Evaluation of a multischool collaborative COVID-19 vaccination project.

To describe experiences of student nurses and faculty who participated in COVID-19 vaccine delivery through a multischool collaboration. Cross-sectional survey. Student nurses and faculty members from five university schools and colleges of nursing who participated in one or more COVID-19 vaccination or education events in 2021. Surveys were designed for students and faculty to document process and outcome experiences associated with project participation. Surveys were administered through an online survey platform. Overall, 648 students and 68 faculty members participated in the project. The evaluation survey was completed by 115 students (18%) and 58 faculty members (85%). Students valued increasing their clinical skills and reported the experience influenced their perspectives on nursing, fueling their passion and informing future career choices. Students reported that it was personally important to contribute to the vaccination effort. Few students reported challenges in participating in the project. Faculty reported positive experiences including gaining knowledge about public health and their communities, fueling their passion for nursing education, feeling a deeper connection with students, and experiencing personal satisfaction from contributing to the pandemic response. This project resulted in meaningful student learning opportunities, enhanced capacity for the public health emergency response, and strengthened partnerships among nursing programs and between academia and public health community partners.

The New to Public Health Residency Program Supports Transition to Public Health Practice.

Training and retaining a competent public health workforce are challenging. Residency programs for new and transitioning professionals are effective in other fields but rare in governmental public health. The New to Public Health Residency Program is a residency program for professionals entering public health practice. On the basis of the Foundational Public Health Services model, the program was designed using adult learning principles and best practices from nurse residency programs. Content created by public health experts is delivered over 12 months through online course sessions that include interactive learning activities. Additional program components include monthly synchronous online discussions and support from a mentor. Residents apply their learning through implementation of an evidence-based practice project at their workplace. The program is accredited for continuing professional development contact hours. Agencies with limited resources to support new public health employees may find the New to Public Health Residency Program a vital training resource.

Risks for acquiring hepatitis C virus among women in the United States.

OBJECTIVE: To conduct a literature review about the breadth of risks for acquiring hepatitis C virus (HCV) among women who are living in the United States. DESIGN: A mixed research synthesis of qualitative, quantitative, and mixed-methods studies guided by the Socioecological Model and Theory of Gender and Power. SAMPLE AND ANALYTIC STRATEGY: The sample consisted of 29 studies: 10 qualitative, 18 quantitative, and one mixed-methods studies. Data were analyzed using a segregated approach and integrated into a narrative synthesis of themes by components of the Socioecological Model. RESULTS: Individual risks themes were drug use as a coping strategy, transition to injection drug use, and lack of awareness about HCV. Interpersonal risks themes were social norms of drug use and drug use and sexual activities. Community risks themes were community re-entry, housing instability, and community HCV resources. Societal risks themes are policies affecting drug markets and social construct of "worthlessness." CONCLUSIONS: Findings highlight the need for comprehensive gender-specific HCV prevention strategies built around harm reduction. In partnership with women with lived experience, public health nurses can apply findings to build harm reduction collaborations aimed at implementing HCV risk-reduction or risk-elimination strategies.

Nursing strategies for environmental justice: A scoping review.

OBJECTIVE: To describe types of strategic actions nurses take to promote environmental justice (EJ) through research, education, advocacy, and practice (REAP) reported in peer-reviewed literature. DESIGN AND SAMPLE: A scoping review of literature was conducted that described EJ nursing strategies and included nurses listed as authors, subjects, partners, or organizational members. The sample consisted of 35 articles, representing 24 primary research studies and 11 nonresearch articles. Data were separately analyzed by research and nonresearch articles for a clearer understanding of evidence-based strategies within domains of REAP. RESULTS: Articles in the sample highlighted the importance of authentic community partnership and represented diversity of nursing strategies that addressed a range of environmental exposures and subsequent health and racial inequities. Climate justice, a concept that emerged from the EJ movement and intersects with planetary health, is a recent focus in professional nursing. CONCLUSIONS: This scoping review establishes an understanding of the extent of nursing knowledge and research in EJ and lays the groundwork for further research on effective EJ nursing strategies. Community-Based Participatory Research/Participatory Action Research methods are fundamental for EJ research, and further theoretical development is needed to guide evaluation of EJ nursing strategies for education, advocacy, and practice.

