Community, Public, and Population Health Content in Nursing Curricula: National Survey Results.

BACKGROUND: Policy, societal, and system changes are prompting nursing programs to expand population health content in curricula. This study examined the current state of community, public, and population health (CPPH) education in nursing curricula throughout the United States. METHOD: This descriptive study examined CPPH education in nursing programs nationally. A survey was developed and distributed to nursing programs from January to May 2021. RESULTS: CPPH content integration occurred across all program levels, and the majority of the participants were involved in the development of CPPH-specific curriculum. Programs experienced reductions in CPPH curriculum due to coronavirus disease 2019 (COVID-19), lack of experienced faculty, budget constraints, and an emphasis on acute care. CONCLUSION: The continuation of CPPH education in current nursing curricula is critical. National and academic nursing organizations must continue to monitor CPPH content in nursing curricula to assure a competent CPPH nursing workforce. [J Nurs Educ. 2024;63(5):282-291.].

Curricular Mapping: Assessing Exemplars in an Integrated Concept-Based Curriculum.

BACKGROUND: A Midwest school of nursing initiated an integrated concept-based curriculum where essential content is taught using exemplars. The specialty courses were integrated to address content overload and the duplication of content with different populations. PROBLEM: The faculty wanted to determine if the previous curriculum had been sufficiently integrated into the exemplars and if there were curricular gaps. APPROACH: A curriculum mapping project was conducted to assess the integration of the previous curriculum into the exemplars. Specifically, faculty evaluated exemplars for characteristics of: (1) individuals, (2) health care systems, (3) specialties, (3) nurse characteristics, and (4) interprofessional practice. CONCLUSIONS: Exemplars in an integrated concept-based curriculum can provide a broad representation of individuals across the life span and settings. Curricular mapping is an assessment tool that can identify curricular gaps and the need for refinement within the curricula to meet current and future directions within the health care environment.

2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association/American Stroke Association.

AIM: The "2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage" replaces the 2012 "Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage." The 2023 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with aneurysmal subarachnoid hemorrhage. METHODS: A comprehensive search for literature published since the 2012 guideline, derived from research principally involving human subjects, published in English, and indexed in MEDLINE, PubMed, Cochrane Library, and other selected databases relevant to this guideline, was conducted between March 2022 and June 2022. In addition, the guideline writing group reviewed documents on related subject matter previously published by the American Heart Association. Newer studies published between July 2022 and November 2022 that affected recommendation content, Class of Recommendation, or Level of Evidence were included if appropriate. Structure: Aneurysmal subarachnoid hemorrhage is a significant global public health threat and a severely morbid and often deadly condition. The 2023 aneurysmal subarachnoid hemorrhage guideline provides recommendations based on current evidence for the treatment of these patients. The recommendations present an evidence-based approach to preventing, diagnosing, and managing patients with aneurysmal subarachnoid hemorrhage, with the intent to improve quality of care and align with patients' and their families' and caregivers' interests. Many recommendations from the previous aneurysmal subarachnoid hemorrhage guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

Mixed-method analysis of the quad council competencies for public health nurses.

OBJECTIVE: Evaluate the knowledge, skills, and attitudes (KSA) of public health nurses (PHNs) related to the eight Domains of the 2011 Quad Council Competencies for Public Health Nurses (QCC-PHN). This manuscript is Part 2 of an exploratory study published in the Public Health Nursing journal on PHNs' knowledge, skills, attitudes, and application of the Quad Council Competencies (Harmon et al., 2020). DESIGN: In this mixed-method descriptive research study, the multisite team conducted an online survey among a convenience sample of 296 PHNs to determine differences in KSA for each of the eight QCC-PHN Domains. MEASUREMENTS: Analysis of variance (ANOVA) testing revealed differences in KSA for the QCC-PHN, Domains. Post-hoc tests and qualitative thematic analysis of PHNs open-ended comments were used to provide additional data. RESULTS: ANOVA results showed significant differences in knowledge and skills in all Domains and a significant difference in attitude in only one domain, Domain 7. Post-hoc test results showed significant differences in KSA between position titles for most Domains. CONCLUSIONS: Recommendations include using the QCC-PHN to standardize the professional and diverse roles of the PHN workforce.

