Essay Role of Public Health Nurses In Risk Factor Modification – Nursing Assignment Help

Assignment Task

Role of Nurse 

The role of public health nurses in  risk factor modification within a  high-risk cardiovascular disease  population in Ireland –  a qualitative analysis 

Background/aims: Health promotion for cardiovascular disease risk factors management is essential to secondary  prevention of cardiovascular disease events. In Ireland, post-cardiac rehabilitation patients are discharged into the care  of community public health nurses, who have a health promotion role. Little is known of the public health nurses’  perceptions or knowledge surrounding their role in cardiovascular disease risk factor management. Underpinned by a  constructivist viewpoint, this study aims to generate empirical evidence on the phenomenon directly from public health  nurses’ encounters within the context of the current health service. 

Methods: This qualitative cross-sectional analysis involved face-to-face, semi-structured interviews with a purposeful  sample of 17 public health nurses. Interviews were audio-recorded, transcribed, subjected to thematic content analysis  and subsequently reported incorporating verbatim quotes. 

A significant gap exists between evidence-based guidelines for cardiovascular disease prevention and current  practices. Variations in public health nurses’ training, experience and knowledge result in inconsistent practices, and public  health nurses feel this is specialised area for which they are not equipped. The changing public health nurse role and increasing  workloads result in prioritisation of other nursing duties over health promotion. Ineffective systems for care delivery and a  lack of community-based rehabilitation programmes also negatively impact on secondary prevention practices. 

Conclusions: Findings support the need to develop a community cardiovascular disease specialist role to effectively  support ongoing cardiovascular disease risk factor management. Evaluation of the mechanisms of current service delivery  is required to ensure a quality-assured equitable service, in line with community needs and current evidence-based  guidelines for practice. A quantitative triangulation study is recommended.

Introduction 

Cardiovascular disease (CVD) is well documented as a  global epidemic and leading cause of premature death.1 High-quality international studies identify worrying trends  in CVD risk factor prevalence and provide an evidence  base for developing preventive strategies.2–4 Global strate gies have been developed and targets set to reduce cardio vascular disease deaths by 25% by the year 2025.5 Morbidity and mortality associated with CVD present  

Considerable financial costs to the health services and the  economy. Scientific evidence demonstrates that lifestyle interven tion for risk factors such as smoking, diet, exercise, hyper tension, hyperlipidaemia, diabetes and prophylactic drug  therapies reduce morbidity and mortality by 90% in people  with coronary heart disease.

Current European Society of Cardiology (ESC) guide lines on CVD prevention7 recommend a combination of  both primary and secondary prevention initiatives. While  advances in cardiac intervention and pharmacotherapy  treatments improve survival rates post-CVD events, patients  who have experienced one cardiac event are at increased  risk of experiencing a second event.7 Management of CVD  risk factors is essential for this particular cohort to promote  health and well-being and prevent secondary events.8,9 

There has been a noticeable increase in the number of  patients post-phase III hospital-based cardiac rehabilita tion being discharged into the primary care community  services. Public Health Nurses (PHN) are employed within  these primary care teams to provide services primarily to  patients over the age of 65 years, from lower socioeco nomic backgrounds, where health inequalities are known  to persist. Chronic disease prevalence increases dramati cally with age. Our imminently aging population will  undoubtedly increase demand on health services, meaning  that effective health promotion initiatives are vital. 

The PHN has a health promotion role and the 2016 ESC  guidelines7 specifically address the importance of the nurses  role in CVD prevention for high-risk patients.10 While stud ies advocate CVD risk factor management,6 a noticeable  gap exists regarding the public health nursing perspective  on this phenomenon within the cohort of post-cardiac reha bilitation patients. Demographic developments and reorien tation of health services towards primary care have  dramatically altered the PHN workload.11 In light of recent  studies regarding the changing role of the PHN12 and the  research gap identified, this study aims to provide a qualita tive account of PHNs’ experiences surrounding their health  promotion role in CVD risk factor management within the  current healthcare system. It seeks to establish their perspec tives on training and support for this role, factors which  effect role execution and how this role could be improved  upon in light of current guidelines. 

