Meeting the continuing education needs of rural nurses in role transition

BACKGROUND: The community health center (CHC) model of care delivery is gaining acceptance throughout Canada's newly created rural health regions. The resulting change in nursing functions presents a challenge to regional health authorities to ensure the attainment and maintenance of practice competencies. METHOD: This qualitative study examined strategies used in selected parts of Canada to prepare and support rural diploma-prepared nurses for role transition from acute care into CHCs. RESULTS: In light of CHC nurses' increased degree of autonomy, skill level, and focus on community wellness, the findings indicate a need for additional educational preparation and supportive strategies for transitioning nurses. CONCLUSION: Regions should educate the public and staff about the principles of primary health care, population health, and factors that determine health to help stakeholders understand their community, the current gaps in service delivery, and the role of CHC nurses. Key players at the provincial level should work together to address competency issues and continuing education needs of nurses in career transition.     

Public health nursing: the generalist in a specialized environment

In implementing a generalist model of public health nursing (the Comprehensive Multi-level Nursing Practice Model) in a rural county health department, a research team encountered critical challenges. The framework for the model was a philosophy of public health nursing practice and action research to support the public health nurse generalist role. Challenges in implementing the model stemmed from conflicts between the research team and the health department that were rooted in philosophical differences about how to implement care and the nature of nursing and the public health nursing role. Key factors were the subtle forces operating in the public health environment that constrain the public health nurse generalist role. Based on conflicts that arose in implementing the model, implications for public health nursing practice are in opportunities to influence policy at health department and other levels and responsibility for assuring professional practice.     

Feminism and public health nursing: partners for health

It is a well-known fact that nursing and feminism have enjoyed an uneasy alliance. In recent years, however, nursing has begun to recognize the importance of feminism. Nevertheless, the literature still rarely addresses the relevance of feminism for public health nursing. In this article, I articulate the relevance of feminism for public health nursing knowledge and practice. First, I define and describe feminism and public health nursing and then I discuss the importance of feminism for public health nursing practice. The importance of feminism for the metaparadigm concepts of public health nursing is then reviewed. Finally, I examine several existing challenges relating to feminism and public health nursing research, education, and practice. The thesis of this article is that feminism is vitally important for the development of public health nursing and for public health care.     

Progression of the mental health nurse practitioner role in Australia

The guiding principle of health care is to serve the needs of the public. Healthcare services are therefore required to be increasingly flexible and open to new approaches to meet changing demands. They must also adjust and expand as new challenges are presented. Public awareness of mental health issues and the current demands placed on health services for access to affordable and appropriate mental health care have never been so great. The introduction of nurse practitioners (NPs) in Australia is a proud and long-anticipated moment for the discipline of nursing. However, a major challenge for the introduction of NPs in Australia will be to reassure medical colleagues, allied health professionals and the public that NPs are able to deliver high-quality primary care. This paper elaborates on the progress of the mental health NP role in Australia. Attention is centred on the characteristics the mental health NP role, the maintenance of professional competency to practise at an advanced clinical level, and the prospects and potential significance of NPs for mental health nursing practice. The nurse-led clinic, implemented through the process of consultation and systematic evaluation, is identified as an avenue for the extension of mental health NP practice in the delivery of autonomous primary care.     

Primary health care in public health nursing

Despite similarities between the goals of primary health care and public health nursing, several obstacles stand in the way of public health nursing's ability to perform its role in achieving an acceptable level of health for all by the year 2000. The purpose of this paper is to describe the essential components of primary health care and public health nursing, discuss obstacles in the way of public health nursing fulfilling its primary health care role, and to pose solutions at the levels of education, practice, and research for overcoming these obstacles.     

Public health nursing in Greece

Nursing is considered, as the main profession that covers the need for primary health care services, in cooperation with physicians and other health and social care professions. In Greece, public or community health nursing as a concept exists since the beginning of professional nursing in the seconf half og the 19 century. There are three professions in Greece that are mainly involved in the provision of community nursing services. These are general nurses, health visitors, and midwives. General nurses are educated at degree level in the university or polytechnics. Health visitors and midwives are separate professions, also educated at degree level in polytechnics. Although all general nurses are prepared to work at any level of health care provision, they are not considered adequately educated to perform their full role in the community, with just their existing knowledge and experience. It is therefore essencial that further education or specialization is needed, in order that they could practice independently or as members of the primary health care teams effectively, and be able to respond to public health needs of the population     

