Barriers and facilitators to the achievement of community-focused public health nursing practice: a UK perspective

Aim  To explore the extent to which Community Health Nurses (CHN) engage in community-focused public health practice and the facilitators and barriers to such practice.
Background  The government promotes the role of nurses in public health. However, there is confusion as to what constitutes public health; a lack of support to move from individual and family-focused practice to community-focused practice; and, inconsistency of the use of titles.
Method  A 15% quota sample ( n  = 409), drawn from a population of 2668 CHNs, participated in a quantitative survey.
Results  Response rate was 67% ( n  = 275). Over half of CHN time was spent with individuals and families, community level activity accounting for only 18%. Only 9% of respondents had completed a community needs assessment. Education was key to the promotion of community-focused practice with collection of individual activity data a major barrier.
Conclusions  There is a gap between the rhetoric and reality of community public health nursing.
Implications for Nursing Management  Development of a shared vision of public health nursing and commissioning of education to meet public health priorities is essential. Furthermore, strengthening public health nurse leadership to foster innovative practice and methods of measuring public health nursing outcomes is required.     

Moving upstream: Becoming a public health nurse, part 2

This article extends the argument in Part 1 that stand- ards, protocols, textbook knowledge, and other external guidelines, while important for beginners, must yield to the "real world" of practice. Additional narratives document how the development of practical reasoning, perceptual skills, and responsiveness to clients supplants the beginner's reliance on external guidelines and promotes a situated understanding of practice. This growth in understanding and clinical know-how, cultivated by frontline experience with individuals and families, fosters a perceptual grasp of the "big picture" and makes it possible for the nurse to learn the community through the eyes of clients. Experiences from home visiting and community-based activities provide critical lessons that inform and inspire nurses to act and think upstream. This interpretation provides additional evidence for legitimizing clinical practice as a rich source of situated knowledge and clinical reasoning.     

Overcoming barriers and improving public health nursing practice

Public health nurses (PHN) are critical to ensuring the health of communities. Absent the most basic information on the PHN workforce in our state, we conducted interviews with 21 PHN and school health nurse (SHN) leaders and an online survey of PHNs and SHNs practicing in Maryland (N = 491). Our study identified an older, very experienced, and well-educated workforce. Both the interviews and survey identified similar barriers: low salaries, recruitment and hiring challenges, limited funding for public health programs, and no opportunities for education or career advancement. Survey participants also identified barriers of inadequate leadership, recognition, and communication including PHNs not being represented at decision-making tables or at the state leadership level. Strategies to promote public health nursing from leaders and survey participants were similar: increasing awareness about what public health and PHNs do and their value; improving advocacy and stakeholder engagement; improving access and availability of services; improving PHN leadership representation at the state level; a improving PHN salaries and benefits including tuition reimbursement. Although results were similar to national studies, comprehensive, granular workforce data is critical to ensure the public health workforce can meet current and emerging public health needs and that public health infrastructure and services are appropriately funded.     

The Precautionary Principle, public health, and public health nursing

ABSTRACT The Precautionary Principle posits that, in the absence of certainty, the appropriate course of action is to err on the side of caution. The Principle has been applied to decision making and policy development related to environmental health issues both internationally and in the United States. The American Public Health Association and the American Nurses Association (ANA) have issued policy statements that invoke the Precautionary Principle, and the Principle has been incorporated into statements that describe the practice of public health nursing. Nursing has always recognized the relationship of the environment with the health of humans—individuals, families, populations, and communities (ANA). The increasing attention to the Precautionary Principle comes at a time of redefinition of the field of public health, environmental public health, and the practice of public health nursing. Thus, it is crucial that practicing public health nurses understand the Precautionary Principle and its relevance to the practice of public health, public health nursing, and the current and future health individuals, families, populations, and communities.     

