Beyond the sick role: situating community health nursing practice

This grounded theory research into the role of the community health nurse in Australia identified that moving from the comfort and structure of an institutional setting to the client's turf results in profound changes to the purpose of nursing practice. Data were collected from 17 'excellent' community health nurses practising in a range of community health settings in three states of Australia. Data included transcripts from in-depth interviews, questionnaires, group discussions with participants, job descriptions, agency documentation, professional organisation documentation and focus groups. Data were analysed using constant comparative techniques. In community health nursing practice, the client's role changes from a sick role to a well role and there is a shift in responsibility for outcomes from the nurse to the client. The central purpose of the community health nursing role is to facilitate Situated Health Competence, which the client achieves within the context of going about their everyday life, including work, recreation, relationships and role responsibilities. Situated Health Competence requires families, groups and communities to address their own illnesses, health problems, health issues and health behaviours; have enough knowledge and power to make their own decisions; question matters that impact on their health; and seek out and access appropriate health resources on an ongoing basis. The findings of this study make the intangible motivations of the community health nurse more explicit. The aim of facilitating Situated Health Competence results in an expanded view of the boundaries of nursing practice. The traditional foci of nursing practice are still present, but are incorporated within a broader 'situated' role.