Household characteristics of persons with complex care needs in the community: A preliminary study

Aim

To identify the characteristics of households of persons with complex care needs and clarify the care period length required to resolve their primary health issues.

Design

A descriptive cross-sectional study design.

Methods

We collected registered data and nursing records from 155 households living in City A within the Tokyo Metropolis. They were designated as complex care cases by the home care and life support centre and needed a multidisciplinary approach to care from April 2018-July 2019.

Results

Most households comprised an elderly with a single adult child (N = 47, 30.3%). Mental illness and economic distress overlapped as the most common issues. The mean length of care period was 147.7 days (SD = 120.6). The log-rank test showed that single persons took significantly less time to resolve their primary health issues than elders with single-child households or single-person <65-year-old households.

Nursing strategies for environmental justice: A scoping review

OBJECTIVE

To describe types of strategic actions nurses take to promote environmental justice (EJ) through research, education, advocacy, and practice (REAP) reported in peer-reviewed literature.

DESIGN AND SAMPLE

A scoping review of literature was conducted that described EJ nursing strategies and included nurses listed as authors, subjects, partners, or organizational members. The sample consisted of 35 articles, representing 24 primary research studies and 11 nonresearch articles. Data were separately analyzed by research and nonresearch articles for a clearer understanding of evidence-based strategies within domains of REAP.

RESULTS

Articles in the sample highlighted the importance of authentic community partnership and represented diversity of nursing strategies that addressed a range of environmental exposures and subsequent health and racial inequities. Climate justice, a concept that emerged from the EJ movement and intersects with planetary health, is a recent focus in professional nursing.

CONCLUSIONS

This scoping review establishes an understanding of the extent of nursing knowledge and research in EJ and lays the groundwork for further research on effective EJ nursing strategies. Community-Based Participatory Research/Participatory Action Research methods are fundamental for EJ research, and further theoretical development is needed to guide evaluation of EJ nursing strategies for education, advocacy, and practice.

Program evaluation of a recuperative care pilot project

Objective

A program evaluation to demonstrate the feasibility of a recuperative care pilot project to address the needs of unhoused individuals.

Design

The study is a descriptive postprogram evaluation.

Sample

A total of 73 referrals were made to the project with 23 admissions.

Measure

Data regarding number and type of referrals for admission, cost of respite care per guest and per day, hospital costs avoided, referrals to community services, and discharge destination were collected.

Intervention

A case management care model was used. The project staff included a public health nurse and an outreach worker.

Results

One local hospital accounted for 65% of all admissions. Admitting diagnoses were abscess/wound care (44%) followed by postsurgery recovery (17%). Housing resources (65%) was a common referral with 22% of guests discharged to stable housing. Actual length of stay exceeded the planned length by an average of 24 days. Total cost per guest per day was $157.45 which is an estimated savings to referring acute care facilities of between $18,000 and $48,000 per day.

Conclusions

The project demonstrated an ability to provide unhoused individuals a place to recuperate following hospitalization in a cost‐effective manner. Challenges and recommendations of the program going forward were identified.

Women-centred workplace health promotion interventions: a systematic review

AIM

To analyse workplace health promotion interventions implemented exclusively for the female population.

BACKGROUND

The differences in biological, psychological and social characteristics, as well as the type of work carried out by men and women, make it necessary for workplace health promotion to be specific for each group. This study focussed on working women.

INTRODUCTION

Workplace health promotion interventions are centred on increasing the well-being and health of the employees. Occupational health nurses play an essential role in the implementation of these interventions.

METHODS

A systematic review was carried out using the MEDLINE and Scopus databases, following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.

RESULTS

Twelve articles met the inclusion criteria. Two lines of interventions were found: (1) promotion of breastfeeding (16.6%) and (2) promotion of physical activity and other healthy lifestyles (83.4%). The interventions studied underlined promoting breastfeeding, preventing a sedentary lifestyle, improving body composition, reducing cardiovascular risk, relieving premenstrual symptoms, time of breastfeeding after returning to work, and showing favourable results.

DISCUSSION

The lack of studies on the subject and the medium-to-low quality of the articles included in the review have made it difficult to analyse workplace health promotion interventions, making it necessary to continue research in this area.

CONCLUSION

There are very few occupational health promotion interventions targeting women (1.9%), and the majority of them focus on promoting physical activity. It is worrying that specific aspects of women's health are poorly addressed.

IMPLICATIONS FOR NURSING PRACTICE AND HEALTH POLICY

The work of the occupational nurse essentially is to guarantee the health of women in the workplace, being the key figure in the research and development of gender-related policies in the field of public health.

Frontline Nursing Care: The COVID-19 Pandemic and the Brazilian Health System

Emerging and reemerging infectious diseases are constant challenges for global public health. After the World Health Organization declared COVID-19 a pandemic on March 11, 2020, the spread of SARS-CoV-2 has been the focus of attention for scientists, governments and populations worldwide. In Brazil, the first case of COVID-19 was identified on February 26 2020, being the first country in Latin America to have affected patients. Almost four months later, more than one million confirmed cases of COVID-19 have been identified in the country, and the virus has spread across all 27 states and is responsible for at least 48,954 deaths until June 19, 2020. In addition, a global outbreak requires the active participation of the nursing workforce in clinical care, education, and sharing of accurate information of public health and policies. This year is particularly important for Nursing, as 2020 is the international year for Nursing and Midwifery Professionals. Nursing professionals corresponds to more than half of the health workforce in the country, being crucial in implementing public health policies and programs. Nurses and frontline health care workers have a critical role in the COVID-19 prevention and response, not only by providing direct assistance to patients and communities, but also in the implementation of health promotion and prevention strategies. Hence, we provide a reflection on the strengths and weaknesses of how the nursing profession is engaged with the COVID-19 response in Brazil.

A discursive paper on the importance of health literacy among foreign domestic workers during outbreaks of communicable diseases

AIM

Using an integrated model of health literacy, we discuss the importance of health literacy among foreign domestic workers in the provision of informal caregiving during outbreaks of communicable diseases. COVID-19 pandemic is used as an example.

BACKGROUND

Adequate health literacy in the population is known to be important for the prevention of communicable diseases. Foreign domestic workers, a group of marginalised caregivers in private households, are generally presumed to have limited health literacy because of numerous socio-cultural disadvantages. To date, there is limited evidence that these informal healthcare providers receive support from community-based nurses.

DESIGN

A discursive paper.

CONCLUSION

Foreign domestic workers, with varying levels of health literacy, may be viewed either as a resource to break the chain of infection or as a potential reservoir of communicable diseases in the community. Meanwhile, restrictions imposed in response to diseases transmissions (e.g. stay-at-home measures for COVID-19) may directly exacerbate the social support received by these foreign domestic works and their ability to access health-related information. There are also concerns about their ability to appraise and evaluate information related to communicable diseases at a time when fake news and misinformation are being disseminated through social media. Language and cultural barriers are important issues that need to be addressed to ensure that foreign domestic workers are in a position to follow public health recommendations.

