Susan J. Zahner

Local Public Health System Partnerships

Objectives. Interorganizational collaboration aimed at community health improvement is an expectation of local public health systems. This study assessed the extent to which such collaboration occurred within one state (Wisconsin), described the characteristics of existing partnerships, and identified factors associated with partnership effectiveness. Methods. In Stage 1, local health department (LHD) directors in Wisconsin were surveyed (93% response rate). In Stage 2, LHDs completed self-administered mailed surveys for each partnership identified in Stage 1 (85% response rate). Two-level hierarchical logit regression methods were used to model relationships between partnership and LHD variables and partnership outcomes. Data from 924 partnerships associated with 74 LHDs were included in the analysis. Results. Partnerships most frequently addressed tobacco prevention and control, maternal and child health, emergency planning, community assessment and planning, and immunizations. Partnering was most frequent with other government agencies, hospitals, medical practices or clinics, community-based organizations, and schools. Partnership effectiveness was predicted by having a budget, having more partners contributing financially, having a broader array of organizations involved, and having been in existence for a longer period of time. A government mandate to start the partnership was inversely related to successful outcomes. Characteristics of LHDs did not predict partnership effectiveness. Conclusions. Financial support, having a broader array of partners, and allowing sufficient time for partnerships to succeed contribute to partnership effectiveness. Further study—using objective outcome measures—is needed to examine the effects of organizational and community characteristics on the effectiveness of local public health system partnerships.

Local health department partnerships with faith-based organizations.

Collaboration between public health and faith communities is encouraged by national and state policies. The study in this article examined the prevalence, characteristics, and effectiveness of partnerships between faith-based organizations and local health departments in Wisconsin. Data were collected from local health departments using a 2-stage, cross-sectional survey. A subset analysis of partnerships that included faith-based organizations was conducted using descriptive, bivariate, and 2-level logit regression methods, with partnerships nested in health departments. Twenty-four percent of local health department partnerships included faith-based organizations (n = 224). Community assessment was the most commonly reported partnership focus. Partnerships that included faith-based organizations were more likely to include many partners and have few partners contributing financially. Partnerships that include faith-based organizations are no more likely to be effective than those that do not. Predictors of local health department/faith-based organizations effectiveness included having a budget and longer time in existence. Local health departments engage faith-based organizations in partnership strategies when addressing issues that require broad community attention. Partnership effectiveness is enhanced by existence of a budget and sufficient time for development.

The Impact of Web-delivered Education on Preceptor Role Self-Efficacy and Knowledge in Public Health Nurses

OBJECTIVE Preceptors are an essential component in preparing student nurses to become practicing public health nurses. Preparation for the preceptor role is important for achieving a quality learning experience for students. This study was conducted to explore the relationship between completion of a Web-delivered preceptor education program and both knowledge of the preceptor role and self-efficacy to perform in the preceptor role. DESIGN AND SAMPLE This study used a pretest-posttest, quasi-experimental design. The participants were experienced public health nurses (n=31) working in one state in the United States. MEASURES Pretest and posttest Web-delivered survey using the preceptor self-efficacy questionnaire and an instrument assessing knowledge gain. INTERVENTION A Web-delivered preceptor education program tailored for public health nurses. RESULTS The program was associated with improved self-efficacy scores at both the immediate and the 3-month posttest, and with increased knowledge of the preceptor role evident at the immediate posttest only. Self-efficacy scores were independent of knowledge scores. Preceptor age was not correlated with self-efficacy or knowledge scores. Nurses with higher levels of education demonstrated higher self-efficacy scores in all 3 measurements. CONCLUSIONS Web-delivered continuing education targeted to public health nurse preceptors is an effective method to increase confidence and knowledge for the preceptor role.

Local health department performance: compliance with state statutes and rules.

Compliance with statutes and rules is a measure of local health department (LHD) performance. This study analyzed compliance rates in one state. High overall compliance rates were found, although gaps existed between measured and expected compliance. Factors associated with lower compliance included lower LHD certification level (characteristic of smaller agencies) and human services organizational structure in lower-level LHDs. Improvements in compliance rates will require increased attention to development and documentation of policies, procedures, and local ordinances. Compliance is necessary for LHD effectiveness but may not be a sufficient measure of overall LHD performance.

Local partnerships for community assessment and planning.

PURPOSE Community assessment is a core function of public health. National and state policies encourage local health departments (LHDs) to engage local partners in conducting community assessments. This study examined the prevalence, characteristics, and effectiveness of community assessment partnerships between LHDs and other organizations. METHODS LHDs in Wisconsin completed a 2-stage, cross-sectional survey. A subset analysis of community assessment partnerships was conducted using descriptive, bivariate, and multivariate statistical methods. RESULTS Ninety percent of LHDs reported a partnership focused on community assessment (n = 69). Sixty-six percent of community assessment partnerships had existed for three or more years, and all of these had implemented plans (n = 43). Community assessment partnerships were more likely than partnerships focused on other issues to have formed because of a mandate, to include many partners, and to receive some forms of financial support from the LHD. Partnerships focused on community assessment were no more likely to be effective than other types of partnerships. CONCLUSIONS LHDs and community partners realize mutual benefits from collaborating on community assessment. Successful community assessment partnerships can be supported by building competencies in the public health workforce and sustaining partnerships for substantial periods of time.

