The use of youth healthcare services and its association with health-related quality of life, physical and mental health and over-the-counter analgesics use in 13-19-year-old adolescents: a cross-sectional study.

BACKGROUND: Youth healthcare services in Norway include a public health nurse (PHN) at school and local youth health centres (YHCs). They provide health services for all adolescents free of charge, focusing on health promotion and disease prevention. The present study aimed to assess possible associations between health-related quality of life (HRQoL), physical and mental health, over-the-counter analgesics (OTCA) use and use of youth healthcare services among 13-19-year-old adolescents. METHODS: This study was based on national, cross-sectional data from the Ungdata Survey conducted in 2022. The sample was comprised of 16 482 adolescents. Multiple logistic regression was used to analyse the associations between HRQoL, headaches, selected physical symptoms, psychological distress, use of OTCA, PHN availability, sociodemographic variables, and use of the PHN at school or at a YHC. The KIDSCREEN-10 was used to measure HRQoL, and the Hopkins Symptoms Checklist 10 was used to measure symptoms of psychological distress. RESULTS: Girls used the youth healthcare services more frequently than boys. Better HRQoL was significantly associated with fewer visits to the PHN at school. Girls reported lower HRQoL and mental health, and more pain and frequent OTCA use than boys. When having symptoms of psychological distress, boys had greater odds of visiting the PHN at school than girls. For girls in senior high school, headaches and OTCA use were strongly associated with visiting the PHN at school and the YHC. In senior high school, boys with an immigration background had greater odds of visiting the YHC than native Norwegian boys, while girls with an immigration background were less likely to visit the YHC than native Norwegian girls. CONCLUSIONS: Our results show that more girls than boys use youth healthcare services. When adolescents experience pain, have mental problems, use OTCA, or report low levels of HRQoL, they have greater odds of using youth healthcare services. Youth healthcare services offer excellent opportunities to support and follow up with adolescents. The findings provide important insights into youth healthcare services used by adolescents for various stakeholders, including PHNs and policy makers, with potential implications for future public health efforts.

The ESSENCE-Q: Can specialist supervision improve scoring agreement across specialist and public health nurses/nursery teachers?

AIM: This study aimed to explore whether the supervision of community public health nurses (PHNs) and nursery school teachers (NSTs) by a specialist, familiar with Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations (ESSENCE), improved the agreement of ESSENCE-Questionnaire (ESSENCE-Q) scoring, across raters. METHODS: A PHN, two NSTs, and a speech-language pathologist (SLP), familiar with ESSENCE, independently assessed 32 children. The ESSENCE-Q results were divided into the first (child 1-18) and second groups (the 19th child and the following children). Changes in score discrepancies were analysed for ESSENCE-Q cutoff scores and total ESSENCE-Q scores across raters. The SLP scores were used as a reference to evaluate sensitivity and specificity. RESULTS: The total ESSENCE-Q scores of the PHN and NSTs showed higher concordance in the second group (p < 0.05). Comparisons of the differences between the PHN/NSTs and SLP in total ESSENCE-Q scores showed a significantly smaller difference in the NSTs' scores in the second group (p < 0.05). CONCLUSION: The findings suggest that specialist supervision may lead to a better agreement between PHN and NSTs regarding ESSENCE-Q scores.

Continuous Support from the Same Public Health Nurse and Parental Perception and Use of Health Care Services: A Retrospective Observational Study.

OBJECTIVE: Continuity is considered essential for high-quality maternal and child health care services, but studies to show this effect on parental well-being are still rare. We studied whether receiving support from the same public health nurse has a beneficial effect on parental perceptions of health care professionals and the use of childcare support services. METHODS: Maternal and child health care services were provided by different nurses in a Japanese municipality until March 2019. From April 2019, all families with infants received continuous support from the same assigned nurse. A questionnaire covering parental perception and the use of services was sent by postal mail to 1,341 families with infants. The data were analyzed using χ2-test, t-test and logistic regression producing odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Parental perceptions of the availability of professionals to discuss children's issues, the degree of understanding about available other childcare support services, the degree of utilizing other services, and satisfaction with health care services were higher in parents who received continuous support from the same assigned nurse compared to those who did not receive continuous support. Continuous support was associated with parental perceptions of the availability of professionals to discuss children's issues (OR = 1.97, 95% CI 1.34-2.91) and the degree of understanding about available other child-care support services (OR = 1.65, 95% CI 1.11-2.44) after adjusting the results for socioeconomic factors. CONCLUSIONS: Continuous support from the same assigned nurse has benefits for parents. This offers a cost-effective way to improve parental well-being.

