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.

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.

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.

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 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.

Epistemic cognition in medical education: a literature review.

OBJECTIVE: To review the research literature on epistemic cognition in medical education. METHODS: We conducted database searches using keywords related to epistemic cognition and medical education or practice. In duplicate, authors selected and reviewed empirical studies with a central focus on epistemic cognition and participant samples including medical students or physicians. Independent thematic analysis and consensus procedures were used to identify major findings about epistemic cognition and implications for research and medical education. RESULTS: Twenty-seven articles were selected. Themes from the findings of selected studies included developmental frameworks of epistemic cognition revealing simple epistemological positions of medical learners, increasing epistemological sophistication with experience, relationships between epistemic cognition and context, patterns in epistemic orientations to clinical practice, and reactions to ambiguity and uncertainty. Many studies identified the need for new instruments and methodologies to study epistemic cognition in medical education settings and its relationship to clinical outcomes. Relationships between epistemological beliefs and humanistic patient care and influences of medical education practices were commonly cited implications for medical education. CONCLUSIONS: Epistemic cognition is conceptualized and operationalized in a variety of ways in the medical research literature. Advancing theoretical frameworks and developing new methodological approaches to examine epistemic cognition are important areas for future research. Also, examination of the relationship between the contexts of medical learning and practice and epistemic cognition has potential for improving medical education. This work also establishes a need for further investigation into the implications of epistemic cognition for humanistic orientations and ultimately for patient care.

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.

The impact of the care equity project with community/public health nursing students.

OBJECTIVE: The purpose of this article is to report on the evaluation process of a multi-disciplinary interactive teaching-learning workshop implemented in a college of nursing baccalaureate program. DESIGN AND SAMPLE: A 6-hr workshop on cultural humility and care equity was implemented using educational theater to bring clinical situations involved in community/public health practice into the classroom. One hundred and forty-nine students participated in the workshop. Stages of Change (Prochaska and DiClemente [2005] Handbook of psychotherapy integration. New York: Oxford University Press) and the Learning Transfer Barriers Framework (Price, Miller, Rahm, Brace, & Larson [2010] Journal of Continuing Education in the Health Professions, 30, 237-245.) provided conceptual underpinnings for project evaluation. MEASURES: Nursing students completed a quiz, post-workshop online surveys at 2 and 8 weeks, and a clinical application report (CAR). Survey data provided information on barriers to the transfer of knowledge from theory class to the clinical setting. Qualitative methods were used to audit the CARs. Each CAR was independently reviewed to determine the Stage of Change reflected in the narrative. RESULTS: Workshop evaluation outcomes provide evidence that cultural humility skill building has created behavior change in clinical practice for new health care community/public health nursing providers.

Expertise, Time, Money, Mentoring, and Reward: Systemic Barriers That Limit Education Researcher Productivity-Proceedings From the AAMC GEA Workshop.

BACKGROUND: To further evolve in an evidence-based fashion, medical education needs to develop and evaluate new practices for teaching, learning, and assessment. However, educators face barriers in designing, conducting, and publishing education research. OBJECTIVE: To explore the barriers medical educators face in formulating, conducting, and publishing high-quality medical education research, and to identify strategies for overcoming them. METHODS: A consensus workshop was held November 5, 2013, at the Association of American Medical Colleges annual meeting. A working group of education research experts and educators completed a preconference literature review focusing on barriers to education research. During the workshop, consensus-based and small group techniques were used to refine the broad themes into content categories. Attendees then ranked the most important barriers and strategies for overcoming them with the highest potential impact. RESULTS: Barriers participants faced in conducting quality education research included lack of (1) expertise, (2) time, (3) funding, (4) mentorship, and (5) reward. The strategy considered most effective in overcoming these barriers involved building communities of education researchers for collaboration and networking, and advocating for education researchers' interests. Other suggestions included trying to secure increased funding opportunities, developing mentoring programs, and encouraging mechanisms to ensure protected time. CONCLUSIONS: Barriers to education research productivity clearly exist. Many appear to result from feelings of isolation that may be overcome with systemic efforts to develop and enable communities of practice across institutions. Finally, the theme of "reward" is novel and complex and may have implications for education research productivity.

Teaching/learning strategies for the essentials of baccalaureate nursing education for entry-level community/public health nursing.

