title: Northern nursing practice in a primary health care setting.
abstract: BACKGROUND
  This paper explicates the nature of outpost nursing work, and/or the day-to-day realities of northern nursing practice in a primary health care setting in Canada. The study was carried out to systematically explore the work of nurses in an indigenous setting. Institutional ethnography, pioneered by Dorothy Smith was the methodology used to guide this research. The theoretical perspective of this methodology does not seek causes or links but intends to explicate visible practices.
  
  
  OBJECTIVE
  It is intended to explicate the social organization of specific discourses that inform work processes of nurses working in remote indigenous communities.
  
  
  METHODS
  The data originated from various sources including spending 2 weeks in a northern remote community shadowing experienced nurses, taking field notes and audio taping interviews with these nurses. One of the two researchers was a northern practice nurse for many years and has had taught in an outpost nursing programme. As part of the process, texts were obtained from the site as data to be incorporated in the analysis. The lived experiences have added to the analytical understanding of the work of nurses in remote areas. Data uncovered documentary practices inherent to the work setting which were then analysed along with the transcribed interviews and field notes derived from the on-site visit. Identifying disjuncture in the discourse of northern nursing and the lived experience of the nurses in this study was central to the research process.
  
  
  RESULTS
  The results indicated that the social organization of northern community nursing work required a broad generalist knowledge base for decision making to work effectively within this primary health care setting. The nurse as 'other' and the invisibility of nurses' work of building a trusting relationship with the community is not reflected in the discourse of northern nursing. Trust cannot be quantified or measured yet it is fundamental to working effectively with the community.
  
  
  CONCLUSIONS
  The nurses in this study saw building trust to promote health and well-being in communities as very important, yet very difficult to achieve. The difficulty in part stems from the constraining, structural, administrative, historical, cultural and political contextual realities that have shaped northern community nursing.
authors.affiliation: School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Adele
authors.initials: A
authors.lastname: Vukic
authors.forename: Barbara
authors.initials: B
authors.lastname: Keddy
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada; D002983:Clinical Competence / Q000592:standards; D003152:Community Health Nursing / Q000458:organization & administration*; D018864:Cultural Diversity; D006303:Health Services, Indigenous / Q000458:organization & administration*; D006801:Humans; D007198:Indians, North American / Q000523:psychology; D008507:Medically Underserved Area; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D009740:Nursing Staff / Q000193:education / Q000458:organization & administration / Q000523:psychology; D011320:Primary Health Care / Q000458:organization & administration*; D019035:Rural Health Services / Q000458:organization & administration*; D035502:Trust