The use of Community/Public Health Nursing Competencies during the COVID-19 pandemic.

OBJECTIVES: (1) Ascertain the use of the Quad Council Competencies for Community/Public Health Nursing (QCC-C/PHN) Competencies by community/public health nurses (C/PHNs) during the COVID-19 pandemic; (2) Inform from a systems-level the need to sustain the C/PHN workforce; (3) Assess the C/PHN infrastructure for response capacity. DESIGN: Cross-sectional. Statewide email distribution lists were used for dissemination. SAMPLE: Convenience sample (n = 169) obtained using emailed Qualtrics link with the eligibility criteria of self-identification as a C/PHN who works in the state of Missouri. MEASUREMENTS: Demographic questions included employment sector, nursing education level, years of nursing, and C/PHN experience. Two Likert-type questions and one optional open-text question were created for the eight domains. RESULTS: One hundred sixty-nine participants' data were analyzed. One hundred fifty-four were employed in a local public health agency. Total 63.2% held a bachelor's degree in nursing or higher. The average number of years of nurse experience was 20.84, and C/PHN experience was 9.84. The domain of Communication Skills scored highest and Cultural Competency was the lowest. Three themes emerged from the open-ended questions including vulnerabilities of the public health system. CONCLUSION: Understanding the experiences of C/PHNs in Missouri related to the utilization of QCC-C/PHN competencies informs efforts to strengthen public health infrastructure and target resources to equip Missouri's C/PHNs.

Public health nurse perspectives on predicting nonattendance for cervical cancer screening through classification, ensemble, and deep learning models.

OBJECTIVES: Women's attendance to cervical cancer screening (CCS) is a major concern for healthcare providers in community. This study aims to use the various algorithms that can accurately predict the most barriers of women for nonattendance to CS. DESIGN: The real-time data were collected from women presented at OPD of primary health centers (PHCs). About 1046 women's data regarding attendance and nonattendance to CCS were included. In this study, we have used three models, classification, ensemble, and deep learning models, to compare the specific accuracy and AU-ROC for predicting non-attenders for CC. RESULTS: The current model employs 22 predictors, with soft voting in ensemble models showing slightly higher specificity (96%) and sensitivity (93%) than weighted averaging. Bagging excels with the highest accuracy (98.49%), specificity (97.3%), and ideal sensitivity (100%) with an AUC of 0.99. Classification models reveal Naive Bayes with higher specificity (97%) but lower sensitivity (91%) than Logistic Regression. Random Forest and Neural Network achieve the highest accuracy (98.49%), with an AUC of 0.98. In deep learning, LSTM has an accuracy of 95.68%, higher specificity (97.60%), and lower sensitivity (93.42%) compared to other models. MLP and NN showed the highest AUC values of 0.99. CONCLUSION: Employing ensemble and deep learning models proved most effective in predicting barriers to nonattendance in cervical screening.

Public health nurses leaving remote islands: An investigation into the turnover rate of remote island PHNs in Japan.

INTRODUCTION: This study investigated the number of public health nurses (PHNs) and the turnover rates of PHNs working in small municipal administrations on remote islands throughout Japan. METHODS: A questionnaire survey was administered on 359 remote islands, each with a population of less than 5000, including islands connected to the Japanese mainland by a bridge or road. The survey questionnaire asked about the number of PHNs stationed on the remote islands, their length of service, the number of retirees, and the ages of those who had retired. RESULTS: Of the 353 islands which responded, 30 islands had a total of 77 PHNs. Of those 30 islands, 29 were isolated islands that were not connected to the mainland by a bridge or road. The turnover rate of PHNs on the 29 islands was 13.3%. CONCLUSION: The turnover rate of 13.3% for PHNs on remote islands (with no bridge or road) with a population of less than 5000 was higher than the 7.9% turnover rate for PHNs in municipalities of equal size. To maintain the quality of life of island residents, preventing PHNs from leaving their jobs is an important challenge.

