Exploring health visitors' perceptions of the public health nursing role

Abstract

This small exploratory study in one local area in Scotland aimed to identify health visitors' perceptions of public health nursing and the factors that influenced their capacity to adopt a broad public health role in line with current policy direction in Scotland. The literature review focused on the historical and political context of public health nursing and the extent to which health visitors across the UK have managed to shift practice towards a greater emphasis on community focused public health work. This study involved 10 qualitative interviews with practising health visitors, who had at least 2 years' experience and trained prior to September 2001 when the public health nursing course replaced the health visiting course in Scotland. Participants identified a range of barriers to local implementation of the model of public health nursing practice set out in recent national policy. Findings suggested that theoretical perspectives of public health and leadership issues for health visitors perpetuate the dominant clinical agenda in their work setting. Although participants were generally willing to develop wider public health work they identified a number of constraints related to the perceived higher value given to clinical duties. This was reinforced by the low priority given to public health work at all levels within the organization and by primary care team colleagues. The study found participants felt powerless to influence change and were frustrated by unrealistic expectations of their ability to develop their public health nursing role without adequate support and planning infrastructure. Dominant themes that emerged from the investigation reinforce the need for effective leadership and application of social science theory to enable public health nurses to challenge the perceived dominant biomedical approach to public health in primary care.