Hepatitis C virus infections among people aged 15-44, United States, 2009-2018.

OBJECTIVES: To estimate the prevalence, characteristics, and gender differences among people aged 15-44 years who are living with current HCV infections in the United States. DESIGN AND SAMPLE: We conducted a cross-sectional, secondary data analysis using data from people who participated in National Health and Nutrition Examination Survey (NHANES) cycles in 2009-2018. MEASUREMENTS: Sociodemographic, social behavior, and clinical factors that had been identified as related to having HCV, barriers to receiving HCV screening, care, or treatment, and health conditions that increase the risks of developing HCV-related complications were studied. A weighted-data analysis approach was used to generate descriptive statistics. RESULTS: The estimated, weighted prevalence of current HCV infections was 0.3% (95% CI, 0.2-0.4), representing approximately 363,161 people (95% CI, 301,402-424, 920). Females were more likely than males to have an unknown risk factor and reported worse overall health. Males were more likely to have comorbidities such as obesity or diabetes that put them at risk for developing life-threatening complications. CONCLUSIONS: Increased public health attention with gender-specific actions are needed to address the health needs of the thousands of people aged 15-44 years who are living with current HCV infections across the United States.

A critical gap: Advanced practice nurses focused on the public's health.

BACKGROUND: The COVID-19 pandemic has highlighted the need for nurse leaders who "embrace the interconnection" between medicine and public health. The inequitable impact of COVID-19 on people of color demonstrates the importance of applying expertise from nursing practice and public health systems to work with communities and other professions on complex health issues. Yet, despite a clear need for improved population health, educational programs designed to produce Advanced Public Health Nurses, with skills to address complex system changes, have become increasingly scarce. PURPOSE: We put forward the perspective that the nation needs more advanced practice nurses prepared for leadership roles focused on the health of whole populations, marginalized communities, and the systems and policies that promote their health. DISCUSSION: We argue that opportunities should be expanded for nurses to attain education for these roles through increased investments in the Doctor of Nursing Practice model to prepare nurses for advanced public health specialty practice.

Estimates of Prenatal HIV, Hepatitis B Virus, and Hepatitis C Virus Testing Among Pregnant People Enrolled in Wisconsin Medicaid, 2011-2015.

BACKGROUND: The opioid epidemic and rising rates of injection drug use are increasing the risk of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections among pregnant people. According to national clinical guidelines, pregnant people should be universally tested for HIV and HBV, and risk-based tested for HCV. The aim of this study was to determine the proportion and characteristics of prenatal HIV, HBV, and HCV testing and diagnosis among pregnant people with Wisconsin Medicaid coverage between 2011 and 2015. METHODS: Wisconsin birth certificates and Medicaid enrollment data were used to identify the sample. Standard billing and diagnosis codes were used to assess study variables. Data for each pregnancy were analyzed to describe the proportion of pregnancies that had evidence of testing, diagnoses, and yearly trends. RESULTS: Of the 78,917 pregnancies, prenatal testing estimates were 67% for HIV, 73% for HBV, and 6% for HCV. The estimated rate of infections during the study period was 1.82 for HIV, 2.09 for HBV, and 3.52 for HCV per 1000 pregnancies. Compared to the other race/ethnicity groups, pregnant people who were Black were most likely to be tested for HIV (78%) and HBV (80%), and pregnant people who were White were most likely to be tested for HCV (7%). CONCLUSIONS: Clinical testing guidelines have not been effectively translated to practice. Additionally, compared to HIV and HBV, HCV infections during pregnancy are becoming more prevalent, yet current national HCV screening guidelines are the least comprehensive.

