Research Priorities for Public Health Nursing

ABSTRACT The Association of Community Health Nursing Educators (ACHNE) Research Committee initiated a revision of the ACHNE Research Priorities for public health nursing practice in 2006, following those developed in 1992 and in 2000. The committee (a) reviewed public health nursing research abstracts (n=485) from 7 selected nursing journals to evaluate progress in addressing the 2000 Priorities; (b) identified research methods used, health issues and health behaviors addressed, and demographics of study populations in the abstracts; and (c) reviewed research priorities from key federal funding agencies and journal editors. Overall, progress toward meeting previous priorities was modest, with a limited range of methods, topics, and samples described. The 2009 ACHNE Research Priorities for public health nursing include: (1) Population‐Focused Outcomes, and (2) Public Health Nursing Workforce. Multisite studies, clinical trials, community‐based participatory research, development and/or analysis of existing large data sets, and development of valid and reliable methods are needed to address these priorities. Collaboration among educators, researchers, and practitioners is crucial to develop the scientific evidence base for population‐based nursing practice.     

Hospital Collaboration with Public Safety Organizations on Bioterrorism Response

Objective. To identify hospital characteristics that predict collaboration with public safety organizations on bioterrorism response plans andmass casualty drills. Methods. The 2003 and2004 Bioterrorism andMass Casualty Supplements to the National Hospital Ambulatory Medical Care Survey examined collaboration with emergency medical services (EMS), hazardous materials teams (HAZMAT), fire departments, andlaw enforcement. The sample included 112 geographic primary sampling units and1,110 hospitals. Data were weighted by inverse selection probability, to yield nationally representative estimates. Characteristics included residency andmedical school affiliation, bed capacity, ownership, urbanicity andJoint Commission accreditation. The response rate was 84.6%. Chi-square analysis was performed with alpha set at p < 0.05. Logistic regression modeling yielded odds ratios with 95% confidence intervals. Results. During a bioterrorism incident, 68.9% of hospitals would contact EMS, 68.7% percent law enforcement, 61.6% fire departments, 58.1% HAZMAT, and42.8% all four. About 74.2% had staged mass casualty drills with EMS, 70.4% with fire departments, 67.4% with law enforcement, 43.3% with HAZMAT, and37.0% with all four. Predictors of drilling with some or all of these public safety organizations included larger bed capacity, nonprofit andproprietary ownership, andJCAHO accreditation. Medical school affiliation was a negative predictor of drilling with EMS.Conclusions. The majority of hospitals involve public safety organizations in their emergency plans or drills. Bed capacity was most predictive of drilling with these organizations. Medical school affiliation was the only characteristic negatively associated with drilling.     

The Nebraska Experience in Biocontainment Patient Care

ABSTRACT Public health nurses in local health departments may receive the first call regarding a potential case of avian influenza, monkeypox, or viral hemorrhagic fever. One public health approach to containing these dangerous infectious disease outbreaks is the use of specialized isolation units. Early access to a biocontainment patient care unit (BPCU) for isolation during a bioterrorism or public health emergency event along with appropriate use of epidemiological and therapeutic interventions in the community may dramatically impact the size and severity of a disease outbreak ( Smith et al., 2006 ). As emerging infectious agents, pandemics, resistant organisms, and terrorism continue to threaten human life; health care and emergency care providers must be empowered to work with nurses and other professionals in public health to plan for the consequences. This article describes the evolution of Nebraska's BPCU strategy for public health preparedness in the face of a biological threat. Design priorities, unit management, challenges, and lessons learned will be shared to guide others in establishing similar infrastructure.     

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.     

Special Features: Health Policy: Hospital Nurse Staffing and Public Health Emergency Preparedness: Implications for Policy

Hospital restructuring policies and an impending nursing workforce shortage have threatened the nation's emergency preparedness. Current emergency response plans rely on sources of nurses that are limited and overestimated. A national investment in nursing education and workforce infrastructure, as well as incentives for hospitals to efficiently maximize nurse staffing, are needed to ensure emergency preparedness in the United States. This review highlights the challenges of maintaining hospital nursing surge capacity and policy implications of a nursing shortage.     

