who used patients' medical records as a data source. Agreement between raters ranged from 35 to 100 percent for specific instrument items. When patients were classified into one of five groups, 69 percent of the visits were accurately predicted. Using this information, the instrument was revised and is currently undergoing further field testing in the agency.
12 citations
TL;DR: The findings revealed that self-concept was the best predictor of loneliness in this sample and that the prediction of loneliness was strengthened in the presence of a weak future time perspective.
Abstract: The purpose of this study was to examine the relationship of self-concept and future orientation to loneliness in a group of pregnant teenagers. Pregnant teenagers attending public health clinics for prenatal care were asked to participate in the study. Subjects completed the Revised UCLA Loneliness Scale, the Heimberg Future Time Perspective Inventory, and the Tennessee Self-Concept Scale. Data analysis revealed a significant negative correlation between self-concept and loneliness and a significant negative correlation between future time perspective and loneliness. Stepwise multiple regression analysis indicated that self-concept and future time perspective together explained 38 percent of the variance in loneliness. The findings revealed that self-concept was the best predictor of loneliness in this sample and that the prediction of loneliness was strengthened in the presence of a weak future time perspective.
TL;DR: The data suggest that the PHN service significantly increased the number of health assessments received in this population of low-income children.
Abstract: Customary public health nursing (PHN) field services such as telephone contacts and home visits to motivate clients to positive health behaviors have not been examined adequately as to outcome. This experimental study investigated the effect of PHN intervention in a preventive child health program. Eight PHNs applied the independent variable (telephone call or home visit) to the experimental group employing a checklist. Using a matched pair design, cases and controls were tracked for receipt of health assessments (dependent variable). The data suggest that the PHN service significantly increased the number of health assessments received in this population of low-income children.
TL;DR: The similarities and differences between nursing an individual as client and nursing a family as client when one uses the Betty Neuman systems model as a guide to practice are identified.
Abstract: This paper identifies the similarities and differences between nursing an individual as client and nursing a family as client when one uses the Betty Neuman systems model as a guide to practice. Several factors contribute to the decision to initiate an individual- or a family-centered approach. Within the context of the Neuman systems model, a clinical situation illustrates several characteristics that highlight features of the two approaches.
TL;DR: Analysis of data generated in home interviews revealed three major themes related to the experience of home health care: nursing care, health problems, and independence.
Abstract: Changes in the health care delivery system resulting in increased need for home health services have led to greater involvement of public health nurses in defining practice and developing research in this area. Gaining an understanding of the experience of home health care from the perspective of frail older clients was the purpose of this investigation. An ethnographic study was conducted with nine older adults recently discharged from home health services. Analysis of data generated in home interviews revealed three major themes related to the experience of home health care: nursing care, health problems, and independence. Informants emphasized the reassurance and support given by nurses, yet did not readily identify teaching as part of the nurses' role. Several health problems were mentioned, emphasizing the experience of declining health and loss of independence. Although initially assistive, home health care was perceived to support dependency as the patients became more well and able to undertake self-care.
TL;DR: The purpose of this historical research was to analyze the liaison between business and the profession of nursing, identifying factors that served as an impetus for the origin, growth, and decline of the Metropolitan Visiting Nurse Service.
Abstract: In the winter of 1909, Metropolitan Life Insurance Company, a large company within the private sector, identified visiting nurses as a means of lowering mortality rates, while improving the image of the company. Although initially associated with the nurses of Lillian Walds Henry Street Settlement House, the Metropolitan Visiting Nurse Service eventually formed an alliance with over 650 Visiting Nurse Associations across the United States, caring for over 30 million policy holders. The purpose of this historical research was to analyze the liaison between business and the profession of nursing, identifying factors that served as an impetus for the origin, growth, and decline of the Metropolitan Visiting Nurse Service. Data were gathered in the Metropolitan Life Insurance Company Archives; the Visiting Nurse Association Archives of New York and Chicago; the New York Public Library; Chicago Historical Society; Schlesinger Library at Radcliffe College in Cambridge, MA; Haven Emerson Public Library in New York; National League for Nursing Education Historical Collection in New York; Walter Library, University of Minnesota, Minneapolis, MN; American Public Health Association Historical Collection, Washington, DC; and Special Collection of Virginia Commonwealth University in Richmond, VA. The results indicate that visiting nurses were masters of improvisation, demonstrating clinical excellence under demanding conditions. Although both nursing and business leaders demanded efficiency, nursing focused on quality of nurses, while business viewed cost of a nursing visit as the priority. Unfortunately for the profession, increased educational sources for nurses coupled with declining volume of visits drove the cost of a nursing visit higher than Metropolitan was willing to pay. Consequently, in 1950 Metropolitan made the decision to terminate the service. In a time when the nursing profession seeks both clinical excellence and cost containment, this study uses the past to stimulate questions about the future: Can the nursing profession provide quality care in an era where cost of care is emphasized? Can the profession use the knowledge and principles of the business world to reach mutually satisfying goals of quality patient care and cost effectiveness? Can nursing balance the values inherent in achieving a cost/care attitude?