RELEVANCE TO CLINICAL PRACTICE

Nurses hold an important position in empowering foreign domestic workers with adequate health literacy, by engaging groups of foreign domestic workers in the community and their consulates in planning educational programmes and effectively disseminating information. At a time of global pandemic, an assessment of the health literacy levels of foreign domestic workers in places like Hong Kong is urgently required.

Public health nurses' experiences learning and delivering a group cognitive behavioral therapy intervention for postpartum depression

OBJECTIVES

Public Health Nurses (PHNs) often provide support to women with postpartum depression (PPD) in the absence of specialized training. The objective of this study was to explore the experiences of six PHNs who were trained to deliver a group cognitive behavioral therapy (CBT) intervention for PPD in the public health setting, and to describe how learning and delivering this intervention affected their professional roles and personal lives.

DESIGN

This qualitative study employed a phenomenological approach.

SAMPLE

Six PHNs who completed the CBT training program and delivered at least one CBT group in their community.

MEASUREMENTS

Individual in-depth interviews were conducted and transcribed verbatim. Transcripts were analyzed according to thematic derivation procedures.

RESULTS

The themes that emerged from the interviews with the PHNs included: (a) components of the CBT training program that nurses most valued, (b) benefits of training for their professional role as a PHN, (c) implications for practice, and (d) using CBT skills in their personal lives.

CONCLUSIONS

The provision of CBT training to PHNs may not only positively impact their work with clients with mental illness, but may also have the potential to provide broader clinical and professional benefits for these skilled professionals and their other clients.

Association of Community Health Nursing Educators 2020 Research Priorities and Research in Action Model

OBJECTIVE

The Association of Community/Public Health Nurse Educators (ACHNE) Research Priorities Subcommittee presents a report on the state of the science of public health nursing education.

DESIGN

Whittemore and Knafl's (Journal of Advanced Nursing, 2005, 52, 546) five-step integrative review was used.

SAMPLE

Fifty-two articles were reviewed.

MEASUREMENTS

Braun et al's. (Handbook of research methods in health social sciences, 2019, 843) thematic analysis methods were used.

RESULTS

Four themes emerged: (a) Community/Public Health Nursing Education and teaching strategies/modalities; (b) Clinical teaching and learning partnerships; (c) Environmental health and emergency response; and, (d) Cultural competence and awareness.

CONCLUSIONS

Themes informed the following research priorities: (a) a need for rigorous scientific studies highlighting the impact and effectiveness of Community/Public Health Nursing Education; (b) a need for evidence on faculty development, support and training related to community/public health activities; (c) a need for evidence on impact of Community/Public Health Nursing teaching on communities and students, and (d) a need for evidence on impact of C/PHNE strategies on long-term student knowledge, attitudes or behavior (competencies). Finally, a Research in Action Model is proposed as a means for continued forward movement of the discipline, connecting the three fundamental driving mechanisms.

To sing the songs of pride: Creating an anthem of inclusion

In this season of public health crises and profound social unrest, we can draw inspiration from those who survived hard times and celebrated the American spirit. Here three students in an accelerated nursing program, poised for graduation in the coming year, join their insights and observation on the challenges facing this country with that of the famed troubadour of the Great Depression, Woody Guthrie. As nurses and public health practitioners, we commit to anthems of inclusion and justice for all.

Service learning in public health nursing education: How COVID-19 accelerated community-academic partnership

Days after COVID-19 physical distancing precautions were implemented, a coalition of community leaders in Baltimore City founded the Baltimore Neighbors Network (BNN), a volunteer network established to provide proactive phone-based support to older adults in Baltimore City. BNN was a community-driven approach aimed at reducing social isolation and improving health equity both during the pandemic and long-term. This paper describes how the Johns Hopkins School of Nursing's (JHUSON) public health nursing clinical faculty and students partnered with BNN to support a community-driven crisis response effort while creatively meeting student learning objectives. While engaging in the work of BNN remotely, nursing students were able to meet competencies across all eight domains of the Quad Council Coalition of Public Health Nursing Organizations. Schools of Nursing throughout the country can use this partnership as a model of a service-learning strategy for public health nursing education during a crisis.

Public health nurses' workforce factors and population health outcomes in the United States

OBJECTIVES

(a) To examine associations between public health nurse (PHN) workforce factors (PHNs' highest education and PHNs' mean years of employment) and health-risk behaviors (smoking and physical inactivity rates), and (b) to investigate the associations between PHN workforce factors and premature mortality rates across all counties of the United States.

DESIGN

Secondary analysis.

SAMPLE

A total of 5,705 PHNs from the 2015 National Nursing Workforce Survey and 2,977 U.S. counties from the 2016 County Health Rankings & Roadmaps data were included.

METHODS

Multilevel linear regression was used.

RESULTS

Bachelor's, and master's or doctorate-prepared PHNs accounted for 41.5% and 17.0%, respectively. The mean year of employment among PHNs was 17.3. The percentages of PHNs with bachelor's, master's, and doctoral degrees were significantly associated with decreased physical inactivity rates. The PHNs' mean year of employment was significantly associated with decreased physical inactivity rates and reduced premature age-adjusted mortality rates.

CONCLUSIONS

The findings indicated that PHNs with higher levels of education and more years of employment were important in improving health outcomes (health-risk behavior and premature mortality). Policymakers need to consider strategies to encourage more PHNs to obtain advanced degrees and to retain PHNs longer in the public health field.

Descriptive Study of Children's Nutritional Status and Identification of Community-Level Nursing Diagnoses in a School Community in Africa

Effectively responding to children’s nutritional status and eating behaviors in Mozambique requires a community-based care approach grounded in sound nursing research that is evidence-based. The Community Assessment, Intervention, and Empowerment Model (MAIEC) is a nursing theoretical model that is based upon clinical decision-making for community health nurses using communities as a unit of care. We used the MAIEC to identify a community-based nursing diagnosis to address children’s nutritional status and eating behaviors in Mozambique. Objectives: (1) to conduct a descriptive study of children’s nutritional status and eating behaviors in a school community in Mavalane, Mozambique, and (2) to identify a community-based nursing diagnosis using the MAIEC clinical decision-making matrix in the same school community. Method: a cross-sectional, quantitative study was conducted to assess the nutritional status of children using anthropometric data, including brachial perimeter and the tricipital skinfold, and standard deviation for the relation of weight–height, in a sample of 227 children. To assess community management of the problem and identify a community-based nursing diagnosis, we surveyed 176 parents/guardians and 49 education professionals, using a questionnaire based on the MAIEC clinical decision matrix as a reference. Results: malnutrition was identified in more than half of the children (51.3%). We also identified a community-based nursing diagnosis of impaired community management related to the promotion of child health and healthy eating evidenced by the lack of community leadership, participation, and processing among more than 70% of the community members (parents/guardians and education professionals). Conclusion: a nursing diagnosis and diagnostic criteria for nutritional status and community management were identified. The need to intervene using a multidisciplinary public health approach is imperative, with the school community as the unit of care. In addition, reliable anthropometric data were identified as important criteria to complement the nursing diagnosis and guide future public health interventions.

