Exploring the Structures and Processes Needed to Support the Development of Collaboration Amongst Public Health Nurses, Family Practice Nurses, and Nurse Practitioners who Work in Breastfeeding Support and Promotion

Abstract

Community health nurses, like all other health professionals, are being called to develop new clinical practices based on collaboration and are faced with the demands of working both interprofessionally and interorganizationally (D’Amour et al., 2008). In Capital Health, public health nurses (PHNs), family practice nurses (FPNs) and nurse practitioners (NPs) are all working in different aspects of breastfeeding support and promotion. However, there is no formal structure for collaboration of services, despite the strong desire of these nurses to work together to improve breastfeeding outcomes. The purpose of this study was to explore the roles of PHNs, FPNs and NPs who work in breastfeeding support and promotion in Capital Health and the structures and processes needed to support the development of collaboration amongst these groups of nurses. Through the analysis of semi-structured focus group interviews and follow-up focus group interviews with a purposeful sample (n=10) of four PHNs, four FPNs and two NPs, four major themes and sub themes were identified that represented the nurses experience with collaboration between public health and primary care in breastfeeding support and promotion. The data generated revealed that participants had not experienced active collaboration, rather developing or potential collaboration (D’Amour et al., 2008). The first theme, Establishing Interpersonal Relationships, provided an overview of the precipitators and barriers to forming relationships and the outcomes of interpersonal relationships between public health and primary care nurses. The second major theme, The Organizational Context: Structures and Processes in the Everyday Work Environment outlines the impact of the organizational context of the nurses work environment on the development of collaboration. Benefits of Collaboration was the third theme identified in the study. Consistent with other studies on collaboration between primary care and public health nurses, the nurses interviewed believed that the development of collaboration in breastfeeding support and promotion would benefit health care professionals and the clients that they serviced. The last theme, Development of New Practices Grounded in Collaboration, described new initiatives or innovations that the participants explained were needed for the development of collaboration between PHNs, FPNs and NPs. Implications for practice include organizational support for PHNs, FPNs and NPs to work to the full scope of their competencies and providing them with opportunities to meet and establish relationships to facilitate joint planning initiatives related to breastfeeding support and promotion. Additionally, exploration of flexible roles and funding structures as alternatives to fee-for-service should be explored in primary care organizations. The development of a communication infrastructure is necessary for future development of collaboration between public health and primary care in breastfeeding support and promotion. Future research is needed in this area with a broader, more diverse sample, exploring organizational structures needed to improve breastfeeding outcomes and optimize FPN and NP roles. PHNs, FPNs and NPs have the opportunity to impact the model of care for breastfeeding families in the Capital Health District of Nova Scotia, optimizing their capacity to address issues in practice and ensuring that breastfeeding support and promotion activities address the complex social factors that influence the breastfeeding experience.