Barbara J. Polivka

Public Health Nursing Competencies for Public Health Surge Events

OBJECTIVE To develop consensus regarding public health nursing competencies in the event of a public health surge event related to disaster. DESIGN AND METHODS Using a 3-round Delphi approach, public health nurses (PHNs) and directors of nursing from local health departments, state nursing leaders, and national nursing preparedness experts reviewed and commented on 49 draft competencies derived from existing documents. RESULTS The final 25 competencies were categorized into Preparedness (n=9), Response (n=8), and Recovery (n=7). The Preparedness competencies focus on personal preparedness; comprehending disaster preparedness terms, concepts, and roles; becoming familiar with the health departments disaster plan, communication equipment suitable for disaster situations; and the role of the PHN in a surge event. Conducting a rapid needs assessment, outbreak investigation and surveillance, public health triage, risk communication, and technical skills such as mass dispensing are Response phase competencies. Recovery competencies include participating in the debriefing process, contributing to disaster plan modifications, and coordinating efforts to address the psychosocial and public health impact of the event. CONCLUSIONS Identification of competencies for surge events that are specific to public health nursing is critical to assure that PHNs are able to respond to these events in an effective and efficient manner.

Graduate Education for Advanced Practice Public Health Nursing: At the Crossroads

The complexity of public health problems and advancement of science framing public health demand an expansion of traditional educational approaches and curriculum to prepare a futuristic advanced practice public health nursing (APPHN) workforce. This position paper sponsored by the Association of Community Health Nursing Educators challenges nurse educators to apply innovative strategies in preparing public health nursing (PHN) professionals and to expand curriculum paradigms to promote PHNs ecological approach to solving problems. To meet the challenges of ensuring public health in the 21st century, advanced practice public health nurses must have greater foundational knowledge in critical content areas discussed in this document. Competence in these areas will enable advanced practice public health nurses to address future health care challenges such as rapidly changing social structures, escalating knowledge explosion, globalization, and growth of new technologies. This education will prepare nurses to forge new knowledge and establish health care teams to create effective solutions.

Public health nurses' knowledge and attitudes regarding climate change.

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

Collaboration between local public health and community mental health agencies

Public health agencies (PHA) and community mental health agencies (CMHA) generally are organizationally and functionally autonomous. Collaboration between PHA and CMHA was explored in a statewide survey of nursing directors of PHA (n = 135) and executive directors of CMHA (n = 214). Findings indicated staff did not know each other well; clients, funds, and information were infrequently exchanged; public health nurses rarely were included in planning for the care of those with mental illness; and satisfaction with relationships was minimal. Path analysis was used to test an interagency collaboration model. Awareness of staff from other agencies increased satisfaction with interagency processes and interagency relationships.

Facilitating Factors and Barriers to BMI Screening in Schools

The National Association of School Nurses advocates for body mass index (BMI) screening. Little research describes school nurse practice of BMI screening. In this descriptive study, 25 Ohio school nurses participated in three focus groups. An adapted Healthy People 2010 Determinants of Health Model guided the research questions. School nurses engaged in multiphasic data collection which was contingent on physical environment, workload, and referrals. Lack of system policy was key barrier in terms of data collection, referral, and follow-up. A key facilitating factor was physical education teachers in terms of reinforcing health. School size and privacy were components of school physical environment that influenced screening. Recommendations on securing adequate resources are presented. Implications for policy included a salient need for reduced SN workload.

