The role of an advanced practice public health nurse in bioterrorism preparedness

The 2001 anthrax events have vividly illustrated that terrorism involving the release of a biological agent is a major public health emergency requiring an immediate and well-coordinated response. If healthcare professionals and emergency responders are to be prepared to manage such attacks, unprecedented cooperative efforts at the national, state, and local levels are necessary. To aid such efforts, advanced practice public health nurses (PHNs) must exercise their ability to collaborate with a variety of disciplines and communities. Using the Los Angeles County Public Health Nursing Practice Model, advanced practice PHNs can be trained to deal effectively with acts of bioterrorism. This model defines the practice of public health nursing as working on a population-based level to create conditions under which healthy people can live within healthy communities. This article will discuss the threat of bioterrorism and describe how the Public Health Nursing Practice Model can be applied to assist advanced practice PHNs in the development of a public health plan for preparedness and response to bioterrorism. Six specific interventions that enable advanced practice PHNs to affect populations at the community and systems level will be discussed along with the implications of bioterrorism for advanced practice public health nursing.     

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.     

Reliability and validity of the CCNCS: a dependency workload measurement system

Aim. To refine, test and evaluate the Community Client Need Classification System (CCNCS). Background. Workload assessment in community nursing is complicated by the range of services that may be delivered in one patient interaction. The CCNCS is a workload measurement system designed to capture the direct and indirect elements of community nursing work and is suitable for use with all care groups in the community. Design. Survey. Method. Forty‐four community nurses implemented the CCNCS with all clients in their caseload for four weeks. Community nursing in the Irish Republic is known as public health nursing. The Public Health Nurses (PHNs) recorded the total time in minutes that was spent on each client each week. The satisfaction with and experiences of PHNs using the CCNCS during the study period was also recorded. Results. Participants endorsed the utility of the CCNCS for use in community nursing. Inter‐rater and intra‐rater reliability results were positive with high level of agreement between raters in relation to scoring community clients. The amount of time the PHNs spent with clients correlated with ascending level of client need. Conclusions. The CCNCS affords insight into the complex nature of community nursing. It discriminates between levels of need and has potential to provide a standardised assessment of need in all community‐nursing clients. Adequate resources are required to conduct further testing of the reliability and predictive validity of this system. Relevance to clinical practice. The CCNCS can provide objective evidence of community nursing workload and thus facilitate workforce planning.     

The ExploreSurge Trail Guide and Hiking Workshop: discipline-specific education for public health nurses

Generic preparedness education and training for the public health workforce has increased in availability over the past 5 years. Registered Nurses also have more opportunities available for participation in emergency and disaster preparedness curricula. Discipline- and specialty-specific training and education for public health nurses (PHNs) incorporating their population-based practice, however, remains a largely unexplored area that is not accessible except for sporadic local venues. The Public Health Nursing Surge Curriculum provides 50 hr of nursing continuing education and activity-based aggregate focused learning experiences that are completed within a 12-month period, including an in-classroom seminar. The Public Health Nursing Surge Curriculum was developed on a foundation of 25 competencies linking PHNs and their population-based practice to surge capability. The curriculum was built in partnership with statewide public health directors of nursing over a 12-month period and is evaluated by a 3-level process to include self-rated confidence in performance. The curriculum's use of a blended learning methodology enables staff-level PHNs to master individual competencies toward surge capability within the public health response system.     

Roles and functions of community mental health nurses caring for people with schizophrenia in Taiwan

Aims and objectives. The study aimed to understand the nursing roles and functions of public health nurses and home health nurses in Taiwan and the factors that affect nursing roles and functions of nurses that provide community mental health home visiting services. Background. Although community nurses provide more psychiatric home visiting services than other psychiatric professionals, little research on their roles and functions has been conducted. Design. Nursing roles and functions were developed through use of grounded theory method of Strauss and Corbin. Methods. Data were collected using semi‐structured face‐to‐face in‐depth interviews and unstructured non‐participant observations. The constant comparative analysis continued during the open, axial and selective coding process until data saturation occurred. Participants were selected using theoretical sampling. Final sample size in this study comprised a total of 29 community nurses (18 public health nurses and 11 home health nurses) who provided community mental health home visiting. Public health nurses conducted a total of 16 (eight carers and eight clients) services and home health nurses conducted 16 (eight carers and eight clients) services. Results. Fourteen nursing roles were identified. These roles included assessor, supporter, educator, consultant, counselor, negotiator, harmoniser, collaborator, advocate, placement coordinator, resource provider, care provider, case manager and case finder. Moreover, several factors that affect nursing roles and functions in the community mental health home visiting service in Taiwan were also identified. Conclusion. This is the first study to identify the role of public health and home health nurses caring for people with schizophrenia in the community in Taiwan. Relevance to clinical practice. The recommendations based on the findings of this research can be used as a guide to improve the delivery of psychiatric home visiting services to community‐dwelling clients with schizophrenia and their carers.     

