Public Health Nurses' Competence Related to Long-Term Breastfeeding in the Context of Maternity and Child Health Clinics.

AIM: To explore public health nurses' competence (namely knowledge, skills, and attitudes) in relation to long-term breastfeeding and their experience of the need for additional training on the subject. DESIGN: The study design was quantitative, descriptive, and cross-sectional. SAMPLE: Public health nurses (n = 270). METHODS: Data were collected with the Long-Term Breastfeeding Competence Scale (LBCS) online survey. Data analysis was done with Spearman's correlation analysis and binary logistic regression analysis. RESULTS: Slightly more than half of the respondents had a good level of knowledge and skills. The majority had a baseline positive attitude toward long-term breastfeeding, but the attitude became more negative as the age of the breastfed child increased. Better competence was associated with younger age, parenthood, an additional degree in midwifery, and breastfeeding specialist certification. Knowledge and skills, and attitudes revealed a high correlation: the higher the knowledge and skills level, the more positive attitudes. Respondents with better knowledge and skills experienced more often the need for additional training on the subject. CONCLUSIONS: This study addresses that public health nurses lack competence in relation to long-term breastfeeding. This may compromise the quality of breastfeeding guidance for families in healthcare settings.

Effectiveness of a web-based learning program for promoting local healthcare planning competencies.

OBJECTIVE: To determine the effectiveness of a web-based educational program regarding local healthcare planning by public health nurses (PHNs) in Japan. DESIGN: A single-blind randomized controlled trial. SAMPLE: Full-time PHNs working for local governments across Japan. MEASUREMENTS: The primary outcome was nurses' self-perception of competencies in public health policy. The secondary outcome was self-perception of knowledge, skills, and perspectives regarding local healthcare planning. We analyzed intergroup differences using the intention-to-treat principle and the Mann-Whitney U-test. INTERVENTION: The intervention group received six web-based learning modules including substantial knowledge and skills regarding local healthcare planning based on the analysis, design, development, implementation, and evaluation model and adult learning theory. RESULTS: Totally, 273 PHNs registered, and 38 were excluded without completing the baseline survey; 235 were randomly allocated to either the intervention (n = 118) or control (n = 117) groups. Sixty-four participants in the intervention group completed the program. Over 70% of the participants lacked opportunities to learn about local healthcare planning. The intervention group showed significant improvement in self-perception of competencies, knowledge, and skills regarding local healthcare planning, except for items related to evaluation. CONCLUSIONS: The web-based learning program effectively improved participants' self-perception of competencies in local healthcare planning.

Creating a quadruple aim model for nursing education.

Baccalaureate nursing education is moving to adopt the new American Association of Colleges of Nursing Essentials for Professional Nursing Education. As identified in two of the six domains of the essentials, graduates need to be prepared to address population health and utilize informatics and healthcare technologies. Community/public health nursing also has eight domains for generalist nurses linked to population health which will help prepare a skilled nursing workforce for the 21st century. The Institute for Healthcare Improvement's Triple Aim which evolved into the Quadruple Aim is focused on improving health outcomes within healthcare delivery. Through a literature review, a need for a Quadruple Aim model for nursing education was identified. Mirroring the Institute for Healthcare Improvement's Triple Aim for healthcare delivery, a Quadruple Aim for Nursing Education Model was developed. The model dimensions include (1) Population-focused Care, (2) Maximize Student Learning Experience, (3) Cost-effective Pedagogy, and (4) Nurse Educator Well-being. The Quadruple Aim for Nursing Education Model supports nursing education to prepare future nurses effectively and efficiently bridging population health concepts and issues with nursing informatics. Nurse educators are encouraged to utilize the model to transform nursing education.

Creating safe relational space: Public health nurses work with mothering refugee women.

OBJECTIVE: Exploring how public health nurses (PHNs) provide community-based support to women who are refugees and mothering. DESIGN: A constructivist grounded theory (CGT) design was used where intersectionality as an analytical tool was applied. Varying data collection approaches including focus groups were used. SAMPLE: Twelve PHNs from four public health units in Western Canada participated in this study. RESULTS: Participants in this study described an overall process of creating safe relational space to address a basic social problem of establishing trust while managing structural forces. This overarching process was expressed through burning with passion, connecting while looking beyond, protecting from re-traumatization, and fostering independence. Findings reveal strategies PHNs used to enhance health equity. This study extends critical caring theory to include sociopolitical and economic influences on public health nursing practice. Consequences of these influences on the mothering refugee women population are also revealed. Implications include structural integration of trauma-and-violence-informed principles to support public health nursing practice. CONCLUSIONS: This study adds to an emerging body of knowledge on PHNs work with complex populations. Innovative application of intersectionality is demonstrated as an effective approach to analyzing impacts of broad sociopolitical priorities on communities that are systemically marginalized.

