Public health - topics: Nursing roles
“Without nurses, much of the public health interventions essential to improving the health of individuals, families, and populations would not be possible on a large scale” (Savage and Kub 2009, p.2847). Many nurses as part of their role have long been involved in health promotion and health improvement activities and preventive work. These include nurses working in sexual health who tackle sexually transmitted infections and teenage pregnancy; nurses working with disadvantaged groups and on projects to reduce health inequalities; nurses involved in travel health and those who work for the health protection agencies; occupational health nurses (OHNs) who are key players in delivering the recommendations made around improving the health of the working age population. One of the challenges is to embed public health into all nursing and in fact to all health contacts.
The Northern Ireland strategy for nursing and midwifery is based on the principle that the contribution of every nurse, midwife and support worker is valued and underlines how important it is “to maximise the effectiveness of the nursing and midwifery contribution to improving health and social wellbeing and tackling inequalities for the population of Northern Ireland” (Department of Health Social Services and Public Safety 2010, p.10). All nursing staff have opportunities to deliver messages about healthier living and behaviours in their interactions with members of the public wherever they provide care.
The importance of 'making every contact count' and developing the skills to support this is highlighted in a range of reports and strategies. Public Health England, working with the Department of Health is working on recommendations to make every contact count across all pathways (NHS Commissioning Board and Department of Health 2012). Resources and tools have been developed to support organisations to do this systematically (NHS local learning 2013). Health care professionals should "be able to look to clinical leadership for strong direction about how to make every contact count" (Department of Health 2012, p.10). The view of the Royal College of Nursing (RCN) is that “a new approach should be adopted across the nursing team to ensure all nurses have an increased and more explicit role in public health and sustainable health” (RCN 2012a, p.9).
To illustrate this and the potential of the nursing contribution to the current public health agenda the RCN has published a guidance document which demonstrates through practice examples how nursing staff in all four UK countries are actively engaged in upstream public health. Upstream approaches in public health are described as those that “seek the causes of disease and preventable disability in order to address problems through prevention, rather than treatment” (RCN 2012a, p.3). The document presents a framework which identifies the core ingredients of the nurses contribution to better health outcomes and suggests how practical approaches for nurses working upstream can be linked to key priorities facing service planners and commissioners.
In addition “nurses also have a key role in minimising the impact of illness, promoting health and function (capabilities), and helping people maintain their roles at home, at work, at leisure and in their communities” (RCN 2012a, p.3). For example the roles of community nurses in delivering quality care to people with long-term conditions (LTCs), supporting self-care and preventing further ill-health are key to reducing the burden of LTCs, though an article by McHugh et al (2009) identifies a need to strengthen nursing and public health roles.
Alongside this there have also been initiatives, which impact on the public health agenda, relating to specific roles. The Government has released a five year plan and programme to expand and strengthen health visiting services in England and “to re-emphasise health visitors as key public health professionals” (Department of Health 2011, p.19).
The RCN has published position statements on both health visiting and school nursing which underline the vital contribution these groups make to health in childhood and beyond. All four countries have policies which emphasise the importance of support in the early years for health improvement across the lifespan and these are highlighted within the position statements.
The RCN position statement on health visiting focuses on the role of health visitors in child health and development in the context of community nursing reforms in the four UK countries (RCN 2011). The document sets out a series of statements which “must be applied in their entirety to developments taking place across the UK reforms of early years to be successful" (RCN 2011, p.7). The RCN position statement on school nursing highlights the significance of the school nursing role in the context of health agendas in each of the four UK countries and the impact school nurses can have “in breaking intergenerational cycles, facilitating behaviour change, promoting healthy lifestyles, and choices for the benefit of children, young people and their families” (RCN 2012b, p.15). District nursing - harnessing the potential (RCN, 2013) sets out the RCN’s position on district nursing, highlighting the current challenges facing the sector. Crucially, it outlines solutions to realise the intentions of all four UK governments to shift care from the acute to the community sector.
The extent of the contribution these groups make is also illustrated by the Scottish career and development framework for public health nursing developed as part of the Scottish Modernising Nursing in the Community programme (NHS Education for Scotland 2011).
References
The items referenced below were last accessed on 19 April 2013. The majority are in PDF format - see How to access PDF files.
Department of Health (2011) Health visitor implementation plan 2011-15: a call to action. London: DH.
Department of Health (2012) The NHS's role in the public's health: a report from the NHS Future Forum. London: DH.
Department of Health, Social Services and Public Health (2010) A partnership for care: Northern Ireland strategy for nursing and midwifery 2010-2015 (PDF 957KB). Belfast: DHSSPS.
McHugh GA et al (2009) Specialist community nurses: a critical analysis of their role in the management of long-term conditions. International Journal of Environmental Research and Public Health 6(10) pp.2550-2567 (special issue on nursing and public health).
NHS Commissioning Board and Department of Health (2012) Compassion in practice: nursing, midwifery and care staff. Our vision and strategy (PDF 850.5KB), Leeds: NHS Commissioning Board.
NHS Education for Scotland (2011) Career and development framework for public health nursing – health visiting and school nursing in Modernising Nursing in the Community. NES website.
NHS local learning (2013) Making Every Contact Count, NHS local learning website.
RCN (2011) RCN's UK position on health visiting in the early years (PDF 576KB). London: RCN.
RCN (2012a) Going upstream: nursing’s contribution to public health: prevent, promote and protect. RCN guidance for nurses (PDF 342KB). London: RCN.
RCN (2012b) The RCN’s UK position statement on school nursing (PDF 240.5KB). London: RCN.
RCN (2013) District nursing - harnessing the potential. The RCN's UK position on district nursing. London: RCN.
Savage C and Kub J (2009) Public health and nursing: a natural partnership. International Journal of Environmental Research and Public Health 6(11) pp.2843-2848 (Special issue on Nursing and public health).