A Model for Public Health Nursing in the Middlesex-London, Ontario, Schools
Mytka, Sharon, Beynon, Charlene, Journal of School Health
Middlesex-London Health Unit (MLHU) is one of 42 health units in the Province of Ontario mandated to provide public health programs and services to a defined geographic district. Historically, public health nurses (PHN) at MLHU worked as generalists, with a variety of populations in different settings such as homes, schools, clinics, and community groups.
One area of responsibility includes assignments to elementary and secondary schools. Time spent in schools varies from less than a half-day to four half-days per week depending on the school's population and needs. Traditionally, public health nurses in school settings focused on interaction with school personnel, students, and families with emphasis on individual/family counseling, classroom teaching, screening programs, and advising school staff regarding student health problems.
The school population for the City of London and the County of Middlesex includes approximately 75,000 students serviced by three publicly funded boards of education and 12 private schools. Some 139 elementary schools and 29 secondary schools operate within MLHU's jurisdiction.
In 1985, MLHU's Public Health Nursing Division initiated a three-year plan to implement the Neuman Systems Model as the division's framework for nursing practice. Two major concepts of this nursing model include stress and reaction to stress.|1~ The Neuman Systems Model incorporates principles of health promotion and emphasizes the client's perception and participation. "Client" can be defined as individual, family, small group, community, or population. The model includes three levels of prevention. By including five variables -- physiological, psychological, social-cultural, developmental, and spiritual -- the model promotes a holistic and comprehensive assessment. The decision to implement a nursing model was precipitated by a move toward theory-based practice by the College of Nurses of Ontario, the provincial regulating body, and introduction of theory-based standards for Community Health Nurses in Ontario.
By 1991, when the Model for Public Health Nursing in Schools was being developed, there was an expectation that practice would be based on the Neuman Systems Model. Therefore, the newly evolving model had to be consistent with the values and assumptions of the Neuman Systems Model. The Neuman Systems Model provides a framework to operationalize the Model for Public Health Nursing in Schools.
In 1989, the Ontario Ministry of Health introduced mandatory programs and guidelines for all Public Health Units.|2~ Four major health goals were identified.
1) All people in the community will have the opportunity to attain an optimal level of physical, mental, emotional, and social development appropriate to their life stage.
2) All people in the community will have the opportunity to adapt and maintain health-promoting practices for themselves, their family, and the community.
3) Communicable diseases will be reduced or eliminated.
4) The community will be a health-supporting environment in which people will be protected from adverse health consequences of exposure to toxic, hazardous substances, and conditions in homes, public places, and the workplace.
Under these goals, 20 mandatory public health programs were identified, each with requirements and standards developed around five key principles:
1) Health as a positive concept with known determinants.
2) Strategic planning for health and for addressing major public health problems in Ontario through established goals.
3) The efficacy of actions aimed at achieving improved health, with an emphasis on general strategies of primary prevention and on health promotion.
4) The efficient and effective use of resources, and use of interdisciplinary teams to gain health program excellence.
5) Relevance, responsiveness, and accessibility of mandatory health programs and services for all Ontarians. …