Assessing Competencies of the Public Health Workforce in a Frontier State

The purpose of this study was to determine the level of perceived proficiency of a public health workforce based on the Public Health Practice Core Competencies. The Public Health Profile and Training Needs Assessment questionnaire was mailed out to public health employees representing mostly public health nursing, environmental health, mental health, and public health management/administration (n = 696). Nearly three-quarters (74%) of participants were female and 96% reported being white. Eighty one percent of participants were currently employed full-time. The majority of participants were trained at the bachelors level (54%). The response rate was 63.9%. Findings from this study show that all disciplines reported higher perceived proficiency in the Communication skills domain compared to the other seven skills domains. Perceived low skills domains included financial planning and management skills and policy development/program planning skills among public health nurses, mental health professionals, and environmental health specialists. Management/administration level staff reported their lowest perceived proficiency in Basic Public Health Science skills. Each group had different strengths and weaknesses and the necessary level of skill needed differs among discipline groups, thus future trainings on the Public Health Core Competencies should be discipline specific.     

'Faced' with responsibility: Levinasian ethics and the challenges of responsibility in Norwegian public health nursing

Abstract This paper is concerned with aspects of responsibility in Norwegian public health nursing. Public health nursing is an expansive profession with diffuse boundaries. The Norwegian public health nurse does not perform ‘hands on’ nursing, but focuses on the prevention of illness, injury, or disability, and the promotion of health. What is the essence of ethical responsibility in public health nursing? The aim of this article is to explore the phenomenon based on the ethics of responsibility as reflected upon by the philosopher Emanuel Levinas (1906–1995). From an ethical point of view, responsibility is about our duty towards the Other, a duty we have not always chosen, are prepared for, or can fully explain; but it is nevertheless a demand we have to live with. Interviews with five experienced Norwegian nurses provide the empirical base for reflection and interpretation. The nurses share stories from their practice. In interpreting the nurses’ stories, the following themes emerge: personal responsibility; boundaries; temporality; worry, fear, and uncertainty; and a sense of satisfaction. As the themes are developed further, it becomes apparent that, despite their diversity, they are all interrelated aspects of ethical responsibility. Responsibility for the Other cannot be avoided, ignored, or transferred. The nurses’ responsibility is personal and infinite. Levinasian ethics can help nurses understand the importance of accepting that being a responsive carer can involve not only contentment in the predictable, but also the fear, worry, and uncertainty of the unpredictable.     

Preparing currently employed public health nurses for changes in the health system

OBJECTIVES: This article describes a core public health nursing curriculum, part of a larger project designed to identify the skills needed by practicing public health workers if they are to successfully fill roles in the current and emerging public health system. METHODS: Two focus groups of key informants, representing state and local public health nursing practice, public health nursing education, organizations interested in public health and nursing education, federal agencies, and academia, synthesized material from multiple sources and outlined the key content for a continuing education curriculum appropriate to the current public health nursing workforce. RESULTS: The skills identified as most needed were those required for analyzing data, practicing epidemiology, measuring health status and organizational change, connecting people to organizations, bringing about change in organizations, building strength in diversity, conducting population-based intervention, building coalitions, strengthening environmental health, developing interdisciplinary teams, developing and advocating policy, evaluating programs, and devising approaches to quality improvement. CONCLUSIONS: Collaboration between public health nursing practice and education and partnerships with other public health agencies will be essential for public health nurses to achieve the required skills to enhance public health infrastructure.     

