Abstract
Objectives
Following the introduction of hospital early postpartum discharge (EPD), public health nurses (PHNs) have provided large-scale in-home follow-up to promote the safety and well-being of mothers and babies. Given high numbers of births per year, this program has affected PHNs’ practice. This descriptive qualitative study aimed to explore PHNs’ perceptions of EPD and its effects on their practice.
Methods
Data were collected in focus groups (n=24) consisting of PHNs in four community health areas (CHAs) in the Winnipeg Regional Health Authority (WRHA). Audiotaped data were transcribed, entered into Microsoft Word XP, and analyzed using constant comparison.
Results
The female participants had a mean of 10 years of PHN experience. Three main themes and 10 subthemes were identified. The main themes were: passion for the PHN role, influence of EPD on practice, and building a PHN future. The subthemes included: valuing public health nursing, building capacity and developing relationships, changes in practice, erosion of health promotion, a new role, proper tools, continuity of care, relationships with community partners, and resources to support public health programs.
Conclusion
The PHNs indicated the introduction of EPD altered their practice by reducing their role in community-level intervention and health promotion activities. Although they identified benefits from undertaking EPD activities, they wanted resources and funding shifted into the public health system to better support PHNs’ increase in scope of practice and historical roles in promoting the health of individuals, families and communities.
Key words: Early discharge, practice, community health, healthy beginnings, post-natal follow-up
Fr: Mots clés, congé précoce, keywords, Occupations, childhood, wounds and injuriespratiques, santé communautaire, bon départ, suivi postnatal
Résumé
Objectifs
Depuis l’introduction dans les hôpitaux du congé précoce en post-partum (CPP), les infirmières hygiénistes font un suivi à domicile à grande échelle pour promouvoir la sécurité et le bien-être des mères et des bébés. Étant donné le grand nombre de naissances par année, ce programme a eu des répercussions sur l’exercice des soins infirmiers de santé publique. Notre étude qualitative descriptive porte sur les perceptions des infirmières hygiénistes à l’égard du CPP et de ses effets sur leur pratique professionnelle.
Méthode
Les données ont été recueillies à la faveur de groupes de discussion (n=24) composés d’infirmières hygiénistes de quatre secteurs sanitaires de l’Office régional de la santé de Winnipeg (ORSW). Les données, enregistrées sur bande sonore, ont été transcrites, entrées dans Microsoft Word XP et analysées en dressant une comparaison des constantes.
Résultats
Les participantes avaient en moyenne 10 ans d’expérience en tant qu’infirmières hygiénistes. L’analyse des données a permis de dégager trois grands thèmes (la passion pour le métier d’infirmière hygiéniste; l’influence du CPP sur les pratiques; l’avenir du métier) et 10 sous-thèmes (la considération envers les services infirmiers de santé publique; le renforcement des capacités et des relations; les changements dans la pratique; l’érosion de la promotion de la santé; un nouveau rôle; les bons outils; le suivi des soins; les relations avec les partenaires communautaires; et les ressources disponibles pour les programmes de santé publique).
Conclusion
Selon les infirmières hygiénistes, l’introduction du CPP a modifié leur pratique professionnelle en réduisant leur participation aux activités d’intervention communautaire et de promotion de la santé. Bien que les activités liées au CPP aient leurs avantages, les infirmières voudraient que l’on achemine des ressources et des fonds vers le réseau de la santé publique pour mieux appuyer l’élargissement de leur champ d’activité et leur rôle traditionnel de promotion de la santé individuelle, collective et familiale.
Footnotes
This study was undertaken in partial fulfillment of the degree of Master of Science in Nursing at the School of Nursing, University of British Columbia.