Community health care nursing in Rajasthan. A registered nurse's perspective

This study focused on the great shortage of registered nurses (RNs) in primary health care in Rajasthan, India. It dealt especially with the nurses' own opinions about working in primary health care and their reasons for not working in it. Nurses at different levels in the health care organization were interviewed. The study was based on interviews with six RNs individually, three groups of six to eight nursing students each, and three policy-making chief nurses individually. The Minister of Health in Rajasthan also participated in the study. The study showed that the reasons for the lack of RNs in community health care were as follows: a government policy decision to place less educated nurses in the communities; the great shortage of nurses in general; the system whereby a nurse is not able to choose her/his place of work; unwillingness on the part of the nurses to work in community health care because of the great security problems; lack of support from authorities and lack of equipment. In general, community health care nursing as a work area was despised by society at large in Rajasthan.     

Development and testing of a practicum matching program for baccalaureate nursing education,a local public health unit

This article describes a novel approach to nursing education, designed to improve the experience of both students in public health nursing, and the local public health unit where they affiliate. Students, faculty, and public health department staff developed a method for matching programs and needs of the local public health unit to the skills and learning needs of nursing students. We describe our experience articulating student competencies, program-specific functions, and an approach to matching student interests and learning opportunities to agency needs. Students, faculty, and staff rated the program moderately to very high in feasibility, satisfaction, and acceptability. Data suggest the novel program served to improve the quality of the practicum affiliation, to the satisfaction of both the school and agency, while contributing to a robust public health learning experience for emerging professional nurses.     

Partnerships for learning population-based public health nursing: Web-delivered continuing education for public health nurse preceptors

Public health and other community health nurses frequently serve as preceptors to undergraduate student nurses learning population-based nursing in community/public health practicum courses. The extent of preparation and support for the preceptor role provided by schools of nursing is often limited. One strategy to address this problem is to provide targeted, Web-delivered continuing education (CE) to preceptors. A Web-delivered CE course entitled, "Partnerships for Learning Community Health Nursing," was created and pilot tested. Course content includes preceptor roles; assisting students in learning population-based public health nursing, critical thinking, and cultural competence; learning styles and teaching strategies; what to do in challenging situations; evaluation and feedback; and specific information about school policies, procedures, and course assignments. Precourse knowledge was assessed using a mailed survey. Postcourse knowledge and satisfaction were assessed using questions embedded in the course. Postsemester knowledge and satisfaction were evaluated through a postsemester survey. Knowledge gain was tested using repeated measures ANOVA and paired t tests. Thirteen preceptors participated in the pilot test. Repeated measures ANOVA indicated that knowledge gain occurred (multivariate F=55.603, df=2, error df=11, p<.0001). Participants increased knowledge from pretest to posttest (t=-10.25, p<.00001) and from pretest to end of the semester (t=-4.95, p<.0003). Knowledge decline from end of course to end of semester was not significant (t=1.94, p=.08). Participants reported satisfaction with the course. Web-delivered CE for community/public health nurse preceptors can support preceptor learning and is an acceptable method for receiving this type of education. Further research is needed on the impact of preceptor education on student learning.     

Leadership and management in mental health nursing

blegen n.e. & severinsson e. (2011) Journal of Nursing Management 19 , 487–497
Leadership and management in mental health nursing Background Mental health nurses are agents of change, and their leadership, management role and characteristics exist at many levels in health care. Previous research presents a picture of mental health nurses as subordinate and passive recipients of the leader’s influence and regard leadership and management as distinct from the nurses’ practical work. Aim The aim was to provide a synthesis of the studies conducted and to discuss the relationship between nursing leadership and nursing management in the context of mental health nursing. Method A literature search was conducted using EBSCO-host, Academic Search Premier, Science Direct, CINAHL and PubMed for the period January 1995–July 2010. Results Leadership and management in the context of mental health nursing are human activities that imply entering into mutual relationships. Conclusion Mental health nurses’ leadership, management and transformational leadership are positively related in terms of effectiveness and nurses’ skills. Implication for nursing management It is important to consider mental health nurses’ management as a form of leadership similar to or as a natural consequence of transformational leadership (TL) and that ethical concerns must be constantly prioritized throughout every level of the organization.     

