[Understanding public health nurses' experience, knowledge, and perception of bioterrorism training in Japan].

Objectives　Bioterrorism is a disease in which the attacks can be covert and latent, take time to manifest, and, when discovered, can result in large outbreaks. When detected, they can become large-scale outbreaks. Therefore, preparedness is essential for early detection and response for damage mitigation. Although public health nurses (PHNs) of public health centers are responsible for detecting and dealing with bioterrorism, their preparation status is not clear. Therefore, this study aimed to elucidate the status of training experience, knowledge, and awareness of bioterrorism among PHNs working in public health centers' infectious disease control departments in Japan's metropolitan areas.Methods　This was a cross-sectional, descriptive study. The participants were PHNs in the infectious disease control departments of 88 public health centers in Tokyo and its three neighboring prefectures. This are densely populated metropolitan areas with many mass gathering events and a high probability of bioterrorism. An anonymous, self-administered questionnaire survey was conducted by mail in 2019. Two PHNs per location were surveyed regarding their attributes, training experience, knowledge, and perceptions.Results　We received 71 responses (40.3%). A total of 10 (14.1%) PHNs reported having experience with bioterrorism training in the workplace. Regarding the knowledge of the four infectious diseases with a high probability of bioterrorism, more than 95% of the respondents answered they had heard of them. However, few were aware of related treatments or terrorist responses. Although survey respondents were aware of the seriousness of bioterrorism and the effectiveness of preparedness, they did not have sufficient opportunity or time to have training. They tended to be less confident in their response and were willing to have training.Conclusion　PHNs who responded to this survey do not have sufficient training experience, knowledge, opportunities, and time for bioterrorism training, and establishing a training system to improve bioterrorism preparedness is a challenge. It will be necessary for PHN students to learn about the existence of bioterrorism. Further, PHNs in public health centers need to be trained at least once using online services, including brushing up on information as needed. Based on the lessons learned from the coronavirus disease 2019 pandemic, health centers will formulate a Health Crisis Management Plan. This will be effective in fiscal 2024, and we believe that it is essential that preparedness against bioterrorism be a part of this plan.

Implementing public health nursing training for Ireland's National Healthy Childhood Programme.

Public health nurses (PHNs) in Ireland provide preventative child health. An evidence-based National Healthy Childhood Program (NHCP) has been in development since 2016. The final program implementation, including training all PHNs coincided with the Covid-19 pandemic. OBJECTIVE: To describe implementation and evaluation of a blended training program for PHNs DESIGN: The evaluation used quantitative and qualitative methods underpinned by an implementation science framework to assess the training program. The three-phase blended training was led by a Training and Resources implementation team. Data from a national cohort of PHNs (n = 1671) who completed training were descriptively analysed. RESULTS: The majority of PHNs completed a suite of four online units (phase 1), as well as self-directed and asynchronous content in phase 2. Results of phase 2 indicated it met participant needs in terms of knowledge but outstanding needs in terms of skills remained. Phase 3 (a modified Face to Face Clinical Skills Review) was completed by 1671 PHNs over a 5-month period in 2020. Evaluation was very positive in terms of organisation and usefulness for practice. CONCLUSIONS: Despite challenges the NHCP training implementation goals were met. A well-designed blended learning training program met service delivery imperatives and PHN needs.

Factors associated with the utilization of community assessment models among Japanese nurses.

OBJECTIVES: This study aimed to identify factors related to the practical utilization of community health needs assessment (CHNA) models that public health nurses (PHNs) learned in their fundamental education. DESIGN: A nationwide questionnaire survey was conducted via postal mail. SAMPLE: We randomly selected 630 public health institutes in Japan. The participants were 3397 full-time novice and mid-level PHNs. MEASUREMENTS: The questionnaire included the participants' basic personal information, six items regarding the perception of CHNA with a 4-point Likert scale, learned models in their undergraduate education, their utilization in practical settings, and the reasons for their answer in narrative form. RESULTS: There were 951 valid responses. The results of logistic regression showed that the significant positively factors with model utilization were perception of CHNA as "not troublesome" or "not impossible as they learned," continuing education with 5 years of experience, and identification of the learned model in continuing education. Furthermore, the results of text mining showed the reasons for non-utilization of the model included being "busy" and having a lack of "opportunity." CONCLUSIONS: This study showed the associated factors with rare utilization of a learned model for PHNs. These findings may suggest improvement of continuing education and development of an appropriate assessment model.

