Overview of Health and Services in Taiwan, ROC

The purpose of health and medicine of course is the elimination of disease and the prolongation of life expectancy. It also includes the improvement of the health of individuals and thus to make it possible for everyone to attain the status of physical, mental, and social well-being and to lead a happy and healthy life. To reach these goals, we are planning, implementing, evaluating, and improving our health programs through organized efforts with the active participation of each citizen.
Today there is a demand for higher quality care in both the clinical and community health care settings. Therefore well-educated, better-prepared nurses are in demand. To upgrade the quality of nurses, the nursing education system should be simplified and raised to college level. The nurse who participates in the profession should maintain competence in nursing. Fortunately, our Chinese nurses who participate in the profession are making an effort to implement and improve the standards of nursing to meet the health needs of the public.     

社区护士岗位设置与职责现状及对策研究

目的:建立一套适合我国社区卫生服务发展现状和管理模式的,便于实际应用的社区护士岗位设置方案和职责规范,以对社区护士的工作提供具体明确的指导.方法:采用访谈法、观察法、个案分析法了解社区护士的岗位设置和职责现状;通过访谈法、问卷调查法和专家论证法,建立社区护士岗位设置与岗位职责建议方案.结果:目前我国社区护士的工作岗位没有进行规范的分类,岗位设置不利于社区护理工作任务的完成;岗位职责不明确,与其他专业人员分工不清晰.结论:建议将社区护上岗位划分为两大类:全科护士岗位和公共卫生护士岗位;建议全科医师与全科护士的比例为1∶(2 ～ 3);公共卫生医师与公共卫生护士的比例为1∶1.     

Japanese development and testing of the Network Establishment Practices Scale for Community and Public Health Nurses

The practices required by community and public health nurses to establish community networks mainly involve communicative competencies. Assessment through development and testing of such competencies is necessary for community and public health nurse educators and practitioners around the world to create and maintain a mutual support network. The purpose of this study was to develop and test a scale for community and public health nurse practices to establish and maintain community networks, and to then determine construct validity in a factorial structure model. The participants were 3970 community and public health nurses in Japan. A 43‐item list was developed from a literature review, individual interviews, and repeated examinations. The secondary structural model consisted of four factors with 21 items. The internal consistency of the 21 items was highly reliable (Cronbach's α = 0.915). Confirmatory factor analysis by structural equation modeling showed the fit criteria to be statistically significant. Attributes of the community and public health nurses (age, years of experience, work municipalities, work positions, and educational institutions) showed significant relationships with the scale scores. The findings validated the efficacy of the Network Establishment Practices Scale to assess community and public health nurse practices to establish community networks.     

Public Health and School Nurses’ Perceptions of Barriers to HPV Vaccination in Missouri

Human Papilloma Virus (HPV) is associated with various forms of cancer and is preventable with vaccination. Nurses are in a unique position to directly influence a person’s decision to receive the HPV vaccine. A statewide sample of both school and public health nurses was used to assess knowledge and attitudes related to the HPV vaccine as well as nurse’s behaviors and behavioral intentions toward educating parents and recommending the vaccine. Positive attitudes and adequate knowledge levels were found, however, the majority of school nurses did not provide information and resources to parents. Targeted health promotion programs for school nurses are recommended.     

Adaptation Themes for Prenatal Care Delivered by Public Health Nurses

An adaptation process involving three cognitive themes provides the framework for community nursing model for prenatal care on the island of Hawaii. The themes are based on the cognitive adaptation model developed by Taylor (1983) and include search for meaning, sense of mastery, and self-esteem. Each theme is used to guide public health nurses and is identified during designated encounters between the nurse and woman throughout the duration of prenatal care. A focus on adaptation themes for each trimester of pregnancy expands on the medical model of prenatal care to highlight developmental processes of childbearing and broaden the scope of practice for public health nurses responsible for assessment and intervention in the community.     

Generalized Public Health and Industrial Nurses Work Together

ABSTRACT Occupational health has been considered a subset of public health nursing for years. The first industrial or occupational health nurses were employed by large companies in the 1890s but the role evolved quickly in the early 20^th century. By mid-century, many large companies employed a physician and nurse(s) to provide examinations, screenings, episodic care, and trauma intervention for workers. Occupational health nurses faced different problems than community-based public health nurses in generalized nursing service. The intersection of public health and employee health was apparent, though, because large industries often constituted the main workplace for a smaller community and sickness could spread throughout a town if the occupational health nurse was not well-prepared in principles of infection control and health promotion. Excerpts from this July 1949 article about building relationship between public health and industrial nurses illustrate the benefits hoped for when they were formally connected to one another through cross-training and in-service education. The author, Margaret Schwem, was a supervisor at the Rensselaer County Department of Health in Troy, New York. In the original article, Schwem included a list of reference materials for those interested in public health and industrial nursing.     

