A scoping review of environmental health nursing research.

OBJECTIVE: The purpose of this scoping review was to determine the extent and focus of published environmental health nursing research. DESIGN AND SAMPLE: The search was limited to peer reviewed, English-language environmental health nursing research with at least one nursing author, published between 1995 and 2015 in a nursing journal, and catalogued in CINAHL. RESULTS: Publication of the 548 identified articles occurred in 118 different nursing journals. Annual number of publications increased from nine articles in 1995 to 50 in 2013 and 2014. Most (63%) of the studies occurred in the Unnited States; the remaining studies took place in 33 other countries. Three primary focus areas were identified: disasters/disaster preparedness, occupational health, and the home environment. Other focus areas included environmental exposures, environmental risk perception, secondhand smoke, and environmental health education. The primary populations studied were nurses/nursing students (40%) and adults (26%). Most common research designs employed were cross-sectional (42%) and qualitative methods (20%). CONCLUSIONS: Findings from this scoping review support a global expansion of published environmental health nursing research addressing a variety of environmental health topics. Additional studies are needed that use more complex research methods and address timely topics such as climate change and sustainability.

Public Health Nursing Position Descriptions Congruence with ANA Standards, Public Health Essential Services, and Quad Council Domains.

OBJECTIVE: To map position descriptions (PDs) for staff public health (PH) nurses to two national frameworks for PH nursing and one framework for PH. DESIGN AND SAMPLE: This descriptive study included PDs (N = 161) from 66 Ohio local health departments. MEASURES: Statements in each PD were analyzed for congruence with the twenty 2007 American Nurses Association Public Health Nursing Standards/Substandards (ANA Standards), the 10 Essential Services of Public Health (ES), and the eight 2003 Quad Council Public Health Nursing Skills Domains (QC domains). Health department and PD characteristics also were obtained. RESULTS: PDs addressed an average of 6.1 of the 20 ANA Standards, 4 of the 10 ES, and 1.9 of the 10 QC domains. The most commonly addressed ANA Standards, ES, and QC domains focused on assessment, linkages, health education, and regulation enforcement. About 78% of the PDs included task statements that did not correspond to any of the professional frameworks. CONCLUSIONS: Findings from this study demonstrate a lack of congruence between the organizational and the disciplinary expectations for PH nurses. Given the increasing focus on PH department accreditation, performance management, and workforce development, PH nursing must address this incongruence to strengthen the profession and the public's health.

The impact of an urban home-based intervention program on asthma outcomes in children.

OBJECTIVES: This program evaluation examines the outcomes of a multicomponent urban home-based asthma program implemented through a city health department in a large Midwestern city. The purpose of the program was to improve asthma outcomes by controlling indoor asthma triggers in the home environment. DESIGN AND SAMPLE: This was a pre-post evaluation study. Participants received home-based education from a public health nurse or a health educator, cleaning and other supplies, and physical home interventions such as mold abatement and pest control. Asthma outcomes, caregiver quality of life, trigger-related activities, and asthma management activities at baseline and 6 months following the intervention were evaluated using survey data. A total of 115 participants for whom baseline and follow-up data were available were included in this analysis. MEASURES: This study used parent self-reported quantitative and qualitative data which were collected through baseline and follow-up surveys administered by program staff. RESULTS: Significant reduction in asthma symptom days, nighttime awakenings, days with activity limitation, and albuterol use were observed. Emergency department visits, missed school days, and caregiver missed work days also were significantly reduced, and caregiver quality of life improved. CONCLUSIONS: This multifaceted home-based intervention decreased asthma triggers and improved asthma outcomes in children, and improved the quality of life of their caregivers.

Congruence between position descriptions for public health nursing directors and supervisors with national professional standards and competencies.