An exploratory survey of public health nurses' knowledge, skills, attitudes, and application of the Quad Council Competencies.

OBJECTIVE: A collaborative research team of community/public health nursing faculty and public health nurses surveyed public health nurses to explore knowledge, skills, attitudes, and application of the Quad Council Competencies for Public Health Nurses (QCC-PHN). METHODS: Evaluate the knowledge, skills, attitudes, and application of the 2011 QCC-PHN by public health nurses. DESIGN: A descriptive, cross-sectional design was used to answer the hypothesis related to the study objective. A convenience sample of 308 public health nurses completed an online survey. MEASUREMENTS: ANOVA was used to determine the difference between the knowledge, skills, attitudes, and application of community/public health nurses (C/PHNs) regarding the QCC-PHN based on nursing specialty preparation, years of nursing experience, and years of C/PHN experience. RESULTS: C/PHNs are described and differences in knowledge, skills, attitudes, and application are delineated. A statistically significant difference was found in knowledge and attitude based upon years of C/PHN experience. CONCLUSIONS: Recommendations are proposed for increasing the QCC-PHN awareness, implementation, and evaluation to effectively enhance the practice of nursing C/PHN.

Using a quality improvement model to enhance community/public health nursing education.

BACKGROUND: Population-focused practice is an essential component of baccalaureate nursing education. The specialty of community/public health nursing (C/PHN) emphasizes prevention and focuses on the multiple determinants of health to improve population health outcomes. This project addressed two problems. How to: (a) Standardize C/PHN education by utilizing a set of competencies, and (b) Evaluate learning outcomes after using the competencies. METHOD: As collaborative team applied community/public health competencies to nursing education using the Omaha System and the four phases of the Quality Improvement Model (QIM) and to enhance C/PHN education. RESULTS: The QIM focused on team-based participation with mutual learning and engagement for both students and faculty. Logical thinking and continuous assessment improves the teaching process and prepares students to work in multiple health care environments. CONCLUSIONS: Systematic quality improvement enhances population-focused care by providing a foundation for the integration of education and practice.

A Concept Analysis of Conceptual Learning: A Guide for Educators.

BACKGROUND: Concept-based curricula, coupled with conceptual approach to teaching, fosters conceptual learning. There is a need for clarity in the definition of conceptual learning. METHOD: Walker and Avant's method of concept analysis was used. RESULTS: Conceptual learning is a process in which learners organize concept-relevant knowledge, skills, and attitudes to form logical cognitive connections resulting in assimilation, storage, retrieval, and transfer of concepts to applicable situations, familiar and unfamiliar. Attributes identified were (a) recognizing patterns in information, (b) forming linkages with concepts, (c) acquiring deeper understanding of concepts, (d) developing personal relevance, and (e) applying concepts to other situations. Antecedents were (a) learner cognitive potential, (b) organized conceptual framework, and (c) conceptual approach to teaching. Consequences were (a) enhanced synthesis and analysis, (b) improved problem solving, (c) ability to translate theory to practice, (d) appreciation of linear/nonlinear ways of thinking, and (e) enhanced concept construction. CONCLUSION: This analysis provides a referent for recognizing the occurrence of conceptual learning and developing instruments to measure its outcomes. [J Nurs Educ. 2019;58(1):7-15.].

Community/public health nursing faculty's knowledge, skills and attitudes of the Quad Council Competencies for Public Health Nurses.

