The Role of the

Public
Health Nurse
within the
Regional Health Authority

Manitoba
Health
Acknowledgments
The public health nurses of Manitoba Health collaborated with City of Winnipeg
public health nurses in preparing The Role of the Public Health Nurse within the
Regional Health Authority. We would like to thank everyone who participated in the
preparation of this document.

October 1998

Additional copies are available from:

Manitoba Health
Community Health Assessment Unit
Fax: (204) 772-2943
Internet: http://www.gov.mb.ca/health
Contents
Introduction 3

Paradigm Shift From Illness to Health 4

Public Health Nursing is Integral to Regional

Health Services 5

Public Health Nursing – An Overview 7

Public Health Nursing Exemplifies The Provincial

Paradigm Shift 8

Health Promotion, Illness Prevention and Health

Protection 9

Role of the Public Health Nurse in the Delivery

of Core Services 11

Health Promotion 12

Prevention 13

Health Protection 14

Outcomes of PHN Services 15

Conclusion 15

References 16

Appendix A 17
2
Introduction
This document describes the role of public health nursing within Manitoba’s
Regional Health Authorities. Health promotion, illness prevention and health
protection are core services of the Regional Health Authorities and core functions
of the public health nurse. This paper illustrates how public health nursing practice
exemplifies the provincial paradigm shift which focuses on:

■ the broad determinants of health,

■ equity of health,
■ intersectoral approaches,
■ health rather than an illness system,
■ partnerships with the community,
■ investments in health promotion and disease prevention, and
■ evidence-based health outcomes.

In addition to discussing the paradigm shift from illness to health, this paper will
also address the following areas:

■ Public Health Nursing is Integral to Regional Health Services

■ Public Health Nursing - An Overview
■ Public Health Nursing Exemplifies the Provincial Paradigm Shift
■ Health Promotion, Illness Prevention and Health Protection
■ Role of Public Health Nursing in the Delivery of Core Services
■ Outcomes of Public Health Nursing Services

3
Paradigm Shift From Illness to Health
Health is a resource for life, not the object of living; it is a positive concept
emphasizing social and personal resources, as well as physical capacities (World
Health Organization, 1986). The new view of health demands a funding and
resource revolution from an illness focus to a balanced resource allocation for
wellness. This resource shift is not likely to occur without controversy and confusion
because of the persistent belief that health is the absence of disease or illness. There
is growing awareness of the many determinants of health, most of which are entirely
outside of the current health sector.

All communities have highly variable and unique strengths and health needs. The
Regional Health Authorities (RHAs) will provide solid foundations for service and
staffing decisions to support the move to “health” oriented care based on ongoing
community health assessments and the core services as defined by Manitoba Health.

The following chart is a graphic representation of where public health nursing

services predominate within the continuum of regional health services.

Health Continuum
Restructuring the system towards a more
appropriately balanced continuum of services

Healthy Public Hospitals

Policy Support
Prevention Services Community Outpatient
Promotion to Health Ambulatory Rural Urban
Protection Seniors Centres Care Community Community Tertiary Palliation

Community Home Care Extended Rehabilitation

Oriented Treatment &
Services Long-Term Care
Public Health
Nursing

(Adapted from Quality Health for Manitobans: The Action Plan, 1992)

4
Public Health Nursing is Integral
to Regional Health Services
Key elements of the role and function of the public health nurse (PHN) within the
regional health structure:

■ Core PHN services are delivered within a community-based framework.

• Community-based services are driven by the needs and resources of the

community and its neighbourhoods. PHNs assess communities on a daily basis
while working with individuals, families and groups in the neighbourhood,
schools, workplaces and homes.

■ PHNs are community leaders.

• PHNs work with community groups, negotiate partnerships and build

collaborative initiatives. They are well positioned to manage the delivery of a
wide variety of services within a restructured system.

■ PHNs are effective members and often leaders of interdisciplinary and

intersectoral teams.