Power and Opportunity in Public Health Nursing Work Environments

Abstract Kanter's structural theory of power in organizations provided the conceptual framework for this comparative study on perceptions of power of two levels of nurses working in three public health agencies during a time of program transition. Forty-six public health nurses and 10 nurse managers were surveyed to examine their perceptions of the amount of power existing in their own and their counterparts' jobs. Propositions from Kanter's theory were supported by the data. Both groups rated their work environments to be somewhat low in power, although managers perceived themselves to be significantly more empowered in their work environments than did staff nurses. In addition, staff nurses perceived themselves to have significantly less access to empowerment structures (opportunity, information, support, and resources) than their managers perceived them to have. Staff nurse empowerment was found to be significantly related to perceptions of their immediate managers' power in the organization.     

Demonstrating the cost effectiveness of an expert occupational and environmental health nurse: application of AAOHN's success tools. American Association of Occupational Health Nurses.

According to DiBenedetto, "Occupational health nurses enhance and maximize the health, safety, and productivity of the domestic and global work force" (1999b). This project clearly defined the multiple roles and activities provided by an occupational and environmental health nurse and assistant, supported by a part time contract occupational health nurse. A well defined estimate of the personnel costs for each of these roles is helpful both in demonstrating current value and in future strategic planning for this department. The model highlighted both successes and a business cost savings opportunity for integrated disability management. The AAOHN's Success Tools (1998) were invaluable in launching the development of this cost effectiveness model. The three methods were selected from several tools of varying complexities offered. Collecting available data to develop these metrics required internal consultation with finance, human resources, and risk management, as well as communication with external health, safety, and environmental providers in the community. Benchmarks, surveys, and performance indicators can be found readily in the literature and online. The primary motivation for occupational and environmental health nurses to develop cost effectiveness analyses is to demonstrate the value and worth of their programs and services. However, it can be equally important to identify which services are not cost effective so knowledge and skills may be used in ways that continue to provide value to employers (AAOHN, 1996). As evidence based health care challenges the occupational health community to demonstrate business rationale and financial return on investment, occupational and environmental health nurses must meet that challenge if they are to define their preferred future (DiBenedetto, 2000).     

Comparisons between the attitudes of student nurses and other health and social care students toward illicit drug use: An attitudinal survey

In the context of a recent emphasis on compassion in the delivery of health care, the current study set out to measure the attitudes of different groups of health and social care students toward illicit drug users. Previous research has identified variations in the attitudes of different groups of health and social care professionals toward working with illicit drug users. Nurses, in particular, have been reported as holding moralistic or stereotypical views of illicit drug users. However, few studies have measured the attitudes of student nurses or compared their attitudes to other health and social care students. This article describes the use of a bespoke attitude scale to measure the attitudes of cohorts of student nurses, clinical psychology trainees, health and social care, social work and midwifery students at the start of their course (N = 308). Results indicated that student nurses had the least tolerant attitudes, reinforcing the need for a specific educational focus on working with illicit drug users in nurse education. Variations between student groups indicate that Interprofessional Education can provide an opportunity to improve attitudes toward illicit drug users, particularly amongst student nurses.     

Community Health Assessment and Program Planning in the Nurse Practitioner Curriculum: Evaluation of a Guided Design Learning Module

A 14-hour learning module based on the Guided Design method was developed to teach community health assessment and program-planning skills to nurse practitioner students. The module was developed because students in the program, part of a master's-level community health nursing major, viewed community skills as irrelevant to their role. The module was implemented for two consecutive classes (n= 19) and was evaluated through a quasi-experimental design that measured changes in (1) students' attitudes toward community health assessment and program planning as part of the nurse practitioner role, and (2) their ability to conduct community health assessment and program planning. Upon completion of the Guided Design module, all students satisfactorily assessed a real community and planned a health program to meet a community need, and they reported highly significant (P < 0.001) improvements in their attitudes toward these aspects of the nurse practitioner role.     

Public Health Nurse Salaries: Associations with Nurse, Agency, and Community Characteristics

This study applied an economic framework to the analysis of public health nurse (PHN) salaries, assessing their relationships to nurse qualifications, agency resources, community economic base, and area competition for the nurse supply. Data were obtained through interviews with 125 Ohio health departments and from various state and local reports. Associations between salaries and explanatory variables were analyzed through correlations and stepwise regression models. The PHN salaries were significantly lower and more compressed than salaries for nurses in area hospitals. Agency and community characteristics were more important than nurse education and experience in explaining salary variations. Maximum PHN salary attainable was significantly related to level of health department funding and community unemployment rate. Health departments in rural locations paid lower salaries at both minimum and maximum levels. Evidence suggested the presence of entry-level wage competition by health departments with both area hospitals and other community nursing agencies. Each 1% increase in minimum hospital nurse salaries was linked to a 0.66% increase in PHN salaries. Findings support the need to improve competitive positions of health departments as nurse shortages intensify.     