The implementation of a dedicated education unit in a public health setting

INTRODUCTION

The dedicated education unit (DEU) is an innovative clinical model that prepares preceptors for success in clinical settings with nursing students. Though the DEU is mostly used in acute-care settings, this project explores the implementation of a DEU in a public health setting.

OBJECTIVES

Better preparation of public health nurses and social workers as clinical preceptors for nursing students with the implementation of a DEU in a public health setting.

DESIGN

IRB approved, pre/post survey with participant comments.

MEASUREMENTS

Clinical Nurse Teacher Survey was assessed pre/post intervention with registered nurses and social work staff (n = 13). Paired t-tests analysis was used to determine significance. The Clinical Learning Environment and Nurse Teacher (CLES+T) scale completed postimplementation by nursing students (n = 8) after the clinical rotation.

RESULTS

Clinical Nurse Teacher Survey mean scores preintervention was 4.56 and increased postintervention to 4.89, though not statistically significant (p-value .11). CLES+T showing 100% fully agree or agree that the Public Health DEU is an effective learning environment.

CONCLUSIONS

The DEU model in a public health setting is an opportunity to improve lived clinical experiences of preceptors and nursing students, which may increase nursing students' positive perceptions of, and increase interest in serving as a public health nurse after graduation.

Characteristics of Hardcore Male Smokers in Taiwan: A Qualitative Study

Objectives: The purpose of this study was to explore the characteristics of hardcore smokers who were previously hospitalized. Study design: A descriptive qualitative design was used to investigate a sample of 29 male Taiwanese smokers. Methods: Male hardcore smokers were recruited at a hospital in southern Taiwan and their smoking behaviors and attitudes were explored in semistructured interviews. Inclusion criteria were: (1) smoking at least weekly or daily during the past year, (2) 100 cigarettes during the lifetime, (3) persistent smoking, or (4) at least one hospitalization. Audio-recorded interview data were analyzed using content categorization of the responses. Results: Four main themes emerged to describe characteristics of Taiwanese hardcore smokers: (1) physiological and psychological dependence, (2) no motivation to quit despite knowledge of negative health consequences, (3) social interaction and cultural norms, and (4) negative attitudes toward, but compliance with, smoking-free policies. Conclusions: The results can inform public health nurses of characteristics of Taiwanese hardcore smokers, which in turn may develop effective smoking cessation program to increase smoking cessation rate among Taiwanese hardcore smokers.

The use of a communication tool about diet at the child health centre: A cluster randomized controlled trial

Aim

To investigate the effect of a communication tool about diet used in public health nurse consultations with parents compared with standard consultations concerning the 2-year-old child's diet.

Design

A cluster randomized controlled trial.

Methods

Ten municipalities were selected randomly and matched in pairs. In each pair, the control or intervention group was randomly allocated. Parents were recruited to participate from January 2015 to January 2017. In intervention clusters, a communication tool about diet was used to help the parents (N = 140) to focus on a healthy diet for their child. In the control clusters, parents (N = 110) attended standard consultations. The participants completed semi-quantitative food frequency questionnaires at baseline and end point.

Results

No effect of the intervention was seen on the child's daily intake of vegetables or saturated fat, or body mass index. Significantly fewer parents desired more information about food for toddlers in the intervention than in the control group.

Assessing Community Empowerment for an Innovative Epidemiologic Approach

Community empowerment can be a process, but also the result of nursing care. To analyze it as a result there is an instrument that allows to quantify its level in nine domains. According to Melo (2020), health centers can be considered communities, becoming the potential target of community and public health nurses care, especially in the public health unit. One of the main functions of a public health unit is the epidemiological surveillance of the population’s health state. However, traditional epidemiological surveillance is focused on diseases and Melo (2020) proposes a new approach for epidemiology focused on people in what concerns nursing diagnosis. The aim of this research is to identify the level of empowerment of four Portuguese primary healthcare structures, named as ACeS, so as to improve the epidemiological surveillance of nursing diagnoses. As methodology, we developed four focus group with all nursing leaders from all primary care units of the four ACeS, using the Portuguese version of the empowerment assessment rating scale. The results present the level of community empowerment of each ACeS according to the nine domains of the scale. The needs of intervention to improve the ACeS empowerment were also identified in order to develop the epidemiological surveillance of nursing diagnoses.

Using simulation to evaluate exam scores in a public health nursing course

OBJECTIVE

Public health nursing courses typically incorporate clinical components but rarely offer simulation education as part of clinical practice. There is limited research examining the impact of simulation for public health nursing courses on final exam scores. The objective of this study was to determine the impact of simulation training on final exam scores in a public health nursing course.

DESIGN

Public health scenarios were created to provide hands-on experience in two settings. Home and school environments were used with discussion of students' performance during debriefing.

SAMPLE

Using a convenience sample, final exam scores were compared between nursing students (n = 79) who participated in a public health nursing simulation and two similar student groups (n = 97) that did not participate in simulation.

RESULTS

Students with simulation training scored higher in both public health domains (Community Health; Clinical Prevention and Population Health). A significant difference in total mean final scores (p = .04; p = .02) was noted between groups of students with simulation training and those without.

CONCLUSION

The difference in mean final scores suggests that simulation may be an effective educational modality in preparing students toward their state board or end of semester exams.

Possible selves, psychological well-being, and substance use in young men within 12 months post-incarceration

OBJECTIVE

Community reentry post-incarceration is fraught with challenges. The investigators examined the influence of highly personalized goals (possible selves) on psychological well-being, drug use, and hazardous drinking in recently incarcerated young men returning to the community.

DESIGN AND SAMPLE

In this cross-sectional study, 52 young men released from jail or prison within the past 12 months were recruited from community-based organizations and reentry events.

MEASUREMENTS

Participants completed open-ended possible selves measure and psychological well-being and substance use questionnaires.

RESULTS

Possible selves accounted for 19%-31% of the variance in sense of purpose, environmental mastery, and personal growth. Having a feared delinquent possible self was associated with lower sense of purpose. Having many feared possible selves was associated with lower environmental mastery. Having an expected possible self related to interpersonal relationships was associated with higher personal growth and environmental mastery. Men having a feared delinquent possible self or an expected possible self related to material/lifestyle were more likely to use marijuana than men who did not.

CONCLUSION

The content and number of possible selves may be an important focus for assessment by public health nurses in correctional and community settings serving young men post-incarceration. Longitudinal studies with larger samples are needed.

Comparing Two Early Child Development Assessment Tools in Rural Limpopo, South Africa

Background

Providing increased cognitive stimulation or learning opportunities to young children significantly increases cognitive and social-emotional competence later in life. This study aims to determine the acceptability of a pediatric assessment tool to track early child development (ECD) in a rural health district in Limpopo, South Africa.

Methods

A total of 11 primary health nurses from the region in two focus groups were selected to learn and compare two ECD assessment tools: the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) and Ages and Stages Questionnaire (ASQ). Data were analyzed using versus coding to compare between the two focus groups and between ASQ and CAT/CLAMS.

Results

The major categories that emerged from the discussion were current practice, usability, resource management, cultural adaptation, patient and parent factors, and new knowledge.