A concept of "cultural competence" among public health nurses in Japan.

OBJECTIVES: To clarify the conceptual structure of "cultural competence (CC)" among Japanese public health nurses (PHNs), to enhance culturally appropriate support. METHODS: A modified grounded theory approach (M-GTA) was used. A total of 11 municipal PHNs participated in this study. Data were collected through semistructured interviews. Interviews were audiotaped and transcribed. A comparative analysis was performed using M-GTA. RESULT: Five categories were identified. Japanese PHNs supported foreign residents while (1) maintaining a sincere attitude with curiosity and humility toward others regarding CC; (2) deepening their realization of issues arising from awareness of one's own and other cultures; (3) developing their knowledge about clients' cultures and the surrounding environments; and (4) mastering the skills of building a relationship with clients while creating supportive systems surrounding them. As they gained more experience in supporting foreign residents, as indicated in the above categories, their cultural competence grew, allowing them to (5) gain experience while encountering individuals without holding stereotypes and prejudice. CONCLUSIONS: The concepts of CC that emerged are based on cultural humility and are cultivated through supportive activities. The concepts identified in this study can serve as educational guidelines for health nurses and other care providers in Japan.

The development and challenges of public health nursing education in China from 1912 to 1949: A historical study.

OBJECTIVE: To examine the development and challenges of public health nursing education in China during the period of the Republic of China (1912-1949). METHODS: This study utilized a historical research design that combined a social framework and a policy framework to explore the early history of public health nursing education in China. Historical data were collected from periodicals, newspapers, archives, books and other sources. RESULTS: Public health was integrated into the nursing school curriculum for the first time during the period of the Republic of China, and health facilities and nursing schools conducted early explorations of public health nurse training. However, public health nursing education faced difficulties in terms of the curriculum, personnel training, and the localization of education. CONCLUSIONS: The achievements and difficulties associated with public health nursing education in China during the period of the Republic of China provide a historical reference for the integration of public health into current basic nursing education and the compatibility between the training of public health nurses and practical needs. Comparative studies of early public health nursing education across countries are expected to offer a better understanding of current public health nursing education.

Reading Groups as a Health-Promoting Intervention in Upper Secondary Schools: A Qualitative Study.

OBJECTIVES: To explore public health nurses' (PHN) perceptions and experiences of supporting siblings of children with complex care needs (CCNs) by using reading groups as a health promotion intervention in upper secondary schools. DESIGN: An action research approach using a qualitative design. SAMPLE: Interviews with 10 PHNs. MEASUREMENTS: Thematic analysis. RESULTS: The analysis resulted in the overarching theme "A much needed health promotion intervention in upper secondary schools," presented in terms of the following three themes: (1) supporting siblings is important, but resources and established procedures are lacking. (2) Reading groups using fiction have potential as a health-promoting intervention in upper secondary schools. (3) A realistic collaborative approach is necessary for reading groups to be implemented. CONCLUSION: PHNs have no established procedures to support siblings of children with CCNs in upper secondary schools. Reading groups can enable PHNs to reach out and support these siblings. Providing the intervention can be a way of reaching all pupils and thus creating an understanding of the plight of siblings who have a brother or sister with CCNs.

Best practice transfer by public health nurses in Japan: actual conditions and related factors.