Updating the Definition and Role of Public Health Nursing to Advance and Guide the Specialty

National changes in the context for public health services are influencing the nature of public health nursing practice. Despite this, the document that defines public health nursing as a specialty--The Definition and Role of Public Health Nursing--has remained in wide use since its publication in 1996 without a review or update. With support from the American Public Health Association (APHA) Public Health Nursing Section, a national Task Force, was formed in November 2012 to update the definition of public health nursing, using processes that reflected deliberative democratic principles. A yearlong process was employed that included a modified Delphi technique and various modes of engagement such as online discussion boards, questionnaires, and public comment to review. The resulting 2013 document consisted of a reaffirmation of the one-sentence 1996 definition, while updating supporting documentation to align with the current social, economic, political, and health care context. The 2013 document was strongly endorsed by vote of the APHA Public Health Nursing Section elected leadership. The 2013 definition and document affirm the relevance of a population-focused definition of public health nursing to complex systems addressed in current practice and articulate critical roles of public health nurses (PHN) in these settings.

Public Health Practice Competency Improvement Among Nurses

BACKGROUND Recommendations for improving public health workforce competency led to an academic-practice partnership project conducted to improve competency for providing essential public health services among public health nurses. PURPOSE To measure competency for public health practice at baseline, identify factors associated with higher competency, document change in competency over 4 years, and assess differential effects associated with project participation. METHODS Perceived competency was assessed using a validated instrument administered through online surveys at baseline (2007) and 4-year follow-up (2011). Analysis was completed in 2014. Overall means and SDs were calculated for each domain in the competency scale. Differences in means by role were tested using multivariate analysis of variance. Factors associated with higher competency were identified using regression analysis. Mean comparisons between baseline and follow-up were tested using paired samples t test and ANCOVA was used to test differential effects of project participation. RESULTS Baseline competency levels were low in most domains. Managers reported higher competency in all domains compared to staff. Mean scores in all domains were higher on follow-up than baseline. Factors associated with higher competency in some domains included expected frequency of performance, higher degree, and younger age. Participants in project activities had higher mean competency scores than those who did not, with statistically significant differences (p<0.05) observed in four of nine domains. CONCLUSIONS Participation in workforce development can contribute to improved perceived competency for public health practice among nurses. Continued investment in workforce development aimed at improving competency and additional research on competency assessment is warranted.

Assuring a strong foundation for our nation's public health systems

BACKGROUND A strong public health infrastructure is necessary to assure that every community is capable of carrying out core public health functions (assessment of population health, assurance of accessible and equitable health resources, and development of policies to address population health) to create healthy conditions. Yet, due to budget cuts and inconsistent approaches to base funding, communities are losing critical prevention and health promotion services and staff that deliver them. PURPOSE This article describes key components of and current threats to our public health infrastructure and suggests actions necessary to strengthen public health systems and improve population health. DISCUSSION National nursing and public health organizations have a duty to advocate for policies supporting strong prevention systems, which are crucial for well-functioning health care systems and are fundamental goals of the nursing profession. CONCLUSION We propose strengthening alliances between nursing organizations and public health systems to assure that promises of a reformed health system are achieved.

Current and planned shared service arrangements in Wisconsin local and tribal health departments.

OBJECTIVE The objective of this study was to explore current and future use of shared service arrangements as a management strategy to increase capacity to provide public health essential services in Wisconsin. DESIGN An online cross-sectional survey of 99 local and tribal health departments in Wisconsin was conducted. Select variables from the 2010 Wisconsin Local Health Department Survey were merged. Other data sources included results from a Board of Health governance analysis and the Wisconsin Department of Health Services region data. Descriptive analysis was performed of current and future shared service arrangements and the characteristics of the types of arrangements and agreements in place. RESULTS Ninety-one of 99 Wisconsin local and tribal health departments responded, yielding a 92% response rate. Seventy-one percent of respondents currently share services with 1 or more other health departments. More frequent arrangements were present in programmatic areas than in departmental operations. Most frequently reported motivators include making better use of resources, providing better services, and responding to program requirements. Extensive qualitative comments indicate arrangements accomplished what the local health department hoped it would with perceived gains in efficiency and effectiveness. CONCLUSION There is widespread use of shared services among health departments in Wisconsin. Extensive qualitative comments suggest participant satisfaction with what the arrangements have accomplished. Motivating factors in developing the arrangements and limited mention of expiration dates suggest continued study of how these arrangements may evolve. Further examination of shared services as a potential mechanism to advance service effectiveness and efficiency is needed.

Sharing Local Public Health Services Across Jurisdictions: Comparing Practice in 2012 and 2014

OBJECTIVE Describe cross-jurisdiction service sharing (CJS) by local and tribal health departments (LHD) in Wisconsin in 2014 compared to 2012. DESIGN An online survey of 91 LHD directors in Wisconsin was conducted. Results were compared to the results of a 2012 survey. Characteristics of CJS arrangements and differences in results by population size, geographic region, and governance type were described. Standardized proportion differences (h) were estimated using the arcsin transformation. Confidence intervals were estimated using unconditional exact confidence intervals for the difference of proportions.8 A forest plot of the estimates and confidence intervals was generated to visualize change in CJS for each population category. RESULTS Seventy-eight percent of respondents in 2014 reported currently sharing services compared to 71% of respondents in 2012. Positive effect sizes indicate increased sharing in year 2014 relative to 2012. CJS was more frequent for LHD serving smaller jurisdictions, consistent with both 2012 survey results and national findings. All governance types continue to engage in sharing public health services. IMPLICATIONS Cross jurisdictional service sharing is widespread and increasing in Wisconsin, implying that it is a useful strategy for providing public health services under some circumstances. Educating public health practitioners and students about CJS strategies in public health is recommended.