COVID-19: Planning and Postpandemic Partnerships.

The emergence of coronavirus disease 2019 (COVID-19) has highlighted the need for strong partnerships between educators and healthcare professionals to facilitate the reopening of schools. School nurses are uniquely positioned to bridge this gap because of their role as a healthcare professional in the educational setting. Past research identifies the effectiveness of collaborative efforts to serve students by community partners, school system personnel, and school nurses. However, partnerships have been episodic and reactive rather than ongoing and proactive. The circumstances of COVID-19 present an opportunity for school nurses to promote collaboration and planning as an ongoing practice. Recommendations for school nurses to form ongoing public health and school system partnerships, as well as with teachers, parents, and school nursing colleagues, are presented.

The effect of the disaster management training program among nursing students.

OBJECTIVE: This study investigated the effect of the Jennings Disaster Nursing Management Model-based and learning management system-assisted six-module training programme on nursing students' disaster preparedness perceptions and response self-efficacy. DESIGN AND SAMPLE: This randomized controlled trial used a two group comparison design, experimental group (n = 127), and control group (n = 108), carried out with third-year nursing students in a city in the west of Turkey. MEASURES: Data included a socio-demographic form, the Disaster Preparedness Perception Scale in Nurses (DPPSN) and the Disaster Response Self-Efficacy Scale (DRSES). RESULTS: After the training, disaster preparedness perceptions and the response self-efficacy of the EG increased significantly (p < .05). This study had a moderate effect on participants' knowledge and self-efficacy. CONCLUSION: Public health nurses are health professionals with important roles and responsibilities in the stages of disaster preparedness, response, and recovery that is all stages of disaster management. This theoretical-based program can be considered for both students and nursing professionals.

[Examination of the effects of a role-playing training program for the improvement of planning and management skills of public health nurses].

Objectives　The Japan Health Insurance Association (JHIA) conducts training in each branch facility to improve the ability of public health nurses (PHNs). The headquarters of the PHNs of JHIA and the researchers conducted a training program for leaders of PHNs at each JHIA branch. The goal of the program was to create a training plan using role-play to acquire facilitation skills. This study aimed to examine the effects of training.Methods　The study was designed in accordance with the Instructional Designs. The training goals were as follows: (1) understanding the role of facilitation and the facilitator in the debriefing session after the role-play, (2) understanding facilitation techniques, (3) being confident in performing as facilitators in the debriefing session; and (4) conducting the debriefing sessions using facilitation skills. The evaluation of the training was based on the Kirkpatrick model from the viewpoint of confidence in using facilitation, knowledge of facilitation, and conduct of training and utilization of facilitation technology. Questionnaire evaluations were conducted three times before the training, immediately after the training, and three months after the training. In August 2016, 4.5 hours of training were conducted in one day.Results　There were 79 participants in the training group. The mean points of knowledge and confidence were 2.6-3.6 before training, 6.3-7.9 after training, and 6.0-6.9 at 3 months after training. The participants rated their interest in three questions of the training as high as 8.1-8.6. In addition, 64.6% of participants held a role-play session at each branch within three months of the initial training. In the role-play session planned by the participants, the practitioners implemented the explanation of the purpose and the rules at each branch 96.1% and 98.0%, respectively. Participants who had attended facilitation training prior to our program scored higher points of knowledge and confidence before and after three months. Three months after the training, 79 participants responded to the question of the role of the facilitator in role-playing. The descriptions were categorized into "opinions on the basics and planning of role-play training" and "opinions on the roles in retrospectives."Conclusion　The participants evaluated the training contents and the materials used as appropriate, and their knowledge and confidence in facilitation improved after the training. To maintain and improve facilitation skills, the educational system needs to implement training using role-playing at each branch consistently.

Impact of web-based learning for health program planning competency, knowledge and skills among mid-level public health nurses: A randomized controlled trial.

