Community-based nursing versus community health nursing: what does it all mean?

These are exciting times in nursing, with great possibilities for reforming nursing as we now know it. The desired outcome is to improve any nurse's ability to care for individuals, families, and communities wherever they are. We believe that articulating CBN and CHN practice is a necessary first step in achieving this outcome; however, it now becomes our challenge to advance this vision. We ask you to join us in this endeavor.

Evaluation of public health nursing home visits to pregnant women on WIC.

Selected pregnant women participating in the Special Supplemental Food Program for Women, Infants and Children (WIC) were receiving public health nursing (PHN) home visiting services. The purposes of this study were to describe PHN services provided to pregnant women on WIC; and to compare birth outcomes and prenatal care (PNC) utilization between two groups, women with WIC services only and women with WIC plus PHN services. In this retrospective cross-sectional study, the sample consisted of all women on WIC (N = 398) at the Madison Department of Health who delivered singleton births during 1991, divided into the WIC-only group (n = 301) and the WIC + PHN group (n = 97). Three instruments were used for data collection: birth certificates, the WIC record, and the antepartal nursing record. Data were described; differences between groups were tested. Primary PHN activities included: assessment of physical and behavioral indicators, parenting skills, and support systems; teaching about nutrition, use of drugs, danger signs, labor signs, and stress management; and referrals to a variety of community resources. No difference in adequacy of PNC or in birth outcomes was found between the two groups. Findings have been used to plan the agency's future PNC coordination services.

Preventing unplanned pregnancies among married couples: are services for only the wife sufficient?

Unplanned pregnancies among married couples in the United States remains an important problem today. The effects of predisposing factors (conceptualized according to the Luker theory of contraceptive risk taking) on use of effective contraceptive methods and on the occurrence of an unplanned pregnancy were examined among a sample of 150 white married couples who did not desire a(nother) child within 2 years. The effects of husbands' predisposing factors on both dependent variables were highly significant, either directly or through interaction with their wives. The findings demonstrate the need for continued research on wife and husband effects on reproductive behaviors and outcomes.

PIP: Researchers used Udry's couple modeling statistical method to analyze data on 150 White, low and middle income, married couples living in the US during 1977-1979 who did not want a child or another child within two years to examine couple effects of predisposing factors on use of effective contraceptive methods and the rate of unplanned pregnancy. Wife's likelihood of quitting contraception was the most powerful variable in terms of use of effective methods (beta = 0.56; p 0.001). Wife's likelihood of quitting contraception, self-perception related to pregnancy, and importance of having a girl had significant interaction effects between the wife and the husband (beta = -0.09, -0.22, and 0.07, respectively; p 0.001 for all except importance of a girl, p 0.01). Effective method preference had a significant positive effect only for the wife (beta = 0.03; p 0.001). Enjoyment of infant care, perceived spousal desire for pregnancy, and encouragement by others to have a child had a significant effect on the occurrence of an unplanned pregnancy for the husband (beta = -0.68, 0.16, and 1.01, respectively; p 0.05 for infant care and encourage pregnancy, p 0.001 for perceived spousal desire for pregnancy; odds ratio [OR] = 0.51, 1.17, and 2.75, respectively). Effective method use was the only significant variable for the wife (beta = -0.42, OR = 0.66). These findings suggest that participation of husbands in reproductive education, decision making, and family planning services should be increased. They also indicate the need for national surveys that include data on both wife and husband to build a knowledge base about the effects of wives and husbands in reproduction, parenting, and family functioning and to use that knowledge to design changes in health care delivery that have a positive effect on the delivery of family planning or childbearing services in the US.

Influencing community leaders toward the promotion of prenatal care at the community level.

The threefold goal of this quasi-experimental study was to have an impact on knowledge, beliefs and intentions of community leaders related to promoting prenatal care for low-income women. Using a twenty-one community leaders from a selected urban community in Wisconsin participated in an educational intervention that used a pre- and post-test design. The primary goal of the intervention (based on change theory) was to increase community leaders' motivation and decrease their resistance to promoting prenatal care for low-income women in their communities. Various media were used to illustrate and emphasize important prenatal concepts. Community leaders were also given information on the status of maternal and infant statistics and health practices in their communities. This intervention significantly increased community leaders' general knowledge related to prenatal issues; positive beliefs toward the promotion of prenatal care; and intent to engage in activities to promote prenatal care for low-income women. This study reveals that community health nurses can function effectively as agents of change with community leaders.

Promoting prenatal care: what do community leaders know and believe about it? (community leader beliefs about promotion).

Community leaders directly affect prenatal services in their local communities. Twenty-nine leaders in an urban community and 47 in a rural community in Wisconsin were interviewed to determine their knowledge and beliefs about and intent to promote prenatal care for low-income women in their communities. The findings showed that leaders generally assigned high importance to prenatal care for low-income women and intended to promote it during the next six months; and they demonstrated good general knowledge about prenatal care and perceived broad-based community support for their decision to promote it. Disturbingly, many community leaders did not know what percentage of local pregnant women entered prenatal care late or how many medical care providers were available to their constituents on Medicaid, cost was cited as a disadvantage to promoting prenatal care for low-income women, and several leaders in both communities believed that promoting prenatal care would result in low-income women wanting to have more babies or increasing their dependence on free programs. Public health nurses can use the findings of this study in their work with community leaders to ensure prenatal services for low-income populations.

Communicating research findings to readers of clinical nursing journals: guidance for prospective authors.

The dissemination of research through publication in professional journals is important for the advancement of pediatric nursing practice. Without knowledge of current research, practitioners cannot take actions to apply research to improve the health of the children and families they serve. To ensure that practitioners can make the most appropriate use of quantitative research findings, research publications must adhere to specific scientific standards for the conduct and reporting of research. This article is intended to guide nurse researchers to adhere to these standards and effectively communicate their research findings to nurses in clinical practice.

Nursing diagnosis in the North Carolina public health system: a statewide project.

A group of North Carolina public health nursing leaders initiated a two-phase process of providing a continuing education module on nursing diagnosis for all public health nurses in the state. In the first phase the authors developed the module to teach the skill of nursing diagnosis and evaluation tools, and statewide workshops were held to teach public health nurse administrators and nurse consultants how to use it with their staffs. Results of the evaluation revealed a significant increase in cognitive learning and a more positive attitude overall toward nursing diagnosis among 148 participants. Written comments revealed two major concerns for using nursing diagnoses: the need for additional practice, and charting issues. Both were addressed in this project. Phase two, in which administrative nurses are using the module to teach nursing diagnoses to their staffs, is under way.