• Through recognition of the importance of the determinants of health, PHNs

develop integrated approaches to address health issues. It is through
interdisciplinary and intersectoral linkages within communities that PHNs
affect the determinants of health.

• PHNs are community and public health experts. PHNs can readily provide
leadership to a team of community practitioners (e.g., audiologists, health
educators, physicians, health inspectors, peer outreach workers).

■ PHNs can be integral members of neighbourhood resource networks and

community nurse resource centres.

• Community nurse resource centres (CNRCs) and PHN services are

complementary. PHN services share four central components of CNRCs :
primary health care, community development, education and outreach, and
research. Both PHN and CNRC services are based on community assessment of
needs and assets, and include evaluation components.

• PHN services differ in that they include those services mandated under the
Public Health Act (i.e., communicable disease prevention and control).

5
■ PHNs must continue to have provincial, national and international linkages.

• These linkages allow PHNs across the country to learn from, and provide
direction regarding the broader implications of policy and to develop common
strategies. These linkages reduce duplication in effort, human and fiscal
resources (e.g., trends in emerging communicable diseases, other
epidemiological issues, community development, school health and healthy
child development).

■ Public health nursing services are directed to the general population with
priority given to high-risk populations.

• For maximum effectiveness, illness prevention efforts are targeted to identify

and intervene with those who are at high-risk of injury or illness.

• While health promotion is relevant to everyone and to all communities

regardless of risk status, it may be most effective to target health promotion
resources to those populations which have the poorest health status.

• Some health protection services apply to high-risk groups while others apply to
the general population.

■ Public health nursing services should be provided by designated PHN positions

separate from other nurses based in the community.

• A health promotion and illness prevention focus is very different from an

illness treatment and care model such as home care and palliative care. Some
persons currently classified as public health nurses in collective agreements
may have functions different or in addition to those identified in this
document (e.g., long-term care, home care).

• An illness prevention, health protection and health promotion focus needs to

be kept as a priority for all communities. As we shift into an integrated health
care model we need to ensure that illness care and treatment demands do not
rob the community of its ability to address long-term investments in health.

• Research demonstrates that long-term investments in health provide financial

savings and personal and community health gains.

6
Public Health Nursing – An Overview
Public health nursing focuses on the health of entire populations or communities.
PHN services are provided to individuals and families within the context of the
health of the larger community. PHN expertise is in the promotion and protection of
health and the prevention of disease. PHNs understand that the health of individuals
and communities directly relates to the determinants of health such as housing,
income, employment, education, sanitation and safety.

PHN practice aims to improve the health of all people and minimizes health
differences among populations by addressing determinants of health. PHNs
understand that equity is a key aspect of the determinants of health.

PHN is an organized system of practice which:

■ synthesizes knowledge from public health sciences and professional

nursing theory;
■ is comprehensive and holistic in its approach;
■ works with community members, other health care professionals,
disciplines and sectors;
■ promotes linkages between individuals, communities, the broader health
system and other health determining sectors; and
■ works with communities to develop specific services, programs and
strategies (Adapted from – Community Health-Public Health Nursing,
Canadian Public Health Association, 1990).

PHNs are generalist practitioners with expertise in areas such as communicable

diseases, maternal-child and school health. PHNs deliver services within a
community-based model. Services are driven by the needs and resources of a
defined community. PHNs work with and not on communities.

PHNs have skills and experience in assessing community assets and needs, in
planning and implementing community development strategies combined with a
broad base of knowledge related to health and health determinants.

PHNs have a major responsibility for implementing legislated services to control health
hazards and communicable diseases as found in The Public Health Act, the Food and
Food Establishment Regulation and the Diseases and Dead Body Regulation.

PHN practice is client-centred and incorporates the strategies of empowering,

enabling, advocating, co-operating and collaborating when working with
individuals, communities and colleagues both with the health system and with
other sectors (Focus on Health, Canadian Public Health Association, 1996).

