An interpretive qualitative study was conducted to examine public health nurses' (PHNs') practice in fostering citizen participation and collaborative practice and the impact of a decade (1992–2002) of health care restructuring. This article presents the perspectives of public health management and a public policy analysis as they relate to PHNs' primary health care practice in Nova Scotia, a province in Eastern Canada. Seven face-to-face interviews were conducted with public health management from across Nova Scotia and 26 relevant public policy documents were analyzed. Three major themes emerged from the coded transcripts and the document analysis: (1) opportunistic shifts in values: constraining structures, operations, and governance; (2) insufficient funding and infrastructure support; (3) opportunities and challenges to PHN capacity and competency. The emergent themes illustrate the unique population health perspective and day-to-day contested realities of public health and PHN practice. The study provides preliminary understanding of PHNs' primary health care practice in Nova Scotia that may resonate with other national and international settings. This knowledge can form a basis for more research to explore the PHNs' practice in the organizational context in which it is embedded. This study was undertaken at a pivotal time in Nova Scotia as the provincial government embarked on primary health care renewal to improve the health of Nova Scotians. The success of this study is in large part attributable to the collaborative effort of university researchers and public health decision makers.

The integration of information technology into the health care system is central to the UK government’s strategy to improve the delivery of health care. There remains uncertainty about how this new technology is being used by practitioners, and the impact it is having in their everyday work and relationships with patients. The objectives of this study were to identify experiences and attitudes of general practitioners (GPs) about the use of the Internet as an information resource for themselves and for their patients, and their perceptions of the obstacles to using it, and to describe how GPs view the potential and limitations of the use of electronic communication with both fellow professionals and patients, and to explore the perceived impact on the GPs’ roles and relationships. A qualitative study design involving interviews with 24 GPs in North West England was used. The methods involved semi-structured interviews with a purposive sample of GPs to explore their views on the use of the Internet in their day-to-day work. Interviews were recorded and transcribed verbatim. Data was analysed with the interview schedules being modified in the light of emerging themes. There were two main themes: the Internet as an information source for GPs and their patients, and the use of email as a form of communication between themselves and patients, and between health professionals in primary and secondary care. Whilst GPs appreciate that the Internet could offer an exceptional quantity of information that could be used within the consultation and which might improve patient management, they cite many barriers to the effective acquisition and use of such a resource. Similarly, GPs reported limiting their use of the Internet to assist communication between the GP and the patient, and were concerned about the Internet duplicating work rather than reducing it. GPs seemed reluctant to grasp the potential that they perceived that the Internet might offer. The current configuration of primary care, and the role of the GP within it, is likely to limit the uptake and use of the Internet as a means of extending opportunities for patient care.

This paper focuses on one aspect of a research study exploring qualified and student nurses' constructed meaning of nursing in a community context. Uncertainty and risk were particularly important factors in the practice constructions reported by qualified nurses. However, this aspect of practice did not constitute a significant element of the clinical curriculum, and students displayed a limited appreciation of these concepts. The visibility and articulation of these aspects of practice may therefore need to be enhanced to develop a more accurate appreciation of practice in the community context, as well as refining the education agenda for this aspect of health care. Four types of uncertainty were identified in this research, namely uncertainty as a consequence of an unpredictable practice context, uncertainty created by the nurse–patient power balance, uncertainty created by exposure to diverse needs and finally, facing risk and dealing with uncertainty when alone. By drawing on a range of literature, the particular dimensions of risk and uncertainty experienced in community practice are differentiated. It is argued that as a core tenet of the practice experience it is timely and appropriate to review perceptions of risk and uncertainty. Acknowledging these as an accepted part of practice may not only facilitate the practitioner's ability to manage the experience but also allow learners to develop their appreciation and understanding of risk and uncertainty.

Primary care policy and practice in Northern Ireland is unique for two main reasons: unlike elsewhere, Northern Ireland has an integrated health and social services system and the primary care reforms witnessed in many countries have not, as yet, taken place in Northern Ireland. This paper is based on a study in Northern Ireland that aimed to review the role and function of community nursing with reference to new developments in practice, education, research and policy. Service commissioning was one of many areas explored within the study and is the main focus of this paper. The study commenced with focus groups of community nurses (n = 38), general practitioners (GPs) (n = 14) and public representatives (n = 8). This was followed by a two stage Delphi investigation using self-report questionnaires. In addition, data from 34 senior policy makers were collected using semi-structured interviews. The research was primarily carried out in Northern Ireland but involved GPs, community nurses and members of the public from the Republic of Ireland. Findings from all these data sources suggest that there is a perception that community nurses do not have the skills to take a lead role in the commissioning of services, that they require intensive training to take on such roles, and those who do should have equal remuneration with GPs who are involved in service commissioning. Recommendations are offered in the form of action points to guide future practice and policy.

This paper presents developments in evidence-based nursing practice in Botswana, Africa. Issues pertaining to evidence-based practice in community health such as the role of research, the digital divide between African countries and developing countries, and evidenced-based nursing curricula are discussed. The role of globalization in capacity building in evidence-based practice is emphasized. Recommendations for addressing challenges faced by some African countries, including Botswana in implementing evidence-based nursing practice are made.

