Street-level bureaucracy and policy implementation in community public health nursing: a qualitative study of the experiences of student and novice health visitors.

Aim To explore the experiences of student and novice health visitors in implementing health visiting policy reform pre- and post-qualification. BACKGROUND: In England, public health nursing has been subject to major policy reform. The Health Visitor Implementation Plan (2011) set out a plan to recruit increasing numbers of nurses and midwives to the profession to deliver an expanded and refocussed health visiting service. Exploring this policy change from the viewpoint of those new to health visiting offers a unique perspective into how a specific policy vision is translated into nursing practice. METHODS: A descriptive qualitative study in which participants were enrolled on a one-year post-graduate health visiting course at a University in South West of England. Qualitative data were collected pre- and post-qualification. A total of 16 interviews and a focus group were conducted with nine participants between September 2012 and March 2013. Findings Descriptive data were interpreted using Lipsky's theoretical framework of street-level bureaucracy. Three themes emerged which relate to this 'bottom-up' perspective on policy implementation; readiness to operationalise policy, challenges in delivering the service vision; and using discretion in delivering the vision. Community public health nurses operate as street-level bureaucrats in negotiating the demands of policy and practice, and by this means, attempt to reconcile professional values with institutional constraints. Barriers to policy implementation at a local level mediate the effects of policy reform, ultimately impacting upon outcomes for children and families.

Covert administration of medicines: a contentious issue.

In its State of Care (2015) report the Care Quality Commission once again highlight unsafe management of medicines as a key concern in those care providers that require improvement. Underpinning the poor management of medicines is the unsafe and routine use of covert administration. In this article Richard Griffith looks at the legal and professional obligations for district nurses when they consider advising the use of covert medicines.

[A qualitative study on perceived changes and improvement in the current state of public health activities of public health nurses in Hokkaido, Japan].

OBJECTIVES: This study aimed to clarify perceived changes in the current state of public health activities by Japanese public health nurses, and further to gather their ideas and proposals for coping with changes from a public health point of view considering the community as a whole. METHODS: Three separate focus group discussions (FGD) were conducted among public health nurses who had at least five years work experience at prefectural public health centers or municipalities in Hokkaido, Japan. Dialogs were analyzed using the qualitative research method developed by Berelson. RESULTS: Changes in the current work situation that twenty four public health nurses perceived through the FGD were categorized into the following five categories, along with their opinions on how to cope with them. First, both the system and curriculum at nursing schools in Japan have recently changed and issues remain on postgraduate education for newly graduated public health nurses as well as those with more experience. Second, job content has been transformed because of public health reform, which resulted in a growing burden on public health nurses due to an increase in workload, collaboration with clerical staff, and allocation of designated tasks. Increased liaison with office staff and regional personnel was suggested as a solution for coping with the work burden. Third, psychological changes in public health nurses were emphasized, especially worry and anxiety arising from changes in their social role, motivation and community health activities. To overcome such a distressed mental state, they believed they needed to improve awareness of their capability as public health specialists, with better real communication among themselves. Finally, focus group members identified how prefectural and municipal health systems as well as the sense of community had gradually changed. Strengthening interactions both between and within systems as well as acting locally were acknowledged as means of mitigating the disadvantages of change. CONCLUSION: This study indicated that to deal with the drastically changing situation in the current community health system, postgraduate education promotion for public health nurses, a redefinition of their mission with more emphasis on self-motivation, sharing worries among colleagues, reinforcing communication with clerical staff as well as the institutions and people concerned, and a reconstruction of the relationship between municipalities and provincial public health centers may be necessary.

Legal basis for standards of driving with diabetes.

The tragic case of a district nurse killed when a car driven by a man in a hypoglycaemic state struck her while she took her regular evening walk highlights the dangers that can occur when a person with diabetes drives without regard to their condition. The man was later jailed for four and a half years for causing death by dangerous driving having been found criminally responsible for his actions because he failed to control his blood sugar levels during the journey (Valek, 2007). This article considers the legal basis for the medical standards for driving imposed on individuals with diabetes and sets out the likely consequences of failing to comply with those standards.

The ethics of sin taxes.

ABSTRACT The current global economic crisis is forcing governments to consider a variety of methods to generate funds for infrastructure. In the United States, smoking-related illness and an obesity epidemic are forcing public health institutions to consider a variety of methods to influence health behaviors of entire target groups. In this paper, the author uses a public health nursing model, the Public Health Code of Ethics (Public Health Leadership Society, 2002), the American Nurses' Association (ANA) Code of Ethics (2001), and other relevant ethical theory to weigh and balance the arguments for and against the use of sin taxes. A position advocating the limited use of sin taxes is supported as a reasonable stance for the public health professional.