Conclusions

This study illustrates the challenges related to adapting and implementing ECD assessment in an environment where ECD is largely unknown by local residents, and differs from the environment in which the tool was initially developed. Further work is needed to develop new tools or alter existing tools that can be adapted to diverse settings and cultures.

Models and frameworks that enable nurses to develop their public health practice-A scoping study

AIMS AND OBJECTIVES

This scoping review commissioned by the Public Health England, WHO collaborating Centre, aimed to explore the models and frameworks which enable nurses to develop their public health practice and deliver public health interventions to individuals, families and communities.

BACKGROUND

There is a plethora of literature regarding the role, activities and scope of practice undertaken by public health nurses across the world. However, only two reviews have explored the models and frameworks used for public health nursing practice.

DESIGN

The study drew upon an established framework with a narrative review drawing upon five methodological steps.

METHODS

A search of databases, Medline, PsycINFO, Embase, CINHAL and British Nursing Index, was undertaken. The search took place between April 2018 and June 2018 retrieving 9,513 peer-reviewed articles published from 2008.

RESULTS

Ninety-five studies were retrieved and analysed thematically. From an initial review of literature, two themes were identified: public health models used in practice and models used in public health education. Within the first theme, three subthemes were emerged: Characteristics of the interventions; Characteristics of the public health nurse; and Lack of measurable health benefits. Within the second theme, three subthemes were identified: Faculty and Students Working Together; The Experiential Academic Approach, and What works in Educating Nurses for Public Health.

CONCLUSION

The review identified that many models and frameworks are used in practice. However, within public health practice there is a limited evidence base and it fails to demonstrate that the frameworks and models developed for practice result in measurable health benefits on an individual or population level. However, within education innovative models were apparent with collaborative partnerships enabling preregistration nursing students to develop public health nursing competencies.

RELEVANCE TO CLINICAL PRACTICE

Innovative approaches to education of preregistration nursing students could point the way forward for the delivery of public health nursing practice.

Nurse-Family Partnership and Geography: An Intersectional Perspective

Nurse-Family Partnership is a targeted public health intervention program designed to improve child and maternal health through nurse home visiting. In the context of a process evaluation, we posed the question: "In what ways do Canadian public health nurses explain their experiences with delivering this program across different geographical environments?" The qualitative methodology of interpretive description guided study decisions and data were collected through 10 focus groups with 50 nurses conducted over 2 years. We applied an intersectionality lens to explore the influence of all types of geography on the delivery of Nurse-Family Partnership. The findings from our analysis suggest that the nature of clients' place and their associated social and physical geography emphasizes inadequacies of organizational and support structures that create health inequities for clients. Geography had a significant impact on program delivery for clients who were living with multiple forms of oppression and it worked to reinforce disadvantage.

Experiences, mental well-being and community-based care needs of fathers of late preterm infants: A mixed-methods pilot study

Aims

We explore fathers' experience of caring for a late preterm infant including their stressors, needs and corresponding interventions proffered by public health nurses.

Design

Pilot mixed-methods exploratory sequential design.

Methods

We collected (a) qualitative data from semi-structured interviews (N = 5) and (b) quantitative data (N = 31) about fathers' levels of stress (Parenting Stress Index), anxiety (Speilberger State-Trait Anxiety) and depression (Edinburgh Postnatal Depression Scale) at 6-8 weeks after birth of their infant.

Results

Fathers appreciated their infant was born 'early', however, discovered through experience the demands of their infant, which appeared as stress (child and parent domains) and anxiety. Themes: hypervigilance in care explained the fathers' sense of competency and role restriction; infant fatigue and parental feeding elucidated the stressful aspect of father-infant interaction. Unscientific advice from healthcare providers was confusing and frustrating while uncertainty of rehospitalization caused worries, fears or stress. One father experienced depressive symptoms.

Pilot testing the effectiveness of the Healthy Ageing Supported by Internet and Community programme for promoting healthy lifestyles for people over 65 years of age

Active ageing is associated with physical, social and mental wellbeing, as well as the participation and integration of older people in society. Currently, demographic changes represent a major challenge while reinforcing the need to improve our current understanding of active ageing and promote appropriate interventions suitable for older people. The aim of this pilot study was to evaluate the impact of the Healthy Ageing Supported by Internet and Community training programme for acquiring the knowledge and skills necessary for adopting a healthy lifestyle in community-dwelling adults over 65 years of age. This study was conducted between 2015 and 2016 and was based on a convenience sample of individuals who responded to questionnaires. The study participants comprised all those who were included in the training programme (n = 71, 47 mentors and 24 participants in peer groups). The statistical analysis demonstrated the effectiveness of the programme regarding feasibility and expected results (p < 0.05 for most items, individually, as well as for the total scores of each test dimension). The programme was based on peer group training and the use of information and communication technologies and proved to be effective for acquiring the knowledge and skills necessary for adopting a healthy lifestyle. Furthermore, increased health scores were obtained in the physical, mental and social domains. It could also be beneficial for other groups of older people in order to support their integration into society, enhance their social skills and decrease any feelings of loneliness and rejection.

Examining boys' and girls' health-related quality of life from the first to the third year of upper secondary school: A prospective longitudinal study

AIM

To examine differences in health-related quality of life between boys and girls in the first and third years of upper secondary school.

DESIGN

Prospective longitudinal study.

METHODS

The KIDSCREEN-10 was used to assess health-related quality of life. Differences in health-related quality of life over time were estimated using a linear mixed-effects model for correlated measurements.

RESULTS

In the first-year boys (N = 168) and girls (N = 228) reported a mean health-related quality of life score of 76.3 (SD 10.7) and 69.8 (SD 11.5), respectively. In the third year, the mean health-related quality of life score for boys and girls was 73.5 (SD 12.4) and 65.7 (SD 13.3), respectively. Boys had a significant decrease in health-related quality of life mean score of -2.6 and girls a significant decrease of -3.8 (p < .001) over the 3-year period. There was no significant difference between boys' and girls' health-related quality of life changes (p = .39).

Public health nurses' experiences of assessing disruptive behaviour in children and supporting the use of an Internet-based parent training programme

BACKGROUND

In Finland, although families generally receive support from child health clinics, some need more help in dealing with their child's emotions, behaviour and psychosocial development. Public health nurses play a central role in providing vital psychosocial support for families, but they often lack the confidence and competence to tackle mental health problems.

AIM

To describe how public health nurses used and experienced a working model that combined a psychosocial tool (Strengths and Difficulties Questionnaire, SDQ) to identify disruptive behaviour in four-year-old children and an Internet-based parent training programme with telephone coaching.

METHODS

This is a descriptive, cross-sectional survey study. The sample consists of public health nurses (n = 138) who were working in child health clinics in Finland that had used the working model. Statistical data were analysed using SPSS Statistics for Windows. The responses to an open-ended question were analysed using inductive content analysis.

RESULTS

The experiences about the working model were mainly positive. The public health nurses felt that the psychosocial tool, the SDQ, was easy and suitable to use in child health clinics. The availability of an Internet-based parent training programme provided greater support for parents by overcoming practical barriers. Overall, the working model helped nurses to develop their mental health competencies.