Public Health Nursing in Japan: New Opportunities for Health Promotion

Major changes are taking place in public health nursing in Japan. These include significant developments in employment, education, and roles of public health nurses (PHNs). Demographic and economic factors have prompted the Japanese government to focus health service delivery on community-based care, particularly for the growing elderly population. Public health nurses are redefining their roles and are assuming important functions in planning, implementing, and evaluating community health programs for the elderly. Japanese PHNs are using a variety of health promotion strategies to initiate change at the local level. This article presents two case studies to highlight the leadership role of PHNs in creating new services that foster healthy communities.     

Research Priorities for Public Health Nursing

ABSTRACT The Association of Community Health Nursing Educators (ACHNE) Research Committee initiated a revision of the ACHNE Research Priorities for public health nursing practice in 2006, following those developed in 1992 and in 2000. The committee (a) reviewed public health nursing research abstracts (n=485) from 7 selected nursing journals to evaluate progress in addressing the 2000 Priorities; (b) identified research methods used, health issues and health behaviors addressed, and demographics of study populations in the abstracts; and (c) reviewed research priorities from key federal funding agencies and journal editors. Overall, progress toward meeting previous priorities was modest, with a limited range of methods, topics, and samples described. The 2009 ACHNE Research Priorities for public health nursing include: (1) Population‐Focused Outcomes, and (2) Public Health Nursing Workforce. Multisite studies, clinical trials, community‐based participatory research, development and/or analysis of existing large data sets, and development of valid and reliable methods are needed to address these priorities. Collaboration among educators, researchers, and practitioners is crucial to develop the scientific evidence base for population‐based nursing practice.     

Supporting Breast‐feeding When a Woman Is Homeless

PURPOSE. This case study demonstrates use of standardized nursing languages in the care of new mothers in community settings. DATA SOURCES. The author collected data from clinical practice as an instructor in a baccalaureate nursing program and from the research literature. DATA SYNTHESIS. The appropriate nursing diagnoses, outcomes, and interventions were identified in partnership with the new mother. CONCLUSIONS. This case shows that NANDA International (NANDA‐I), the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) are useful to direct nursing care in community settings. IMPLICATIONS FOR NURSING. When teaching nursing students in a baccalaureate program, nurse faculty can use NANDA‐I, NOC, and NIC classifications to guide the growing practice of nursing students in community settings.     

Developing public health competence among RN-to-BSN students in a rural community

A new RN/BSN nursing program offers rural students in a western state the opportunity to address significant health care needs on a local level by developing public health leadership competencies in their home communities. The innovative program, funded by a grant from the Health Resources and Services Administration, makes it possible for RNs to complete their BSN degrees without travel, as they position themselves to provide critically needed health care leadership in their local areas. Partnerships between the university, community colleges, and local health agencies allow students in the RN-to-BSN program to benefit from a streamlined BSN admission process, onsite mentoring, and newly developed courses that lead students to reflect on health needs in their home communities. On the basis of Public Health Nursing Competencies as defined by the Nursing Quad Council (2004), the re-designed curriculum prepares students for public health leadership by encouraging application of competencies while participating in the delivery of essential public health services in their communities. Initial response to this new opportunity indicates that students can develop as leaders by developing public health competencies, and facets of the program may encourage more students to commit to completing the BSN while increasing capacity among PHNs.     