Comparison of Poison Exposure Data: NHIS and TESS Data

Objective: To identify age-adjusted poisoning episode rates, and poison control center contacts due to poisonings in children under 6 years old based on 1997–1999 National Health Interview Survey data; and compare findings with 1997–1999 Toxic Exposure Surveillance System data. Methods: Secondary analysis of National Health Interview Survey poisoning episode data for children 5 years and younger. Respondents were asked about poison exposures during the previous 3 months. Results: Based on National Health Interview Survey population weighted data there were 196/10,000 poisonings to young children <6 years. These exposures resulted primarily from harmful solid or liquid substances. A poison control center was called in 86% of exposures to children <4 years, but only in 70% of the 4–5 year old exposures. The odds of a poison control center not being called were 3.2 times greater for 4–5 year olds (compared to ≤3 years) and 4.5 times greater for African-American (compared with White-Americans). Comparison of National Health Interview Survey data with data in the 1997–1999 Annual Reports of the Toxic Exposure Surveillance System revealed the number of estimated exposures in the National Health Interview Survey data were approximately half those reported in the Toxic Exposure Surveillance System data. In both datasets, children 1–2 years of age had the highest percent of poisoning exposures. Conclusions: Using multiple datasets to explore poisoning rates in young children provides a broader perspective. Differences in findings reflect divergent data collection methods and biases inherent in each database. Although the majority of National Health Interview Survey respondents reporting contacting a poison control center for a poisoning exposure, rates are lower in specific subgroups indicating a need for targeted educational efforts.

Hospital and emergency department use by young low-income children.

BACKGROUND Limited data are available concerning determinants of health care service usage by low-income young children. OBJECTIVES To explore predictors of hospitalization and emergency department (ED) use by young children of low-income families by using the Aday and Andersen Access Framework. METHODS Low-income women (n = 474) with a child younger than 6 years completed a structured face-to-face interview at human service offices or Women, Infants, and Children (WIC) clinics in four central Ohio counties. Women were considered low-income if they or their child were Medicaid eligible or uninsured. Data were collected for both the mother and the index child on sociodemographic status, health services use, health status, and access to care. RESULTS Fifteen percent of the children had been hospitalized the previous year, and half had an ED visit. Hospitalization was significantly related to maternal hospitalization the previous year (OR = 2.5), child age younger than 1 year old (OR = 2.1) and more than two chronic conditions (OR = 2.2). Maternal ED usage in the last year (OR = 2.2), Medicaid fee for service plan (OR = 1.7), and rural residence (OR = 2.0) were predictive of ED use. CONCLUSIONS Predisposing characteristics (maternal hospital/ED use) were predictive of both hospitalization and ED use by the index child. Enabling characteristics (fee-for-service Medicaid plan, rurality) were only predictive of ED use, and need characteristics (childs health) were only predictive of hospitalization. Further research to explore linkages between maternal and child use of health care services as well as the effect of changes in health care access, managed care, and other innovations on hospitalization and ED use in young, low-income children is recommended.

What Young African American Women Want in a Health Care Provider

The Institute of Medicine’s report on racial and ethnic disparities in health care encourages enhancing patient—provider relationships by building trust. We explored factors important to 19- to 24-year-old African American women (N = 40) in choosing a health care provider. Eight focus groups were held in seven Ohio counties. Discussion was aided by photographs of client—provider interactions: two African American and two White providers (man or woman in each); in similar settings, attire, and pose; with a young African American woman client. Participants commented on what was happening in the photographs, how the woman felt, and their perceptions of each provider. Fongwa’s Quality of Care model guided analysis. Women providers were favored; race was not of primary concern. Provider proximity, perceived interest, and understandability were persistent preferences. Trust, awareness of body language, interest in client, and conveying information clearly are critical for providers caring for young African American women.

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 curriculums use of a blended learning methodology enables staff-level PHNs to master individual competencies toward surge capability within the public health response system.

Dental Insurance and Dental Service Use by U.S. Women of Childbearing Age

OBJECTIVES Oral health has a significant effect on health, and for women, poor oral health can lead to poor birth outcomes and can affect their childs health. Nursing interventions to improve the oral health of at-risk women have the potential to increase maternal and child systemic and oral health. The identification of women at a high risk for poor oral health is a necessary to develop and evaluate these interventions. DESIGN AND SAMPLE This study examined the factors related to dental insurance and dental service use for women of childbearing age in the United States. A secondary analysis of the 2003-2004 National Health and Nutrition Examination Survey was completed to examine the predisposing, enabling, and need variables associated with dental insurance status and dental service use in a representative random sample of 1,071 women. RESULTS The results showed that over 40% of women had no dental insurance. Women with less education, lower income, and dental need were significantly less likely to have dental insurance. Dental utilization by the uninsured was low and a racial/ethnic disparity was noted. CONCLUSION A lack of dental insurance and dental service utilization is a significant concern. Nurses working with low-income women should educate the population about oral health and advocate for policies to increase dental insurance coverage.