A multisite collaborative team of community/public health nursing (C/PHN) faculty surveyed baccalaureate nursing faculty to explore their knowledge, skills, attitudes, and application of the Quad Council Competencies for Public Health Nurses (QCC-PHN). OBJECTIVES: (1) Evaluate the knowledge, skills, and attitudes of the 2011 QCC-PHN by academic C/PHN faculty; (2) Evaluate the application of 2011 QCC-PHN by C/PHN faculty in the clinical practicum for undergraduate baccalaureate C/PHN students; and (3) Determine if a significant difference existed in the knowledge for each domain. DESIGN: A mixed methods descriptive research design was used to answer three specific hypotheses related to the study objectives. A convenience sample of 143 faculty teaching C/PHN in baccalaureate schools of nursing completed an online survey. MEASUREMENTS: ANOVA was used to determine the difference between knowledge, skills, attitudes, and application of nursing faculty regarding the QCC-PHN based on years of nursing experience, C/PHN experience, and nursing specialty preparation. Participants' qualitative comments for each domain were analyzed for themes. RESULTS: C/PHN nursing faculty are described and differences in knowledge, skills, and attitudes delineated. A statistically significant difference was found in skills based on years of experience in C/PHN and in the application of the competencies based on nursing specialty preparation. Variations in knowledge of the QCC-PHN are identified. CONCLUSIONS: Ten recommendations are proposed for key skill sets and necessary preparation for faculty to effectively teach C/PHN in baccalaureate schools of nursing.

The Global Health Nursing Imperative: Using Competency-Based Analysis to Strengthen Accountability for Population Focused Practice, Education, and Research.

BACKGROUND: The Quad Council Competencies for Public Health Nurses are used to guide community and public health nursing course development in baccalaureate nursing programs. As clinical practice has expanded to global settings, the appropriateness of the 2011 Quad Council Public Health Nursing (PHN) Competencies to guide global clinical practice and evaluation was questioned. OBJECTIVE: To describe a comparison and analysis of three sets of competencies: PHN competencies, competencies for global health nurses, and interprofessional competencies for health professionals. METHOD: A literature review identified the most current guidelines and competencies for global health practice. Two seminal articles, "Global Health Competencies for Nurses in the Americas" and "Identifying Interprofessional Global Health Competencies for 21st-Century Health Professionals," were reviewed and compared with the 2011 Quad Council Public Health Nursing Competencies. A six-member multi-site team conducted a qualitative thematic approach to competency analysis. A four column crosswalk spreadsheet grid was used for comparison of the three sets of competencies. Column four was created to identify possible exemplars for clinical practice. FINDINGS: Gaps exist in the PHN competencies for specific global and interprofessional competencies. RECOMMENDATIONS: Enhanced and consistent emphasis on population/global health, and interprofessional content throughout nursing curricula is necessary to prepare providers for practice in global settings. Incorporation of global and interprofessional competencies should be considered in the revision of competencies for PHN practice to enhance productive contributions to community health outcomes. Consideration of proper placement of content gaps within basic and advanced nursing education as well as leveling for community/public health nursing practice needs to be addressed by nursing education and practice. In the interim, a special course or elective may be appropriate, especially for schools having clinical nursing practicums in international settings. Clinical evaluation in low-resource settings needs to be enhanced and aligned with competencies.

The Preparation of Community/Public Health Nurses: Amplifying the Impact.

In summary, improved population health, population focused care, and community-based networks are the objectives of health care delivery systems. Community/public health nursing education, practice, and research must be re-examined, re-focused, and re-designed to address the challenges of an expanding 21st century health care delivery to populations and communities. Common standards are in place to be utilized by academia, practice and research. With a unified front, C/PHN can collectively play an important transformative role and go forward to meet the ever expanding challenges of the 21st century populations and communities. The Association of Public Health Nurses (APHN) and the Association of Community Health Nurse Educator (ACHNE) have a joint meeting planned in June 2016 in Indianapolis. Please bring your colleagues, stakeholders, and community partners to join the voices of C/PHN to make a positive impact on the changing health care environment through our education, practice and work.

Original research: Giving sexual assault survivors time to decide: an exploration of the use and effects of the nonreport option.

