Public health nurses' activities at a time of specialization in nursing-A national study.

OBJECTIVES: To provide a detailed, up-to-date account of the job description and practice areas of current public health nurses. DESIGN AND SAMPLE: A cross-sectional study. A sample of 824 public health nurses, 80% of public health nurses in Israel, participated in a national structured survey. MEASURES: A structured questionnaire eliciting self-reported public health nursing activities, priorities, perceived deficiencies, and job satisfaction was compiled. RESULTS: Nearly 70% of surveyed public health nurses provided individual-level interventions and less population-health-focused activities such as community needs assessments and development and implementation of community-based projects. CONCLUSIONS: Advanced training should be required in several areas of practice and the scope of public health nurses' practice should be expanded, with greater emphasis on population health.

Public School Nursing Practice in the United States.

School nursing practice has changed dramatically over the past 20 years, yet few nationally representative investigations describing the school nursing workforce have been conducted. The National School Nurse Workforce Study describes the demographic and school nursing practice patterns among self-reported public school nurses and the number and full-time equivalent (FTE) positions of all school nurses in the United States. Using a random sample stratified by public/private, region, school level, and urban/rural status from two large national data sets, we report on weighted survey responses of 1,062 public schools. Additional questions were administered to estimate the school nurse population and FTEs. Findings reported illustrate differences by strata in public school nurse demographics, practice patterns, and nursing activities and tasks. We estimate approximately 132,300 self-identified practicing public and private school nurses and 95,800 FTEs of school nurses in the United States. Research, policy, and school nursing practice implications are discussed.

Leveraging public health nurses for disaster risk communication in Fukushima City: a qualitative analysis of nurses' written records of parenting counseling and peer discussions.

BACKGROUND: Local public health nurses (PHNs) have been recognized as the main health service providers in communities in Japan. The Fukushima nuclear disaster in 2011 has, however, created a major challenge for them in responding to mothers' concerns. This was in part due to difficulties in assessing, understanding and communicating health risks on low-dose radiation exposure. In order to guide the development of risk communication plans, this study sought to investigate mothers' primary concerns and possible solutions perceived by a core healthcare profession like the PHNs. METHODS: A total of 150 records from parenting counseling sessions conducted between PHNs and mothers who have attended mandatory 18-month health checkups for their children at the Fukushima City Health and Welfare Center in 2010, 2011 (year of disaster) and 2012 were examined. Discussion notes of three peer discussions among PHNs organized in response to the nuclear disaster in 2012 and 2013 were also analyzed. All transcribed data were first subjected to text mining to list the words according to their frequencies and inter-relationships. The Steps Coding and Theorization method was then undertaken as a framework for qualitative analysis. RESULTS: PHNs noted mothers to have considerable needs for information on radiation risks as they impact on decisions related to relocations, concerns for child safety, and experiences with interpersonal conflicts within the family owing to differing risk perceptions. PHNs identified themselves as the information channels in the community, recommended the building of their risk communication capacities to support residents in making well-informed decisions, and advocated for self-measurement of radiation levels to increase residents' sense of control. PHNs also suggested a more standardized form of information dissemination and an expansion of community-based counseling services. CONCLUSIONS: Inadequate risk communication on radiation in the Fukushima nuclear incident has resulted in multiple repercussions for mothers in the community. Empowerment of local residents to assume more active roles in the understanding of their environment, increasing PHNs' capacity in communication, and an expansion of health services such as counseling will together better address risk communication challenges in post-disaster recovery efforts.

Trends in geographic distribution of nursing staff in Japan from 2000 to 2010: a multilevel analysis.

