Valuing tacit nursing knowledge during the COVID-19 pandemic

Public health nurses in Ontario, Canada, support the healthy growth and development of children across the province through a variety of programs including home visits for pregnant individuals and families with young children. During the COVID-19 global pandemic the needs of families increased while access to health and social services decreased. During this time, home visiting teams closely involved in supporting families also experienced staff redeployment to support pandemic efforts (e.g., case and contact management, vaccinations) and changes to the nature of home visiting work, including shifts to remote or virtual service delivery. To support nursing practice in this new and evolving context, a framework for capturing and sharing the tacit or how-to knowledge of public health nurses was developed. A valuing of this type of knowledge for informing future public health nursing practice – well beyond the pandemic response – was recognized as a pandemic silver lining when reflecting on two years of supporting home visiting teams in our province.     

Dropping out of maternal and child home visits

The purpose of this study was to examine the relationship between nurse and client characteristics and the reason for client termination from public health nursing maternal and child home visits. The results indicate that clients who dropped out of services received more contacts from the nurses, missed more appointments with the nurses, and were given advice from the nurses on more topics. They also differed from clients who continued with services until the nursing care plan goals were met in reference to marital status, mental illness, source of payment for services, and use of WIC and food stamps. Nurses whose clients were more likely to continue until goals were met were higher in conscientiousness, learned more from experience, and learned less from coworkers or learning on their own. They also worked more hours per week. These findings have implications for practice and research.     

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.     

The Black Bag

In the early‐ to mid‐twentieth century, stories about nursing practice submitted by nurses frequently appeared in Public Health Nursing. The article reprinted here is an example of this genre of publications. Originally published in April 1936, this article tells the story of a day in the work of one public health nurse as she moves about the city making home visits. In this article, Snow (1936) used personification of the iconic black bag to tell her story. Using this technique she brings to life the nuances of her day, the personalities of her patients, and the importance of the black bag to the work of public health nurses. What did nurses learn from stories such as this one? Themes embedded in this story reflect the role of the Public Health Nurse (PHN), as well as the environment in which she worked. For instance, in this story we learn that not only was the PHN a welcomed visitor in the homes of families struggling with health problems, but that she brought order out of chaos, as illustrated in “The New Arrival”. “The Black Bag” also highlights the humor nurses experienced in their encounters with families, as well as the pathos in other situations. Stories served as a vehicle for nurses to share and learn about both the common elements of their work, as well as the unique features related to location and environment, such as rural and urban locales.     

Updating the Definition and Role of Public Health Nursing to Advance and Guide the Specialty

National changes in the context for public health services are influencing the nature of public health nursing practice. Despite this, the document that defines public health nursing as a specialty—The Definition and Role of Public Health Nursing—has remained in wide use since its publication in 1996 without a review or update. With support from the American Public Health Association (APHA) Public Health Nursing Section, a national Task Force, was formed in November 2012 to update the definition of public health nursing, using processes that reflected deliberative democratic principles. A yearlong process was employed that included a modified Delphi technique and various modes of engagement such as online discussion boards, questionnaires, and public comment to review. The resulting 2013 document consisted of a reaffirmation of the one‐sentence 1996 definition, while updating supporting documentation to align with the current social, economic, political, and health care context. The 2013 document was strongly endorsed by vote of the APHA Public Health Nursing Section elected leadership. The 2013 definition and document affirm the relevance of a population‐focused definition of public health nursing to complex systems addressed in current practice and articulate critical roles of public health nurses (PHN) in these settings.     

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.     

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.     

Repeating history? Public and community health nursing in Australia

Despite the long history in Australia of public and community health nursing, it has never been regarded as important as hospital‐based nursing. Notwithstanding the establishment of nursing organisations in the very early years of the 20th century and subsequent efforts to develop the nursing workforce, public and community health nursing has been neglected in terms of policy, research into public health nursing practice and workforce development. Even in the present day, public and community health nurses are marginalised from mainstream nursing interests and there is a lack of conceptualisation about the value of nursing’s contribution to the primary health sector. This sector is experiencing a new wave of reforms driven by a combination of managerialism and systems change for improved responses to address health inequalities. Because there is not a strong institutionalised professional policy and support base for public and community health nurses, they are vulnerable in these reforms to increased domination and appropriation of their practice by stronger professional interests. There is an urgent need for professionally organised support from mainstream nursing to ensure that public and community health nurses are positioned as a unified force in efforts to advance the health of the community.     

Barriers and facilitators in the delivery of environmental risk reduction by public health nurses in the home setting

ABSTRACT Objective: The goal of this study was to identify the factors that contributed to or detracted from the ability of public health nurses (PHNs) to deliver environmental risk reduction (ERR) in the home setting. Design and Sample: Structured one‐to‐one interviews were conducted with 10 PHNs from 2 county health departments in the western United States that were delivering an ERR intervention in a randomized clinical trial. Results: Barriers to incorporating ERR into PHN practice were: a change in the perceived mission of public health, nurses' lack of environmental health (EH) training, the absence of a strong relationship with EH, the multidimensional role of PHNs, presentation of nurse participation by management, incorporation of ERR visits into nursing schedules, and challenges engaging parents in EH. Facilitating factors included: training and support, opportunities for capacity building, belief that ERR is important, building a more visible face for PHN, and personal interest in EH and ERR. Conclusions: Adapting PHN practice to include ERR strategies is feasible, but not without challenges. With adequate training, time, and institutional support, multiple challenges can be overcome. PHNs are well positioned to improve the health of families and communities by integrating ERR into their scope of practice.     

