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.

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.

The crucial importance of accurate enumeration to bringing public health nurses out from behind the "Other" category.

Public health nursing is a unique field of nursing with specialized skills, roles, and functions designed to address disease prevention and health promotion of populations and to respond to emerging health crisis such the COVID-19 pandemic. Despite the unique role and professional responsibilities of public health nurses, they are not identified as a distinct nursing specially by the U.S. Bureau of Labor Statistics workforce data. This is problematic as accurate enumeration of public health nursing can supply the necessary data to identify gaps of these essential professionals. To effectively address this gap and have the capacity to identify public health nursing workforce needs, a method to define, describe, and enumerate the public health nursing workforce nationally with a unique split Standard Occupational Classification is necessary. Further, the Centers for Disease Control and Prevention's Public Health and Data Authority must have the ability to coordinate data reporting on the public health workforce, support standardization, and streamline annual enumeration.

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.

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.

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.

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

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

Organizational commitment and quality of life at work among public health nurses in Israel.

OBJECTIVE: To test the relationship between job satisfaction, professional self-image, work environment, organizational commitment (OC), and quality of life at work (QoLW) among public health nurses in Israel. To determine which variables can predict OC and QoLW among public health nurses. DESIGN AND SAMPLE: One hundred and thirty-two public health nurses participated in this cross-sectional study with a structured self-administered questionnaire that examined OC, professional self-image, job satisfaction, nursing work environment, and QoLW. Pearson correlation tested correlations between variables and multiple regression was conducted to predict OC and QoLW. MEASUREMENTS: The five measurements (job satisfaction, professional self-image, work environment, OC, and QoLW) based on validity questionnaires with high internal confident. RESULTS: All five variables showed a significant positive correlation. Job satisfaction (t = 5.77, p < 0.001) and nursing work environment (t = 4.55, p < 0.001), contributed significantly to the explanation of OC and QoLW variance. Nursing work environment (t = 6.42, p < 0.01) and job satisfaction (t = 2.99, p < 0.01) were the variables that predicted QoLW. CONCLUSIONS: Nursing managers should be proactive and create a professional environment for nurses to encourage their OC and QoLW as factors that may influence public health nurses.

The Public Health Intervention Wheel in Norway.

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

Public health nurses' activities at a time of specialization in nursing-A national study.

OBJECTIVES: To provide a detailed, up-to-date account of the job description and practice areas of current public health nurses. DESIGN AND SAMPLE: A cross-sectional study. A sample of 824 public health nurses, 80% of public health nurses in Israel, participated in a national structured survey. MEASURES: A structured questionnaire eliciting self-reported public health nursing activities, priorities, perceived deficiencies, and job satisfaction was compiled. RESULTS: Nearly 70% of surveyed public health nurses provided individual-level interventions and less population-health-focused activities such as community needs assessments and development and implementation of community-based projects. CONCLUSIONS: Advanced training should be required in several areas of practice and the scope of public health nurses' practice should be expanded, with greater emphasis on population health.

Sexually transmitted disease services and third-party payer reimbursement: Attitudes, knowledge, and current practices among 60 health departments/districts. Why does this matter to public health nurses?

OBJECTIVE: To assess staff attitudes, knowledge, and current practices in billing third-party payers for sexually transmitted disease (STD) services in public health departments/districts. DESIGN AND SAMPLE: A cross-sectional, online survey was administered to staff at 60 urban and rural health departments/districts. Snowball sampling was used for greater representation. There were 311 staff responses from 56 agencies represented in the data analysis. Of the 311 responses, 106 were public health nurses and seven of the health directors had nursing backgrounds. MEASUREMENT: The survey measured attitudes, knowledge, and current billing practices for STD services. Analysis of data was performed at both individual and agency level. RESULTS: Almost 90% reported it was acceptable to bill insurance. However, 56% felt these services should remain a "free" service in the agency. Most agencies were billing Medicaid for STD services (95%) and 70% bill private third-party payers. CONCLUSIONS: Current funding for public STD clinics is not sustainable and other viable income streams such as third-party payer reimbursement must be utilized. Public health nurses play a pivotal role in developing policies and procedures in billing third-party payers for STD and other clinical services. Understanding the interactions between attitudes, knowledge and practice are vital in this development.