The aim of this study was to examine trends in the geographic distribution of nursing staff in Japan from 2000 to 2010. We examined time trends in the rates of nursing staff per 100,000 population across 349 secondary health service areas. Using the Gini coefficient as a measure of inequality, we separately analyzed the data of 4 nursing staff types:public health nurses (PHN), midwives (MW), nurses (NS), and associate nurses (AN). Then, using multilevel Poisson regression models, we calculated the rate ratios (RRs) and their 95% confidence intervals (CIs) for each type of nursing staff per 1-year change. Overall, the distribution of PHN, MW, and NS improved slightly in terms of the Gini coefficient. After adjusting for prefectural capital and population density, PHN, MW, and NS significantly increased;the RRs per 1-year increment were 1.022 (95% CI:1.020-1.023), 1.021 (95% CI:1.019-1.022), and 1.037 (95% CI:1.037-1.038), respectively. In contrast, AN significantly decreased;the RR per 1-year increment was 0.993 (95% CI:0.993-0.994). Despite the considerable increase in the absolute number of nursing staff in Japan (excluding AN), this increase did not lead to a sufficient improvement in distribution over the last decade.

Development of a public health nursing data infrastructure.

An invited group of national public health nursing (PHN) scholars, practitioners, policymakers, and other stakeholders met in October 2010 identifying a critical need for a national PHN data infrastructure to support PHN research. This article summarizes the strengths, limitations, and gaps specific to PHN data and proposes a research agenda for development of a PHN data infrastructure. Future implications are suggested, such as issues related to the development of the proposed PHN data infrastructure and future research possibilities enabled by the infrastructure. Such a data infrastructure has potential to improve accountability and measurement, to demonstrate the value of PHN services, and to improve population health.

A systematic method to document population-level nursing interventions in an electronic health system.

Many public health electronic health systems lack the specificity to distinguish between individual- and population-based levels of care provided by public health nurses. Data that describe the broad scope of the everyday practice of public health nurses are critical to providing evidence of their effectiveness in promoting community health, which may not be fully appreciated in an arena of scarce resources. This article describes a method to document population-based nursing practice by adding population-based interventions to the nursing taxonomy underlying an electronic health information system. These interventions, derived from the Intervention Wheel, were incorporated into the Omaha System taxonomy, the conceptual framework for the Automated Community Health Information System (ACHIS), which is a longstanding data system used to capture nursing practice in community nursing centers. This article includes a description of the development and testing of the system's ability to capture the practice of the district public health nurse model. This method of adapting an existing data system to capture population-based interventions could be replicated by public health administrators interested in better evaluating the processes and outcomes of public health nursing and other public health professionals.

Public health nursing case management for women receiving temporary assistance for needy families: a randomized controlled trial using community-based participatory research.

OBJECTIVES: We evaluated the effectiveness of a community-based participatory research-grounded intervention among women receiving Temporary Assistance for Needy Families (TANF) with chronic health conditions in increasing (1) health care visits, (2) Medicaid knowledge and skills, and (3) health and functional status. METHODS: We used a randomized controlled trial design to assign 432 women to a public health nurse case management plus Medicaid intervention or a wait-control group. We assessed Medicaid outcomes pre- and posttraining; other outcomes were assessed at 3, 6, and 9 months. RESULTS: Medicaid knowledge and skills improved (P < .001 for both). Intervention group participants were more likely to have a new mental health visit (odds ratio [OR] = 1.92; P = .007), and this likelihood increased in higher-risk subgroups (OR = 2.03 and 2.83; P = .04 and .006, respectively). Depression and functional status improved in the intervention group over time (P = .016 for both). No differences were found in routine or preventive care, or general health. CONCLUSIONS: Health outcomes among women receiving TANF can be improved with public health interventions. Additional strategies are needed to further reduce health disparities in this population.

Family home visiting outcomes for mothers with and without intellectual disabilities.

