Core competency model for the family planning public health nurse.

OBJECTIVES: A core competency model for family planning public health nurses has been developed, using a three stage Delphi Method with an expert panel of 40 family planning senior administrators, community/public health nursing faculty and seasoned family planning public health nurses. DESIGN AND SAMPLE: The initial survey was developed from the 2011 Title X Family Planning program priorities. The 32-item survey was distributed electronically via SurveyMonkey(®). RESULTS: Panelist attrition was low, and participation robust resulting in the final 28-item model, suggesting that the Delphi Method was a successful technique through which to achieve consensus. CONCLUSIONS: Competencies with at least 75% consensus were included in the model and those competencies were primarily related to education/counseling and administration of medications and contraceptives. The competencies identified have implications for education/training, certification and workplace performance.

Implications of preparedness and response core competencies for public health.

Public health care practitioners and organizations are a part of community readiness for, response to, and recovery from emergencies and disasters of all kinds. Although response to health threats, particularly communicable disease outbreaks, have long been a part of public health practice, 2 advancements in preparedness, including the integration of public health into the broader community emergency response system and the clarification of exactly what knowledge, skills, and attitudes a public health professional brings to the response, have been made since 2001. This article presents the newly affirmed core competencies to be attained and maintained by the majority of the public health workforce and discusses some of the many ways in which these competencies influence practice, research, and education.

Update on competencies and education.

The beginning of the 21st century has been marked by an increase in attention to the quality of emergency and disaster response, particularly the preparedness of health workers of all kinds. The increase in natural disasters, civil unrest, and dislocation of populations has seen health workers mobilized. These workers are moving, both within countries and across borders, as members of long- organized teams such as the National Disaster Medical System (NDMS), volunteers joining through a nongovernmental organization (NGO) such as a Red Cross/Red Crescent unit, or individuals self-deploying to the scene of the emergency. Postevent evaluations have consistently identified the need for those responding to be able to join in an organized response that includes taking on assigned roles, communication through established channels and minimization of the number of "SUVs" or "spontaneous unrequested volunteers." Although bystanders and self-deployed helpers (some with professional qualifications) are the first at any disastrous event, the subsequent response efforts are expected to be organized, efficient, and effective. This requires advance training of the responders.

Emergency preparedness training and response among community health centers and local health departments: results from a multi-state survey.

Due to their access to medically underserved and vulnerable populations, community health centers (CHCs) can play an essential role in emergency response. CHCs often fill this role in partnership with other local health resources, such as local health departments (LHD). Little research has been done to understand the success of these partnerships as it relates to emergency planning and emergency response. This study compares CHC and LHD personnel regarding past, present, and future collaborative preparedness and response activities. Surveys were distributed electronically to 1,265 clinical and clerical staff at LHDs and CHCs in 23 states who met the study criteria. Of the 522 respondents, 287 (55%) reported having engaged in collaborative preparedness activities in general, with CHCs more likely to report partnering than LHDs. LHDs were more likely than CHCs to report taking part in specific preparedness activities, such as planning activities (91, 79%), (chi(2)(1, N = 280) = 7.395, P < 0.05), mass dispensing drill/exercises (65, 42%), (chi(2)(1, N = 279) = 14.019, P < 0.001), and communication drill/exercises (69, 47%), (chi(2)(1, N = 280) = 13.059, P < 0.001). This study suggests that collaborations between CHCs and LHDs in general are occurring, but these general collaboration are not being translated into participation in functional drills or exercises. Additional efforts to ensure a more comprehensive partnership between CHCs and LHDs in emergency preparedness are warranted.

Public health preparedness and response competency model methodology.

OBJECTIVE: The Pandemic and All-Hazards Preparedness Act calls for establishing a competency-based training program to train public health practitioners. To inform such training, the Centers for Disease Control and Prevention and the Association of Schools of Public Health managed groups of experts to produce a competency model which could function as a national standard of behaviorally based, observable skills for the public health workforce to prevent, protect against, respond to, and recover from all hazards. DESIGN: A systematic review of existing competency models generated a competency model of proposed domains and competencies. PARTICIPANTS: National stakeholders were engaged to obtain consensus through a three-stage Delphi-like process. RESULTS: The Delphi-like process achieved 84 percent, 82 percent, and 79 percent response rates in its three stages. Three hundred sixty six unique individuals responded to the three-round process, with 45 percent (n = 166) responding to all three rounds. The resulting competency model features 18 competencies within four core learning domains targeted at midlevel public health workers. CONCLUSIONS: Practitioners and academics have adopted the Public Health Preparedness and Response Core Competency Model, some of whom have formed workgroups to develop curricula based on the model. Efforts will be needed to develop evaluation materials for training and education programs to refine the model as well as for future training and education initiatives.