Three population-patient care outcome indicators for public health nursing: results of a consensus project

ABSTRACT Objectives: Difficulties in recruiting nurses into public health settings threaten the public's health. Gaps in existing data make determining the health impact of workforce changes numbers difficult to perform. Public health practice leaders are left to make difficult staffing and program decisions without knowing how the health of their vulnerable populations will be affected. The objective of this study was to identify indicators that could be used to document the effect of the shortage of public health nurses (PHNs) on the health of a population. Design and Sample: A consensus‐building process was used. Nursing directors from 6 local health departments (LHDs) in 2 states participated along with 3 public health system researchers. Results: The findings from this collaborative process suggest that it is possible to identify outcome indicators across states and multiple LHDs that may be sensitive to PHN staffing levels and interventions. Possible connections between PHN staffing and each population‐patient care indicator (rates of Chlamydia, first trimester prenatal care, early childhood immunization) are presented. Conclusions: The process used here in identifying these indicators and the proposed nursing‐sensitive population outcome indicators themselves provide a template for the development and analysis of additional outcome indicators sensitive to the quality of nursing and other health care.     

Population-Based Public Health Nursing Interventions: A Model from Practice

Abstract In a changing and complex health care system, public health nurses face challenges to explain their work and contributions to health outcomes. In response to this need, the Minnesota Department of Health, Section of Public Health Nursing, initiated a process to describe public health nursing interventions. The Public Health Nursing Interventions (PHI) Model was developed through a collaborative process by public health nurses at the state and local levels. The purpose of the model was to define more clearly the practice of public health nursing and to describe better the work of public health nurses at the community and systems levels. The PHI model identifies 17 interventions and provides practice examples at the systems, community and individual/family levels. The model defines a broader view of the mission and scope of public health nursing. Practice examples are given for agency staff, administrators, educators, and policy makers.     

Vision for the Future of Public Health Nursing: A Case for Primary Health Care

Abstract Canada has embraced the goal of the World Health Organization to achieve health for all. This has created a paradigm shift from a focus on direct care to include health promotion and community development, consistent with a primary health care approach. Nevertheless, a clearly articulated vision for the role of public health nurses (PHNs) is lacking. Despite the fact that PHNs make up the largest group of health care workers in the community, their collective opinions and ideas regarding their own practice are seldom sought in a systematic manner. We conducted a survey of public health nurses in British Columbia. Using a two-wave Delphi approach, PHNs were asked to define issues for the future of public health nursing, and to state publicly their preferences for change and transformation. The responses were rank ordered, analyzed, and compared with recent nursing and health care literature to interpret their content. The PHNs' visions for tomorrow agree with concepts of primary health care and community development, and have implications for community health nursing's practice and education.     

Nursing agency and governance: registered nurses' perceptions

AIM: To explore registered nurses' perceptions of standards of nursing practice and factors that affect nursing practice standards. BACKGROUND: Nursing governance affects nurses' ability to manage nursing practice standards. Lack of nursing professional autonomy has been associated with occupational dissatisfaction, stress, turnover and low morale, which impact upon care quality. METHOD: Grounded theory was used. Data, gathered by semistructured interviews with 142 nurses, theoretically sampled from three National Health Service hospitals were analysed using constant comparative analysis. FINDINGS: Nurses were dissatisfied with their governance over factors that they believed had most influence on nursing practice standards. Perceived lack of control over factors that affect practice standards generated dissatisfaction, frustration and demoralization. CONCLUSIONS: Nurses' perceived lack of governance over their practice requires investigation and attention if occupational dissatisfaction, stress, turnover and low morale, which impact on quality care, are to be reduced. Dissatisfaction with nursing governance indicates a need to review nurses' professional involvement in clinical governance.     

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.     

Essentials of Baccalaureate Nursing Education for Entry‐Level Community/Public Health Nursing

ABSTRACT Community/public health nursing (C/PHN) educators and practitioners need a framework from which to plan, implement, and evaluate curriculum and community‐based practice. The Association of Community Health Nursing Educators (ACHNE) periodically updates the Essentials of Baccalaureate Nursing Education for Entry Level Community/Public Health Nursing to reflect changes in core knowledge, basic competencies, and practice. This update reflects relevance to 21st‐century health care and to national trends influencing nursing education. The 2009 revision is based on critical analysis of key C/PHN literature and input from public health nursing educators and practitioners. A key assumption is that a baccalaureate nursing degree is the minimum requirement for professional C/PHN. Fifteen essential concepts for baccalaureate nursing education are delineated along with related competencies. Newly defined essentials include communication, social justice, and emergency preparedness, response, and recovery. Issues related to didactic and clinical experiences are addressed. The ACHNE Essentials is an important guide for baccalaureate education curriculum planning and evaluation. The Essentials may be useful as a baseline from which to develop competencies of graduate nursing programs. The document is also useful for guiding practice setting orientation and professional development.     

