The crucial importance of accurate enumeration to bringing public health nurses out from behind the "Other" category.

Public health nursing is a unique field of nursing with specialized skills, roles, and functions designed to address disease prevention and health promotion of populations and to respond to emerging health crisis such the COVID-19 pandemic. Despite the unique role and professional responsibilities of public health nurses, they are not identified as a distinct nursing specially by the U.S. Bureau of Labor Statistics workforce data. This is problematic as accurate enumeration of public health nursing can supply the necessary data to identify gaps of these essential professionals. To effectively address this gap and have the capacity to identify public health nursing workforce needs, a method to define, describe, and enumerate the public health nursing workforce nationally with a unique split Standard Occupational Classification is necessary. Further, the Centers for Disease Control and Prevention's Public Health and Data Authority must have the ability to coordinate data reporting on the public health workforce, support standardization, and streamline annual enumeration.

The Doctor Is In-Listed: TriCare in Civilian Practice.

North Carolina's TriCare Reserve Select is used by more than 4,000 members, and TriCare Retired Reserve is used by less than 400 members. The purpose of this article is to identify strengths, weaknesses, opportunities, and threats to quality TriCare delivery for active and nonactive military and their families in North Carolina.

Are Nursing Students Learning About Social Determinants of Health?

Nurses must be knowledgeable about social determinants of health (SDH) to provide holistic care with improved patient outcomes. When evaluating the Baccalaureate of Science in Nursing curriculum, it is unclear if SDH are adequately identified, assessed, and discussed, or if students grasp their importance. To move to a population health approach, faculty need to be more inclusive of community and public health. For purposes of this study, the factors comprising SDH were identified as childhood experiences, housing, education, social support, family income, employment, communities, and access to health services. These eight factors were used to categorize participants' qualitative responses to baseline and completion surveys.

Overcoming language barriers in community-based research with refugee and migrant populations: options for using bilingual workers.

BACKGROUND: Although the challenges of working with culturally and linguistically diverse groups can lead to the exclusion of some communities from research studies, cost effective strategies to encourage access and promote cross-cultural linkages between researchers and ethnic minority participants are essential to ensure their views are heard and their health needs identified. Using bilingual research assistants is one means to achieve this. In a study exploring alcohol and other drug service use by migrant women in Western Australia, bilingual workers were used to assist with participant recruitment and administration of a survey to 268 women who spoke more than 40 different languages. DISCUSSION: Professional interpreters, bilingual students, bilingual overseas-trained health professionals and community sector bilingual workers were used throughout the research project. For the initial qualitative phase, professional interpreters were used to conduct interviews and focus group sessions, however scheduling conflicts, inflexibility, their inability to help with recruitment and the expense prompted exploration of alternative options for interview interpreting in the quantitative component of the study. Bilingual mature-age students on work placement and overseas-trained health professionals provided good entry into their different community networks and successfully recruited and interviewed participants, often in languages with limited interpreter access. Although both groups required training and supervision, overseas-trained health professionals often had existing research skills, as well as understanding of key issues such as confidentiality and referral processes. Strategies to minimise social desirability bias and the need to set boundaries were discussed during regular debriefing sessions. Having a number of workers recruiting participants also helped minimise the potential for selection bias. The practical and educational experience gained by the bilingual workers was regarded as capacity building and a potentially valuable community resource for future health research projects. SUMMARY: The use of bilingual workers was key to the feasibility and success of the project. The most successful outcomes occurred with students and overseas-trained health professionals who had good community networks for recruitment and the required linguistic skills. By describing the advantages and disadvantages encountered when working with bilingual workers, we offer practical insights to assist other researchers working with linguistically diverse groups.

Providing health information for culturally and linguistically diverse women: priorities and preferences of new migrants and refugees.