Policy brief on climate change and mental health/well-being.

Climate change has a significant global impact on individuals' mental health and well-being. However, global health systems are inadequately prepared to address this issue. Studies indicate that climate events such as floods, droughts, tornados, earthquakes, and fires not only exacerbate chronic mental illness, but also impact well-being causing anxiety, stress, and in the worst case, suicide. The World Health Organization estimates that 12.6 million preventable deaths per year can be attributed to environmental factors, all of which are exacerbated by climate change, and an additional 250,000 deaths per year are projected between 2030 and 2050. Nurses must advocate for research, education, and policies that support disaster-resilient infrastructure and human services that allow communities across the globe to effectively mitigate the impact of climate change on human health.

Financial and Legal Characteristics of Cross-Jurisdictional Shared Service Agreements Between Local Public Health Agencies.

BACKGROUND: Cross-jurisdictional sharing is a resource management strategy increasingly being used by local health departments to provide essential and mandated public health services. Cross-jurisdictional shared service agreements (CJSSAs) are the legal documents that govern cross-jurisdictional sharing arrangements. Information on the financial and legal characteristics of CJSSAs is limited. OBJECTIVE: This study described the financial and legal elements of a set of formal, written CJSSAs in one state to offer guidance to practitioners on how to structure the financial and legal elements in CJSSAs. DESIGN: CJSSAs, which included a written statement about the financial commitment governed by the agreement (n = 63), were analyzed. Data collection occurred through 2 structured data extraction tools and structured telephone interviews conducted with local and tribal health department directors. Descriptive statistics of all variables and a single predictor linear regression were performed. RESULTS: The higher population partner to the CJSSA more often provided the public health service and received payment (n = 41; 65%). Financial statements were found to vary by CJSSA characteristic. CJSSAs were more likely to be legally complete when a legal counsel was involved in creating them (odds ratio = 2.74; 95% confidence interval, 2.19-3.29; P ≤ .001). Yet, only 2 (3%) of the CJSSAs described all the legal elements and were considered legally complete. CONCLUSION: Clearly identifying and including necessary fiscal and legal elements when creating and managing CJSSAs may strengthen agreements and reduce local health department legal and fiscal vulnerabilities. Local health department capacity for planning, coordination, budgeting, management, and evaluation is essential when creating CJSSA. Careful consideration of cost-sharing and consulting with legal counsel could strengthen the CJSSA.

Forecasting the Revenues of Local Public Health Departments in the Shadows of the "Great Recession".

CONTEXT: The ability of local health departments (LHD) to provide core public health services depends on a reliable stream of revenue from federal, state, and local governments. This study investigates the impact of the "Great Recession" on major sources of LHD revenues and develops a fiscal forecasting model to predict revenues to LHDs in one state over the period 2012 to 2014. Economic forecasting offers a new financial planning tool for LHD administrators and local government policy makers. This study represents a novel research application for these econometric methods. METHODS: Detailed data on revenues by source for each LHD in Wisconsin were taken from annual surveys conducted by the Wisconsin Department of Health Services over an 8-year period (2002-2009). A forecasting strategy appropriate for each revenue source was developed resulting in "base case" estimates. An analysis of the sensitivity of these revenue forecasts to a set of alternative fiscal policies by the federal, state, and local governments was carried out. FINDINGS: The model forecasts total LHD revenues in 2012 of $170.5 million (in 2010 dollars). By 2014, inflation-adjusted revenues will decline by $8 million, a reduction of 4.7%. Because of population growth, per capita real revenues of LHDs are forecast to decline by 6.6% between 2012 and 2014. There is a great deal of uncertainty about the future of federal funding in support of local public health. A doubling of the reductions in federal grants scheduled under current law would result in an additional $4.4 million decline in LHD revenues in 2014. CONCLUSIONS: The impact of the Great Recession continues to haunt LHDs. Multiyear revenue forecasting offers a new financial tool to help LHDs better plan for an environment of declining resources. New revenue sources are needed if sharp drops in public health service delivery are to be avoided.

