Incorporating a built environment module into an accelerated second-degree community health nursing course

ABSTRACT Environmental quality is a leading indicator of population health. Environmental health content has been integrated into the curriculum of an Accelerated Bachelor of Science in Nursing program for second-degree students through development of an environmental health nursing module for the final-semester community health nursing course. The module was developed through collaboration between two professional schools at Duke University (the School of Nursing and the Nicholas School of the Environment and Earth Sciences). It focused on the role of the built environment in community health and featured a mix of teaching strategies, including five components: (1) classroom lecture with associated readings, (2) two rounds of online small-group student discussions, (3) assessment of the built environment in local neighborhoods by student teams, (4) team presentation of the neighborhood assessments, and (5) individual student papers synthesizing the conclusions from all team presentations. The goal of the module was to provide nursing students with an organizing framework for integrating environmental health into clinical practice and an innovative tool for understanding community-level components of public health.     

Short-term effects of a health promotion course for Taiwanese nursing students

The purposes of this study were to (a) develop a teaching course on health promotion for nursing students in Taiwan, (b) evaluate the effects of this teaching course, and (c) understand students' appraisals of its effectiveness in helping them to change unhealthy behavior. A sample of 65 randomly selected female nursing students took an 18-week course developed by the investigators, which included 30 h of classroom lectures and 4 weeks of written reports by students chronicling the changes in their behavior. Health promotion questionnaires administered before and after the course and content analysis of the students' reports were used to evaluate the effects of the course. Students' questionnaire scores after course completion indicated significantly increased intent to adopt healthy lifestyles. Content analysis of students' reports on their personal behavior-changing experiences showed that they accepted the potential value of curriculum aspects such as experiencing the struggle, suffering, and even abandonment of the process, experiencing the benefits of change, increasing self-confidence, and empathizing with how difficult it is for clients to change behavior. These results support the value of teaching courses on health promotion to nursing students. The authors recommend including such a course as part of a regular nursing education.     

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.     

Mapping the future of environmental health and nursing: strategies for integrating national competencies into nursing practice

Nurses are increasingly the primary contact for clients concerned about health problems related to their environment. In response to the need for nursing expertise in the field of environmental health, the Institute of Medicine (IOM), Agency for Toxic Substances and Disease Registry (ATSDR), and National Institute of Nursing Research (NINR) have designed core competencies for the nursing profession. The IOM competencies focus on four areas: (1) knowledge and concepts; (2) assessment and referral; advocacy, ethics, and risk communication; and (4) legislation and regulation. The competencies establish a baseline of knowledge and awareness in order for nurses to prevent and minimize health problems associated with exposure to environmental agents. To address the known difficulties of incorporating new priorities into established practice, nurses attending an environmental health short course participated in a nominal group process focusing on the question, “What specific actions can we take to bring environmental health into the mainstream of nursing practice?” This exercise was designed to bring the concepts of the national initiatives (IOM, NINR, ATSDR) to the awareness of individual nurses involved in the direct delivery of care. Results include 38 action items nurses identified as improving awareness and utilization of environmental health principles. The top five ideas were: (1) get environmental health listed as a requirement or competency in undergraduate nursing education; (2) improve working relationships with interdepartmental persons—a team approach; (3) strategically place students in essential organizations such as NIOSH, ATSDR, or CDC; (4) educate nurse educators; and (5) create environmental health awards in nursing. The 38 original ideas were also reorganized into a five‐tiered conceptual model. The concepts of this model include: (1) developing partnerships; (2) strengthening publications; (3) enhancing continuing education; (4) updating nursing practice; and (5) strengthening schools of nursing. The model serves as a road map for action in building environmental health capacity within mainstream nursing.     

Swimming without the water: A critical perspective on mental health experience for adult nursing students

Adult nurses and adult field nursing students come into contact with a diverse range of other patient groups in their practice but perhaps none more so than those who have co-existing mental health issues. Consequently adult field student nurses must be equipped with the requisite knowledge and skills to competently care for their patients who also experience mental health problems. Given the pressure on placements many education providers have developed alternatives to direct mental health experiences. The authors review their own experience of some of the modalities that higher education institutes (HEI) use to instruct their students in this field. They argue that, ideally, there is no substitute for the practical experience of placements in the mental health sector, particularly if these include contact with mental health nursing. The paper concludes with some recommendations for nursing education and our professional body that could help equip adult field nursing students with the necessary experience and skills of mental health to support them into their future careers.     