The purpose of this article is to describe teaching/learning strategies for each of the 15 Essentials of Baccalaureate Nursing Education for Entry-Level Community/Public Health Nursing (ACHNE, 2009). Carper's ways of knowing serve as foundations for creating classroom and clinical experiences that focus on clinical action with community as client. Each community/public health essential is defined with relevance to community/public health nursing practice. Five teaching/learning strategies have been delineated for each essential with suggestions of teaching resources and/or target population application. Teaching/learning strategies that focus on community as client, population health, and the essential knowledge and competencies of C/PH nursing will help ensure preparation of baccalaureate prepared nurses with knowledge and skills to improve the health of populations.

E-portfolio competency metadata: pilot study for a call to action.

The six competency domains required by the Accreditation Council for Graduate Medical Education (ACGME) have led to a proliferation of measurement tools, assessment methods, and all forms of data from paper to electronic. The need exists to develop a standardized electronic (e)-portfolio to provide the aggregate data to improve education and patient care. This process requires a sound methodology using XML metadata to allow portability of e-portfolio data. We surveyed publicly available metadata and developed an e-portfolio system for the Henry Ford Hospital General Surgery Residency Program. Based on our implementation of e-portfolios for 70 physicians, we call upon the ACGME, the Residency Review Committees, and the American Board of Medical Specialties to establish a method to formalize and develop a standard for residency competency metadata. Using an approach similar to that of our study can streamline data and lead to improved medical education and ultimately better patient care.

Development of an institutional resident curriculum in communication skills.

OBJECTIVE: We describe a collaboration between the graduate medical education office and the Henry Ford Health System's Office of Clinical Quality and Safety to create an institution-wide communication skills curriculum pertinent to the institution's safety and patient- and family-centered care initiatives. METHODS: A multidisciplinary committee provided oversight for the curriculum design and used sentinel event and other quality and safety data to identify specific target areas. The curriculum consisted of 3 courses: "Informed Consent," "Sharing Bad News," and "Disclosure of Unanticipated Events." Each course included 3 components: a multimedia online module; small group discussions led by the program director that focused on the use of communication scripts; and 2 objective structured clinical examinations (OSCEs) requiring residents to demonstrate use of the communication scripts. All first-year residents (N  =  145) and faculty (N  =  30) from 20 residency programs participated in this initiative. Evaluation of the residents consisted of a self-assessment; the standardized patients' assessment of the residents' performance; and faculty assessment of resident performance with verbal feedback. RESULTS: Survey data showed that residents found the courses valuable, with residents identifying communication scripts they would use in clinical settings. Focus groups with faculty highlighted that the resident debriefing sessions provided them with insight into a resident's communication skills early in their training. CONCLUSION: Our institutional curriculum was developed in a collaborative manner, and used an evidence-based approach to teach communication skills relevant to institutional safety and quality initiatives. Other institutions 5 wish to adopt our strategy of departmental collaboration and alignment of resident education with institutional initiatives.

Linking residency training effectiveness to clinical outcomes: a quality improvement approach.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME)'s Outcome Project requires training programs to use external measures such as quality of care indicators to assess their effectiveness. A practical, quality improvement (QI) process was implemented at Henry Ford Hospital to enhance the training program's educational effectiveness and clinical outcomes. METHODS: A QI process consisting ofa modified Plan-Do-Study-Act (PDSA) cycle was applied to residency and fellowship curricula in a medical intensive care unit (MICU). The PDSA activities focused on improving clinical outcomes but also outlined educational goals for residents and fellows, defined teaching methods, and determined assessment methods for the ACGME curricula. The improvement process linked clinical outcomes to specific competency-based educational objectives. Residents and fellows received instruction on QI and applied the new curricula to their clinical training in the MICU. RESULTS: Two of seven MICU clinical outcomes demonstrated initial performance below national benchmarks: iatrogenic pneumothorax rate and sepsis-specific mortality. During the QI process, clinical outcomes in both areas improved. Training program directors used the MICU clinical outcomes as indicators of their programs' educational effectiveness. They also assessed individual trainee performance in QI initiatives through direct observation and review of their written summaries of these projects. CONCLUSIONS: Training programs can use hospital-tracked clinical outcomes to analyze their educational strengths and weaknesses and accordingly to enhance their educational curricula. Linking competency-based learning objectives for trainees to the clinical outcomes of their patients can improve physician education and patient care.

Use of the kalamazoo essential elements communication checklist (adapted) in an institutional interpersonal and communication skills curriculum.