Assuring a strong foundation for our nation's public health systems.

BACKGROUND: A strong public health infrastructure is necessary to assure that every community is capable of carrying out core public health functions (assessment of population health, assurance of accessible and equitable health resources, and development of policies to address population health) to create healthy conditions. Yet, due to budget cuts and inconsistent approaches to base funding, communities are losing critical prevention and health promotion services and staff that deliver them. PURPOSE: This article describes key components of and current threats to our public health infrastructure and suggests actions necessary to strengthen public health systems and improve population health. DISCUSSION: National nursing and public health organizations have a duty to advocate for policies supporting strong prevention systems, which are crucial for well-functioning health care systems and are fundamental goals of the nursing profession. CONCLUSION: We propose strengthening alliances between nursing organizations and public health systems to assure that promises of a reformed health system are achieved.

Updating the definition and role of public health nursing to advance and guide the specialty.

National changes in the context for public health services are influencing the nature of public health nursing practice. Despite this, the document that defines public health nursing as a specialty--The Definition and Role of Public Health Nursing--has remained in wide use since its publication in 1996 without a review or update. With support from the American Public Health Association (APHA) Public Health Nursing Section, a national Task Force, was formed in November 2012 to update the definition of public health nursing, using processes that reflected deliberative democratic principles. A yearlong process was employed that included a modified Delphi technique and various modes of engagement such as online discussion boards, questionnaires, and public comment to review. The resulting 2013 document consisted of a reaffirmation of the one-sentence 1996 definition, while updating supporting documentation to align with the current social, economic, political, and health care context. The 2013 document was strongly endorsed by vote of the APHA Public Health Nursing Section elected leadership. The 2013 definition and document affirm the relevance of a population-focused definition of public health nursing to complex systems addressed in current practice and articulate critical roles of public health nurses (PHN) in these settings.

The mobilizing action toward community health partnership study: multisector partnerships in US counties with improving health metrics.

INTRODUCTION: Multisector partnerships are promoted as a mechanism to improve population health. This study explored the types and salient features of multisector partnerships in US counties with improving population health metrics. METHODS: We used the "Framework for Understanding Cross-Sector Collaborations" proposed by Bryson, Crosby, and Stone to guide data collection and interpretation. Comparative case studies were conducted in 4 counties selected on the basis of population, geographic region, an age-adjusted mortality decline better than the US average, and stable per capita income. Data were collected through website and report reviews and through in-depth interviews with key informants (N = 59) representing multiple sectors. County reports were developed and cross-case themes related to partnership types and salient features were derived. RESULTS: Multisector collaboration was common in all 4 counties despite substantial variations in population, geographic size, demographic diversity, and other characteristics. Most partnerships were formed by professionals and organizations to improve delivery of health and social services to vulnerable populations or to generate policy, system, and environment changes. Multisector collaboration was valued in all cases. Outcomes attributed to partnerships included short- and long-term effects that contributed to improved population health. CONCLUSION: The Bryson, Crosby, and Stone model is a useful framework for conducting case study research on multisector partnerships. Outcomes attributed to the multisector partnerships have the potential to contribute to improvement in population health. Further study is needed to confirm whether multisector partnerships are necessary for improving population health within counties and to understand which partnership characteristics are critical for success.

Current and planned shared service arrangements in Wisconsin local and tribal health departments.