OBJECTIVES: This study described the extent to which position descriptions (PDs) for public health directors of nursing (DONs) and non-DON public health nursing (PHN) supervisors in Ohio local health departments incorporate national standards of PHN practice and competencies for public health managers. DESIGN: Ninety-four PDs were obtained from 66 local health departments. Statements in each PD were analyzed for congruence with the 2007 American Nurses Association Public Health Nursing Scope and Standards of Practice (ANA Standards) and the Council on Linkages Core Competencies for Public Health Professionals (COL Competencies). Health department and PD characteristics were also obtained. COL Competencies within each COL skill domain were pooled for analysis. RESULTS: Position descriptions addressed an average of 7.6 of the 20 ANA Standards/Substandards (range, 1-15). The most commonly addressed ANA Standards were Leadership, Regulatory Activities, Collegiality and Professional Relationships, and Planning; the least often addressed were Population Diagnosis and Priorities, Professional Practice Evaluation, Outcomes Identification, Advocacy, and Evaluation. Position descriptions addressed an average of 3.6 of the 8 COL skill domains (range, 0-6). Financial Planning and Management, Policy Development/Program Planning, Community Dimensions of Practice, and Analytic/Assessment were the most commonly addressed COL skill domains, whereas Cultural Competence and Basic Public Health Sciences were the least commonly addressed. About 75% of the PDs included task statements that did not correspond to any of the ANA Standards or COL Competencies. CONCLUSIONS: Results indicate that PDs do not reflect compliance with professional mandates for the practice of PHN. This lack of fit between PDs and nationally recognized standards of practice and competencies suggest that PHN may be undifferentiated as a public health discipline and as a nursing specialty.

Application and modification of the integrative model for environmental health.

The Integrative Model for Environmental Health (IMEH) has guided research, literature reviews, and practice initiatives since 2002. This article presents the Modified IMEH that was developed based on using the IMEH as a guiding conceptual framework in a community-based participatory research environmental health project. Concepts from the Model of Risk Information Seeking and Processing as well as emergent themes from the data analysis were instrumental in this process. The Modified IMEH alters the structure of the IMEH in that the Vulnerability and Epistemological Domains are more prominent and feedback between domains is included.

Home environmental hazard education for undergraduate and prelicensure nursing students.

This paper presents a Healthy Homes education module for undergraduate and prelicensure nursing students. The education module, which is based on the National Center for Healthy Housing's framework for Healthy Homes, was developed, implemented, and evaluated in three phases. Phase 1 included nine Web-based recorded lectures on the Healthy Homes principles and on home assessment and referral. In the next phase, a Healthy Homes clinical laboratory simulation (home visit scenario and four rooms of an apartment) was created. Phase 3 involved piloting home visits by students who, under the supervision of a clinical instructor, conducted Healthy Homes assessments of clients living in two low-income subsidized housing sites. Using a pretest-posttest format, students' knowledge of Healthy Homes concepts significantly increased after completing the Phase 1 Web-based lectures. Student evaluations, which were collected after each phase, were consistently positive.

Dental insurance and dental service use by U.S. women of childbearing age.

OBJECTIVES: Oral health has a significant effect on health, and for women, poor oral health can lead to poor birth outcomes and can affect their child's health. Nursing interventions to improve the oral health of at-risk women have the potential to increase maternal and child systemic and oral health. The identification of women at a high risk for poor oral health is a necessary to develop and evaluate these interventions. DESIGN AND SAMPLE: This study examined the factors related to dental insurance and dental service use for women of childbearing age in the United States. A secondary analysis of the 2003-2004 National Health and Nutrition Examination Survey was completed to examine the predisposing, enabling, and need variables associated with dental insurance status and dental service use in a representative random sample of 1,071 women. RESULTS: The results showed that over 40% of women had no dental insurance. Women with less education, lower income, and dental need were significantly less likely to have dental insurance. Dental utilization by the uninsured was low and a racial/ethnic disparity was noted. CONCLUSION: A lack of dental insurance and dental service utilization is a significant concern. Nurses working with low-income women should educate the population about oral health and advocate for policies to increase dental insurance coverage.

Impact of an urban healthy homes intervention.

In the study described in this article, the authors evaluated the impact of an urban Healthy Homes intervention that included educational home visits. Their one-group, pre-post design used a structured interview at baseline and postintervention. The sample (N = 84) was comprised of low-income children younger than 18 years of age with an asthma diagnosis or with an asthmatic mother. Children were primarily male (62%), < or =10 years old (74%), and lived in a single family home (69%) with moisture (61%). Interventions included a personalized action plan, education, demonstrations, and home remediation as needed. Significant post-intervention decreases occurred in reported asthma symptoms for the child, school days missed, caregiver work days missed, and emergency department/urgent care center visits. Caregiver self-efficacy and quality of life increased significantly. The comprehensive home visitation intervention program effectively impacted asthma symptoms, lost school and work days, emergency use of the health care system, and improved caregiver quality of life and self-efficacy.