Emergency Medicine Public Health Research Funded by Federal Agencies: Progress and Priorities

The emergency department (ED) visit provides an opportunity to impact the health of the public throughout the entire spectrum of care, from prevention to treatment. As the federal government has a vested interest in funding research and providing programmatic opportunities that promote the health of the public, emergency medicine (EM) is prime to develop a research agenda to advance the field. EM researchers need to be aware of federal funding opportunities, which entails an understanding of the organizational structure of the federal agencies that fund medical research, and the rules and regulations governing applications for grants. Additionally, there are numerous funding streams outside of the National Institutes of Health (NIH; the primary federal health research agency). EM researchers should seek funding from agencies according to each agency's mission and aims. Finally, while funds from the Department of Health and Human Services (HHS) are an important source of support for EM research, we need to look beyond traditional sources and appeal to other agencies with a vested interest in promoting public health in EDs. EM requires a broad skill set from a multitude of medical disciplines, and conducting research in the field will require looking for funding opportunities in a variety of traditional and not so traditional places within and without the federal government. The following is the discussion of a moderated session at the 2009 Academic Emergency Medicine consensus conference that included panel discussants from the National Institutes of Mental Health, Drug Abuse, and Alcoholism and Alcohol Abuse and the Centers for Disease Control and Prevention (CDC). Further information is also provided to discuss those agencies and centers not represented.     

High‐Fidelity Simulation and Emergency Preparedness

ABSTRACT Ongoing threats of bioterrorism and the consequences of natural disasters require nurses entering the workforce to be competent in emergency preparedness. Nurses need to collaborate with multidisciplinary teams and use their critical thinking skills to provide safe nursing care during potentially chaotic public health emergencies. Using Institute of Medicine recommendations and Quality and Safety Education for Nurses competencies, the authors describe a public health emergency simulation exercise with undergraduate senior nursing students enrolled in a public health clinical course. Students applied chronic disease, mental health, and pharmacology knowledge acquired in previous nursing courses to an unfolding infectious disease outbreak while practicing their assessment, treatment, delegation, organizational, and leadership skills. The students' quantitative evaluation of the experience indicated that 90.36% thought the purpose of the experience was clear, 91.5% thought the importance of delivering safe care during a public health emergency was stressed, and 79.5% thought the presimulation briefing and postsimulation debriefing helped them understand and participate in the drill. Qualitatively, the students' reflections of the exercise indicated that although they initially felt overwhelmed and anxious, they realized the importance of participating in emergency preparedness and recognized their ability to apply nursing skills learned in previous courses.     

The Quad Council Practice Competencies for Public Health Nursing

This article describes the most recent efforts by the Quad Council of Public Health Nursing organizations to review and revise the competencies for PHN practice, and highlights the implications of these competencies for practice, education, and research. The Quad Council is a coalition of four nursing organizations with a focus on public health nursing and includes the Association of Community Health Nursing Educators; the Association of Public Health Nursing (known prior to July 1, 2012 as the Association of State and Territorial Directors of Nursing); the Public Health Nursing section of the American Public Health Association; and the Council on Economics and Practice of the American Nurses' Association. The Quad Council competencies are based on the Council on Linkages competencies for public health professionals and were designed to ensure that public health nursing fits in the domain of public health science and practice.     

Hints for the Aspiring Public Health Nurse

ABSTRACT The original article from which these excerpts were taken, “Some Hints to the Nurse Who Seeks to Become a Successful Partner in the Community Health Program,” by Mary Margaret Muckley, was published the 1923 volume of the original Public Health Nursing journal. The paper listed practical pointers to nurses wanting to work in the area of public or community health nursing. The author's advice involved personal attributes, professional engagement, skills, effective organization, and community relations. Much of the original article contained sound advice for aspirants to nursing work in community settings, but some advice may be considered too idealistic even for this optimistic time period. While the particular references to organizations and agencies existing in Helena, Montana have been omitted, the nurse reading the paper in 1923 had a general guide to her key stakeholders. The excerpts from this paper may give contemporary readers an appreciation of the endurance of what Muckley terms the public health nurse's “Valuable Assets.”     

