Japanese public health nurses classified based on empathy and secondary traumatic stress: variable-centered and person-centered approaches.

BACKGROUND: Healthcare providers frequently help traumatized people and are regularly exposed to indirect trauma from their work, resulting in negative psychological responses, such as secondary traumatic stress. Empathy has been associated with patient's quality of care and secondary traumatic stress among healthcare providers. However, the relationship between dispositional empathy and secondary traumatic stress has not been fully elucidated. This study used person- and variable-centered approaches to explore the nature of this relationship. METHODS: A total of 1,006 Japanese public health nurses working in the Tohoku region and Saitama prefecture completed questionnaires that included scales assessing dispositional empathy, secondary traumatic stress, and burnout. First, we examined predictors of secondary traumatic stress using multiple linear regression analysis. Then, we conducted a latent profile analysis to classify participants into unique groups based on four subscales of dispositional empathy (i.e., empathic concern, perspective taking, personal distress, fantasy) and secondary traumatic stress. Finally, we compared the mean values of the study variables across these groups. RESULTS: The multiple regression indicated that in those working in Saitama prefecture, lifetime traumatic experiences, work-related distress, and personal distress were positively related to secondary traumatic stress, but perceived support was negatively related to secondary traumatic stress. Latent profile analysis extracted four unique subgroups. Group 1 displayed the highest secondary traumatic stress levels. Group 2 was characterized by the highest level of empathic concern, personal distress, and fantasy and the lowest perspective taking. Group 3 had a moderate secondary traumatic stress level. Group 4 had the lowest secondary traumatic stress and personal distress scores. In these four groups, the burnout scale (exhaustion, cynicism, and professional efficacy) showed a pattern similar to the secondary traumatic stress scale. CONCLUSIONS: Our person-centered approach showed that this sample of public health nurses could be classified into four unique groups based on their empathy and secondary traumatic stress scores. Although this group of public health nurses was not large, one group displayed high personal distress levels and high secondary traumatic stress levels. Further research is needed to determine effective interventions for this group.

Algorithm development to improve intervention effectiveness for parents with mental health signs and symptoms.

OBJECTIVES: In this study we aimed to describe and compare groups formed by a rules-based algorithm to prospectively identify clients at risk of poor outcomes in order to guide tailored public health nursing (PHN) intervention approaches. DESIGN: Data-driven methods using standardized Omaha System PHN documentation. SAMPLE: Clients ages 13-40 who received PHN home visiting services for both the Caretaking/parenting and Mental health problems (N = 4109). MEASUREMENT: We applied a theory-based algorithm consisting of six rules using existing Omaha System data. We examined the groups formed by the algorithm using standard descriptive, inferential statistics, and Latent Class Analysis. RESULTS: Clients (N = 4109) were 25.1 (SD = 5.9) years old and had an average of 7.3 (SD = 3.2) problems, 250 (SD = 319) total interventions, and 32 (SD = 44) Mental health interventions. Overall outcomes improved after PHN interventions (p < .001 for all) and having more Mental health signs/symptoms was negatively associated with outcome scores (p < .001 for all). CONCLUSIONS: This algorithm may be helpful in identifying high-risk clients during a baseline assessment who may benefit from more intensive mental health interventions. Findings show there is value using the Omaha System for PHN documentation and algorithm clinical decision support development. Future research should focus on algorithm implementation in PHN clinical practice.

Metodología para la aplicación del Modelo de Enfermería Salubrista / A Methodology for Using the Public Health Nursing Model

Introducción: Las prácticas de cuidados con la aplicación del Modelo de Enfermería Salubrista suponen la aplicación de la perspectiva interdisciplinar. Objetivos: Diseñar una metodología para favorecer la inserción del Modelo de Enfermería Salubrista en contextos de prácticas de enfermería. Métodos: Investigación de desarrollo realizada en el período 2017- 2020. Para su diseño se realizaron talleres teóricos-metodológicos y se validó con su aplicación en un estudio. Resultados: La metodología describe tres etapas: Identificación de perspectivas de prácticas de cuidados, acciones para la asunción de la perspectiva salubrista y constatación de resultados a partir de la aplicación de la perspectiva salubrista. Conclusión: La propuesta metodológica permite la asunción de la perspectiva interdisciplinar y salubrista por los profesionales de enfermería(AU)

