Public health nursing and public health policies: a case study

Cunha, Carmen Maria dos Santos Lopes Monteiro da; Henriques, Maria Adriana Pereira; Costa, Andreia Jorge Silva

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RESEARCH • Esc. Anna. Nery 25 (5) • 2021 • https://doi.org/10.1590/2177-9465-EAN-2021-0204 copy

Public health nursing and public health policies: a case study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives

to characterize the interventions of specialist nurses of community health and public health of a Group of Health Centers, to identify the main facilitating factors for the performance of competences, and the contribution to public health policies.

Method

this is a case study carried out with nurses specialized in community health and public health nursing. Data were collected through interviews from October to December 2019. Analysis was guided by two strategies: starting from the theoretical propositions and working the data from the ground up; and two techniques: pattern matching and explanation building.

Results

from the constructed matrix, ten theoretical propositions, ten emerging evidences, five patterns and five explanatory hypotheses emerged. There are interventions for epidemiological surveillance, planning and project management. Personal training and communication stand out as facilitating factors.

Conclusion and implications for practice

the intervention of the nurses of these specialties presents a dimension centered on project planning and management identifies and reflects the facilitating factors of the performance of their competencies, as an applicator of public health policies.

Keywords:
Public Health Nursing; Public Health Nurses; Public Health; Public Health Policy; Case Study

Patterns	Empirical data
1. The main commitment of most public health nurses is centered on vaccination.	1. We did not find any correspondence to the first pattern, related to vaccination, we found out that it is an activity among others, as we will explain below.
	2. The same happened with regard to the second pattern, as we did not obtain data to confirm the provision of individualized services, rather than community ones.
	3. For the third pattern, we have already found combinations with our empirical data, assuming the following dimensions:
2. Most services are provided on an individual rather than community level.	[…] nurses’ contribution is diluted in the team, nurses are involved in many activities, lack of peer recognition and appreciation of nurses’ role, lack of recognition and lack of public disclosure of nurses’ interventions (E01).
	4. Regarding the fourth pattern, several evidences stand out in our data, in different formulations: nurses do not feel well if they are limited to working at the desk (E05); hence the desire for the model to include more the presence and intervention of nurses in the community (E05, E08); expresses the need for a nurse coordinator, as the existing model only provides for a medical coordinator (E05); inclusion of more human resources and definition of roles (E02); manuals of procedures (E05); proposal for various changes, such as meetings and conferences (E02).
	5. The fifth pattern concerns the facilitating factors for the performance of skills: we found that nurses also underline the importance of continuous updating (E01), more training (E08), but above all more and better human and material resources (E02, E08).
3. Public health nurses are involved in many activities to prevent disease and contribute to the health of populations. However, their activities are not always visible to the public and policy makers.
4. The need for a different model of community health services that implements collaboration and finds common denominators among public health team members.
5. The demonstration of a fruitful alliance between academic work and professionals, in the sense of being able to provide effective, quality services, as well as the existence of new resources.

Explanatory hypotheses	Empirical data
1. The type of intervention of public health unit nurses does not only provide for an individualized relationship with the user/client, and their action will not focus solely on vaccination.	For the question of the hypothetical prevalence of the vaccination activity as the most important for public health nurses¹²12 Cunha C, Costa A, Henriques MA. Competências e intervenções do enfermeiro de saúde comunitária e de saúde pública: uma revisão de literatura. Atas CIAIQ2019 [Internet]. 2019; [citado 2020 abr 5];2:361-70. Disponível em: https://proceedings.ciaiq.org/index.php/CIAIQ2019/article/view/2038 https://proceedings.ciaiq.org/index.php/... 13 Cunha C, Henriques MA, Costa A. Investigação e inovação em saúde: intervenções do enfermeiro de saúde comunitária e de saúde pública. Rev ROL Enferm [Internet]. 2020; [citado 2020 abr 5];43(Suppl 1):32-42. Disponível em: https://e-rol.es/rol_2020/IC_RESEARCH_INNOVATION_DEVELOPMENT_NURSING_2019.pdf https://e-rol.es/rol_2020/IC_RESEARCH_IN... ^-¹⁴14 Cunha C, Costa A, Henriques MA. Community health and public health nursing: a systematic literature review. Gestão & Saúde. 2020;11(2):80-96. http://dx.doi.org/10.26512/gs.v11i2.29414. http://dx.doi.org/10.26512/gs.v11i2.2941... , we found that this is an activity in the interventions of our nurse as:
	[…] responsible for vaccination at ACES […] make the flu vaccination session for homes and other institutions (E02). Another that, […] until last year I participated in the vaccination, (E05). And yet another one, […] I collaborate in the management of the vaccination project, […], and as I am with vaccination, it includes the management of flu and flu vaccines, in the various units (E08).