[Community health and social action in the epidemiologic control of infantile trachoma, Spain (1932-1939)]. / Salud comunitaria y acción social en el control epidemiologíco del tracoma infantil, España (1932-1939).

Within the context of the endemic trachoma that affected different regions of Spain until the 1960s, this paper analyses the epidemiological determinants of child trachoma and its treatment, based on a preventive care model which incorporated the concept of community health that took shape during the interwar period. Early detection of cases, together with preventive measures, education, therapy and inspections, such as those carried out by visiting nurses, all helped to control the disease. Our results reaffirm the validity of the horizontal intervention strategies used for improving the sanitary conditions and environmental factors responsible for this prevalence of trachoma.

Consent and capacity: a guide for district nurses.

The Mental Capacity Act 2005, which came into force in 2007, sought to provide a statutory framework to facilitate empowerment and provide protection to individuals who lack capacity. District nurses must be aware of the legislation regarding mental capacity (Nursing and Midwifery Council, 2008) and understand how and when they may need to assess decision-making capacity. The article explores the legal and ethical issues surrounding consent, and seeks to inform district nurses as to the guidelines used in assessing a person's capacity to consent, along with best interests policy.

Flexible working requests and the law: a guide for district nurses.

Flexible working provides employees with the ability to make it easier to balance work and caring responsibilities. All qualifying employees, including those who are district nurses, have a right to request an adjustment to their working hours and work patterns. Where the request is refused an appeal can be made to an employment tribunal and further action can be considered on the grounds of discrimination.

[The professionalization of nursing in Argentina: political and institutional disputes during Peronism.]. / La profesionalización de la enfermería en Argentina: disputas políticas e institucionales durante el Peronismo.

This paper discusses the professionalization of nurses in Argentina during Peron's administration (1946-1955). We will focus on two nursing schools during such period: Escuela de Engermas de la Secretaría de Salud Pública (1947) and Escuela de Enfermeras "7 de mayo" member of Fundación Eva Perón (1950). We will analyze the institutional disputes over budgetary positions in the context of greater government intervention in public health issues.

The influence of human rights on district nurse practice.

In the decade since its introduction, the Human Rights Act 1998 has had a profound effect on the way district nurses practice. New laws underpinning the principles and obligations of human rights law have seen a gradual legalisation of health care and a reigning in of the discretionary powers of health professionals such as district nurses.This article reflects on the Human Rights Act 1998's influence on district nurse practice.

Assisted suicide: increased support for a change in the law.

Calls for a change in the law to allow strictly controlled forms of assisted dying in the UK continue following a recent attempt to change the law and an announcement by the Royal College of Nursing that it was shifting its position on the issue from opposition to a neutral stance. In this article Richard Griffith and Cassam Tengnah review the current stance of the law on assisted dying and discuss laws that allow assisted dying in Australia, Europe and the USA.

The law and grievance resolution in the workplace: a guide for DNs.

Disputes at work are never pleasant and can lead to long term strain on the relationship between district nurses and managers. It is in the best interest of both to deal with any problems openly and fairly. The legislation relating to workplace grievances and claims arising from these to an employment tribunal changed on 6th April 2009. The new framework requires grievances to be resolved by both the employer and employee working together and abiding by a revised statutory Code of Practice from the Advisory, Conciliation and Arbitration Service (ACAS, 2009a). It is, therefore, important that district nurses are aware of the new law, the Code and their rights in the event of a grievance at work.

Informing patients of risks inherent in treatment.

Consent to treatment lies at the heart of autonomous decision making by patients who are entitled to make a free choice about whether to accept or refuse treatment. To help patients arrive at their decision district nurses must ensure that they give sufficient information about the nature and risks inherent in the treatment to allow an informed choice to be made. This article considers how much information regarding risks needs to be disclosed. It discusses how the law requires a different level of disclosure for patients who ask no questions about risks, those who make general enquiries about risks and those who ask specific questions about the risks inherent in treatment.

Deprivation of liberty safeguards.

The Mental Health Act 2007 introduced an amendment to the Mental Capacity Act 2005 that authorizes the deprivation of liberty of a person who lacks decision-making capacity in a care home or hospital where this is necessary to protect them from harm. District nurses will have such patients on their case loads and will need to be aware of the requirements that are due to come into force in April 2009.

Proposals for legal reform in the coronial process 3.

In the final article reviewing the role and function of the coronial service Richard Griffith and Cassam Tengnah consider the proposals for reforming the system to take account of the recommendations of the Shipman Inquiry and the Bristol Royal Infirmary Inquiry. The Government's proposals are in the form of a Draft Bill that allows district nurses to consider the impact of the reforms on their practice and provides an opportunity to contribute to the debate on reform before it is presented to parliament.