Emergency preparedness and bioterrorism response: development of an educational program for public health personnel

Public health departments are under increasing pressure to provide emergency preparedness and bioterrorism response education to public health personnel. The challenge that health departments face is to provide cost-efficient, timely education to a large number of multidisciplinary personnel. This article describes an innovative strategy for providing this education to public health personnel using the health department's intranet system. The intranet system provided confidential information specific to the staff role and allowed for concurrent access to the program by multiple individuals at different service sites. Knowledge acquisition was tested through short multiple-choice questions that followed the specific information modules. The intranet system faced a number of challenges during the pilot-testing phase, primarily related to changes in the role of the public health nurse and limitations in funding and public health staff to maintain and monitor the bioterrorism response program and the intranet system. The design of the program may prove useful for other public health organizations when a need exists for quick delivery of information to a large number of personnel. It may especially be useful in providing basic emergency preparedness and bioterrorism education to new personnel in health departments.     

An Open Letter to Public Health Nurses

ABSTRACT Public health nursing celebrated its 100^th anniversary in 1993. In a guest editorial for Public Health Nursing Dr. Marla Salmon, then director of the Division of Nursing, Bureau of Health Professions, U. S. Department of Health and Human Services, wrote a "retrospective vision" in which she projected the roles that American public health nurses would play in 21^st century health care reform. The picture she painted was highly optimistic and 16 years later the profession has yet to realize the accomplishments Salmon envisioned: a more visible leadership in directing health policy, creation of systems that expand public health department roles in both direct and indirect services, cooperation among agencies, and empowerment of the communities and individuals served by the public health care system. As she saw it, the period between 1893 and 1993 was a prelude to the coming of age of public health nursing as a specialty. She cautioned that those who practice public health nursing between 1993 and 2093 are responsible for authoring the next volume of history through their own actions. This historical reprint originally appeared in the December 1993 issue of Public Health Nursing .     

Assessing Emergency Preparedness of Families Caring for Young Children With Diabetes and Other Chronic Illnesses

PURPOSE.  To help children with chronic illnesses and their caregivers assess emergency preparedness.
CONCLUSIONS.  Little work has been done to ascertain patient adherence levels to these recommendations. Additionally, little is known about the seeking patterns of healthcare providers and/or changes in interventions based on certain elements of emergency preparedness, such as the presence of medical alert identification and an emergency kit.
PRACTICE IMPLICATIONS.   Healthcare providers must discover their patients' level of emergency preparedness and facilitate the acquisition and implementation of elements of emergency preparedness that meet their patients' needs.     

Barriers and Facilitators to the Incorporation of Environmental Health into Public Health Nursing Practice

ABSTRACT Objectives: To describe the environmental health (EH) demands placed on public health nurses (PHNs) as well as the barriers and facilitators to incorporating EH into PHN practice. Design and Sample: A cross‐sectional multimode (Web and pencil/paper) survey was used to collect data from PHNs in 1 rural western state. Research participants included 141 PHNs from a total of 228 survey invitations (61% response). Measures: A 39‐item questionnaire was developed to measure the frequency of EH demands experienced by PHNs as well as the barriers and facilitators to the incorporation of EH into PHN practice and standard demographics. Results: Significant numbers of PHNs reported less than baccalaureate preparation (29%), suggesting that EH competencies cannot be assumed. PHNs are often asked for basic EH information and cite lack of time and lack of interest on the part of the populations being cared for as barriers to incorporating EH into their practice. Facilitators included free or inexpensive continuing education programs offered via the Internet and additional Internet resources or staff resource people. Conclusion: PHNs represent a significant portion of the public health workforce and have implied and explicit mandates to address EH issues in their practice. Resources should be directed toward helping PHNs become better prepared to address the current and future EH needs of populations.     

Population Health Surveillance Practice of Public Health Nurses

ABSTRACT Objective: To report the population health surveillance functions of public health nurses and to describe factors that impede these functions.
Design and Sample: An interpretive qualitative study was conducted in Public Health Service areas in Eastern Canada. Participants were public health nurses ( n =55) with an average of 14.5 years of pertinent work experience.
Measures: Semistructured face-to-face, telephone interviews, and focus groups were conducted, transcribed, coded, and analyzed.
Results: The nurses in this study used ecosocial population health surveillance functions that included multilevel societal influences on health. Extensive interprofessional and intersectoral networks were foundational to their surveillance work, allowing them to monitor what was occurring in the community and transfer this knowledge into various systems to contribute toward improved health outcomes. However, the nurses did not acknowledge the significance of their population health surveillance work, and documentation structures did not support these surveillance functions.
Conclusion: New surveillance methods and documentation structures that reflect an ecosocial surveillance approach are needed that are more consistent with public health nurses' population-focused practice.