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NURSING For HEALTH: TWO YEARS ON
CHAPTER 2 NURSING'S CONTRIBUTION TO PUBLIC HEALTH - THE SCOTTISH VISION
There were a number of opportunities during 2002 for nurses and midwives to debate and develop their vision for their developing public health roles. In particular, participants in the Public Health Nursing Conferences and "Reality or Rocket Science" seminars were asked in different ways to describe what their public health roles would look like in the future and what was required to take them there. The collective views of the participants in both arenas broadly concurred with the recommendations set out in
Nursing for Health. The discussions also identified areas for further development.
NURSING FOR HEALTH'S VISION
The Scottish Executive's vision for public health nurses and for the wider nursing workforce is set out in the recommendations in
Nursing for Health.
It set a primary aim of enabling nurses to realise their potential to influence the health of the people of Scotland.
Specifically it set out to:
Build upon the skills of nurses, midwives and health visitors, working with individuals, families and communities as well as at leadership, strategy and policy levels to become full and legitimate partners in the health improvement process.
Ensure that nursing contributions are properly focused and targeted to effectively address the health needs of the people of Scotland in partnership with other professionals and agencies and with local communities.
Ensure that nurses are well prepared and supported to play a full and equal part, alongside fellow professionals and agencies, at local, regional and national levels in efforts to improve the health of the people of Scotland in a co-ordinated and planned way.
In order to achieve this vision, it was recognised that effective enabling leadership and a change in the culture and attitude of organisations and professionals would be necessary.
THE PUBLIC HEALTH NURSING VISION
The consensus conferences on developing public health nursing practice held in the summer of 2002 produced a broad consensus on the future direction of practice. This is summarised under four main headings:
Clarifying the public health nursing role: A clear direction for public health nursing as part of a public health infrastructure was seen as crucial. Public health nurses should be focused on health improvement rather than disease management with evidence-based practice and addressing inequalities and life circumstances central to their role.
Partnership working: in community-based, multi-agency teams, was seen as a key approach for breaking down barriers, developing mutual respect between medical and social models, and achieving better communication between disciplines. Most of all, partnership working should enable the provision of integrated services and integrated resources to meet the needs of the population.
Organisational change: and support for that change is required to enable the vision for new ways of working to become a reality. In particular, strong leadership at all levels was regarded as essential. LHCCs should give higher priority to community development and community involvement, with better integration between the NHS and local authorities as well as between different NHS structures, and sustainable, long term funding for developments. Within the LHCC or GP practice, different caseload models could be used and GP engagement in, and support for, the public health agenda should be sought.
Education and development: were regarded as essential in developing the new public health nursing role. In particular, the importance of developing the whole public health nursing workforce, not just new entrants was emphasised. Education should reflect community needs, be evidence based and multi-disciplinary where possible. Good practice should be shared as a means of supporting development and alternative development opportunities such as mentorship and shadowing supported.
There were three areas where consensus on the vision was not achieved during the conferences. These were:
There is scope for both models to develop. Public health nurses have public health at the heart of their role and should seek to develop specialist skills to enable them to act as a resource to the communities they serve. Equally, all nurses have an unrivalled opportunity in their communications with people to improve and promote health.
Again the answer is not as simple as either/or. As will be seen in the practice examples outlined in
chapter 3, there are many different models of service delivery starting to emerge in response to local needs. It will always be necessary to maintain close links with Primary Health Care Teams and LHCCs, but where local needs warrant it, there are some clear benefits to developing wider community focused approaches.
The greatest risk for all public health nurses is in attempting to do everything for everyone. There are many good examples in
Chapter 3 of how public health nurses have started to target their efforts. Inevitably, there is more to do. The debate will continue, with further opportunities to share approaches and successes.
THE WIDER NURSING AND MIDWIFERY WORKFORCE VISION
The PPHiN seminars supported by PHIS and the Nursing and Midwifery Practice Development Unit (NMPDU) provided an opportunity for nurses and midwives from a wide variety of backgrounds to discuss the role of public health approaches in their day-to-day work. Their collective vision can be described as follows:
Within a public health role, nurses and midwives would focus on both health and social needs, working in collaboration with other NHS disciplines and other agencies. They would develop services based on evidence - including mapping needs, evaluation of services and demonstrating positive outcomes. There would be greater public involvement and public accountability, and more access to training and professional development, particularly in public health leadership and IT.
The public health role of nurses and midwives was described most often as being in working with marginalised groups, including with asylum seekers, child protection, domestic abuse, social inclusion and anti-poverty initiatives.
It was not clear from discussion to what extent nurses and midwives from the wider workforce were able to use public health approaches such as mapping population needs and collaborative working with different population groups. Further debate is required to ensure effective and realistic implementation of the vision for the wider nursing workforce.
DELIVERING THE VISION
Delivering the vision of "
enabling nurses to realise their potential to influence the health of the people of Scotland" will not be easy. However it is clear that the challenging and far reaching recommendations set out in
Nursing for Health have been widely accepted and are driving forward change at all levels. Indeed the thinking is continuing to evolve as evidenced by the outcomes of the two series of conferences outlined above.
Common themes emerge through both series of conferences, which reflect the priorities outlined in
Nursing for Health and the extent to which nurses have accepted and applied the principles outlined in its recommendations.
There is:
A willingness to change practice in relation to evidence of need
An enthusiasm and commitment to working in partnership with others, inside and outside the NHS
A desire to develop new ways of working and new configurations of service providers
A recognition of the need to take a long-term approach to health improvement
A desire to develop a mix of targeting vulnerable groups and a providing universal services at key points in the life span.
Much has already been achieved in developing and delivering the vision, both nationally via pieces of work led by NHS Education for Scotland, the Public Health Institute of Scotland and the Scottish Executive Health Department and locally through the leadership of NHS Boards and Trusts.
Each NHS Board area has identified a senior person responsible for implementation, often working across the local NHS system. In most cases this is a Director of Nursing or someone reporting directly to them. A variety of approaches have been taken within Board areas to develop local priorities, engage with key stakeholders and ensure progress is made.
In Greater Glasgow, all managers within the PCT, from the chief executive down, has implementation of Nursing for Health as a key objective. This has helped ensure a co-ordinated and strategic approach to developing practice.
In Western Isles, multi-disciplinary sub groups of the implementation group were set up, dividing up the chapters and in particular looking at the life cycle. Each group looked at the recommendations, what's happening now, where are the gaps and what needs to happen to address them, from which an action plan was developed.
In Lothian, a Board wide Public Health Reference Group, with involvement of the NHS Board and all trusts oversees the development of public health. The reference group has a specific remit to implement Nursing for Health.
In Ayrshire and Arran the lead responsibility for implementation is shared between the Director of Nursing and the Director of Public Health, enabling a consistent and systematic approach to implementing change.
Chapter 3 summarises what has been achieved across all 77 of Nursing for Health's recommendations and illustrates this with a variety of practice examples from across Scotland.
Chapter 4 draws together the achievements to date alongside the findings from the conferences outlined above in setting out further actions to develop nursing's contribution to public health.
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