NURSING OUTSIDE HOSPITALS: THE WORKING EXPERIENCE OF COMMUNITY NURSES. EDUCATIONAL CHARACTERISTICS AND JOB PERCEPTIONS

The community nursing practice research project reports the results of a mailed questionnaire survey of nurses employed outside hospitals and nursing homes in Victoria in 1985. Two 10 per cent random samples stratified across practice areas were selected from listings of community nurses providing detailed employment information to the Victorian Nursing Council. An 84 per cent response rate was obtained from these listings yielding 689 responses. This paper reports that part of the study relevant to job entry, job satisfaction, job mobility and perceived career options as well as educational preparation. One half of community nurses entered community nursing after five years of hospital experience. The major reasons for choosing employment in community health nursing were its conditions of work, its autonomy and a dissatisfaction with hospital nursing, rather than a specific orientation to community nursing. These can be appreciated in terms of competing demands by the nurse's family life and her sense of growing professional maturity. Job satisfaction was high, with 87 per cent of nurses in the study population being satisfied or very satisfied. Only one quarter considered opportunities for career advancement to exist in their practice area. In the event only one fifth of nurses regarded promotion as important. The high levels of job satisfaction and the low importance attached to promotion are explicable given the nature of female employment and dissatisfaction with hospital nursing. Despite this high level of job satisfaction, one third of nurses believed they would not be nursing in five years time. Less than one third of nurses felt there was adequate opportunity for advancement in their practice area. Fifty per cent of community nurses were aged over 40 (the majority of these are in the maternal and child health and medical clinic groups) and some had the non-nursing educational standards that would be expected given this age composition. Overall 61 per cent of nurses believed that their basic nursing education was an adequate preparation for community nursing at least at a beginning level. However, a perceived need for preparation beyond a beginning level existed given that 83 per cent perceived regular ongoing in-service education to be essential. No more than 29 per cent however supported either a post-basic in-service course, a Diploma in Community Health Nursing, or a Bachelor degree in Applied Science with a major in Community Health Nursing or other college program as being essential. It was considered that the non-academic nature of the educational background of the majority of nurses was the principal reason for these findings. It was concluded that planning for future development in community nursing, especially with regard to the appropriate educational preparation and career structure, should recognise the current experiences and expectations of nurses. These, however, are likely to change with the introduction of college-based nursing. They may also be affected by the current absence of an adequate career structure in most community nursing practice areas.     

HIV Prevention in Practice: An Assessment of the Public Health Response of Physicians and Nurses in the Midwest

Epidemiological trends in HIV infection in the United States suggest existing primary and secondary prevention efforts are inadequate. Healthcare providers may be missing valuable opportunities to engage in necessary public health services, such as prevention education, risk assessment, and case finding. This study examined the HIV-related practice behaviors and training needs of physicians and nurses in the Midwest. A cross-sectional survey method was employed. A questionnaire was mailed to a probability sample of 1,500 physicians and registered nurses licensed as of August 1999 in one of six Midwestern states. A total of 534 physicians and nurses replied to the survey, and over half had received prior HIV-related continuing medical education and training. One third of nurses and 26.8 percent of physicians reported that they did not engage in any HIV-related public health role in their practice. Physicians with prior HIV continuing medical education and training were 3.1 times more likely to report HIV-related public health services in their practice than providers without prior training (p = .004). Nurses with prior experience serving HIV-infected patients were 2.0 times more likely to identify a public health role (p = .012). These findings reflect the need for greater awareness among medical providers of the importance of assuming a public health role with the HIV epidemic.     

Public health nurses' knowledge and attitudes regarding climate change

Background: Climate change affects human health, and health departments are urged to act to reduce the severity of these impacts. Yet little is known about the perspective of public health nurses—the largest component of the public health workforce—regarding their roles in addressing health impacts of climate change.Objectives: We determined the knowledge and attitudes of public health nurses concerning climate change and the role of public health nursing in divisions of health departments in addressing health-related impacts of climate change. Differences by demographic subgroups were explored.Methods: An online survey was distributed to nursing directors of U.S. health departments (n = 786) with Internet staff directories.Results: Respondents (n = 176) were primarily female, white public health nursing administrators with ≥ 5 years of experience. Approximately equal percentages of respondents self-identified as having moderate, conservative, and liberal political views. Most agreed that the earth has experienced climate change and that climate change is somewhat controllable. Respondents identified an average of 5 of the 12 listed health-related impacts of climate change, but the modal response was zero impact. Public health nursing was perceived as having responsibility to address health-related impacts of climate change but lacking the ability to address these impacts.Conclusions: Public health nurses view the environment as under threat and see a role for nursing divisions in addressing health effects of climate change. However, they recognize the limited resources and personnel available to devote to this endeavor.     

