Young parents' understanding and actions related to the determinants of health.

Broad health determinants are accepted as key contributors to health; however, little is known about the public's understanding of these determinants. We describe the results of a survey of young parents (18-30 years) in Alberta regarding their understanding of determinants of health, and their actions (planned or undertaken) in promoting well-being and health for themselves, their families, and their communities. A telephone survey of young parents (N = 652) was conducted, using both open-ended and fixed response questions. In the open-ended responses, social support networks (46%) and personal health practices (40%) were most often cited as contributors to family well-being and health and as current actions (62% and 54% respectively). Health services were rarely mentioned as a contributor. Most frequently mentioned barriers to well-being and health related to income (36%) and coping skills (34%). Sub-sample differences by gender, age, income, and residence were detected. Fixed response questions indicated that parents rated a broad range of health determinants as "very important."

Fostering partnerships between peers and professionals.

One of the 5 principles of primary health care is public participation. Partnership between professionals and their clients is compatible with this principle. This article describes how professionals and peers can work together in support group interventions. Examples are cited from 3 intervention studies focused on myocardial infarction survivors and their spouses, parents of children with chronic conditions, and older women with disabilities. Each of the support groups entailed co-leadership by and partnerships between peers and professionals. The article describes the characteristics, roles, and training of peers and professionals; data collection involving peers, professionals, and participants; and pertinent intervention processes. Peers and professionals collaborated as co-leaders and partners in 21 support groups in the 3 studies. Participants expressed satisfaction with the leadership of the support groups. Moreover, professional facilitators and peer facilitators each acknowledged the important role and perspective of the other.

Advocating healthy public policy: implications for baccalaureate nursing education.

Advocating healthy public policy is increasingly recognized as an essential strategy for enhancing the health of populations. The purpose of this paper is to discuss the implications this priority area portends for the educational preparation of public health nurses (PHNs). Population health is central to public health nursing, and as such, it is imperative that PHNs employ policy advocacy strategies to influence positively the determinants that affect the health of populations. In this paper, we introduce the concept of healthy public policy and its relevance for public health nursing and baccalaureate nursing education. We outline substantive content areas that are fundamental to policy advocacy, such as determinants of health and their interrelationships, the policy process, and theoretical frameworks consistent with a socioenvironmental approach to health. In addition, we detail examples of specific learning experiences that provide students with opportunities to apply the content. Some of these activities include analysis of a population health issue, developing a position paper or resolution, writing letters to policy makers and the media, and working with lobbyists and policy makers.

A review of the research on the health of low-income Canadian women.

Reducing health inequities associated with poverty is an important public health nursing role. This article describes the scope of research on the health of low-income Canadian women. The research included was published in English-language peer-reviewed journals between 1990 and 1997. The 26 articles retrieved are summarized according to the focus of the study and the composition of the sample. Most addressed personal health practices and health status. Only one intervention study was identified. The studies and the findings of this analysis are discussed in relation to three recommendations for research on women's health: an emphasis on social context, including the structural conditions affecting women's health; active participation of women in the research process; and recognition of diversity among low-income women. Suggested priority areas for future research are: intervention studies; studies addressing the structural context of the lives of low-income women; research strategies that enhance the participation of women in the research process; and increased involvement of diverse groups of women such as homeless women and women of varied ethnic backgrounds, including First Nations women.

Public perceptions of the relationship between poverty and health.

The public's view on how poverty and health are related will influence support for different policies and programs. The purpose of this study was to examine public perceptions of the relationship between poverty and health and to identify demographic variables that predict support for the four explanations of the relationship between poverty and health (artifact, drift, behavioural, and structural) first identified in the Black Report in the United Kingdom. A telephone survey of a representative sample of Albertans (N = 1,216) was conducted. The majority of respondents believed that poverty leads to poor health. The explanation that health is influenced by the context in which individuals live (structural) received the most support. Demographic variables (sex, age, education, occupation, income, residence, conservatism) explained less than 10% of the variance for each of the four explanations, with conservatism the most consistent predictor.

Women's health and community health nursing practice in geographically isolated settings: a Canadian perspective.