CONCLUSION

Within primary care, the need to tackle psychosocial problems is increasing, and for this, public health nurses need extra support and tools. It seems that the working model, including the SDQ and the online and telephone coaching programme, worked well in child health clinics. This working model can be used to provide parental support and improve nurses' mental health competencies.

Quit Happens: A community clinic-based, multitiered smoking cessation intervention

OBJECTIVES

To evaluate the "Quit Happens" program launched to reduce tobacco use in low-income populations in a federally qualified nonprofit health center with clinics in Washington and Idaho. Quit Happens was implemented in 2015 and involved a public health nurse, patient, provider, clinic, health system, and community components.

DESIGN AND SAMPLE

This smoking cessation program was assessed using a pre-post evaluation design. Nine clinics in a single system of federally qualified nonprofit health centers participated in this program.

INTERVENTION

The Quit Happens program was implemented across nine clinics in Washington and Idaho. A specialized public health nurse led the tobacco cessation training of all clinic staff and assisted with development of the smoking cessation program. The 5A model was used as the framework for the training.

MEASUREMENTS

The proportion of patients identifying as a current or former smoker was measured using data extracted from electronic health records.

RESULTS

Declines in patient reports of currently smoking were observed between 2016 and 2018. The percent of current smokers identified in electronic health records decreased 18.7% and percent of former smokers doubled.

CONCLUSION

This community-based tobacco cessation program had wide clinic and community support and self-reported smoking behavior declined over time. A public health nurse's leadership in offering training and program development around tobacco cessation to a local community organization can contribute to reductions in smoking rates.

Using the TIDieR checklist to describe health visitor support for mothers with mental health problems: Analysis of a cross-sectional survey

At least half of the 20% of mothers who experience mental health problems (MHPs) during pregnancy or after birth are not receiving the help they need that will lead to recovery. In order to identify where improvements need to be made, it is necessary to describe exactly what is being done and the barriers and facilitators that compromise or enhance optimal care. The majority of mothers experience mild to moderate anxiety or depression. The expectation is that primary care professionals, such as health visitors (HVs), can provide the support they need that will lead to recovery. The aim of this study was to explore the views of HVs regarding the content and purpose of an intervention to support mothers with MHPs, described as 'listening visits' (LVs). A link to an online survey was offered to the members and champions of the Institute of Health Visiting (n = 9,474) March-May 2016. The survey was completed by 1,599 (17%) of the target population, of whom 85% were offering LVs. The Template for Intervention Description and Replication (TIDieR) checklist was used to provide a framework to describe commonalities and variations in practice. There appeared to be a shared understanding of the rationale for LVs but a lack of agreement about what the intervention should be called, the techniques that should be used and the duration, frequency and expected outcomes of the intervention. Contextual factors such as staff shortages; conflicting priorities; the needs and circumstances of mothers; the capability and motivation of HVs; inadequate training and supervision; and the absence of clear guidance contributed to variations in perceptions and practice. There are many ways in which the HV contribution to the assessment and management of mothers with MHPs could be improved. The intervention delivered by HVs needs to be more clearly articulated. The contextual factors influencing competent and consistent practice also need to be addressed.

Parent and facilitator experiences of an intensive parent and infant programme delivered in routine community settings

AIM

The aims of this study were to (1) assess the initial experiences of parenthood amongst mainly disadvantaged mothers; (2) explore their views on the extent to which they felt they had benefitted (or not) from participating in a newly developed, intensive mother and baby support programme in the community; and (3) explore the perspectives of those who delivered the programme (i.e., facilitators), most of whom were Public Health Nurses (PHNs).

BACKGROUND

Positive parent-child interactions and appropriate levels of infant stimulation are essential to promoting a child's well-being and laying a foundation in the early years for positive developmental outcomes. It is important, therefore, to examine participants' experiences of community-based, family-focused, early prevention and intervention programmes.

METHODS

This study was undertaken as part of a larger evaluation of a newly developed parent and infant (PIN) programme which was delivered in two disadvantaged areas in Ireland. One-to-one interviews were conducted with both mothers (n = 22) and facilitators (n = 8) (including three PHNs) plus six focus groups with an additional sub-group of facilitators (n = 17).

FINDINGS

The collective findings suggest that mothers found the programme helpful in promoting a greater understanding of their infants' behaviour and needs, and in alleviating stress and concerns associated with motherhood. Mothers described feeling more knowledgeable about the importance of regular and appropriate infant interaction to encourage learning and development. Facilitators, specifically PHNs, also reported a greater awareness of the value of infant socioemotional development for their clinical practice and observed greater positive communication between mothers and infants.

CONCLUSION

These findings suggest that a community-based, intensive mother and baby programme can help to promote parental competence and enhance infant learning and development. Additional benefits in terms of early intervention and positive changes to public health nursing practice are also discussed.

Comparison of Rural Childhood BMI Percentiles: Prevalence and Trends in a Midwest County, 2008-2016

The number of children who are obese and overweight continues as a public health challenge despite decades of research. The purpose of this article is to describe trends in body mass index (BMI) percentile data collected from 11- to 14-year-old school children in 2008-2009 and 2015-2016 in rural Wisconsin. The BMI percentiles from 1,347 students were compared using time, gender, age, and school (public vs. parochial) as predictors. The trend over time indicated a decrease in students of healthy weight and an increase in those overweight or obese. Also noted was a significantly higher proportion of children who were overweight or obese in parochial compared to public schools. Discussed are the observed trends, community-wide initiatives implemented, as well as how schools can employ a more comprehensive approach to childhood obesity that first ensures community readiness and involves school, home, and community.

A meta-ethnography of adult smokers' exploring the meanings of tobacco dependency medications adherence behaviours during smoking cessation

AIMS

To synthesize the experiences and adherence of adult smokers' with tobacco dependence medications.

DESIGN

Meta-ethnography.

DATA SOURCES

Seven bibliographic databases were systematically searched until April 2016.

REVIEW METHODS

A standardized appraisal tool evaluated the quality of the selected studies.

RESULTS

Seven studies met the eligibility criteria. Three major themes described the experiences and adherence of adult smokers' with tobacco dependence medications; the psychosocial context, predilection for willpower and "natural" methods and a tendency to resist medications.

CONCLUSION

The findings of this meta-ethnography are important to future clinical practice guideline development so health professionals contribute effectively to further reduction in smoking prevalence. Further research is needed to understand resistance to tobacco dependence medications and to inform the design of person-tailored interventions to improve tobacco dependence medication adherence that can be incorporated into smoking cessation interventions.

IMPACT

Smoking causes more death and disability in the world than any other avoidable factor. Research on smoker perspectives on tobacco dependence medications is sparse. Tobacco dependency is a unique treatment context with specific adherence issues. Smokers are active decision-makers regarding tobacco dependence medications. Inconsistent adherence to tobacco dependency medication regimens was apparent. Implications for health professionals, healthcare policy and clinical practice guidelines regard the structure of consultations with smoking patients. It is critical for all health professionals to assess the person seeking to stop smoking and foresee the possible causes of non-adherence behaviour. Addressing non-adherence will to lead to more effective health communications and positively contribute to quality of smoking cessation care.

