The scope of public health nursing practice in Sri Lanka: a cross-sectional study

Globally, Public Health Nurses (PHNs) play a central role in disease prevention and health promotion. In Sri Lanka, the PHN service, discontinued in the 1980s, was reintroduced in 2018. However, a standardised framework for defining, implementing, and documenting their roles and services is still lacking, despite record-keeping being vital for evaluating service delivery. This study aimed to describe the duties performed by Sri Lankan PHNs.

A descriptive cross-sectional study was conducted among the PHNs working in 08 provinces in Sri Lanka during October 2024. Data collection was performed using a pre-tested, validated, self-administered questionnaire, and the results were analysed descriptively.

Of 171 eligible PHNs, 127 responded (74.3%). Within the month, almost all (99.2%) delivered NCD prevention, running 1,183 screening clinics (median 8 per nurse) and registering 10,822 people (median 71 per nurse). In palliative care, 94% conducted 1,518 home visits (median 8), commonly providing catheter care (76.4%), wound care (59.8%), and NG feeding (48.8%). For geriatric services, 74.8% of patients received home-based care (744 visits), and their blood pressure was monitored (1,371 instances) and blood sugar levels checked (1,275 instances). Health promotion was universal, with 85% of the population contributing to mental healthcare. Although 83.5% of PHNs had attended in pain management, only 41.7% assessed pain, and 37.8% administered prescribed analgesics. Disaster management (4.7%) and research engagement (13.4%) were limited. Service volumes varied by district, with higher pain-management activity in Nuwara Eliya and Ratnapura. Female PHNs more often attended bereavement sessions and mental healthcare (p = 0.036; p = 0.025), while older age correlated with longer travel for mobile clinics (r_s=0.201) and more elderly home visits (r_s=0.220).

PHNs in Sri Lanka make strong contributions to NCD prevention, health promotion, and palliative care, with additional roles in elderly and mental healthcare. Yet, their involvement in pain management, disaster response, and research remains limited. Clearer role definitions, more PHN recruitments, targeted capacity building, and a workforce need assessment are essential to maximise their impact on community health.