In this article we examine the literature on women's health and community health nursing practice in geographically isolated settings from a Canadian perspective. An extensive review of journal literature, Canadian government documents and reports, and reports by women's organizations forms the basis of this examination. Following a brief introduction to the concept of geographical isolation, literature relating to women's health issues in rural and northern settings is described. This is followed by a discussion of community health nursing practice and women's health in rural and northern settings. The discussion section identifies major gaps in the literature and suggests implications for community health nursing practice and research, as well as strategies for policy and programming to improve women's health and community health nursing practice in geographically isolated settings in Canada.

Perceptions of changes in public health nursing practice: a Canadian perspective.

This paper describes public health nurses' perceptions of changes in their practice. The participants were 28 public health staff nurses from six Alberta, Canada health units serving urban and rural populations. Data were collected in 1993-94 using individual and focus group interviews. Content analysis was used to identify the following themes: "pulling back", "from hands on to arms length", "handing over responsibility", "developing working partnerships", and "doing less surveillance". These themes are discussed in terms of their implications for population health and for public heath nursing, using as a point of reference the principles of Primary Health Care. Continuing research is needed to chronicle further changes in public health nursing practice that will result from health care restructuring and health system reform.

Nursing research on the health of low-income women.

The purpose of this paper is to describe the scope of published nursing research on the health of low-income women. Williams' (1990) model of the relationship between socioeconomic status and health was used as a framework for the analysis. This model includes three major components: Medical Care, Psychosocial Factors, and Health Outcomes. There is a body of published nursing research that addresses a range of health issues of low-income women. Our search of English language literature published between 1989 and 1995 retrieved 49 articles that met the inclusion criteria. Most of the nursing studies examined a portion of Williams' model but did not address multiple components. The most frequently addressed component was Psychosocial Factors, particularly health practices, stress and coping, and social ties. Williams' model was an effective framework to classify nursing research. Results of our analysis suggest that further research is needed on the pathways by which low income influences health and on the effectiveness of nursing interventions.

Enhancing client competence: melding professional and client knowledge in public health nursing practice.

Providing health information is an important aspect of public health nursing. This article describes how public health nurses (PHNs) give information to enhance client competence. The findings are part of a larger study that explored PHNs perspectives and experiences of their practice. The study employed an exploratory descriptive qualitative research design. Data were gathered through in-depth individual and focus group interviews with 28 PHNs in Alberta, Canada. Content analysis revealed that nurses work to enhance client competence by sharing professional knowledge and by building on the client's experiential knowledge. Nurses provide information to assist clients with immediate concerns and for future use, PHNs use three main strategies to deal with immediate concerns: being direct, providing options, and presenting a different view. Information for future use focused on enhancing development and forestalling future problems. Nurses build on clients' experiential knowledge by acknowledging their present situation, giving positive feedback, being there, and gently persuading. The authors suggest that the melding of professional and client knowledge is foundational to health promotion approaches that enhance client competence. There is a need for further research that explores the intricacies of developing partnerships between professionals and clients that embrace a sharing of professional and experiential knowledge.

Socialization into nursing: nursing students as learners.

In this article, we describe how the functionalist and interactionist approaches to socialization are exemplified in the learning experiences of nursing students in a 4-year baccalaureate program. A qualitative longitudinal exploratory research design was used to study the socialization of baccalaureate nursing students in a large western Canadian university. The findings suggest that student learning reflects a combination of functionalist and interactionist approaches, with the relative emphasis of each approach varying over the 4 years. In the first year, functionalist learning predominates as students learn the "ideal." In second and third year, students are confronting and adapting to reality, which requires a more interactionist approach. Fourth year students look beyond their practice situation as they anticipate and prepare for a reality beyond the student world. This article concludes with implications for nursing education.

A critical review of the literature on sharps injuries: epidemiology, management of exposures and prevention.

This article reviews the literature related to the epidemiology, prevention and management of sharps injuries in health care workers, particularly nurses, and the subsequent risk of harm. The studies are reviewed chronologically, beginning with the efforts to reduce sharps injuries by changing behaviours, followed by the introduction of barriers to protect the caregiver, and finally, the engineering of safer products. Initial efforts to prevent sharps injuries focused on placing rigid, disposal containers at the site where sharps were used and instructing health care workers to refrain form the practice of recapping. When these interventions were shown to alter the type, but not the overall number, of sharps injuries, alternative measures were sought. This search intensified with the increasing evidence of the small, but measurable, risk of the transmission of human immunodeficiency virus from sharps injuries. The current knowledge of the factors related to sharps injuries has been collected primarily through retrospective surveillance. This surveillance has been conducted primarily in hospital settings and has focused on the type of sharp and the purpose for which it was used rather than prospective research. Research is now needed to elucidate the organizational and behavioural factors leading to sharps injury both within the hospital as well as other health care settings. The implications for nursing practice are discussed.