BACKGROUND: The purpose of this study was to evaluate outcomes of public health nurse home visiting for mothers with intellectual disabilities (ID) and a comparison group. METHODS: The study was a secondary analysis of existing de-identified family home visiting data. It used a two-group comparative, 1:3 match design. Sixty-eight clients were in the study (n = 17 for mothers with ID and n = 51 for mothers without ID). Client characteristics and problem prevalence were compared using standard descriptive and inferential statistics. Mixed model methods were used for the analysis of outcomes, accounting for baseline scores, time of services and matched cases. RESULTS: Mothers with and without ID showed statistically significant improvement following family home visiting services. For both groups, discharge scores were consistently higher than the corresponding admission scores, with a mean increase of 0.37 (range = 0.05-0.90). Mothers without ID attained higher outcomes than mothers with ID. Seven of 21 outcomes significantly improved for mothers with ID, and 10 of 21 for the comparison group. The percentage of mothers with ID attaining the benchmark of 4 ranged from 13.3% to 90.4% and for the comparison group ranged from 30% to 95.7%. Public health nurses addressed 15 environmental, psychosocial, physiological and behavioural problems for both groups. CONCLUSION: Family home visiting appears to be effective in assisting parents with ID to have improved outcomes in many domains. These results provide an opportunity for service providers, home visiting nurses and public health agencies to understand the unique needs of mothers with ID.

Hepatitis C virus in primary care: survey of nurses' attitudes to caring.

AIM: This paper is a report of a study measuring attitudes of primary care nurses towards caring for people with hepatitis C. BACKGROUND: Hepatitis C is a major public health problem. Attitudes to caring for people with hepatitis C vary and can have an impact on nursing care practices. International literature has identified discriminating practices amongst healthcare professionals including nurses. There is limited research examining primary care nurses' attitudes to caring for people with hepatitis C. METHODS: A cross-sectional postal census survey of 981 nurses working in one health board region in the Republic of Ireland was conducted during the period March 2006 to June 2006. RESULTS: A response rate of 57.1% (n=560) was achieved. Exploratory factor analysis of an attitude scale identified three latent variables: 'infection control behaviour', 'caring' and 'fear'. Attitudes were generally positive towards caring for persons with hepatitis C; however, 51.7% of respondents would use additional infection control precautions if caring for someone with known hepatitis C. Younger nurses and those educated to degree level and above held significantly more positive attitudes to caring. Nurses agreed that they have a central role in managing and treating people with hepatitis C; however, many agreed that they lack the knowledge and skills to care for persons with hepatitis C. CONCLUSIONS: Negative attitudes can result in discriminatory experiences for persons with hepatitis C or at risk. Nurses require ongoing education on hepatitis C to improve knowledge, to limit concerns and ensure adherence to infection control guidelines.

Public health nurses tailor interventions for families at risk.

OBJECTIVES: To use structured clinical data from public health nurse (PHN) documentation to describe client risk, to describe family home visiting interventions, including tailoring, and to assess the associations between client risk and intervention tailoring. DESIGN AND SAMPLE: Retrospective cohort design. A cohort of 486 family home visiting clients who received at least 3 visits from PHNs in a local Midwest public health agency (2000-2005). MEASURES: Omaha System variables documenting assessments, interventions, and outcomes. A risk index was created to identify low- and high-risk clients. Descriptive and inferential methods were used to describe interventions, and to assess intervention tailoring between groups. INTERVENTION: Routine PHN family home visiting practice. RESULTS: The risk index meaningfully discriminated between groups. PHNs provided more visits and interventions to clients in the high-risk group, with variations in problem, category, and target by group, demonstrating that PHNs tailored interventions to address specific client needs. CONCLUSIONS: Standardized terminologies and structured clinical data are useful tools to support PHN practice, and may be useful to advance health care quality research, program evaluation, policy development, and population health outcomes.

Barriers and facilitators in the delivery of environmental risk reduction by public health nurses in the home setting.

OBJECTIVE: The goal of this study was to identify the factors that contributed to or detracted from the ability of public health nurses (PHNs) to deliver environmental risk reduction (ERR) in the home setting. DESIGN AND SAMPLE: Structured one-to-one interviews were conducted with 10 PHNs from 2 county health departments in the western United States that were delivering an ERR intervention in a randomized clinical trial. RESULTS: Barriers to incorporating ERR into PHN practice were: a change in the perceived mission of public health, nurses' lack of environmental health (EH) training, the absence of a strong relationship with EH, the multidimensional role of PHNs, presentation of nurse participation by management, incorporation of ERR visits into nursing schedules, and challenges engaging parents in EH. Facilitating factors included: training and support, opportunities for capacity building, belief that ERR is important, building a more visible face for PHN, and personal interest in EH and ERR. CONCLUSIONS: Adapting PHN practice to include ERR strategies is feasible, but not without challenges. With adequate training, time, and institutional support, multiple challenges can be overcome. PHNs are well positioned to improve the health of families and communities by integrating ERR into their scope of practice.