PHNs take a long-term, investment-in-health approach. A focus on health and

wellness, rather than illness, is the basis of all PHN work. PHN services are unique
in that these contributions are offered comprehensively in an organized system of
health care delivery.

7
 The document A Planning Framework to Promote, Preserve and Protect the Health of
Manitobans (1997) identifies the changed thinking that needs to be incorporated
into planning and action. PHN approaches exemplify these suggested changes.

Public Health Nursing Exemplifies

The Provincial Paradigm Shift
From To Public Health Nursing Approaches

Focus on health Focus on health and broad Holistic focus on health and broad
services determinants of health determinants of health.

Inequity of health Equity of health Assess need, identify, and advocate for
appropriate resources and services for
those at highest need and risk. Reduce
barriers by providing flexible and
accessible services.

Responsibility of Intersectoral approach An integrated approach emphasizing

Manitoba Health intersectoral partnerships and multi-
disciplinary linkages within communities.

Illness care system Health system Focus on health gains (improvement in

determinants of health) of individuals
within the context of communities and
society/population at large.

Reliance on Partnership with Support and mobilize community

government community participation to identify health issues,
define strategies, develop solutions and
to be involved in delivery and evaluation
initiatives.

Short-term action Investment in health Invest in long-term promotion and

promotion, disease protection of health, and prevention of
prevention disease for the entire community.
Legislated mandate reinforces this.

Service provider- Focus on health outcome, Health outcomes are determined by

driven research evidence-based quantitative and qualitative research,
including epidemiology, surveys, social
research and community assessments.

8
Health Promotion, Illness Prevention
and Health Protection
Health promotion, illness prevention and health protection are core services of
RHAs and core functions of the PHN (Backe, 1996). Health protection addresses
the environment to limit health risks and maximize health benefits. Illness
prevention is concerned with avoiding the development of health problems in
those who are susceptible or potentially susceptible.

A brief description of health promotion follows because it is a cornerstone of public

health practice. All of these concepts are central to the PHN role.

Health Promotion

PHNs provide the leadership in health promotion. Health promotion is the process
of enabling people to increase control over, and to improve their health. Health
promotion:

■ involves the population as a whole in the context of everyday life, rather than
focusing only on at-risk people;

■ is directed toward action on the determinants or causes of health (e.g., food

security, parenting skills, self-care skills, social support);

■ combines diverse, but complementary, methods or approaches including

communication, education, legislation, fiscal measures, organizational
change, community development and spontaneous local activities against
health hazards;

■ aims particularly at effective and concrete public participation;

■ is basically an activity in the health and social services fields, and not a medical
service. Health professionals, particularly in primary health care, have an
important role in nurturing, enabling and practicing in health promotion.

(Adapted from – Ottawa Charter for Health Promotion, World Health

Organization, 1986)

9
Health promotion action implies acting on the
determinants of health by:

1. Building healthy public policy

Health must be put on the policy agenda of all sectors and at all levels,
directing policy makers to review the health consequences of all decisions.

2. Creating supportive environments

The inextricable links between people and their social (e.g., culture,
community), spiritual and physical environments constitutes the basis for a
socio-ecological approach to health.

3. Strengthening community action

Health promotion works through concrete and effective community

action. Strategies include community work in setting priorities, making
decisions, planning and implementing them to achieve better health.

4. Developing personal skills

Health promotion supports personal and social development through

providing information, education for health and enhancing life skills (e.g.,
parenting skills, perinatal self-care skills, group leadership, maintaining
healthful choices).

5. Reorienting health services

The responsibility for health promotion in health services is multi-sectoral

and shared among individuals, community groups, health professionals,
health service institutions and all levels of government.