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.

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.

Leveling the core competencies of public health nursing to evaluate senior baccalaureate nursing students.

OBJECTIVES: This study assessed a revised instrument based on the tier one Core Competencies for Public Health Nurses. Following instrument revision, the self-reported competence of prelicensure baccalaureate nursing students was examined. DESIGN AND SAMPLE: In this descriptive study, 102 senior, prelicensure baccalaureate nursing students completed a revised Core Competencies instrument prior to and immediately following completion of public health nursing courses. Parametric statistics were used to determine if there were significant differences in pre- and postcourse domain scores and the impact of selected demographic variables on postcourse domain scores. RESULTS: Pilot testing confirmed the reliability and validity of the revised instrument. A paired t test determined postcourse domain scores were significantly higher than precourse domain scores. Overall, students rated themselves as competent in all domains, with the lowest ratings of competence in policy development/program planning. Likelihood of choosing a future career in public health was significantly higher for students in traditional public health clinical settings. CONCLUSION: The revised tier one Core Competency instrument provided information related to students' self-reported competence in public health nursing competencies. These findings provide valuable insight for development and revision of public health nursing courses ensuring a nursing workforce competent in the provision of population health.

Development and implementation of a health education station by community health nursing students.

This paper examines the development and implementation of a health literacy/education station at a large free clinic in a metropolitan city in southern California. The station was made possible through a partnership between the leadership team at the clinic and senior nursing students at a large university located in southern California. This paper outlines the importance of health literacy, the partnership between the community health senior nursing students and faculty and a yearly 3-day health clinic, the Core Competencies of Public Health Nursing met by the event, student preparation prior to the event, outcomes, and recommendations for future clinics and for future collaborations.

Development of a new graduate public health nurse residency program using the core competencies of public health nursing.

BACKGROUND: Due to the continued shortage of public health nurses, some local public health agencies have begun hiring new graduate baccalaureate nurses into the public health nurse role. These new graduates require an increased level of support for transition to practice. AIMS: The goal of this project was creation of a transition to practice program designed specifically to meet the needs of new graduates hired in public health settings. METHODS: The core competencies of public health nursing were used as a framework to develop this residency program. A group of public health staff, supervisors, and faculty met monthly for three years to develop this program. Key features include general orientation, preceptors, looping experiences, case studies and peer support. RESULTS: The program is available as a web resource beginning spring 2018. In order to evaluate this program, data on job satisfaction, employee retention and level of competence in the core competencies of public health will occur using instruments administered prior to beginning and immediately following completion of the new graduate residency. DISCUSSION: The components of the program mirror best practices for new graduate residencies and are based on core competencies for public health nursing. This residency program is an important step for enhancing the professional development of new baccalaureate graduates in public health settings, and preparing the next generation of public health nurses. CONCLUSION: Through the increased support and intentional education of the residency program, public health agencies will be able to attract and retain new graduates who develop the essential knowledge and skills to provide safe and effective care in the public health setting.

The evaluation of public health nursing students' skill achievement levels by educational improvement.

OBJECTIVE: This study aimed to evaluate the educational improvement outcomes after introducing undergraduate public health nursing electives from the perspective of students, teachers, and public health nurses. DESIGN AND SAMPLE: Post-test design with control group was used. We surveyed three groups of participants on the relevance of achieved skill items. These groups were as follows: fourth-year students, teaching staff from seven universities, and public health nurses from special districts of Tokyo who had pioneered the introduction of public health nursing electives. MEASURES: The three participant groups were surveyed in 2013 and 2014 to compare the students' levels of achievement in the 98 skill items presented by the Japanese Ministry of Health, Labour, and Welfare. Practical training introduced educational reform in 2014. Anonymous self-administrated questionnaires were used. RESULTS: The mean achievement rates of the 98 items in 2013 and 2014 were 67.9% and 72.6%, respectively, for students; 40.9% and 59.7% for teachers; and 44.4% and 59.4% for PHNs. A significant difference was observed between ratios of 2013 and 2014 in all three groups. CONCLUSIONS: The results demonstrated that the introduction of educational reform increased the achievement rates of students through the electives.

Linking public health nursing competencies and service-learning in a global setting.