Child Health Assessment at School Entry (CHASE) project: evaluation in 10 London primary schools

AIMS: To assess the feasibility of implementing the Child Health Assessment at School Entry (CHASE) questionnaire, developed to capture the multiple dimensions of the health of children in their first year at school, and to evaluate data quality, reliability and validity. METHODS: Parents of 278 year-1 children, from 10 primary schools in two London boroughs, received a parent questionnaire and school nurses completed a separate questionnaire from health and education records for children whose parents consented. Additional data on free school meal eligibility and ethnicity were obtained from the two Local Education Authorities. The parent questionnaire included the Strengths and Difficulties Questionnaire (SDQ) and four dimensions of the Child Health Questionnaire Parent Form-28 (CHQ-PF28). RESULTS: Response rate was 61%. The association between school free school meals eligibility and response rate in each school approached significance (r = -0.62, P = 0.05). Data completeness of the parent questionnaire was high (mean 98%). Data completeness of the school nurse questionnaire was more variable (mean 82%). Cronbach's Alpha was greater than 0.6 for four of the five SDQ scales and greater than 0.7 for the two CHQ-PF28 multi-item scales. Relative to parents with qualifications, parents with no qualifications rated their children as having significantly more conduct problems, peer problems, and overall mental health problems (P < 0.01) as assessed by the SDQ, and significantly lower global health (P < 0.01) as assessed by the CHQ-PF28. Children with special educational needs and children with long-standing illness or disability were rated as having significantly lower global health (P < 0.05) than children without these. Sample tables of inter-school and inter-borough comparison of key findings demonstrate considerable differences in physical and mental health status. DISCUSSION: The questionnaire was acceptable to parents and school nurses, and feasible to implement within existing school resources. Initial tests of internal reliability and validity are satisfactory. These data have the potential to inform interventions and service provision at school and borough level, and public health trends over time.     

Community care: changing the role of hospital social work

Health and social services have been subjected to many changes over the past decade. Legislative reforms in the National Health Service (NHS), the implementation of policies for care in the community, and the transfer of funding for social care have given Local Authorities the lead role in the assessment of need and development of a mixed economy of care. The challenge for the organization and management of health social work is how to adjust to the change, whilst ensuring that increased choices are made available to users. It raises questions as to whether the reforms will provide a real opportunity for innovation or lead to a different form of rationing of services—a ‘top-down’, imposed, technocratic solution to reducing public spending. This paper presents the findings of an exploratory research study which considers the effect of organizational change on the provision of hospital-based social-work services to adults with health and social care needs in four Local Authorities in England. Local Authorities have responded differently; some have integrated care management within a social-work perspective; others have moved towards employing care managers who need not be qualified social workers. Change is proceeding slowly, not surprisingly, for none has been wholeheartedly enthusiastic. This paper examines the limited evidence on how social-work managers and practitioners are meeting the changes imposed upon them. Managers are more optimistic and see the changes as challenging, offering opportunities for acquiring new knowledge and different skills; workers are more pessimistic, fearing that preventive, professional practice will be eroded, disempowering users. Both are in agreement that the process has been stressful and that the practice of social work in hospitals has changed.     

北京地区医务人员对应对突发公共卫生事件薄弱环节认知情况的调查分析

目的了解各级医院医务人员对目前应对突发公共卫生事件的管理现状,尤其是薄弱环节所获数据为全国各医院健全突发公共卫生事件的应急机制,完善应急处置预案提供有益的借鉴和参考,为政府相关部门制定突发公共卫生事件应急体系提供可靠依据.方法采用抽样问卷调查方法,对北京地区15家医院和2家医疗卫生单位的1223名医务人员进行有关突发公共卫生事件及救治知识的认知情况、管理现状、救治能力等方面的调查.结果应对突发公共卫生事件的管理水平和救治能力亟待提高.结论政府和各级卫生行政部门要重视救治常识的宣传教育、公共卫生体系的建设、医院应急预案的完善,提高医院的危机管理水平和医务人员的救治能力.     

