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.     

Finding common ground in public health nursing education and practice

Preparation of the public health nursing (PHN) workforce requires public health nurses from academia and practice to collaborate. However, a shortage of PHN clinical sites may lead to competition between schools of nursing for student placements. The Henry Street Consortium, a group of 5 baccalaureate schools of nursing and 13 local health departments in the state of Minnesota, developed a model for collaboration between PHN education and practice. This paper describes the development process--the forming, storming, norming, and performing stages--experienced by the Henry Street Consortium members. The consortium developed a set of entry-level core PHN competencies that are utilized by both education and practice. It developed menus of learning opportunities that were used to design population-based PHN clinical experiences. In addition, the consortium created a model for training and sustaining a preceptor network. The members of the Henry Street Consortium collaborated rather than competed, used consensus for decision making, and respected and accepted different points of view. This collaboration significantly impacted how schools of nursing and local health departments work together. The consortium's ability to retain its relevance, energy, and momentum for both academic and agency partners sustains the collaboration.     

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.     

A public health nursing practice model: melding public health principles with the nursing process

There has been a shift in emphasis in public health from the provision of personal health services for individuals to efforts targeted at improving the health of the whole community. Many in public health nursing (PHN) have welcomed this shift, recognizing the important role PHN can play in promoting health and preventing disease for all. There continues to be a need to redefine PHN roles and practice so that public health nurses can participate more effectively. Los Angeles County Department of Health Services Public Health Nursing (LAC PHN) has developed a practice model grounded in nationally recognized components: the public health team, PHN standards of practice, the 10 Essential Public Health Services, Healthy People 2010's 10 Leading Health Indicators and additional local indicators, and the Minnesota Public Health Nursing Interventions Model. The LAC PHN Practice Model provides a conceptual framework that assists in clarifying the role of the public health nurse and presents a guide for public health practice applicable to all public health disciplines.     

Development of a public health nursing data infrastructure

An invited group of national public health nursing (PHN) scholars, practitioners, policymakers, and other stakeholders met in October 2010 identifying a critical need for a national PHN data infrastructure to support PHN research. This article summarizes the strengths, limitations, and gaps specific to PHN data and proposes a research agenda for development of a PHN data infrastructure. Future implications are suggested, such as issues related to the development of the proposed PHN data infrastructure and future research possibilities enabled by the infrastructure. Such a data infrastructure has potential to improve accountability and measurement, to demonstrate the value of PHN services, and to improve population health.     

Cornerstones of public health nursing

The "Cornerstones of Public Health Nursing" describe the values and beliefs that underlie the practice of Public Health Nursing, which is a synthesis of public health and nursing. The impetus for the development of the Cornerstone framework originated from the need to advocate for public health nursing programs, positions, and funding. Grounded in practice, their development engaged stakeholders from the public health nursing community at every phase. The Cornerstone framework has been used over the past decade by educators to teach public health nursing and by administrators in state and local health departments for orientation and continuing education. The Cornerstones have been nationally and internationally disseminated. This paper describes the development and dissemination of the Cornerstones framework by public health nurses in Minnesota and features exemplars from practice.     

A win-win partnership between academia and public health practice

Partnerships are fundamental to successful public health practice, and collaborations between academia and public health practice, as recommended by the Institute of Medicine and the Council on Linkages between academia and public health practice, are vital to ensuring a competent public health workforce. During times of economic crisis, graduate public health nursing students with clinical expertise, people and communication skills, and critical thinking capabilities are uniquely positioned to bridge the gap between academia and public health practice. In 2009, 5 registered nurses enrolled in a master of science in nursing program with a focus on public health partnered with public health professionals from the state Department of Public Health to conduct an active surveillance study to understand the increase in vancomycin-resistant enterococci incidences that occurred since 2005. The purpose of this paper is to describe the successes and challenges of the collaboration to provide an insight for those who wish to build similar collaborations. Even in light of the challenges that occurred during this collaboration, faculty should strongly consider developing partnerships with public health practice in order to contribute to important public health surveillance and other functions, and to provide relevant experiences for students.     

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.     

