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.

Importancia del tamaño del efecto para la comparación de dos o más grupos en investigaciones en salud pública / The Importance of Effect Size for Comparing Two or More Groups in Public Health Research

Señor Editor: Muchos estudios en ciencias de la salud, con el objetivo de comparar las puntuaciones de una variable entre dos o más grupos (por ejemplo, sexo, nivel socioeconómico, nivel de instrucción, tipo de enfermedad, entre otras), recurren a la determinación de la existencia o no de diferencias estadísticamente significativas reportadas, fundamentalmente, a través de los valores del test de significancia de la hipótesis nula (NHST, por sus siglas en inglés), procedimiento que actualmente se encuentra en discusión.1,2 En este sentido, el NHST puede considerarse como un procedimiento insuficiente para la valoración de la importancia práctica de los resultados. Entre las limitaciones del NHST se pueden mencionar las siguientes: considerar solo el error máximo permitido para rechazar una hipótesis nula (Ho) de ausencia de diferencias estadísticamente significativas y la alta sensibilidad respecto al tamaño de la muestra, donde muestras grandes tienden a estar asociadas también con el rechazo de la Ho.3,4,5 Ante esta situación, se hace necesario el reporte de medidas del tamaño del efecto que permiten la cuantificación de la eficacia de diferentes niveles de una variable independiente. De esta manera, de acuerdo a lo sugerido por el Comité Internacional de Editores de Revistas Médicas,6 se busca complementar la información acerca de la existencia de diferencias estadísticamente significativas (obtenida a través del NHST) con información que indique la magnitud de tales diferencias...(AU)

Identifying target behaviors for weight management interventions for women who are overweight during pregnancy and the postpartum period: a qualitative study informed by the Behaviour Change Wheel.

BACKGROUND: Maternal overweight is increasing, and it is associated with several risk factors for both the mother and child. Healthy lifestyle behaviors adopted during pregnancy are likely to impact women's health positively after pregnancy. The study's aim was to identify and describe weight management behaviors in terms of the Capability, Opportunity and Motivation Behaviour (COM-B) -model to target weight management interventions from both the perspectives of women who are overweight and maternity care professionals. METHODS: This qualitative, descriptive study was conducted between 2019 and 2020. Individual interviews with pregnant and postpartum women who were overweight (n = 11) and focus group interviews with public health nurses (n = 5) were undertaken in two public maternity clinics in Southwest Finland. The data were analyzed using deductive content analysis consistent with the COM-B model. RESULTS: In the capability category, the women and the public health nurses thought that there was a need to find consistent ways to approach overweight, as it had often become a feature of the women's identities. The use of health technology was considered to be an element of antenatal care that could be used to approach the subject of weight and weight management. Smart wearables could also support an evaluation of the women's lifestyles. The opportunity category highlighted the lack of resources for support during perinatal care, especially after birth. Both groups felt that support from the family was the most important facilitating factor besides motivation. The women also expressed a conflict between pregnancy as an excuse to engage in unhealthy habits and pregnancy as a motivational period for a change of lifestyle. Furthermore, the women wanted to be offered a more robust stance on weight management and discreet counseling. CONCLUSIONS: Our findings offer a theoretical basis on which future research can define intervention and implementation strategies. Such interventions may offer clear advice and non-judgmental support during pregnancy and after delivery by targeting women's capabilities, opportunities, and motivation. Health technology could be a valuable component of intervention, as well as an implementation strategy, as they provide ways during maternity care to approach this topic and support women.

Personal reflections on navigating the COVID-19 pandemic: From vision to reality.

Transitioning from bedside nursing to public health nursing after graduating with my Master's in Public Health was a unique experience, particularly as I navigated the COVID-19 pandemic as a new public health and nursing leader. Personal reflection pieces can provide a meaningful review of the experiences of integrating clinical nursing practice and more broad public health practice. The purpose of this paper is to offer my reflection and synthesis of the lessons learned while leading a Federally Qualified Health Center (FQHC) through the COVID-19 pandemic. Additionally, I reflect on the future of FQHCs and the critical need to advance public health as a field and empower public health nurses.

Prevalence and predictors of coronaphobia among frontline hospital and public health nurses.