[Relationship between the manpower of full-time and part-time public health nurses and standardized mortality ratios: An ecological study in municipalities in Japan].

Objectives　The purpose of this ecological study was to clarify the relationship between the manpower of full-time and part-time public health nurses (PHNs) and standardized mortality ratios (SMRs) in municipalities in Japan.Methods　We divided 1,225 municipalities with a population over 10,000 for which SMRs were officially published into two groups based on whether the municipality had established a public health center (PHC): general municipalities and PHC-established cities. A linear mixed model was used to examine the relationships among the number of full-time PHNs; cumulative total number of workdays for part-time PHNs; and other healthcare and social welfare resources for SMRs for all causes, malignant neoplasms, cerebrovascular disease, and heart disease.Results　A higher cumulative total number of workdays for part-time PHNs was significantly associated with lower SMRs in both groups for all causes (males and females), lower SMRs in the general municipalities for malignant neoplasms (males) and heart disease (males), and lower SMRs in PHC-established cities for malignant neoplasms (males and females). The number of full-time PHNs had no effect on SMRs.Conclusion　This study suggested that an increase in the manpower of municipal PHNs improves the health and wellbeing of residents.

Challenges and demands in the population-based work of public health nurses.

AIMS: Government programs and the Norwegian Directorate of Health give public health nurses in Norway an explicit role in population-based health promotion and disease-prevention work. The aim of this paper is to explore Norwegian public health nurses' experiences with population-based work. METHODS: A phenomenological hermeneutic approach was adopted, involving face-to-face interviews with a purposeful sample of 23 public health nurses from urban and rural districts in two counties in Norway. RESULTS: Three themes were identified: the predominance of work at the individual level, a lack of resources, and adherence to administrative directives. The interviews revealed that the public health nurses were mostly occupied with individual problem-solving activities. Population-based work was hardly prioritized, mostly because of a lack of resources and a lack of recognition of the population-based role of public health nurses. CONCLUSIONS: The study indicates contradictions between the public health nursing practice related to population-based work and the direction outlined by the government and the public health nursing curriculum, which may mean that the public health nursing role is not sufficiently clarified. The implementation of practice models and administrative directives and resources, as well as an explicit emphasis on population health in public health nursing education, can contribute to increased population-based interventions. Greater knowledge of and emphasis on population-based work in public health nursing are needed.

The structure of the perceived professional identity of Japanese public health nurses.

OBJECTIVE: As health problems become more diverse and complicated, the way public health nurses (PHNs) work is changing. Research at the conceptual level of professional identity of PHNs is lacking. This study aimed to explore the structure of the perceived professional identity of Japanese PHNs. DESIGN AND SAMPLE: Grounded theory method was used. Twenty-five PHNs in Japanese municipalities were participated in the study. MEASUREMENTS: Data were collected through semistructured interviews and analyzed using open, axial, and selective coding. RESULTS: Three categories emerged: (1) providing support to the consulter directly, (2) working as a member of the administrative organization, and (3) working for all residents to improve community development. The modality of perceived professional identity showed interindividual and intraindividual differences and was either stable or unstable. The perceived professional identities coexisted, but there was a conflict between (1) and (2). CONCLUSION: PHNs should be made aware of the three identities revealed in our study and the possibility of a conflict between identities. Moreover, to ensure working for all residents to improve community development, a population-based approach to education is needed with cooperation of universities and clinical practice.

Caries risk assessment tool and prevention protocol for public health nurses in mother and child health centers, Israel.