Do public health nurses in Norway promote information on oral health?

BACKGROUND: (i) to describe oral health counselling in Norway to parents with infants and toddlers, ii) to assess existing collaboration and routines in oral health matters between nurses and personnel in the PDS, iii) to evaluate to what extent oral health was integrated in the basic educational curriculum of public health nurses. METHODS: This study was based on two separate surveys: the sample of Study I was 98 randomly selected child health clinics. A questionnaire covering oral health promotion counselling of parents with young children was returned by 259 nurses. Study II was a telephone survey addressing teachers of public health nurses at the eight educational institutions in Norway. RESULTS: The response rate in Study I was 45%. Nutrition (breast feeding, diet) was the health subject most often prioritized in the counselling targeting parents of young children (by 60% of the nurses). Oral health was not among the first priority counselling subjects. The subject was seldom spontaneously mentioned by parents. Seventy percent of respondents reported (agreed or totally agreed) that they managed to provide information parents needed and 72% believed that the information they gave influenced parents' health behaviours. Seven nurses (5.2%) responded that they agreed with the statement that the information they gave only slightly influenced parents' health behaviour. Lack of time was mentioned as being a problem. Approximately half of the nurses (48%) had regular contact with the PDS for the 0-3 year-old children, but only a quarter of the nurses claimed that children's teeth were routinely examined at the child clinics. Some forms of previously established contact with the PDS enhanced the likelihood of nurses' referrals. Oral health was a minor part of the educational curriculum for public health nurses; at three institutions, the subject was totally absent. CONCLUSION: Collaboration between nurses and the PDS in Norway could be improved. Oral health should have a bigger place in the basic educational curriculum.

Elder abuse and neglect in a population offering care by a primary health care center in Izmir, Turkey.

The objective of this study is to investigate the prevalence of abuse and neglect of the elderly aged 65 years and older, living with their relative in a primary health care center area and affecting factors. A descriptive study included 331 people aged 65 years. The most frequent type of abuse was psychological abuse and the least frequent was sexual abuse. Female gender, low education levels, living with spouses and children, and perception of familial relationships as average or below average significantly increased abuse. The nurses providing primary health care should be able to identify and observe the elderly at risk of abuse and conduct programs preventing abuse.

[Evaluative study of nursing consultation in the basic networks of Curitiba, Brazil]. / Estudo avaliativo da consulta de enfermagem na Rede Básica de Curitiba--PR.

The implementation of the electronic health record in the basic networks of Curitiba enabled an advance in the implementation of the nursing consultation and the ICNPCH, whose modeling uses the ICNP axes structure and the ICNPCH list of action. The objective of this study was to evaluate the nursing consultation from the productivity and assistance coverage perspective. The studied population was obtained from a secondary database of nursing consultations from April to June of 2005. The analysis was performed using the Datawarehouse and OLAP tool. The productivity per professional was found to be 2.5 consultations per day. Professionals use 16% of their daily work time with this activity and up to 27% of their potential per month. The ICNPCH was used in 21% of the consultations. There is a 0.08 consultation coverage per inhabitant for 6% of the population. The nursing consultation makes it possible to characterize the nurses' role in health care and a new professional position capable of affecting the construction of public politics.

Building community and public health nursing capacity: a synthesis report of the National Community Health Nursing Study.

