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Public Health and Community Nursing

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Commissioning Editor: Mairi McCubbinDevelopment Editor: Carole McMurrayProject Manager: Joannah DuncanDesigner: George AjayiIllustration Manager: Bruce Hogarth

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Public Health and Community NursingFrameworks for PracticeT H I R D E D I T I O N

E d i t e d b y

Dianne Watkins EdD MSc HV RM RN RNT Cert EdDirector of External Relations, Learning and Teaching, Cardiff School of Nursing and Midwifery Studies, Cardiff University

Judy Cousins MSc PGCE ONC RGN HVLecturer, Cardiff School of Nursing and Midwifery, Cardiff University

F o r e w o r d b y

Dean Whitehead PhD MSc BEd RN

Senior Lecturer, School of Health and Social Services, Massey University, New Zealand

Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2009

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First edition published 1996Second edition published 1993Third edition © 2009, Elsevier Limited.All rights reserved.

No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the Publishers. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department, 1600 John F. Kennedy Boulevard, Suite 1800, Philadelphia, PA 19103-2899, USA: phone: (+1) 215 239 3804; fax: (+1) 215 239 3805; or, e-mail: healthpermissions@elsevier.com. You may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com), by selecting ‘Support and contact’ and then ‘Copyright and Permission’.

Third edition published 2009

ISBN: 978 0 7020 2947 9

British Library Cataloguing in Publication DataA catalogue record for this book is available from the British Library

Library of Congress Cataloging in Publication DataA catalog record for this book is available from the Library of Congress

NoticeKnowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Authors assume any liability for any injury and/or damage to persons or property arising out or related to any use of the material contained in this book.

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Contents

Contributors vii

Foreword ix

Editors’ introduction xi

Section 1 The changing landscape of public health 1

1 Recent health and social policy developments 3 Stephen Peckham and Alison Hann

2 Developments in primary care 15 Stephen Peckham

3 Innovation and change in public health 27 David Fone, Shantini Paranjothy and Rhianwen Elen Stiff

Section 2 Public health frameworks 47

4 Epidemiology and its application to practice 49 John Watkins

5 Social capital and health 67 Sarah Cowley

6 Needs assessment, public health and commissioning of services 81 Nigel Monaghan

7 Public health and health promotion – frameworks for practice 93 Dianne Watkins

8 Developments in promoting workplace health 109 Denis D’ Auria

Section 3 The family as a framework for practice 121

9 The family: a sociological perspective 123 Graham Allan and Graham Crow

10 The family: a psychological perspective 135 Neil Frude

11 Violence within the family 145 Neil Frude

12 Safeguarding children from physical abuse 161 Dianne Watkins and Judy Cousins

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Section 4 Shifting the boundaries of public health and community practice 175

13 Practice nursing 177 Judith Carrier

14 District nursing 189 Carol Alstrom and Pat McCamley

15 Specialist community public health nurse: health visiting 201 Dianne Watkins and Lorraine Joomun

16 Specialist community public health nurse: school nursing 215 Ros Godson

17 Specialist community public health nurse: occupational health nursing 225

Bashyr Aziz

18 Community mental health nursing 237 Ben Hannigan

19 Community learning disability nursing 249 Ruth Wyn Williams and David Coyle

20 Community children’s nursing 259 Anna Sidey and David Widdas

Section 5 Challenges for the future 271

21 Partnership working in health and social care 273 Judy Cousins

22 Alternative ways of working 285 Helen Beswick, Joanne Chambers, Julie Davidson, Aileen Fraser, Celia Phipps,

Kirsten Robson and Janet Vokes

23 Advancing public health in nursing practice 297 Dianne Watkins and Judy Cousins

Index 309

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Contributors

Graham Allan BA MA PhD

Professor of Sociology, University of Keele

Carol Alstrom MSc BSc RN DipDN

Chief Nurse, Isle of Wight NHS Primary Care Trust

Bashyr Aziz PGCE PGDip RN OHNC SCPHN Grad IOSH

MIIRSM FHEA

Senior Lecturer in Primary Healthcare, University of Wolverhampton

Helen Beswick RGN, MSc

Community Matron, Bristol PCT

Judith Carrier MSc PGCE RGN DipPPSp Practitioner

(Practice Nursing)

Professional Head, Primary Care/Public Health Nursing, Cardiff School of Nursing and Midwifery, Cardiff University

Joanne Chambers RN BSc BSc (District Nursing) PGcert

advanced practice

Emergency Nurse Practitioner, Bristol PCT

Judy Cousins MSc PGCE ONC RGN HV

Lecturer, Cardiff School of Nursing and Midwifery, Cardiff University

Sarah Cowley BA PhD PGDE RGN RCNT RHV HVT

Professor and Head of Public Health and Health Services Research Section, Florence Nightingale School of Nursing and Midwifery, King’s College London