Shaping an Australian nursing and midwifery specialty framework for workforce regulation: criteria development

One of the biggest obstacles identified in achieving Millennium Development Goals (MDGs) was the lack of available qualified health personal to meet the health needs of the global population. With nurses being the main workforce component in health systems, the human resource challenge for most countries is to address the reported shortage of nurses. Skill mix is one suggestion. In Australia, workforce projections indicated a shortage of 40,000 nurses by 2010. Toward the reform of the Australian health workforce, one project aimed to develop a nationally consistent framework for nursing and midwifery specialization based on knowledge and skills to generate the first national database iteration for designated specialties. A literature review looked at the way nursing specialty practices were defined in the United Kingdom, the United States of America and Canada. Three international and three national sources of criteria for specialty nursing practice were mapped against each other. The result was six criteria synthesized to define nursing practice groups as Australian nursing specialties. Each criterion was operationalized with criteria indicators to meet Australian expectations. The nurses in Australia commented on the criteria before they were finalized. An audit of national workforce databases identified nursing practice groups. The criteria were applied to identify nursing specialties and practice strands that would form a national nursing framework. This paper reports on the criteria developed to assess specialty practice at a national level in Australia. Copyright © 2010 John Wiley & Sons, Ltd.     

Variations in practice nursing: implications for family health services authorities

Differences between Family Health Services Authorities (FHSAs) in practice nurse activities are described and interpreted, using the results of postal questionnaires to all practice nurses in England and Wales in late 1992. There were an estimated 15000 practice nurses of whom 12589 (85%) returned a completed questionnaire, which asked about 30 tasks, including domiciliary visits, carried out by practice nurses; employment conditions, professional qualifications, experience, and clinical grading; and practice characteristics. The proportion of nurses undertaking four out of five tasks varied by a factor of two or more across FHSAs. Just over a third (39%) of the variation in nurses' activities could be explained by professional and practice characteristics. The analysis distinguished between FHSAs where nurses were more likely to engage in tasks requiring diagnostic and clinical skills, including assisting with minor surgery, and FHSAs where nurses were more likely to conduct domiciliary visits, help with chronic disease management, and provide advice on welfare benefits, incontinence and health promotion. The former FHSAs were characterized by larger practices with four or more partners employing several nurses, training practices, and practices with a manager. The latter group was characterized by smaller inner city or urban practices, including single-handed partnerships, and practices often employing one nurse. The 1990 general practitioner (GP) contract boosted nurses' involvement in those activities attracting new payments but its impact on their roles and responsibilities was mediated by their professional skills and experience and the type of practice where they worked. The contribution of practice nursing to the delivery of primary and community health care varies considerably. Further research is required to find out whether role diversity reflects uncertainty about the appropriate use of their skills. FHSAs need to develop a variety of strategies to support and promote practice nursing.     

School Nurses' Perceptions and Practices of Assisting Students in Obtaining Public Health Insurance

BACKGROUND: From January through June 2009, 6.1 million children were uninsured in the United States. On average, students with health insurance are healthier and as a result are more likely to be academically successful. Some schools help students obtain health insurance with the help of school nurses. METHODS: This study assessed public school nurses' knowledge and beliefs of the impact of health insurance on students' health and academic success. The study also determined whether public school nurses or their schools were involved in helping students obtain public health insurance, and if so, how they did so. Additionally, the study assessed the public school nurses' perceived benefits of and barriers to helping students obtain public health insurance. A paper-and-pencil survey was sent to a national random sample of 750 public school nurses. The response rate was 56%. RESULTS: Nearly 60% of respondents had helped students enroll in public health insurance. The majority perceived that helping students obtain public health insurance would reduce school absenteeism (90%), improve attention during school (84%), reduce the number of students held back (80%), reduce school dropouts (72%), and increase academic test scores (69%). Although the majority (53%) of nurses thought schools should assist students' parents with filling out public health insurance enrollment forms, some expressed reservations about the process. CONCLUSION: School nurses indicated health insurance is important for the health and academic success of students. These beliefs are congruent with state Child Health Insurance Program (CHIP) directors' perceptions, yet few schools have taken on the role of facilitating student enrollment in public health insurance programs.     