OBJECTIVES: Dental caries is the most prevalent chronic disease in children. Caries risk assessment tools enable the dentists, physicians, and nondental health care providers to assess the individual's risk. Intervention by nurses in primary care settings can contribute to the establishment of oral health habits and prevention of dental disease. In Israel, Mother and Child Health Centers provide free preventive services for pregnant women and children by public health nurses. MATERIALS AND METHODS: A caries prevention program in health centers started in 2015. Nurses underwent special training regarding caries prevention. A customized Caries Risk Assessment tool and Prevention Protocol for nurses, based on the AAPD tool, was introduced. A two-step evaluation was conducted which included a questionnaire and in-depth phone interviews. RESULTS: Twenty-eight (out of 46) health centers returned a completed questionnaire. Most nurses believed that oral health preventive services should be incorporated into their daily work. In the in-depth phone interviews, nurses stated that the integration of the program into their busy daily schedule was realistic and appropriate. The lack of specific dental module for computer program was mentioned as an implementation difficulty. DISCUSSION: The wide use of our tool by nurses supports its simplicity and feasibility which enables quick calculation and informed decision making. The nurses readily embraced the tool and it became an integral part of their toolkit. CONCLUSION: We provide public health nurses with a caries risk assessment tool and prevention protocol thus integrating oral health into general health of infants and toddlers.

Relationships between public health nurse-delivered physical activity interventions and client physical activity behavior.

AIM: The purpose of this study was to identify physical activity interventions delivered by public health nurses (PHNs) and examine their association with physical activity behavior change among adult clients. BACKGROUND: Physical activity is a public health priority, yet little is known about nurse-delivered physical activity interventions in day-to-day practice or their outcomes. METHODS: This quantitative retrospective evaluation examined de-identified electronic-health-record data. Adult clients with at least two Omaha System Physical activity Knowledge, Behavior, and Status (KBS) ratings documented by PHNs between October 2010-June 2016 (N=419) were included. Omaha System baseline and follow-up Physical activity KBS ratings, interventions, and demographics were examined. RESULTS: Younger clients typically receiving maternal-child/family services were more likely to receive interventions than older clients (p<0.001). A total of 2869 Physical activity interventions were documented among 197 clients. Most were from categories of Teaching, Guidance, Counseling (n=1639) or Surveillance (n=1183). Few were Case Management (n=46). Hierarchical regression modeling explained 15.4% of the variance for change in Physical activity Behavior rating with significant influence from intervention dose (p=0.03) and change in Physical activity Knowledge (p<0.001). CONCLUSION: This study identified and described physical activity interventions delivered by PHNs. Implementation of department-wide policy requiring documentation of Physical activity assessment for all clients enabled the evaluation. A higher dose of physical activity interventions and increased Physical activity knowledge were associated with increased Physical activity Behavior. More research is needed to identify factors influencing who receives interventions and how interventions are selected.

Public Health Nursing Practice in the Affordable Care Act Era: A National Survey.

OBJECTIVES: To explore public health nurses' knowledge, perceptions, and practices under the Affordable Care Act (ACA). DESIGN AND SAMPLE: A cross-sectional, web-based survey was completed by a sample of 1,143 public health nurses (PHNs) in the United States. MEASURES: Descriptive statistics were analyzed for variables related to general knowledge and perception of the ACA and for the extent of involvement in activities related to the implementation of the ACA. Qualitative analysis was conducted on free text comments to two open-ended questions about current and future PHNs involvement in the ACA. RESULTS: Approximately 45% of PHNs reported changes in their daily work due to the ACA. PHNs reported being very or somewhat involved in these activities of the ACA: integration of primary care and public health (62%), provision of clinical preventive services (60.3%), care coordination (55.4%), patient navigation (55.3%), establishment of private-public partnerships (55.3%), population health strategies (53.6%), population health data assessment and analysis (53.8%), community health assessments (49%), involvement in medical homes (37.8%), provision of maternal and child health home visiting services (32.1%), and involvement in Accountable Care Organizations (29.2%). CONCLUSION: PHNs are making substantial contributions to implementation of the ACA.