Dental services utilization by women of childbearing age by socioeconomic status.

For women of childbearing age, oral health not only affects their physical and psychological well-being but also that of their children. This study used the 2003-2004 Ohio Family Health Survey (N = 9,819) to examine dental need and utilization by women in Ohio. Predisposing, enabling, and need variables were examined as they effect dental health service utilization by women of childbearing age at different socioeconomic status (SES) levels. The proportion of women in the low SES group self reporting a dental need (18%) was 3 times that of the proportion of women in the higher SES group with a self reported need (6%). Results of bivariate analysis showed that having a dental visit in the past year varied significantly by SES, race, insurance status, provider density, and need. A racial disparity in dental service utilization was noted in the bivariate analysis of the middle SES group. While dental need and type of dental coverage varied by SES, both were significantly associated with utilization of dental services within all 3 SES categories in the logistic regressions. These results suggest that measures need to be implemented to meet the goal of increasing access and utilization of dental health services by low-income populations.

What young African American women want in a health care provider.

The Institute of Medicine's report on racial and ethnic disparities in health care encourages enhancing patient-provider relationships by building trust. We explored factors important to 19- to 24-year-old African American women (N = 40) in choosing a health care provider. Eight focus groups were held in seven Ohio counties. Discussion was aided by photographs of client-provider interactions: two African American and two White providers (man or woman in each); in similar settings, attire, and pose; with a young African American woman client. Participants commented on what was happening in the photographs, how the woman felt, and their perceptions of each provider. Fongwa's Quality of Care model guided analysis. Women providers were favored; race was not of primary concern. Provider proximity, perceived interest, and understandability were persistent preferences. Trust, awareness of body language, interest in client, and conveying information clearly are critical for providers caring for young African American women.

Facilitating factors and barriers to BMI screening in schools.

The National Association of School Nurses advocates for body mass index (BMI) screening. Little research describes school nurse practice of BMI screening. In this descriptive study, 25 Ohio school nurses participated in three focus groups. An adapted Healthy People 2010 Determinants of Health Model guided the research questions. School nurses engaged in multiphasic data collection which was contingent on physical environment, workload, and referrals. Lack of system policy was key barrier in terms of data collection, referral, and follow-up. A key facilitating factor was physical education teachers in terms of reinforcing health. School size and privacy were components of school physical environment that influenced screening. Recommendations on securing adequate resources are presented. Implications for policy included a salient need for reduced SN workload.

Using mixed methods to evaluate the Pediatric Lead Assessment Network Education Training Program (PLANET).

The Pediatric Lead Assessment Network Education Training Program (PLANET) is a peer-to-peer in-person 1-hr lead poisoning prevention educational program for health professionals. This evaluation was designed to determine the impact of the PLANET program. Evaluation methods included analyzing data from PLANET sign-in sheets, evaluation forms, pre/postknowledge tests, claims data, and focus groups (FGs) and interviews (IVs) with PLANET attendees and nonattendees. Claims data were used to compare blood lead testing rates for physicians attending and those not attending a PLANET program. Over 2,000 health professionals attended the 192 PLANET presentations delivered between June 2001 and December 2006; most were registered nurses or physicians. Written evaluations were overwhelmingly positive. Posttests indicated increased provider knowledge about childhood lead poisoning prevention, and assessment of blood lead testing rates showed higher testing rates for PLANET attendees. FG and IV participants suggesting improvements including using alternative delivery modes.

The Precautionary Principle, public health, and public health nursing.

The Precautionary Principle posits that, in the absence of certainty, the appropriate course of action is to err on the side of caution. The Principle has been applied to decision making and policy development related to environmental health issues both internationally and in the United States. The American Public Health Association and the American Nurses Association (ANA) have issued policy statements that invoke the Precautionary Principle, and the Principle has been incorporated into statements that describe the practice of public health nursing. Nursing has always recognized the relationship of the environment with the health of humans--individuals, families, populations, and communities (ANA). The increasing attention to the Precautionary Principle comes at a time of redefinition of the field of public health, environmental public health, and the practice of public health nursing. Thus, it is crucial that practicing public health nurses understand the Precautionary Principle and its relevance to the practice of public health, public health nursing, and the current and future health individuals, families, populations, and communities.