BACKGROUND: The workload of public health nurses (PHNs) working for local governments has been increasing as health issues become more diverse and complicated. Even amidst the ongoing administrative and fiscal reforms, there is an urgent need to ensure how effectively and efficiently public health nurses can practice in health service development. The objective of this research was to clarify the actual conditions of best practice transfer (BPT) and its related factors. METHODS: An anonymous postal and self-administered questionnaire survey was conducted among PHNs working at 334 sites, including the local government offices and health centers across Japan, and analysed mainly through logistic regression analysis. RESULTS: One hundred eighty-five of the 334 institutions (55.4%) agreed to participate, and of the 966 questionnaire forms distributed, 709 forms (73.4%) were collected, of which 702 responses (72.7%) were valid. Although less than half (43.2%) have experience in BPT in health service development, more than 80% are willing to perform going forward. Significant factors for both the group with experience in BPT and the group with willingness to perform include an organizational culture that promotes BPT, as well as multiple elements of the workplace environment and facilitating factors related to knowledge and learning. The experienced group recognised the needs for criteria to evaluate the adaptability of best practice, while the willing group, to evaluate the quality of practice. CONCLUSIONS: Through a nationwide survey, this research elucidated for the first time the actual conditions of BPT by PHNs in Japan and related factors. The results indicated the importance of developing a system to promote BPT at the workplace level, also highlighted the importance for practitioners and experts, including researchers, to work together to develop practical guidelines to ensure evidence-based practices. Urgent actions are needed for the national and local governments to develop a system to promote BPT from diverse perspectives, building on the findings of this research.

[Understanding public health nurses' experience, knowledge, and perception of bioterrorism training in Japan].

Objectives　Bioterrorism is a disease in which the attacks can be covert and latent, take time to manifest, and, when discovered, can result in large outbreaks. When detected, they can become large-scale outbreaks. Therefore, preparedness is essential for early detection and response for damage mitigation. Although public health nurses (PHNs) of public health centers are responsible for detecting and dealing with bioterrorism, their preparation status is not clear. Therefore, this study aimed to elucidate the status of training experience, knowledge, and awareness of bioterrorism among PHNs working in public health centers' infectious disease control departments in Japan's metropolitan areas.Methods　This was a cross-sectional, descriptive study. The participants were PHNs in the infectious disease control departments of 88 public health centers in Tokyo and its three neighboring prefectures. This are densely populated metropolitan areas with many mass gathering events and a high probability of bioterrorism. An anonymous, self-administered questionnaire survey was conducted by mail in 2019. Two PHNs per location were surveyed regarding their attributes, training experience, knowledge, and perceptions.Results　We received 71 responses (40.3%). A total of 10 (14.1%) PHNs reported having experience with bioterrorism training in the workplace. Regarding the knowledge of the four infectious diseases with a high probability of bioterrorism, more than 95% of the respondents answered they had heard of them. However, few were aware of related treatments or terrorist responses. Although survey respondents were aware of the seriousness of bioterrorism and the effectiveness of preparedness, they did not have sufficient opportunity or time to have training. They tended to be less confident in their response and were willing to have training.Conclusion　PHNs who responded to this survey do not have sufficient training experience, knowledge, opportunities, and time for bioterrorism training, and establishing a training system to improve bioterrorism preparedness is a challenge. It will be necessary for PHN students to learn about the existence of bioterrorism. Further, PHNs in public health centers need to be trained at least once using online services, including brushing up on information as needed. Based on the lessons learned from the coronavirus disease 2019 pandemic, health centers will formulate a Health Crisis Management Plan. This will be effective in fiscal 2024, and we believe that it is essential that preparedness against bioterrorism be a part of this plan.

[Involvement of public health nurses in supporting mothers after maternity health checkups].

Objectives　This study aimed to analyze and clarify the role of public health nurses (PHNs) in assisting mothers who need assistance during antenatal checkups.Methods　This study was conducted in core city, A. The study participants were PHNs who experienced supporting at least three mothers who required support during maternity health checkups. We interviewed the respondents about their observations, decision points, difficulties in coordination, and other aspects of support. Data were extracted from verbatim transcripts and analyzed inductively.Results　Sixteen PHNs participants had an average of 9.3 years of experience. The analysis included 10 categories, 43 subcategories, and four themes. PHNs connected with mothers early depending on the mothers' wants, based on information gathered during the gestational period (theme 1). PHNs make early telephone visits to mothers based on information obtained during the gestational period. If the mother did not respond to the initial visit, the PHNs attempted to establish contact through other means.PHNs carefully observed and assessed mothers' childcare routines and mental and physical conditions (theme 2). To assess the mothers' mental health status, they were interviewed in detail using the Edinburgh postnatal depression scale. Determining the mother's condition was challenging; therefore, several PHNs conducted multiple visits and repeated the observations to achieve accurate assessments.The PHNs stayed close to their mothers and carefully supported them toward independence while assessing their progress (theme 3). PHNs established trusting relationships with mothers.PHNs served as coordinators in resolving problems and provided ongoing support in cooperation with medical institutions and related organizations (theme 4). The PHNs carefully coordinated consultations and encouraged mothers to consult psychiatrists if appropriate. Conclusion　Although PHNs provided attentive care to mothers requiring assistance, difficulties arise in accurately diagnosing postpartum depression and connecting mothers to psychiatric services. Guidelines that standardize the assessment of and responses to mental health issues are required. It is necessary to organize the problems faced by mothers and develop a system of cooperation among various organizations.