Problem based learning in mental health nursing: the students' experience

Problem based learning (PBL) is well established within the field of health-care education for professionals worldwide, although little has been done to explore the experiences of students undertaking a PBL course in mental health nursing. Without firm evidence of the benefits of PBL, educationalists in mental health might be reluctant to view it as an option in curricula design. This U.K. study examined the experiences of pre-registration post-graduate mental health student nurses undertaking a 2-year educational course in which all teaching and assessment followed a PBL philosophy. Focus groups were used throughout the course to elicit in-depth qualitative data that was analysed by applying a constant comparative method. The analysis of the data uncovered the following broad themes: 'moves to autonomy, 'surviving the groups' and 'the impact of PBL'. The findings show that participants had mainly positive experiences and gained a range of study and interpersonal skills central to mental health nursing. Participants described initial anxieties resulting from engagement in PBL. However, they increasingly gained confidence in this approach, exercising increasing control over the PBL process. Despite this increased autonomy, participants continued to value the input of skilled facilitators. A recurring issue centred on the potential for interpersonal conflict within the student group and its impact on their learning. It is suggested that more research is needed examining the use of PBL in mental health nursing.     

Evaluating the impact of a preceptorship course on mental health nursing practice

The crisis in the recruitment of nursing graduates into the mental health nursing field dictates the need for assertive and innovative strategies to promote the positive aspects of this field of nursing. A positive clinical experience has been identified as one of the most important determinants of nursing students' attitudes towards mental health nursing. The Centre for Psychiatric Nursing Research and Practice implemented the course "Preceptorship in Psychiatric Nursing" as a means to increase the skill level within and interest towards the preceptorship role in clinical practice. This paper presents an evaluation of courses conducted between 2000 and 2002. The findings suggest that participants (n = 150) were highly satisfied with the content and delivery of the course, and that it is likely to affect their attitude towards and fulfillment of the preceptorship role.     

Using a site visit to a contaminated location as a focus for environmental health education for academic and public health nurses

We describe a conference initiative that is distinguished by the use of a "community case study" to increase the knowledge and skills of nursing faculty and public health nurses in environmental health and to provide networking support to facilitate infusion of environmental health into nursing curricula and public health nursing practice. The Institute of Medicine's (1995) general environmental health competencies for nurses provided the conference framework. Woburn, Massachusetts, a Superfund site, served as the community case study to illustrate a complex environmental health problem. Over an extended period of time, Woburn was contaminated with multiple chemicals that eventually contaminated the drinking water supply; a cluster of childhood leukemia cases was linked subsequently to the Superfund site contaminants. A 6-hr interpreted walking and bus tour of the Superfund site enabled us to visit the premises of responsible parties, the vapor extraction fields, the capped Well H in the wooded wetlands, and to tour the affected neighborhood. This intensive, hands-on approach to learning environmental health content and skills that incorporated multiple learning strategies serves as a model for developing future conferences for public health nurses and nursing faculty.     

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.     

Challenges and successes of infusing environmental health content in a nursing program

Environmental health has received minimal attention in nursing curricula over the past decade, despite efforts by the Institute of Medicine (1995) and others to advance the environmental health agenda in nursing education, practice, and research. This paper describes an initiative that was first funded as a part of the Environmental Health Scholars Program in 2000 to incorporate environmental health into master's and undergraduate nursing programs at one university. Evaluation of this initiative highlights the challenges and successes experienced in this academic setting. A number of recommendations based on this experience and the literature are offered. There is a perceived need to define the critical body of knowledge and skills in environmental health and to develop tools to enable educators and practitioners to apply this knowledge in public health nursing and other specialty practices. In tandem, opportunities and incentives are needed to encourage faculty development and the infusion of environmental health into existing curricula. Changes are also needed across practice settings to proactively address environmental health issues so that environmental health becomes and remains an integral part of nursing.     

Placing physical activity in mental health care: a leadership role for mental health nurses

The wide-ranging benefits of physical activity for consumers with mental illness are acknowledged within the mental health nursing field; however, this is not commonly translated to practice. The primary aim of this paper is to argue that mental health nurses are well positioned to, and should, provide leadership in promoting physical activity to improve the quality of care for people with mental illness. Topics addressed in this paper include the relationship between physical activity and both physical and mental health, the views and experiences of consumers with physical activity, the efficacy of physical activity interventions, the attitudes of nurses to physical activity as a component of care, barriers to a physical activity focus in care for mental illness, and the role of mental health nurses in promoting physical activity. There is a clear and important relationship between physical activity and mental health. Mental health nurses are well positioned to encourage and assist consumers to engage in physical activity, although they might lack the educational preparation to perform this role effectively.     

Enhancing students' perspectives of health through non-traditional community experiences

• ? The shift in emphasis to community-based health care necessitates that opportunities be provided for nursing students to acquire an understanding of the complex nature of health.
• ? A qualitative study was used to demonstrate the benefits accrued by junior baccalaureate nursing students in non-traditional community settings.
• ? Key themes that emerged from data analysis included definitions of health and illness as context specific, and environmental factors influencing health.
• ? The study demonstrated that learning experiences with diverse communities can broaden students' perspectives and understanding of health behaviours. Students gained an appreciation of the sociocultural variation in meanings of health and illness as well as of the social and political dimensions of health.