References
- 1.McCall-Jones P. Patient satisfaction with home care following early postpartum hospital discharge. Home Care Prov. 1997;2:235–43. doi: 10.1016/S1084-628X(97)90117-9. [DOI] [PubMed] [Google Scholar]
- 2.Canadian Paediatric Society. Joint Statement Soc Obstet Gynaecol Can. 2004. Facilitating discharge home following a normal term birth. [Google Scholar]
- 3.Sword W, Watt S, Gafni A, Soon-Lee K, Krueger P, Roberts J, et al. Can Health Services Research Foundation, 2001. 2005. The Ontario mother & infant survey postpartum health and social service utilization: A five-site Ontario study. [Google Scholar]
- 4.Walker CR, Watters N, Nadon C, Graham K, Niday P. Discharge of mothers and babies from hospital after birth of a healthy full-term infant: Developing criteria through a community-wide consensus process. Can J Public Health. 1999;90(5):313–15. doi: 10.1007/BF03404517. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Brown LP, Town SA, York R. Controversial issues surrounding early postpartum discharge. Nurs Clin N Am. 1996;31(2):333–38. [PubMed] [Google Scholar]
- 6.Dalby DM, Williams JI, Hodnett E, Rush J. Postpartum safety and satisfaction following early discharge. Can J Public Health. 1996;87(2):90–94. [PubMed] [Google Scholar]
- 7.Gagnon AJ, Edgar L, Kramer M, Papageorigiou A, Waghorn K, Klein M. A randomized trial of a program of early postpartum discharge with nurse visitation. Am J Obstet Gynecol. 1997;176(1):205–11. doi: 10.1016/S0002-9378(97)80037-3. [DOI] [PubMed] [Google Scholar]
- 8.Lieu TA, Braveman PA, Escobar GJ, Fischer AF, Jensvold NG, Capra AM. A randomized comparison of home and clinic follow-up visits after early postpartum hospital discharge. Pediatrics. 2000;105(5):1058–65. doi: 10.1542/peds.105.5.1058. [DOI] [PubMed] [Google Scholar]
- 9.Cooke M, Barclay L. Are we providing adequate postnatal services? Aust and N Z Public Health. 1999;23:210–12. doi: 10.1111/j.1467-842X.1999.tb01239.x. [DOI] [PubMed] [Google Scholar]
- 10.Fishbein EG, Burggraf E. Early postpartum discharge: How are mothers managing? J Obstet Gynecol Neonatal Nurs. 1997;25:1061–69. doi: 10.1111/j.1552-6909.1998.tb02604.x. [DOI] [PubMed] [Google Scholar]
- 11.Grullon KE, Grimes DA. The safety of early postpartum discharge: A review and critique. Obstet Gynecol. 1997;90:860–65. doi: 10.1016/S0029-7844(97)00405-5. [DOI] [PubMed] [Google Scholar]
- 12.Community Health Nurses Association of Canada CHNAC. Canadian Community Health Nursing Standards of Practice. 2003;2:10–17. [Google Scholar]
- 13.Speziale HJS, Carpenter DR. Qualitative Research in Nursing: Advancing the Humanistic Imperative. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003. [Google Scholar]
- 14.Reutter LI, Ford JS. Perceptions of public health nursing: Views from the field. J Adv Nurs. 1996;24:7–15. doi: 10.1046/j.1365-2648.1996.01681.x. [DOI] [PubMed] [Google Scholar]
- 15.Meagher-Steward D, Aston M. Fostering citizen participation and collaborative practice: Tapping the wisdom and voices of public health nurses in Nova Scotia 2004. 2005. [Google Scholar]
- 16.Underwood J. The value of nurses in the community. 2003. [Google Scholar]
- 17.Gagnon AJ, Dougherty G, Jimeniz V, Leduc N. Randomized trial of postpartum care after hospital discharge. Pediatrics. 2002;109:1074–80. doi: 10.1542/peds.109.6.1074. [DOI] [PubMed] [Google Scholar]
- 18.Lock M, Ray JG. Higher neonatal morbidity after routine early hospital discharge: Are we sending newborns home too early? CMAJ. 1999;161:249–53. [PMC free article] [PubMed] [Google Scholar]