The Measles Outbreak: School Nurses' Population-based Care Super Power

Population-based care is an important part of school nursing practice in the 21st century. However, many school nurses may not fully understand what population-based care means. This article outlines what population-based care entails and provides several school nursing examples.

Effectiveness of an educational program for mid-level Japanese public health nurses to improve program planning competencies: A preliminary randomized control trial

OBJECTIVE

To evaluate the effectiveness of an education program for mid-level Japanese public health nurses (PHNs) to improve their competencies in program planning, which will fulfill community health needs.

DESIGN

Randomized control trial.

SAMPLE

During 2017, 103 PHNs with 5-20 years of PHN work experience in Japan were enrolled and randomly allocated to the intervention (n = 51) or control group (n = 52).

MEASUREMENTS

The primary outcome measured competency in program planning based on Competency Measurement of Creativity for PHNs (CMC), knowledge, and skills regarding program planning.

INTERVENTION

Six web-based learning modules followed by two face-to-face group sessions.

RESULTS

The PHN participants averaged about 12 years of experience. In the intervention group, 25 PHNs completed all modules (49.0%). Post intervention, there were no statistically significant differences among any between-group CMC scores. However, the intervention group's CMC 3 score was significantly higher than that of the control group of ≥12 years of experience. Total knowledge and skill scores also improved significantly in the intervention group compared with the control group.

CONCLUSIONS

The results suggest that PHNs with ≥12 years of experience are a suitable target of this educational program, and should play a key role in program planning.

Parental experience of counselling about food and feeding practices at the child health centre: A qualitative study

AIMS AND OBJECTIVES

To investigate how parents experience counselling about food and feeding practices and the use of a communication tool about diet at the child health centre.

BACKGROUND

Food-related counselling is a key element in parents' consultations with public health nurses at child health centres. Public health nurses possess limited strategies and tools for addressing nutritional issues, especially in the context of client diversity.

DESIGN

An interpretive description approach, fulfilling the COREQ checklist criteria.

METHODS

Individual interviews performed between January 2017-May 2017 among parents (n = 12) of children (mean age 28 months) who had been exposed to a communication tool about diet, in regular child health centre consultations with their child. These consultations were included in clinical trial (ClinicalTrials.gov.: Identifier: NCT02266953).

RESULTS

Counselling using the communication tool about diet was primarily based on the public health nurse presenting images of healthy food choices. After infancy, consultations sometimes became more time-pressured, inhibiting parents from asking questions related to the child's diet. The parents who had questions related to food allergy or breastfeeding of their child sometimes experienced limited support. Some parents felt overwhelmed with information about healthy food choices if their child's diet differed from the recommendations presented.

CONCLUSIONS

The parents' existing expectations and needs had an impact on their satisfaction in relation to their perceptions of nutritional counselling. The use of the communication tool about diet to promote a two-way dialogue instead of providing one-way dietary information might be particularly useful in consultations for parents who do not follow customary recommendations.

RELEVANCE TO CLINICAL PRACTICE

If the diet of the family differs from what is recommended, parents often experience limited support at the child health centre. Promoting a two-way dialogue in consultations using a communication tool about diet could help parents in their concerns related to feeding their child.

Achieving consensus on the undergraduate curriculum of public health nursing in Turkey

OBJECTIVE

The aim of this study was to construct a consensus on the undergraduate learning objectives and topics for public health nursing (PHN) in Turkey.

DESIGN

A three-round e-mail-based Delphi study was conducted between May and July 2015 with a national sample.

SAMPLE

Ninety-one academics from 54 universities were invited as experts to participate by e-mail. Fifty-nine academics from 43 universities participated in the study.

MEASUREMENTS

Data were analyzed by computing the median, quartiles one and three, and the interquartile range for each learning outcome and topic. Consensus was considered as less than the interquartile range of 1.2.

RESULTS

Experts who participated in the study added 70 learning outcomes, eight main topics, and 278 sub-topics during the first round. Round I generated 170 learning outcomes, 28 main topics, and 385 sub-topics. At the end of Round II, consensus was reached on 126 learning outcomes, 22 main topics and 168 sub-topics. At the end of Round III, consensus was achieved for 126 learning outcomes, 22 main topics, and 169 sub-topics.

CONCLUSION

The learning outcomes and topics that were decided upon through a consensus process will contribute to the standardization and development of PHN education.

Working with women in Turkey exposed to childhood sexual abuse

OBJECTIVE

Sexual abuse of children is an important public health issue. The aim of this study was to provide a multidimensional examination of women over the age of 18 who were exposed to sexual abuse in childhood and the effect of this abuse on their lives.

DESIGN AND SAMPLE

This qualitative study was conducted over the period June 2015-February 2017. Twenty-three women were gathered by the snowball sampling method.

MEASURES

We collected the data using a semi-structured questionnaire and in-depth interviews. Content analysis was used in the evaluation of the data.

RESULTS

We found five themes that participants considered to result from their sexual abuse: emotional effects, sexuality, marriage, academic, and social aspects.

CONCLUSION

Sexual abuse adversely affected the physical, psychological, and social lives of individuals. Public health nurses play a role in working with women who were exposed to sexual abuse in childhood.

Governing through lifestyle-Lalonde and the biopolitical management of public health in Canada

In 1974, the Liberal government of Pierre Trudeau released a "green paper" known as the Lalonde Report, after the health minister at that time. The report formulated perspectives on health and the main concepts and ideas developed in it, particularly the concept of "lifestyle," which became the foundation of public health policies in many different European countries and the United States. The concept of "lifestyle" connected personal behaviour and habits to the individual health condition; people were not dying due to a lack of access to medical care but because they lived a life prone to personal risk taking. Furthermore, what is seldom discussed is that this report not only propagated the (neo)liberal view of citizens as autonomous rational actors (homo oeconomicus), with personal responsibility for their health, but it was a first step in the transformation of Medicare and went far beyond the question of health promotion. Health was no longer something that happened to a person but was created through personal choice and, therefore, one had to assume responsibility for one's behaviour. Using Foucault's definition of government as the "conduct of conduct," we will demonstrate that the Lalonde report must be understood as a specific "technology of government" and contributed to a neoliberal transformation of health care despite the fact that the Canadian system of Medicare was based on the idea of universality, meaning citizens had equal access to health care independent of their socio-economic situation. As we will demonstrate, the Lalonde report undermined this foundation and initiated a profound reorientation, not only of the healthcare system, but even more importantly, it radically changed the way we think about our behaviour around health-related issues. We will also discuss how the making of the report contributed to the redefinition of politics and demonstrated a lack of concern with liberal-democratic decision-making processes.

Social support network of family members of abused children and adolescents: Perspectives and possibilities

AIMS AND OBJECTIVES

To analyse the network of care and social support from the perspectives of family members of children and adolescents who have been abused.

BACKGROUND

The theoretical-methodological background of the ecological model for understanding violence and the Paradigm of Complexity provide a broad perspective of violence. The paradigm considers all aspects that constitute a phenomenon as well as particular features.