Introduction: Care practices, with the application of the public health nursing model, involve the application of the interdisciplinary perspective. Objectives: To design a methodology to facilitate the insertion of the public health nursing model in nursing practice settings. Methods: A development research was carried out in the period 2017-2020. For its design, theoretical-methodological workshops were conducted. It was validated with its application in a study. Results: The methodology describes three stages: identification of perspectives of care practices, actions for assuming the public health perspective, and verification of outcomes from the application of the public health perspective. Conclusion: The methodological proposal allows nursing professional to assume the interdisciplinary and public health perspective(AU)

Experiencias en la formación de recursos humanos de enfermería en Cuba y su desafío ante la salud universal / Experiences Regarding the Training of Nursing Human Resources in Cuba and Universal Health Challenges

Introducción: La enfermería cubana es una profesión que ha experimentado cambios trascendentales en sus funciones como prestadora de servicios de salud, así como en el proceso de formación que ha realizado de forma acelerada, por etapas y niveles, lo que conllevó a ajustar los modelos de formación. Los programas de estudio son perfeccionados en correspondencia con el encargo social y desarrollo científico técnico, lo que permite dar respuesta oportuna a la salud universal. Objetivo: Exponer experiencias en la formación de recursos humanos de enfermería en el contexto cubano, logros alcanzados y principales desafíos ante la salud universal. Métodos: Ensayo cualitativo teórico-reflexivo, realizado en enero a mayo de 2020, basado en literatura nacional e internacional. Para buscar los estudios se utilizaron descriptores controlados "Recursos humanos", "Enfermería", "Salud", en bases de datos latinoamericanas e internacionales. Los datos se procesaron a través del análisis de contenido. Conclusión: Cuba ha conseguido desarrollar la formación de los recursos humanos en enfermería y alcanzar adecuada cobertura de salud, lo que resulta un logro que garantiza atención sin exclusión de las personas que requieran sus servicios(AU)

Introduction: Nursing, as a profession, has undergone transcendental changes in Cuba regarding its functions as provider of healthcare services; as well as in the training process, which has undergone accelerated transformations, by stages and levels, and thus led to adjustments in the training model. The study programs are improved in correspondence with the social order and technical-scientific development, which allows a timely response to universal health. Objective: To present experiences regarding the training of nursing human resources in the Cuban context, as well as achievements and main challenges concerning universal health. Methods: Theoretical-reflective and qualitative essay carried out from January to May 2020, supported by national and international literature. To identify the studies, controlled descriptors were used (Recursos humanos [human resources], Enfermería [nursing], Salud [health]), searching in Latin-American and international databases. The data was processed through content analysis. Conclusion: Cuba has managed to develop the training of human resources in nursing and achieve adequate health coverage, an achievement that guarantees care without exclusion of the people who require such services(AU)

Nurse to adolescent health communication process: approach to Event History Calendar.

OBJECTIVES: comprehend the Event History Calendar components that are relevant for the nurse to adolescent communicative process, in the context of Primary Health Care. METHODS: reflective study, based on the Event History Calendar approach, in the relational, communicative, and educational dimensions. RESULTS: best practices for adolescent health promotion are vital and constitute a challenge to nurses. The Event History Calendar is a potential tool for research and care practices to comprehend the needs of adolescents, with reminder of key personal events, culturally and socially specific. The comprehension of retrospective data referring to activities, behaviors, experiences and transitions of life, in certain periods of time, enables dialogue and new understandings about the history of adolescents. FINAL CONSIDERATIONS: the Event History Calendar provides nursing professionals with an expansion of their practice in educational, relational, and communicative dimensions, as well as to instruct care planning and management.

How Nurses Come to Race: Racialization in Public Health Breastfeeding Promotion.

