Katherine Laux Kaiser

Reliability, validity, and scoring of the Health Status Questionnaire-12 version 2.0.

Measuring health status as an indicator of individual, population, and community health is critical in reducing health disparities in populations. The purpose of this study was to test the psychometric properties of the Health Status Questionnaire-12 (HSQ-12) Version 2.0, a brief self-reported health status instrument available within the public domain, in a lowincome sample (N = 7,793). The internal consistency reliability was .88. Initial and confirmatory factor analysis revealed two factors explaining 67% of the variance, interpreted as super scales of physical and mental health. Second order factor analysis isolated one factor explaining 82% of the variance, interpreted as a total health status. Comparison of subjects with and without disabilities using t tests and the Mann–Whitney U Test showed that the scale, super scale, and total scale scores differentiated significantly. The HSQ-12 is a reliable, valid, and low-cost measure of health status.

Using Focus Groups to Evaluate and Strengthen Public Health Nursing Population-Focused Interventions:

Nebraska Health Connection Access Medicaid’s(NHC AM) public health nursing (PHN) population-focused practice model is designed to provide enrollment, education, and PHN case management interventions for the Medicaid Managed Care population. Evaluation and continuous improvement of these interventions are, in part, completed through a collaborative effort between NHC AM and a quality management team at the University of Nebraska Medical Center College of Nursing. Focus group methodology was used to access non-English-speaking populations to evaluate and strengthen population-focused PHN interventions.

Setting a new course for advanced practice community/public health nursing

In recent years the changes in the organization and delivery of health care have created an environment that places great demands on nursing education at all levels. Determining a sound, responsive course of study in advanced practice community/public health nursing (C/PHN) is dependent on clear educational outcomes and competencies. Outcomes and competencies for C/PHN practice need to continue to be derived from the rich knowledge, experience, and research tradition with populations living in the community. However, in todays health care environment, these outcomes and competencies also must be integrated within the context of a very different health care system perspective. This article describes the outcomes and competency indicators developed to guide a curriculum designed to integrate traditional C/PHN and a health systems perspective for students seeking advanced practice education in C/PHN at the College of Nursing, University of Nebraska Medical Center.

Public and Community Health Nursing Interventions With Vulnerable Primary Care Clients: A Pilot Study

The primary aim of this pilot study was to test the effects of public/community health nursing (P/CHN) home visitation and a mutual goal-setting intervention on the intensity of need for nursing care levels and health behavior of vulnerable primary care clients. A secondary aim was to describe the content of client health behavior improvement goals. Eighty clients, aged 19–93 years, judged by their primary care providers to have unmet health needs were referred for P/CHN services. A quasi-experimental design was used, with the intervention group receiving the mutual goal-setting intervention. Senior baccalaureate nursing students, guided by faculty case managers, provided home visitation nursing care and the mutual goal-setting intervention. No significant effects of mutual goal-setting were found, however the 10-week P/CHN home visitation intervention was found to have significant positive effects on intensity of need for nursing care levels and health behaviors. Also, preferred client health improvement goals for this population are described. Several implications for P/CHN practice and research are discussed.

Participant Satisfaction Methods and Outcomes in Medicaid Managed Care

Abstract: Participant satisfaction is an important outcome in evaluating the effectiveness of healthcare programs and benefits. With vulnerable populations, such as Medicaid beneficiaries, determining participant satisfaction poses unique challenges. The purpose of this article is to discuss participant satisfaction methods and outcomes from a multi‐year experience of surveying Medicaid Managed Care (MMC) participants in Nebraska (2000–2005). Using a variety of survey methods, the foci were to measure satisfaction with MMC enrollment, understanding of MMC guidelines, and satisfaction with education services provided. Results illustrate response rate patterns and outcome trends that contribute to quality improvement knowledge useful for others surveying Medicaid populations.