(Adapted from World Health Organization, The Summary of the Working

Group on Concepts and Principles of Health Promotion, 1984)

10
Role of the Public Health Nurse
in the Delivery of Core Services
RHA boards will make decisions about how to deliver the core services listed in the
document Core Health Services in Manitoba (1997). The following table identifies the
listed core services in health promotion, illness prevention and health protection.
Many PHN services can be listed under all three categories. To avoid redundancy,
each PHN service is listed only once.

HEALTH PROMOTION

• Build Healthy Public Policy

• Create Supportive Environments
• Strengthen Community Action
• Reorient Health Services
• Develop Personal Skills

PREVENTION

• Reproductive & Family Health

• Sexual Health
• Prevention of Chronic Illness
• Nutrition/Food Security
• Mental Health

HEALTH PROTECTION

• Communicable Diseases
• Protection from Injury
• Environmental Health
• Emergency Health

A detailed description of PHN services in each of these core service areas follows.

11
 HEALTH PROMOTION
Build Healthy Public Policy Reorient Health Services
Goal Goal
Public policy is developed consistent with improvements in the Responsibility for the determinants of health is shared among
determinants of health. individuals, community groups, health professionals, health
service institutions, all levels of government and all sectors,
Services including justice, health, education, business, housing, social
• Encourage and support community-based advocacy for healthy services and recreation.
public policy at all levels and in all sectors (e.g. justice,
education, housing, social services, recreation). Services
• Direct advocacy for healthy public policy. • Primary role in community assessment. Provide consultation
• Educate and encourage decision makers in all sectors and at with decision makers (e.g., RHA management and board)
all levels to participate in the development of healthy public regarding community strengths and needs as a foundation for
policy. health care decisions.
• Foster partnership with community decision makers to • Promote responsible and effective use of the health care
evaluate public policy. system and community resources.
• Refer individuals, families, groups and communities for
An Example of Service appropriate service.
• Engage other sectors in addressing the determinants of health.
PHNs work with communities to advocate for smoke-free public
buildings. An Example of Service
Outcome: Ninety per cent of public buildings are smoke free. PHNs work with a community to reorient speech and language
services from a facility to accessible community locations based
on a partnership among health, education and community
members.
Create Supportive Environments Outcome: A 5 per cent increase in early identification and
Goal intervention for preschool children with speech and language
Community members live in healthy social, emotional, spiritual, problems.
physical and ecological environments.
Services
• Assess and directly act on the factors affecting health in the
community’s social, emotional, spiritual, physical and Strengthen Community Action
ecological environment. Goal
• Encourage and participate in health promoting initiatives with Community members are actively involved in achieving health.
other communities and sectors.
• Increase awareness of the ecological and social environments Services
affecting the health of individuals, families, groups or • Mobilize individuals, families, groups and communities to
communities. Encourage and support related action. take individual and collective action on the determinants of
health in the contexts in which they live, learn, work and play
An Example of Service (e.g., schools, workplaces, homes, economic and social
environments).
PHNs work with communities to develop strategies to promote • Develop and support community-based and self-care services in
safe environments for children. which community members have ownership and an active role.
Outcome: The number of latch-key children under 12 is reduced
by 10 per cent. An Example of Service
PHNs work with a community to identify their assets and needs,
determine priority issues, develop strategies and take action
Outcome: An active ‘Healthy Community’ network is established.

Develop Personal Skills

Goal
Community members will make effective choices to attain an optimal level of physical, emotional, spiritual and social development.
Services
• Mobilize individuals to take individual and collective action on the determinants of health.
• Provide information regarding choices.
• Counsel and facilitate healthy choices.

An Example of Service
PHNs facilitate “Nobody’s Perfect” parenting sessions for teen mothers and fathers.
Outcome: All parents involved in the parenting program have identified an improved understanding of early childhood development.