- 19.Maisels MJ, Kring E. Length of stay, jaundice, and hospital readmission. Pediatrics. 1998;101:995–98. doi: 10.1542/peds.101.6.995. [DOI] [PubMed] [Google Scholar]
- 20.Lannon C, Stark AR. Closing the gap between guidelines and practice: Ensuring safe and healthy beginnings. Pediatrics. 2004;114:494–96. doi: 10.1542/peds.114.2.494. [DOI] [PubMed] [Google Scholar]
- 21.Chang WY, Tseng IJ, Hsiao FH, Wang MY. Continuing education needs and barriers for public health nurses in aboriginal townships in Taitung, Taiwan. J Nurs Res. 2003;11:295–301. doi: 10.1097/01.JNR.0000347649.65745.dd. [DOI] [PubMed] [Google Scholar]
- 22.McNaughton DB. A synthesis of qualitative home visiting research. Public Health Nurs. 2000;17:405–14. doi: 10.1046/j.1525-1446.2000.00405.x. [DOI] [PubMed] [Google Scholar]
- 23.Grumbach K, Miller J, Mertz E, Finocchio L. How much public health in public health nursing practice? Public Health Nurs. 2004;21:266–76. doi: 10.1111/j.0737-1209.2004.21309.x. [DOI] [PubMed] [Google Scholar]
- 24.McKay M. Community health nursing in Canada. In: Stamler LL, Yie L, editors. Community Health Nursing in Canada: A Canadian Perspective. Toronto: Pearson Education Canada Inc.; 2005. pp. 1–15. [Google Scholar]
- 25.Scruby LS. The community health nurse’s role in health promotion policy: An interdisciplinary feminist research paradigm [Unpublished doctoral thesis] Winnipeg, Manitoba: University of Manitoba; 1999. [Google Scholar]
- 26.Lichtveld MY, Cioffi JP. Public health workforce development: Progress, challenges, and opportunities. J Public Health Manag Prac. 2003;9:443–50. doi: 10.1097/00124784-200311000-00003. [DOI] [PubMed] [Google Scholar]
- 27.Public H A o Canada E p-t c o t m t t community. Family-Centred Maternity and Newborn Care: National Guidelines. 2002. [Google Scholar]
- 28.Wilkerson NN. Appraisal of early postpartum discharge programs. J Perinatal Ed. 1996;5:1–5. [Google Scholar]
- 29.Escobar GJ, Braveman PA, Ackerson L, Odouli R, Coleman-Phox K, Capra AM, et al. A randomized comparison of home visits and hospital-based group follow-up visits after early postpar-tum discharge. Pediatrics. 2001;108(3):719–27. doi: 10.1542/peds.108.3.719. [DOI] [PubMed] [Google Scholar]
- 30.Steel O’Connor KO, Mowat DL, Scott HM, Carr PA, Dorland JL, Young Tai KF. A randomized trial of two public health nurse follow-up programs after early obstetrical discharge: An examination of breastfeeding rates, maternal confidence and utilization and costs of health services. Can J Public Health. 2003;94:98–103. doi: 10.1007/BF03404580. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Goulet L, D’Amour D, Labadie JF, Pineault R, Seguin L. Canadian Health Services Research Foundation. 2001. Assessing the impact of methods for postnatal monitoring of mother and newborn in the context of early obstetrical discharge. [Google Scholar]
- 32.Yaffe MJ, Russillo B, Hyland C, Kovacs L, McAlister E. Better care and better teaching: New model of postpartum care for early discharge programs. Can Fam Physician. 2001;47:2027–33. [PMC free article] [PubMed] [Google Scholar]
- 33.Laschinger HKS, Wong C. Staff nurse empowerment and collective accountability: Effect on perceived productivity and self-rated work effective-ness. Nurs Econ. 1999;17:308–51. [PubMed] [Google Scholar]
- 34.Upenieks V. Recruitment and retention strategies: A magnet hospital prevention model. Nurs Econ. 2003;21:7–23. [PubMed] [Google Scholar]