OBJECTIVES: To determine the prevalence as well as the predictors of coronaphobia in frontline hospital and public health nurses. DESIGN: This study used a cross-sectional research study involving 736 nurses working in COVID-19 designated hospitals and health units in Region 8, Philippines. Four structured self-report scales were used, including the Coronavirus Anxiety Scale, the Brief Resilience Scale, the Perceived Social Support Questionnaire, and the single-item measure for perceived health. RESULTS: The prevalence of coronaphobia was 54.76% (n = 402): 37.04% (n = 130) in hospital nurses and 70.91% (n = 273) in public health nurses. Additionally, nurses' gender (ß = 0.148, p < .001), marital status (ß = 0.124, p < .001), job status (ß = 0.138, p < .001), and personal resilience (ß = -0.167, p = .002) were identified as predictors of COVID-19 anxiety. A small proportion of nurses were willing (19.94%, n = 70) and fully prepared (9.40%, n = 33) to manage and care for coronavirus patients. CONCLUSION: Coronaphobia is prevalent among frontline Filipino nurses, particularly among public health nurses. Interventions to address coronaphobia among frontline nurses in the hospital and community should consider the predictors identified. By increasing personal resilience in nurses through theoretically driven intervention, coronaphobia may be alleviated.

Associations between oil development and sexually transmitted infections: Public health nurse perspectives.

BACKGROUND: Oil development (OD) has been associated with increased sexually transmitted infection (STI) rates, with limited focus on the North Dakota (ND) oil boom. Public health (PH) nurse experiences can provide context related to health challenges during OD-related population booms. OBJECTIVE: To compare reported STI rates in ND oil-producing (OP) and non-oil-producing (NOP) counties before, during, and after the oil boom and describe PH nurse experiences during this time. DESIGN: We conducted secondary data analysis of oil production data and reported rates for chlamydia and gonorrhea, and conducted interviews with ND PH nurses. SAMPLE: PH nurses within ND counties geographically located in or near OD in the state. MEASUREMENTS: ND county-level OD data trends were compared to similarly timed reported rates of chlamydia and gonorrhea in OP and NOP counties. PH nurse interviews were conducted addressing their STI-related experiences working in PH during the oil boom. RESULTS: Significant findings include a correlation between OD and gonorrhea rates. PH nurses described a limited PH infrastructure to meet the health needs of a transient, increasing population. CONCLUSIONS: Expanding the role of PH nurses in ND to implement STI screening and treatment would improve access to STI testing allowing for comprehensive reporting of STIs.

Development of a COVID-19 alternate care site from ground zero: A nursing perspective.

The novel coronavirus disease SARS-CoV-2 (COVID-19) outbreak rapidly generated an unprecedented global, national, and state public health crisis with the need to rapidly develop alternate care sites (ACS) to care for COVID-19 patients within an overburdened health care system. A hospital care model ACS to increase the health care capacity, provide care for mild to moderately symptomatic patients, and offer local self-sustainment for a surge of patients was developed in Memphis, Tennessee located in Shelby County. We completed a temporary conversion of a large unused newspaper publication building to a health care facility for COVID-19 patients. Developing an ACS from ground zero was met with many challenges, and throughout the process important lessons were learned. With the goal to complete the building conversion within a 28-day timeframe, collaboration among the numerous governmental, health care, and private agencies was critical and nursing leadership was key to this process. The purpose of this paper is to describe the development of a COVID-19 ACS in Memphis, TN, which has a large at-risk population with limited access to health care. Specifically, we will discuss the strong leadership role of nursing faculty, key challenges, and lessons learned, as well as provide checklists and models for others in similar circumstances.

Burnout and its prevalence among public health nurses in Ireland.

This paper presents the findings from an analysis of survey data which was collected from public health nurses (N = 136) as part of a larger study with more than 4000 nurses and midwives in Ireland. The purpose of the study was to examine the prevalence of burnout using the Oldenburg Burnout Inventory and to compare relationships between burnout, demographic and work characteristics across this group of nurses. Younger PHNs were most likely to report feeling burnout (68%) compared with those aged 51 or over (47%) who reported the lowest levels. PHNs whose highest level of qualification was a primary degree were least likely to report feeling burnout (31%) compared with those who held a Masters / Doctoral degree (54.5%). PHNs who reported working on a fixed-term full-time contract were most likely to report feeling burnout (70%) compared with those who were on a permanent part-time contract (49%). Quantitative analysis, using both descriptive and inferential statistics, was carried out and the findings show that PHNs reported moderate levels of burnout. The findings also show that burnout among PHNs is strongly correlated with the physical demands placed on individuals during work, having constant time pressures, too much being expected of individuals, the work environment being too demanding and dissatisfaction with the physical conditions.

