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Public Health Nurses in Norway

History of Public Health Nurses in Norway
The first nursing education in Norway started in Oslo in 1868. Teaching took place through practical exercises, and the nurses were educated in a church context with the German diaconate education as a role model. In 1898 the Norwegian Women's Public Health Association established its own nursing school.

In 1912, the Norwegian Nurses Association (NSF) was founded by Bergljot Larsson. Bergljot Larsson and saw education as the very key to strengthening nurses' status and independence. She made the fight for a uniform three-year nursing education a priority. In 1948, the Act on Authorization for Nurses was passed.

It was voluntary organizations that took the initiative and carried out the public health work in Norway. The first nationwide voluntary organization to deal with health and social issues was the Norwegian Women's Public Health Association. The organization ran more than half of the child health clinics in Norway until the state took over in 1972.

Parish nurses and male deacons provided nursing care in the community. Later, nursing care in the community expanded to provide public health nurses (PHNs) who functioned as family and school nurses. In 1925, the name "public health nurse" was used for the first time.

In 1947, Norwegian Public Health Nursing education was established, using models for public health nursing from the United States and Canada. A Norwegian nurse, Borghild Kessel, funded by the Rockefeller Foundation, studied public health nursing in the United States and Canada, and subsequently, established Norwegian public health nursing education. In contrast to the United States and other countries, public health nursing in Norway focuses on families, children, and adolescents.

The first Act on Public Health Nurse and the Act on health work in schools and other educational institutions was passed in 1957. The Act on child health clinics came into force in 1974. It led to the systematization and development of child health clinic work and has been described as the most significant law for preventive health work since the Health Act of 1860. The law designated public health nurses as administrative managers of child health clinics and laid the foundations for a significant upgrading of the child health clinic service. These laws are no longer applicable and current laws for public health nurses are the Health and Care Services Act, the Public Health Act and the Health Personnel Act.

Employment Location of Public Health Nurses in Norway

Public health nurses work in child health clinics, schools, youth health care and immunization clinics. A recent report reveals that there are about 3,600 public health nurses (full-time equivalents) in Norway, this is a shortage of public health nurses of 2,078 full-time equivalents in the child health clinics, school and youth health service, compared to the Norwegian Directorate of Health's recommendation. According to the directorate's set standard figures, the need for public health nurses in child health clinic, school and youth health services in Norway is about 5,663 full-time equivalents. Norway's population is 5.5 million people of those 1.1 million are children 0-17 years. The PHN workload varies depending on the municipality. The recommendation from the Norwegian Association for Public Health Nurses is 40-60 births per year for one PHN in a full-time position, but the municipalities often do not follow this recommendation. Usually, PHNs are responsible for an area with 80-120 births per year, and in some municipalities PHNs have responsibility for up to 150 births per year. PHNs may also have additional responsibility for school health service in one or two schools with 400 to 1000 pupils.

Norwegian public health services are extended to all pregnant women and families with children. The prevention of ill health is a key principle in the new Public Health Act. The national goal is to provide Norwegians with good opportunities for quality of life and coping skills, which requires a greater emphasis on early prevention. Municipalities are responsible for managing the services within Norwegian laws and regulations. Public health nurses offer routine child health examinations free of charge at a universal level, including detection of a range of environmental and family issues that influence children’s safety and health. The goal of preventive childcare is to foster an optimal trajectory for growth and development in childhod and to provide guidance to parents and communities.

