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UBC Theses and Dissertations

An exploration of factors influencing Public Health Nurses' capacity to engage in health promotion Dhari, Ranjit Kaur


In the 1980s Canada was viewed as a leader in health promotion with the articulation of a framework to move health promotion into nursing practice, which was influential in structuring public health programs (Crichton, 2000; Richard et al., 2010; Stewart, 2000). Over time, public health nursing has experienced a shift in emphasis from health promotion—characterized by building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, and reorienting health services (Ward & Verrinder, 2008)—to population health, with its emphasis on the management of risk factors through activities such as screening, disease prevention, and immunizations. The objective of this research inquiry was to understand the range and nature of influences on Public Health Nurses’ capacity to engage in health promotion work in a public health agency. Institutional ethnography methodology was utilized to understand the ruling relations, the forces that have the power to shape the day-to-day realities for Public Health Nurses and the agencies they work in. Interviews from 12 experienced Public Health Nurses, from different practice settings, were examined as an “entry into the social relations of the setting” (Smith, 2006, p. 92). The following influences have diminished the Public Health Nurse’s role in health promotion: (a) the changing context and increasing acuity of public health nursing practice; (b) operational influences on Public Health Nurses’ capacity to engage in health promotion (including time, budget, and other factors); (c) weakening relationships with community partners; (d) organizational leaders’ perceived lack of understanding of the Public Health Nurse’s role; and (e) centralized decision making. Public Health Nurses’ conceptualizations of health promotion are affected by these factors. The implications of these findings for public health nursing practice are discussed and recommendations for future research are made.

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