[Relationship between the number of public health nurses and the total number of people receiving home-visit nursing services for mental health/intractable diseases, and those numbers' regional differences].

Objectives　The primary aim of this study was to clarify the relationship between the number of public health nurses (PHNs) and the total number of people who received home-visit nursing services for mental health or intractable diseases. The secondary aim was to clarify the extent of regional differences in the number of PNHs and mental health or intractable diseases.Methods　This study used the total number of people who received home-visit nursing services for mental health or intractable diseases in 2019 from the Portal Site of Official Statistics of Japan (e-Stat) and population and area data in January 2020. Single and multiple regression analyses (covariates: population and area) were performed on the relationship between the number of PHNs per 100,000 population (abbreviated as "ratios of PHNs") and the total number of people who received home-visit nursing services for mental health or intractable diseases per 100,000 population (abbreviated as "mental health/intractable disease achievements"). Regional differences in ratios of PHNs and mental health/intractable disease achievement were examined using mean, standard deviation, maximum/minimum values, and Gini coefficients. Analyses were performed for each of the five units: the prefectures as a whole, prefectural public health centers, municipalities within the jurisdiction of prefectural public health centers, and cities in which public health centers are established (including or not including special wards).Results　Regression analyses indicated a positive relationship between the ratios of PHNs and mental health/intractable disease achievements. Multiple regression analysis indicated that both achievements were positively associated with population size and negatively associated with area size. The largest regression coefficients between the ratios of PHNs and achievements were 34.07 and 5.48 regarding mental health achievements and intractable disease achievements, respectively. For regional differences, the smallest Gini coefficient was the ratios of PHNs, and the largest was intractable disease achievements. The smallest and largest coefficient of the prefectures as a whole was 0.15 and 0.34, respectively. The maximum/minimum values of the prefectures as a whole also indicated that the smallest was 3.8 in the ratio of PHNs and the largest was 30.0 in intractable disease achievement.Conclusions　Increasing number of PHNs is needed to provide more home-visit nursing services for mental health and intractable diseases. It is particularly important to fill up the larger number of PHNs in smaller populations or larger area prefectures. Due to regional differences in the home-visit nursing service, it is important to promote the increase in the level of these activities.

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.

Relationship between changes in the public health nurses' workforce and the empirical Bayes estimates of standardized mortality ratio: a longitudinal ecological study of municipalities in Japan.

BACKGROUND: The role of public health nurses (PHNs) in the community is expected to become increasingly important, along with the promotion of a comprehensive community care system. However, a comprehensive study of all municipalities is yet to be undertaken, and the relationship between the workforce of PHNs and health indicators is yet to be clarified. This study examined the effect of workforce change among PHNs, one of the structural indicators of PHNs' activities regarding changes in the empirical Bayes estimate of standardized mortality ratios (EBSMRs). METHODS: An ecological study was conducted using municipality-level aggregate data. The data used were publicly available Japanese government statistics. The first-difference model of panel data analysis was used to examine the relationship between changes in EBSMR and changes in the number of PHNs per 100,000 population from 2010 to 2015, adjusting for the effects of population and other healthcare resources, including the number of physicians, medical clinics, general hospitals, and welfare facilities. The variation by the 47 prefectures was added to the linear model as a random effect. We also performed a sensitivity analysis using the full Bayesian inference using the Besag-York-Mollie model. RESULTS: For males, EBSMRs for all causes and malignant neoplasms significantly decreased with an increase in the number of PHNs per population (coefficients: -1.00 and -0.89, p values: 0.008 and 0.043, respectively). For females, although all EBSMRs except malignant neoplasms showed decreased tendencies due to the increase in the number of PHNs per population, none of them were significant. The full Bayesian inference confirmed these associations. CONCLUSIONS: An increase in the number of PHNs per population was significantly associated with a greater reduction in deaths from all causes and malignant neoplasms in males. The results of the full Bayesian inference also suggest that the workforce of PHNs may be related to changes in standardized mortality ratios for deaths from all causes in females.