BACKGROUND: Forensic nurses, sexual assault nurse examiners (SANEs), and victim advocates have long recognized the trauma of sexual assault crimes and the significance of survivors' decisions around reporting these crimes to law enforcement agencies. Until recently, survivors who didn't report the crime were not entitled to a free medical forensic examination. In a significant policy shift, the Violence Against Women and Department of Justice Reauthorization Act of 2005 provided an additional decision option with regard to the medical examination for survivors of sexual assault. This provision, referred to here as the nonreport option, was established to offer survivors a full range of reporting options and to ensure exemplary health care, with evidence collection as an important secondary goal. OBJECTIVES: This study sought to examine the implementation of the nonreport option in Texas; explore its impact on SANEs, survivors, and the criminal justice system; and identify strengths and challenges of the nonreport process. METHODS: A mixed-method approach was used that included qualitative interviews with 79 professionals who regularly respond to sexual assault crimes, a Web-based survey questionnaire of such professionals that yielded 131 completed surveys, and a review of existing data. RESULTS: The step-by-step process involved in a nonreport case was described, and findings in three descriptive areas emerged: confidentiality processes, storage and shipment of evidence, and the use of the nonreport option. Beneficial effects of the nonreport option were identified in five areas: the role of SANEs, the impact on survivors, collaborative relationships, collateral crimes, and anonymous reporting strategies. Seven areas of remaining dilemmas were also identified. CONCLUSIONS: Findings indicate that the nonreport option has had a considerable positive impact on SANEs, survivors of sexual assault, and the criminal justice system. But challenges remain if this option is to be fully utilized in the future; further research is warranted. The authors also present recommendations to improve health care delivery.

Cigarette smoking topography among alternative school youth: why African American youth smoke less but are at higher long-term risk.

A paradox exists in health disparities research where African-American cigarette smokers consume fewer cigarettes per day, yet experience higher rates of tobacco-related disease compared to White American smokers. In this study we conducted focus group interviews among alternative high school youth (N = 78; age 18-19 years old) in an urban area in Southwest Texas to investigate if African-American youth smoke cigarettes differently than their White-American and Hispanic-American counterparts. The majority of African-American participants reported inhaling deeper and smoking their cigarettes "to the filter" because of their concern over wasting any part of an expensive cigarette. White and Hispanic respondents most often put out their cigarettes closer to the middle, and did not express concern about wasting cigarettes. The implication from this qualitative study is that because African Americans smoke differently they are exposed to a higher level of harmful particulate per cigarette. Further research on smoking topography is warranted.

Building community partnerships to end interpersonal violence: a collaboration of the schools of social work, law, and nursing.

The article discusses the University of Texas at Austin's (UT Austin) Institute on Domestic Violence and Sexual Assault (IDVSA), an institution that was established in 2001. IDVSA is a collaboration of the Schools of Social Work, Law, and Nursing, and 150 community affiliates. Recognizing that interpersonal violence does not occur in a vacuum, the IDVSA operates within an ecological framework in which explanations for interpersonal violence acknowledge that individuals and families are nested in larger mezzo and macro systems, and factors such as gender, poverty, ethnicity, religion, disability, sexual orientation, and immigration status play influential roles in our understanding of these issues. The overarching goal is to advance knowledge and meaningful practice in the field through partnerships with survivors and community practitioners. Specifically, the mission is to advance the knowledge related to domestic violence and sexual assault in order to end interpersonal violence. IDVSA seeks to achieve its mission by focusing on three key areas: (1) rigorous research and scholarship on domestic violence and sexual assault; (2) comprehensive training, technical assistance, and information dissemination to the practitioner community and the community at large; and (3) substantial collaboration with our community partners. This article summarizes the authors' pursuit.

Improving access to health care for uninsured elderly patients.

The purpose of this article is to explore the barriers that the uninsured elderly population encounter when accessing health care in the United States. These barriers include, but are not limited to lack of transportation, insurance, or family support; the daunting complexity of the health care system; poverty; culture; poor patient-health care provider communications; race/ethnicity; and lack of health care professionals such as nurses and doctors with adequate geriatric preparation, or generalists who are undereducated in geriatrics. The number of health care professionals currently available to treat elderly persons in the United States is inadequate. The Federal government should take steps to develop solutions to improve access to health care and decrease health disparities for older adults. As a nation, we should be proactive in addressing these concerns instead of waiting for new barriers to arise that further limit access to health care for elderly patients and their families. In this article, we provide an assessment of the barriers that limit access to health care in the uninsured elderly population and suggest recommendations and possible solutions to eliminate or reduce these barriers.