Health Effects of Life Transitions for Women and Children: A Research Model for Public and Community Health Nursing

Because maternal-child populations have traditionally been a major practice target for public and community health nursing (P/CHN), understanding the health effects of life transition experiences for women and their children is key to the advancement of P/CHN practice and research. To date there are no integrated conceptual models available that examine transition and its health effects in women, and ultimately their children, to single or multiple transitions. In order to help women and those with dependent children transition successfully, strong transition frameworks for nursing are needed. The purpose of this paper is to describe a conceptual model, Health Effects of Life Transition for Women and Children. Major components include the transition experience (developmental, situational, health illness), transition assets/risks (personal, environmental), cognitive-behavioral health indicators of transition (perception of situation, personal efficacy, change readiness, engagement, help-seeking, health behaviors, services use), transition adaptive outcomes of health (health status, intensity of need for nursing care) and competence (transition specific skill acquisition, health management, resourcefulness) and long-term preventive health outcomes (risk reduction, disability prevention, cost savings, mastery, injury prevention). The authors propose that cognitive-behavioral health indicators are foundational to a successful transition experience, are why some people have better transition outcomes than others, and when influenced by P/CHN intervention lead to improved long-term outcomes.

Public health nursing data. Building the knowledge base for high-risk prenatal clients.

PURPOSE To examine and compare referral reason, clinical pathway variance, and intensity of need for care for high-risk prenatal clients of public health nurses. DESIGN A prospective, descriptive design was used for this pilot study. METHODS Reasons for referral to the high-risk prenatal home visitation program, variances from a prenatal clinical pathway, and intensity of need for care scores obtained using the Community Health Intensity Rating Scale (CHIRS) were collected at 28 weeks and 38 weeks of gestation from the clinical records of 20 high-risk prenatal clients (age range 16-43 years) visited by five expert public health nurses in one midplains public health nursing department. RESULTS Findings indicated that the three sources of clinical data provided congruent but not identical data, with each contributing elements needed to specify public health nurses interventions for high-risk prenatal clients. CLINICAL IMPLICATIONS Collaborative clinical research studies such as this one are useful in advancing evidenced-based practice in clinical agencies. The congruence between the clinical path variance and the intensity of need for care scores reaffirms the importance of the domain of health behavior intervention as a major aspect of public health nurses practice.

Integrating Quality Improvement and Translational Research Models to Increase Exclusive Breastfeeding

Exclusive breastfeeding (EBF), a perinatal core measure, is associated with a longer duration of breastfeeding. The purpose of this quality improvement project was to increase the percent of healthy term singleton newborns who were exclusively breastfed at an academic medical center in the Midwest. Implementation of skin-to-skin contact between mother and newborn immediately following birth resulted in an increase in the percent of healthy term singleton newborns who were EBF from 55% to 64%.

Voluntary STD Testing and Treatment Program at a Metropolitan Correctional Facility: Evaluation of Test Acceptability and Associated Risk Factors

Few studies have addressed challenges of diagnosis and treatment of sexually transmitted diseases (STDs) within correctional facilities. Initiatives that screen all inmates can be cost-prohibitive, while symptom-based screening undoubtedly fails to recognize significant numbers of asymptomatically infected persons. This study discusses a voluntary STD screening and treatment program developed at the Douglas County (Nebraska) Department of Corrections where student volunteers interviewed, screened, and educated 456 inmates. Inmate urine samples and interview responses about risk behaviors and motivators for participation in the screening program were analyzed. The results support the ongoing project method to screen and treat inmates in the community correctional facility. Risk factor analysis suggests that targeted testing and treatment efforts may have a role in providing cost-effective care for STD among the incarcerated population.

Improving access and managing population health through multidisciplinary partnerships.

The purpose of this article was to present Nebraskas model of collaboration between public health, public health nursing, medicine, and community partners. Another purpose was to provide exemplars of data trends and outcomes of the multiyear experience with the model. The goal of the collaborative model was to promote the concept of a medical home, improve access to care, and better manage population health for the diverse and vulnerable Medicaid population by implementing a change from fee-for-service to managed care. The vision was to better match population health needs to health services used and to reduce disparities. A unique feature of the model is the use of public health professionals and strategies.