From Rhetoric to Reality: The Changing Face of Public Health Nursing in Southern Ontario


  • Adeline R. Falk Rafael R.N., Ph.D.,

  • Adeline Falk Rafael is an Assistant Professor at the University of Western Ontario, London, Ontario, Canada.

Address correspondence to Adeline Falk Rafael, 56–50 Chapman Court, London, Ontario, N6G 5E1, Canada.


A feminist, postmodern oral history was undertaken to make visible the work and struggles of public health nurses in Southern Ontario in the midst of drastic cutbacks and dramatic changes in public health. The study focused on the period between 1980 and 1996, during which time two distinct practice modalities were apparent: district nursing and program-focused practice. The narrators' stories describe the nature of their work in both those modalities, the skills and expertise they demonstrated, and the often conflicting influences of medicine and the health promotion movement that dramatically changed their practice. District nursing was characterized by the public health nurse's integral connection with the community; program-focused practice, occurring at a time when political and economic factors also impacted on practice, was characterized by a loss of that integrality. Narrators saw many positive aspects to the changes in public health but identified problems as well. They articulated a preferred vision for the future as one in which “nurses should be nursing.” To do that, public health nurses are challenged to return their practice to a nursing center rather than struggling to conform to dominant paradigms in public health.