Public health nursing: What difference does it make for priority perinatal women?




Hill, Mary Eleanor

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The purpose of this study was to investigate how routine, day-to-day public health nursing (PHN) practice in one BC health authority affected health outcomes related to breastfeeding initiation and duration, infant immunizations, and household tobacco use within the population of perinatal women who were a high priority for additional and ongoing PHN services. Using administrative data from the integrated public health information system (iPHIS), outcomes for the priority population were compared to those of the general population of new mothers receiving usual PHN services. Additionally, through semi-structured interviews with PHNs, this study explored how the context of the work environment influenced PHN practice, and ultimately the achievement of those outcomes. Based on a philosophical foundation of critical realism, and a theoretical framework of critical caring, a mixed methods case study design was used to study PHN practice, as it existed day-to-day, amidst the array of ever changing organizational influences. Results from the statistical analysis of administrative data and thematic analysis of PHN interviews and organizational guiding documents, showed that priority women, who received five or more postnatal contacts from PHNs initiated breastfeeding in higher proportions than non-priority women, and continued breastfeeding to 18 months in the same proportion as non-priority mothers. Rates of breastfeeding duration for priority women were higher than expected based on current literature. Children of priority mothers were fully immunized in a slightly higher, but not significantly different proportion than children of the non-priority population, also at rates higher than expected. Although high rates of household tobacco use among this group of priority women did not appear to be influenced by PHN contact, the relationships that developed between priority women and PHNs suggest that organizational support for tobacco cessation activities may be a missed opportunity. Thematic analysis of PHN interviews and guiding documents provided background context and clarification for the kinds of organizational factors and underlying mechanisms that may have influenced the ability of PHNs to provide additional and ongoing support to priority perinatal women in achieving these three outcomes of interest. Finally, the theory of critical caring was verified and extended through the experiences and explanations of PHNs, with the addition of “navigating organizational complexity” to the original seven carative health promoting processes.



perinatal, breastfeeding, tobacco, immunizations, administrative data, Public health nursing