Perceptions of public health nursing: views from the field.

While there has been considerable debate about future roles for public health nurses, there is little research that explores public health nursing from the practitioner's perspective. The findings reported in this paper are part of a larger study that explored public health nurses' perspectives and experiences of their practice: what they do and how they feel about what they do. Qualitative data were gathered through in-depth individual and focus group interviews with 28 female public health nurses (PHNs) in Alberta, Canada. This paper describes how PHNs feel about their work. The analysis revealed that public health nurses perceived that their work was valuable and worthwhile, enjoyable, demanding, and not well understood by others. These perceptions are discussed in terms of their implications for the future role of public health nursing in a reformed health care system and for the quality of nursing worklife.

Using critical feminist principles to analyze programs for low-income urban women.

Public health nurses are committed to promoting the health of vulnerable populations, including the economically disadvantaged. One of the perspectives that can be used to work with low-income women is feminist theory. In this paper, we analyze program descriptions from 45 community agencies whose services are accessed by urban low-income women. The purpose of the analysis is to identify congruence between agency programs and selected feminist principles. As a result of the content analysis, empirical referents and examples were identified for each principle. Public health nursing programs can incorporate feminist principles by responding to the perspectives of the vulnerable and facilitating their efforts to change the conditions that led to their vulnerability. Questions are presented that could guide public health nurses in stimulating reflection and in facilitating dialogue in the process of developing programs for low-income women.

Managing occupational HIV exposures: a Canadian study.

The findings reported in this paper are part of a larger study that explored how nurses cope with the risk of acquiring HIV infection while caring for persons with AIDS (PWAs). The data were collected through in-depth interviews with 13 nurses who cared for PWAs in a large Western Canadian hospital. Seven of these nurses perceived that they had been exposed to HIV-infected blood or body fluids. This paper describes how these seven nurses coped with actual exposures to HIV-infected blood or body fluids. Data were analyzed using the methodology of grounded theory. Nurses' coping efforts after exposure were grouped into four categories: minimizing the effect of exposures, reducing a sense of vulnerability, selective disclosure to others, and assigning meaning. Nurses minimized the physical effects of exposure through measures such as 'bleeding' the needlestick injury and immersing the affected area in bleach solution. Nurses reduced their sense of vulnerability by assessing the possibility of harm, avoiding situations that aroused fear, and confronting the decision for HIV testing. Nurses limited their disclosures to co-workers to avoid rejection and to preserve professional self-esteem. Disclousre to significant others was influenced primarily by the support nurses perceived they would receive. Finally, nurses attempted to assign meaning to the exposure by determining why the event occurred and by evaluating the implications it has had on their lives. The article concludes with implications for nursing practice.

Students' evolving beliefs about nursing: from entry to graduation in a four-year baccalaureate programme.

Students become socialised into nursing during an educational programme through interaction with faculty members, classes and seminars, and by the experience of practicing nursing. In this paper, some results from a qualitative study that examined the socialisation of nursing students from one four-year baccalaureate programme are described. The changes in the students' attitudes and values are presented. Davis' (1975) theory of doctrinal conversion is used to examine progress in the process of socialisation. There is evidence that students moved from a lay to a professional image of nursing over the course of their four-year programme. While they tended to remain idealistic, elements of realism were evident in the final year as they looked toward their role as a registered nurse and recognised the constraints inherent in the hospital system.

Learning to nurse in the clinical setting.

The findings reported in this paper are part of a larger study examining student socialization into nursing. In analysing the data, it became evident that two major factors influenced the students' learning in the clinical setting: the first was the clinical instructor, the second peer support. Instructors who were organized, encouraging, outgoing, and who had good relationships with students, patients and nursing staff were seen as 'good' role models. When instructors were unable to establish rapport on a unit, negative feedback from nursing staff could be detrimental to student learning. Peer support encompassed three dimensions: facilitating learning, providing emotional support, and assisting with physical tasks. There was evidence that practising faculty had a stronger influence in shaping students' attitudes towards nursing than classroom teachers.