This research study shows how race becomes ascribed through nursing theory and day-to-day workplace socialization processes. We show how public health nurses supporting and promoting breastfeeding for new mothers learn about and reproduce racialized stereotypes, which shape the care they provide. Even when nurses attempt to actively resist racialized stereotypes, most participate in essentialized nursing practice by using racialized institutional practices. Nursing theory needs to expand to help the nurse navigate and understand both the nurses' and client's local histories as well as individual-to-systems level constraints and supports that may impede, or promote, a mother's ability to breastfeed.

Nurse to adolescent health communication process: approach to Event History Calendar / El proceso de comunicación en salud de la enfermería con el adolescente: un enfoque desde el Event History Calendar / Processo de comunicação em saúde da enfermagem com o adolescente: abordagem do Event History Calendar

ABSTRACT Objectives: comprehend the Event History Calendar components that are relevant for the nurse to adolescent communicative process, in the context of Primary Health Care. Methods: reflective study, based on the Event History Calendar approach, in the relational, communicative, and educational dimensions. Results: best practices for adolescent health promotion are vital and constitute a challenge to nurses. The Event History Calendar is a potential tool for research and care practices to comprehend the needs of adolescents, with reminder of key personal events, culturally and socially specific. The comprehension of retrospective data referring to activities, behaviors, experiences and transitions of life, in certain periods of time, enables dialogue and new understandings about the history of adolescents. Final Considerations: the Event History Calendar provides nursing professionals with an expansion of their practice in educational, relational, and communicative dimensions, as well as to instruct care planning and management.

RESUMEN Objetivos: comprender los elementos del calendario histórico de eventos relevantes al proceso comunicativo del enfermero con el adolescente, en el ámbito de la Atención Primaria de Salud. Métodos: estudio reflexivo, desde el enfoque del Event History Calendar, en las dimensiones relacionales, comunicativas y educativas. Resultados: las buenas prácticas para la promoción de la salud de los adolescentes son esenciales y constituyen un desafío al enfermero. El Event History Calendar es una herramienta potencial a las investigaciones y prácticas de asistencia para comprender las necesidades de los adolescentes, y contiene un recordatorio de los eventos clave personales, culturales y sociales específicos. El conocimiento de los datos retrospectivos referentes a las actividades, los comportamientos, las experiencias y el paso de la vida, en ciertos períodos de tiempo, permite el diálogo y nuevos entendimientos sobre la trayectoria del adolescente. Consideraciones Finales: el Event History Calendar permite que el profesional enfermero aumente su actuación en las dimensiones educativas, relacionales y comunicativas, además de establecer planes y una gestión del cuidado.

RESUMO Objetivos: apreender os componentes do calendário histórico de eventos relevantes ao processo comunicativo do enfermeiro com o adolescente, no âmbito da Atenção Primária à Saúde. Métodos: estudo reflexivo, fundamentado na abordagem do Event History Calendar, nas dimensões relacionais, comunicativas e educativas. Resultados: boas práticas para a promoção da saúde dos adolescentes são vitais e configuram um desafio para o enfermeiro. O Event History Calendar é ferramenta potencial para pesquisas e práticas de cuidado para apreender necessidades do adolescente, com recordatório de eventos-chave pessoais, culturalmente e socialmente específicos. A apreensão de dados retrospectivos referentes a atividades, comportamentos, experiências e transições da vida, em determinados períodos de tempo, possibilita o diálogo e novos entendimentos sobre a trajetória do adolescente. Considerações Finais: O Event History Calendar confere ao profissional enfermeiro uma expansão de sua atuação em dimensões educativas, relacionais e comunicativas, bem como para instruir planos e gestão do cuidado.

PART I: The role of public health nursing in addressing health care needs of children in foster care.