OBJECTIVES: To evaluate the impact of web-based learning modules for health program planning competency, recognition, knowledge and skills among mid-level public health nurses (PHNs). DESIGN: Parallel-group randomized controlled trial. SAMPLE: During 2018, 244 Japanese PHNs were eligible as participants with 5-20 years experiences as a PHN were randomly allocated to the intervention (n = 121) or control group (n = 123). MEASUREMENTS: The outcome was assessed using the Competency Measurement of Creativity for PHNs (CMC) and 26 questions about recognition, knowledge, and skills for health program planning. INTERVENTIONS: Eight web-based modules. RESULTS: No significant differences in CMC scores between the control and intervention groups at base line and post-intervention. By contrast, significant differences in total score of the 26 items of knowledge and skills. In an exploratory analysis, there was a significant difference identified in CMC scores in the demographic of post graduate training in program planning at base line and post-intervention. (p = .034). CONCLUSIONS: The findings suggested that web-based learning with flexibility in terms of time and location would improve competency, skills and knowledge of health program planning among mid-level PHNs.

Environmental justice screening tools: Implications for nursing.

Environmental justice (EJ) means socially and economically disadvantaged communities and citizens are entitled to an equally clean environment and resources to enjoy. EJ communities are mostly located close to polluters such as Superfund sites, coal-fired power plants and landfills and are more likely to be exposed to higher levels of environmental hazards than the U.S. population on average. It is often a difficult task to identify EJ communities and the environmental hazards in the communities without using specific EJ screening tools. Therefore, the goal of this manuscript is to introduce public health nurses to map-based EJ screening tools. This will help public health nurses to identify EJ communities and take appropriate actions. Public Health Nurses can also use other relevant web sites, such as the U.S. Environmental Protection Agency (EPA), National Institute of Environmental Health Sciences (NIEHS) and Toxicology Data Network (TOXNET) as resources concerning potential health effects of pollutants. Using the provided tools in this paper, nurses should be able to identify EJ communities and be united to recognize barriers of EJ communities and become promoters for EJ advocacy in practice, leadership and education.

Effectiveness of an educational program for mid-level Japanese public health nurses to improve program planning competencies: A preliminary randomized control trial.

OBJECTIVE: To evaluate the effectiveness of an education program for mid-level Japanese public health nurses (PHNs) to improve their competencies in program planning, which will fulfill community health needs. DESIGN: Randomized control trial. SAMPLE: During 2017, 103 PHNs with 5-20 years of PHN work experience in Japan were enrolled and randomly allocated to the intervention (n = 51) or control group (n = 52). MEASUREMENTS: The primary outcome measured competency in program planning based on Competency Measurement of Creativity for PHNs (CMC), knowledge, and skills regarding program planning. INTERVENTION: Six web-based learning modules followed by two face-to-face group sessions. RESULTS: The PHN participants averaged about 12 years of experience. In the intervention group, 25 PHNs completed all modules (49.0%). Post intervention, there were no statistically significant differences among any between-group CMC scores. However, the intervention group's CMC 3 score was significantly higher than that of the control group of ≥12 years of experience. Total knowledge and skill scores also improved significantly in the intervention group compared with the control group. CONCLUSIONS: The results suggest that PHNs with ≥12 years of experience are a suitable target of this educational program, and should play a key role in program planning.

Releasing latent compassion through an innovative compassion curriculum for Specialist Community Public Health Nurses.

AIMS: To evaluate the impact of a curriculum based on the Compassionate Mind Model (CMM) designed to facilitate the expression of compassion in Specialist Community Public Health Nurses. BACKGROUND: The CMM identifies that fear of compassion creates a barrier to the flow of compassion. There is some evidence linking self-compassion to compassionate care but no previous research has explored this potential with postregistration specialist community public health nursing students. DESIGN: Prospective, longitudinal design using focus group interviews. METHODS: Twenty six students (81% of cohort) agreed to participate in a wider evaluation (2014-2015). For this study, two groups were drawn from those participants (total 13 students) who attended audio-taped group interviews at the course mid- and end-points to explore their perceptions on compassion and compassionate care. Transcripts were analysed thematically. FINDINGS: Several subthemes were identified. "Cultural change in the NHS", "Workload and meeting targets" and "Lack of time were barriers to compassionate care, as was negative "Role modelling". These were collated under a macro-theme of "A culture lacking in compassion". Secondly, the subthemes "Actualization of compassion" and "Transformation" were collated within a macro-theme: "Realization of compassion". This theme identified realization of latent compassion from their previous roles that in some transferred into students' personal lives suggesting a transformation beyond professional attitude. CONCLUSION: The curriculum facilitated a realization of compassion in students over the period of the course by enhancing their capacity to be self-compassionate and by actualization of compassion that had previously been suppressed.

