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.     

Legal Implications Regarding Self‐Neglecting Community‐Dwelling Adults: A Practical Approach for the Community Nurse in Ireland

ABSTRACT This paper explores the current literature related to legal issues encountered by the public health nurse in Ireland in visiting clients exhibiting self‐neglecting behavior. Nurses working in community settings where home visiting of clients is required will at some point encounter situations of client self‐neglect. Possession of a clear legal framework for the local area that addresses both the nurse's professional responsibility and the client's rights is needed. Because a high incidence of depression and dementia seen in self‐neglecting adults has prompted calls for wider screening of the agreeable client, an understanding of the definition of competence and capacity in the national legal system for that client becomes critical. In Ireland, as in many other countries, refusal of care or screening is the right of any competent adult. However, issues of mandatory reporting, confidentiality, and trespass may differ from other areas. Nursing care delivered at the community level to a client exhibiting self‐neglecting behavior involves a delicate balance of trust and support. Through this overview of the legal implications for self‐neglecting clients in Ireland, nurses have the opportunity to begin an exploration of similarities and differences in approach on a global level.     

Building a Community‐Academic Partnership to Improve Health Outcomes in an Underserved Community

ABSTRACT East Garfield Park, IL, is an impoverished community with 59.7% of residents falling below twice the poverty level and 42.6% of its children in poverty. In 2001, the leading causes of hospitalizations were heart disease (10.3%), diabetes (2%), and asthma (3.9%), all of which occur at frequencies 33% greater than the Chicago average. Finally, a review of the health care facilities in the community suggests that there is a need for accessible primary health care services in the area. The purpose of this project was to improve health outcomes in an impoverished, underserved community with documented health care needs and lack of adequate health care services by creating a community‐academic partnership to provide on‐site, interdisciplinary, health care services within an established and trusted community‐based social service agency, Marillac House. The short‐term objectives for this project included creating a community‐academic partnership between Marillac House and Colleges of Nursing, Medicine, and Health Sciences; providing comprehensive health care services; and developing an innovative clinical education model for interdisciplinary care across specialties. Long‐term objectives included providing preventative services; evidenced‐based management of acute and chronic illness; evaluating client's health outcomes; and creating a sustainability plan for the long‐term success of the health center.     

The impact of recent changes in public health insurance on community‐based health‐care in the USA

Recent changes in US government‐funded healthcare insurance are having profound impacts on all types of community‐based health‐care, reducing access to care by vulnerable populations. This article traces the impacts of recent policies on a range of community institutions in which nurses play a critical role, such as health centers, highlighting the effects on access to care and the survival of non‐profit services in less‐advantaged communities. In general, the new policies shifted revenues into fixed payment per client contracts (capitation) paid to for‐profit managed care organizations and away from non‐profit community services. The full impact of this competitive, market‐oriented system of health services has just begun to be felt. The uncertainties and dissatisfactions assure continued activity to change current conditions, including efforts by groups that seek greater access to health services for all populations and security for committed providers and personnel, including nurses.     

Evidence‐Based Outcomes in Pain Research and Clinical Practice

The growing emphasis on evidence‐based medicine dictates that reliable, evidence‐based outcomes be utilized in documenting response to treatment, as well as determining the treatment efficacy and cost‐effectiveness of different treatment modalities. The biopsychosocial model conceptualizes pain as a complex multifactorial interaction of biological, psychological, and social components that play a role in the development, exacerbation, and perpetuation of pain. As a result, outcomes relevant to pain management are necessarily complex and multifactorial in nature. Two broad categories of evidence‐based outcomes relevant to pain management are discussed: patient‐reported outcomes and objective outcomes. Patient‐reported outcomes are discussed within the context of pain measures, health‐related quality of life, and psychological constructs. Objective outcomes are discussed within the context of healthcare utilization and occupational status. The discussion within each section highlights the unique constructs measured by each category of outcome measure and highlights their consistency with current evidence‐based guidelines and knowledge from pain research.     

Research Article: Culturally sensitive health counseling to prevent lifestyle‐related diseases in Japan

This study explored the methods that are used by public health nurses to provide culturally sensitive health counseling to elderly Japanese farmers in order to motivate them to adopt healthy behaviors. Fourteen elderly farmers (eight men and six women) from three rural communities underwent health counseling and then changed their habits to prevent lifestyle‐related diseases. Qualitative and inductive analyses were conducted to determine the effects of the culturally sensitive counseling. Five methods for providing culturally sensitive counseling were identified: (i) showing an interest in, and respect for, the local culture; (ii) stimulating the participants' awareness of the health risks inherited in their local cultural practices through the use of familiar examples; (iii) accepting and understanding the participants' ambivalence about their local culture; (iv) connecting the reasons for the participants to change their lifestyle with their local culture; and (v) adjusting the health‐promoting behaviors of the participants to fit their local culture. Public health nurses should consider the pride that elderly farmers have in their background and their resistance to change and use these factors to point out the discrepancies in their lifestyle and promote more quality‐of‐life‐oriented and practical self‐care behaviors.     

Self‐efficacy in providing smoking‐cessation services among psychiatric nurses in central and southern Taiwan: An exploratory study

Smoking by psychiatric patients remains prevalent. The purpose of this cross‐sectional study was to understand the influence of self‐efficacy and its correlates among psychiatric nurses when providing smoking‐cessation services (SCS). A convenience sample of 193 nurses from psychiatric institutions was obtained. Surveys were conducted using self‐report measures regarding SCS provided by psychiatric nurses. The survey questions focused on self‐efficacy, attitude, practical experience, and smoke‐free policies, and their implementation in the workplace. The participants reported low self‐efficacy for providing SCS in their self‐assessment, as demonstrated by their scores of 55.3 ± 20.4, on a scale of 0 (low confidence) to 100 (high confidence). Using multiple linear regressions, statistically‐significant, relevant factors included perceived provider‐related barriers in providing SCS, environmental tobacco smoke exposure, the nurse's attitude towards a patient smoking, and the nurse's frequency and practical experience in providing SCS. The correlates of this self‐efficacy can serve as a reference for in‐service curriculum planning of SCS by psychiatric nurses. In addition, policies to limit exposure to second‐hand tobacco smoke should be explored.