AIMS AND OBJECTIVES: The purpose of this study was to describe the role of Public Health Nurses (PHN) addressing the needs of children and adolescents in foster care. BACKGROUND: Children in foster care have more physical, mental, dental, developmental health problems than the general pediatric population. National data indicate that between 30%-80% of children come into foster care with at least one physical health problem. DESIGN: An online survey was developed to describe PHN day-to day activities, PHN funding, case load and case management responsibilities. METHOD: Thirty-nine PHNs completed the survey (72% response rate). RESULTS: Nurses described the most important needs as being mental and emotional health services, self-esteem/self-worth and dental care. Care coordination, case management and monitoring/oversight of psychotropic medications were the top responsibilities. CONCLUSION: The study demonstrated that public health nursing expertise is an essential part of the child welfare team in addressing medical, dental, mental and developmental needs of children in foster care. RELEVANCE TO CLINICAL PRACTICE: There is an expanding role of Public Health Nurses in non-health care settings to intervene at the system level of the Intervention Wheel that includes policy development and enforcement, community organizing, and coalition building.

Sociodemographic and health situation of teenage students according to sex.

OBJECTIVE: To verify the association between sex (male and female) and sociodemographic, reproductive and sexual variables in teenagers and identify the highest rates of social and health issues among them. METHOD: This was a cross-sectional study conducted with 239 adolescents enrolled in a public school of Salvador, Bahia, Brazil, whose data were produced by applying a structured form processed in Stata. RESULTS: The research indicated an association between females and higher education level (p = 0.02), living with both parents (p = 0.02) and a higher rate of mental, social and behavioral issues. Being a man was associated with sexual initiation (p = 0.00), which occurred before they turned 14 years old (p = 0.05). CONCLUSION: The study variables behave, depending on sex, with smaller or greater chances of experiencing harmful situations, this understanding being essential for subsidizing educational activities that promote the quality of life of teenagers.

The Public Health Intervention Wheel in Norway.

OBJECTIVE: This study explored experiences Norwegian public health nurses (PHNs) have with using interventions from the Public Health Intervention Wheel (PHIW). DESIGN AND SAMPLE: The researchers used both quantitative and qualitative measures to explore how Norwegian PHNs use PHIW interventions in their practice. Data were gathered from six focus group meetings with 15 school and 16 family health nurses in Norway. METHOD: Instruments included: (a) demographic data form, (b) the Public Health Intervention Questionnaire developed by the researchers, and (c) focus group questions. RESULTS: Following discussion of PHIW interventions in focus groups, PHNs reported they had a clearer understanding of each intervention and they had performed activities in their practice consistent with each of the Wheel interventions. CONCLUSION: Descriptions of the Wheel interventions provided the PHNs with the terminology and language to identify and explain their work in public health nursing practice. Although there are some differences between the United States and Norway in the structure of public health nursing practice, the PHIW is a framework that is applicable to the work of PHNs in Norway.

Sociodemographic and health situation of teenage students according to sex / Situación sociodemográfica y de salud de adolescentes escolares según el sexo / Situação sociodemográfica e de saúde em adolescentes escolares segundo o sexo

ABSTRACT Objective: To verify the association between sex (male and female) and sociodemographic, reproductive and sexual variables in teenagers and identify the highest rates of social and health issues among them. Method: This was a cross-sectional study conducted with 239 adolescents enrolled in a public school of Salvador, Bahia, Brazil, whose data were produced by applying a structured form processed in Stata. Results: The research indicated an association between females and higher education level (p = 0.02), living with both parents (p = 0.02) and a higher rate of mental, social and behavioral issues. Being a man was associated with sexual initiation (p = 0.00), which occurred before they turned 14 years old (p = 0.05). Conclusion: The study variables behave, depending on sex, with smaller or greater chances of experiencing harmful situations, this understanding being essential for subsidizing educational activities that promote the quality of life of teenagers.