Beliefs and perceived norms concerning body image among African-American and Latino teenagers.

Focus groups, utilizing the Theory of Planned Behavior, examined the beliefs and perceived norms regarding body image in a sample of urban African-American and Latino teenagers (N = 83, 18-19 years old) from Texas. Cultural eating (behavioral belief) explained the acceptance and tolerance of overweight. Popularity of hip-hop fashion and limited income explicated peer and familial normative beliefs, respectively. Thinness equated HIV infection in African-Americans (parental normative belief). Barriers to healthy eating and active living (control beliefs) included willpower, laziness, fast food, and excessive work. Findings can guide the development and implementation of culturally appropriate obesity interventions for African-American and Latino adolescents.

The link between recent sexual abuse and drug use among African American male college students: it's not just a female problem in and around campus.

This study examined the relationship between sexual abuse in or around campus and drug use among young African-American males in college. It offers cross-sectional analysis of data collected from the Alcohol and Substance Abuse Awareness and Use Study (ASAAUS). Data collection took place in October 2004 via a self-administered survey among 181 African-American male students. Males who reported past sexual abuse in or around campus were significantly more likely than nonsexually-abused males to have used tobacco (41% v. 19%, p < .05), alcohol (82% v. 49%, p < .05), marijuana (59% v. 30%, p < .05), and cocaine (18% v. 2%, p < .05) in the 30 day preceding the interview. Logistic regression analyses indicated that sexual abuse history in or around campus was significantly associated with past year (OR = 9.8, p < or = 0.001) and past 30 day (OR = 5.0, p < or = 0.001) drug use.

Advances in understanding and treating childhood sexual abuse: implications for research and policy.

Childhood sexual abuse is a major public health problem affecting thousands of children and adolescents in the United States each year. For more than 20 years, researchers, healthcare professionals, and policymakers have had considerable disagreements about various aspects of child sexual abuse. Although everyone agrees that sexual abuse is a harmful thing for children to experience, there is a lack of consensus on a definition of sexual abuse, investigation of allegations, long-term consequences, what constitutes appropriate psychotherapy, and what public health policies should be developed to prevent sexual abuse. The purpose of this article is to explore advances that have been made in understanding and treating child sexual abuse, to look at the implications for further research, and to address the public health policies that exist for preventing child sexual abuse.

Attachment and sexual health behaviors in homeless youth.

PURPOSE: To explore relationships and group differences in attachment-related constructs (social connectedness and social support) and sexual health behaviors in a sample of homeless youth. DESIGN AND METHODS: An exploratory design, this study analyzed baseline data from an ongoing intervention study. Survey data were collected by audio, computer-assisted self-interview (A-CASI) from a nonprobability sample of homeless youth (n = 176). RESULTS: Social connectedness was positively correlated with period of time homeless, while social support was positively related to sexual self-concept and to self-efficacy and intention to use condoms. PRACTICE IMPLICATIONS: The street group that homeless youth identify with may be a potential resource for peer-mentoring and skill-building regarding healthy sexual behavior.

Beliefs and social norms about sildenafil citrate (Viagra) misuse and perceived consequences among Houstonian teenage males.

In the current study, a qualitative approach was used to investigate relevant beliefs and norms associated with sildenafil citrate (Viagra) consumption, initiation, and perceived consequences. Focus groups were conducted with 43 young men aged 18 and 19 years who identified themselves as lifetime sildenafil citrate users. The majority of focus group participants believed that "curiosity" and "peer pressure" contributed to their initial use. Most revealed that they first heard about sildenafil citrate from television advertisements, family members, friends, or sporting events, and they were able to obtain the drug from their friends and family members or they stole it from their father or grandfather. These findings may highlight the relative importance of exposure to prescription drug messages among those to whom the message is not specifically targeted, that is, young men. It is possible that the sildenafil citrate television messages are recalled by not only older male audiences but also by teenagers and younger men, producing similar cognitive processing and curiosity in both age cohorts.