Public health nursing: the generalist in a specialized environment

In implementing a generalist model of public health nursing (the Comprehensive Multi-level Nursing Practice Model) in a rural county health department, a research team encountered critical challenges. The framework for the model was a philosophy of public health nursing practice and action research to support the public health nurse generalist role. Challenges in implementing the model stemmed from conflicts between the research team and the health department that were rooted in philosophical differences about how to implement care and the nature of nursing and the public health nursing role. Key factors were the subtle forces operating in the public health environment that constrain the public health nurse generalist role. Based on conflicts that arose in implementing the model, implications for public health nursing practice are in opportunities to influence policy at health department and other levels and responsibility for assuring professional practice.     

Embracing a Competency‐Based Specialty Curriculum for Community‐Based Nursing Roles

The Quad Council competencies for public health nursing (PHN) provide guidance in developing curricula at both the generalist and specialist level. However, these competencies are based on nursing roles in traditional public health agencies and community/public health is defined more broadly than official agency practice. The question arises as to whether community‐based specialties require largely the same knowledge and skill set as PHN. The purpose of the competency cross‐mapping project reported here was to (a) assess the intersection of the Quad Council competencies with four community‐based specialties and (b) ensure the appropriateness of a Quad Council‐based curriculum to prepare graduates across these four specialties (home health, occupational health, environmental health, and school nursing). This article details the multistep cross‐mapping process, including validation with practice leaders. Results indicate strong alignment of community‐based specialty competencies with Quad Council competencies. Community‐based specialty‐specific content that did not align well is identified, along with examples of didactic and clinical strategies to address gaps. This work indicates that a Quad Council‐based curriculum is appropriate to prepare graduates in community‐based specialties when attention to the specialty‐specific competencies in the clinical setting is included. This work guides the development of a doctorate of nursing practice curriculum in PHN, encompassing the four additional community‐based specialties.     

Developing simulation games to advance public health nursing competence in baccalaureate education

We describe the development of an innovative baccalaureate nursing education strategy for public health nursing. Virtual simulation pedagogy is known to be effective for acute care nursing practice while less known for public health nursing. Three Canadian nursing schools, the Canadian Association of Schools of Nursing (CASN), and the Canadian Alliance of Nurse Educators using Simulation (CAN-Sim) partnered to develop three public health nursing virtual simulation games. Learners work through unfolding population health scenarios, simulating public health nursing practice focused on entry level public health nursing competencies. Each game fosters clinical reasoning and collaborative, community decision-making to respond to population health issues during community assessment, evidence-informed health promotion planning, and evaluation processes. A companion guide was developed to support best practices in implementing virtual simulation and promote optimum student learning using the public health nursing games.     

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.     

Using a digital storytelling assignment to teach public health advocacy

The need and expectation for advocacy is central to public health nursing practice. Advocacy efforts that effectively call attention to population health threats and promote the well‐being of communities rely on strategies that deliver influential messaging. The digital story is a lay method to capture meaningful, impactful stories that can be used to advocate for public health concerns. Readily available, user‐friendly digital technologies allow engagement in digital media production to create digital stories. This paper describes how digital story making can be utilized as an academic assignment to teach public health advocacy within an undergraduate nursing curriculum. Providing nursing students this artistic outlet can facilitate meeting academic learning goals, while also equipping them with creative skills that can be applied in future professional practice. Nursing educators can take advantage of institutional resources and campus culture to support the use of novel digital media assignments that facilitate application of advocacy concepts.     

From miasma to fractals: the epidemiology revolution and public health nursing

If public health nursing is truly a synthesis of public health science and nursing science, then nurses must keep track of current developments in public health science. Unfortunately, the public health nursing literature has not kept pace with revolutionary developments in epidemiology, one of the sciences that informs population-focused nursing practice. Most epidemiology chapters in community health nursing texts do not reflect the intellectual development that has taken place in epidemiology over the past two decades. The purpose of this article therefore is to facilitate an updated synthesis by (a) reviewing the development of epidemiology and the focus of public health nursing practice through three historical eras, (b) discussing current controversies and tensions within epidemiology, (c) introducing an emerging paradigm in epidemiology based on an ecosocial perspective, and (d) discussing the congruence of this perspective with the evolving theory and practice of public health nursing.     

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.     

Use of the Public Health Nursing Bag Reexamined

A stratified random sample of 104 NLN-accredited baccalaureate schools was surveyed regarding use of standard public health nursing bags by students in public health nursing courses. Return rate was 60 percent. Results indicated 66 percent of responding schools used public health nursing bags (Henry Street type) when students provided home care. It can be concluded that teaching of bag technique continues to be an applicable component of many nursing education programs despite rumors to the contrary.     

Changing times, changing needs, changing programs.1952

EDITOR's NOTE  The following reprint of the unsigned editorial for the April 1952 issue of Public Health Nursing describes the historical needs and the continuing development of school health nursing from the early to mid-20th century. Twenty-first century schools continue to deal with some of the same issues such as hunger, poor nutrition, and the adverse effects of overly burdensome work schedules on adolescent health and mental well-being. The goal, so optimistically anticipated by the editors of Public Health Nursing in 1952, of continuous, well-coordinated health supervision from birth to maturity continues to elude us. Of course, school nurses and other health personnel address problems not openly discussed in the 1950s—substance abuse, violence, sexually transmitted diseases, and teen pregnancy. The theme of this historical editorial is the power of advocacy—and the responsibility public health nurses have to use our talents to improve child health.