A public health nursing practice model: melding public health principles with the nursing process

There has been a shift in emphasis in public health from the provision of personal health services for individuals to efforts targeted at improving the health of the whole community. Many in public health nursing (PHN) have welcomed this shift, recognizing the important role PHN can play in promoting health and preventing disease for all. There continues to be a need to redefine PHN roles and practice so that public health nurses can participate more effectively. Los Angeles County Department of Health Services Public Health Nursing (LAC PHN) has developed a practice model grounded in nationally recognized components: the public health team, PHN standards of practice, the 10 Essential Public Health Services, Healthy People 2010's 10 Leading Health Indicators and additional local indicators, and the Minnesota Public Health Nursing Interventions Model. The LAC PHN Practice Model provides a conceptual framework that assists in clarifying the role of the public health nurse and presents a guide for public health practice applicable to all public health disciplines.     

Nurse leadership within primary care: the perceptions of community nurses, GPs, policy makers and members of the public

AIM: The aim of this section of a wider study was to seek the views of community nurses, general practitioners, members of the public and policy makers on nursing leadership in primary care. The wider study aimed to review the role and function of primary care services and community nursing with reference to developments in practice, education, research and policy. BACKGROUND: Key messages, challenges and opportunities for leaders within nursing have been highlighted in the literature and in turn emphasis placed on the positive effect this would have on improved quality of services [Department of Health and Social Services (1998) Valuing Diversity...A Way Forward. Department of Health and Social Service, Belfast]. In order to grasp these opportunities, nursing has to invest in the development of leaders. METHODS: A two round Delphi technique was employed using a focus group approach in round one and a postal questionnaire in round two. Semi-structured interviews were carried out with senior policy makers. RESULTS: Findings show that there was agreement that strong leadership was needed for the development of community nursing but that at present there is confusion and disagreement over whether it exists currently. Other findings focus on problems inherent in identifying future nurse leaders. CONCLUSION: The traditional subservient culture of community nursing is blamed for the perceived inability to nurture strong leaders. Recommendations are made for the development of nurse leaders.     

Identification of nurses' competencies in primary health care through a Delphi study in southern Brazil

ABSTRACT Objective: This investigation aimed to identify and analyze the general and specific competencies of nurses in the primary health care practice of Brazil.
Design: The Delphi Technique was used as the method of study.
Sample: 2 groups of participants were selected: One contained primary health care nurses ( n =52) and the other specialists ( n =57), including public health nurses and public or community health faculty.
Measurements: 3 questionnaires were developed for the study. The first asked participants to indicate general and specific competencies, which were compiled into a list for each group. A Likert scale of 1–5 was added to these 2 lists in the second and third questionnaires. A consensus criterion of 75% for score 4 or 5 was adopted.
Results: In the nurses' group, 17 general and 8 specific competencies reached the consensus criterion; 19 general and 9 specific competencies reached the criterion in the specialists' group. These competencies were classified into 10 domains: professional values, communication, teamwork, management, community-oriented, health promotion, problem solving, health care, and education and basic public health sciences.
Conclusions: These competencies reflect Brazilian health policy and constitute a reference for health professional practice and education.     

Three population-patient care outcome indicators for public health nursing: results of a consensus project

ABSTRACT Objectives: Difficulties in recruiting nurses into public health settings threaten the public's health. Gaps in existing data make determining the health impact of workforce changes numbers difficult to perform. Public health practice leaders are left to make difficult staffing and program decisions without knowing how the health of their vulnerable populations will be affected. The objective of this study was to identify indicators that could be used to document the effect of the shortage of public health nurses (PHNs) on the health of a population. Design and Sample: A consensus‐building process was used. Nursing directors from 6 local health departments (LHDs) in 2 states participated along with 3 public health system researchers. Results: The findings from this collaborative process suggest that it is possible to identify outcome indicators across states and multiple LHDs that may be sensitive to PHN staffing levels and interventions. Possible connections between PHN staffing and each population‐patient care indicator (rates of Chlamydia, first trimester prenatal care, early childhood immunization) are presented. Conclusions: The process used here in identifying these indicators and the proposed nursing‐sensitive population outcome indicators themselves provide a template for the development and analysis of additional outcome indicators sensitive to the quality of nursing and other health care.     

