Defining public health nursing.

Public health nursing has never been adequately defined. American nurse visionary, Lillian Wald, is said to have coined the term public health nurse (PHN) in the 1890s, as she worked to improve the health and living environments of disadvantaged communities in New York's slums. She sought to influence policy makers about the social, economic and environmental causes of ill health. More than a century later, the tack of consensus and clarity on what public health nursing is, has meant the practice of PHNs has become reactive and very adaptable, accommodating service contracts to the health needs of the day.

In New Zealand, PHNs once had support and leadership within the former Department of Health. The chief PHN maintained and coordinated the work of PHNs nationally. In history almanacs on health, PHNs are written up as a group of health professionals who worked in partnership with tangata whenua to ameliorate the devastating health effects of colonisation, and who were readily equipped to participate in controlling disease outbreaks and identifying health trends in the variety of communities they served. These are still pivotal parts of the PHN role and PHNs remain a responsive and skilled workforce, using knowledge and expertise to support and nurture the health and wellbeing of individuals, groups and communities throughout New Zealand.

Potential untapped

But in today's health environment the skill and dynamic nature of the PHN rote remains relatively untapped. Established relationships with school and pro-schools and ready access to children and their families offer opportunities not otherwise available to create innovative programmes to address population health goals. They also enable early intervention for identified problems. But continual health reforms and ongoing competition within the health sector have resulted in a shrinking PHN workforce and have contributed to PHNs' invisibility. To achieve positive health outcomes, therefore, is becoming problematic with increasingly complex workloads, a decreasing workforce and service provision that often fluctuates and changes. Ask anyone what a PHN does and you are likely to hear "Don't know. Do we still have PHNs?" or "Oh, are they the nit nurses?" or, perhaps, "Aren't they the nurses who gave us the MeNZB injections?" These are all important aspects of the PHN role, however the role is far more diverse and far more vital to children and the communities' health and well being than these responses indicate.

Public health nursing promotes and protects the health of populations, using knowledge from nursing, education, social and public health sciences. Much of our work is in schools, pro schools and communities, through home visits, community clinics, outreach and other avenues. A PHN understands the critical [ink between epidemiological data, determinants of health, political ethos and health promotion, and has a clinical understanding of health and illness as experienced in peoples' lives.

Across the country, PHNs establish and maintain a vital relationship with communities where a group of our most precious and vulnerable citizens congregate five days a week, for up to 40 weeks a year. Those communities are, of course, our schools, pro schools and the families of those attending them. Schools and families are based within a wider community and ensuring the health of the wider community is fundamental to the PHN role. This includes working with local bodies and other governmental and non-governmental groups on issues pertaining to the ongoing wellbeing of citizens, in particular children. Examples of this work include identifying and supporting the development of accessible and affordable recreational facilities, and encouraging our primary health providers to adapt their services to better support safe, accessible and affordable services within their communities. It is here that our children grow and learn and it is PHNs, with their in-depth knowledge and understanding of factors that determine society's health and wellbeing, who work to maintain, develop and enhance structures that will best nurture our communities.

Every school has a relationship with a PHN. This relationship takes various forms. In our current environment it is, generally speaking, dictated by regional service specifications, health targets and contracts. Regardless of upheaval in the health sector, PHNs remain connected with school and pre school communities working alongside education services to maintain and improve formal and informal curriculum and the health and well being of individuals. Collaboration is the key to assisting communities maintain and improve the health of their environment and, ultimately, the health potential of children. The collaborative nature of the work is a true reflection of the professionalism and passion of PHNs. The practice of most PHNs involves establishing contacts and building relationships with families, and with the plethora of professionals who also work to maintain and advance the social, educational and health potential of children. It is a privilege to work with children and have them share aspects of their Lives not always readily shared with others.

Where does public health nursing fit?

Where public health nursing fits in the overall health sector is an ongoing challenge. The workforce has diminished and become dissipated. The continuing establishment of new services that appear to duplicate existing ones, and the rising cost of delivering a nursing service outside hospitals and traditional primary care settings and beyond the influence of a medical model of practice, is another challenge. Children and their families must have access to health services that respect the reality of their daily lives. Health services must also maintain access with their communities and the groups within them. Public health nursing achieves this in a way no other health provider does. Families, children, young people and school staff have direct access to a PHN. If this were to cease, we would jeopardise the health care and support all these groups need. Maintaining and enhancing the public health nursing workforce is vital for the future wellbeing of all children. Just as they did in their pioneering days, PHNs today want to continue responding to community health needs and working collaboratively to improve health outcomes for our children.

Julia Anderson, RN, PG Cert (Child and Family Health), is a public health nurse/ clinical supervisor with the Canterbury District Health Board.