Abstract
Objective: Outpost nurses function as primary care providers and in a community health nursing role, providing comprehensive primary health care in Canada’s underserved northern communities. Little information exists regarding how outpost nurses meet this expectation. The purpose of this interpretive study was to address the following research questions: 1) How do experienced outpost nurses perceive and enact their role? 2) How are practical knowledge and clinical wisdom revealed in the practice narratives of experienced outpost nurses?
Methods: Purposive sampling was used to recruit the nine experienced outpost nurses who participated by sharing narratives of clinical practice. Data analysis was conducted in accordance with Benner’s model of interpretive phenomenology. Paradigm and exemplary cases served to ground the interpretation in the data.
Results: Four themes emerged from the data: a) primary care competencies are fundamental to outpost practice, b) nurses evolve into the outpost role by learning community health competencies and adapting to context-specific practice issues, c) experienced outpost nurses build and maintain responsive relationships with communities, and d) experienced outpost nurses become comfortable with the autonomy and responsibility of practice.
Discussion: The findings of this study reinforce the complex nature of outpost nursing; it is an anomalous community health nursing role grounded in primary care competency. Interpretation of the data suggests that outpost nurses share practice domains and competencies with nurse practitioners. A better understanding of the outpost nursing role clarifies how nurses might better contribute to improving the health status of northern residents, helping northern communities become healthy communities.
Résumé
Objectif: Les infirmières en région éloignée [le terme comprend les infirmiers] jouent le rôle de prestateurs de soins primaires et, dans un contexte de santé communautaire, offrent des soins de santé primaires globaux dans les collectivités mal desservies du Nord canadien. On trouve peu d’information sur la façon dont les infirmières répondent à ces attentes. Notre étude interprétative portait sur les questions de recherche suivantes: 1) Comment les infirmières expérimentées travaillant en région éloignée perçoivent-elles et jouent-elles leur rôle? 2) Que révèlent les récits d’infirmières en région éloignée sur leurs connaissances pratiques et leur érudition clinique?
Méthode: Par échantillonnage au jugé, nous avons recruté neuf infirmières expérimentées en région éloignée, qui nous ont communiqué le récit de leur pratique clinique. Ces données ont été analysées selon le modèle d’interprétation phénoménologique de Benner. Des cas paradigmatiques et exemplaires ont permis d’ancrer l’interprétation dans les données.
Résultats: Quatre thèmes sont ressortis: a) les compétences en soins primaires sont fondamentaux pour la pratique en région éloignée, b) les infirmières en région éloignée apprivoisent leur rôle par l’acquisition de compétences en santé communautaire, qu’elles adaptent ensuite au contexte particulier de leur pratique, c) les infirmières expérimentées en région éloignée sont constamment à l’écoute des besoins des collectivités, et d) les infirmières expérimentées en région éloignée s’acclimatent progressivement à l’autonomie et aux responsabilités de leur pratique.
Discussion: Les résultats de l’étude confirment la nature complexe des soins infirmiers en région éloignée: ce sont des soins infirmiers communautaires irréguliers exigeant une bonne maîtrise des soins primaires. L’interprétation des données suggère que les infirmières en région éloignée ont des domaines et des compétences en commun avec les infirmières praticiennes. Une meilleure compréhension du rôle des soins infirmiers en région éloignée permet de clarifier comment les infirmières pourraient mieux contribuer à améliorer l’état de santé des résidents du Nord et aider les collectivités nordiques à devenir des collectivités en santé.
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