Perceptions of public health nursing: views from the field

While there has been considerable debate about future roles for public health nurses, there is little research that explores public health nursing from the practitioner's perspective The findings reported in this paper are part of a larger study that explored public health nurses' perspectives and experiences of their practice what they do and how they feel about what they do Qualitative data were gathered through in-depth individual and focus group interviews with 28 female public health nurses (PHNs) in Alberta, Canada This paper describes how PHNs feel about their work The analysis revealed that public health nurses perceived that their work was valuable and worthwhile, enjoyable, demanding, and not well understood by others These perceptions are discussed in terms of their implications for the future role of public health nursing in a reformed health care system and for the quality of nursing work-life     

Primary care quality: community health center and health maintenance organization

OBJECTIVE: This study compares the primary health care quality of community health centers (CHCs) and health maintenance organizations (HMOs) in South Carolina to elucidate the quality of CHC performance relative to mainstream settings such as the HMO. METHODS: Mail surveys were used to obtain data from 350 randomly selected HMO users. Surveys with follow-up interviews were conducted to obtain data from 540 randomly selected CHC users. A validated adult primary care assessment tool was used in both surveys. Multivariate analyses were performed to assess the association of health care setting (HMO versus CHC) with primary care quality while controlling for sociodemographic and health care characteristics. RESULTS: After controlling for sociodemographic and health care use measures, CHC patients demonstrated higher scores in several primary care domains (ongoing care, coordination of service, comprehensiveness, and community orientation) as well as total primary care performance. CONCLUSION: Users of CHC are more likely than HMO users to rate their primary health care provider as good, except in the area of ease of first contact. The positive rating of the CHC is particularly impressive after taking into account that many CHC users have characteristics associated with poorer ratings of care.     

Graduate education for advanced practice public health nursing: at the crossroads

The complexity of public health problems and advancement of science framing public health demand an expansion of traditional educational approaches and curriculum to prepare a futuristic advanced practice public health nursing (APPHN) workforce. This position paper sponsored by the Association of Community Health Nursing Educators challenges nurse educators to apply innovative strategies in preparing public health nursing (PHN) professionals and to expand curriculum paradigms to promote PHN's ecological approach to solving problems. To meet the challenges of ensuring public health in the 21st century, advanced practice public health nurses must have greater foundational knowledge in critical content areas discussed in this document. Competence in these areas will enable advanced practice public health nurses to address future health care challenges such as rapidly changing social structures, escalating knowledge explosion, globalization, and growth of new technologies. This education will prepare nurses to forge new knowledge and establish health care teams to create effective solutions.     

Public health: a new nursing role for community practitioners

This article discusses the six key activities identified by the Royal College of Nursing (1994) as essential ingredients for public health nursing. Examples of public health practice and community nurse involvement are given to illustrate each activity. Public health skills such as health profiling, building healthy alliances and policy development are outlined. Current barriers to community nurses participating in these activities are identified and models of public health practice are reviewed. The potential for a radical transformation of community nursing practice is discussed in the context of an expanding public health role of community nurses in Scotland. Options for future practice are presented and discussed.     

Developing simulation games to advance public health nursing competence in baccalaureate education

We describe the development of an innovative baccalaureate nursing education strategy for public health nursing. Virtual simulation pedagogy is known to be effective for acute care nursing practice while less known for public health nursing. Three Canadian nursing schools, the Canadian Association of Schools of Nursing (CASN), and the Canadian Alliance of Nurse Educators using Simulation (CAN-Sim) partnered to develop three public health nursing virtual simulation games. Learners work through unfolding population health scenarios, simulating public health nursing practice focused on entry level public health nursing competencies. Each game fosters clinical reasoning and collaborative, community decision-making to respond to population health issues during community assessment, evidence-informed health promotion planning, and evaluation processes. A companion guide was developed to support best practices in implementing virtual simulation and promote optimum student learning using the public health nursing games.     

The future of graduate education in nursing: Scholarship, the health of communities, and health care reform

The authors critically examine the urgent needs posed by national health care reform and the forces impinging on the nursing profession to prepare nurse practitioners to meet these needs. With references to other struggles in nursing's professional history, the authors caution against exclusive investment in the nurse practitioner role as the discipline's hope for long overdue recognition of nursing's value to society. They argue that with health care reform, nurses have the chance to make graduate nursing education more responsive to the actual health needs of the populace and more relevant for practice in communities. The actions advocated include reflecting carefully on the articulation of nurse practitioner roles with others in the discipline, taking a partisan stand with vulnerable groups, developing substantive expertise in community-based practice and research, applying an understanding of the broader environmental context of health, and committing as a discipline to practice and scholarship that really makes a difference in the health of the public.     