BACKGROUND: This study examined the psychometric properties of the Kalamazoo Essential Elements Communication Checklist (Adapted) (KEECC-A), which addresses 7 key elements of physician communication identified in the Kalamazoo Consensus Statement, in a sample of 135 residents in multiple specialties at a large urban medical center in 2008-2009. The KEECC-A was used by residents, standardized patients, and faculty as the assessment tool in a broader institutional curriculum initiative. METHODS: Three separate KEECC-A scores (self-ratings, faculty ratings, and standardized patient ratings) were calculated for each resident to assess the internal consistency and factor structure of the checklist. In addition, we analyzed KEECC-A ratings by gender and US versus international medical graduates, and collected American Board of Internal Medicine Patient Satisfaction Questionnaire (PSQ) scores for a subsample of internal medicine residents (n  =  28) to examine the relationship between this measure and the KEECC-A ratings to provide evidence of convergent validity. RESULTS: The KEECC-A ratings generated by faculty, standardized patients, and the residents themselves demonstrated a high degree of internal consistency. Factor analyses of the 3 different sets of KEECC-A ratings produced a consistent single-factor structure. We could not examine the relationship between KEECC-A and the PSQ because of substantial range restriction in PSQ scores. No differences were seen in the communication scores of men versus women. Faculty rated US graduates significantly higher than international medical graduates. CONCLUSION: Our study provides evidence for the reliability and validity of the KEECC-A as a measure of physician communication skills. The KEECC-A appears to be a psychometrically sound, user-friendly communication tool, linked to an expert consensus statement, that can be quickly and accurately completed by multiple raters across diverse specialties.

The CD200 receptor is a novel and potent regulator of murine and human mast cell function.

CD200R is a member of the Ig supergene family that is primarily expressed on myeloid cells. Recent in vivo studies have suggested that CD200R is an inhibitory receptor capable of regulating the activation threshold of inflammatory immune responses. Here we provide definitive evidence that CD200R is expressed on mouse and human mast cells and that engagement of CD200R by agonist Abs or ligand results in a potent inhibition of mast cell degranulation and cytokine secretion responses. CD200R-mediated inhibition of FcepsilonRI activation was observed both in vitro and in vivo and did not require the coligation of CD200R to FcepsilonRI. Unlike the majority of myeloid inhibitory receptors, CD200R does not contain a phosphatase recruiting inhibitory motif (ITIM); therefore, we conclude that CD200R represents a novel and potent inhibitory receptor that can be targeted in vivo to regulate mast cell-dependent pathologies.

Muddling through a merger: a qualitative study of two combined family practice residencies.

BACKGROUND AND OBJECTIVES: Mergers of residency training programs have become more common, but little has been published about their educational impact. Following our own merger, we sought to understand this process and its aftermath by conducting focus groups. METHODS: Three 1-hour focus groups were conducted-one with third-year residents, one with first- and second-year residents, and one with core faculty members. The interview script was based on a five-factor transitional model where each factor represented a potential fracture point that could result in organizational conflict. The five factors were curriculum, corporate culture, day-to-day operations, teaching environment, and financial resources. Focus group audiotapes were transcribed, and the investigators independently identified themes using an immersion and crystallization approach. Feedback from participants was obtained. RESULTS: Themes identified included unmet potential of the combined curriculum, a blending of two disparate cultures resulting in feelings of loss and displacement for some, and a sense of rapid policy change and lack of resident and faculty accountability. Faculty recommendations for other programs involved in mergers include creating frequent facilitated retreats, acknowledging loss, and establishing new rituals for the combined program. CONCLUSIONS: The transition through a merger of two residency programs is difficult and has direct educational and emotional impact. Such difficulties can, in part, be predicted, and improved communication and planning may facilitate this process.

Interleukin-23 rather than interleukin-12 is the critical cytokine for autoimmune inflammation of the brain.

Interleukin-12 (IL-12) is a heterodimeric molecule composed of p35 and p40 subunits. Analyses in vitro have defined IL-12 as an important factor for the differentiation of naive T cells into T-helper type 1 CD4+ lymphocytes secreting interferon-gamma (refs 1, 2). Similarly, numerous studies have concluded that IL-12 is essential for T-cell-dependent immune and inflammatory responses in vivo, primarily through the use of IL-12 p40 gene-targeted mice and neutralizing antibodies against p40. The cytokine IL-23, which comprises the p40 subunit of IL-12 but a different p19 subunit, is produced predominantly by macrophages and dendritic cells, and shows activity on memory T cells. Evidence from studies of IL-23 receptor expression and IL-23 overexpression in transgenic mice suggest, however, that IL-23 may also affect macrophage function directly. Here we show, by using gene-targeted mice lacking only IL-23 and cytokine replacement studies, that the perceived central role for IL-12 in autoimmune inflammation, specifically in the brain, has been misinterpreted and that IL-23, and not IL-12, is the critical factor in this response. In addition, we show that IL-23, unlike IL-12, acts more broadly as an end-stage effector cytokine through direct actions on macrophages.