Public health certification.

In 2003, the Institute of Medicine (IOM) recommended voluntary certification of graduates achieving the Master of Public Health degree. The Association of Schools of Public Health (ASPH), the American Public Health Association, the Association of State and Territorial Health Officials, the National Association of County and City Health Officials, and the Association for Prevention Teaching and Research joined together to establish the National Board of Public Health Examiners (5). This new body will certify graduates of accredited schools and programs of public health who successfully pass their examination. If this certification becomes common, the debate will move to other questions such as (a) can those who lack a degree from a school of public health be certified through the same examination, or a similar one; (b) how will this general certificate relate to specialized areas of public health practice which are also learned elsewhere; and (c) how will we assess the public health competence of public health workers who do not have a professional education?

Public health workforce enumeration.

Comprehensive data on the public health workforce are fundamental to workforce development throughout the public health system. Such information is also a critical data element in public health systems research, a growing area of study that can inform the practice of public health at all levels. However, methodologic and institutional issues challenge the development of comparable indicators for the federal, state, and local public health workforce. A 2006-2007 Association of State and Territorial Health Officials workforce enumeration pilot project demonstrated the issues involved in collecting workforce data. This project illustrated key elements of an institutionalized national system of workforce enumeration, which would be needed for a robust, recurring count that provides a national picture of the public health workforce.

Transitions in state public health law: comparative analysis of state public health law reform following the Turning Point Model State Public Health Act.

Given the public health importance of law modernization, we undertook a comparative analysis of policy efforts in 4 states (Alaska, South Carolina, Wisconsin, and Nebraska) that have considered public health law reform based on the Turning Point Model State Public Health Act. Through national legislative tracking and state case studies, we investigated how the Turning Point Act's model legal language has been considered for incorporation into state law and analyzed key facilitating and inhibiting factors for public health law reform. Our findings provide the practice community with a research base to facilitate further law reform and inform future scholarship on the role of law as a determinant of the public's health.

Building a system for preparedness: the NYCEPCE NEST experience.

The New York Consortium for Emergency Preparedness Continuing Education grew from clinician-oriented, Web-based continuing education developed with and primarily for clinicians associated with the New York Presbyterian Healthcare System. As the consortium expanded to reach all of New York State (and beyond, via the Web), courses originally developed at Columbia were transferred to a widely advertised Web site, and the content expanded. The National Education Strategy Team supplemental funds allowed New York Consortium for Emergency Preparedness Continuing Education to consider how to overcome one of the major challenges in emergency preparation, connectivity across all sectors, and levels of the public health community. We chose to use community health centers as paradigmatic of the challenge: the clinician needs emergency preparedness competencies, but if the site at which practice takes place has no plan, those skills will not be best used; if the practice site is not connected to the community-wide plan, capacity may be duplicated or unused. If clinician, practice and community all plan, train, and practice in a common framework, the community should be much more resilient in the face of emergencies of any dimension.

Modernizing state public health enabling statutes to reflect the mission and essential services of public health.

It is unclear whether efforts of the past decade to modernize state public health statutes have succeeded in codifying into state law the currently understood mission and essential services of public health. Although many state health agencies may be operating in a manner consistent with these principles, their codification in state law is crucial for the sustainability of agency efforts in disease prevention and health promotion. This research examines the 50 state public health enabling statutes for their correspondence with the 6 mission statements and the 10 essential services of public health described in Public Health in America. This analysis finds that modernization efforts have not been universally effective in ensuring that the legislative basis of public health is commensurate with the accepted scope of authority necessary to support health agency performance. Given current imperatives for law modernization in public health, this analysis highlights the importance of model statutory language in facilitating the codification of the mission and essential services of public health in state law. As a result, this research provides the practice community with a research base to facilitate statutory reform and develops a framework for future scholarship on the role of law as a determinant of the public's health.

Examination of the relationship between public health statute modernization and local public health system performance.

