Public health nurses' community development practice with women in high-risk environments

grantor: University of TorontoThis dissertation contributes to a deeper understanding of the complex community development practice of public health nurses working with women in high-risk environments. It explicates how the economic and sociopolitical context of the health care setting posed barriers for the nurses' practice and how they negotiated these constraints. Through a feminist, ethnographic inquiry (over a 14 month period) that included interviews (30), participant observation (76 hours), document analysis, and personal reflective journalling, the practice knowledge of 13 public health nurses was articulated. Three meta themes emerged from the data. 'Being in Community' characterized the nurses' practice of community development as a multidimensional concept rooted in a philosophy and process of empowerment for social justice and health. They valued their practice as a unique and essential beginning step with marginalised women, "starting where the women are", and progressing from personal empowerment, to a group of women, to a community of women and community empowerment. Regardless of an individual, group, or community focus, the values and ways of practising were more similar than different. Building trusting relationships, establishing connections with community resources, and measuring progress were core factors in the nurses' community development model. Praxis and an extensive repertoire of roles, strategies, and complex contextual and relational knowledge were needed to negotiate uncertain partnerships and to catalyse significant transitions for the women. 'The Contested Terrain: Social Construction of Public Health Nursing ' highlighted constraints on the nurses' autonomy and practice by larger organizational processes and the nurses' everyday work environment. Ethical conflict, moral distress, job dissatisfaction, and increased invisibility in community development work were significant consequences. 'Creating Space for Possibility' reflected the factors that influenced the nurses' evolving community development consciousness and their strategies for sustaining meaning and negotiating barriers for themselves and for the marginalised women. This study establishes public health nurses' unique contribution to community development and to primary health care. It confirms the need for critical and feminist, ethnographic research to uncover the impact of economic and sociopolitical factors on public health nursing practice and policy and practice changes that decrease health damaging conditions for disadvantaged women.Ph.D