Epistemological barriers to addressing the social determinants of health among public health professionals in Ontario,Canada: a qualitative inquiry

To date, Ontario public health units (PHUs) have generally neglected the social determinants of health (SDH) concept in favor of risk aversion and behaviorally oriented health promotion approaches. Addressing SDH and responding to the presence of health inequities is required under the Ontario Public Health Standards and is a component of provincial public health documents and reports. Nevertheless, units vary in their understanding and application of the SDH concept in their activities. The authors conducted 18 interviews with Medical Officers of Health and lead staff persons from nine Ontario PHUs, in order to better understand how these differences in addressing the SDH among health units come about. The findings suggest that differences in practice largely result from epistemological variations: conceptions of the SDH; the perceived role of public health in addressing them; and understandings concerning the validity of differing forms of evidence and expected outcomes. Drawing from Bachelard’s concept of epistemological barriers and Raphael’s seven discourses on the SDH, we examine the ways in which the participating units discuss and apply the SDH concepts. We argue that a substantial barrier to further action on the SDH is the internalization of discourses and traditions that treat health as individualized and depoliticized.     

Specialist public health capacity in England: working in the new primary care organizations

OBJECTIVES: To determine the capacity and development needs, in relation to key areas of competency and skills, of the specialist public health workforce based in primary care organizations following the 2001 restructuring of the UK National Health Service. STUDY DESIGN: Questionnaire survey to all consultants and specialists in public health (including directors of public health) based in primary care trusts (PCTs) and strategic health authorities (SHAs) in England. RESULTS: Participants reported a high degree of competency. However, skill gaps were evident in some areas of public health practice, most notably "developing quality and risk management" and in relation to media communication, computing, management and leadership. In general, medically qualified individuals were weaker on community development than non-medically qualified specialists, and non-medically qualified specialists were less able to perform tasks that require epidemiological or clinical expertise than medically qualified specialists. Less than 50% of specialists felt that their links to external organizations, including public health networks, were strong. Twenty-nine percent of respondents felt professionally isolated and 22% reported inadequate team working within their PCT or SHA. Approximately 21% of respondents expressed concerns that they did not have access to enough expertise to fulfil their tasks and that their skills were not being adequately utilized. CONCLUSIONS: Some important skill gaps are evident among the specialist public health workforce although, in general, a high degree of competency was reported. This suggests that the capacity deficit is a problem of numbers of specialists rather than an overall lack of appropriate skills. Professional isolation must be addressed by encouraging greater partnership working across teams.     

区域公众健康服务平台的惠民应用

通过对江苏省南京市12320卫生热线和公众健康服务平台进行研究,探索了个人健康管理、健康行为干预、健康宣传教育、智慧健康服务、投诉举报受理"五位一体化"服务模式,旨在更好地、更有效地向社会公众提供优质医疗资源共享、便捷高效应用、触手可及的卫生健康服务.     

Specialist capacity in public health: are we hitting the target?

OBJECTIVES: The aim of this study was to audit specialist public health capacity in one strategic health authority (SHA), and to compare capacity with the targets suggested by the Faculty of Public Health (FPH). METHODS: A census of all public health specialists and specialists in training, working within the geographical boundary of one SHA, was performed in late 2004. The number of whole-time-equivalent (WTE) public health specialists was quantified using a variety of methods, including the public health network database, informal networks, existing written reports, personal knowledge and telephone interviews. The number of specialists was compared with the targets suggested by the FPH and with other regions. RESULTS: There were 12 WTE public health specialists per million population in the SHA, and the FPH's target was 25 WTE per million population. There was a particular shortage of specialists in academic public health. CONCLUSIONS: There was a marked shortfall in specialist public health capacity in the SHA compared with the FPH's targets. Comparisons with the FPH's targets were difficult; the FPA used WTE as the metric, while the local public health network database provided information in terms of numbers of specialists and WTE data were time consuming to obtain. Comparisons with other regions were of limited use as the workforce data were not comparable. The FPH's targets were found to have little resonance outside the world of specialist public health, and so are unlikely to be helpful in securing local investment in specialist public health capacity. The service needs to be marketed, and new ways of inter-organizational and collaborative working and of expanding the wider public health workforce need to be examined in order to deliver effective public health.     