BACKGROUND: Nurse educators in baccalaureate programs are charged with addressing student competence in public health nursing practice. These educators are also responsible for creating nursing student opportunities for civic engagement and development of critical thinking skills. The IOM report (2010) on the Future of Nursing emphasizes the nurse educator's role in promoting collaborative partnerships that incorporate interdisciplinary and intraprofessional efforts to promote health. AIM: The purpose of this article is to describe an innovative approach to address public health nursing competencies and to improve the health and well-being of indigenous populations in a global setting through promotion of collaboration and service- learning principles. METHODS: As part of a hybrid elective course, baccalaureate nursing students from various nursing tracks participated in a 2 week immersion experience in Belize that included preimmersion preparation. These students were to collaborate among themselves and with Belizean communities to address identified health knowledge deficits and health-related needs for school-aged children and adult populations. RESULTS: Students successfully collaborated in order to meet health-related needs and to engage in health promotion activities in the Toledo district of Belize. They also gained practice in developing public health nursing competencies for entry-level nursing practice. Implementation of service-learning principles provided students with opportunities for civic engagement and self-reflection. DISCUSSION: Some challenges existed from the students', faculty, and global community's perspectives. Lack of culturally appropriate and country specific health education materials was difficult for students and the community. Faculty encountered challenges in communicating and collaborating with the Belizean partners. CONCLUSION: Commonalities exist between entry-level public health nursing competencies and service-learning principles. Using service-learning principles in the development of public health experiences increases the likelihood of success in achieving these competencies. While students demonstrated intraprofessional collaboration in a global setting, these same collaborative opportunities can occur in local communities.

Influence of simulated and actual community vaccination clinics on student empowerment and self-efficacy for public health nursing competencies.

OBJECTIVES: To examine students' structural empowerment during simulated learning and actual nursing practice, and assess students' self-efficacy for public health nursing competencies (PHNC) after involvement in a mass influenza vaccination clinic as a community practice experience. DESIGN: A nonexperimental survey design was used with a sample of year three baccalaureate nursing students. METHODS: Students completed a demographic form after the simulated clinic experience, they were assessed for perceptions of empowerment after being involved in the simulated and actual clinic settings, and self-efficacy was assessed after the actual clinic experience. RESULTS: Students perceived themselves as structurally empowered after completing the simulated and actual community vaccination clinics. Students reported a high level of self-efficacy for PHNC after their actual community vaccination clinic involvement. There was a significant correlation between empowerment and self-efficacy, which suggests that when students have access to empowering structures, they feel more confident to enact PHNC that align with practice in the clinics. CONCLUSION: This study suggests that nursing students acquired the necessary knowledge and skills for safe vaccination administration through the combination of simulated practice and participating in an actual public health vaccination clinic.

Core competency model for the family planning public health nurse.

OBJECTIVES: A core competency model for family planning public health nurses has been developed, using a three stage Delphi Method with an expert panel of 40 family planning senior administrators, community/public health nursing faculty and seasoned family planning public health nurses. DESIGN AND SAMPLE: The initial survey was developed from the 2011 Title X Family Planning program priorities. The 32-item survey was distributed electronically via SurveyMonkey(®). RESULTS: Panelist attrition was low, and participation robust resulting in the final 28-item model, suggesting that the Delphi Method was a successful technique through which to achieve consensus. CONCLUSIONS: Competencies with at least 75% consensus were included in the model and those competencies were primarily related to education/counseling and administration of medications and contraceptives. The competencies identified have implications for education/training, certification and workplace performance.

The Quad Council practice competencies for public health nursing.

This article describes the most recent efforts by the Quad Council of Public Health Nursing organizations to review and revise the competencies for PHN practice, and highlights the implications of these competencies for practice, education, and research. The Quad Council is a coalition of four nursing organizations with a focus on public health nursing and includes the Association of Community Health Nursing Educators; the Association of Public Health Nursing (known prior to July 1, 2012 as the Association of State and Territorial Directors of Nursing); the Public Health Nursing section of the American Public Health Association; and the Council on Economics and Practice of the American Nurses' Association. The Quad Council competencies are based on the Council on Linkages competencies for public health professionals and were designed to ensure that public health nursing fits in the domain of public health science and practice.

Embracing a competency-based specialty curriculum for community-based nursing roles.

The Quad Council competencies for public health nursing (PHN) provide guidance in developing curricula at both the generalist and specialist level. However, these competencies are based on nursing roles in traditional public health agencies and community/public health is defined more broadly than official agency practice. The question arises as to whether community-based specialties require largely the same knowledge and skill set as PHN. The purpose of the competency cross-mapping project reported here was to (a) assess the intersection of the Quad Council competencies with four community-based specialties and (b) ensure the appropriateness of a Quad Council-based curriculum to prepare graduates across these four specialties (home health, occupational health, environmental health, and school nursing). This article details the multistep cross-mapping process, including validation with practice leaders. Results indicate strong alignment of community-based specialty competencies with Quad Council competencies. Community-based specialty-specific content that did not align well is identified, along with examples of didactic and clinical strategies to address gaps. This work indicates that a Quad Council-based curriculum is appropriate to prepare graduates in community-based specialties when attention to the specialty-specific competencies in the clinical setting is included. This work guides the development of a doctorate of nursing practice curriculum in PHN, encompassing the four additional community-based specialties.