Health care reform and the scope of independence in decision making by environmental/family nurses. III. New concept of health care and currently provided scope of services.

Until recently, corrective medicine and narrowly-understood prophylaxis have remained the focus of attention of health care staff. Various factors influenced the modification of current health activities. Providers of medical services, especially those engaged in PHC should react to the change in the concept of health care by expanding the present services offered. According to the WHO concept, dealing with healthy people is not a waste of time. Therefore, an attempt was undertaken to discover whether in the practice of environmental/family nurses, tasks were proposed to patients in the area of health promotion and prophylaxis. The studies covered 110 environmental/family nurses from the Bialystok Region. The material obtained in two groups of health care units--public and non-public--was then compared. Significant statistical differences with respect to 'very frequent' realization of health promotion programmes were observed between nurses employed in public health care units and those from non-public units. These programmes most often concerned breast feeding, and care of mother and child. In the area of prophylaxis, however, both groups undertook a 'very small' scope of actions on behalf of environment protection and prevention of three of the health problems recognized: prevention of faulty posture, dental caries and counteracting accidents, injuries and poisonings. Prophylactic tasks concerning cardiovascular system diseases, cancer, addictions and contagious diseases were more often realized.