Mental health services in the school environment-Future visions using a phenomenographic approach.

AIMS AND OBJECTIVES: First, to describe the variation in stakeholders' perceptions related to the desirable mental health services in school environments. Second, to construct alternative future visions based on these perceptions. Finally, to describe stakeholders' perceptions about the actions needed to reach such an ideal state. BACKGROUND: The increased need for mental health care has challenged the role of schools and school health care in the area of mental health services for those of school-age. There is a need for future visions and comprehensive statements concerning the mental health services provided in the school environment. DESIGN: The study was undertaken in Finland, between February 2020 and February 2021. Qualitative individual interviews were conducted with 15 professional stakeholders and focus group interviews with 10 stakeholders advocating for adolescents or parents. METHOD: The study was conducted with the phenomenographic approach using a visioning methodology. The study is reported following the COREQ checklist. RESULT: Four alternative future visions were formulated based on the perceptions of the stakeholders. They emphasised different aspects: (1) non-medicalising the school environment, (2) early and extensive intervention by school nurses enabled by work distribution with mental health specialists, (3) a multiprofessional team providing help on overall health questions and (4) a focusing of the services on mental disorders. Necessary changes were identified at the micro-, mezzo- and macro-level. CONCLUSION: The future visions are based on opposite perceptions related to the mission and focus of school health care. One extreme emphasises overall health promotion for everyone, while the other accentuates treatment for those suffering from mental disorders. The former may lead to inadequate help for mental health problems and the latter insufficient help for other health problems. RELEVANCE TO CLINICAL PRACTICE: This study contributes alternative future visions, promotes strategic planning and helps to clarify the future role of school nurses.

Mothers and public health nurses' experiences of sleep problems in children aged 6 months to 3 years: A qualitative study.

AIM AND OBJECTIVE: The aim of this study was to explore mothers' and public health nurses' (PHN) experiences with sleep problems in children aged 6 months to 3 years in Norway. BACKGROUND: Sleep problems in children are common, affecting their health and development, and their mothers' well-being. It is also the primary reason parents seek help in well-child clinics (WCC). However, there is limited knowledge regarding the experiences of these mothers and the public health nurses who consult them. DESIGN: Qualitative design. METHODS: Four semi-structured focus group interviews were conducted: two with mothers (n = 14) who had children with sleep problems and two with public health nurses (n = 14) from well-child clinics. The Framework Method was used for analysing the interviews of mothers. Data from public health nurses were charted onto the analytical framework of maternal data to understand how or whether public health nurses addressed the issues raised by mothers. The study is reported according to the COREQ checklist. RESULT: The analysis resulted in two main themes: 'therapeutic alliance' (categories 'alliance ruptures' and 'demanding negotiation process') and 'reorganisation of identity' (categories 'unfulfilled expectations' and 'internal tension conflicts'). CONCLUSION: Young children's sleep problems present challenges to new mothers due to failed expectations, negatively affecting their feelings as mothers and towards their children, and consequently the reorganising of maternal identity. Most mothers experienced unsatisfactory therapeutic alliances while seeking help from public health nurses because advice was considered overly general, contradictory and unsafe for their children. Public health nurses were mostly aware of the parental consequences of children's sleep problems, but many appeared unable to help because of limited time and knowledge. RELEVANCE TO CLINICAL PRACTICE: Public health nurses need to establish a therapeutic alliance and provide evidence-based knowledge and guidance on sleep problems while also considering women's reorganisation of identity when becoming mothers. CLINICAL TRIAL REGISTRATION: Open Science Framework: osf-registrations-6ag38-v1 (https://archive.org/details/osf-registrations-6ag38-v1).