DESIGN

Qualitative research based on the Paradigm of Complexity, developed by Edgar Morin, the primary philosopher. We have adhered to the COREQ Checklist guidelines for qualitative research.

METHODS

Data were collected through Minimal Maps of Personal Social Networks, and semi-structured interviews were held with 15 families who were assisted by a nongovernmental organisation in a Brazilian city. The notions of comprehension and contextualisation guided the data analysis.

RESULTS

Two categories emerged from the data analyses: "Social isolation" and "Affective relationships needs." The maps revealed a weakened and limited network with low-density, homogeneous bonds and few significant bonds. Therefore, the network provided predominantly instrumental and material social support with few important effective relationships. The participants disclosed some strategies to empower their lives.

CONCLUSIONS

We conclude that it is urgent to develop strategies in a broad manner to promote family empowerment, especially on education and employment dimension, and to construct supportive and respectful relationships between services and families as well.

RELEVANCE TO CLINICAL PRACTICE

The present study contributes to international clinical nursing, especially in low- and middle-income countries, by discussing (a) looking at and caring for family members of children and adolescents who have been abused in a contextualised manner; (b) family empowerment, which enables them to have access to healthier environments and to educational/employment opportunities; and (c) broad comprehension of health care among the family members, which provides perspectives not only for looking at violence but also for strengthening supportive social relationships.

Nurses' practices in the context of primary healthcare in Portugal

AIM

The aim of this study was to identify and categorise the nursing practices of Portuguese nurses in the context of primary healthcare services.

METHODS

A scoping review was undertaken using the Latin American and Caribbean Health Sciences literature database; Spanish Bibliographic Index of Health Sciences; Medical Literature Analysis and Retrieval System Online; Cochrane Library; Scientific Electronic Library Online; El Banco de Datos de Enfermería nursing database; and Cumulative Index to Nursing and Allied Health Literature databases. The search strategy included articles of original research, which involved nurses or nursing practices in the context of Portugal's primary healthcare, published in Portuguese, Spanish and/or English. The review involved the analysis of 11 studies published in Latin American, Brazilian and Portuguese journals, therefore all were available in Portuguese, published between 2007 and 2013.

RESULTS

From the analysis it was possible to establish four categories of primary healthcare nurses' work: technical procedures, health promotion, independent actions, and management and training practices.

CONCLUSIONS

Primary healthcare nursing in Portugal is challenged in the context of making more effective use of its own competences, investing more in actions of health promotion and disease prevention and less in technical curative procedures, thus contributing to better performance in the Portuguese National Health System.

Has the Experience of Hepatitis C Diagnosis Improved Over the Last Decade? An Analysis of Canadian Women's Experiences

Background In Canada, incidents of new hepatitis C virus infections are rising among women aged 15-29 years and now comprise 60% of new infections among this age group. A negative diagnosis experience continues to be a problem affecting women living with hepatitis C virus. With new effective treatments, nurses will have more involvement in hepatitis C virus care and diagnosis, which is a critical time to facilitate appropriate education and management. Purpose This study explored Canadian women's experience of hepatitis C virus diagnosis in order to develop recommendations to improve care at the point of diagnosis. Methods Purposive sampling was used to recruit and interview 25 women. Using narrative inquiry, we examined Canadian women's experience of hepatitis C virus diagnosis. Results Women's diagnosis experiences were shaped by the context of diagnosis, factors prompting the testing, the testing provider, and information/education received. The context of diagnosis foreshadowed how prepared women were for their results, and the absence of accurate information magnified the psychological distress that can follow an hepatitis C virus diagnosis. Conclusion Our findings provide a compelling case for a proactive nursing response, which will improve women's experiences of hepatitis C virus diagnosis and, in turn, enhance women's access to hepatitis C virus care and other healthcare services.

Family-Focused Practice for Families Affected by Maternal Mental Illness and Substance Misuse in Home Visiting: A Qualitative Systematic Review

Maternal mental illness is a major public health issue and can adversely affect the whole family. Increasingly, research and policy are recognizing the benefits of a family-focused approach to practice, an approach that emphasizes the family as the unit of care. This review was conducted with the aim of systematically analyzing the qualitative literature surrounding health visitors' family-focused practice with mothers who have mental illness and/or substance misuse. Through the synthesis, we developed three main findings: (a) parents' needs regarding health visitors' family-focused practice, (b) the ambiguity of mental illness in health visiting, and (c) the challenges of family-focused practice in health visiting. Above all, health visitors, families, and mothers with mental illness experience many challenges in family-focused practice, even though it is both desirable and beneficial. This calls for a deeper understanding of how family-focused practice can be effectively practiced in health visiting.

A falls case summary: Application of the public health nursing intervention wheel

BACKGROUND

The Public Health Intervention Wheel (PHIW) is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. Public health nurses (PHNs) provide care at the three levels of practice. Prevention of falls is a public health issue and the majority of falls happen at home. Therefore, prevention and management of falls in the community could benefit from a public health systems approach by PHNs underpinned by the PHIW.

CASE PRESENTATION

A hypothetical case is presented of a 78-year-old gentleman who had a fall which resulted in a fractured right acetabulum and surgery before being discharged home.

METHODS

The aim of this paper was to use a case summary to illustrate PHN practice in the context of the PHIW as applied to falls management and prevention. This paper focuses on fall incidence and PHN response in Ireland and Norway. The PHIW is described and relevant interventions from the PHIW are applied to PHN practice in managing the case.

CONCLUSIONS

The PHIW model provides insight into the potential scope of public health nursing in falls, articulating PHN practice in the community.

Evaluation of a nursing student health fair program: Meeting curricular standards and improving community members' health

BACKGROUND

Public health nursing (PHN) is an essential component of baccalaureate nursing education. In order to build PHN competencies, universities must design and operationalize meaningful clinical activities addressing community and population health. Currently, there is a paucity of literature delineating best practices for promoting competency in PHN.

AIMS

The purpose of this manuscript is to describe a PHN-student health fair program as a means for meeting undergraduate PHN curricular standards, and to report results of an evaluation conducted examining its effectiveness in improving community member's health knowledge.

METHODS

Health fairs were held at community agencies that served the homeless or victims of intimate partner violence. A total of 113 community members that attended a health fair were assessed at baseline and immediate posttest using open-ended questionnaires. The design of the health fairs included a community assessment, intervention, and evaluation flow that followed the nursing process.

RESULTS

We report that results from participants surveyed indicated that PHN-student delivered health fairs improved health knowledge among community members in this sample (p = .000).

CONCLUSION

Health fairs conducted by PHN students appear to be promising community health promotion and disease prevention interventions that can serve as an effective strategy for teaching PHN student competencies and facilitating engagement with the community.