Being a real nurse: A secondary qualitative analysis of how public health nurses rework their work identities.

Many Western nations are emphasizing the importance of population health across health care delivery organizations and education systems. Despite significant momentum to integrate population health into nursing practice, a parallel effort to examine how these efforts impact practicing nurses' views of their professional role and work identity has not occurred. This secondary qualitative analysis, employing an abductive approach, explored processes public health nurses use in creating and maintaining their work identity through three organizing themes: narrative self-identity, mandated identity, and identity as struggle. The analysis was based on interview data collected from 30 US public health nurses residing in 17 states. 'Being a real nurse' describes public health nurses' efforts to balance a contradictory work identity where at times they are expected to focus on populations and at other times, on individuals. The identity work revealed through this study should be further explicated and specific strategies developed for stabilizing a work identity for public health nurses, as well as for any nurse charged with a population health role.

Public health nurses' experiences during the H1N1/09 response.

OBJECTIVE: H1N1/09 was the first pandemic flu ever responded to with mass vaccinations. Public health nurses (PHNs) were pivotal in implementing the H1N1/09 vaccination clinics. With the ongoing threat of pandemic influenza and other viral outbreaks, much can be learned from these PHNs' H1N1/09 experiences. This study's purpose was to explore PHNs' experiences in the H1N1/09 mass vaccination clinics. DESIGN AND SAMPLE: In a qualitative interpretive description, 23 PHNs (16 immunizers, seven supervisors) who worked in a large Canadian municipal public health agency, participated in semistructured interviews. RESULTS: Three overarching themes were identified. 'Anticipating an Emergency' discusses participants' experiences learning about the pandemic response and their role preparation. 'Surviving the Chaos' reflects the challenges of the clinics, particularly during the first few hectic weeks of the response. 'Persevering Over Time' encompasses participants' experiences as they became familiar with clinics' operations and their own responsibilities. CONCLUSIONS: Participants' experiences have implications for future public health pandemic planning and research. Key recommendations include to communicate with PHNs in a timely manner about their clinic roles, and to provide PHNs with appropriate training to optimize clinics' operations. This will help support PHNs in their roles to protect the public and provide quality population care.

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.

Supporting public health practice in healthy growth and development in the Province of Ontario, Canada.

BACKGROUND: As public health services are modernized in Ontario, Canada, there is a need to inform the system-level roles and responsibilities of government agencies. The aim of this study was to identify how Public Health Ontario (PHO) can optimally support evidence-based planning and programming in Healthy Growth and Development (HGD) across Ontario. METHODS AND DESIGN: A situational assessment was conducted with key informants from public health and other HGD fields. SAMPLE: Key informants were identified using purposeful snowball sampling and included public health nurses, health promoters, and medical officers of health. Analytic strategy: Twenty telephone interviews and seven focus groups were used to collect data. A thematic analysis was conducted concurrently with data collection. RESULTS: Five themes were identified: (a) Transition to the new Ontario Public Health Standards (OPHS) included experiences of adopting the new OPHS within local public health units (PHUs). (b) Collaborating and networking referred to the ability to work with community partners. (c) Data, evidence, and research described the presence of data, evidence, and research to support practice. (d) Decision making, planning, and priority setting described resources available that influenced decision making. (e) Current and emerging issues in HGD included high-priority topics. CONCLUSION: Public health practice in HGD is complex with many challenges in data and evidence, and making programming decisions without adequate or measurable indicators. A specialized position at PHO is an opportunity to support some of these system-wide needs.

An experiential approach to developing radiological content for public health nursing: Lessons from a nuclear disaster.

OBJECTIVE: This study identified the radiological content required for PHNs and public health nursing students based on PHNs' experiences caring for people affected by the 2011 Fukushima Daiichi nuclear power plant accident. DESIGN: We used qualitative research, interviews, and content analysis. SAMPLE: Participants were eight PHNs employed by local governments in Fukushima and neighboring prefectures. RESULTS: Six content themes regarding the nuclear disaster were identified: (a) basic knowledge about radiation, (b) public health nursing activities in emergency exposure situations, (c) management in emergency exposure situations, (d) consultation to support residents affected by the nuclear disaster, (e) activities in the existing exposure situations, and (f) disaster preparedness in the planned exposure situations. Necessary content shifted depending on the phase of the nuclear disaster recovery. CONCLUSIONS: The use of the experiences of PHNs after the nuclear power plant accident to inform PHNs and public health nursing students will enable PHNs to respond appropriately and support people without difficulties. Comprehensive radiation content is needed to address the range of situations caused by nuclear disaster.