Caring for patients under Medicaid mandatory managed care: perspectives of primary care physicians.

The purpose of the study was to describe the experiences of primary care physicians caring for Medicaid recipients in a demonstration mandatory health maintenance organization (HMO) managed care program. The authors collected data through semistructured individual or focus group interviews with 14 physicians and through interviews with the chief executive officers of the three HMOs participating in the demonstration program. Interview questions, developed initially from a review of the literature, addressed physicians' experiences as primary care providers for Medicaid recipients under traditional fee-for-service and under managed care arrangements through the demonstration program. Four themes emerged: providers' hassles and burdens, the complex needs of Medicaid patients, improved access to care under managed care, and individual providers' disconnect from the processes of health policy implementation and program evaluation.

A cohort study of former and current Medicaid recipients in two North Carolina counties, 1996-1999.

This article presents findings of a 1998-99 resurvey of Medicaid recipients (adults and children) who were first surveyed in 1996 in Mecklenburg and New Hanover Counties in North Carolina. It reports the insurance status and health care of former Medicaid recipients and compares them with those still on Medicaid in 1998-99 in respect to access to care and satisfaction. Just under half of those who had left Medicaid were without employer-sponsored health insurance (ESI) at the time of the second survey. Former Medicaid recipients without ESI rated their access to healthcare lower than those with Medicaid and former Medicaid recipients with ESI. Over 50% of target respondents in all groups were more positive than negative on access-related variables. But only those on Medicaid in Mecklenburg County had significant increases in satisfaction with health care between 1996 and 1998-99. Those in the control county who were off Medicaid and those still receiving it and former recipients in Mecklenburg showed no significant change. The study has great policy relevance in light of recent national welfare reform.

Public health nurses' knowledge and attitudes regarding climate change.

BACKGROUND: Climate change affects human health, and health departments are urged to act to reduce the severity of these impacts. Yet little is known about the perspective of public health nurses--the largest component of the public health workforce--regarding their roles in addressing health impacts of climate change. OBJECTIVES: We determined the knowledge and attitudes of public health nurses concerning climate change and the role of public health nursing in divisions of health departments in addressing health-related impacts of climate change. Differences by demographic subgroups were explored. METHODS: An online survey was distributed to nursing directors of U.S. health departments (n = 786) with Internet staff directories. RESULTS: Respondents (n = 176) were primarily female, white public health nursing administrators with ≥ 5 years of experience. Approximately equal percentages of respondents self-identified as having moderate, conservative, and liberal political views. Most agreed that the earth has experienced climate change and that climate change is somewhat controllable. Respondents identified an average of 5 of the 12 listed health-related impacts of climate change, but the modal response was zero impact. Public health nursing was perceived as having responsibility to address health-related impacts of climate change but lacking the ability to address these impacts. CONCLUSIONS: Public health nurses view the environment as under threat and see a role for nursing divisions in addressing health effects of climate change. However, they recognize the limited resources and personnel available to devote to this endeavor.

Regional differences as barriers to body mass index screening described by Ohio school nurses.

BACKGROUND: Body mass index (BMI) screening is advocated by the National Association of School Nurses (NASN). Research identifying barriers to BMI screening in public elementary school settings has been sparse. The purpose of the study was to identify barriers and facilitating factors of BMI screening practices among Ohio school nurses working in suburban, rural, and urban public elementary schools. METHODS: This descriptive study used focus groups with 25 school nurses in 3 geographic regions of Ohio. An adapted Healthy People 2010 model guided the development of semistructured focus group questions. RESULTS: Nine regional themes related to BMI screening emerged specific to suburban, rural, and/or urban school nurses' experiences with BMI screening practice, policy, school physical environment, school social environment, school risk/protection, and access to quality health care. Key facilitating factors to BMI screening varied by region. Key barriers to BMI screening were a lack of privacy, time, policy, and workload of school nurses. CONCLUSION: Regionally specific facilitating factors to BMI screening in schools provide opportunities for schools to accentuate the positive and to promote school health.