Outbreak investigations: Community participation and role of community and public health nurses

Community and public health nurses (C/PHNs) may play a vital role in the investigation of disease outbreaks. C/PHNs possess skills in conducting interviews on sensitive subjects and in collaborating with communities. C/PHNs maintain key links to community providers, symptomatic clients, their families and associates, as well as community institutions where outbreaks occur. This combination of skills makes C/PHNs ideally suited to perform outbreak investigations. There are, however, pressing questions about whether C/PHNs are adequately prepared to contribute to investigation outcomes, to foster participation of affected communities, and to fully apply nursing skills to outbreak investigations to stop the spread of disease. Using one case study, the authors explore investigation outcomes, community participation issues, educational preparation, and public health funding and workforce policies required to achieve these ends successfully. One model of community participation in the steps of outbreak investigation and several Quad Council domains and competencies are proposed for use in practice. Questions regarding the use of emergency preparedness funding and employment of C/PHNs in epidemiology roles are raised.     

牡丹江市社区护理人员组织承诺现状调查分析

目的了解牡丹江市所属32个社区卫生机构护理人员组织承诺现状。方法用组织承诺量表对158名社区护理人员进行调查,并对组织承诺现状进行差异分析。结果社区护理人员的组织承诺处于中等偏上水平;理想承诺和规范承诺随学历的增高而增高,而机会承诺随学历的增高而降低;理想承诺随职称的升高而增高,感情承诺高级职称显著高于初级和中级,而初级和中级相比差异无统计学意义(P0.05);≥41岁的社区护理人员机会承诺、感情承诺、经济承诺均显著高于其他年龄组,感情承诺30岁组高于30~40岁组,经济承诺30~40岁组高于30岁组;正式在编护士的感情承诺、经济承诺和机会承诺均高于合同护士。结论社区护理人员的组织承诺处于较高水平,组织承诺的现状在人口统计学上存在着一定差异。     

Overcoming barriers and improving public health nursing practice

Public health nurses (PHN) are critical to ensuring the health of communities. Absent the most basic information on the PHN workforce in our state, we conducted interviews with 21 PHN and school health nurse (SHN) leaders and an online survey of PHNs and SHNs practicing in Maryland (N = 491). Our study identified an older, very experienced, and well-educated workforce. Both the interviews and survey identified similar barriers: low salaries, recruitment and hiring challenges, limited funding for public health programs, and no opportunities for education or career advancement. Survey participants also identified barriers of inadequate leadership, recognition, and communication including PHNs not being represented at decision-making tables or at the state leadership level. Strategies to promote public health nursing from leaders and survey participants were similar: increasing awareness about what public health and PHNs do and their value; improving advocacy and stakeholder engagement; improving access and availability of services; improving PHN leadership representation at the state level; a improving PHN salaries and benefits including tuition reimbursement. Although results were similar to national studies, comprehensive, granular workforce data is critical to ensure the public health workforce can meet current and emerging public health needs and that public health infrastructure and services are appropriately funded.     

Retaining older nurses in primary care and the community

Title.  Retaining older nurses in primary care and the community.
Aim.  This paper is a report of a study conducted to examine issues associated with the impact of age on the retention of female primary and community care nurses in the National Health Service in England.
Background.  Little is known about why older nurses in the primary and community care workforce leave and what might encourage them to stay.
Methods.  A cross-sectional survey using a semi-structured postal questionnaire was carried out during 2005. Responses were received from 485 (61%) district nurses, health visitors, school nurses and practice nurses in five primary care trusts in England. Data were analysed to test for associations.
Results.  Older nurses were more likely than younger ones to report that their role had lived up to expectations ( P  = 0·001). Issues important for older nurses were feeling valued and being consulted when change was implemented. Important factors encouraging nurses to stay were pension considerations, reduced working hours near retirement, and reduced workload. For those with degree-level qualifications, enhanced pay was a factor encouraging retention ( P  = 0·044). Nurses might leave in response to high administrative workloads, problems in combining work and family commitments ( P ≤  0·001), and lack of workplace support ( P  = 0·029). Retirement and pensions advice was not widely available.
Conclusion.  Since two-thirds of nurses were generally happy in their role, it is important that the conditions necessary to maintain this level of satisfaction are continued throughout a nurse's working life. Nurses may all too easily consider leaving prematurely unless policy makers and managers ensure that their working environment reflects the issues nurses consider to be conducive to retention.     

社区护士健康评估能力培养存在问题及对策

作为护理程序的第一步,健康评估是护士尤其是社区护士应该掌握的最基础、最重要的专业知识技能之一。本文就中国社区护士培养现状及注重培养健康评估能力的必要性进行了分析,并提出提高社区护士健康评估能力的相应对策。     

不同级别医疗机构的社区卫生服务护理人员组织承诺分析

目的了解不同级别医疗机构的社区卫生服务护理人员的组织承诺水平。方法用组织承诺量表对牡丹江市158名社区卫生服务护理人员进行问卷调查与分析。结果不同等级医疗机构的社区卫生服务护理人员组织承诺得分差异具有统计学意义(F=4.164,P0.01),三级医院护理人员的理想承诺和机会承诺高于一、二级医院(P0.05);三级医院中,省级医院社区护理人员的组织承诺水平高于市级医院(t=4.164,P0.01)。结论组织承诺水平受医院的级别和规模的影响,三级医疗机构的社区卫生服务护理人员组织承诺水平较高。     

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.     