Factors associated with professional confidence in Japanese public health nurses: A cross-sectional survey.

OBJECTIVES: To clarify factors associated with professional confidence in Japanese public health nurses (PHNs) and to examine the relationship between professional confidence and professional competency. DESIGN: A cross-sectional study. SAMPLE: Public health nurses (N = 1,512) working in local government agencies. MEASUREMENTS: An anonymous, self-administered questionnaire with questions on demographic characteristics (sex, age, experience as a PHN, educational background, affiliation, and position) and 34 items on professional confidence developed by the researchers based on a literature review was administered. Factors associated with the professional confidence were extracted through an exploratory factor analysis, and construct validity of the confidence was verified through a confirmatory factor analysis. RESULTS: In total, 883 responses (response rate, 58.4%) were received; only 467 (30.9%) of them were valid. On the basis of the exploratory factor analysis results, professional confidence included 17 items, with the following four factors: "technical practice," "effortful learning," "exploring the evidence," and "educators in workplace." The goodness-of-fit model in the confirmatory factor analysis proved the construct validity of professional confidence. CONCLUSIONS: Professional confidence was gained by self-improvement that reflects on public health practice. Professional confidence underpinned the generalist level of professional competency among PHNs.

[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.

Professional nurses' experiences of caring for patients in public health clinics in Ekurhuleni, South Africa.

BACKGROUND: Caring for patients is the core aspect of nursing and a cornerstone of all nursing duties. Although caring is seen as a critical component of nursing delivery and an essential characteristic of nursing, there seems to be a gap between theory and practice. AIM: The aim of this article was to explore and describe the experiences of caring for patients by professional nurses in public health clinics in Ekurhuleni. SETTING: The study was conducted in Ekurhuleni, an area east of the Gauteng Province in two public health clinics. METHODS: A qualitative, exploratory, descriptive phenomenological and contextual research design was used. In-depth, individual phenomenological interviews were conducted with eight purposefully sampled professional nurses to explore their experiences of caring for patients in public health clinics in Ekurhuleni. Data were analysed using Giorgi's coding method. RESULTS: Two themes were revealed in the study findings. The first theme was the experienced empowering aspects of caring while the second theme was the experienced disempowering aspects of caring. The experienced empowering aspects of caring had two categories: empowering interpersonal experiences and the empowering experiences through client affirmation. These were identified by the participants as enabling effective caring for patients. The experienced disempowering aspects of caring also had two categories: disempowering interpersonal experiences and the disempowering experiences resulting from public health clinic system challenges. The disempowering aspects were identified by participants as disenabling effective caring for patients. CONCLUSION: The study findings reveal that the professional nurses had empowering and disempowering experiences while caring for patients in the public health clinics.

To initiate the conversation - Public health nurses' experiences of working with obesity in persons with mobility disability.

AIM: Developing a theory explaining how public health nurses accomplish and adapt counselling in lifestyle habits to decrease obesity in people with mobility disability. DESIGN: Empirical research - qualitative. METHOD: Classic grounded theory with face-to-face interviews, 2017-2018, using inductive approach to understand public health nurses' intervening experiences with obesity patients. RESULTS: To initiate the conversation emerged as the main concern meaning having difficulties initiating conversations about obesity with patients. Public health nurses' facilitators to communicate lifestyle changes emerged as the pattern generating the theory, which consists of the categories; person-centeredness in the situation, experience and knowledge, strengthening conditions, access to other professionals and prioritization in everyday work. CONCLUSIONS: Public health nurses hesitate to raise topics of obesity in patients with mobility disability. They advocate increased integration with lifestyle changes in everyday work including multi-professional cooperation. The implication is testing the emerged theory at primary health care centres. IMPACT: Obesity is more common in people with mobility disability than in those without. There is a need to understand how public health nurses adapt counselling in lifestyle habits. Public health nurses hesitate to talk about obesity with patients in fear of offending anyone. Public health nurses did not distinguish between patients with or without mobility disability. Several facilitators could be helpful initiating conversation with the patients. Public health nurses need more time and resources to facilitate conversation with patients with mobility disability to counsel lifestyle changes.