	This reality reinforces a large arsenal of interventions, in which this nurse is involved, such as:
	[…] epidemiological research I have partnerships, partnership meetings. I have two groups, one of them is a social intervention group from a certain geographic area, […]. The other group of social intervention is the group of the support center for the homeless, […] I have in teamwork, the management, I am part of the management, the inspection of homes and dangerous establishments. […] mental health project management (E01). […] I do epidemiological surveillance […] I am part of the seasonal health contingency plan, winter module (E02). I am responsible for SINAVE […] I do epidemiological surveillance by geodemographic area. […] health literacy project […] the diabetes intervention area (E05).
2. As a result of the above, we also did not identify a prevalence of individualized services rather than community services.	With regard to services at the community level, we obtained some evidence, such as the fact that nurses are:
	[…] working in the smoking field, whether in the community area, for the smoke-free community, outdoor spaces, as well as in the health areas, […] area of school health, which we also developed a manual, […] to support school health teams […] (E02). And coordinates […] vaccination and the management of the school health program (E02). And also, I go to the field, support, collaborate with colleagues, guide colleagues in the vaccination, as just last week we were in the units to support, guiding a little some procedures (E08).

3. Nurses perceive little visibility of their interventions, taking into account that they are part of a multidisciplinary team, to which they belong.	For the issue of (in)visibility for the public and policy makers, we have already found evidence of this reality in the data, as follows:
	[…] nursing activities that end up being included in a multidisciplinary team. In the multidisciplinary team, at this moment, it is not possible to assess what are the concrete activities that nurses performed (E05).
	[…] Professionals around us do not value us as much as we would like it to be possible. Many times, even our peers (E01).
	[…] ask what do you do in public health, besides vaccination? (E08).

	And lastly...
	[…] the work of public health is not highly valued, which is immense. On the other hand, sometimes, the coordination does not properly publicize or market what we actually produce in public health. And so, in terms, outwards, there is not the impact that there should be (E01).
4. Nurses are available to see their operating model changed, in the sense of being more on the ground, and facing the community, but also in the organizational dimension, with a nurse coordinator, definition of functions, human resources and procedure manuals.	On the implementation of a different model of community service, several testimonies illustrate this desire:
	[…] that there was a greater intervention in the community, that public health nurses were more on the street, closer to the population, closer to the communities, because that’s the only way we can always have gains in health (E08).
	[…] After carrying out all this field work on computers, it is necessary to effectively go out into the field, evaluate and implement measures (E05).

	And, with regard to human resources,
	[…] teams are increasingly reduced to the geographic areas we have (…) we can’t even respond to the work we have daily (E02). […] often, when you have to intervene, at the level, outside of public health, sometimes it was important that we all speak the same language, and sometimes that doesn’t happen (E01).

	The presence of a nursing coordinator is also noticed and, apparently, desired, thus,
	[…] put a fifth element of nursing, to have an internal head. This is strategy number one for me (E05).
5. Nurses are aware that it is important to continue their education, but they also recognize that other factors facilitate their performance, such as good communication, well-defined functions, better facilities and working conditions.	Regarding the facilitating factors of performance:
	[…] One of the very important things in performance is not thinking that the knowledge you have is enough (E01).
	[…] contributes better equipment, flexibility of time, multidisciplinary teams, that we had more people, and even good communication between us (E02). […] it is very important to define functions, prepare manuals of procedures (…), and then give visibility to the work (E05).
	[…] If I have internalized my skills well, in each area, I will give the right answer (E08).

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[1] 3Universidade de Lisboa, Faculdade de Medicina, Instituto de Saúde Ambiental. Lisboa, Portugal.Corresponding author:Carmen Maria dos Santos Lopes Monteiro da Cunha. E-mail: carmencunha@campus.esel.pt.