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Negotiating expectations : how community health nurses conceptualize health promotion in the context of their practice Ryan, Deborah


The theory and rhetoric of health promotion are proclaimed in academic circles, the policies are decreed by those in control of health service organizations, but little attention has been given to how the people expected to apply these ideas to social action are managing change. The purpose of this research was to generate an inductive theory of how community health nurses (CHNs) describe their conceptualizations of health promotion within the context of their practice. The initial research question was: how have CHNs transformed policy and management expectations into action at the messy, indeterminate place of clients and community? What have been their supports in this process? What have been the barriers? The grounded theory, negotiating expectations, provides an explanation of how CHNs cope with the multiple and diverse demands they experience in the context of their practice as they implement health promotion. Negotiating expectations is the fulcrum process in the theory and facilitating possibilities describes how they conceptualize health promotion as a currently preferred facet of their practice. This theory provides a guide for implementation of any innovation in community health nursing. It also contributes to a better understanding of the dialectic of policy, implementation and adaptation.

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