OBJECTIVE: The objective of this study was to explore current and future use of shared service arrangements as a management strategy to increase capacity to provide public health essential services in Wisconsin. DESIGN: An online cross-sectional survey of 99 local and tribal health departments in Wisconsin was conducted. Select variables from the 2010 Wisconsin Local Health Department Survey were merged. Other data sources included results from a Board of Health governance analysis and the Wisconsin Department of Health Services region data. Descriptive analysis was performed of current and future shared service arrangements and the characteristics of the types of arrangements and agreements in place. RESULTS: Ninety-one of 99 Wisconsin local and tribal health departments responded, yielding a 92% response rate. Seventy-one percent of respondents currently share services with 1 or more other health departments. More frequent arrangements were present in programmatic areas than in departmental operations. Most frequently reported motivators include making better use of resources, providing better services, and responding to program requirements. Extensive qualitative comments indicate arrangements accomplished what the local health department hoped it would with perceived gains in efficiency and effectiveness. CONCLUSION: There is widespread use of shared services among health departments in Wisconsin. Extensive qualitative comments suggest participant satisfaction with what the arrangements have accomplished. Motivating factors in developing the arrangements and limited mention of expiration dates suggest continued study of how these arrangements may evolve. Further examination of shared services as a potential mechanism to advance service effectiveness and efficiency is needed.

Strategies for academic nursing to advance global and planetary health: A call to action.

Nurses play a crucial role in addressing human health influenced by global forces such as pandemics, and political conflicts that displace millions; in leading efforts to promote planetary health; and in achieving the United Nations (UN) Sustainable Development Agenda. Academic nursing programs have a significant role in actualizing nursing's impact on global health (GH) and planetary health (PH). This paper describes how nursing programs can actualize their GH and PH nursing perspectives to benefit students and society, thereby increasing nursing's effectiveness and improving health outcomes in local and global settings. Numerous strategies to actualize GH and PH perspectives were derived from current literature and an assessment of eleven nursing program websites. Nursing programs may adopt program-wide strategies such as reflecting GH and PH in their mission statement; through education, in courses; and through faculty or student scholarship, policy endeavors, and/or partnerships. Now is the time to take such action, recommitting to GH and PH nursing and deepening nursing's impact. Academic nursing programs' leadership role in society, and their role in preparing nurses to lead, educate, discover, and advocate is essential for the health of populations and the planet long into the future.

Interest in public health careers among undergraduate student nurses.

CONTEXT: Public health workforce trends demonstrate threats to a vital national resource. The current shortage of public health nurses is due to a variety of factors. One route to addressing the public health nursing shortage is to increase the level of interest in public health as a career option for nurses. OBJECTIVE: The main objective of this study was to examine the relationship of nursing education program and field experience characteristics on the level of interest in a public health career among student nurses. DESIGN: Cross-sectional, online surveys of undergraduate student nurses were conducted over 6 semesters to assess the relationship of field practicum characteristics and level of interest in a public health career. SETTING: Undergraduate student nurses (N = 882) enrolled in traditional baccalaureate nursing programs (n = 18) and online associate to baccalaureate degree completion programs (n = 2) in one US state participated in the survey after completing the required community or public health coursework and field experiences. MAIN OUTCOME MEASURE: Level of interest in a career in public health was measured using a 4-point Likert-type scale anchored by "no interest" and "very strong interest." RESULTS: Overall, 46% of respondents expressed either moderate or strong interest in a future career in public health. Having had a field experience in a local health department was the only type of experience associated with stronger interest in a public health career. Enrollment in baccalaureate completion programs was associated with higher interest, and enrollment in programs located in a region of the state where students were significantly less likely to have field experiences in local health departments was associated with lower interest. CONCLUSION: Career interests for nurses are developed in part through field experiences while in nursing school. Interest in public health careers may be nurtured through field experiences in local health departments.

The impact of Web-delivered education on preceptor role self-efficacy and knowledge in public health nurses.