Counseling Immigrant Parents about Food and Feeding Practices: Public Health Nurses' Experiences.

OBJECTIVES: To describe the experiences of public health nurses (PHNs) in counseling immigrant parents on food and feeding practices at child health centers (CHCs). DESIGN AND SAMPLE: In this study employing a qualitative description (QD) approach, the participants (n = 26) were PHNs from five CHCs in the greater Oslo region of Norway. MEASURES: Data were collected through five focus group interviews and examined using qualitative content analysis. RESULTS: Counseling on food and feeding practices was an important topic in most consultations with immigrant parents. The PHNs were concerned that the child should eat ordinary, healthy food regularly. Immigrant families were often experienced as a "generic group" and the PHNs disclosed that they rarely adjusted their counseling strategy based on enquiries about families' food culture or parents' level of education or knowledge. Time constraints and language and cultural barriers were common challenges. The PHNs suggested that culturally adapted information materials and visual aids from health authorities could improve communication. CONCLUSIONS: Counseling immigrant parents on food and feeding at CHCs is often challenging for PHNs. The study findings could be used in the development of guidelines to assist PHNs in delivering culturally competent counseling about food and feeding practices.

Understanding Barriers for Communicating Injury Prevention Messages and Strategies Moving Forward: Perspectives from Community Stakeholders.

OBJECTIVES: The primary objective of this study was to elicit the perspectives of direct care providers on barriers and facilitators to communicating injury prevention messages to parents/caregivers of children under 4 years of age. The secondary objective was to examine characteristics of an injury prevention messaging strategy preferred by direct care providers. DESIGN AND SAMPLE: This qualitative study was conducted across four regions in Ontario Canada. Fifty-nine direct care providers were purposefully sampled and data interpreted using focus group analysis. MEASURES: Transcripts were analyzed verbatim using content and discourse analysis. RESULTS: Several barriers to communicating injury prevention messages were identified encompassing (a) role, (b) parental, (c) social determinants, and (d) evidence impediments. In an effort to offset some of these barriers, participants endorsed the development of a tailored multicomponent injury prevention strategy adopting action-based messages. CONCLUSION: The results of this study provide an in-depth exploration of direct care providers perceptions that can inform the design of materials and dissemination strategies to help increase and optimize access to injury prevention information. Injury prevention messages should be action-oriented, specifically tailored to the stage of child development, and disseminated through both face-to-face interactions and mobile technology.

Vaccination-Related Side Effects, Humoral Immunity, and Adverse Events during the Civilian Smallpox Vaccination Campaign, Arkansas, 2003.

OBJECTIVE: Smallpox vaccination has been associated with notable side effects and adverse events. This study assessed the frequency of each among public health workers immunized during the 2003 Arkansas civilian smallpox vaccination campaign to allow individuals and policymakers to make informed decisions whether repeat vaccination, as recommended in 10-year intervals, should be considered. DESIGN AND SAMPLE: This descriptive study summarizes postvaccination surveillance data for all civilians receiving smallpox vaccine (Dryvax) in Arkansas in 2003. MEASURES: Rates of side effects and adverse events were determined. Vaccinia-specific antibody titers among a subset of public health response team members were also assessed. RESULTS: Of the 1,124 vaccine recipients, 87% had a major take response. Substantial symptomatology, a 2% adverse event rate, a 0.5% hospitalization rate, and zero inadvertent transmission following vaccination were observed. Vaccinia-specific antibody titers increased on average 9-fold from 2.21*10(2) to 2.16*10(3) one month after vaccination. We found no association of age, sex, or racial subgroups with adverse events, hospitalizations, a lower take response rate, or lower postvaccination antibody titers. CONCLUSIONS: Prominent side effect profiles and adverse events among study participants seem to support individual and institutional reluctance to vaccinate civilians in the absence of smallpox reemergence.