OBJECTIVES: 1) To describe the community health nursing workforce in Canada; 2) To compare, across political jurisdictions and community health sectors, what helps and hinders community nurses to work effectively; 3) To identify organizational attributes that support one community subsector--public health nurses--to practise the full scope of their competencies. METHODS: Our study included an analysis of the Canadian Institute for Health Information nursing databases (1996-2007), a survey of over 13,000 community health nurses across Canada and 23 focus groups of public health policy-makers and front-line public health nurses. RESULTS: Over 53,000 registered and licensed practical nurses worked in community health in Canada in 2007, about 16% of the nursing workforce. Community nurses were older on average than the rest of their profession. Typical practice settings for community nurses included community health centres, home care and public health units/departments. To practise effectively, community nurses need professional confidence, good team relationships, supportive workplaces and community support. Most community nurses felt confident in their practice and relationships with other nurses and professionals, though less often with physicians. Their feelings about salary and job security were mixed, and most community nurses would like more learning opportunities, policy and practice information and chances to debrief about work. They needed their communities to do more to address social determinants of health and provide good quality resources. Public health nursing needs a combination of factors to succeed: sound government policy, supportive organizational culture and good management practices. Organizational attributes identified as supports for optimal practice include: flexibility in funding, program design and job descriptions; clear organizational vision driven by shared values and community needs; coordinated public health planning across jurisdictions; and strong leadership that openly promotes public health, values their staff's work and invests in education and training. CONCLUSION: The interchangeable and inconsistent use of titles used by community nurses and their employers makes it difficult to discern differences within this sector such as home care, public health, etc. Our studies also revealed that community nurses: thrive in workplaces where they share the vision and goals of their organization and work collaboratively in an atmosphere that supports creative, autonomous practice; work well together, but need time, flexible funding and management support to develop relationships with the community and their clients, and to build teams with other professionals; could sustain their competencies and confidence in their professional abilities with more access to continuing education, policies, evidence and debriefing sessions.

Vaccination competence.

OBJECTIVE: Vaccinating is one of the most significant methods of health promotion in the world. The purpose of this study was to describe vaccination competence from the perspective of professionals, clients, and students. DESIGN: A cross-sectional interview study. SAMPLE: Participants (n=40) were public health nurses, physicians, nursing teachers and graduating public health nursing students, and vaccinated clients of various ages or vaccinated children's parents in Finland. MEASUREMENTS: Interview data were collected using semistructured interviews in focus groups and individual interviews, and were analyzed by content analysis. RESULTS: The participants pointed out that the competent vaccinator (CV) displays distinctive personal qualities, possesses the necessary attributes required in the vaccinator-client relationship, and is authorized to administer vaccinations. The competent vaccinator is a health care professional who is committed to vaccinating and who fosters social awareness of vaccinations. The competent implementation of the vaccination procedure consists of the vaccinator's actions before, during, and after the vaccination. The outcomes of a competent implementation are divided into immediate and long-term outcomes. CONCLUSIONS: Vaccination competence is a broad entity. These results may be utilized for improving the practical implementation of vaccinations, administration, education, and research of vaccination procedures.

Work satisfaction of Japanese public health nurses: assessing validity and reliability of a scale.

The Index of Work Satisfaction, developed by Stamps et al., was administered to 583 nurses who had practiced public health nursing in Japan. After psychometric evaluation, three components were identified as contributing to their job satisfaction: the work environment, professional confidence, and commitment to the profession. Overall, the participants in the study were quite satisfied. The findings corroborated previous reports on Japanese nurses' job satisfaction, in that the nurses in the study were most satisfied with their relationships with peers, patients/families, and supervisors. However, they were least satisfied with having enough time for client care, having confidence, and promotion opportunities. The implications are discussed, to the effect that understanding the factors related to public health nurses' job satisfaction could help administrators to improve regulations and other issues related to the work environment.

Barriers and facilitators to the achievement of community-focused public health nursing practice: a UK perspective.