Simulation as a learning method in public health nurse education.

OBJECTIVE: To view simulation as a learning method in the light of learning theories and to describe the student's reflections and experiences of simulating anaphylaxis during vaccination. DESIGN AND SAMPLE: Public health nursing students at a university in Norway simulated scenarios related to anaphylaxis during vaccination of an infant. The aim of the intervention was to facilitate the competence of public health nurses to handle unforeseen events associated with vaccinations. The students wrote reflection notes about their experiences after the simulation. The reflection notes were analyzed using qualitative content analysis. RESULTS: The students experienced simulation as a realistic educational method with feelings of stress in an acute situation. They discovered the importance of cooperation and communication to avoid misunderstandings that could lead to serious failure in the treatment. The students emphasized that simulation gave them a preparation for practice to handle anaphylaxis associated with vaccines. CONCLUSION: The public health nurse students experienced simulation as a realistic and effective educational method. Simulation made them reflect on the public health nurse's area of responsibility. Kolb's learning theory and Schön's theory of knowledge-in-action, may explain how simulation as a didactic method develops competence to act in a concrete situation of anaphylaxis by vaccination of children.

[Education systems for occupational health nursing in the basic education course for public health nurses in Japan].

OBJECTIVES: This study aimed to clarify the education systems for occupational health nursing (OHN) in the basic education course for public health nurses (PHNs) in Japanese nursing universities. METHODS: An anonymous self-administered questionnaire survey was conducted among 234 nursing universities with PHN courses. We surveyed the outline of PHN/OHN curricula, clinical practicum in OHN, and the skill achievement levels of students in OHN clinical practicum according to the "Minimum Requirements in PHNs Education 2004" (MR2004) developed by the Japan Association of PHN Educational Institutions. The data were analyzed using a t-test and Mann-Whitney U test. All statistical analyses were carried out using IBM SPSS ver. 21.0. RESULTS: In the analysis, we used data from the 80 respondent schools (response rate 34.2%). In 39 schools (48.1%), lectures related to a clinical practicum in OHN were offered as independent subjects in the school curriculum; of these 39, two schools (2.5%) offered OHN as multiple independent subjects. In 49 schools (60.5%), clinical practicum in OHN was designated as a part of PHN training. In colleges that had a clinical practicum in OHN, the number of lecture hours related to OHN was 9.7 ± 11.6 hours, which was more than that in colleges without such a practicum, although the difference was not significant. We compared the skill achievement levels between the groups where the number of days in the OHN clinical practicum was up to two and up to three or more. There was a tendency for the skill achievement level to be higher in the group with the greater number of days, with a significant difference in 16 of 19 items. CONCLUSIONS: We clarified that the PHN curriculum is offered with many variations in colleges, and that the lectures and clinical practicum in OHN are developed according to each college's policy. We observed the following tendency: the more days in the OHN clinical practicum, the higher the student's skill achievement level. These findings suggest that guaranteeing a certain number of days in a clinical practicum in OHN is important for realizing high-quality PHN training.

Enhancing health system integration of nurse practitioners in Ontario

Nurses have a long tradition of informally working in expanded roles in rural and remote communities in Canada (e.g., outpost nurses).(1; 2) The formalization of the nurse practitioner role in Canada began in the mid1960s as a response to four interrelated factors: 1) introduction of publicly funded healthcare; 2) perceived physician shortage; 3) increased attention on primary care; and 4) increased medical specialization.(1) In the 1970s there were a number of initiatives led by provincial nursing groups to legitimize expanded nursing roles, which led to the development of educational programs.(1) The ways in which the nurse practitioner role has been formally introduced to health systems has varied across provinces and territories in Canada, and has resulted in jurisdictional variability in terms of the scope of practice (e.g., prescribing and referrals to specialists), remuneration and employment settings.

The development of a public health nurses precepting experiential learning scale.