David Stuart Coyle RN MEd Cert Ed

Senior Lecturer, University of Chester

Graham Crow PhD MSc BSc

Professor of Sociology, University of Southampton; Deputy Director, ESRC National Centre for Research Methods

Denis D’Auria MA LLM MD DIH DipRCPath (Tox) CBiol MIBiol

MFFLM FFOM FFOM (Lond)

Senior Lecturer in Toxicology and Occupational Medicine, Cardiff University; Honorary Consultant Occupational Physician, Cardiff and Vale NHS Trust

Julie Davidson RGN

Nurse Independent/Supplementary Prescriber, Community Matron, Bristol PCT

David L. Fone MD FFPH

Deputy Head: Department of ‘Primary Care and Public Health Cardiff; Honorary Consultant in Public Heath Medicine, National Public Health Service for Wales

Aileen Fraser RGN, Nurse Practitioner Diploma, MSc

Consultant Nurse for Older People/Safeguarding Adults, Bristol PCT

Neil Frude MPhil PhD CPsychol FBPsS

Consultant Clinical Psychologist, Cardiff and Vale NHS Trust

Ros Godson RGN

Professional Officer, Community Practitioners’ and Health Visitors’ Association

Alison Hann BA(Hons) PhD

Lecturer, School of health Science, Swansea University

Ben Hannigan BA(Hons) MA PhD PGCE RMN RGN DPSN

Senior Lecturer, Cardiff School of Nursing and Midwifery Studies, Cardiff University

Lorraine Joomun MSc RGN HV CHSdip PGCE

Lecturer, Cardiff School of Nursing and Midwifery, Cardiff University

Pat McCamley SRN ONC DIP/DN BSc

Clinical Lead, District Nursing, Isle of Wight NHS Primary Care Trust

Nigel Monaghan BDS, MSc, LLM, FFPH, FDS RCPS (Glasg)

Deputy Director of Health and Social Care Quality, National Public Health Service, Cardiff

Shantini Paranjothy PhD

Lecturer in Public Health Medicine, Cardiff University

Stephen Peckham BSc MA(Econ) HMFPH

Reader in Health Policy, Director NCCSDO, London School of Hygiene and Tropical Medicine

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Celia Phipps MSc BSc RGN HV

Locality Manager (Adults), Bristol Primary Care Trust

Kirsten Robson RN BSc PGC (Advanced Practice)

Community Matron, Bristol Primary Care Trust

Anna Sidey RSCN RGN DNCert

Independent Adviser in Community Children’s Nursing, Stretton, Shropshire

Rhianwen Elen Stiff MBBCh BSc

Walport Academic Clinical Fellow in Public Health Medicine, Cardiff University

Janet VokesSouthmead Health Centre, Bristol

Dianne Watkins EdD MSc HV RM, RN RNT Cert Ed

Director of External Relations, Learning and Teaching, Cardiff School of Nursing and Midwifery Studies, Cardiff University

John WatkinsClinical Senior Lecturer in Epidemiology, Department of Primary Care and Public Health, Cardiff University

David Widdas RGN RSCN DN

Consultant Nurse for Children with Complex Care Needs – Coventry and Warwickshire/Honorary Lecturer University of Coventry and the University of Birmingham

Ruth Wyn Williams MSc BN (Hons) RN (Adult) RNLD

Postgraduate Diploma in Higher Education Inter-professional

Studies (Learning Disability)

PhD student, School of Healthcare Sciences at Bangor University

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Foreword

During my long and ongoing ‘crusade’ to champion all things health promotion for nurses and nursing – several things have remained a constant to me. One is a distinct lack of nursing-specific quality texts that encompass how, why and where health promo-tion should most distinctly occur. While I have espoused the validity of ‘seamless services’, where health promotion crosses the traditional divide of acute and community provision, most will acknowl-edge that the majority of health promotion activity occurs in the community setting – and within a public health context. With the advent of this new title the above-mentioned issues are addressed. It is a quality text aimed primarily at nurses with an interest in public health. Although much of the book is aimed at nurses working in a community environ-ment, it has relevance for all nurses wherever they work.

Another constant for me has been the ability (or lack of it) for most nurses to both understand and engage in the political landscape that underpins most health promotion practice (Whitehead 2003a, 2003b). Accompanying this, I have often been bemused by nursing’s unwillingness to acknowledge and embrace the wider dimensions of health promo-tion that are more relevant for the practice of today’s community-based health professionals (Whitehead 2004, 2005, 2006, 2007, 2008). This book directly faces up to those challenges. It espouses a much-needed awareness of the changing landscape of primary healthcare and public health. In doing so, it addresses the fundamental principles of a required wider agenda for health promotion through explor-ing dimensions such as population health, health and social policy and social capital – all correctly aligned

to a socio-ecological model of practice. More impor-tantly, this book does all this in such a way that it is accessible to both nurse practitioners and under-graduate and postgraduate students working in a variety of community-based specific disciplines. This book is also accessible through its sequential format. It begins with a section that explores the current landscape of public health and its frameworks (Sections 1 and 2) right through to a concluding section on ‘challenges for the future’ (Section 5).

