UBC Theses and Dissertations

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UBC Theses and Dissertations

They're limited by their circumstances...maybe it's the best they can do : public health nurses' understanding of their work with families living with social and material disadvantages Gunn, Nancy Jane


Public health nurses (PHNs) have a long history of supporting the health of families living with social and material disadvantages. Professional nursing organizations, researchers and theorists emphasize that consideration of the social determinants of health and efforts to address health inequities are critical components of nursing’s mandate. Literature emphasizes that nurses’ practices are shaped by personal, organizational and ideological factors that influence their assumptions about, and understanding of their role with, vulnerable families. Literature also highlights the need for PHNs to engage in critical reflection about their personal assumptions regarding their clients in order to provide care that is socially just. The purpose of this qualitative study is to explore the range of understandings and assumptions PHNs may hold about families living with social and material disadvantages, how PHNs understand their work with these families and the ways in which PHNs reflect on their assumptions and nursing practice. The specific research questions are: What is the range of assumptions that PHNs have in relation to families living with social and material disadvantages? How do PHNs understand their work with families living with disadvantages? How do PHNs describe engagement in self-reflection regarding their assumptions about clients living with disadvantages and how does this impact the PHNs’ nursing practice? What can be learned from the perspective of expert PHNs on the ways that nurses can work effectively with families living with social and material disadvantages? What recommendations can be generated to help support PHNs working with families living with social and material disadvantages? A qualitative exploratory research design was used to address these research objectives. Six, experienced PHNs participated in interviews with the researcher. The findings are organized around five main themes: (i) understanding clients’ context and engaging with individuals and families, (ii) building trusting relationships, (iii) PHNs are one agent, among many, that may influence change, (iv) recognizing the significance of small increments of change, (v) PHNs’ practice has a primary focus on mothers and children. PHNs valued opportunities to engage in self-reflection, but identified barriers to this practice. Recommendations are suggested in domains of education, organizations, PHNs’ practice and research.

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