Community health nursing takes place in a socio-economic, political and cultural context. In the post-Soviet era, the Baltic country of Latvia is undergoing a wrenching transition with growing health and social disparities. Statistics indicate a troubling decline in the health status of children, and an increase in the number of children removed from families because of neglect. A qualitative study using the methods of interpretive phenomenology was carried out to understand how community health nurses define and manage the changing context of practice with increasingly vulnerable families and children. Fifty-six clinical vignettes related by nurses (N=17)in group and individual interviews and observed field visits were analyzed to identify paradigm cases and themes: managing change through reframing, experiencing increased emotional and physical burdens of work, and feeling "out on a limb" and marginalized by apparent governmental indifference. Clinical reasoning concerning the degree and manageability of risk to children was reflected in labeling families as "good little families", those that were "simply poor", and those that were "unfavorable" With the first two types of families, concern about children was balanced with concern about the family as a whole. With "unfavorable" families, characterized by poverty and alcohol abuse, all nurses shifted to child protection and an adversarial stance toward parents, but experienced nurses were more skillful than novices at finding some common ground and maintaining vigilant engagement rather than opting for child removal as an initial strategy.
Learning Objectives: Identify the impact of contextual influences on community health nursing practice with vulnerable families in a post-Soviet country.
Keywords: Child Health, International MCH
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.