Unique to this book, it extends its content to a framework where readers can appreciate the appli-cability of theoretical concepts to practice. In par-ticular, this uniqueness extends to particular sections of the book that focus on both the importance of ‘family-centredness’ (Section 3) and discipline- specific roles (Section 4). While, for the most part, this book is located against the backdrop of UK-based policy and clinical examples this does not exclude it from a wider audience. Such is its range and diversity that most readers will benefit from its content in some way. It is with this in mind and the other above-mentioned strengths of this book that I wholeheartedly recommend this text to anyone who is interested in health promotion, community health and public health – and I hope that you enjoy it and gain from it as much as I have.

Dean Whitehead Senior Lecturer PhD, MSc, BEd, RN

Massey UniversitySchool of Health and Social Services

Palmerston NorthNew Zealand

References

Whitehead D 2003a Incorporating socio-political health promotion activities in nursing practice. Journal of Clinical Nursing 12(5): 668–677

Whitehead D 2003b The health-promoting nurse as a policy expert and entrepreneur. Nurse Education Today 23(8): 585–592

Whitehead D 2004 Health promotion and health education: advancing the concepts. Journal of Advanced Nursing 47(4): 311–320

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Whitehead D 2005 The culture, context and progress of health promotion in nursing. In: Scriven A (ed.) Health Promoting Practice: The Contribution of Nurses and Allied Health Professions. Palgrave Macmillan, London: pp. 19–31

Whitehead D 2006 Health promotion in the practice setting: findings from a review of clinical issues. Worldviews on Evidence-Based Nursing 3(4): 165–184

Whitehead D 2007 Reviewing health promotion in nursing education. Nurse Education Today 27: 225–237

Whitehead D 2008 Arriving at a consensus for health promotion and health education in nursing practice, education and policy: an international Delphi study. Journal of Clinical Nursing 17(7): 891–900

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Editors’ introduction

The ever-changing political context continues to influence public and primary health care, hence the need for revising the content of this book, ensuring it offers as contemporary a view as any textbook can. The NHS is witnessing radical reforms in an attempt to redress the imbalance in health across social groups in society (Welsh Assembly Government (WAG) 2005, 2008, Scottish Executive Health Department 2005, Department of Health, Social Services and Public Safety (DHSSPS) 2005, Depart-ment of Health 2004, 2008). Inequalities in health influenced by structural and environmental issues, beyond the control of the individual, are guiding public health practice, whilst the organization of public health and primary health care is again under review (Department of Health 2006, NHS Scotland 2005, WAG 2008). Different models of public health and primary care organizations are emerging across the four countries of the United Kingdom, with devolution playing a major part in determining differences between these. An increased emphasis on prevention, expedient transition of patients from acute to primary care, resource effectiveness, effi-cient commissioning of services and patient and public involvement, as well as protection of vulner-able groups, are major drivers for change.

This third edition of Public Health and Commu-nity Nursing – Frameworks for Practice brings these issues to the forefront and considers the implica-tions for nurses in the delivery of public health and care in the community. It updates each chapter and responds to the changing landscape of working to improve health. This is evident from inclusion in this edition of chapters on epidemiology and its applica-tion to practice, the influence of social capital on health, needs assessment and commissioning, pro-moting health: frameworks for practice, occupa-tional health nursing, partnership working in health and social care, developments in promoting work-force health and advancing public health in nursing practice. These new chapters broaden the scope of the book and increase its public health focus.

The text remains broad based and is designed to support students undertaking graduate and post-graduate programmes, at a pre-registration and

post-registration level. Students studying for first registration in the fields of mental health, learning disability and adult and children’s nursing would benefit from using elements of this book as an accompaniment to their community modules and associated clinical placements. It would help them to understand the broad nature of public health and primary healthcare and the roles of various nursing professionals working within the field, as well as guiding them through those factors that adversely affect health and well-being.

Qualified nurses studying for either a specialist practice qualification in district nursing, community mental health nursing, community learning disabil-ity nursing, practice nursing, or community chil-dren’s nursing, or nurses studying for a specialist community public health nurse qualification in health visiting, school nursing or occupational health nursing will find this book invaluable to their studies. Nurses undertaking study into public health at Masters level would also find useful material within this third edition. This new version has incorporated chapters specifically relating to occupational health nursing along with all the other disciplines, thereby increasing its acceptability to these groups of specialist community nurses. It aims to provide a stimulating resource for both public health and com-munity nursing students and educators in clinical practice and higher education institutions. The book poses questions and issues for reflection, seminars and debate, as well as offering referenced and recommended reading to promote depth and breadth of study.