Design 

The aims of this study fit the inductive nature of the social ist-constructivist paradigm and interpretivist methodolo gies. A qualitative cross-sectional analysis incorporating  semi-structured interviews centred on an underpinning  phenomenological research paradigm, was employed.13 Existing knowledge, clinical experience and a literature  

review formed the conceptual basis for the interview  guide.14 Five open-ended questions were used to elicit the  PHNs’ experience regarding their health promotion role in  CVD risk factor management among the specified patient  cohort.

These focused on:

(a) Does PHN training equips  nurses for this role?

(b) What supports are available to the  PHN in this role?

(c) Factors affecting the execution of this  role?

(d) How current workloads impact on this role?

(e)  How this role could be better supported or improved? This  interview guide was pilot-tested with two colleagues to  assure intelligibility and relevance to the study aims.

Sample/participants 

Seventeen participants were purposefully recruited by dis seminating a study advertisement, participant information  leaflet, an invitation to participate and a copy of the inter view questions. Inclusion criteria included PHNs working  within the community services of the chosen region in the  southwest of Ireland. Exclusion criteria included anyone  not working as a PHN within this region and PHNs hold ing a child-health-only caseload. All participants were  female as there were no male PHNs in this region at the  time. Years of qualification as a PHN ranged from 1–22  years (mean=10.8 years). 

Data collection 

Data was collected by the lone researcher, through private  face to face interviews in the workplace, during May 2017.  Interviews were digitally recorded and handwritten notes  were taken to expand and clarify points. Only demographic  information pertinent to the study was recorded. Interviews  ended when the subject deemed they had described their  experience sufficiently. Interview length ranged from 15– 27 min (mean=18.5 min). 

Data analysis 

Thematic analysis and the constant comparative method  were employed to categorise and code evolving themes  and develop a framework of ideas.14 This process was con ducted by the principal researcher. No computer-assisted  software or coding framework was used. 

Ethical considerations and data storage 

Meticulous care was taken to address all ethically rele vant factors.15 Written consent to partake and to be  recorded was obtained. All participants were English speaking and had capacity to give consent.

A guarantee of anonymity and confidentiality was  assured by allocating each participant a unique coded ID  number. Data protection measures were rigorous. Only  data pertinent to the study was collected. Audio-recording  equipment and data were securely locked during transit  and storage. Electronic data from transcribed interviews  was stored on a secure server, on a hard drive using  encrypted software which was password protected. No  USB or SD card was used. 

Rigour 

Lone researcher bias is acknowledged as a potential risk  but systematic rigorous planning, and transparency of  design and execution limited any potential impact on  results. Analytical procedure was followed strictly and the  content was substantiated with written field notes to ensure  the credibility of data, while verbatim quotes enhanced the  confirmability of the findings. By accomplishing the objec tives of the study, the empirical findings attest to the valid ity of the design adopted. 

Results 

The results demonstrated that, prior to PHN training, par ticipants came from a range of nursing backgrounds  including maternity, paediatrics, general nursing and acute  specialities. Greater than 50% (n=10) of the PHNs inter viewed came from a midwifery background. Only two par ticipants (12%) had experience in a cardiac-care setting  prior to PHN training. Within their PHN training the  majority of participants received only training in the  generic principles of health promotion, but not cardiac specific. Only one PHN (6%) had a cardiac-specific health  promotion qualification. Three PHN’s (18%) had received  in-service training for cardiac patients in the community,  however this was delivered 10–12 years previously and no  in-service training was offered since then. 

Emergent concepts from this study are presented under  three overarching themes: (a) current health promotion  practices; (b) factors which currently affect the PHNs’  health promotion role; (c) how the PHN role and services  within the community could be improved. Each theme is  presented in a separate table, and related subthemes are  conveyed with the support of verbatim quotes from partici pants. These quotes are denoted as P1, P2 and so on. 

Current health promotion practices 

All participants reported that current health promotion  practices are inconsistent, opportunistic and largely  dependent on the individual PHN, as illustrated in Table  1. All participants unanimously reported that they consider cardiology to be a specialised area of continuous  new developments, and feel that the current generalist  role of the PHN does not facilitate competency in such  specialist topics. A resounding consensus on the impor tance of health promotion for this cohort of patients was  evident; however, numerous factors within the current  health service context were persistently reported to nega tively influence the PHNs’ ability to provide this service.  This is expressed eloquently by a participant’s statement  that: