Checking the Pulse of Holistic and Culturally Competent Nursing Practice in Pennsylvania.

Traditionally, underrepresented racial and ethnic groups experience marginalization, leading to inequities and disparities in health and health care. A holistic approach to care delivery can help providers meet a culturally diverse patient population's unique healing needs. A systematic assessment of nurses' cultural competency practice was conducted in Pennsylvania to reveal opportunities and provide direction for holistic, culturally competent health care services. This exploratory cross-sectional descriptive study used the Cultural Competence Education and Awareness Survey (CCEAS) to examine cultural competence practices of registered nurses employed in the state of Pennsylvania. A total of 1246 registered nurses completed the survey. Respondents expressed a strong desire for cultural competency. Education and organizational infrastructure to facilitate cultural competency could be improved. Health care leaders and policy makers at all levels should explore opportunities to strengthen nurses' culturally competent practices through ongoing professional-development activities and enhanced organizational infrastructure.

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.

Quad Council Coalition community/public health nursing competencies: Building consensus through collaboration.

BACKGROUND: The changing professional environment for community/public health nursing practice necessitates competencies grounded in current evidence-based practice. The Quad Council Coalition (QCC) appointed a Task Force to revise the 2011 QCC Competencies for Public Health Nursing. The goal of the competencies is to guide professional nursing practice, curricula, research, and policy development. This paper describes the process used to develop the revised 2018 Competencies. METHODS: A biphasic Delphi technique was used to conduct a detailed examination and build consensus. Four individuals representing community/public health practice and education collaborated to identify and implement a systematic process for revising the QCC Competencies. The process included multiple iterations of review and feedback using consistent methods and tools to analyze and synthesize themes. RESULTS: The primary result of this project is the 2018 QCC Competencies document that has strong consensus and provides a coherent voice from professionals on the practice of community/public health nursing. DISCUSSION: Use of current QCC Competencies will strengthen the community/public health nursing capacity to positively impact the health and well-being of populations.

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.

Living libraries: Nurse integration in interprofessional homeless health care team.

BACKGROUND: Despite an increase in national health care service utilization, entry into the health care system remains inequitable. This disparity in health care access disproportionately affects those experiencing homelessness. Because the homeless population faces significant financial and nonfinancial barriers, health care system engagement with these individuals must be reconsidered. OBJECTIVE: This article will describe the piloting of an interprofessional model within an urban library to address barriers to health care access that homeless individuals face. DESIGN: The library's unique status as a community hub presents an opportunity for partnership in addressing this population's health care access issues. This community-based model is the first recorded to utilize three distinct professions-nursing, social work, and library science-in a public library. RESULTS AND CONCLUSIONS: The implementation of this pilot project resulted in a high retention rate of referrals to community health services for those unstably housed and facilitated a system of warm transfers. Although opportunities to improve generalizability exist, this initiative sets the stage for discussion around co-location of health and social services in a nontraditional community-based setting to achieve equitable access to health care.

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.

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 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.

Diversity Impacts of Coronavirus Disease 2019.

This article describes how coronavirus disease 2019 (COVID-19) health disparities relate to the social determinants of health and reviews the importance of a diverse nursing workforce prepared to advance social justice. The article reviews recommendations from the National Academy of Medicine and highlights practical strategies to promote diversity and social justice, including mentoring nurses from underrepresented backgrounds, amplifying diverse nursing voices, and leveraging the power of coalitions. In highlighting the interwoven impact of COVID-19 and demand for social change throughout 2020 to 2022, the article strives to move beyond the acute COVID-19 crisis to sustained social justice in health care.

Does it make a difference? Exploring the value of combining public health and nursing education.

BACKGROUND: Within the evolving United States healthcare system, there is a need to strengthen the public health nursing workforce. Historical and more recent trends within nursing education have demonstrated this need. Nurses who obtain a Master of Public Health (MPH) contribute to this workforce's development. PURPOSE: This study aimed to describe nurses' educational and professional experiences with an MPH and better understand how professionals use this combination in practice. METHODS: This study utilized a phenomenological, qualitative research method. Researchers interviewed 11 nurses with an MPH via the telephone. The researchers independently coded the interview transcripts and developed a codebook. Qualitative analysis facilitated the emergence of subsequent themes. RESULTS: Four themes emerged: (1) educational pathway decisions, (2) education experience, (3) role in the workforce, and (4) nursing and public health in practice. Participants worked in a variety of settings, including primary care, academia, and administration. All participants reported utilizing their nursing and public health skills and described the actual integration of these skills in the workplace. CONCLUSION: These findings suggest that nurses with an MPH value the education and report being better equipped to promote health on both the individual and community levels.

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.

Development of novel genic microsatellite markers from transcriptome sequencing in sugar maple (Acer saccharum Marsh.).

BACKGROUND: Sugar maple (Acer saccharum Marsh.) is a hardwood tree species native to northeastern North America and economically valued for its wood and sap. Yet, few molecular genetic resources have been developed for this species to date. Microsatellite markers have been a useful tool in population genetics, e.g., to monitor genetic variation and to analyze gene flow patterns. The objective of this study is to develop a reference transcriptome and microsatellite markers in sugar maple. FINDINGS: A set of 117,861 putative unique transcripts were assembled using 29.2 Gb of RNA sequencing data derived from different tissues and stress treatments. From this set of sequences a total of 1068 microsatellite motifs were identified. Out of 58 genic microsatellite markers tested on a population of 47 sugar maple trees in upper Michigan, 22 amplified well, of which 16 were polymorphic and 6 were monomorphic. Values for expected heterozygosity varied from 0.224 to 0.726 for individual loci. Of the 16 polymorphic markers, 15 exhibited transferability to other Acer L. species. CONCLUSIONS: Genic microsatellite markers can be applied to analyze genetic variation in potentially adaptive genes relative to genomic reference markers as a basis for the management of sugar maple genetic resources in the face of climate change.

Nursing Students as Epidemiologists: A Simulation Approach.

Simulation is commonly used in nursing education to teach clinical skills. Here, we describe the development processes, implementation, and evaluation of an epidemiology simulation used in a community and public health nursing undergraduate clinical course at the University of Pennsylvania. The simulation was designed to teach students the principles and concepts of outbreak investigation and was based on the 2003 Severe Acute Respiratory Syndrome outbreak in Toronto, Canada. The simulation places students in the role of a public health nurse in the outbreak investigation team, working in groups of five to seven students to complete analyses and make recommendations under time and information constraints. Since piloting in spring 2014, we have run the simulation three times (summer and fall 2014 and summer 2015). Student evaluations show high levels of engagement and interest and substantial increase in the skills and expertise required in an outbreak investigation. We share key lessons learned, including resources required for simulation development and delivery, revisions to the simulation format and content in response to student feedback, and transferability and sustainability of the simulation. Overall, simulation was a feasible and effective modality to teach epidemiology and should be considered in community and public health nursing courses.