An ethnography of child health nursing: Understanding child health nurses' concept of risk in community child health practice

 In health care the concept of risk has evolved on a medical and epidemiological platform (Hennekens & Buring 1987; Heyman 1998; Jacobs 2000) but despite use in nursing as early as Nightingale (1952) it has not been developed theoretically from a nursing perspective (Spiers 2000). At a time when contemporary health policy, managers and clinical practitioners are increasingly focusing on 'at risk' and `vulnerable' groups in society (Queensland Health 1993; Baum 1998) the terms risk and vulnerability continue to  be recognised as nebulous (Appleton 1994), and conceptualised differently in epidemiological, clinical and individual terms (Spiers 2000; Jacobs 2000). Acknowledging these differences and clarifying these concepts has relevance for nursing practice and research (Rose & Killien 1983), in particular the development of common understandings has the potential to develop nursing knowledge, direct nursing research and ultimately develop the practice of nursing (Norris 1982; Kim 1999; Jacobs 2000). 

This study was motivated by the need to understand and account for a Child Health Nurses' (CHNs') concept of risk within contemporary child health practice so as to develop the knowledge base of child health nursing in relation to risk and to encourage reflection by child health nurse practitioners. Additionally this knowledge could lead to common meanings and shared understandings among CHNs, and ultimately improved practice. For the purposes of this study risk will be recognised as a term having both quantitative and qualitative dimensions with epidemiological, clinical and individual attributes which, when linked to nursing assessment directs the planning and implementation of preventive health practices.