The aim of the study was to obtain information about factors that contribute to the maternal competence of first-time mothers when the child is 3 months old. Data collection was by structured questionnaires. The sample consisted of 271 first-time mothers, who completed the questionnaires when their infants were 3 months old. The multivariate method used was a stepwise regression analysis. According to multivariate analysis, seven predictors remained in the model to explain maternal competence. The better the mother felt about succeeding in child care, the more balanced was her state of mind, and the more cheerful and easy-going the child was, the greater was the mother's competence. Younger mothers, those who received more concrete support from members of their social network and those who were more attached to their child showed better competence. Those mothers who received more guidance on breastfeeding from public health nurses also showed greater maternal competence. The research findings suggest that important factors that contribute to the maternal competence of first-time mothers include maternal resources, social support received from those close to the mother, and guidance on breastfeeding from public health nurses.

Current UK health policy guidance locates primary care at the frontiers of health care modernization. New organizational structures have resulted in general practitioner (GP) practices being brought together in Primary Care Groups (PCGs) and Primary Care Trusts (PCTs) each serving a much larger population group than the traditional GP practice. These changes have been accompanied with a need to explore new ways of working and thinking. This paper draws upon the experiences of nurses and GPs participating in an evaluation of workforce planning issues in primary health care. It explores how practitioners working in PCGs across one geographical area were able to gain a better understanding of what these changes, to both the structure and process of practice, might involve. During this developmental process the respondents used ‘the family’ metaphor, as a form of ‘shorthand’ to orientate themselves to the new responsibilities, challenges and opportunities presented by these changes to primary health care. It was in the use of terms and constructs that were familiar to their ‘everyday life’ experiences that made taking the first tentative steps in the change process easier. This paper suggests that using metaphors may be a powerful tool for policy makers, practitioners,managers and for researchers as they seek to communicate a plan for change and in understanding what these changes might mean.

Within the NHS health check (NHSHC) programme, there is evidence of marked inconsistencies and challenges in practice-level self-reporting of uptake. Consequently, we explored the perceptions of those involved in commissioning of NHSHC to better understand the implications for local and national monitoring and evaluation of programme uptake. Semi-structured, one-to-one, telephone interviews (n=15) were conducted with NHSHC commissioners and leads, and were analysed using inductive thematic analysis. NHSHC data were often collected from practices using online extraction systems but many still relied on self-reported data. Performance targets and indicators used to monitor and feedback to general practices varied between localities. Participants reported a number of issues when collecting and reporting data for NHSHC, namely because of opportunistic checks. Owing to the perceived inaccuracies in reporting, there was concern about the credibility and relevance of national uptake figures. The general practice extraction service will be important to fully understand uptake of NHSHC.

There is a raising demand for unscheduled care in the United Kingdom. Minor Ailments Schemes (MAS) were introduced to reduce the burden of minor ailments on higher cost settings such as general practices and emergency departments. The number of visits for minor ailments at GPs often declined following the implementation of MAS. Retail clinics in America employ nurse practitioners (NPs) and physician assistants (PAs) who can diagnose and treat minor illness, and minor injuries. Similar to the retail clinics, MAS can merge with walk-in centres. PAs and NPs can take over some primary care workload from pharmacists to prevent the pharmacists from being overwhelmed with all their current duties. MAS can also initiate the development of telehealth service to accommodate the home-bound patients. MAS must continue to change and evolve to meet the current and future demands of health care.

Department of Health efforts to make primary care more effective depend on the availability of relevant research findings. This implies a need for management and organization research, but it is not clear what role practice managers will play in this. The priority given to research governance also raises questions about how best to manage research in primary care. The aims of this study were to identify practice managers' involvement in research, their attitudes to research and their training needs. To do this, we conducted a postal survey of all general practices in East London and Essex. Of the 622 practices, 510 employed a manager. Of these, 232 responded, giving a 45% response rate. One hundred and forty-five (62%) respondents had been involved in research and 90 had been as a practice manager. Forty-five (20%) had some research training. Most had a positive attitude to research. The most commonly requested training topic was ‘How to manage research projects’. They wanted research to be conducted on delivering effective health care, access and appointments systems, patients' expectations of general practice, team management and their own role in the NHS. We conclude that managers have two distinct roles in research. First, undertaking research into management and service delivery and secondly managing and supporting research in the practice. Most need further training to take these forward. Research networks could do more to involve managers.

South Africa like many countries is moving towards a system of community care for people with mental health problems. This is set against a backdrop of under-resourced and overburdened services. These problems are particularly apparent in the township communities. The aim of this study was to devise an education programme for South African volunteer health workers using principles adapted from the UK evidence base for psychosocial intervention (PSI) and to evaluate the impact of the education programme on community volunteer health workers' knowledge about mental health issues. A stakeholder consultation exercise was held to explore: the context of South African services; the transferability of the UK evidence base and educational strategies to South Africa; and to inform the design of an educational programme. Evaluation of the community volunteer educational programme was undertaken using pre- and post-education focus groups. Twenty-one volunteers working with mentally ill people in the community from one township attended a three-day, six module course. After the course, volunteers: were able to articulate a greater range of aetiological and contributing factors to the development of mental health problems, including stress vulnerability and traditional belief frameworks; could describe a more humanistic model of mental health identification; identified a wider range of both formal and informal helping strategies; were more aware of the negative impact of interpersonal behaviours for people with mental health problems. Volunteer involvement has been confined to communicable diseases in South Africa. Volunteers educated about mental health care could assist in the South African policy of ‘horizontal’ integration of services into primary care from their current ‘vertical’, specialist-orientated structures.