Evaluating Community Partnerships Addressing Community Resilience in Los Angeles, California

Community resilience has grown in importance in national disaster response and recovery efforts. However, measurement of community resilience, particularly the content and quality of relationships aimed at improving resilience, is lacking. To address this gap, we used a social network survey to measure the number, type, and quality of relationships among organizations participating in 16 coalitions brought together to address community resilience in the Los Angeles Community Disaster Resilience project. These coalitions were randomized to one of two approaches (community resilience or preparedness). Resilience coalitions received training and support to develop these partnerships and implement new activities. Both coalition types received expert facilitation by a public health nurse or community educator. We also measured the activities each coalition engaged in and the extent to which partners participated in these activities at two time points. We found that the community resilience coalitions were initially larger and had lower trust among members than the preparedness communities. Over time, these trust differences dissipated. While both coalitions grew, the resilience community coalitions maintained their size difference throughout the project. We also found differences in the types of activities implemented by the resilience communities; these differences were directly related to the trainings provided. This information is useful to organizations seeking guidance on expanding the network of community-based organizations that participate in community resilience activities.

Challenges and demands in the population-based work of public health nurses

AIMS

Government programs and the Norwegian Directorate of Health give public health nurses in Norway an explicit role in population-based health promotion and disease-prevention work. The aim of this paper is to explore Norwegian public health nurses' experiences with population-based work.

METHODS

A phenomenological hermeneutic approach was adopted, involving face-to-face interviews with a purposeful sample of 23 public health nurses from urban and rural districts in two counties in Norway.

RESULTS

Three themes were identified: the predominance of work at the individual level, a lack of resources, and adherence to administrative directives. The interviews revealed that the public health nurses were mostly occupied with individual problem-solving activities. Population-based work was hardly prioritized, mostly because of a lack of resources and a lack of recognition of the population-based role of public health nurses.

CONCLUSIONS

The study indicates contradictions between the public health nursing practice related to population-based work and the direction outlined by the government and the public health nursing curriculum, which may mean that the public health nursing role is not sufficiently clarified. The implementation of practice models and administrative directives and resources, as well as an explicit emphasis on population health in public health nursing education, can contribute to increased population-based interventions. Greater knowledge of and emphasis on population-based work in public health nursing are needed.

Innovation in values based public health nursing student selection: A qualitative evaluation of candidate and selection panel member perspectives

OBJECTIVES

Values based recruitment emerges from the premise that a high degree of value congruence, or the extent to which an individual's values are similar to those of the health organization in which they work, leads to organizational effectiveness. The aim of this evaluation was to explore how candidates and selection panel members experienced and perceived innovative methods of values based public health nursing student selection.

DESIGN AND SAMPLE

The evaluation was framed by a qualitative exploratory design involving semi-structured interviews and a group exercise. Data were thematically analyzed. Eight semi-structured interviews were conducted with selection panel members. Twenty-two successful candidates took part in a group exercise.

INTERVENTION

The use of photo elicitation interviews and situational judgment questions in the context of selection to a university-run public health nursing educational program was explored.

RESULTS

While candidates were ambivalent about the use of photo elicitation interviews, with some misunderstanding the task, selection panel members saw the benefits for improving candidate expression and reducing gaming and deception. Situational interview questions were endorsed by candidates and selection panel members due to their fidelity to real-life problems and the ability of panel members to discern value congruence from candidates' responses.

CONCLUSIONS

Both techniques offered innovative solutions to candidate selection for entry to the public health nursing education program.

Perceptions of experiences with interprofessional collaboration in public health nursing: A qualitative analysis

In public health nursing interprofessional collaboration has become a goal, however, there is little clarity on the distribution of responsibility or approach to cooperation between the professional groups. The aim of the study was to explore public health nurses' perceptions of their experiences related to interprofessional collaboration. A qualitative content analysis was carried out. An interview study with a purposeful sample of 23 Norwegian public health nurses (PHNs) was conducted. Data were analysed using semi-structured interviews to identify categories and themes of PHNs' working lives. The data were classified into three major themes: institutionality: the institutional understanding of the professional roles; competence: clarifying jurisdictional borders, and recognition: professionals' recognition of different roles. There needs to be a robust strategy in collaborative working that involves public health nurses among other professionals to avoid role overlap, interpersonal and interprofessional conflict and reduce the damaging threat or stress that comes with informal or ad hoc rules of engagement and status claiming by one profession over another.

How Do Communities Use a Participatory Public Health Approach to Build Resilience? The Los Angeles County Community Disaster Resilience Project

Community resilience is a key concept in the National Health Security Strategy that emphasizes development of multi-sector partnerships and equity through community engagement. Here, we describe the advancement of CR principles through community participatory methods in the Los Angeles County Community Disaster Resilience (LACCDR) initiative. LACCDR, an initiative led by the Los Angeles County Department of Public Health with academic partners, randomized 16 community coalitions to implement either an Enhanced Standard Preparedness or Community Resilience approach over 24 months. Facilitated by a public health nurse or community educator, coalitions comprised government agencies, community-focused organizations and community members. We used thematic analysis of data from focus groups (n = 5) and interviews (n = 6 coalition members; n = 16 facilitators) to compare coalitions’ strategies for operationalizing community resilience levers of change (engagement, partnership, self-sufficiency, education). We find that strategies that included bidirectional learning helped coalitions understand and adopt resilience principles. Strategies that operationalized community resilience levers in mutually reinforcing ways (e.g., disseminating information while strengthening partnerships) also secured commitment to resilience principles. We review additional challenges and successes in achieving cross-sector collaboration and engaging at-risk groups in the resilience versus preparedness coalitions. The LACCDR example can inform strategies for uptake and implementation of community resilience and uptake of the resilience concept and methods.

Person-centred care dialectics-Inquired in the context of palliative care

Although a widely used concept in health care, person-centred care remains somewhat ambiguous. In the field of palliative care, person-centred care is considered a historically distinct ideal and yet there continues to be a dearth of conceptual clarity. Person-centred care is also challenged by the pull of standardization that characterizes much of health service delivery. The conceptual ambiguity becomes especially problematic in contemporary pluralistic societies, particularly in the light of continued inequities in healthcare access and disparities in health outcomes. Our aim was to explicate premises and underlying assumptions regarding person-centred care in the context of palliative care with an attempt to bridge the apparently competing agendas of individualization versus standardization, and individuals versus populations. By positioning person-centredness in relation to the hermeneutics of the self according to Paul Ricœur, dialectics between individualization and standardization, and between individuals and populations were constructed. The competing agendas were related in a dialectic manner in the way that population health is of importance for the individual, and standardization is of importance for the population. The analysis suggests that person-centred care is an ethical stance, which gives prominence to both suffering and capability of the individual as a person. The dialectic analysis points towards the importance of extending person-centred care to encompass population and societal perspectives and thereby avoiding a problematic tendency of affiliating person-centred care with exclusively individualistic perspectives. Considerations for person-centred palliative care on micro-, meso- and macrolevels conclude the paper.

Climate Change, Health, and the Role of Nurses

Climate change is progressing and carries significant public health consequences that nurses will need to be aware of and address in practice and research. The Alliance of Nurses for Healthy Environments encourages nurses and professional nursing organizations to learn about the health effects of climate change and to conduct research and implement adaptive strategies to provide optimal patient care within a changing environment. Pregnant women, newborns, and children are particularly vulnerable to potential health effects related to climate change.