Effectiveness of Community Health Worker/Nursing Student Teams as a Strategy for Public Health Nursing Education

ABSTRACT A unique program that partners community health workers with nursing students was developed in response to community‐based participatory research data and integrated into a public health practicum at a baccalaureate nursing program in West Michigan. The goal of the program is to promote the health of 3 underserved urban neighborhoods while educating nursing students in population health and public health nursing. The purpose of this paper is to describe program conception and implementation and discuss evaluation of educational outcomes as a public health learning experience.     

Community Outreach and Engagement Strategies from the Wisconsin Study Center of the National Children's Study

The purpose of this methods article was to describe and evaluate outreach and engagement strategies designed to initially build county‐wide awareness and support for the National Children's Study (NCS or the study) and subsequently to target the segment communities where recruitment for the study occurred. Selected principles from community outreach, social marketing, and health care system and personal referral formed the foundation for the strategies. The strategies included a celebration event, community advisory board, community needs assessment, building relationships with health care providers and systems, eliciting a network of study supporters, newsletters, appearances at local young family‐oriented events (health fairs, parades), presentations to local community leaders, community forums, “branding” with assistance from a women‐owned local marketing firm, and mailings including an oversized, second‐touch postcard. Six months after study launch, approximately 4,600 study‐eligible women were asked in a door‐to‐door survey if and how they became aware of the study. On average, 40% of eligible women reported being aware of the study. The most frequently cited strategy to cultivate their awareness was study‐specific mailings. Awareness of the NCS increased by 7.5% among those receiving a second‐touch postcard relative to controls (95% CIs [4.9, 10.7] z = 5.347, p < 0.0000, d = 0.16). Community outreach and engagement strategies, in particular the oversized postcard as a second‐touch effort, may be used effectively by researchers for participant recruitment and by public health nurses for delivery of important population‐focused messages.     

Influencing Genomic Change and Cancer Disparities through Neighborhood Chronic Toxic Stress Exposure: A Research Framework

Black Americans have disproportionately higher incidence and mortality rates for many cancers. These disparities may be related to genomic changes that occur from exposure to chronic toxic stress and may result from conditions associated with living in racially segregated neighborhoods with high rates of concentrated poverty. The purpose of this article is to present a nursing research framework for developing and testing neighborhood‐level interventions that have the potential to mitigate exposure to neighborhood‐associated chronic toxic stress, improve individual‐level genomic sequelae and cancer outcomes, and reduce cancer health disparities of Black Americans. Public health nursing researchers should collaborate with local officials to determine ways to reduce neighborhood‐level stress. Intermediate outcomes can be measured using genomic or other stress biomarkers, and long‐term outcomes can be measured by evaluating population‐level cancer incidence and mortality.     

Researching Together: A CTSA Partnership of Academicians and Communities for Translation

Background

The Colorado Clinical and Translational Sciences Institute (CCTSI) aims to translate discovery into clinical practice. The Partnership of Academicians and Communities for Translation (PACT) represents a robust campus–community partnership.

Methods

The CCTSI collected data on all PACT activities including meeting notes, staff activity logs, stakeholder surveys and interviews, and several key component in‐depth evaluations. Data analysis by Evaluation and Community Engagement Core and PACT Council members identified critical shifts that changed the trajectory of community engagement efforts.

Results

Ten “critical shifts” in six broad rubrics created change in the PACT. Critical shifts were decision points in the development of the PACT that represented quantitative and qualitative changes in the work and trajectory. Critical shifts occurred in PACT management and leadership, financial control and resource allocation, and membership and voice.

Discussion

The development of a campus–community partnership is not a smooth linear path. Incremental changes lead to major decision points that represent an opportunity for critical shifts in developmental trajectory. We provide an enlightening, yet cautionary, tale to others considering a campus–community partnership so they may prepare for crucial decisions and critical shifts. The PACT serves as a genuine foundational platform for dynamic research efforts aimed at eliminating health disparities.     