AIM: To explore the extent to which Community Health Nurses (CHN) engage in community-focused public health practice and the facilitators and barriers to such practice. BACKGROUND: The government promotes the role of nurses in public health. However, there is confusion as to what constitutes public health; a lack of support to move from individual and family-focused practice to community-focused practice; and, inconsistency of the use of titles. METHOD: A 15% quota sample (n = 409), drawn from a population of 2668 CHNs, participated in a quantitative survey. RESULTS: Response rate was 67% (n = 275). Over half of CHN time was spent with individuals and families, community level activity accounting for only 18%. Only 9% of respondents had completed a community needs assessment. Education was key to the promotion of community-focused practice with collection of individual activity data a major barrier. CONCLUSIONS: There is a gap between the rhetoric and reality of community public health nursing. IMPLICATIONS FOR NURSING MANAGEMENT: Development of a shared vision of public health nursing and commissioning of education to meet public health priorities is essential. Furthermore, strengthening public health nurse leadership to foster innovative practice and methods of measuring public health nursing outcomes is required.

Public health nurses in rural/frontier one-nurse offices.

INTRODUCTION: Public health nursing is the foundation of the United States' (US) public health system, particularly in rural and remote areas. Recent increasing interest in public health in the USA has highlighted that there is limited information available about public health nursing in the most isolated areas, particularly in the US. The purposes of this study were to: (1) describe the characteristics, competency levels, and practice patterns of public health nurses (PHNs) working in remote one-nurse offices; and (2) compare PHNs working in one-nurse offices with nurses working in multi-nurse offices in Idaho, in relation to their demographic characteristics, practice patterns and competency levels. METHODS: Using a cross-sectional descriptive design, a statewide sample of 124 PHNs in Idaho, including 15 working in one-nurse satellite offices, were assessed in relation to their demographic characteristics, experience, educational background, job satisfaction, practice characteristics, and competency levels in March to May 2007. RESULTS: The solo (nurses working in one-nurse offices) PHNs were based in 15 different counties, 10 frontier (population density of less than 7 persons/1.6 km(2); 7 persons/mile(2)) and 5 rural. The counties ranged in population from 2781 to 28 114 (mean = 11 013), with population densities ranging from 0.9 to 29.4 persons/1.6 km(2) (mean = 8.6; 0.9 to 29.4 persons/mile(2)). The distance from their offices to the district main office ranged from 25.8 to 241.4 km (mean = 104 km; 16 to 150 miles, mean = 64.6 miles). All the solo PHNs were Caucasian females, with a mean age of 46.9 years and a mean of 22.5 years' nursing experience. Educationally, 7 (47%) held a bachelor degree in nursing, 6 (40%) had associates degrees, 1 (7%) had a diploma in nursing, and 1 (7%) was a licensed practical nurse (LPN). These solo PHNs provided a wide array of services with support from other nurses in the district, including epidemiology, family planning/sexually transmitted disease clinics, immunization clinics, communicable disease surveillance, and school nursing. They expressed strong job satisfaction, citing the benefits of autonomy, variety, and close community ties, but also voiced some frustrations related to isolation. Their self-rated levels of competency were highest in the areas of communication, cultural competency, community dimensions of care, and leadership/systems thinking skills; and lowest in the areas of financial management, analytical assessment, policy development/program planning, and basic public health sciences skills. When the solo PHNs were compared with PHNs based in multi-nurse offices, there were no statistically significant differences between the solo and non-solo PHNs in demographics or competency levels, except in the competency area of community dimensions of practice skills. The mean self-rating for solo PHNs in relation to community dimensions of practice skills was significantly higher (3.9) than non-solo PHNs (3.2) (t = 3.547, p = .002). CONCLUSIONS: These findings suggest that US PHNs practicing in isolated one-nurse offices in rural and remote communities are comparable to PHNs working in less isolated settings; however, solo nurses may have stronger community dimensions of practice skills. Their practice is more generalized than other PHNs and they express high levels of job satisfaction. The study was limited in that it was conducted in only one state and data were collected only by self-report. Further research is indicated to describe this unique subset of PHNs, particularly in terms of factors promoting recruitment and retention. Additional study into the conceptual aspect of isolation is also indicated in relation to public health practice in rural and remote areas.