Primary care team
Public health nurses are generalists. The community is our client and we see everyone from mothers and babies to older people and those in need of palliative care. What we do as public health nurses in Ireland is carried out by two dedicated specialists in other European countries: district nurses and health visitors.
There is currently a debate about whether we should or can continue to offer all the services we do. In my view, the generalist nature of our work is what makes it so special.
Personally, what I enjoy most is the variety. To a large extent, public health nurses are in charge of their own days as well as being part of the local primary care team. Home visits are planned around the different clinics in health centres and there is good support between the various health professionals working within the primary care team.
When we visit people in their homes, we offer guidance and information about how best to meet their health needs. We observe their surroundings and assess whether there are gaps that could be filled by any of the other health professionals in the primary care team and we make appropriate referrals; for example, to an occupational therapist for handrails or a physiotherapist for walking aids, and so on.
Through building up relationships, we also find out whether clients, young or old, are isolated and need to become part of mother-and-toddler or active-retirement groups. We are sometimes asked to give talks about falls prevention for older people and healthy eating for parents of school-age children.
What I find frustrating about this work is the waiting lists for older people to receive daycare services and for families to receive respite care when they need a break. As part of my new job, I assess older clients in hospital for home care packages and co-ordinate daycare and respite care for older people and their families, referred by the public health nurses.
It’s very disheartening to recommend these services knowing that families will wait months to get the supports that would keep them safely at home for longer, and often the patients’ hospitalisation is extended as a result.
The work of a public health nurse is never ending, in that there are always new babies being born and more older people to look after. Some people would find these aspects of the work frustrating, but it’s what I enjoy most.
Mothers and babies
As public health nurses, we are the only health professionals entitled to visit people in their homes. We receive details of every new birth in our geographical area and we arrange to visit the mum and baby within 48 hours of discharge from the maternity hospital service.
On this primary visit, we offer breastfeeding support and information about looking after a newborn baby.
We are also contactable by phone although we usually visit the mum and baby a couple of times at home before suggesting that she brings the baby to the child welfare clinic run in most health centres on a weekly basis for further weight checks or to advise about any concerns they may have.
In Co Wicklow there is a public health nurse seconded as a part-time lactation consultant.
She runs an introductory breastfeeding class for mothers-to-be and takes referrals from public health nurses for mums who are experiencing breastfeeding difficulties and who we feel need more detailed advice than we can offer.
We run weekly breastfeeding support groups in local health centres and will also pass on details of other breastfeeding support groups such as Cuidiú – the Irish Childbirth Trust and La Leche League.
Postnatal depression screening is offered to every new mother in Co Wicklow when the baby is six weeks old.
This involves a specific appointment for the mother at home and we use the Edinburgh Post-Natal Depression Screening tool, in which we have all received training.
It gives a good indication of how the mother is coping and, if necessary, we can suggest extra support such as the Community Mothers peer-to-peer support programme. I’ll often advise new mothers to ask their own mothers to come and give a hand after their baby is born.
We check babies’ development at three months, seven months, 18 to 24 months and three to four years.
This involves discussing the baby’s feeding and sleeping patterns as well as checking their weight gain and general development.
If necessary, and following discussion with parents, we can refer children to GPs, speech and language therapists, physiotherapists or other health professionals. Parents who are concerned about their child’s development are always free to contact their local public health nurse, with whom they have usually built up a good relationship.
We also offer parents support and advice and see how they are coping generally; for example if they need to get out more or have contact with other new parents.
Sometimes, I have even found myself encouraging parents to set up new parent and toddler groups where they don’t already exist.
We currently run a weaning clinic at the health centre in Bray. At this hands-on clinic, a public health nurse will demonstrate preparing food for weaning and give advice about when to start weaning babies on to solid foods and the best foods to start with.
It’s a very interactive, practical class and takes away the fear many new parents, particularly first-time parents, have about starting their children on solid food.
The advice given is always up to date and often varies from what was practised a few generations ago: the current advice is for breastfed babies to start on solids at about six months, while formula-fed infants can begin earlier.
School-age children
Public health nurses screen children’s sight and hearing in senior infants and sixth class in the primary schools in their catchment area. The parents receive a consent form to fill out and return to the school.
The public health nurse visits during school hours and the parents are not required to attend.
Public health nurses also organise and carry out the required immunisation for school-age children.
A number of public health nurses in Wicklow have specialist training in areas such as enuresis [involuntary urination, most usually bed-wetting], sleep, fussy eating, breastfeeding, tissue viability, parenting courses and audiology. Some of us run clinics in our specialist area as an add-on to our regular job .
Child protection is also part of our job, and public health nurses are often the first health professional to pick up on a problem within a family. Sometimes we can offer support ourselves by calling to see a mother who is struggling to cope at home.
We can also refer families in difficulty to social workers or the community mental health nursing teams.
Older people, andpeople with disabilities
Visiting older people who have been referred to the public health nursing system by GPs, hospitals or families form a large part of our workload and it is an area I particularly enjoy. Many of the older people in the community who we visit have heart or breathing problems, or leg ulcers that require dressing.
It is a real pleasure spending time getting to know them and their families as we discuss the issues at hand, often enjoying a cuppa as we chat. There is also a growing population suffering with dementia and both the individuals and their families require a lot of support, including referrals to dementia-specific day centres or carer-support groups.
In Co Wicklow, there are also quite a lot of older people living in rural areas who are very isolated. When we visit them, we will also assess their home environment to see if the house is cold, if there is food in the fridge or if they are very lonely or losing weight.
We see if it’s possible to refer them for meals on wheels or find ways to attend meetings of a local retirement group.
A lot of rural communities are very good at looking after older people but there will be some who fall through the cracks and we can be an advocate for these vulnerable people.
My new job
In February 2014, I started a new job as Liaison Public Health Nurse between St Vincent and St Columcille’s hospitals in Dublin and the public health nurses and community nurses in Co Wicklow.
I attend multidisciplinary meetings in these hospitals and feed information back to the nurses in Wicklow about patients from Co Wicklow.
The community-based nurses also make contact with me about patients about whom they may have concerns, before they return to their homes. Essentially, my role is to work out, in conjunction with families, what patients will need once they return home. Will they need home help or day care/respite services? Will they need the support of a social worker or public health nurse once they are back in their homes?
This is a new position in St Vincent’s Hospital and I find that some of the medical staff have very little awareness of patients’ needs outside of the hospital. In St Columcille’s, it’s more effective because it is smaller and many of the patients have long-term illnesses that need to be managed by the hospitals and in the community.
While I enjoy my new job, I miss the interaction with the mothers and their new babies. My work now requires more advanced planning. Previously, it was more unpredictable and spontaneous. There are pluses and minuses on each side but regardless of which job I’m in, people embrace you warmly as a public health nurse. They see you as a good person.
Margaret's career
I trained as a registered general nurse (RGN) in the Adelaide Hospital, which is now part of Tallaght hospital, and as a midwife in the Rotunda Hospital in the late 1970s/early 1980s.
I later worked in the Adelaide Hospital, the Royal City of Dublin (Baggot Street) and St Columcille’s Hospital in Loughlinstown and then as a community-based RGN in Bray, Co Wicklow. I nursed part-time when my children were young.
In 2004, I completed the one-year full-time graduate diploma in public health nursing at University College Dublin.
Since then, I have worked as a public health nurse, based in Roundwood, Wicklow town, Greystones and, more recently, as the Co Wicklow liaison public health nurse between St Vincent’s and St Columcille’s hospitals in Dublin and the public health nurses and community nurses in Co Wicklow.