Improving public health nursing education: recommendations of local public health nurses

OBJECTIVES: This paper reports recommendations for improving public health nursing (PHN) undergraduate, graduate, and continuing education (CE) made by staff-level public health nurses working in local health departments (LHDs). Implications for academia and practice are discussed. DESIGN: A cross-sectional written survey was used to collect data from 424 public health nurses in 76 LHDs in Wisconsin (68% response rate) in 2003. Recommendations for improving undergraduate, graduate, and CE were made through responses to open-ended survey questions. Content analysis was conducted to identify major themes among responses. RESULTS: Major themes emerging from the recommendations for undergraduate education included the need for more clinical public health experiences and population-focused practice content. Graduate education improvement recommendations included addressing access barriers and increasing organizational incentives. Improved access and more public health content were the major recommendations for improving CE. CONCLUSIONS: Implications for academia focus on increasing opportunities for students to experience population-focused PHN and to learn organizational and collaborative practice skills, supporting PHN preceptors and building evidence for PHN intervention through research. Implications for practice include the need to expand opportunities for students with LHDs and to collaborate with academic partners for education and research.     

Evaluation of a statewide public health nursing training in Utah

Public health nurses continue to struggle to provide culturally relevant services that focus on the multiple needs of an ethnically diverse population while at the same time providing services to the population at large. This article describes the formative research, implementation, and results of a statewide effort to broaden UtahAEs public health nurses perception about their role and responsibility in addressing and serving the emerging needs of underserved and atrisk populations in Utah. A total of 51% of Utah state and local health department public health nurses participated in the training. There was a statistically significant increase in the mean level of perceived understanding of topic material from pretest to posttest, and 80% of participants reported applying what they learned in the training to their practice. Our experience demonstrates that even with limited resources, it is possible to deliver high quality training to a large proportion of public health nurses practicing in urban, rural, and frontier populations; observe significant results in their comprehension of training material and, most importantly; see application of what they learned in the training to their health care practice.     

社区公共卫生应急护理培训的实施及效果

[目的]探讨社区突发公共卫生应急护理培训的内容及培训模式,提高社区护理人员突发性公共卫生事件应急护理能力。[方法]采用互动式学习、开放式教育方法对郑州市79名社区护士进行社区公共卫生应急护理培训,培训前后进行考核,分析培训效果。[结果]79名社区护士培训后突发公共卫生应急护理知识、技能与健康教育运用能力等较培训前提高。[结论]社区突发公共卫生应急护理培训应以全国卫生应急工作培训规划为指导,以完善的评价系统为保障,充分体现"三结合"即培训与当地医疗服务实际相结合,培训与护理人员的自身需求相结合,培训中多种教学形式相结合,提高培训效果。     

School nursing on the iron range in a public health nursing model

Frontier nursing in the public health model might invoke images of school nurses on horseback in rural Kentucky or the wilds of the western prairies. Northern Minnesota was a frontier in the last decade of the 19th century, due to the discovery of one of the richest seams of iron ore on the North American continent. Immigrants from Europe responded to the opportunities this discovery created. Among the many Finns arriving on the Iron Range of Minnesota, as it came to be named, were the parents of Lillian Augusta Wilhelmena Beck, John and Hulda Beck. Over her more than nine decades of life, their daughter became one of the most well known school nurses on the Iron Range. Her story evokes memories of the creation of school nursing in the public health model by nurses at the Henry Street Settlement in New York City.     

The best of public health nursing, circa 1941

ABSTRACT Public health nursing was the term Lillian Wald used to describe the work of nurses whose role it was to address both the immediate impact of sickness and the underlying relationship between poverty, social disadvantage, environmental hazards, and disease. The nature and content of American public health nursing of the 1930s are reflected in exemplars from Marguerite Wales's 1941 book, The Public Health Nurse in Action . Nurses' roles as educators, caregivers, and case managers overcoming barriers emerge from the tales. These vignettes illustrate the organic relationships that existed between nurses and communities. Nurses' understanding of the nature and influence of environmental, psychological and social factors on health behavior was essential to effective public health work. Their stories help us interpret the meaning of nursing at a moment in time. They also reflect the values of the founders of Henry Street Nursing Service and supervisors of public and voluntary agencies throughout the U.S. and Canada who selected and edited them for instructive purposes. Reading collections of such narratives also helps us to appreciate the difficulty of negotiating complex needs, and may provide greater appreciation for the work of our predecessors as well as our own.