| Summary: | The literature reports the need for nurses to develop and implement health policy. The extent to which community health nurses are involved in the development and implementation of health promotion policy is addressed by this doctoral research. The interdisciplinary perspective of Women's Studies provided the theoretical framework and methodology to investigate the following research questions: What is the role of the community health nurse in the development and implementation of health promotion policy? What systematic changes to the existing mechanisms of policy development and implementation are required to establish health promotion policy which is congruent with the WHO's definition of "health promotion"? Community health nurses (n = 31), working in two public health nursing service delivery agencies in an urban setting were recruited through a letter of invitation. Data were collected using a semi-structured interview schedule which explored health policy, work environment, health promotion needs, and the opportunity for women's voices to be heard. Transcribed data from tape recorded interviews were analyzed verbatim using qualitative methods in the form of content analysis. All elements of the method, which is naturalistic inquiry, and more specifically women-centered interviewing, were shaped by the tenets of feminist science. The feminist lens was chosen because of the hierarchical nature of organizational structures, the need to make the invisible, visible and, the need to hear the voices of these nurses. By using feminist theory and feminist methodology, themes, categories, concepts, and their relationships emerged from the data. Fourteen themes were identified pertaining to the "work world" of community health nurses; their alienation from policy development and implementation, their frustration and resistance; and, their desire for equity in terms of gender, programming, and professional status. This study reveals the lack of community health nurses' involvement in policy development and implementation and the consequences of not involving nurses in policy making. Alienation and marginalization come at a cost. The price is high and ultimately everyone pays; the government/agencies, colleagues, and the public. Findings are discussed within the context of health care reform and the work of the community health nurse. Beyond the implications for nursing practice, education, research, and management, the findings have meaning for health policy development and implementation at all levels of the existing health care system. One example is the need of a feminist model for policy development and implementation. A model was developed by bringing into focus each recommendation generated by the study within the framework of structure, process, and outcome. Feminist analysis reveals theoretical and practical links between nurses' lack of involvement in policy development and caring values offered by community health nurses who endeavour to contribute to health promotion policy.
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