RESUMEN Objetivo: Verificar la asociación entre el sexo (hombre y mujer) y las variables sociodemográficas, sexuales y reproductivas de adolescentes e identificar los mayores promedios de problemas sociales y de salud de ellos. Método: Estudio transversal en el cual participaron 239 adolescentes matriculados en una escuela pública de Salvador, Bahía, Brasil; siendo recolectados los datos mediante la aplicación de formulario estructurado y procesados en el programa Stata. Resultados: La investigación presentó una asociación entre el sexo femenino y mayor nivel de escolaridad (p-valor = 0,02), convivir con ambos padres (p-valor = 0,02) y con un mayor promedio de problemas psíquicos, sociales y comportamentales. Se asoció ser hombre con la iniciación sexual (p-valor = 0,00), que ocurre hasta los 14 años de edad (p-valor = 0,05). Conclusión: Las variables en cuestión se comportaron, dependiendo del sexo, con menor o mayor posibilidad para una experiencia de agravios, siendo fundamental entenderlas para subsidiar acciones que promuevan la calidad de vida de los adolescentes.

RESUMO Objetivo: Verificar a associação entre sexo (homem e mulher) e as variáveis sociodemográficas, sexuais e reprodutivas para adolescentes e identificar maiores médias de problemas sociais e de saúde para estes. Método: Estudo transversal realizado com 239 adolescentes matriculados numa escola pública de Salvador, Bahia, Brasil, cujos dados foram produzidos mediante aplicação de formulário estruturado e processado no programa Stata. Resultados: A pesquisa apontou associação entre o sexo feminino e maior escolaridade (p-valor = 0,02), conviver com ambos os pais (p-valor = 0,02) e com maior média de problemas psíquicos, sociais e comportamentais. Ser homem foi associado com iniciação sexual (p-valor = 0,00) e desta ocorrer até os 14 anos (p-valor = 0,05). Conclusão: As variáveis em estudo se comportam, a depender do sexo, com menor ou maior chance para vivência de agravos, sendo essencial tal compreensão no sentido de subsidiar ações que promovam a qualidade de vida dos adolescentes.

Trauma informed public health nursing visits to parents and children.

Adverse Childhood Experiences (ACEs) research has demonstrated a strong correlation between a traumatic childhood and poor health and social status in adulthood. Maternal/child Public Health Nursing (PHN) home visiting teams frequently encounter families experiencing trauma, thus offering a unique opportunity to assist parents in recognizing the potential harm such stress may have for their child. The Sonoma County Field Nursing team developed a trauma-informed model utilizing ACEs education in a self-reflective approach with parents to increase family resilience and reduce the risk for future childhood trauma. This paper presents the supporting research used to develop the trauma-informed approach and describes the execution of the model by the Sonoma County Field Nursing team.

Opening the doors for school health-An exploration of public health nurses' capacities to engage in comprehensive school health programs.

OBJECTIVES: Public health nurses (PHNs) have a significant role in engaging the voice and actions of school communities in promoting the health of children and youth. School nursing was one of the early 20th century public health nursing foci and specialties in Canada, however over several decades, there has been a gap in actualizing PHNs' full potential in schools. At the same time, intersectoral and interdisciplinary comprehensive school health (CSH) models have emerged as exemplars of partnerships between schools and communities to advance health promotion and ultimately chronic disease prevention with school populations (Pan-Canadian Joint Consortium for School Health, ; World Health Organization, ). DESIGN AND MEASUREMENT: Using a participatory action research methodology we explored the role of PHNs in CSH, drawing on the concept of engagement in intersectoral healthy school teams. RESULTS AND CONCLUSIONS: The three themes that emerged from the data analysis were: facilitators of public health nursing engagement, barriers to public health nursing engagement, and the influences of community context on engagement. Overall, findings indicate that the PHN role in CSH must be developed and supported so that PHNs remain a vital link between school health communities, programs, and policies in the promotion of health.

Feasibility of describing community strengths relative to Omaha system concepts.

OBJECTIVES: The purpose was to determine the feasibility of using a standardized language, the Omaha System, to describe community-level strengths. The objectives were: (a) to evaluate the feasibility of using the Omaha System at the community level to reflect community strengths and (b) to describe preliminary results of community strengths observations across international settings. DESIGN AND SAMPLE: A descriptive qualitative design was used. The sample was a data set of 284 windshield surveys by nursing students in 5 countries: Mexico, New Zealand, Norway, Turkey, and the United States. MEASURES: An online survey included a checklist and open-ended questions on community strengths for 11 concepts of the Omaha System Problem Classification Scheme: Income, Sanitation, Residence, Neighborhood/workplace safety, Communication with community resources, Social contact, Interpersonal relationship, Spirituality, Nutrition, Substance use, and Health care supervision. Themes were derived through content analysis of responses to the open-ended questions. RESULTS: Feasibility was demonstrated: Students were able to use the Omaha System terms and collect data on strengths. Common themes were described among the five countries. CONCLUSIONS: The Omaha System appears to be useful in documenting community-level strengths. Themes and exemplar quotes provide a first step in developing operational definitions of strengths at a more granular level.