12
 PREVENTION
Reproductive and Family Health Prevention of Chronic Illness
Goal Goal
Individuals and families will have healthy pregnancies and children. Chronic illness is prevented, reduced or eliminated.
Services Services
• Reproductive health education, counselling and provision of • Identify and remove/remediate risks for chronic illness.
supplies (e.g., sexuality, family planning, infertility). • Develop program and policy to reduce rates of chronic illness.
• Preconceptual and prenatal education and support. • Educate, counsel, refer and support individuals, families and
• Antenatal monitoring and support for high-risk pregnancies. groups regarding lifestyle choices.
• Assessment and follow-up during newborn and postpartum • Provide education regarding substance abuse prevention.
period (including postpartum stress and depression, perinatal • Early identification through screening (e.g., PKU, blood pressure).
loss). • Develop resources.
• Promote, assess and support breast-feeding. • Research and surveillance to prevent chronic illness.
• Parenting education and support for families (e.g., “Nobody’s • Plan, monitor and evaluate regional programs and rates and
Perfect”, “Ready or Not” parenting programs). risks of chronic illness.
• Assessment and education of infant growth and development.
• Health counselling and support for parents. An Example of Service
• Child abuse prevention, identification and education.
• Support to family resource centres. PHNs promote community participation in eliminating the factors
• Participate in adolescent health clinics. that contribute to acute asthma attacks.
• Pregnancy counselling. Outcome: Reduce emergency utilitization by 25 per cent for
• Outreach, advocacy, support and referral to individuals and acute asthma attacks.
families at high risk.
• Develop resources.
• Participate in research into reproductive and family health.
• Plan, monitor and evaluate regional programs.
Nutrition / Food Security
An Example of Service
Goal
PHNs provide outreach to young women and their peer groups Communities will act to ensure individuals and families have
who regularly use alcohol and other teratogenic drugs. access to nutritionally adequate and safe food.
Outcome: Decreased numbers of alcohol/drug exposed/affected Services
infants. • Provide education and resources related to individual and
family nutrition.
• Facilitate community strategies regarding food security (e.g.,
community kitchens, kids cooking clubs, food safety).
• Advocate for community supports and services.
Sexual Health • Outreach to and referral for individuals, families and groups at
Goal risk for nutritional deficits.
Community members will integrate the physical, emotional, • Develop resources.
intellectual, and social aspects of their sexuality. • Research and surveillance about nutrition and food security.
• Plan, assess and evaluate regional nutrition/food security
Services issues and initiatives.
• Educate, counsel, advocate, and refer individuals, families
and at-risk groups regarding relationships, communication, An Example of Service
sexual decision making and behaviour, sexual orientation,
personal safety and sexually transmitted infections. PHNs promote activities and practices to reduce iron deficiency
• Promote healthy self-esteem (body image, eating disorders, anemia in infants.
weight management, steroid use). Outcome: A 20 per cent reduction in nine-month-old infants with
• Develop resources. iron deficiency anaemia.
• Research and surveillance regarding sexual health.
• Plan, monitor and evaluate regional programs.

An Example of Service
PHNs participate in school family life education.
Outcome: Students will have an increased knowledge about
growth and development related to their reproductive system.

13
Mental Health • Identify, support, advocate and/or refer those persons who
are unable to function in their own environment.
Goal • Promote the recognition and development of interpersonal
Community members will have personal supports and coping supports.
skills to function effectively in everyday life. • Develop resources.
Services • Research and surveillance about mental health issues.
• Provide information, support, counseling and resources related • Plan, monitor and evaluate regional programs.
to life transitions, self-esteem, asser tiveness, decision making,
communication, relationships, coping and stress management. An Example of Service
• Identify, counsel and/or refer for depression and suicide risk. PHNs identify, counsel and/or refer suicidal adolescents in the
• Assess, counsel and/or refer for weight preoccupation, community.
obesity, body image and eating disorders.
• Support and link those with chronic illness to appropriate Outcome: Reduction of adolescent suicidal behaviour and deaths
resources. by 10%.
• Provide crisis intervention and trauma postvention services.