ISSUES ADDRESSED: Preferences for topics and means of access to health information among newly arrived, culturally and linguistically diverse women in Perth, Western Australia, were explored. METHODS: A mixed-methods approach was adopted. Qualitative material obtained from focus groups and interviews with 22 service providers and 26 migrant women was used to develop a questionnaire, which was then administered to 268 newly arrived migrant and refugee women from 50 countries. Participants' information and support priorities were ascertained from a ranking exercise conducted in a non-threatening context. Responses of migrant and refugee women were compared quantitatively. RESULTS: Women's top priorities for information and support included employment advice, as well as information regarding mental health issues, women's health, exercise and nutrition, family violence and alcohol and other drug issues. Their preferred methods for receiving information were interactive talks or presentations, with written material support. Audiovisual and Web-based material were also considered useful. There were differences between refugee women's and other migrants' preferences for means of receiving information and topics of most concern. DISCUSSION: The use of a non-threatening ranking process encouraged women to prioritise sensitive topics, such as family violence, and revealed a need for such topics to be incorporated within general health information presentations. Internet-based technologies are becoming increasingly important methods for disseminating information to migrant women. SO WHAT? Differences between migrant and refugee women's priority health issues and their preferred methods for receiving information highlight the desirability of tailoring information to particular groups. Although advice on employment pathways and mental health concerns were top priorities, the study revealed a need for more discussion on other sensitive topics, such as family violence and alcohol-related issues, and that ideally these should be incorporated into general information sessions to destigmatise attendance The increasing relevance of computer technology and social media for information dissemination was also of note.

One service, many voices: enhancing consumer participation in a primary health service for multicultural women.

BACKGROUND: Consumer participation in primary health care is important in providing quality consumer-focused care, but challenging when working with disadvantaged groups of diverse cultural and linguistic backgrounds. Women's Health Services (WHS) works with women from over 60 different nationalities, including many newly arrived migrants and refugees. New arrivals access a wide range of WHS programmes including medical services, counselling, information, community talks and workshops, referral, and outreach, but few ethnic women attended the alcohol and other drug (AOD) services offered by the organisation. AIM: To establish an active consumer reference group to assist understanding and reducing the barriers to AOD services for a heterogeneous disadvantaged group that includes individuals from different cultural, language and educational backgrounds. RESULTS: Leaning heavily on experiences from the mental health field, WHS overcame many practical and philosophical considerations which included: agreeing upon the purpose of the group and how it would operate within the structure of the organisation; the level of English language required by participants for the group to function; issues of resourcing the group; and ensuring an appropriate, workable demographic mix in terms of age, language, and migration experiences. CONCLUSION: The process and the outcome of establishing a consumer reference group (CRG) in a primary healthcare setting has been valuable for consumers' and health service providers within the organisation.

Nosocomial MRSA infection in vascular surgery patients: impact on patient outcome.

Although methicillin-resistant Staphylococcus aureus (MRSA) infection is a worldwide problem, data on its significance among vascular surgery patients remain scant and conflicting. This study was designed to evaluate the association between nosocomial MRSA infection and patient outcome following vascular surgery procedures. Outcomes among patients with MRSA infection were also compared to those infected with methicillin-sensitive Staphylococcus aureus (MSSA). All patients admitted to a tertiary care Vascular Surgery ward during the year 2002 were included in this retrospective review. In addition to information on demographic and comorbid conditions, data on surgical interventions, nosocomial infection incidence rates as defined by the Center for Disease Control guidelines, and MRSA screening results were collected. Primary outcome was in-hospital death. Secondary outcomes measures included length of hospital stay, readmissions, or repeat surgeries, and ICU admissions. Of a total of 408 subjects, 110 were documented with a nosocomial infection (27.0%). Of these, 16 patients (3.9%) were colonized with MRSA on screening at time of admission, 22 (5.4%) had acquired MRSA infection during hospitalization, and 15 (3.7%) had MSSA infection. Patients with MRSA, MSSA, and non-MRSA infection had similar baseline characteristics except for hypertension and tobacco use. Age and MRSA infection were significant risk factors for in-hospital deaths (OR 1.07, 95% CI 1.01-1.13, p = 0.01 and OR 7.44, 95% CI 1.63-33.9, p = 0.01, respectively). Adjusted for the effects of age, MRSA infection remained a significant independent risk factor associated with in-hospital deaths (OR 4.38, 95% CI 1.09-17.7, p = 0.04). After adjustment for baseline risk factors, MRSA infection was also independently associated with secondary outcome measures. Although risks of non-MRSA infections were also associated with adverse outcomes in the multivariate analyses, MRSA posed higher risks, as reflected by higher odds ratio in all instances. The 22 patients with documented MRSA infection had significantly longer hospital stays than those with MSSA infection (median 24 days vs 8 days, p = 0.02). However, no significant differences were noted between the 2 groups in terms of secondary outcome. These results show that MRSA infection is a significant risk factor for adverse clinical outcomes among patients undergoing vascular surgery procedures. Infection with MRSA results in a greater risk of these outcomes when compared with non-MRSA infection. However, despite concerns regarding the virulence of this strain of staphylococcus, patients infected with MRSA had no higher rates of morbidity or mortality except for increased length of hospital stay when compared to patients with MSSA.