A Conceptual Model for Community Interagency Collaboration

Although interagency community collaboration has been suggested to increase programming and decrease costs, theoretical understanding for this in nursing is limited. A conceptual framework for community interagency collaboration is described that depicts collaboration as a function of environmental conditions, organizational situations, and task characteristics. Transactional patterns including intensity, formalization, interrelational patterns, and structured relationships are discussed as are outcomes pertaining to organizations, interorganizational relations, clients, and communities.     

Community-based participatory research and the challenges of qualitative analysis enacted by lay, nurse, and academic researchers

There are multiple challenges in adhering to the principles of community‐based participatory research (CBPR), especially when there is a wide range of academic preparation within the research team. This is particularly evident in the analysis phase of qualitative research. We describe the process of conducting qualitative analysis of data on community perceptions of public maternity care in the Dominican Republic, in a cross‐cultural, CBPR study. Analysis advanced through a process of experiential and conversational learning. Community involvement in analysis provided lay researchers an imperative for improvements in maternity care, nurses a new perspective about humanized care, and academic researchers a deeper understanding of how to create the conditions to enable conversational learning. © 2012 Wiley Periodicals, Inc. Res Nurs Health 35:550–559, 2012     

Service user's actual involvement in mental health research practices: A scoping review

Service user involvement in mental health research is on the international political agenda, for example mirrored by an emphasis on user involvement in funding of research. The idea is that service users contribute with their lived experiences of mental distress to the research process and thereby heighten the quality and relevance of the research. The purpose of this scoping review was to identify and evaluate empirical research of how mental health service users actually partake in collaborative research processes and to summarize this research in dialogue with mental health user‐researchers. The review included 32 studies. Main findings indicated that actual involvement of service user‐researchers in research processes encompassed a complex set of precarious negotiation practices, where academics and service user‐researchers were positioned and positioned themselves in alternative ways. The review accounts for how mental health service users were involved in collaborative research processes. The extracted themes concerned: (i) Expectations of research processes, (ii) Contribution to research processes, and (iii) Training and learning from research processes. The study reveals that collaborative research in mental health requires changes to traditional research practices to create and support genuine collaborative partnerships and thereby avoid tokenism and power inequalities.     

Using an Academic‐Community Partnership Model and Blended Learning to Advance Community Health Nursing Pedagogy

This article describes a model of teaching community health nursing that evolved from a long‐term partnership with a community with limited existing health programs. The partnership supported RN–BSN students' integration in the community and resulted in reciprocal gains for faculty, students and community members. Community clients accessed public health services as a result of the partnership. A blended learning approach that combines face‐to‐face interactions, service learning and online activities was utilized to enhance students' learning. Following classroom sessions, students actively participated in community‐based educational process through comprehensive health needs assessments, planning and implementation of disease prevention and health promotion activities for community clients. Such active involvement in an underserved community deepened students' awareness of the fundamentals of community health practice. Students were challenged to view public health from a broader perspective while analyzing the impacts of social determinants of health on underserved populations. Through asynchronous online interactions, students synthesized classroom and community activities through critical thinking. This paper describes a model for teaching community health nursing that informs students' learning through blended learning, and meets the demands for community health nursing services delivery.     

Assessing Research Interest and Capacity in Community Health Centers

Objective

Community health centers (CHCs) have great potential to participate in the development of evidence‐based primary care but face obstacles to engagement in clinical translational research.

Methods

To understand factors associated with CHC interest in building research infrastructure, Harvard Catalyst and the Massachusetts League of Community Health Centers conducted an online survey of medical directors in all 50 Massachusetts CHC networks.

Results

Thirty‐two (64%) medical directors completed the survey representing 126 clinical sites. Over 80% reported that their primary care providers (PCPs) were slightly to very interested in future clinical research and that they were interested in building research infrastructure at their CHC. Frequently cited barriers to participation in research included financial issues, lack of research skills, and lack of research infrastructure. In bivariate analyses, PCP interest in future clinical research and a belief that involvement in research contributed to PCP retention were significantly associated with interest in building research infrastructure.

Conclusion

CHCs critical role in caring for vulnerable populations ideally positions them to raise relevant research questions and translate evidence into practice. Our findings suggest a high interest in engagement in research among CHC leadership. CTSAs have a unique opportunity to support local CHCs in this endeavor.     