HEALTH PROTECTION
Communicable Disease Prevention Environmental Health
Goal Goal
Communicable disease is prevented, reduced or eliminated People are safe from biological, chemical, environmental and
(e.g., sexually transmitted infections, tuberculosis, rabies, food- social hazards.
borne illness, infectious hepatitis).
Services
Services • Facilitate community participation to advocate for safe and
• Manage, control and prevent communicable disease and healthy environments.
outbreaks. • Provide education regarding environmental issues and hazards.
• Plan, co-ordinate, deliver, monitor and evaluate immunization • Participate in the monitoring and investigation of chemical,
programs. biological and social hazards.
• Provide education and resources to prevent, detect and treat • Develop resources.
communicable diseases. • Research and surveillance regarding environmental health
• Work with Manitoba Health regarding communicable disease issues.
prevention, management and control. • Plan, monitor and evaluate regional programs.
• Develop resources.
• Research and surveillance about communicable disease. An Example of Service
• Plan, monitor and evaluate regional programs.
PHNs promote the use of sun screen and hats to decrease
An Example of Service sunburn.

PHNs provide a public health response to a meningitis outbreak. Outcome: Decreased number of emergency room visits for
sunburns and heat strokes.
Outcome: No new meningitis cases related to the index case.

Emergency Health
Protection from Injury
Goal
Goal Minimize community morbidity and mortality related to disasters
Injuries are reduced or eliminated. and emergencies.
Services Services
• Advocate for program and policy development for safer • Participate in the development and implementation of the
environments. emergency response plan.
• Injury investigation and follow-up. • Facilitate provision of services for identified health and social
• Participate in the identification and removal/remediation of issues.
injury risks. • Prevent, monitor potential for, and control the spread of
• Participate in research regarding injury protection/prevention. communicable disease.
• Participate in injury investigation and follow-up. • Provide crisis intervention and trauma postvention services.
• Develop resources. • Provide immediate and post-disaster emotional support for
• Research and surveillance about injuries. individual, families and communities.
• Plan, monitor and evaluate regional program • Provide timely communication to the public (e.g., health
information lines).
An Example of Service • Recruit and mobilize community members to provide mutual
support.
PHNs facilitate community planning and strategies to reduce • Develop resources.
injuries among children and adolescents. • Related research.
Outcome: Removal and replacement of unsafe playground • Plan, monitor and evaluate regional programs.
equipment.
An Example of Service
Public health nursing response to massive flooding.
Outcome: No major outbreaks of communicable diseases.
Community members are aware of the potential injury risks.
Outcomes of PHN Services
Health service outcomes and their indicators can be related directly to the client,
the determinants of health or the health service delivery system itself. PHN
outcomes can be measured by using:

■ Traditional Health Status Indicators

• natality (number of births)

• mortality (number of deaths)
• morbidity (disease and disabilities)

■ Quality of Life Indicators

• feelings (subjective sense of well-being)

• functions (ability to function)
• futures (prognosis for future “feelings” and “functions”)

■ Determinants of Health Indicators

• social, economic and cultural environment

• behavioural and lifestyle
• ecological and physical environment

■ Structure, process and output indicators can be used as health service outcome
indicators if:

• they are relevant to the stated goals and objectives of the service;
• they were intentionally or unintentionally changed by the service;
• the change in structure, process or output indicators is associated with change
in some other indicator of the service.

(Adapted from Outcome Indicators: A Users Guide, CHIS Secretariat, 1994)

Conclusion
Public health nurses play a significant role in improving the health status of
communities in Manitoba. The health of the public can be maintained and
improved through changes to the institutional sector and support for health
promotion, health protection and disease prevention. Restructuring of the health
care system will be successful only if there is a sustained investment in health. The
challenge for regional health authorities is to support the shift from an illness to a
health focus.

15
References
Backe, Horst. Public Health Nursing Services in Rural and Northern Regional Health
Authorities: Policy Options for Boards. Unpublished Paper. Winnipeg: 1996

Canadian Public Health Association. Community Health – Public Health Nursing in

Canada: Preparation and Practice. Ottawa: 1990.