TL;DR: There seems to be consensus that the concepts of family-centered care, health maintenance/promotion, community, levels of prevention, holism, continuity of care, epidemiology, self-care, population-based care, and home health care constitute the theoretical base of public health nursing education.
Abstract: A national study was conducted to determine what constitutes baccalaureate public health nursing education. The primary focus of this article is the essential concepts in the education of public health nursing. The assumption was that an ideal curriculum represents a knowledge base that is acceptable to members of the profession based on an accepted paradigm. Data were collected using a mailed questionnaire distributed to all National League for Nursing-accredited baccalaureate programs and completed by the person responsible for the public health nursing curriculum. The questionnaire obtained information related to theory and practice objectives. A response rate of 82 percent (N= 275) was obtained after follow-up mailings and telephone calls. Content analysis of responses allowed us to identify 11 concept areas considered essential and receiving great or some emphasis by more than 90 percent of the respondents. There seems to be consensus that the concepts of family-centered care, health maintenance/promotion, community, levels of prevention, holism, continuity of care, epidemiology, self-care, population-based care, and home health care constitute the theoretical base of public health nursing education. These results were compared with results offered by the Consensus Conference report. Public health nursing educators are encouraged to continue to define what constitutes baccalaureate preparation for public health nursing.
TL;DR: A health needs assessment of inner-city, low-income adolescents was conducted by the staff of a nurse-managed, community-oriented primary care clinic, and survey results were used for decision making, program planning, and implementation of a teen health clinic.
Abstract: A health needs assessment of inner-city, low-income adolescents was conducted by the staff of a nurse-managed, community-oriented primary care clinic. A multiethnic sample of 568 high school students was studied. The findings indicated that the most commonly used source of health care was the family doctor. Barriers to receiving care were fear and costs. Subjects reported insufficient knowledge about many health-related topics, and desired services in the areas of drug and substance use, reproduction and sexuality, family relations, mental health, and dental health. Eighty-four percent of the subjects were interested in using the services of a neighborhood clinic specifically for teens. Survey results were used for decision making, program planning, and implementation of a teen health clinic.
TL;DR: The relationships of organizational process and productivity in 20 nursing work groups in a sample of local health departments in North Carolina were evaluated, together with implications of findings for strategies to improve the functioning of Nursing work groups.
Abstract: A major determinant of organizational productivity is the design of structures and processes within a functioning organization. Research has focused on structures that contribute to productivity, but has given much less attention to the processes that occur particularly in health service organizations. We examined the relationships of organizational process and productivity in 20 nursing work groups in a sample of local health departments in North Carolina. Analysis focused on level of organizational climate (communication flow, decision-making practices, motivational conditions, concern for human resources), leadership behaviors, and quality of group interactions. The relationships of these processes to productivity (number of services produced per unit of staff time available) across a series of major departmental services were evaluated, together with implications of findings for strategies to improve the functioning of nursing work groups.
TL;DR: The results of the first interview of the 662 females who composed the sample for the study are described, including the following characteristics of a minority, high-risk population: health orientation, health beliefs about their unborn babies, and use of health services.
Abstract: This article reports on initial findings of a continuing longitudinal study investigating the relationships of health beliefs as conceptualized by the health belief model and the use of well-baby services among first-time black mothers. The health beliefs of mothers about their babies were measured before the babies were born and during their use of the services at the baby's first and sixth-month visits. Mothers in the sample who became nonusers of the well-baby services were also interviewed. This report describes the results of the first interview of the 662 females who composed the sample for the study, including the following characteristics of a minority, high-risk population: health orientation, health beliefs about their unborn babies, and use of health services. These findings are discussed with implications for community health nursing practice with maternal clients.