OBJECTIVES: Wide variation in performance of public health (PH) systems, coupled with national interest in improving PH system quality, makes it a priority to identify factors associated with performance. One factor may be congruence between a state's PH enabling statutes and the obligations outlined in Public Health in America-the collaboratively developed framework that defines the mission and essential services (ESs) of PH. SUBJECTS: This research examined the relationship between (1) the degree to which language in a state's PH enabling statutes reflects PH's mission and ESs and (2) the performance of local public health systems in delivering ESs, measured by National Public Health Performance Standards scores in 207 local jurisdictions. METHODS: Binary logistic regression demonstrated that a high degree of congruence between statutory language and public health's mission increased the odds of above-average system performance for 5 of 10 ESs. RESULTS: High levels of congruence between statutory language and the ESs themselves increased odds of above-average system performance for 6 of 10 ESs. Results yielded modest odds ratios (<2.0). CONCLUSIONS: Limitations of the data make it impossible to draw firm conclusions; however, these modest results suggest that statutory language may account for little of the variation in local public health system performance.

20th-century reports on nursing and nursing education: what difference did they make?

At the beginning of the 21st century, public policy attention is being drawn to the profession of nursing by reports identifying demographic trends that are expected to lead to a significant shortage of nurses, given an aging population, a lengthening life span, and the increasing use of medical interventions to prevent or treat disease. This shortage is alleged to be more profound than the cyclic shortages experienced during the previous century, primarily for 2 reasons: (1) the nursing workforce is older, on average, than other professional groups, with more nurses entering practice at older ages with shorter expected work life, and (2) the capacity of the educational system to provide replacements for retiring nurses is inadequate due to a shortage of qualified faculty and limitations in clinical training sites.

Assessment of emergency preparedness of veterinarians in New York.

Veterinarians have unique skills and abilities that could be useful in preparing for and responding to disasters and emergencies. However, veterinarians are often absent from emergency preparedness planning and exercises, and little is known about veterinarians' perceptions of emergency preparedness. A focus group was conducted among veterinarians to explore issues such as previous emergency-preparedness education, types of training needed, barriers to participation in training, and future steps to overcome identified barriers. Focus-group participants reported that they had had little to no emergency-preparedness training and had no clear understanding of what their specific role should be in an emergency. Participants also reported several barriers to participation in training and expressed significant concerns about their ability to respond in an emergency. The concerns reported include limited knowledge of zoonotic diseases, confusion about providing care for animals displaced during natural disasters, and poor relationships with other health professions. In order to respond to disasters, veterinarians require training tailored to their concerns and needs. Furthermore, partnerships between veterinarians and health care workers need to be further developed and strengthened.

Education for the public health profession: a new look at the Roemer proposal.

Demands for a high level of professionalism in public health practice, and concomitant strengthening of public health education to match 21st-century community challenges provide an opportunity to reconsider the current paradigm for professional degrees in public health. In this article, we consider whether the currently typical public health education meets the requirements of a professional education, examine the current state of public health education, and provide a rationale for renewed emphasis on the doctor of public health (DrPH) degree. We also present one potential three-year DrPH curriculum to stimulate further discussion, while acknowledging the multiple challenges that face any school of public health moving to implement such an education.

Visits coded as intimate partner violence in emergency departments: characteristics of the individuals and the system as reported in a national survey of emergency departments.

INTRODUCTION: This study was conducted to explore the characteristics of intimate partner violence (IPV) victims whose visit was coded as IPV and the health care delivery system in emergency departments (ED). METHODS: This study utilized a secondary data analysis of a national probability sample that comprised the National Hospital Ambulatory Medical Care Survey for 1997 to 2001. RESULTS: There were 111 coded ED visits of IPV victims 16 years or older (equivalent of 482,979 out of 4 million national visits for the 5-year study period). Women (94%), African Americans (35%), those 25 to 44 years of age (64%), and uninsured patients (38%) were significantly more likely to be categorized as an IPV visit (odds ratios 14, 1.9, 2.7, and 2.4, respectively) compared with non-IPV visits. Characteristics of the health care delivery system (region, metropolitan vs. non-metropolitan, type of hospital, and type of health care provider) were not associated with IPV. DISCUSSION: Caution should be implemented when interpreting the study results because they represent only coded IPV visits in the emergency department. The study findings suggest the critical need to improve identification, documentation, and coding of IPV visits.

Training for interdisciplinary health research: defining the required competencies.