The role of public health nurses in risk factor modification within a high-risk cardiovascular disease population in Ireland - a qualitative analysis.

BACKGROUND/AIMS: Health promotion for cardiovascular disease risk factors management is essential to secondary prevention of cardiovascular disease events. In Ireland, post-cardiac rehabilitation patients are discharged into the care of community public health nurses, who have a health promotion role. Little is known of the public health nurses' perceptions or knowledge surrounding their role in cardiovascular disease risk factor management. Underpinned by a constructivist viewpoint, this study aims to generate empirical evidence on the phenomenon directly from public health nurses' encounters within the context of the current health service. METHODS: This qualitative cross-sectional analysis involved face-to-face, semi-structured interviews with a purposeful sample of 17 public health nurses. Interviews were audio-recorded, transcribed, subjected to thematic content analysis and subsequently reported incorporating verbatim quotes. RESULTS: A significant gap exists between evidence-based guidelines for cardiovascular disease prevention and current practices. Variations in public health nurses' training, experience and knowledge result in inconsistent practices, and public health nurses feel this is specialised area for which they are not equipped. The changing public health nurse role and increasing workloads result in prioritisation of other nursing duties over health promotion. Ineffective systems for care delivery and a lack of community-based rehabilitation programmes also negatively impact on secondary prevention practices. CONCLUSIONS: Findings support the need to develop a community cardiovascular disease specialist role to effectively support ongoing cardiovascular disease risk factor management. Evaluation of the mechanisms of current service delivery is required to ensure a quality-assured equitable service, in line with community needs and current evidence-based guidelines for practice. A quantitative triangulation study is recommended.

Public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools: A phenomenographic study.

AIMS AND OBJECTIVES: To describe the variation in public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools in Norway. BACKGROUND: Mental health problems among adolescents account for a large portion of the global burden of disease and affect 10%-20% of adolescents worldwide. Public health nurses in school health services play an important role in disease prevention and promotion of physical and mental health. In order to serve adolescents with regard to mental health problems, public health nurses are dependent on collaboration with other professionals in schools. DESIGN: Qualitative interviews were conducted with 18 public health nurses working in the school health services. METHOD: A phenomenographic approach was used for interviewing and for analysing the qualitative interviews. This study is presented in line with COREQ's checklist. RESULT: The analysis resulted in three descriptive categories based on eight identified conceptions. The categories are as follows: "The formal structure has an impact on interprofessional collaboration"; "The public health nurse is an important, but not always self-evident, partner in interprofessional collaboration"; and "The primary players are the teachers in collaboration." CONCLUSION: The public health nurses describe that they had limited impact on collaboration and were dependent on both the school principal and the teachers for achieving good collaboration. Teachers have the power to decide whether to collaborate with the public health nurse, and public health nurses regard teachers as the most important collaborative partners. The public health nurses need to make themselves and their competence visible. RELEVANCE TO CLINICAL PRACTICE: The findings demonstrated that public health nurses are important collaborators, but are not always included in interprofessional collaboration. This knowledge is essential to strengthen public health nurses' roles and presence in schools, which could most certainly benefit adolescents with mental health problems in secondary school.

The challenges to public health nurse practice in rural Ireland.

OBJECTIVES: The primary objective was to understand the contemporary public health nurse's (PHN) role and the issues that they face working in rural Ireland. DESIGN AND SAMPLE: This study was based on an ethnographic approach with 13 PHNs working in rural areas in the South West of Ireland. MEASUREMENTS: A combination of solicited diaries and semi-structured interviews referred to as the diary/interview method were employed. Diaries were used by the PHNs to record their working day on a staggered basis from February to April 2017 with the subsequent interviews carried out in June and July 2017. RESULTS: Working as a PHN in a rural area presented a number of issues such as time spent on traveling as a result of geographical disparity & poor road networks; client transport issues; a sense of working in isolation; communication issues with respect to computer/tablet hardware availability, mobile phone and broadband connectivity and the availability of, and the physical access to services. CONCLUSION: PHNs operating in rural communities face a distinct set of challenges that they have a limited ability to address. Legislators, health care providers and policymakers need to create a supportive environment that helps address these challenges in Ireland.