The Henry street consortium population-based competencies for educating public health nursing students

The Henry Street Consortium, a collaboration of nurse educators from universities and colleges and public health nurses (PHNs) from government, school, and community agencies, developed 11 population-based competencies for educating nursing students and the novice PHN. Although many organizations have developed competency lists for experts, the Consortium developed a set of competencies that clearly define expectations for the beginning PHN. The competencies are utilized by both education and practice. They guide nurse educators and PHNs in the creation of learning experiences that develop population-based knowledge and skills for baccalaureate nursing students. Public health nursing leaders use the competencies to frame their expectations and orientations for nurses who are new to public health nursing. This paper explains the meaning of each of the 11 population-based competencies and provides examples of student projects that demonstrate competency development. Strategies are suggested for nurse educators and PHNs to promote effective population-based student projects in public health agencies.     

Building Community Participation in Health Care: A Model and Example from South Africa

A conceptual model was developed for a community-based intervention study in a Black township in South Africa. The model shows a useful way to structure the complex role public health nurses play as they meet community health needs using a community's priorities and building toward community involvement in health and self-care. The model was applied over a 2-yearperiod in an under-developed community of 100,00 people where the unemployment rate was over 50%, fewer than 10% of the homes had electricity, and only one-third had access to the sewage removal system. Over half of older adults interviewed were illiterate. The residents, in collaboration with the nurse researcher, gathered data, prioritized needs, and chose projects to produce solutions. The model guided activities for community empowerment through a deliberate transfer of information and expertise from the nurse to members of the community. Conceptual models or paradigms are useful to focus nursing strategies, to guide professional nursing practice, and to support interdisciplinary goals for cooperative efforts. The principles are also applicable in the United States and other developed countries as more effective ways to achieve health goals are sought.     

The meaning of public health nursing: creating 24 hour care in a community in Japan

Abstract This case study describes the strategies and activities of public health nurses to increase the availability of services in a municipality of 36 000 and to transform community attitudes so that those needing services would feel free to use them. Strategies and activities are seen in the context of Japan, Minakuchi Town and the leadership of the chief public health nurse. Practicing in partnership with members of the community, strategies of public health nurses include technical activities (conducting needs assessment and framing program alternatives) and information sharing and health education (e.g. 75 meetings organized with health promoters for residents in the districts of the town). On the basis of the results of Minakuchi Town, viewed as an example of expert public health nursing practice, a general model for public health nursing practice is presented.     

Nursing Diagnosis in the North Carolina Public Health System: A Statewide Project

A group of North Carolina public health nursing leaders initiated a two-phase process of providing a continuing education module on nursing diagnosis for all public health nurses in the state. In the first phase the authors developed the module to teach the skill of nursing diagnosis and evaluation tools, and statewide workshops were held to teach public health nurse administrators and nurse consultants how to use it with their staffs. Results of the evaluation revealed a significant increase in cognitive learning and a more positive attitude overall toward nursing diagnosis among 148 participants. Written comments revealed two major concerns for using nursing diagnoses: the need for additional practice, and charting issues. Both were addressed in this project. Phase two, in which administrative nurses are using the module to teach nursing diagnoses to their staffs, is under way.     

Public health nurses’ views on quality measures: A cross-sectional study

BackgroundThe quality indicators program has intended and unintended consequences that may affect nurses’ professional performance and organisational outcomes.AimsTo explore public health nurses’ knowledge, attitudes, and perceptions of the nursing-sensitive quality indicators applied in mother–child health clinics and their associations with organisational quality outcomes: quality of care, burnout, and communication.MethodsA cross-sectional study with a convenience sample. In total, 177 public health nurses completed a self-administered questionnaire measuring their knowledge, attitudes, and perceptions of the quality indicators regarding their performance and organisational outcomes. A structural equation modelling analysis was performed to describe the associations between the variables and to identify the mediating variables.FindingsThe structural equation modelling analysis revealed that the intended (positive) impact on the nurse's professional level was the mediating variable between the nurses’ knowledge and attitudes towards the National Health Quality Measure program, their seniority, and the unintended (negative) impact on the nurse's professional level, and the organisational outcomes.Discussion and conclusionPublic health nurses perceive quality indicators as contributing to and improving their professional work, with a positive impact on organisational outcomes. Nursing leaders and policymakers may promote good organisational outcomes by developing methods that will emphasise the importance of quality indicators in nursing practice.     

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.