Nurses and public health: evolution of missions and trainings

Reflection upon the role of nurses in public health is not something new; however, over the past few years, a questioning and similar reports have sprung up pointing to the difficulty perceived by nurses in reconciling their professional practice and public health. Currently, in light of the evolution of public health, where does the practice of nursing fit into public health practice? What are the potential movements and trends in terms of training? The goal of this paper is to present a number of possible avenues for thought on the subject, namely concerning the training and the allocation of competencies. It would be undoubtedly a pity to conceive of public health training today being intended only for nurses. It is rather preferable that post-graduate public health training is aimed at a variety of professional categories, regardless of their initial training or degree course. The development of schools of public health to which nurses could have access in the same way that other health professionals or from the social and educational fields do is critical. Above and beyond what is at stake for specialisation, and even independent of the implication of nurses in public health work, the current trend to re-balance the work and tasks of both nurses and doctors constitutes a significant challenge for public health.     

Education and practice: dynamic partners for improving cultural competence in public health

This article reports on a collaborative project linking Washington State University College of Nursing Vancouver and Southwest Washington Health District. Designed to improve the cultural competence and public health skills of registered nurses who are baccalaureate student nurses, quantitative and qualitative evaluative analyses were used to document and describe themes and strategies. The Inventory to Assess the Process of Cultural Competence Among Healthcare Professionals (IAPCC) was useful in measuring the students' progress toward cultural competence, and significant changes were documented. Themes that lead students toward population-focused nursing practice were uncovered as well as barriers to the process of cultural competency.     

International rescue? The dynamics and policy implications of the international recruitment of nurses to the UK

This paper focuses on one global aspect of the current health sector workforce policy agenda - the international recruitment and migration of health workers. It does so primarily by using a case study of the recruitment of nurses to the UK, as a means of exploring the policy challenges and associated research questions. The paper highlights the limitations in comparing national data on the nursing workforce, illustrating the extent to which currently collated national data can present a misleading picture of staff:population ratios in different countries. It then reports on the significant growth in the numbers of nurses entering the UK from other countries, using registration data. In 2001/02, more than 16 000 nurses entered the UK nursing register from non-UK sources. In this year, for the first time, the number exceeded the number of home-trained nurses. An analysis of postcode data highlights that these non-UK nurses have a younger age profile than home-based registered nurses and are more likely to report a postcode in London and south-east England. The paper also examines the push and pull factors that contribute to the international mobility of health workers. The paper concludes by examining the policy implications of this growing reliance on international recruitment, including the effect of the ethical guidelines on international recruitment introduced by the Department of Health in England.     

Public health re-energised: what the new White Paper will mean

The Coalition Government has set out its intended strategy for public health in England in the White Paper "Healthy Lives, Healthy People" (November 2010). This aims to tackle high levels of "lifestyle" health problems such as obesity, alcohol misuse and smoking, and to reduce health inequalities. Policies will be evidence-based and the emphasis will be on outcomes rather than targets. The focus will be local and will include wider dimensions of public health such as tobacco control and transport. Mental health will have greater prominence. Local government will play a major part, with Directors of Public Health and public health budgets transferring from Primary Care Trusts to Local Authorities. Public health funding will be ring-fenced. A dedicated public health service, Public Health England, will be established in the Department of Health, to provide disease control and support local innovation. There will be greater investment in the early years of life, and an increase in health visitor numbers and Family Nurse Partnerships. The public health role of school nurses is likely to increase under a forthcoming review of school nursing.