Science Cafés: Engaging Scientists and Community through Health and Science Dialogue

Engagement of the community through informal dialogue with researchers and physicians around health and science topics is an important avenue to build understanding and affect health and science literacy. Science Cafés are one model for this casual interchange; however the impact of this approach remains under researched. The Community Engagement Key Function of the Clinical and Translational Science Institute of Southeast Wisconsin hosted a series of Science Cafés in which topics were collaboratively decided upon by input from the community. Topics ranged from Personalized Medicine to Alzheimer''s and Dementia to BioMedical Innovation. A systematic evaluation of the impact of Science Cafés on attendees'' self‐confidence related to five health and scientific literacy concepts showed statistically significant increases across all items (Mean differences between mean retrospective pre‐scores and post‐scores, one tailed, paired samples t‐test, n = 141, p < .0001 for all items). The internal consistency of the five health and scientific literacy items was excellent (n = 126, α = 0.87). Thematic analysis of attendees'' comments provides more nuance about positive experience and suggestions for possible improvements. The evaluation provides important evidence supporting the effectiveness of brief, casual dialogue as a way to increase the public''s self‐rated confidence in health and science topics.     

Portland Water Fluoridation: A Newspaper Analysis

Portland, Oregon is the largest city in the United States without community water fluoridation (CWF). A newspaper analysis was conducted of the failed 2013 CWF campaign to evaluate anti‐fluoridation and pro‐fluoridation messaging provided by newspapers during the campaign. News content was categorized by type and slant (pro‐fluoridation, anti‐fluoridation, or neutral) and 34 variables were tabulated (23 anti‐fluoridation, 11 pro‐fluoridation). Results showed overall messaging was slightly pro‐fluoridation, as compared to anti‐fluoridation or neutral content (35%, 32%, and 33% respectively). Editorial content was 85% pro‐fluoridation and 15% anti‐fluoridation. The most frequent anti‐fluoridation variables were alternatives to water fluoridation, mass/forced medication and concerns about the political process. Conversely, tooth decay and social justice were the most commonly cited pro‐fluoridation variables. Newspapers can be influential in shaping public policy opinions in the fight for community water fluoridation.     

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.     

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.     

An argument for practice-based public health research on sexually transmitted infection management

Over the last few years, the rates of certain sexually transmitted infections (STIs) have again begun to rise in Canada, the United Kingdom, and the United States. Paradoxically, these increases are occurring at the same time that greater numbers of researchers are publishing reports about highly successful safer sex interventions. Research that investigates this phenomenon reveals that the majority of new STIs management initiatives never reach day-to-day practice after the research period has terminated. In reaction to this, it is suggested here that researchers should begin developing their STIs management interventions in practice-based settings, with a strong emphasis being placed on ensuring target group input from the outset. While such an approach may not be able to discern precise cause-and-effect relationships, it has the benefit of enhancing use after researchers have withdrawn their support. The benefits that arise from long-term and widespread use of this approach may therefore outweigh the advantages that can occur from developing highly efficacious, but unused, STIs management strategies.     

Nursing curriculum through a social justice lens: An upstream approach

This article describes a one‐day seminar rooted in critical interactionism for nursing students in a diverse urban setting in the United States. The authors are registered nurses and members of Nurses for Social Justice (NSJ)—a loose network of nurses and nursing students committed to societal change. Informed by the history of NSJ and larger social justice movements, the authors intentionally incorporate their personal experiences and offer an example of how nursing education can improve health at the micro and macro levels. The seminar starts with introductions and creating a safe space for authentic engagement. Students are guided to connect with their own journey to nursing and the experiences that have shaped their identities, including being oppressed and privileged. The lack of diversity within the nursing workforce and various nursing roles along the continuum of care are discussed. Case‐based scenarios are presented where students explore leveraging their power and privilege to effectively partner with individuals and communities. In closing, lessons learned are shared through a group activity that uses the ecologic model. Recommendations are made to equip nursing students with tools to better understand their role in the broader context of health.