Safe practice of population-focused nursing care: Development of a public health nursing concept

Patient safety, a cornerstone of quality nursing care in most healthcare organizations, has not received attention in the specialty of public health nursing, owing to the conceptual challenges of applying this individual level concept to populations. Public health nurses (PHNs), by definition, provide population-focused care. Safe practice of population-focused nursing care involves preventing errors that would affect the health of entire populations and communities. The purpose of this article is to conceptually develop the public health nursing concept of safe practice of population-focused care and calls for related research. Key literature on patient safety is reviewed. Concepts applying to population-focused care are organized based on Donabedian's Framework. Structural, operational and system failures and process errors of omission and commission can occur at the population level of practice and potentially influence outcomes for population-patients. Practice, research and policy implications are discussed. Safe PHN population-focused practice deserves attention.     

Using behavioral science theory to enhance public health nursing

The application of behavioral science theory is instrumental in advancing nursing research and practice. Nurses can benefit from a thorough understanding of theoretical perspectives related to health behavior change. Behavioral science theory can provide a conceptual context for understanding patient behavior, it can guide research on the determinants of health behavior and health service delivery, and it can offer alternative approaches to nursing practice that may improve the effectiveness of patient care. The aim of this paper is to provide some examples of behavioral theories that can be used in nursing research and practice, and provide an example of how one theory, Stages of Change (Transtheoretical Model), can be applied to older adult fall prevention. Given the critical role behavior plays in premature morbidity and mortality, public health nurses and researchers can benefit by broadening the use of theory in the design and implementation of interventions, using behavioral theory as their guide.     

Thinking beyond "the wheelchair to the car": RN-to-BSN student understanding of community and public health nursing

The purpose of this study was to explore the online discussions of postlicensure nursing students taking a community health course in an RN-to-BSN program. Final discussion forums asked students to share their perceptions and understandings of the public and community health nurses' role and practice after participating in a community health clinical course. Inductive content analysis was used to assess the narratives. Analysis of the discussions yielded two categories: (1) awareness by the RNs of their individual community and the context of the public and community health nursing role, and (2) increased understanding of the patients' experience with transitions between health care settings (home-hospital-home). This research suggests a need to assess practicing RNs' professional understanding and teaching of the public and community health nurses' role if they are to facilitate effective patient transitions home and into community-based settings.     

Preventive work with families: issues facing public health nurses

This paper examines the issues that nurses experience when entering the family system to work preventively. The theoretical basis of family-centered nursing is analysed and the need for empirical work is identified in order to develop a knowledge base for this practice. Some unique characteristics of the public health nursing role are discussed with emphasis on territorial issues, power relationships and accountability problems. The need for public health nurses to function as advanced generalists across different system levels is recommended and family skills necessary for effective family nursing are examined. The authors identify the unique role of public health nurses because they have access to healthy families and families dealing with early stages of health concerns. The authors support the general structure of public health practice as of value for preventive work with families. However, clarity regarding referrals, contracting and the rights of clients is called for to facilitate collaborative family-centred nursing.     

Developing population health competencies among public health nurses in Georgia

As part of a new vision for public health in Georgia, the role of the public health nurse (PHN) is shifting from a predominantly individual and clinic-based care model to a population health practice model. Based on focus groups conducted with management and frontline PHNs in 2001, nurses in Georgia were unprepared for this transition and lacked a strong understanding of population health concepts and competencies. To prepare nurses for their new and expanded responsibilities, an online population health course was developed specifically for currently employed PHNs. The Quad Council PHN Competencies (2003) provided the roadmap in identifying the population health online course and continuing education training program priority competencies for PHNs in Georgia. Along with incorporating the competencies into case studies and didactic learning, the required projects served as evidence of competency application. The population health online course was offered from fall 2000 to spring 2005 in collaboration with Georgia schools of nursing and has enabled a cohort of nurses to lead the way as Georgia transitions into a new public health model. Nurses who completed the course reported greater experience with and an understanding of population health competencies.     

Preparation of community health nursing leaders for social action

Indiana University School of Nursing graduate Department of Community Health Nursing has been preparing community health nurses for primary health care practice, as defined by the World Health Organization since 1978. The faculty are committed to preparing community health nursing leaders for social action aimed at improving the health of the community in both the Department's major in the master's programme and its new major in the doctoral programme. The core curricula for these majors in both programmes are presented. The master's curricula is based on integrating public health principles with those of community development. The doctoral major builds on this base of primary health care practice with a curriculum focused on the contribution of community health nursing to public and health policy. The graduates of the master's programme are prepared to work with community groups as a social force in promoting the health of the community. The graduates of the new doctoral major entitled "Health Policy and the Health of the Community" are being prepared as community health nursing leaders with expertise in health care policy and the legislative process with a focus on issues related to nursing and community health. These graduates will be able to function within the broader community, including national and international settings. Based on experiences in graduate education in community health nursing recommendations are made for the response graduate nursing education must make in order to prepare appropriate leaders who can work toward the goal of improving the community's health.