Understanding the work of Community Public Health Nurses in Fiji and the challenges they face : a thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing, Massey University, Auckland, New Zealand
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2024-09-09
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Massey University
Figures 1 and 6-11 inclusive are reproduced with permission.
Figures 1 and 6-11 inclusive are reproduced with permission.
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Abstract
Aim: To investigate the type of work (interventions) undertaken by community public health nurses (CPHNs) in Fiji to determine if there has been a shift from a broader health promotion and primary disease prevention focus to a narrower focus on providing direct patient care.
Methods: The study used a mixed methods explanatory sequential research design, which included two phases. The first phase was a survey of 458 CPHNs working in Fiji. The survey examined the social, demographic and geographical characteristics of CPHNs (urban/peri urban, rural, rural remote/maritime), along with the interventions they performed (72 in total) covering direct patient care and health promotion and primary prevention at individual, community and system-population based levels. Additionally, it assessed the knowledge and clinical preparation of CPHNs for their current roles. Quantitative analysis techniques used were descriptive statistics, chi-square, Fisher’s exact and Cramer’s V tests. The second phase comprised in-depth interviews with ten CPHNs to determine the ways they undertook interventions; changes to their role within the past ten years; perspectives on the reasons for any change/s, and the challenges that can be encountered when undertaking daily tasks. Thematic analysis was used to analyse interviews.
Results: Phase 1: quantitative findings showed CPHNs undertook diverse interventions with geographical practice location often associated with the frequency of interventions. All CPHNs, irrespective of geographical practice location, performed direct patient care more than expected on a daily and weekly basis and less than expected on a quarterly basis. All CPHNs performed health promotion and primary prevention less than expected on a daily and weekly basis and more so on a quarterly basis. Phase 2: the qualitative findings revealed that CPHNs in rural and remote rural/maritime areas engaged in health promotion and primary prevention through coalition building and community organising due to isolation and physical environment. Nurses in urban/peri urban settings engaged in direct patient care interventions such as immunisation, management of NCD complications and home-based care. CPHNs reported that in the past decade there had been a shift from health promotion and primary prevention to direct patient care and attributed this to expanded roles and growing workloads, an increased focus on community-based healthcare, an increase in population size and service demands.
Conclusion: CPHNs in Fiji have experienced a shift in their role from a broader focus on health promotion and primary disease prevention to a narrower focus on providing increasingly more direct patient care.
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community public health nursing, Fiji, rural remote nursing, mixed methods study