Current Public Health Nurse Education

Public health nursing education is offered at the post‐graduate or master’s level following a 180 ECTS bachelor’s degree in nursing. Public health nurses can finish their education after 90 ECTS (one ECTS is 25-30 hours of work) or continue with writing a master’s thesis (120 ECTS.). In both cases you become a public health nurse, so you do not need a master’s degree to work as a public health nurse. This program is based on the new regulations on national guidelines for PHN education. Here, learning outcomes for PHNs’ competence areas are described, stating that the public health nurse education is close to practice and research-based and must meet society’s demands for equal and knowledge-based services. Upon completion of their education, the candidate must be able to contribute to a sustainable development of the health service in step with global, demographic, social, environmental, and technological changes. The new Norwegian national guidelines for PHN education describe five competence areas: 1) public health work; 2) children, young people and their family/caregivers; 3) communication, relationship and interaction; 4) management, service improvement and innovation; 5) research, dissemination and professional development (part I); and 6) a master’s thesis (part II).
Public Health Nurse Activities in Norway
PHNs in Norway work independently, with responsibility for public health nursing. This work to improve the population’s health occurs in homes, in child health clinics and at schools, and thus at an individual, community and system level. The municipalities (local districts) are responsible for managing the services within Norwegian laws and regulations. The PHNs’ leader may be a PHN him/herself or have a different background; these decisions are made at the municipal level.

Typically, a PHN in Norway is responsible for preventive services provided to infants, children, adolescents, and their families in a geographically defined area, including work in child health clinics, school health services, and youth health clinics. PHNs assist individuals and families to take action to improve their health behavior choices in their everyday lives. Often PHN actions take the form of teaching and counseling about healthy lifestyle choices. Collaboration with other health professionals is also an important part of the public health nursing work. PHNs have a strong desire to have standards for workload following the National Guidelines for child health clinics and school health service and youth health clinics.

Public health nurses have been given more and more demanding tasks. There has been a shift towards more children and families having problems related to mental health and violence, which are demanding tasks to handle. In addition, the public health nurses have been given more assigned tasks. Health interview at the 8th stage and several vaccines, including the HPV vaccine which requires two doses, are some of the tasks that have been added in recent years. The result is that the health nurses must opt out of other important tasks.

All Norwegian municipalities are required to provide health services in maternity care, well baby clinics for the 0–5-year-old population, school health, and youth health clinics. The publicly organised services are offered to pregnant women and to all parents with children and adolescents 0–20 years old. The service keeps a record of physical, mental, and social health status and other matters of concern for children’s health and welfare public health nurses have a central role in this service and are the health care workers who meet with the family most frequently.

Child health clinics

The child health clinic offers regular consultations that follow a standardized program of 14 consultations. The first consultation is a home visit by the public health nurse. Consultations at the child health clinic are carried out until the child is four years old. Some of the regular consultations are carried out in groups. It is possible to choose an individual consultation instead.

The purpose of the child health clinics is to increase health skills and for parents to experience mastery in their parental role. This means that public health nurses talk to all parents about topics such as interaction between parents and children, sleep, food and children's general development. Themes can also be drug use, violence and neglect. Parents can also bring up topics you need to talk about.

At the consultations, the child's weight, length/height and head circumference are measured. The child receives vaccines offered in the national child vaccination program. Each child has 12 to 15 visits up to school age, including eight vaccinations by the PHN. After the first home visit, the PHN sees the family about 10 times during the child’s first year at the child health clinic.

School health service

The school health service is a health service at school for children and young people. The purpose of the school health service is, in collaboration with the school, to promote pupils' health, well-being and learning. They must also contribute to coping with everyday challenges and increase their health skills. The school health service consists of a public health nurse and a doctor. The school health service collaborates with the school and GP. If necessary, they also collaborate with other services for children and young people in the municipality, or with specialist health services. The public health nurses carry out most of the tasks in the school health service.

The school health service offers health talks, vaccination, weighing and measuring, teaching in groups and classes, talks about physical, mental and sexual health, drop-in/open door. The public health nurse can participate in parent meetings.

Youth health clinic

Youth health clinic is a free offer for youths between the ages of 12-20 (24). At the youth health clinic, the young people can get help and advice from a public health nurse, or doctor. The youth can get advice and guidance on, body and health, puberty, sexual orientation and gender identity, sex and cohabitation, contraception, pregnancy, sexually transmitted infections, problems with friends or family, difficult thoughts, feelings and concerns and more. The purpose of the youth health clinic is to promote health and to increase the health skills of young people.

The youth do not need to make an appointment to speak to the public health nurse. The youth health clinic has opening hours in the afternoon, so the youth don’t have to be away from school or work to visit the health clinic.


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