Nursing the community, a look back at the 1984 dialogue between Virginia A. Henderson and Sherry L. Shamansky

Dr. Sherry L. Shamansky, one of the founding editors of Public Health Nursing, interviewed renowned 20th-century leader, Virginia Avenal Henderson (1897-1996), then research associate emeritus at Yale University School of Nursing, about the nursing of "aggregates." Their discussion, originally published in Public Health Nursing, in 1984 (Vol. 1, No. 4), highlights Henderson's views about the scope of nursing, health care organization and funding, and perceived tension between direct care of the sick in the community and preventive activities directed toward communities or populations at risk. Readers familiar with Henderson's influential definition of nursing may find her responses to interview questions helpful in understanding her view of the opportunities and challenges faced by public or community health nurses of the time.     

Nursing implementation of a telestroke programme in a community hospital in the US

rafter r.h. & kelly t.m. (2011) Journal of Nursing Management 19, 193–200
Nursing implementation of a telestroke programme in a community hospital in the US Aim To describe the nursing implementation of a telestroke programme including the development of a stroke care delivery model in a community hospital. Background Successful nursing implementation of a telestroke programme in a community hospital requires planning, education, and preparation. Telemedicine technology provides the bedside clinician with rapid, expert, neuroscience stroke consultation in order to optimize outcomes in patients with acute stroke. Key issues Nursing implementation of a telestroke programme includes the development of a practical, precise, evidence-based stroke care delivery model. Such a model requires delineation of specific roles and responsibilities, development of a detailed treatment timeline, provision of comprehensive education, preparation of policies and procedures, standardization of education and initiation of programme quality monitoring. Conclusions Nursing implementation of a telestroke programme can be accomplished by nurse leaders and the Stroke team with comprehensive planning and preparation. The stroke care delivery model must be designed specifically with the community hospital’s resources and organizational capabilities in mind. Implications for management Nurse leaders need to facilitate a vision, motivation, and a practice framework when implementing a telestroke programme. Multidisciplinary collaboration is key to a successful planning process. Allocation of nursing resources and the impact of the stroke care delivery model on nursing operations needs to be considered and evaluated by nurse leaders.     

Clinical major option: a model for implementing critical care nursing into baccalaureate preparation

What was initiated as a directive from a provincial government in an attempt to increase the number of critical care nurses has evolved into an exciting educational opportunity for many nurses and student nurses in the year 2000. Between 1993 and 1997 there has been significant downsizing of acute care beds across Canada (Code Blue: Critical Care Nursing in Nova Scotia, 1998). At the same time patient acuity has increased, due to shorter hospital stays, and the number of nurses working full-time has decreased with the increased use of casual nurses. Several studies at both the provincial and national levels report current and future shortages of specialized nurses (emergency, critical care and perioperative). It is expected that this shortage will continue into the future, a shortage that is driven by technological advances, as well as an aging general and nursing population. Continued shortages of these acute care nurses will result in fierce competition for skilled nurses as well as aggressive recruitment and retention strategies (Code Blue: Critical Care Nursing in Nova Scotia, 1998). It is generally agreed within the nursing community that specialty nurses in critical care require a unique body of knowledge that is not acquired in a basic undergraduate nursing program (Fitzsimmons, Hadley, & Shively, 1999). This specialized knowledge can be gained informally through experience; however, it is largely developed in additional formal education programs. The purpose of this article is to outline a strategy for the delivery of specialty education at three educational levels in acute care nursing with three streams: emergency, critical care and perioperative nursing. This clinical major option is to be delivered in partnership among the Queen Elizabeth Hospital II, the Health Science Centre and Dalhousie University School of Nursing, Halifax, Nova Scotia, Canada. This model of offering specialty education in university preparation could be a template for preparing nurses in the new millennium.