As editors we made a decision to continue with a ‘framework’ approach that links social and health policy with public health and community nursing practice. There is a deliberate overlap in some parts of the book to guide the reader through a multitude of subject areas that interlink, thus reinforcing important messages. Each chapter is cross-refer-enced with other chapters, which allows the reader to gain an in-depth knowledge of particular areas and assists with building the ‘picture’ of nursing in a public health, community, workplace and primary care environment.

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Structure and organization of the book

The book is organized into five sections, each using a different perspective to explore the issues relevant to public health and community nursing practice. Section 1 focuses on the changing landscape of public health, highlighting relevant health and social policy developments and their consequent effects on the organization and management of public health and primary care.

Section 2 uses public health as a framework for practice, with chapters that explore the use of epi-demiology as a method of gathering an evidence base for practice. The section continues with a vision of the modern public health movement and empha-sizes the use of a social model of health. The empha-sis in this section is on those factors that adversely affect health and the associated issues for preventa-tive work. Needs assessment and the commissioning process are examined and a framework for under-taking a needs analysis is presented. The next chapter in this section outlines frameworks for pro-moting health, providing an overview of the theory of health promotion and how this fits into a public health framework. The final chapter in Section 2 outlines developments in promoting workplace health, and presents numerous frameworks for practice.

Section 3 reviews the family as a framework for public health and community nursing practice, outlining sociological and psychological perspec-tives. Society’s view of what constitutes a family changes over time, and the perceived functions of a family all impact upon the way in which nurses deliver care in any environment. Violence and abuse in families is a major health-related problem and one which public health and commu-nity nurses need to be aware of when undertaking an assessment. Protecting children from abuse is of importance to all nurses, and an ecological frame-work for prevention of violence to children by their parents is presented in this chapter. In the final chapter in this section the family is discussed as a provider of healthcare, as well as the unit for nursing assessment. It presents a way of working with families that would suit all public health and community nurses, regardless of the specialism being studied.

Section 4 contains chapters pertaining to each of the specialist areas of community nursing previously mentioned. Each chapter outlines the historical development of that area of nursing, highlights issues relevant to current practice, and discusses the future development in relation to health and social policies. The section, read in its totality, will serve to provide an overview of nursing in a public health, workplace and primary healthcare setting, accu-rately describing how each diverse discipline con-tributes to the delivery of care through collaboration and team working.

The final section is concerned with partnership working in health and social care, alternative ways of working and advancing public health in nursing practice. New nursing roles associated with greater autonomy are rapidly developing in public health and primary care settings, leading to new issues associ-ated with partnership working, accountability and promoting patient and public involvement. These concerns are addressed in the first chapter of this section. The next chapter illustrates the emergence of a diverse range of nursing roles in public health and community nursing practice. The editors present a final chapter in this section which brings together many of the issues discussed within the book and introduces a framework of engagement that outlines nurses’ current involvement in public health. It debates ways in which nursing could further develop public health in practice and advocates for recogni-tion of the nurse’s contribution to the nation’s health.

This book is by no means inclusive of all issues influencing public health in nursing practice. It does, however, provide an overview of the complexities influencing and shaping the current and future prac-tice of public health and community nursing. An important message based on our personal beliefs is that, although we play a critical part in the lives of many people on their pathway to recovery or death, our role will only be valued if we value others. Each person’s experience of illness or health is unique, shaped by personal life experience, and this must be respected. As public health and community nurses we are privileged to share people’s homes and families and we must never abuse our position. This philosophy underpins each page of this new edition of Public Health and Community Nursing – Frame-works for Practice.

Dianne Watkins and Judy Cousins, 2009

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References

Department of Health 2004 Choosing health. The Stationery Office, London

Department of Health 2006 Our health, our care, our say. The Stationery Office, London

Department of Health 2008 High quality care for all: NHS next stage review. Final report. The Stationery Office, London

Department of Health, Social Services and Public Safety 2005 Caring for

people beyond tomorrow: a strategic framework for the development of primary health and social care. The Stationery Office, Belfast

NHS Scotland 2005 The national framework for service change in NHS Scotland: elective care action team – final report. SEHD, Edinburgh

Scottish Executive Health Department 2005 Delivering for health. SEHD, Edinburgh

Welsh Assembly Government 2005 Designed for life: creating world class health and social care for Wales in the 21st century. Wales Assembly Government, Cardiff

Welsh Assembly Government 2008 Proposals to change the structure of the NHS in Wales: Consultation paper. WAG, Cardiff

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