Although interdisciplinary research is becoming the dominant model for understanding complex health issues, little is known about the competencies required for successful interdisciplinary collaboration. Published research has discussed attitudes about interdisciplinary work and organizational resources but not the needed competencies. This report describes the method and results of the competency specification process for health research. Based on an established definition of interdisciplinary research, a preliminary set of competencies was developed from expert opinion of key informants and a review of the interdisciplinary research literature. A Delphi panel of interdisciplinary researchers then reached consensus on 17 competencies necessary for interdisciplinary research.

Defining interdisciplinary research: conclusions from a critical review of the literature.

OBJECTIVE: To summarize findings from a systematic exploration of existing literature and views regarding interdisciplinarity, to discuss themes and components of such work, and to propose a theoretically based definition of interdisciplinary research. DATA SOURCES/STUDY SETTING: Two major data sources were used: interviews with researchers from various disciplines, and a systematic review of the education, business, and health care literature from January 1980 through January 2005. STUDY DESIGN: Systematic review of literature, one-on-one interviews, field test (survey). DATA COLLECTION/EXTRACTION METHODS: We reviewed 14 definitions of interdisciplinarity, the characteristics of 42 interdisciplinary research publications from multiple fields of study, and 14 researcher interviews to arrive at a preliminary definition of interdisciplinary research. That definition was then field tested by 12 individuals with interdisciplinary research experience, and their responses incorporated into the definition of interdisciplinary research proposed in this paper. PRINCIPAL FINDINGS: Three key definitional characteristics were identified: the qualitative mode of research (and its theoretical underpinnings), existence of a continuum of synthesis among disciplines, and the desired outcome of the interdisciplinary research. CONCLUSION: Existing literature from several fields did not provide a definition for interdisciplinary research of sufficient specificity to facilitate activities such as identification of the competencies, structure, and resources needed for health care and health policy research. This analysis led to the proposed definition, which is designed to aid decision makers in funding agencies/program committees and researchers to identify and take full advantage the interdisciplinary approach, and to serve as a basis for competency-based formalized training to provide researchers with interdisciplinary skills.

Non-hospital based registered nurses and the risk of bloodborne pathogen exposure.

The aim of this study was to assess the risk of blood and body fluid exposure among non-hospital based registered nurses (RNs) employed in New York State. The study population was mainly unionized public sector workers, employed in state institutions. A self-administered questionnaire was completed by a random stratified sample of members of the New York State Nurses Association and registered nurse members of the New York State Public Employees Federation. Results were reviewed by participatory action research (PAR) teams to identify opportunities for improvement. Nine percent of respondents reported at least one needlestick injury in the 12-month period prior to the study. The percutaneous injury (PI) rate was 13.8 per 100 person years. Under-reporting was common; 49% of all PIs were never formally reported and 70% never received any post-exposure care. Primary reasons for not reporting included: time constraints, fear, and lack of information on reporting. Significant correlates of needlestick injuries included tenure, patient load, hours worked, lack of compliance with standard precautions, handling needles and other sharps, poor safety climate, and inadequate training and availability of safety devices (p<0.05). PAR teams identified several risk reduction strategies, with an emphasis on safety devices. Non-hospital based RNs are at risk for bloodborne exposure at rates comparable to hospital based RNs; underreporting is an important obstacle to infection prevention, and primary and secondary risk management strategies appeared to be poorly implemented. Intervention research is warranted to evaluate improved risk reduction practices tailored to this population of RNs.

Role of exercises and drills in the evaluation of public health in emergency response.

INTRODUCTION: Public health agencies have been participating in emergency preparedness exercises for many years. A poorly designed or executed exercise, or an unevaluated or inadequately evaluated plan, may do more harm than good if it leads to a false sense of security, and results in poor performance during an actual emergency. At the time this project began, there were no specific standards for the public health aspects of exercises and drills, and no defined criteria for the evaluation of agency performance in public health. OBJECTIVE: The objective of this study was to develop defined criteria for the evaluation of agency performance. METHOD: A Delphi panel of 26 experts in the field participated in developing criteria to assist in the evaluation of emergency exercise performance, and facilitate measuring improvement over time. Candidate criteria were based on the usual parts of an emergency plan and three other frameworks used elsewhere in public health or emergency response. RESULTS: The response rate from the expert panel for Delphi Round I was 74%, and for Delphi Round II was 55%. This final menu included 46 public health-agency level criteria grouped into nine categories for use in evaluating an emergency drill or exercise at the local public health level. CONCLUSION: Use of the public health-specific criteria developed through this process will allow for specific assessment and planning for measurable improvement in a health agency over time.