Changing praxis from within - an in-depth qualitative exploration of how home visits affected statutory service at a Child Health Clinic.

PURPOSE: This study aims to define critical domains of salutogenic home visits conducted by public health nurses, and how thevisits can supplement a universal Child Health Clinic. DESIGN AND METHOD: A qualitative grounded theory study was conducted among three public health nurses in Stovner district, Oslo, Norway. The nurses were followed for 26 months offering home visits to all first-time parents. Data from focus group discussions, monthly reflection notes and bi-weekly meeting minutes were analysed using qualitative content analysis. RESULTS: Three critical themes emerged: building trust, prenatal visits and maintaining a salutogenic, strength-based approach. Extended public health nurse autonomy facilitated tailored support based on individual family needs. This promoted proportionate universalism to naturally be the gradient of the home visit intensity and kept actions at a universal level. CONCLUSIONS: The key component of family access and utilizing support was building and maintaining trust. Conducting prenatal visits was an important part of the nurse-family relationship, positively affecting later Child Health Clinic follow-up and continued care. PRACTICE IMPLICATIONS: Critical domains and benefits of practicing home visits emerged in this study and disclosed important aspects necessary for family access and utilizing support. By changing the point of entry from postnatal to prenatal, public health nurses-family relationship gets an important head start, positively affecting later follow-up and continued care. A tailored support to new families without using a predefined agenda and a salutogenic, strength-based philosophy can fit the public health nurses' professional beliefs and extend their autonomy.

How do public health nurses in Norwegian school health services support siblings of children with complex care needs?

AIMS: There is a paucity of data regarding the care and support provided by Norwegian school health services to siblings of children with complex care needs. Public health nurses are an integral part of these universal services, which focus on health promotion and disease prevention in primary and secondary schools. This study aimed to explore health promotion interventions by public health nurses for siblings in Norwegian schools and to identify regional differences. METHODS: An online national questionnaire was distributed to Norwegian public health nurses and leaders of public health nursing services (N = 487). The questions were related to how the nurses support siblings of children with complex care needs. The quantitative data were analysed using descriptive statistics. An inductive thematic analysis of free-text comments was conducted. ETHICAL APPROVAL: The study was approved by the Norwegian Centre for Research Data. RESULTS: The majority of public health nursing leaders (67%) reported that the services in their municipality had no system to identify siblings or to provide them with routine care. However, 26% of public health nurses reported that routine support was provided to siblings. Regional differences were identified. STUDY LIMITATIONS: This study included responses from 487 PHNs from all four health regions in Norway. The study design is limited and gives a brief outline of the current situation. Further data are needed to provide in-depth knowledge. CONCLUSIONS: This survey provides important knowledge for health authorities and professionals working with siblings, about inadequate support and regional differences in care provided to siblings by school health services.

Developing a scale for Japanese public health nurses supporting resident groups toward community-building.

OBJECTIVE: This study developed a scale for public health nurses supporting resident groups toward community-building and verified its reliability and validity. DESIGN AND SAMPLE: In this cross-sectional investigation, self-administered questionnaires were distributed to 1,924 public health nurses in Japanese municipalities. MEASUREMENTS: The questionnaire included items on the public health nurses' demographic attributes, the developmental stage of the resident groups they supported, a draft scale, and an external criterion. Reliability was verified by calculating the alpha coefficient and test-retest reliability. To clarify construct validity, we conducted exploratory and confirmatory factor analyses. RESULTS: We analyzed 570 questionnaires. The scale was structured using 30 items covering four factors: "Creating opportunities to connect with community residents, other groups, and governments," "Stimulating activities by improving organizational capacity," "Promoting stable organizational management," and "Providing opportunities to review community health issues and activities." The Cronbach's alpha coefficient for this scale was 0.944. The intraclass correlation coefficient was 0.923 using test-retest relativity. Correlations were noted for criterion-related validity (r = 0.388, p < .01). Confirmatory factor analysis with structural equation modeling revealed a reasonable fit to the data. CONCLUSIONS: The scale for public health nurses supporting resident groups toward community-building was confirmed to be reliable and valid.