Development of a comprehensive infection control program for a short-term shelter serving trafficked women.

A shelter for trafficked women has unique infection control needs that require a comprehensive infection control plan, balancing the needs of infection prevention with respect for the vulnerable population served. Using a trauma-informed model and evidence from infection control in other shelter settings, a group of senior baccalaureate students developed a program in a short-term shelter for commercially sexually exploited individuals that included a written infection control manual, policies and procedures, and staff training. This partnership between academia and a nonprofit agency was an experiential service learning project in the domain of public health nursing, allowing students the opportunity to apply evidence toward a sustainable intervention for the agency.

Machine Learning Methods for Identifying Critical Data Elements in Nursing Documentation.

BACKGROUND: Public health nurses (PHNs) engage in home visiting services and documentation of care services for at-risk clients. To increase efficiency and decrease documentation burden, it would be useful for PHNs to identify critical data elements most associated with patient care priorities and outcomes. Machine learning techniques can aid in retrospective identification of critical data elements. OBJECTIVE: We used two different machine learning feature selection techniques of minimum redundancy-maximum relevance (mRMR) and LASSO (least absolute shrinkage and selection operator) and elastic net regularized generalized linear model (glmnet in R). METHODS: We demonstrated application of these techniques on the Omaha System database of 205 data elements (features) with a cohort of 756 family home visiting clients who received at least one visit from PHNs in a local Midwest public health agency. A dichotomous maternal risk index served as the outcome for feature selection. APPLICATION: Using mRMR as a feature selection technique, out of 206 features, 50 features were selected with scores greater than zero, and generalized linear model applied on the 50 features achieved highest accuracy of 86.2% on a held-out test set. Using glmnet as a feature selection technique and obtaining feature importance, 63 features had importance scores greater than zero, and generalized linear model applied on them achieved the highest accuracy of 95.5% on a held-out test set. DISCUSSION: Feature selection techniques show promise toward reducing public health nursing documentation burden by identifying the most critical data elements needed to predict risk status. Further studies to refine the process of feature selection can aid in informing PHNs' focus on client-specific and targeted interventions in the delivery of care.

Developing a national competency-based curriculum for technical nurses in Egypt.

Nursing in Egypt has evolved over recent decades. Development has accelerated following recent government recognition of the contribution nurses make to healthcare access, quality and delivery. A vision to enhance nursing capacity resulted in a recent mandate requiring all nursing curricula to be competency based. Concurrently, the Educational Development Fund of the Egyptian Cabinet of Ministers drafted a nursing educational plan including a strategy to develop and implement a contextually congruent educational model with proven success comparable to international standards. This report discusses the 4-year curriculum development project designed to upgrade the current technical-level nursing curriculum to a consistent competency-based model. The competency-based educational model will be trialled in 3 technical institutes before nationwide rollout and implementation. Details of the project plan are described, including an overview of curriculum development considerations. This report provides insights for policy-makers and educators embarking on similar health workforce reform and capacity development initiatives.

Development and implementation of a health education station by community health nursing students.

This paper examines the development and implementation of a health literacy/education station at a large free clinic in a metropolitan city in southern California. The station was made possible through a partnership between the leadership team at the clinic and senior nursing students at a large university located in southern California. This paper outlines the importance of health literacy, the partnership between the community health senior nursing students and faculty and a yearly 3-day health clinic, the Core Competencies of Public Health Nursing met by the event, student preparation prior to the event, outcomes, and recommendations for future clinics and for future collaborations.