Canadian Public Health Association. Focus on Health: Public Health in Health Services
Restructuring. Ottawa: 1996.

Community Health Information Systems Working Group, Policy and Consultation

Branch, Health Canada. Outcome Indicators : A Users Guide. Ottawa: 1994.

Manitoba Health. A Planning Framework to Promote, Preserve and Protect the Health of
Manitobans. Winnipeg: 1997.

Manitoba Health. Quality Health for Manitobans: The Action Plan. Winnipeg: 1992.

Northern/Rural Regionalization Task Force, Manitoba Health. Core Health Services

in Manitoba. Winnipeg: 1997.

World Health Organization. The Summary Report of the Working Group on Concepts and
Principles of Health Promotion, Copenhagen, 9-13 July 1984. ICP/HSR 602 (m01): 1984.

World Health Organization, Health and Welfare Canada & Canadian Public Health
Association. Ottawa Charter for Health Promotion. Ottawa: 1986.

16
Appendix A
Qualifications and Competencies of the Public Health Nurse
(Community Health-Public Health Nursing in Canada, Canadian Public Health
Association, Nov. 1990)

A. Qualifications
A baccalaureate degree in nursing is essential for beginning practice.

B. Competencies
Public health nurses require a broad range of competencies to be effective in their
role.

1. Knowledge
The public health nurse must have a sound base in nursing theory, art and science
as well as in public health. This includes knowledge of:

■ nursing theories and the art and science of nursing;

■ public health and related sciences such as epidemiology, environmental
health, biostatistics and communicable disease control;
■ the determinants of health;
■ primary health care;
■ the liberal arts and sciences;
■ public policy, management and program development;
■ community development process;
■ program and public policy evaluation;
■ relevant legislation and regulations;
■ professional boundary practice, recognizing local mandates, legal and
ethical requirements;
■ cultural awareness;
■ health care systems and their organizations;
■ major international health issues and problems;
■ information systems and other advanced technologies;
■ research methods, current research and its utilization; and
■ outcome evaluation.

2. Skills
In the performance of the role of the public health nurse, the following skills are used:

■ community assessment, diagnosis and related planning;

■ client (individual, family and group) health assessment, diagnosis and
related planning;
■ conducting and analyzing research;
■ outreach;
■ building on strengths and assets of individuals and communities;

17
 ■ involving community members in decisions affecting health;
■ advising, teaching and consulting;
■ technical procedures such as immunization;
■ supportive counselling/crisis counselling;
■ team building;
■ group facilitation, including conducting meetings;
■ written or verbal communication with individuals, groups in various settings;
■ conflict management;
■ adaptation of techniques, approaches and procedures as necessary to the
setting and circumstances;
■ decision-making using the nursing process and taking into account ethical
aspects;
■ adapting programs and services to meet diverse needs;
■ management, administration;
■ community responsive program planning, development, implementation
and evaluation;
■ advocacy for community, groups, families and individuals including
involvement in community development, community organization and in
the political process; and
■ policy development.

3. Attitudes and Professional Qualities

In the performance of their role, public health nurses are:

■ comfortable working in an unstructured environment and receptive to

appropriate change;
■ open to collaborative decision-making with clients, colleagues and other
professionals;
■ oriented toward wellness rather than illness and toward prevention rather
than treatment;
■ able to respond appropriately to groups with diverse cultures and languages;
■ self-directed and motivated to take responsibility for their own learning
and apply this to program initiatives;
■ prepared to take calculated risks based on sound judgement to promote
change;
■ committed to share with clients only accurate and current knowledge and
information;
■ able to judge the relative importance/urgency of health status information
gained through data collection and analysis; determine appropriate timing
and extent of nursing intervention; identify need for referral and involve
clients in this decision;
■ willing to seek assistance/advice when necessary; and
■ committed to equity and social justice.

18