Objectives　The Japanese government has supported public health nurses' systematic career development and preceptors' learning. Previous studies on precepting public health nurses indicated the value of precepting for career development. However, assessment scales for preceptor learning were not found. The purpose of this study was to develop the "PHN Precepting Experiential Learning Scale" (PHN-PELS) based on Kolb's experiential learning theory.Methods　This study included three phases of questionnaire development. First, the preliminary qualitative pilot study resulted in the PHN-PELS. The second pilot study was a questionnaire survey, returned by 52 (54.2%) public health nurses (PHNs) who had examined the validity and modified the items. Finally, a nation-wide questionnaire survey was conducted for PHNs who precepted novice PHNs in public health units from 2012 to 2016.Results　Of the 868 questionnaires mailed to 86 public health units, 438 (59.4%) were returned with 378 (43.5%) valid responses. PHN-PELS has 20 items forming four sub-scales, with confirmed content validity, construct validity, and reliability (α>.7). Sub-scales were: "Role Performance of Fostering Novice PHN," "Self-development as a PHN," "Sharing to Foster Novice PHN," and "Improving Career Development Environment."Conclusion　Scale development of the PHN-PELS resulted in four sub-scales with 20 items; its validity and reliability were supported. The PHN-PELS measures experiential learning in precepting novice PHNs, therefore, its usability is recommended for preceptors to evaluate their experiential learning and for preceptor training program in selecting sub-scales as appropriate.

Public health nurses' graduate education decision making processes.

INTRODUCTION: A well-educated public health workforce is needed to improve population health. Although nurses constitute the largest number of U.S. public health professionals, those holding graduate degrees remain low. This study describes public health nurses' (PHNs) perspectives on graduate school decision-making processes. METHODS: Using a qualitative descriptive design, semi-structured, qualitative telephone interviews with PHNs (n=30) were conducted June 2014-January 2015. Study participants included PHNs from 17 states employed in a variety of positions within government health agencies, academe, and business. Interview transcripts were coded and thematically analyzed. RESULTS: PHNs' pursuit of a graduate degree varied, often depending on work setting and/or availability of degree programs. Many study participants were unaware of the public health nursing graduate degree option, with only 9 of 26 participants obtaining an advanced degree in public health nursing. The MPH degree however, was well-known and particularly valued. CONCLUSION: Opportunities for graduate public health nursing are limited; as such, marketing of existing programs need to be nationally coordinated and new collaborative efforts between schools of nursing and schools of public health developed. These efforts are required if graduate-prepared public health nurses are to be part of the future workforce, prepared to tackle increasingly complex population health issues.

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.

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.

Experience of migrant care and needs for cultural competence training among public health workers in Korea.

OBJECTIVE: This study explored the experiences of public health workers (PHWs) providing health care for migrants living in Korea and clarified needs for cultural competence training. DESIGN AND SAMPLE: Twenty-six PHWs from five public health centers in Gwangju city, South Korea, participated in this exploratory qualitative study. METHODS: Five semi-structured focus group interviews of PHWs were conducted from September to December 2016. A directed content analysis approach was conducted using four categories: perceived characteristics of migrants, interaction between PHWs and migrants, interaction between PHWs and organizations/systems, and cultural competence training needs. RESULTS: PHWs perceived that migrants lacked autonomy in health decisions and awareness of health behaviors. PHWs experienced difficulties in communicating and in establishing trusting relationships. They found clients hard to reach and easy to miss, a lack of continuity in health care programs, and inadequate human and material resources. They preferred passive teaching methods to activity-based simulation. PHWs believed essential training should be provided through e-learning to all PHWs, including management. CONCLUSION: PHWs reported experiencing multiple challenges from a lack of preparedness for culturally competent care and their clients' vulnerability. Development of cultural competence training is suggested through e-learning that reflects the PHWs' experiences and provides systematic support.

Collaborative Processes of Developing A Health Literacy Toolkit: A Case from Fukushima after the Nuclear Accident.

Following the Fukushima nuclear accident in 2011, the central government provided health and radiation-related information that was incomplete, difficult to understand and contradictory, leading to widespread distrust in the community. Thus, from 2013 to 2014, we developed and implemented a series of health literacy training workshops for local public health nurses, often the first health care professionals with whom members of the community interact. The results from our program evaluation revealed that the task of paraphrasing professional terms and skills related to relaying numeric information to the community were difficult for the nurses to acquire. In 2016, to further support the communication efforts of public health nurses, we developed a pocket-size "health literacy toolkit" that contained a glossary explaining radiation-related terms in plain language and an index to measure the accessibility of both text and numerical information, so that nurses could calibrate and appreciate the literacy demand of information. This case study documents an interprofessional collaborative effort for the development of the toolkit, and highlights the iterative process of building health literacy skills in health care professionals.

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.