Collaboration between local public health and community mental health agencies

Public health agencies (PHA) and community mental health agencies (CMHA) generally are organizationally and functionally autonomous. Collaboration between PHA and CMHA was explored in a statewide survey of nursing directors of PHA (n = 135) and executive directors of CMHA (n = 214). Findings indicated staff did not know each other well; clients, funds, and information were infrequently exchanged; public health nurses rarely were included in planning for the care of those with mental illness; and satisfaction with relationships was minimal. Path analysis was used to test an interagency collaboration model. Awareness of staff from other agencies increased satisfaction with interagency processes and interagency relationships. © 1997 John Wiley & Sons, Inc. Res Nurs Health 20: 153–160, 1997     

Effects of an empowerment-based education program for public health nurses in Taiwan

Aim and objectives. The aim of this study was to examine the effects of an empowerment‐based education program (EBEP) on employee empowerment, job satisfaction, job productivity and innovative behaviours for public health nurses (PHN) in Taiwan. Background. Empowerment is an important consideration among nurses trying to function in ever‐changing health care and education settings. Several studies focused on the trend of public health nursing revealed that PHN have experienced a severe feeling of powerlessness. Developing empowerment strategies through organisations may be a means of helping employees recognise powerlessness in difficult situations and take appropriate action. Design. Quasi‐experimental design. Methods. PHN in two health bureaus in Taiwan were assigned into an empowerment group (n = 29) and a control group (n = 32). Twenty‐four hours of the EBEP lasted four weeks included four empowerment classes and four group workshops following each curriculum for PHN to apply principles of empowerment in their work environment. Data were collected at baseline and four weeks after the intervention. Analysis of covariance (ancova ) was used to examine the intervention effect. Results. The experimental group reported significantly higher psychological empowerment [F (1,47) = 5·09, MSE = 3·25, p = 0·001, η² = 0·18] and competence [F (1,47) = 3·96, MSE = 28·78, p = 0·05, η² = 0·22] and impact [F (1,47) = 4·98, MSE = 44·79, p = 0·002, η² = 0·20] subscales, job productivity [F (1,47) = 4·88, MSE = 5·18, p = 0·002, η² = 0·19] and innovative behaviours [F (1,47) = 5·09, MSE = 3·25, p = 0·001, η² = 0·24] than the control group after the EBEP. Conclusion. The EBEP had significant effect on psychological empowerment and subscales of competence and impact, innovative behaviour and job productivity but no effect on organisational empowerment and job satisfaction for PHN. Relevance to clinical practice. Our findings suggest public health administration could design empowerment‐based education to improve employee empowerment and job productivity for PHN. Furthermore, using multiple components to design empowerment education should be considered in further studies.     

临床护士组织承诺与离职意愿的相关分析

[目的]了解锦州市三级甲等医院临床护士组织承诺及离职意愿的现状,探讨组织承诺对离职意愿的影响.[方法]采用便利抽样法对锦州市某3所三级甲等医院598名护士进行组织承诺与离职意愿的问卷调查.[结果]临床护士离职意愿得分为（17.61±2.58）分,组织承诺得分为（73.56±8.69）分,组织承诺与离职意愿呈负相关;护士离职意愿水平受科室、职称、学历、年龄、月收入、护龄等人口学特征的影响.[结论]提高护士的组织承诺水平,可以有效地降低临床护士的离职行为,是促进护理队伍健康发展的重要手段.     

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.     

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.     

Public health nurse perceptions of empowerment and advocacy in child health surveillance in West Ireland

ABSTRACT Objective: The objective of this study was to analyze public health nurses' perceptions of empowerment and advocacy within a child health screening and surveillance program in West Ireland. Design and Sample: This study combined both qualitative and quantitative research methods. A purposive sample of 9 public health nurses (PHNs) (phase 1) participated in 2 focus groups and a purposive sample of 43 clients attending the child health screening service completed a questionnaire (phase 2). Measures: Focus groups and Questionnaires were used. Results: Thematic content analysis revealed that PHNs in the study did not perceive themselves to be empowered in their work. They attributed this to workload, lack of professional advocacy, and restricted access to power and opportunity, while also identifying the need for continued managerial support and feedback. Conclusions: The results suggest that PHNs need to be empowered in order to facilitate client empowerment. PHNs struggled with empowerment and client advocacy. There is a need for professional development for PHNs in order to support them to more critically engage with empowerment and self‐efficacy in their work. This needs to be done within organizational structures that support PHNs to critically analyze the role of advocacy and empowerment in their practice.     

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.