     

Applications of simulation technology in psychiatric mental health nursing education

The purpose of this paper is to review the use of simulation in education across the health professionals, to describe the development and implementation of innovative simulation techniques for an undergraduate psychiatric mental-health nursing course, and to identify lessons learned and future directions for successful simulation experiences in psychiatric nursing.     

Integrating Climate Change in the Curriculum: Using Instructional Design Methods to Create an Educational Innovation for Nurse Practitioners in a Doctor of Nursing Practice Program

An applied epidemiology course for doctor of nursing practice students was revised to include a module on the impact of climate change on population health. The Analyze, Design, Develop, Implement, and Evaluate (ADDIE) model of instructional design is a gold standard framework for creating course content and guided the module development. A nurse content expert discussed the environmental impacts of climate change on health using literature, actual clinical scenarios, and the application of epidemiologic data. Topics included safeguarding workers and vulnerable populations within the context of the coronavirus disease 2019 pandemic. Students posted reflections on their understanding of module content in response to structured prompts electronically in the learning management system for review by the faculty. Faculty evaluation of responses identified the need to further develop and integrate environmental epidemiology and climate change content more fully within the doctor of nursing practice curriculum.     

A scoping review of environmental health nursing research

Objective

The purpose of this scoping review was to determine the extent and focus of published environmental health nursing research.

Design and Sample

The search was limited to peer reviewed, English‐language environmental health nursing research with at least one nursing author, published between 1995 and 2015 in a nursing journal, and catalogued in CINAHL.

Results

Publication of the 548 identified articles occurred in 118 different nursing journals. Annual number of publications increased from nine articles in 1995 to 50 in 2013 and 2014. Most (63%) of the studies occurred in the Unnited States; the remaining studies took place in 33 other countries. Three primary focus areas were identified: disasters/disaster preparedness, occupational health, and the home environment. Other focus areas included environmental exposures, environmental risk perception, secondhand smoke, and environmental health education. The primary populations studied were nurses/nursing students (40%) and adults (26%). Most common research designs employed were cross‐sectional (42%) and qualitative methods (20%).

Conclusions

Findings from this scoping review support a global expansion of published environmental health nursing research addressing a variety of environmental health topics. Additional studies are needed that use more complex research methods and address timely topics such as climate change and sustainability.     

Public health nursing competencies for public health surge events

OBJECTIVE: To develop consensus regarding public health nursing competencies in the event of a public health surge event related to disaster. DESIGN AND METHODS: Using a 3-round Delphi approach, public health nurses (PHNs) and directors of nursing from local health departments, state nursing leaders, and national nursing preparedness experts reviewed and commented on 49 draft competencies derived from existing documents. RESULTS: The final 25 competencies were categorized into Preparedness (n=9), Response (n=8), and Recovery (n=7). The Preparedness competencies focus on personal preparedness; comprehending disaster preparedness terms, concepts, and roles; becoming familiar with the health department's disaster plan, communication equipment suitable for disaster situations; and the role of the PHN in a surge event. Conducting a rapid needs assessment, outbreak investigation and surveillance, public health triage, risk communication, and technical skills such as mass dispensing are Response phase competencies. Recovery competencies include participating in the debriefing process, contributing to disaster plan modifications, and coordinating efforts to address the psychosocial and public health impact of the event. CONCLUSIONS: Identification of competencies for surge events that are specific to public health nursing is critical to assure that PHNs are able to respond to these events in an effective and efficient manner.     

Integrating environmental health into nursing and midwifery practice

AIM: With the recognition that environmental health has relevance to all nursing and midwifery activities, the aim of this paper is to discuss nurses' and midwives' past and present involvement in environmental health in the UK, where the international situation demonstrates good practice, and the challenges and possibilities for greater and more effective UK-based activity in the future. BACKGROUND: The association between environmental hazards and adverse health effects has received increasing attention over recent years. In the United States of America (USA), the importance of developing an environmental health role for nurses outside of the "traditional" occupational and environmental health nursing specialty has been recognized and acted upon through education, information programmes and policy developments. In the United Kingdom (UK), the same degree of interest, commitment and activity is somewhat lacking. DISCUSSION: Little nursing and midwifery activity on environmental health issues has taken place in the UK over recent years. The lack of development in this field may relate to the problems of an already overstretched disease treatment service and the lack of an upstream approach to public health. Theoretical and philosophical influences, as well as individual and organizational obstacles or constraints, exist and may hinder nurses and midwives in their efforts to address the subject. Yet nurses and midwives are the largest group in the National Health Service workforce and this gives enormous potential for effective interventions in environmental health. CONCLUSIONS: Whilst barriers and obstacles to nursing and midwifery involvement in environmental health in the UK exist, they are all surmountable and appropriate interventions could prove cost-effective in the middle and long-term. Additionally, they may be viewed as a necessary activity for nurses and midwives in response to real health threats and the expressed worries and concerns of patients and communities.     

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.     

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.