OBJECTIVE: Preceptors are an essential component in preparing student nurses to become practicing public health nurses. Preparation for the preceptor role is important for achieving a quality learning experience for students. This study was conducted to explore the relationship between completion of a Web-delivered preceptor education program and both knowledge of the preceptor role and self-efficacy to perform in the preceptor role. DESIGN AND SAMPLE: This study used a pretest-posttest, quasi-experimental design. The participants were experienced public health nurses (n=31) working in one state in the United States. MEASURES: Pretest and posttest Web-delivered survey using the preceptor self-efficacy questionnaire and an instrument assessing knowledge gain. INTERVENTION: A Web-delivered preceptor education program tailored for public health nurses. RESULTS: The program was associated with improved self-efficacy scores at both the immediate and the 3-month posttest, and with increased knowledge of the preceptor role evident at the immediate posttest only. Self-efficacy scores were independent of knowledge scores. Preceptor age was not correlated with self-efficacy or knowledge scores. Nurses with higher levels of education demonstrated higher self-efficacy scores in all 3 measurements. CONCLUSIONS: Web-delivered continuing education targeted to public health nurse preceptors is an effective method to increase confidence and knowledge for the preceptor role.

Multisector partnerships in population health improvement.

Many new initiatives for population health improvement feature partnerships of leaders and organizations across multiple sectors of society. The purpose of this article is to review 1) the rationale for such partnerships as an important, if not essential, tool for population health improvement; 2) key organizational and contextual factors that appear to be associated with effective multisector partnerships; and 3) the limited evidence regarding the effect of such partnerships on population health outcomes. We conclude that systems thinking - accounting for the collective effect of many actors and actions - is essential to organizing and sustaining efforts to improve population health, and to evaluating them. More research is needed to understand how and why multisector partnerships are formed and sustained and the conditions under which multisector partnerships are necessary or more effective than other strategies for population health improvement. Research on and evaluation of multisector partnerships also need to incorporate more standard measures of partnership contexts, characteristics, and strategies and adopt longitudinal and prospective designs to accelerate social learning in this area. Finally, studies of multisector partnerships must be alert to the value of such initiatives to individuals and communities apart from any direct and measurable impact on population health.

Providers' experiences with young people's cognitive representations and emotions related to the prevention and treatment of sexually transmitted infections.

OBJECTIVE: The Common Sense Model (CSM) was used as the organizing framework to examine providers' experiences with young people's cognitive representations and emotions related to the prevention and treatment of sexually transmitted infections (STIs). This study was conducted to develop insights into potential avenues for enhancing the effectiveness of STI education and counseling for young people. DESIGN: This was a qualitative investigation using semi-structured focus group interviews. SAMPLE: The 5 focus groups were comprised of 30 providers of STI education and counseling: public health nurses, peer educators, and nurse practitioners. MEASUREMENT: Content of transcribed focus group interviews was coded using a predetermined coding scheme based on the five dimensions of representational beliefs and emotions defined by the CSM. RESULTS: The providers identified that young people hold a number of STI misconceptions within each dimensions of the CSM. Anger and embarrassment about STIs are common emotions experienced by young people. CONCLUSIONS: This investigation suggests that providers are able to elicit and identify STI-related misconceptions held by young people, and that the CSM model is a useful classification method. Identifying misconceptions could be useful in developing tailored STI education and counseling interventions by public health nurses.

Supporting nurse preceptors through online continuing education.

BACKGROUND: A pilot study was conducted to assess the feasibility of using an online continuing education course to increase knowledge and self-efficacy in nurse preceptors who work with student nurses in acute and primary care settings. METHODS: A one-group pre- and posttest repeated measures design was used. Pre-course knowledge and self-efficacy were assessed with an electronic survey. Post-course knowledge and satisfaction assessments were embedded in the course. Knowledge retention and change in self-efficacy were assessed with an electronic follow-up survey. Analysis used paired sample t tests. RESULTS: Participants (N = 13) reported satisfaction with the course. Participant knowledge increased from pretest to post-course and from pretest to follow-up. Knowledge declined from post-course to follow-up. No change in self-efficacy ratings was observed. CONCLUSION: This study suggests that online continuing education is a feasible strategy to support preceptor learning. Further research on the effectiveness of this approach in changing and retaining knowledge and improving self-efficacy is needed.