TL;DR: Overall, occupational health nurses and medical society physician members were similar on many aspects of their counseling, although some significant differences did exist.
Abstract: The purpose of the study was to validate an instrument that measures health counseling practices of occupational health nurses The measure, the health habits counseling questionnaire (HHCQ), was derived from a model of physician counseling practices The health habits included smoking, alcohol, weight management, and exercise Safety at work was added for this random sample of California occupational health nurses Reliability was comparable to original findings for a random sample of physicians drawn from the roster of a western medical society The validity of the hypothesized global constructs of aggressiveness and indications was not supported Physicians in the normative sample were more likely to use primary prevention as an indication for counseling Overall, occupational health nurses and medical society physician members were similar on many aspects of their counseling, although some significant differences did exist
TL;DR: Public health nurses' assessment of infants for established, biologic, and environmental risk was examined in a retrospective analyses of records and led to recommendations for improve documentation and future continuing education.
Abstract: Public health nurses' assessment of infants for established, biologic, and environmental risk was examined in a retrospective analyses of records. Findings indicated that nurses assessed infants for selected risk factors and growth and development, but did not comprehensively assess for en vironmental risk. This led to recommendations for improvec documentation and future continuing education.
TL;DR: Mothers tended to rely more on their traditional family networks and reading, and less on their doctors and the CHN for informational support during the postpartum, suggesting the importance of clarifying the role of CHNs to the public, and of recognizing the important of the interpersonal dimension of that role.
Abstract: This exploratory study examined the perceptions and use of services provided by community health nurses (CHNs) for two groups of rural mothers sampled one year apart. The stratified samples (30 primiparas, 20 multiparas in each group) consisted of mothers who had normally delivered a healthy, full-term infant in a small regional hospital. A short-term, longitudinal design was used to determine mothers' pre-discharge perceptions of the need for services provided by CHNs; perceptions and use of services at one week postdis-charge and six weeks' postpartum; and variables related to mothers' willingness to initiate seeking information/support from CHNs. All but two mothers had received at least one CHN visit by six weeks' postpartum. The majority were positive about these visits. Most identified a general checkup of the baby or a check of the weight or cord as the most useful services. Only 32 and 26 percent of the women, respectively, had initiated contact with their CHN during this time, and active information seeking was not significantly related to their reports of problems during the postpartum. Mothers tended to rely more on their traditional family networks and reading, and less on their doctors and the CHN for informational support during the postpartum. Mothers' degree of familiarity with CHNs was an important variable in initiating contact. These and related findings suggest the importance of clarifying the role of CHNs to the public, and of recognizing the importance of the interpersonal dimension of that role.
TL;DR: A pilot study to determine the reliability of a classification index for well mothers and children in community health nursing practice indicated that Cronbach's alpha was 0.98 for the composite index and that the internal consistency for each of the six component subscales in the index ranged from 0.91 to 0.
Abstract: Community health nurses in county health departments continue to provide disease-prevention and health-promotion services to mothers or families with children who are considered well. We lack available instruments with demonstrated reliability that can classify the nursing problems of these clients by type and seventy. The purpose of this pilot study was to determine the reliability of a classification index for well mothers and children in community health nursing practice. The study indicated that Cronbach's alpha was 0.98 for the composite index and that the internal consistency for each of the six component subscales in the index ranged from 0.91 to 0.98.
TL;DR: The author offered the caveat “… this sketch of public health nursing literature cannot in any sense be considered exhaustive,” but one cannot help being impressed with the amount and quality of writing published during these years.
Abstract: Historical Reprint
The annotated bibliography, in edited version, that follows was first published in its entirety 62 years ago in Public Health Nurse; February 18(2):83-90, 1926. It was first presented as a paper at the Fifth International Congress of Nurses, in Helsingfors, Finland, July 1925. The author, and editor of the journal, Ada M. Carr, acknowledged the assistance of Lavinia Dock, Adelaide Nutting, and A. M. Peterkin. The latter was general superintendent, Queen Victoria's Jubilee Institute for Nurses, London, England. For convenience, Carr divided the literature review into three time periods: 1860-1900, 1901-1912, and 1913-1925. Although she offered the caveat “… this sketch of public health nursing literature cannot in any sense be considered exhaustive,” one cannot help being impressed with the amount and quality of writing published during these years.
Ruth N. Knollmueller, M.P.H.
Historical Editor