Barriers and facilitators to the achievement of community-focused public health nursing practice: a UK perspective

Aim  To explore the extent to which Community Health Nurses (CHN) engage in community-focused public health practice and the facilitators and barriers to such practice.
Background  The government promotes the role of nurses in public health. However, there is confusion as to what constitutes public health; a lack of support to move from individual and family-focused practice to community-focused practice; and, inconsistency of the use of titles.
Method  A 15% quota sample ( n  = 409), drawn from a population of 2668 CHNs, participated in a quantitative survey.
Results  Response rate was 67% ( n  = 275). Over half of CHN time was spent with individuals and families, community level activity accounting for only 18%. Only 9% of respondents had completed a community needs assessment. Education was key to the promotion of community-focused practice with collection of individual activity data a major barrier.
Conclusions  There is a gap between the rhetoric and reality of community public health nursing.
Implications for Nursing Management  Development of a shared vision of public health nursing and commissioning of education to meet public health priorities is essential. Furthermore, strengthening public health nurse leadership to foster innovative practice and methods of measuring public health nursing outcomes is required.     

Questions and answers: Some questions discussed at one of the round tables held at Chicago Institute with public health nurses

There were a number of issues confronting public health nurses in 1919, including the differentiation of practice between visiting nurses and public health nurses, use of community partnerships when developing a new nursing service in a community, and standards of nursing work. Other issues included the focus of nursing work at the community/population versus individual level, how to balance the work load where there was only one nurse in a community, and educating the public about the value of public health nursing to the community. In this excerpt from the original publication, Ella Phillips Crandall responded to questions raised at a round table session held in Chicago in 1919 as a part of a Public Health Nursing Forum, and then published in the October 1919 issue of The Public Health Nurse. While the social context in which PHNs worked in 1919 were significantly different from those nurses face today, these insights are prescient to the issues faced by PHNs today as the profession continues to address issues related to standards of practice, role development, and educational preparation for both entry level and advanced practice.     

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.     

School nursing on the iron range in a public health nursing model

Frontier nursing in the public health model might invoke images of school nurses on horseback in rural Kentucky or the wilds of the western prairies. Northern Minnesota was a frontier in the last decade of the 19th century, due to the discovery of one of the richest seams of iron ore on the North American continent. Immigrants from Europe responded to the opportunities this discovery created. Among the many Finns arriving on the Iron Range of Minnesota, as it came to be named, were the parents of Lillian Augusta Wilhelmena Beck, John and Hulda Beck. Over her more than nine decades of life, their daughter became one of the most well known school nurses on the Iron Range. Her story evokes memories of the creation of school nursing in the public health model by nurses at the Henry Street Settlement in New York City.     

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.     

Creating a brand image for public health nursing

Public health nurses (PHNs) have declined as a proportion of both the nursing and the public health workforces in the past 2 decades. This decline comes as 30 states report public health nursing as the sector most affected in the overall public health shortage. Taken together, these data point to a need for renewed recruitment efforts. However, the current public images of nurses are primarily those of professionals employed in hospital settings. Therefore, this paper describes the development of a marketable image aimed at increasing the visibility and public awareness of PHNs and their work. Such a brand image was seen as a precursor to increasing applications for PHN positions. A multimethod qualitative sequential approach guided the branding endeavor. From the thoughts of public health nursing students, faculty, and practitioners came artists' renditions of four award-winning posters. These posters portray public health nursing-incorporating its image, location of practice, and levels of protection afforded the community. Since their initial unveiling, these posters have been distributed by request throughout the United States and Canada. The overwhelming response serves to underline the previous void of current professional images of public health nursing and the need for brand images to aid with recruitment.     

Enhancing a public health nursing shelter program

The Shelter Nurse Program offers important nursing care and resources that help meet the health needs of the homeless population and improve the health of homeless individuals and families. However, formalized program goals and objectives, along with an evaluation plan that demonstrates population outcomes, had never been developed even as the program has evolved over time. Thus, the agency sought our assistance as public health nursing consultants to enhance the overall program to improve the health of the homeless population. To accomplish this, we worked with the agency and the shelter nurses throughout each step of the process to assess the needs of the program, develop appropriate goals and objectives, and develop an effective outcome evaluation plan for the existing Shelter Nurse Program. Lessons learned included the value and applicability of the selected program development model, the importance of agency ownership and active participation by front‐line workers, and the value of educating the workers and introducing resources throughout the process.